Brazilian Dialysis Survey 2022 / Censo Brasileiro de Diálise 2022

Abstract Introduction: The Brazilian Dialysis Survey (BDS) is an annual national survey about patients on chronic dialysis that contributes to health policies. Objective: To report the 2022 epidemiological data from the BDS of the Brazilian Society of Nephrology (BSN). Methods: A survey was carried out in Brazilian chronic dialysis centers using an online questionnaire that included clinical and epidemiological aspects of patients on chronic dialysis, dialysis therapy data, and dialysis center characteristics. Results: Overall, 28% (n = 243) of the centers answered the questionnaire. In July 2022, the estimated total number of patients on dialysis was 153,831. The estimated prevalence and incidence rates of patients per million population (pmp) were 758 and 214, respectively. Of the prevalent patients, 95.3% were on hemodialysis (HD, 4.6% of these on hemodiafiltration) and 4.7% on peritoneal dialysis (PD). Only 1.3% of patients were not vaccinated against COVID-19. The prevalence of anemia (Hb < 10g/dL) was 27% and hyperphosphatemia (P > 5.5mg/dL) reached 30%. The estimated overall crude annual mortality rate was 17.1%. Conclusions: The absolute number and prevalence rate of patients on chronic dialysis continue to increase. A growing number of patients were receiving hemodiafiltration. The mortality rate decreased, probably due to the end of COVID-19 pandemic. The conclusions were drawn in the context of relatively low voluntary participation, which imposed methodological limitations on our estimates.

Resumo Introdução: O Censo Brasileiro de Diálise (CBD) é uma pesquisa nacional anual sobre pacientes em diálise crônica que contribui para as políticas de saúde. Objetivo: Informar os dados epidemiológicos de 2022 do CBD da Sociedade Brasileira de Nefrologia (SBN). Métodos: Foi realizada uma pesquisa em centros brasileiros de diálise por meio de um questionário online que incluiu aspectos clínicos e epidemiológicos de pacientes em diálise crônica, dados da terapia dialítica e características do centro de diálise. Resultados: No total, 28% (n = 243) dos centros de diálise ativos cadastrados na SBN responderam ao questionário. Em julho de 2022, o número total estimado de pacientes em diálise era de 153.831. As taxas estimadas de prevalência e incidência de pacientes por milhão (ppm) de habitantes foram 758 e 214, respectivamente. Dos pacientes prevalentes, 95,3% estavam em hemodiálise (HD; 4,6% desses em hemodiafiltração) e 4,7% em diálise peritoneal (DP). Apenas 1,3% dos pacientes não foram vacinados contra a COVID-19. A prevalência de anemia (Hb < 10g/dL) foi de 27% e de hiperfosfatemia (P > 5,5mg/dL) alcançou 30%. A taxa bruta total anual de mortalidade estimada foi de 17,1%. Conclusões: O número absoluto e a taxa de prevalência de pacientes em diálise crônica continuam a aumentar. Um número crescente de pacientes estava em hemodiafiltração. A taxa de mortalidade diminuiu, provavelmente devido ao fim da pandemia da COVID-19. As conclusões foram de um contexto de participação voluntária relativamente baixa, o que impõe limitações metodológicas às nossas estimativas.

Análise epidemiológica das fraturas de mão em um hospital terciário / Epidemiological analysis of hand fractures in a tertiary hospital

Introdução: O trauma de mão constitui uma epidemia, ocorrendo por diversos fatores, como acidentes de trabalho e violência urbana. Isso gera um impacto significativo por ser uma unidade anatômica vulnerável e importante na realização de atividades cotidianas e para o trabalho. Desse modo, faz-se necessária uma avaliação epidemiológica mais aprofundada no que tange, sobretudo, às fraturas de mãos, entendendo sua elevada morbidade. Método: Estudo descritivo e retrospectivo, feito por análise de prontuários de pacientes conduzidos em um hospital terciário no período de janeiro de 2018 a dezembro de 2020. Resultados: Participaram do estudo 290 pacientes, sendo 85,7% do sexo masculino e 14,3% do sexo feminino. 138 indivíduos tinham entre 20 e 39 anos, representando um total de 47,6%. 51,6% eram do interior do estado do Ceará e 48,4% eram da capital. O principal mecanismo de trauma associado às fraturas foram os acidentes de trânsito (36,4%), seguidos por acidentes de trabalho (26,9%) e ferimentos por arma de fogo (14%). Em relação aos ossos fraturados, houve uma acentuada prevalência do acometimento das falangeanas, em todas as faixas etárias, representando 210 pacientes (72,4%). Conclusão: O presente estudo corrobora com os dados presentes na literatura. Desse modo, é evidenciada a repetição de prevalência de faixa etária, principais mecanismos de trauma envolvidos, bem como ossos acometidos nas fraturas de mão.

Introduction: Hand trauma is an epidemic occurring due to several factors, such as work accidents and urban violence. This significantly impacts it as it is a vulnerable and important anatomical unit for daily activities and work. Therefore, a more in-depth epidemiological assessment is necessary regarding hand fractures and understanding their high morbidity. Method: A descriptive and retrospective study was conducted by analyzing the medical records of patients treated in a tertiary hospital from January 2018 to December 2020. Results: 290 patients participated in the study, 85.7% male and 14.3 % female. One hundred thirty-eight individuals were between 20 and 39 years old, representing 47.6%. 51.6% were from the interior of the state of Ceará, and 48.4% were from the capital. The main trauma mechanism associated with fractures was traffic accidents (36.4%), followed by work accidents (26.9%) and firearm injuries (14%). Concerning fractured bones, there was a marked prevalence of phalangeal involvement in all age groups, representing 210 patients (72.4%). Conclusion: The present study corroborates the data present in the literature. In this way, the repetition of the prevalence of age group, main trauma mechanisms involved, as well as bones affected by hand fractures is evidenced.

O trauma de face submetido a cirurgia: Uma análise epidemiológica de 10 anos no interior do Brasil / Facial trauma undergoing surgery: A 10-year epidemiological analysis in the interior of Brazil

Introdução: O trauma de face representa significativa incapacitação para a vítima, além de um desafio para as equipes de saúde devido a sua complexidade e envolvimento de estruturas nobres. Analisar a sua epidemiologia permite coordenar medidas em saúde pública para melhorar o atendimento e a prevenção. Método: Estudo observacional, descritivo, longitudinal, com abordagem retrospectiva a partir dos prontuários dos pacientes vítimas de trauma de face atendidos pela clínica cirúrgica no período entre 2010 e 2019. Resultados: Dentre os 529 prontuários incluídos no estudo e analisados, 71,08% tratava-se de cirurgias eletivas e o restante, 28,92%, de cirurgias de urgência. O trauma foi mais frequente em indivíduos de 20 a 29 anos, o que corresponde a 31,76% do total de casos. Também foi mais frequente em indivíduos do sexo masculino, correspondendo a 78,45% do total de casos. Acidentes automobilísticos foram a causa mais comum, descrita em 22,31% dos prontuários, e a principal fratura, presente em 85,83% dos casos, foi dos ossos próprios do nariz. Conclusão: As vítimas de traumatismo bucomaxilofacial atendidas no Hospital de Clínicas da Universidade Federal do Triângulo Mineiro são predominantemente homens na terceira década de vida, envolvidos em acidentes automobilísticos, com lesões em ossos do nariz que foram abordadas de forma eletiva.

Introduction: Facial trauma represents significant incapacitation for the victim, as well as a challenge for healthcare teams due to its complexity and involvement of important structures. Analyzing its epidemiology allows us to coordinate public health measures to improve care and prevention. Method: Observational, descriptive, longitudinal study with a retrospective approach based on the medical records of patients who suffered facial trauma treated by the surgical clinic between 2010 and 2019. Results: Among in individuals aged 20 to 29 years, which corresponds to 31.76% of total cases. It was also more common in males, corresponding to 78.45% of total cases. Car accidents were the most common cause, described in 22.31% of medical records, and the main fracture, present in 85.83% of cases, was of the bones of the nose. Conclusion: Victims of oral and maxillofacial trauma treated at the Hospital de Clínicas da Universidade Federal do Triângulo Mineiro are predominantly men in their third decade of life, involved in automobile accidents, with injuries to the bones of the nose that were treated electively.

Caracterización del cáncer vesical en adultos según variables clínicas y epidemiológicas / Characterization of bladder cancer in adults according to clinical and epidemiological variables

Introducción: El cáncer de la vejiga es uno de los más frecuentes del tracto urinario y se manifiesta de dos formas: como tumor superficial de bajo grado o como neoplasia invasora de alto grado. Objetivo: Caracterizar el cáncer vesical en adultos, según variables clínicas, epidemiológicas y de servicio. Métodos: Se realizó un estudio observacional descriptivo y retrospectivo, para caracterizar el cáncer vesical en adultos, según variables clínicas, epidemiológicas y de servicio de los pacientes atendidos en el servicio de Urología del Hospital Universitario Clínico-Quirúrgico «Arnaldo Milián Castro» en el periodo comprendido de octubre 2019 y 2022. Población del estudio: 242 pacientes diagnosticados con cáncer vesical. Resultados: La mayoría de los pacientes diagnosticados con cáncer vesical corresponden al año 2019 (45,86 %): masculinos (75,20 %); blancos (89,25 %); mayores de 70 o más años (64,46 %) y fumadores (95,45 %). La hematuria fue el síntoma principal (91,73 %), como expresión del carcinoma urotelial papilar de bajo grado (36,77 %). Tratamiento: la resección transuretral (88,01 %), sin metástasis a distancia (88,42 %). Conclusiones: La mayoría de los pacientes diagnosticados con cáncer vesical corresponden al año 2019, masculinos, blancos, mayores de 70 o más años, fumadores y con hematuria. Más frecuente: el carcinoma urotelial papilar de bajo grado. El tiempo trascurrido antes del diagnóstico de la enfermedad fue de 36-40 días, y un mes, el tiempo trascurrido antes del tratamiento de la enfermedad.

Introduction: bladder cancer is one of the most frequent cancers of the urinary tract and manifests itself in two ways: as a superficial low-grade tumor or as a high-grade invasive neoplasm. Objective: to characterize bladder cancer in adults according to clinical, epidemiological and service variables. Methods: a descriptive and retrospective observational study was carried out to characterize bladder cancer in adults according to clinical, epidemiological and service variables of patients treated in the Urology service at "Arnaldo Milián Castro" Clinical and Surgical University Hospital from October 2019 and 2022. The study population was 242 patients diagnosed with bladder cancer. Results: most of the patients diagnosed with bladder cancer correspond to the year 2019 (45.86%): male (75.20%); whites (89.25%); older than 70 or more years (64.46%) and smokers (95.45%). Hematuria was the main symptom (91.73%), as an expression of low-grade papillary urothelial carcinoma (36.77%). The treatment was transurethral resection (88.01%), without distant metastasis (88.42%). Conclusions: most of the patients diagnosed with bladder cancer correspond to the year 2019, male, whites, older than 70 years or older, smokers and with hematuria. Low-grade papillary urothelial carcinoma was the most frequent cancer. The time elapsed before the diagnosis of the disease was 36-40 days, and the time elapsed before the treatment of the disease was 1 month.

The value of mathematical modelling approaches in epidemiology for public health decisión making

It is discussed the relevance of quantitative approaches, specifically mathematical modelling in epidemiology, in the public health decision-making process. This topic is discussed here based on the experience of various experts in mathematical epidemiology and public health. First, the definition of mathematical modelling is presented, especially in the context of epidemiology. Second, the different uses and socio-political implications, including empirical examples of recent experiences that have taken place at the international level are addressed. Finally, some general considerations regarding the challenges encountered in the use and application of mathematical modelling in epidemiology in the decision-making process at the local and national levels.

Se trata sobre la importancia de los abordajes cuantitativos, específicamente la formulación de modelos matemáticos en epidemiología, dentro del proceso de toma de decisiones en salud pública. Esta importante temática se analiza basándose en la experiencia de algunos expertos en epidemiología matemática y salud pública. En primer lugar, se presenta la definición de modelación matemática, particularmente dentro del contexto de la epidemiología. En segundo lugar, se abordan los diferentes usos y las implicaciones socio-políticas, incluyendo ejemplos de experiencias recientes que han ocurrido a nivel internacional. Finalmente, se hace referencia a ciertas consideraciones generales respecto a los retos que representa el uso y la aplicación de modelos matemáticos en epidemiología para el proceso de toma de decisiones a nivel local y nacional.

Epidemiología de la apendicitis aguda en Colombia: Un análisis de las bases de datos administrativas del Ministerio de Salud / Epidemiology of acute appendicitis in Colombia: An Analysis of the Ministry of Health administrative databases

Introducción. La apendicitis aguda es una afección común, con un pico de incidencia entre los 10 y 20 años. La cirugía es el tratamiento preferido y la apendicectomía por laparotomía sigue siendo el estándar, aunque el abordaje laparoscópico ha mostrado menos complicaciones. El objetivo de este artículo fue caracterizar tanto la enfermedad como el tratamiento quirúrgico en Colombia, usando datos de bases oficiales. Métodos. Se accedió a la base de datos del Sistema Integrado de Información para la Protección Social (SISPRO) del Ministerio de Salud de Colombia en febrero de 2023. Se recogieron datos de los pacientes con diagnóstico de apendicitis y con procedimiento de apendicectomía entre 2017 y 2021, y se analizaron por edad, sexo y ubicación geográfica. Resultados. Entre 2017 y 2021 se diagnosticaron 345.618 casos de apendicitis (51,8 % mujeres), con pico de incidencia a los 15-20 años. Se realizaron 248.133 apendicectomías, el 16,7 % por laparoscopia. Los hospitales con más procedimientos reportados estaban en Bogotá, Yopal, Popayán y Florencia. La mortalidad fue de 0,56 % en hombres y 0,51 % en mujeres. Conclusión. La apendicitis es común, con pico a los 10-19 años. Las mujeres tienen mayor probabilidad de apendicectomía, debido a otras afecciones ginecológicas. El acceso a la apendicectomía disminuye la mortalidad; en estos pacientes, el 16 % fue laparoscópica, lo que sugiere que se necesita más entrenamiento y acceso a esta técnica. Este estudio aporta a la comprensión de la epidemiología de la apendicitis y apendicectomías en Colombia.

Introduction. Acute appendicitis is a common condition, with a peak incidence between 10 and 20 years of age. Surgery is the preferred treatment and laparotomy appendectomy remains the standard, although the laparoscopic approach has shown fewer complications. The objective of this article was to characterize both the disease and the surgical treatment in Colombia, using data from official databases. Methods. The Integrated Information System for Social Protection (SISPRO) database of the Ministry of Health was accessed in February 2023. Data with diagnosis of apendicitis and with appendectomy between 2017 and 2021 were collected. Analysis was done by age, gender, and geographic location. Results. Between 2017 and 2021, 345,618 cases of appendicitis were diagnosed (51.8% females), with peak incidence at 15-20 years of age. A total of 248,133 appendectomies were performed, 16.7% by laparoscopy. The hospitals with most reported procedures were located in Bogotá, Yopal, Popayán, and Florencia. Mortality was 0.56% in men and 0.51% in women. Conclusion. Appendicitis is common, peaking at ages 10-19. Women are more likely undergo appendectomy due to other gynecological conditions. Access to appendectomy improves mortality. In these patients, 16% were laparoscopic, suggesting that more training and access to this technique is needed. This study contributes to the understanding of the epidemiology of appendicitis and appendectomies in Colombia.

Validación de cuestionarios para la medición de variables en salud: conceptos fundamentales / Validation of questionnaires for the measurement of health variables: Fundamental concepts

Dentro de la práctica clínica, así como en la salud poblacional, es habitual utilizar cuestionarios que permiten evaluar condiciones o variables que no son directamente observables. No obstante, la construcción y validación de estos instrumentos o cuestionarios suele ser poco conocida. El objetivo de esta revisión narrativa es sintetizar de manera general el proceso de construcción y validación de estos cuestionarios, para así tener una mejor comprensión de este proceso, de los aspectos que se evalúan y de la mejor forma de utilizarlos. La validación de cuestionarios corresponde a un proceso de análisis de este, cuya finalidad es medir una variable latente o constructo, así como sus dimensiones, las que no pueden ser observadas directamente. Una variable latente puede ser inferida a través de un conjunto de atributos específicos que forman parte de ella, como los ítems de un cuestionario y que sí son observables. En este artículo se abordan de manera teórica los conceptos fundamentales de validación de cuestionarios o test, variables latentes o constructos, estudio de la confiabilidad y de la validez, así como los factores que afectan a estas dos últimas características, a través de una revisión narrativa. En el texto, se presentan ejemplos sobre estos conceptos.

In clinical practice and population health, it is common to use questionnaires to assess conditions or variables that are not directly observable. However, the construction and validation of these instruments or questionnaires are often poorly understood. This narrative review aims to summarize in a general way the process of construction and validation of these questionnaires in order to have a better understanding of this process, the aspects that are evaluated, and the best way to use them. The validation of questionnaires corresponds to a process of analysis of the questionnaire, aiming to measure a latent variable and its dimensions, which cannot be observed directly. A latent variable can be inferred through a set of specific attributes that are part of it, such as the items of a questionnaire, which are observable. Through a narrative review, this article addresses the fundamental concepts of questionnaire or test validation, latent variables or constructs, reliability and validity studies, and the factors that theoretically affect the latter two characteristics. Examples of these concepts are presented in the text.

Diabetes, hemoglobin A1c, and cognitive performance in older adults: is there any impact of frailty? Evidence from the ELSI-Brazil study

Abstract The aim of this study was to evaluate the association between diabetes and cognitive performance in a nationally representative study in Brazil. We also aimed to investigate the interaction between frailty and diabetes on cognitive performance. A cross-sectional analysis of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) baseline data that included adults aged 50 years and older was conducted. Linear regression models were used to study the association between diabetes and cognitive performance. A total of 8,149 participants were included, and a subgroup analysis was performed in 1,768 with hemoglobin A1c data. Diabetes and hemoglobin A1c levels were not associated with cognitive performance. Interaction of hemoglobin A1c levels with frailty status was found on global cognitive z-score (P-value for interaction=0.038). These results suggested an association between higher hemoglobin A1c levels and lower cognitive performance only in non-frail participants. Additionally, undiagnosed diabetes with higher hemoglobin A1c levels was associated with both poor global cognitive (β=-0.36; 95%CI: -0.62; -0.10, P=0.008) and semantic verbal fluency performance (β=-0.47; 95%CI: -0.73; -0.21, P=0.001). In conclusion, higher hemoglobin A1c levels were associated with lower cognitive performance among non-frail participants. Higher hemoglobin A1c levels without a previous diagnosis of diabetes were also related to poor cognitive performance. Future longitudinal analyses of the ELSI-Brazil study will provide further information on the role of frailty in the association of diabetes and glycemic control with cognitive decline.

Perfil de óbitos por dengue (2015-2023) em cidade paulista: desafios para a saúde pública / Dengue death profile (2015-2023) in a são paulo municipality: challenges for public health / Perfil de muertes por dengue (2015-2023) en una ciudad del interior del estado de são paulo: desafíos para la salud pública

O número de casos de dengue no continente americano, no primeiro semestre de 2023, superou o total de casos de 2022 e o Brasil lidera com 2,3 milhões de ocorrências da doença e 769 mortes. A dengue se expande no mundo e já é considerada endêmica em mais de 100 países. Este estudo objetiva caracterizar o perfil dos óbitos por dengue, no período de 2015 a 2023, em uma cidade do interior do estado de São Paulo. Este é um estudo transversal, retrospectivo e descritivo, com análise de dados secundários do Sistema Nacional de Notificação (Sinan), Sistema de Mortalidade (SIM) e banco de dados dos óbitos por dengue, do comitê de mortalidade da vigilância epidemiológica municipal. A capacidade das equipes de saúde em identificar os sinais e sintomas ocorreu em apenas 42,9% dos casos antes da internação e do óbito, seguida por no dia do óbito (11,7%) e após o óbito (8,8%). A mortalidade por dengue predominou em indivíduos do sexo masculino (51,4%), com idade mediana de 74 anos. A análise dos dados demonstrou que o manejo clínico da dengue ainda é desafiador para a equipe de saúde, que precisa se manter permanentemente capacitada para o reconhecimento dos sintomas, sinais de alarme e gravidade, para a correta condução de cada caso, visando a redução da mortalidade.

In the first half of 2023, the number of dengue cases in the Americas surpassed the total for 2022, with Brazil leading the list with 2.3 million disease occurrences and 769 deaths. Dengue is expanding globally and is already considered endemic in more than 100 countries. This study characterizes the profile of dengue deaths from 2015 to 2023 in a municipality of São Paulo. A cross-sectional, retrospective, and descriptive study was conducted with secondary data obtained from the National Notification System (SINAN), Mortality System (SIM), and dengue death database of the municipal epidemiological surveillance mortality committee. Only in 42.9% of cases were the health teams able to identify the signs and symptoms before hospitalization and death, followed by after death (8.8%) and on the day of death (11.7%). Dengue mortality predominated among male individuals (51.4%) with a median age of 74 years. Data analysis showed that the clinical management of dengue remains challenging for health teams, who needs continuous training to recognize the signs and symptoms, warning signs, and severity for correct management of each case, aiming to reduce mortality.

Los casos de dengue en las Américas superaron en el primer semestre de 2023 al total de casos de 2022, en el cual lidera Brasil con 2,3 millones de notificaciones de la enfermedad y 769 muertes. El dengue se expande por el mundo, y más de 100 países ya lo consideran una endemia. Este estudio tiene como objetivo caracterizar el perfil de las muertes por dengue en el período de 2015 a 2023, en una ciudad del interior del estado de São Paulo. Se trata de un estudio transversal, retrospectivo y descriptivo con análisis de datos secundarios del Sistema Nacional de Notificación (SINAN), del Sistema de Mortalidad (SIM) y de la Base de Datos de Muertes por Dengue del Comité de Mortalidad de la Vigilancia Epidemiológica Municipal. Los equipos de salud fueron capaces de identificar los signos y síntomas en solo el 42,9% de los casos antes de la hospitalización y de la muerte, seguida del día de la muerte (11,7%) y tras la muerte (8,8%). La mortalidad por dengue predominó en individuos del sexo masculino (51,4%) con una edad media de 74 años. El análisis de datos demostró que el manejo clínico del dengue sigue siendo un desafío para el equipo de salud, quien necesita mantenerse capacitado continuamente para detectar los signos y síntomas, señales de alarma y gravedad, para la correcta conducción de cada caso, con el objetivo de reducir la mortalidad.

Características clínicas e epidemiológicas das internações pediátricas por COVID-19 na Amazônia brasileira: um estudo observacional / Clinical and epidemiological characteristics of pediatric hospitalizations due to COVID-19 in the Brazilian Amazon: an observational study

OBJETIVO: Apontar os aspectos clínicos e epidemiológicos de crianças internadas por COVID-19 em um hospital público situado em um estado da Amazônia Brasileira. MÉTODO: Estudo observacional, descritivo, retrospectivo e documental com uma abordagem quantitativa dos casos de internação pediátrica por COVID-19. RESULTADOS: No Hospital da Criança e Adolescente, foram registrados um total de 5016 casos suspeitos de COVID-19 em crianças. Destes, 666 foram confirmados com a doença e resultaram em 140 internações. Analisamos 136 notificações de crianças internadas por COVID-19. A maioria dos pacientes era lactente (39%) e pré-escolar (36%), com prevalência do sexo masculino (67,6%) e raça/cor preta/parda (86%). Além disso, 83,1% delas residem em área urbana. Quanto ao desfecho, 96,67% evoluíram para a cura e 3,33% resultaram em óbito. CONCLUSÃO: No contexto amazônico, a análise das características clínicas e epidemiológicas deste grupo etário é essencial para orientar os cuidados clínicos, prever a gravidade da doença e determinar o prognóstico.

OBJECTIVE: To determine the clinical and epidemiologic aspects of children hospitalized for COVID-19 in a public hospital located in a state in the Brazilian Amazon. METHODS: Observational, descriptive, retrospective, and documentary study with a quantitative approach to pediatric hospitalization cases due to COVID-19. RESULTS: In the Hospital for Children and Adolescents, a total of 5016 suspected cases of COVID-19 in children were recorded. Of these, 666 were confirmed with the disease, resulting in 140 hospitalizations. We analyzed 136 reports of children hospitalized for COVID-19. Most patients were infants (39%) and preschool children (36%), with a prevalence of males (67.6%) and black/brown race/color (86%). In addition, 83.1% live in urban areas. Regarding the outcome, 96.67% were cured, and 3.33% resulted in death. CONCLUSION: In the Amazonian context, the analysis of this age group's clinical and epidemiologic characteristics is essential to guide clinical care, predict the severity of the disease, and determine the prognosis.

Prenatal, neonatal and postnatal factors and the developmental defects of dental enamel / Fatores pré-natais, neonatais e pós-natais e defeitos de desenvolvimento do esmalte dentário

ABSTRACT Objective: To estimate the prevalence of developmental defects in dental enamel and its possible association with prenatal, neonatal and postnatal conditions in six-year-old schoolchildren in a southern Brazilian municipality. Methods: A cross-sectional study was conducted involving 655 six-year-old schoolchildren. Sociodemographic and health data were collected through interviews with mothers and children's oral examinations at schools. Multivariate analyses were performed using Poisson regression with robust estimator. Results: The prevalence of developmental defects of enamel was 44.0%. Demarcated opacities were the most prevalent, followed by diffuse opacities. Late pregnancy, maternal schooling less than eight years, female gender and child's white skin color were independently associated with the prevalence of demarcated opacities. Conclusions: The prevalence of developmental defects in dental enamel was 44.0%. Late pregnancy, maternal schooling less than eight years, female gender and child's white skin color were associated with the prevalences.

RESUMO Objetivo: Estimar a prevalência de defeitos de desenvolvimento do esmalte dentário e sua possível associação com fatores pré-natais, neonatais e pós-natais em escolares de seis anos de idade em um município do sul do Brasil. Métodos: Foi conduzido um estudo transversal envolvendo 655 escolares de seis anos de idade. Os dados sociodemográficos e de saúde foram coletados por meio de entrevistas com as mães e exames bucais das crianças nas escolas. As análises multivariadas foram realizadas por meio de regressão de Poisson com estimador robusto. Resultados: A prevalência de defeitos de desenvolvimento do esmalte foi de 44,0%. As opacidades demarcadas foram as mais prevalentes, seguidas das difusas. Gravidez tardia, escolaridade materna inferior a oito anos, sexo feminino e cor da pele branca da criança foram independentemente associados à prevalência de opacidades demarcadas. Conclusões: A prevalência de defeitos de desenvolvimento do esmalte dentário foi de 44,0%. Gravidez tardia, escolaridade materna inferior a oito anos de estudo, sexo feminino e cor da pele branca da criança estiveram associados às prevalências.

Habitual physical activity and sedentary behavior as predictors of dynapenia in older adults: a cross-sectional study

ABSTRACT BACKGROUND: Dynapenia is a risk factor of mortality. Therefore, the development of low-cost and easy-to-apply tools is essential to optimize the health surveillance actions of older people. OBJECTIVES: To compare the time spent on habitual physical activity (HPA) and sedentary behavior (SB) among dynapenic and non-dynapenic older adults and ascertain the predictive ability of these behaviors on outcome. DESIGN AND SETTING: A cross-sectional population epidemiological survey was conducted involving 208 older adults. METHODS: HPA and SB were quantified using the International Physical Activity Questionnaire, and dynapenia was identified by handgrip strength (women: 18.37 kgf; men: 26.75 kgf). RESULTS: The prevalence was 24.50%. In both sexes, dynapenic individuals reported a HPA median time of 70.00 minutes/week (min/wk), while non-dynapenic women and men reported HPA median times of 240.00 and 280.00 min/wk, respectively (P < 0.05). For SB among dynapenic individuals, a median of 388.75 min/day was observed in women and 428.57 min/d in men. In contrast, non-dynapenic women and men had 291.42 and 274.28 min/day in SB (P < 0.05), respectively. The best cutoff HPA to discriminate the outcome was 150.00 min/wk in women (sensitivity: 73.30%; specificity: 60.67%) and 140.00 min/wk in men (sensitivity, 71.43%; specificity, 61.54%). The best cutoff SB was 381.43 min/day in women (sensitivity, 53.30%; specificity, 84.80%) and 351.43 min/day in men (sensitivity, 71.43%; specificity, 73.85%). CONCLUSION: Older individuals with dynapenia spent less time on HPA and more time in SB. Furthermore, HPA was found to be a better discriminator of dynapenic individuals, and SB better discriminated non-dynapenic individuals.

Oral health of an indigenous population in northeastern Brazil: a cross-sectional Study of the Fulni-ô ethnic group

ABSTRACT BACKGROUND: There is a lack of studies evaluating the oral health of traditional indigenous communities in Brazil. OBJECTIVES: Thus, the objective of this study was to describe the oral health characteristics of the indigenous Fulni-ô ethnic group in Northeast Brazil. DESIGN AND SETTING: A cross-sectional observational investigation was conducted within the Project on Atherosclerosis among Indigenous Populations. METHODS: This study included participants of both sexes from the Fulni-ô ethnic group. The participants included in this investigation underwent a comprehensive oral health evaluation by a registered and experienced dentist to assess oral health and identify potentially malignant oral lesions. Participants with suspicious lesions were referred for biopsy. Shapiro-Wilk, Mann-Whitney, and Student's t-tests were used, and measures of central tendency and dispersion were described. Statistical significance was 5%. RESULTS: A total of 104 individuals were included in this study. The prevalence of the use of tobacco derivatives was 94.0%, with similarities between sexes. The prevalence of oral changes in this study population was 84.4%. Fifty-one individuals who underwent oral reassessment were referred for oral lesion biopsy. CONCLUSIONS: This study demonstrated a high prevalence of oral alterations in the Fulni-ô population. Histopathological analyses indicated the presence of mild oral epithelial dysplasia in five cases.

Epidemiological and Clinicopathological Analysis of Odontogenic Tumors: A 20-Year Study

ABSTRACT Objective: To perform the epidemiological and clinicopathological analyses of odontogenic tumors in Kerman for 20 years. Material and Methods: The present study investigated collected records from pathology departments of the Faculty of Dentistry, Bahonar, and Shafa teaching-medical hospitals for 20 years. Data on odontogenic tumors was recorded based on age, sex, and tumor location in the information forms. The statistical t-test and the Kappa coefficient computer codes were utilized for data analysis. Results: 38 samples of odontogenic tumors were considered in the present study. The mean age of participants was 31.7± 10.3 years. The frequency of tumors was higher in women (63.2%) and in the lower jaw) 78.9%). Among various tumors, ameloblastoma (63.1%) and odontoma (18.4%) were the most common tumors, respectively. The correlation between clinical and histopathologic diagnoses was 71.8% using the kappa coefficient. Conclusion: Ameloblastoma is the most common odontogenic tumor. The incidence of lesions was higher in the mandible, and odontogenic tumors were higher in women. Since the diagnosis of odontogenic tumors is based on radiographic and histologic appearances, clinical physicians and pathologists should collaborate for the definitive diagnosis of the disease.

Manifestaciones orales en pacientes cubanos con COVID-19 hospitalizados y no hospitalizados: Análisis transversal a través de una encuesta / Oral Manifestations in Hospitalized and Non-Hospitalized Cuban Patients with COVID-19: A Cross-Sectional Analysis through a Survey

Introduction: COVID-19 continues to drive research aimed at elucidating the disease's behavior and clinical aspects for improved diagnosis. Objective: To describe oral manifestations reported through a survey by dentate and denture-wearing Cuban individuals hospitalized due to confirmed COVID-19 infection. Methods: A cross-sectional descriptive study was conducted through a survey, involving Cuban individuals aged 18 years and above, confirmed COVID-19 positive by PCR. Exclusions encompassed smokers, alcoholics, regular medication users, those with poor oral hygiene, and individuals with pre-existing oral manifestations. A questionnaire was administered to over a thousand individuals, of which 264 met the criteria. Variables related to COVID-19 infection and oral hygiene were assessed. Data were processed using SPSS, adhering to ethical principles. Results: The study comprised 264 participants with an average age of 39.96 years. Xerostomia emerged as the most prevalent oral manifestation (40.2 por ciento), followed by mandibular pain, TMJ, or bone pain (18.9 por ciento), and non-dental mouth pain (12.5 por ciento). Xerostomia was more prevalent in the 35 to 39 age group, while mandibular pain predominated in the 50 to 54 age group. No statistically significant evidence was found for dentate individuals or denture wearers, but significance was observed for those requiring hospitalization, exhibiting painless tongue lesions, single ulcers, and painful tongue lesions. Conclusions: Xerostomia was the most prevalent oral manifestation, followed by mandibular pain, TMJ or bone pain, and non-dental mouth pain. A statistically significant association was noted between the need for hospitalization and certain oral manifestations. The use of dentures was not significantly related to the studied manifestations(AU)

Introducción: La COVID-19 continúa generando interés en investigaciones que buscan esclarecer el comportamiento de la enfermedad y sus aspectos clínicos para facilitar el diagnóstico. Objetivo: Describir las manifestaciones orales informadas por individuos cubanos dentados, con prótesis, que fueron hospitalizados al dar positivo por COVID-19. Métodos: Se llevó a cabo un estudio descriptivo transversal a través de una encuesta con una muestra de individuos cubanos mayores de 18 años, infectados por COVID-19 y confirmados mediante PCR. Se excluyeron fumadores, alcohólicos, usuarios regulares de medicamentos, personas con mala higiene bucal y aquellos con manifestaciones bucales previas a la infección. Se aplicó un cuestionario a más de mil individuos, de los cuales 264 cumplieron con los criterios. Se utilizaron variables relacionadas con la infección por COVID-19 y la higiene bucal. Los datos se procesaron con SPSS, respetando los principios éticos. Resultados: El estudio incluyó a 264 participantes con una edad promedio de 39,96 años. La xerostomía fue la manifestación bucal más prevalente (40,2 percent), seguida por el dolor mandibular, ATM o hueso (18,9 percent) y el dolor de boca no dental (12,5 percent). La xerostomía fue más frecuente en el grupo de 35 a 39 años, mientras que el dolor mandibular predominó en el grupo de 50 a 54 años. No se encontró evidencia estadística significativa para pacientes dentados o portadores de prótesis, pero sí para aquellos que necesitaron hospitalización, con lesiones en la lengua sin dolor, úlceras únicas y lesiones en la lengua con dolor. Conclusiones: La xerostomía fue la manifestación bucal más prevalente, seguida por el dolor mandibular, ATM o hueso, y el dolor de boca no dental. Se observó una asociación estadísticamente significativa entre la necesidad de hospitalización y ciertas manifestaciones bucales. No se encontró significativo el uso de prótesis en relación con las manifestaciones estudiadas(AU)

Leprosy in children under fifteen years of age in the most hyperendemic municipality in Brazil / Hanseníase em menores de quinze anos no município mais hiperendêmico do Brasil

ABSTRACT Objective: To describe leprosy involvement and physical disability profiles in children and adolescents under 15 years old. Methods: Ecological time series study, based on data from the Brazilian Notifiable Diseases Information System, including new cases of leprosy residing in Palmas (TO), from 2001 to 2020. Results: A total of 471 notified cases in children and adolescents under 15 years of age were evaluated, resulting in a detection coefficient of 26.5 per 100,000 inhabitants. Of these, 52% (n=243) were women, 5% (n=24) corresponded to grade two disability, and 36% (n=168) were diagnosed through spontaneous demand. The temporal trend analysis showed a 0.5% reduction in the detection coefficient. There was a significant decrease in the diagnosis of the undetermined and tuberculoid clinical forms and a significant increase in the dimorphous form. Diagnosis through contact examination increased significantly by 13.1% and that through spontaneous demand decreased by 4.9%. The detection coefficient of cases with grade two disability reduced significantly by 7.4% while those with grade one increased by 16.8%. Conclusions: Despite the downward trend in the detection coefficient in children and adolescents under 15 years of age and in cases with grade two disability, other factors indicate failure in the adequate management of leprosy in Palmas.

RESUMO Objetivo: Descrever os perfis de acometimento de hanseníase e incapacidade física em menores de 15 anos. Métodos: Estudo ecológico de série temporal, baseado em dados do Sistema Nacional de Agravos de Notificação, incluindo casos novos de hanseníase residentes em Palmas (TO), no período de 2001 a 2020. Resultados: Foram avaliados 471 casos notificados em crianças e adolescentes menores de 15 anos, resultando em um coeficiente de detecção de 26,5 por cem mil habitantes. Destes, 52% (n=243) eram do gênero feminino, 5% (n=24) correspondiam ao grau dois de incapacidade física, e 36% (n=168) foram diagnosticados por demanda espontânea. A análise de tendência temporal mostrou queda do coeficiente de detecção em 0,5%. Houve queda significativa no diagnóstico das formas clínicas indeterminada e tuberculoide e aumento significativo da dimorfa. O diagnóstico por exame de contato teve um aumento significativo de 13,1% e o por demanda espontânea, queda significativa de 4,9%. O coeficiente de detecção de casos com grau dois de incapacidade apresentou uma queda significativa de 7,4%, enquanto o de casos com grau um, apresentou um aumento de 16,8%. Conclusões: Apesar da tendência de queda do coeficiente de detecção em menores de 15 anos e do coeficiente de detecção de casos com grau dois de incapacidade, outros fatores indicam falha no manejo adequado da hanseníase em Palmas.

Firework-related ocular trauma in Pernambuco, Brazil / Trauma ocular por fogos de artifício em Pernambuco, Brasil

ABSTRACT Purpose: This study aimed to describe the demographic and clinical characteristics of victims of fireworkrelated ocular trauma treated at the ophthalmologic emergency de partments of two reference centers in Pernambuco, Brazil, and to identify risk factors related to poor visual prognosis. Methods: We retrospectively evaluated the medical records of patients admitted in emergency departments with a report of firework-related trauma between January 2012 and December 2018. Data collected included patient's age, sex, place of origin, month and year of the accident, ocular structures affected, characteristics of the injuries, and type of treatment that patients received. For patients who were followed for >30 days, the final visual acuity and patient's origin were analyzed. Results: Three hundred and seventy eyes from 314 patients were included, of which 248 (79.0%) were male and 160 (51.0%) were from the metropolitan region of Recife. The mean patient age was 25.6 ± 18.8 years. In 56 (17.8%) patients, the ocular trauma was bilateral. A total of 152 (48.4%) cases occurred in June. The most affected sites were the eyelids in 91 (24.6%) eyes and ocular surface in 252 (68.1%). Surgical treatment was required in 87 (23.5%) eyes. After clinical and surgical management, 37 (10.0%) eyes presented final visual acuity of <20/400. Of these, 34 (91.9%) eyes were from patients from the countryside or from another state. Patients from the countryside presented higher risk of developing blindness after a firework trauma than those from the metropolitan area (odds ratio of 5.46). Conclusions: Victims of firework-related ocular trauma were mostly male, from the metropolitan region of Pernambuco state and mainly pediatric patients or economically active. Those coming from the countryside and other states had higher risk of developing blindness

RESUMO Objetivos: Descrever as características demográficas e clínicas das vítimas de trauma ocular por fogos de artifício atendidas nas emergências oftalmológicas de dois centros de referência em Pernambuco e identificar fatores relacionados a mau prognóstico visual. Métodos: Avaliação retrospectiva dos prontuários de pacientes admitidos na emergência oftalmológica com história de trauma por fogos de artifício entre janeiro de 2012 e dezembro de 2018. A coleta de dados incluiu idade, gênero, procedência, mês e ano do acidente, estruturas oculares acometidas e características das lesões, além do tipo de tratamento a que os pacientes foram submetidos. Naqueles pacientes acompanhados por mais de 30 dias, analisou-se a acuidade visual final e a associação com sua procedência. Resultados: Foram incluídos 370 olhos de 314 pacientes. Destes, 248 (79,0%) vítimas eram do sexo masculino e 160 (51,0%) da região metropolitana do Recife, com uma média de idade de 25.6 ± 18.8 anos. Em 56 (17,8%) dos casos o trauma foi bilateral. No mês de junho ocorreu um total de 152 (48,4%) casos. Os sítios mais acometidos foram pálpebras em 91 (24,6%) olhos e superfície ocular em 252 (68,1%). O tratamento cirúrgico foi necessário em 87 (23,5%) olhos. Após manejo clínico-cirúrgico, 37 (10.0%) olhos desenvolveram visão pior do que 20/400. Destes, 34 (91,9%) olhos eram de pacientes do interior do estado de Pernambuco ou de outro estado. Os pacientes provenientes do interior do estado apresentaram maior chance de desenvolver cegueira quando comparados aos que eram provenientes da região metropolitana (Odds Ratio de 5,46). Conclusões: As vítimas de trauma ocular por fogos de artificio foram em sua maioria do sexo masculino, procedentes da região metropolitana do estado e das faixas etárias pediátrica e economicamente ativa. Aqueles provenientes do interior ou de outros estados apresentaram maior chance de desenvolver cegueira.

Epidemiologic profile and prevalence of live births with orofacial cleft in Brazil: a descriptive study / Perfil epidemiológico e prevalência de nascidos vivos com fissura orofacial no Brasil: um estudo descritivo

ABSTRACT Objective: To describe the epidemiological profile and prevalence of live births with orofacial clefts in Brazil between 1999 and 2020. Methods: Descriptive study. The population corresponded to live births with isolated orofacial clefts in Brazil registered in the Live Birth Information System between 1999 and 2020. Descriptive variables were selected according to their availability and grouped into socioeconomic and demographic, maternal and child health care, and biological variables. Data were submitted to a descriptive analysis using the Software for Statistics and Data Science (STATA). Results: During the period, 33,699 children were born with orofacial clefts, and 82.1% (27,677) of them were isolated clefts. Regarding these cases, the majority were cleft lip and palate (9,619 or 34.7%), followed by cleft palate (9,442 or 34.1%), and by cleft lip (8,616 or 31.3%). Conclusions: Live births with orofacial clefts in Brazil were male, white, with birthweight ≥2,500 g and gestational age ≥37 weeks, born by cesarean section, and with Apgar scores ≥7. The cases were more frequent among mothers who were in their first and single pregnancy and had seven or more prenatal appointments. The mothers were 20 and 29 years old, had eight to ten years of study, and were single. The national prevalence of clefts was 4.24/10,000. The South and Southeast regions of Brazil had the highest prevalence, while the lowest prevalence was recorded in the Northeast and North regions. For the Federative Units, the highest and lowest prevalences were found, respectively, in Paraná and Acre.

RESUMO Objetivo: Descrever o perfil epidemiológico e a prevalência dos nascidos vivos com fissuras orofaciais no Brasil entre 1999 e 2020. Métodos: Estudo descritivo. A população correspondeu aos nascidos vivos com fissuras orofaciais isoladas no Brasil registrados no Sistema de Informação de Nascidos Vivos entre 1999 e 2020. As variáveis descritivas foram selecionadas de acordo com a sua disponibilidade e agrupadas em variáveis socioeconômicas e demográficas, de atenção à saúde materno-infantil e biológicas. Os dados foram submetidos a análise descritiva utilizando o Software for Statistics and Data Science (STATA). Resultados: No período, 33.699 indivíduos nasceram com fissura orofacial no Brasil, e 82,1% (27.677) deles foram fissuras isoladas. Com relação a esses casos, a maioria foi de fissuras de lábio e palato (9.619 ou 34,7%), seguidas por fissura de palato (9.442 ou 34,1%) e por fissura de lábio (8.616 ou 31,1%). Conclusões: O perfil epidemiológico dos nascidos vivos com fissuras orofaciais no Brasil foi de nascidos do sexo masculino, da raça/cor branca, por parto cesáreo, com peso ao nascer ≥2,500 g, idade gestacional ≥37 semanas e com índices de Apgar ≥7. Os casos foram mais frequentes entre mães que estavam na primeira gestação, única e que haviam realizado sete ou mais consultas de pré-natal. As mães, com maior frequência, tinham entre 20 e 29 anos, apresentavam oito ou mais anos de estudo, eram solteiras e residiam em cidades do interior. A prevalência nacional de fissuras foi de 4,24/10.000. As Regiões Sul e Sudeste apresentaram as maiores prevalências, enquanto as menores foram registradas nas Regiões Nordeste e Norte. Para as Unidades Federativas, as maiores e menores prevalências foram encontradas, respectivamente, no Paraná e no Acre.

Microbial keratitis in Sao Paulo, Brazil: a 10-year review of laboratory results, epidemiological features, and risk factors / Ceratite microbiana em São Paulo, Brasil: uma revisão de 10 anos dos resultados de laboratório, características epidemiológicas e fatores de risco

ABSTRACT Purpose: To study epidemiological data, laboratory results, and risk factors associated with microbial keratitis. Methods: We conducted a retrospective study of corneal sample cultures from patients with microbial keratitis from January 2010 to December 2019. Results were analyzed according to the etiological diagnosis of bacterial, mycotic, or parasitic infection and were associated with related risk factors. Results: We analyzed 4810 corneal samples from 4047 patients (mean age 47.79 ± 20.68 years; male 53.27%). The prevalence of bacterial, fungal, and Acanthamoeba infections were 69.80%, 7.31%, and 3.51%, respectively. The most frequently isolated bacteria were coagulase-negative Staphylococcus (CoNS) (45.14%), S. aureus (10.02%), Pseudomonas spp. (8.80%), and Corynebacterium spp. (6.21%). Among CoNS, the main agent was S. epidermidis (n=665). For mycotic keratitis, Fusarium spp. (35.42%) and Candida parapsilosis (16.07%) were the most common agents among filamentous and yeasts isolates, respectively. Contact lens use was associated with a positive culture for Acanthamoeba spp. (OR = 19.04; p < 0.001) and Pseudomonas spp. (OR = 3.20; p < 0.001). Previous ocular trauma was associated with positive fungal cultures (OR = 1.80; p = 0.007), while older age was associated with positive bacterial culture (OR = 1.76; p = 0.001). Conclusions: Our findings demonstrated a higher positivity of corneal sample cultures for bacteria. Among those, CoNS was the most frequently identified, with S. epidermidis as the main agent. In fungal keratitis, Fusarium spp. was the most commonly isolated. Contact lens wearers had higher risks of positive cultures for Acanthamoeba spp. and Pseudomonas spp. Ocular trauma increased the risk of fungal infection, while older age increased the risk of bacterial infection.

RESUMO Objetivo: Estudar os dados epidemiológicos, resultados laboratoriais e fatores de risco associados às ceratites infecciosas. Métodos: Estudo retrospectivo das amostras de cultura de córnea em pacientes com ceratites infecciosas entre Janeiro/2010 a Dezembro/2019. Os resultados foram analisados de acordo com o diagnóstico etiológico de infecção bacteriana, fúngica ou parasitária e correlacionado com os fatores de risco relacionados. Resultados: Quatro mil, oitocentas e dez amostras corneanas de 4047 pacientes (média de idade de 47,79 ± 20,68 anos; homens em sua maioria (53,7%) foram incluídas. A prevalência de infecções por bactéria, fungo e Acanthamoeba foram de 69.80%, 7,31%, and 3,51%, respectivamente. A maioria das bactérias mais frequentemente isoladas foram Staphylococcus coagulase-negativo (CoNS) (45,14%), S. aureus (10,02%), Pseudomonas spp. (8,80%), e Corynebacterium spp. (6,21%). Dentre CoNS, o principal agente foi S. epidermidis (n = 665). Nas ceratites fúngicas, Fusarium spp. (35,42%) e Candida parapsilosis (16,07%) foram os agentes mais comuns entre os filamentosos e leveduriformes, respectivamente. O uso de lentes de contato foi associado à cultura positiva para Acanthamoeba spp. (OR = 19,04; p < 0,001) e Pseudomonas spp (OR = 3,20; p < 0,001). Trauma ocular prévio foi associado a culturas positivas para fungo (OR = 1,80; p = 0,007), e idade avançada foi associada a culturas positivas para bactéria (OR = 1,76; p = 0,001). Conclusões: Nossos achados demonstraram uma maior positividade para bactérias em amostras de cultura corneana. Dentre estas, CoNS foi mais frequentemente identificado, sendo S. epidermidis o principal agente. Nas ceratites fúngicas, Fusarium spp. Foi o mais comumente isolado. O risco de positividade para Acanthamoeba spp. e Pseudomonas spp. foi maior em usuários de lentes de contato. Trauma ocular aumentou o risco de cultura positiva para fungo, ao passo que idade mais avançada aumentou o risco de infecção bacteriana.