Geographical Health District and Distance Traveled Influence on Clinical Status at Admission of Patients with Gestational Trophoblastic Disease / A influência do distrito de saúde e da distância viajada sobre o estado clínico na apresentação de pacientes com doença trofoblástica gestacional

Abstract Objective To assess the potential relationship of clinical status upon admission and distance traveled from geographical health district in women with gestational trophoblastic disease (GTD). Methods This is a cross-sectional study including women with GTD from the 17 health districts from the São Paulo state (I-XVII), Brazil, referred to the Botucatu Trophoblastic Disease Center (specialized center, district VI), between 1990 and 2018. At admission, hydatidiform mole was assessed according to the risk score system of Berkowitz et al. Gestational trophoblastic neoplasia was evaluated using the International Federation of Gynecology and Obstetrics / World Health Organization (FIGO/WHO) staging/risk score. Data on demographics, clinical status and distance traveled were collected. Multiple regression analyses were performed. Results This study included 366 women (335 hydatidiform mole, 31 gestational trophoblastic neoplasia). The clinical status at admission and distance traveled significantly differed between the specialized center district and other districts. Patients referred from health districts IX (β = 2.38 [0.87-3.88], p = 0.002) and XVI (β = 0.78 [0.02-1.55], p = 0.045) had higher hydatidiform mole scores than those from the specialized center district. Gestational trophoblastic neoplasia patients from district XVI showed a 3.32 increase in FIGO risk scores compared with those from the specialized center area (β = 3.32, 95% CI = 0.78-5.87, p = 0.010). Distance traveled by patients from districts IX (200km) and XVI (203.5km) was significantly longer than that traveled by patients from the specialized center district (76km). Conclusion Patients from health districts outside the specialized center area had higher risk scores for both hydatidiform mole and gestational trophoblastic neoplasia at admission. Long distances (>80 km) seemed to adversely influence gestational trophoblastic disease clinical status at admission, indicating barriers to accessing specialized centers.

Resumo Objetivo Avaliar a possível relação entre estado clínico na apresentação e distância percorrida a partir do distrito de saúde em mulheres com doença trofoblástica gestacional. Métodos Estudo transversal incluindo mulheres com doença trofoblástica gestacional dos 17 distritos de saúde do estado de São Paulo (I-XVII), Brasil, encaminhadas ao Centro de Doenças Trofoblásticas de Botucatu (distrito VI), entre 1990 e 2018. Na admissão, avaliaram-se mola hidatiforme pelo sistema de pontuação de risco de Berkowitz et al. e neoplasia trofoblástica gestacional pelo escore de risco/estadiamento Federação Internacional de Ginecologia e Obstetrícia / Organização Mundial da Saúde (FIGO/OMS). Coletaram-se dados demográficos, clínicos e distância percorrida e análises de regressão múltipla foram realizadas. Resultados Este estudo incluiu 366 mulheres (335 mola hidatiforme, 31 neoplasia trofoblástica gestacional). O estado clínico na apresentação e distância percorrida diferiram significativamente entre o centro especializado e demais distritos. Nas pacientes encaminhadas pelos distritos IX (β = 2,38 [0,87-3,88], p = 0,002) e XVI (β = 0,78 [0,02-1,55], p = 0,045), os escores de mola hidatiforme foram maiores que no centro especializado. As pacientes com neoplasia trofoblástica gestacional do distrito XVI apresentaram escores FIGO 3,32 vezes maior que no centro especializado (β = 3,32, 95% CI = 0,78-5,87, p = 0,010). A distância percorrida pelas pacientes dos distritos IX (200km) e XVI (203,5km) foi significativamente maior do que a percorrida pelas pacientes do centro especializado (76km). Conclusão Pacientes de distritos de saúde fora da cobertura do centro especializado apresentaram escores de risco mais alto para mola hidatiforme e para neoplasia trofoblástica gestacional na admissão. Longas distâncias (>80 km) pareceram influenciar negativamente o estado clínico da doença trofoblástica gestacional na apresentação, indicando barreiras no acesso a centros especializados.

Características e desfechos clínicos dos pacientes diagnosticados com ceratocone / Characteristics and clinical outcomes of patients diagnosed with keratocone

RESUMO Objetivos: Traçar o perfil epidemiológico, clínico, evolução e desfechos dos pacientes com ceratocone diagnosticados no serviço de referência oftalmológica do estado de Santa Catarina, Brasil. Métodos: Foram analisados retrospectivamente os prontuários de todos os pacientes com ceratocone do setor de córnea do Hospital Regional de São José, entre Janeiro de 2016 e dezembro de 2018. Os seguintes dados foram extraídos: sexo, idade, estágio da doença, doenças sistêmicas, sintomas oftalmológicos, adaptação de lentes de contato, tratamentos prévios, melhor acuidade visual monocular, medidas ceratométricas, condutas oftalmológicas, desfechos clínicos. Resultados: Os prontuários de 267 pacientes foram avaliados. A média de idade foi de 23 anos (intervalo: 06 - 60 anos), 159 (59,55%) eram do sexo masculino. 12 (4,49%) pacientes já haviam realizado ceratoplastia penetrante; 22 (8,24%) haviam realizado crosslinking; 07 (2,62%) já possuíam implante de anel intraestromal. 81 (30,34%) pacientes já haviam adaptado lentes de contato. 168 (62,92%) possuíam acuidade visual corrigida, do melhor olho, igual ou superior a 20/40. Encontrou-se uma distribuição entre casos leves, moderados e graves de: 03 (1,12%), 78 (29,21%), 157 (58,80%), respectivamente. Ao longo do período, efetivaram-se 51 (73,9%) transplantes de córnea, 09 (90,0%) implantes de anel intraestromal, 35 (32,4%) crosslinking, 22 (23,4%) adaptações de lentes de contato; 205 (76,77%) pacientes perderam seguimento, 12 (4,49%) receberam alta. Conclusão: Os pacientes são em sua maioria jovens, com doença moderada a grave, e boa acuidade visual no melhor olho. Ainda assim, muitos receberam indicação de tratamento cirúrgico. A perda de seguimento clínico constitui um fator importante na qualidade da assistência oftalmológica desta população.

ABSTRACT Objectives: To describe the epidemiological and clinical profile, evolution and outcomes of keratoconus patients diagnosed in the ophthalmologic reference service of the state of Santa Catarina, Brazil. Methods: The medical records of all patients with keratoconus attended at the Cornea service of the Regional Hospital of São José, between January 2016 and December 2018 were retrospectively analyzed. The following data were extracted: sex, age, disease stage, systemic diseases, ophthalmological symptoms, adaptation of contact lenses, previous treatments, best monocular visual acuity, keratometric measurements, ophthalmological procedures, clinical outcomes. Results: The medical records of 267 patients were analyzed. The average age was 23 years (range: 06 - 60 years), 159 (59.55%) were male. 12 (4.49%) patients had already performed penetrating keratoplasty; 22 (8.24%) had performed crosslinking; 07 (2.62%) had already an intrastromal ring implant. 81 (30.34%) patients had already adapted contact lenses. 168 (62.92%) had best corrected visual acuity, of the better eye, equal to or greater than 20/40. A distribution between cases was found light, moderate and severe of: 03 (1.12%), 78 (29.21%), 157 (58.80%), respectively. Throughout the period, a total of 51 (73,9%) corneal transplants, were performed 09 (90,0%) intrastromal ring implants, 35 (32,4%) crosslinking, 22 (23,4%) contact lens adaptations were performed; 205 (76.77%) patients lost follow-up, 12 (4.49%) were discharged. Conclusion: The patients are mostly young, with moderate to severe illness and good visual acuity in the best eye. Even so many received a surgical management. The loss of clinical follow-up is an important factor in the quality of ophthalmic care in this population.

The development of the Philippine General Hospital as a referral center in the COVID-19 Pandemic: A qualitative study

@#Background. The University of the Philippines-Philippine General Hospital (UP-PGH) was designated as a COVID Referral Center for one cluster in Metro Manila during the pandemic. We reviewed and described how UP-PGH prepared for this endeavor. This can serve as reference for similar events in the future. Methods. We conducted a qualitative cross-sectional study with 20 key informant interviews and 5 focus group discussions involving 32 hospital front liners. All proceedings were transcribed and analyzed manually following the conceptual framework. Minutes of meetings, memoranda, and other official materials and communications were also reviewed. Results. The salient points of both internal (operations, structure, staff, supplies, and continuation of regular services) and external aspects (relation with other hospitals, the local government, the national health authority, and the general public) were enumerated and elaborated. Both best practices and areas needing improvement were identified. Conclusion and Recommendations. The UP-PGH tried its best to prepare and respond to the COVID-19 pandemic by protecting its hospital personnel and delivering evidence-based and quality care to patients. The response was not a perfect one and there were certain aspects for improvement.

Clinical and epidemiological characterization of trypanosoma cruzi infected patients attending a referral center of chagas disease in Paraguay, preliminary results

A pesar de que la transmisión vectorial de la tripanosomiasis americana se ha interrumpido y las tasas de nuevas infecciones se han reducido en grandes áreas de América Latina, todavía existen muchos pacientes infectados crónicos. Determinamos las características clínicas y epidemiológicas de pacientes infectados con Trypanosoma cruzi que asistieron al Departamento de Medicina Tropical del Instituto de Investigaciones en Ciencias de la Salud (IICS) desde 1985 al 2007 analizando sus fichas clínicas manteniendo el anonimato y la confidencialidad. El paquete estadístico SPSS 11.5 se usó para analizar 1.024 fichas de pacientes de los cuales el 70,1 por cento (723/1024) estaba en el grupo etario de 21-60 años (38,7±10,5); 74,5 por cento (763/1024) nació en departamentos endémicos, 13,2 por cento (135/1024) en el Departamento Central, 5,9 por cento (60/1024) en Asunción y 6,4 por cento(66/1024) en otros departamentos. En el momento de la consulta, 38,2 por cento (391/1024) vivía en departamentos endémicos, 27,8 por cento (285/1024) en el Departamento Central, 22,6 por cento (231/1024) en Asunción y 11,4 por cento (117/1024) en otros. Los motivos de consulta fueron: palpitaciones (43,5 por cento; 445/1024), disnea de esfuerzo (34,1 por cento; 349/1024), decaimiento (32,8 por cento; 336/1024), cefalea (26,1 por cento; 267/1024), constipación (24,7 por cento; 253/1024) entre otros...

Although vector transmission of American trypanosomiasis has been interrupted and there are decreased rates of new infections in large areas of Latin America, there are still many chronically infected patients. We determined the clinical and epidemiological characteristics of Trypanosoma cruzi infected patients attending the Department of Tropical Medicine of the Institute of Research in Health Sciences (IICS) from 1985 to 2007 by analyzing their clinical records, maintaining anonymity and confidentiality. The SPSS 11.5 statistical package was used to analyze 1024 patient records of whom 70.1 percent (723/1024) were in the age group of 21-60 years (38.7±10.5); 74.5 percent (763/1024) were born in endemic departments, 13.2 percent (135/1024) in the Central department, 5.9 percent (60/1024) in Asunción and 6.4 percent (66/1024) in other departments. At consultation, 38.2 percent (391/1024) lived in endemic departments, 27.8 percent (285/1024) in Central Department, 22.6 percent (231/1024) in Asunción and 11.4 percent (117/1024) in others. Consultation reasons were: beatings (43.5 percent; 445/1024), effort dyspnea (34.1percent; 349/1024), enervation (32.8percent; 336/1024), headache (26.1percent; 267/1024) and constipation (24.7percent; 253/1024), among others...

O psicólogo brasileiro no SUAS: quantos somos e onde estamos? / Brazilian psychologist at SUAS: how many and where are we? / La psicología brasileña en SUAS: cómo y dónde estamos?

O Sistema Único da Assistência Social (SUAS) provocou a expansão e a interiorização da profissão de psicólogo em todo o país. Objetiva-se com este estudo mapear a presença desse profissional no SUAS, identificando quantos somos e onde estamos atuando nesta política. Realizou-se um estudo descritivo-exploratório, de natureza quantitativa, tendo como fonte para a coleta, organização e sistematização dos dados o Cadastro Nacional do SUAS (CadSUAS). Entre os resultados, identificou-se que o Brasil conta com 7.607 CRAS e 2.155 CREAS, distribuídos nos 5.565 municípios. Ao todo, são 8.079 os psicólogos que atuam no SUAS (6.022 em CRAS e 2.057 em CREAS). O Nordeste destaca-se como o que conta com o maior número de psicólogos em CRAS (2.252), e o Sudeste, em CREAS (706). Ademais, 92,9% dos psicólogos do SUAS atuam em municípios interioranos. Neste contexto, entende-se o SUAS como um importante dispositivo de capilarização da atuação do psicólogo brasileiro para as cidades de médio e pequeno porte do país.

The Unique System of Social Assistance (USSA) caused expansion and interiorization of the profession in the whole country. This study aims to map the presence of the psychologist in Social Assistance, identifying how many and where are we acting in this policy. An exploratory-descriptive study was realized, of quantitative nature, having as source of collection, organization and systematization of the data , the National Cadastre (CadSUAS). Among the results, it is identified that Brazil counts with 7,607 CRAS and 2,155 CREAS distributed in 5,565 cities. There are 8,079 psychologists in USSA (6,022 in CRAS and 2,057 in CREAS). The northeast stands out with the major number of psychologists in CRAS (2,252) and the southeast in CREAS (706). Moreover, 92.9% of SUAS psychologists acts in inner cities. Through this, SUAS is understood as an important device of capillarisation of Brazilian psychologist action for small and medium size cities of the country.

El Sistema Único de Asistencia Social (SUAS) ha fomentado la expansión y la internalización de la profesión en todo el país. El objetivo de este estudio fue cartografiar la presencia del psicólogo en el SUAS e identificar cómo y dónde estamos actuando en esta política. Se realizó un estudio exploratorio descriptivo, cuantitativo, a partir de los datos del Registro Nacional de SUAS (CadSUAS). Entre los resultados, encontramos que hay en el país 7.607 CRAS y 2.155 CREAS distribuidos en 5.565 municipios. Hay en Brasil 8.079 psicólogos vinculados al SUAS (6.022 CRAS y 2.057 CREAS). El Nordeste se destaca con mayor número de psicólogos en el CRAS (2.252) y el sudeste en CREAS (706). Además, 92,9% de los psicólogos trabajan en municipios del interior. De esta manera, consideramos el SUAS como un dispositivo importante de la capilarización de la actuación de los psicólogos para ciudades brasileñas de tamaño pequeño y mediano.

Classical fever of unknown origin (FUO): current causes in Mexico / Fiebre de origen indeterminado (FOI): causas actuales en México

Background. Causes of FUO change according to medical innovations, modifications of social circumstances, and emerging health risks. Aim. To describe the epidemiology of classical FUO, the time and procedures to achieve a definitive diagnosis, and to underline the variables useful in distinguishing FUO categories. Setting. A third-referral center in Mexico City. Methods. Patients admitted with prolonged fever were evaluated. Clinical charts of patients with classical FUO were assessed; comparisons between classical FUO categories were made. Results. 45 patients with 44.9 ± 17.2 years of age, previous fever duration of 51.2 ± 51.5 days, and 88.9% referred from other hospitals were evaluated. Nineteen patients had infectious causes; eight, neoplastic conditions; 12, inflammatory non-infectious diseases; one had another cause, and five were discharged with no etiologic diagnosis. Age, LDH levels, length of fever, and weight loss greater than 10 kg may be used to classify patients into a definite category. Conclusions. Classical FUO is an unusual presentation of frequent infectious diseases; SLE is the main cause within the inflammatory non-infectious conditions, and non-Hodgkin's lymphoma is the first cause of cancer. Some clinical and laboratory clues may be used to guide the study work up of patients with classical FUO.

Las causas de fiebre de origen indeterminado (FOI) varían de acuerdo con las innovaciones médicas o con modificaciones de las circunstancias sociales y riesgos para la salud. Objetivo. Describir la epidemiología de la FOI, el tiempo y procedimientos empleados para alcanzar un diagnóstico definitivo y evaluar las variables que pueden usarse para diferenciar sus categorías. Hospital. Centro de referencia de tercer nivel de la ciudad de México. Métodos. Se evaluó a pacientes con fiebre prolongada; los expedientes clínicos de aquellos con FOI fueron analizados y se compararon sus principales categorías. Resultados. Fueron evaluados 45 pacientes, de 44 ± 17.2 años de edad y duración promedio de la fiebre de 51.2 ± 51.5 días, de los cuales 88.9% habían sido referidos de otros hospitales. De ellos, 19 fueron diagnosticados con causas infecciosas, ocho con enfermedades neoplá-sicas, 12 con enfermedades inflamatorias no infecciosas, uno por alguna otra causa y cinco fueron dados de alta sin diagnóstico definitivo. La edad, niveles de DHL, la duración de la fiebre y la pérdida de peso mayor de 10 kg fueron marcadores útiles para clasificar a los pacientes en alguna de las categorías de la FOI. Conclusiones. La FOI es una manifestación inusual de enfermedades infecciosas frecuentes, el lupus erítematoso generalizado es la causa principal dentro de las condiciones inflamatorias no infecciosas y el línfoma no-Hodgkin en las neoplásicas. Algunas pistas clínicas y de laboratorio pueden emplearse para guiar el estudio de pacientes con FOI clásica.

The Prevalence of Proteinuria and Hematuria at a Tertiary Referral Hospital / 대한신장학회잡지

Urinalysis is one of the basic laboratory tests in patient care and routine examinations. But few studies have been carried out about the prevalence of proteinuria and hematuria in Korea, especially in tertiary referral hospital, and the meanings of them are not clear until now. So we performed a cross- sectional study to find out the prevalence of proteinuria and hematuria at a tertiary referral hospital, Seoul National University Hospital. From Jan. 1. 1995 to Dec. 31. 1995, there were 35,361 adults (17,123 males and 18,238 females) in whom urinalyses were carried out. The age of them ranged from 15 to 96 years and the average was 49 years with the distribution of 2.3% in 15-19 years, 10.6% in 20-29 years, 16.0% in 30-39 years, 19.6% in 40-49 years, 24.3% in 50-59 years, 19.2% in 60-69 years, and 8.0% in 70 years or older. The degree of proteinuria was classified to '-', '+/-', '+', '++', '+++' by dipstick method. In males, 80.0% were '-', 6.3% '+/-, 6.8% '+', 3.7% '++', 3.2% '+++', and 5.0% '+/-', 5.1% '+', 2.8% '++', 2.1% '+++' in females. Proteinuria of degree '+/-' or higher was defined as significant and found in 19.9% of males and 14.9% of females. According to the age groups, 17.0% in 15 to 19 years, 17.3% in 20 to 29 years, 16.3% in 30 to 39 years, 15.2% in 40 to 49 years, 16.8% in 50 to 59 years, 18.6% in 60 to 69 years, 23.6% in 70 years or older had significant proteinuria. Hematuria was classified by the number of erythrocytes per 400X high-power field, to grade 1 (30), 6 (many). In males, 62.9% were grade 1, 23.5% grade 2, 5.3% grade 3, 3.9% grade 4, 1.9% grade 5, 2.6% grade 6, and 47.4% grade 1, 32.6% grade 2, 8.8% grade 3, 5.3% grade 4, 2.4% grade 5, 3.4% grade 6 in females. Hematuria of grade 3 or higher was defined as significant and found in 13.6% of males and 20.0% of females. According to the age groups, 11.1% in 15 to 19 years, 13.7% in 20 to 29 years, 16.8% in 30 to 39 years, 17.4% in 40 to 49 years, 16.7% in 50 to 59 years, 18.0% in 60 to 69 years, 19.9% in 70 years or older had significant hematuria.