Cutaneous leishmaniasis treatment and therapeutic outcomes in special populations: A collaborative retrospective study.

BACKGROUND: Treatment guidance for children and older adult patients affected by cutaneous leishmaniasis (CL) is unclear due to limited representation of these groups in clinical trials. METHODS: We conducted a collaborative retrospective study to describe the effectiveness and safety of antileishmanial treatments in children ≤ 10 and adults ≥ 60 years of age, treated between 2014 and 2018 in ten CL referral centers in Latin America. RESULTS: 2,037 clinical records were assessed for eligibility. Of them, the main reason for non-inclusion was lack of data on treatment follow-up and therapeutic response (182/242, 75% of children and 179/468, 38% of adults). Data on 1,325 eligible CL patients (736 children and 589 older adults) were analyzed. In both age groups, disease presentation was mild, with a median number of lesions of one (IQR: 1-2) and median lesion diameter of less than 3 cm. Less than 50% of the patients had data for two or more follow-up visits post-treatment (being only 28% in pediatric patients). Systemic antimonials were the most common monotherapy regimen in both age groups (590/736, 80.2% of children and 308/589, 52.3% of older adults) with overall cure rates of 54.6% (95% CI: 50.5-58.6%) and 68.2% (95% CI: 62.6-73.4%), respectively. Other treatments used include miltefosine, amphotericin B, intralesional antimonials, and pentamidine. Adverse reactions related to the main treatment were experienced in 11.9% (86/722) of children versus 38.4% (206/537) of older adults. Most adverse reactions were of mild intensity. CONCLUSION: Our findings support the need for greater availability and use of alternatives to systemic antimonials, particularly local therapies, and development of strategies to improve patient follow-up across the region, with special attention to pediatric populations.

Clinical and genomic data of sars-cov-2 detected in maternal-fetal interface during the first wave of infection in Brazil.

Brazil has the highest SARS-CoV-2 case-fatality rate in pregnant women in the Americas. In this study, clinical and virological findings of five mildly symptomatic pregnant women and their infected fetuses/newborns treated at a referral hospital for COVID19-pregnant women in Midwestern Brazil are reported. Mother and fetal samples were tested by RT-qPCR, ECLIA and Illumina MiSeq sequencing. From the five cases, one resulted in spontaneous abortion, one was stillborn, two were preterm births and one full-term birth. Maternal and fetal placenta, newborn and stillborn secretions were SARS-CoV-2+; one neonate developed ground-glass opacities in his lungs. One neonate's umbilical cord was IgG+ and all were IgM negative upon hospital discharge. Genomes recovered from two placentas belong to the B.1.1.28 and B.1.1.33 lineages and present nonsynonymous mutations associated with virus fitness and infectivity; other not frequently reported mutations (B.1.1.33: NSP3 V2090G, M A2S and ORF3ab S253P and Y264N; B.1.1.28: NSP3 E995D, NSP12 R240K, NSP14H1897Y and in ORF7b V21F) were found in proteins involved in viral replication, viral induction of apoptosis, viral interference on interferon and on NF-Κß pathways. Phylogeny indicates the south of Brazil as the possible origin of these lineages circulating in Mato Grosso State. These findings contribute to describe SARS-CoV-2 infection and outcomes in pregnant women and their fetuses, at any stage of gestation and even in mild symptomatic cases.

Taxas de cesarianas em um hospital universitário a partir da classificação de Robson / Cesarean section rates in a university hospital based on the Robson classification

Objective:to describe the cesarean section rates in a university hospital using the Robson Classification. Method:descriptive and cross-sectional, based on data from the Live Birth Information System of deliveries happened in a university hospital, between 2015 and 2017. Results:there was a progressive increase in the route of cesarean delivery and the consequent maintenance of the high general rate of cesarean sections. A considerable number of parturient women had favorable obstetric conditions for vaginal delivery and, if nurse midwives had accompanied them, their chances of having a vaginal delivery could have increased. The greatest group in the Robson Classification was the multiparous group, with previous cesarean section and full-term pregnancy (group 5), which is probably related to the high number of cesarean sections identified in primiparous women (group 1) and the limitations of the labor induction methods. Conclusion:the use of the Robson Classification has enabled us to know, with more specificity, the profile of women submitted to cesarean section in the service, which may subsidize the preparation of more effective strategies and consistent with the reality in coping with high rates of cesarean section.

Objetivo: descrever as taxas de cesáreas de um hospital universitário a partir da Classificação de Robson. Método: descritivo e transversal, realizado a partir de dados do Sistema de Informações de Nascidos Vivos dos partos ocorridos em um hospital universitário, entre 2015 e 2017. Resultados: houve aumento progressivo da via de parto cesárea e a consequente manutenção da elevada taxa geral de cesariana. Quantidade considerável das parturientes possuía condições obstétricas favoráveis para o parto vaginal e, caso tivesse sido acompanhada por enfermeiras (os) obstétricas (os), poderia ter aumentado a sua possibilidade de ter um parto vaginal. O maior grupo da Classificação de Robson foi o de multíparas, com cesárea anterior e gestação a termo (grupo 5), que provavelmente está relacionado ao número elevado de cesariana identificado em primíparas (grupo 1) e a limitações dos métodos de indução para o trabalho de parto. Conclusão: o uso da Classificação de Robson permitiu conhecer, com maior especificidade, o perfil das mulheres submetidas à cesárea no serviço, o que pode subsidiar a elaboração de estratégias mais efetivas e condizentes com a realidade no enfrentamento das taxas elevadas de cesariana.

Assistência pré-natal na estratégia saúde da família: uma avaliação de estrutura / Prenatal care in the family health strategy: assessment of structure

O objetivo desta pesquisa foi avaliar a estrutura disponível nas unidades da Estratégia Saúde da Família para prestação da assistência pré-natal na cidade de Cuiabá, Estado de Mato Grosso, na perspectiva de avaliação de serviços de saúde proposta por Donabedian. Trata-se de uma pesquisa de avaliação de qualidade em saúde de abordagem quantitativa. Foi desenvolvida com a utilização de dados secundários do banco de dados do grupo de pesquisa Argos/Gerar. Os resultados revelaram que as unidades contavam com estrutura física deficitária, uma vez que várias delas não possuíam sala de pré-consulta e sala de reuniões. A falta de equipamentos, dentre eles o sonar Doppler e o estetoscópio Pinard, prejudica a assistência pré-natal. A dimensão de recursos humanos foi a mais deficitária, devido à não permanência de alguns profissionais na unidade, evidenciando grande rotatividade, principalmente dos técnicos de enfermagem e médicos. Na classificação geral, a dimensão mais comprometida foi a de recursos humanos. Por sua vez, a dimensão melhor classificada foi a de sistema de informação. Embora os aspectos relativos à estrutura das unidades básicas de saúde para atendimento pré-natal tenham sido considerados parcialmente adequados neste estudo, em relação à classificação geral, as unidades de saúde da família de Cuiabá, MT, ainda estão deficitárias em vários quesitos.

The goal of this study was to assess the structure available at Family Health Strategy units for the provision of prenatal care in the city of Cuiabá, State of Mato Grosso, Brazil, from the perspective of health services assessment proposed by Donabedian. This research assesses health quality from a quantitative approach. It was carried out using secondary data from the database of the Argos/Gerar Research Group. The results revealed that the units had deficient physical structure, since many of them did not have a pre-consultation room and a conference room. The lack of equipment, including Doppler sonar and Pinard stethoscopes, undermines prenatal care. The dimension 'human resources' was the most deficient, due to the non-permanence of some professionals in the unit, highlighting intense turnover, mainly of nursing technicians and physicians. In the general classification, the most compromised dimension was 'human resources'. In turn, the best classified dimension was 'information system'. Although the aspects regarding the structure of basic health units for prenatal care have been considered partially inadequate in this study, family health units of Cuiabá, MT, are still deficient on several aspects with respect to the general classification

Análise da atenção pré-natal no município de Cuiabá-Mato Grosso segundo dados do SISPRENATAL / Análisis de la atención prenatal en la ciudad de Cuiabá-Mato Grosso según los datos SISPRENATAL / Analysis of the prenatal care in Cuiabá-Mato Grosso according to sisprenatal data

Objetivo: Analisar, na perspectiva do Programa de Humanização do Pré-Natal e Nascimento, a assistência ao pré-natal em Cuiabá-MT a partir dos dados do SISPRENATAL, em 2010. Método: Abordagem quantitativa. População composta por dados relativos a 474 gestantes. Dados coletados através dos relatórios gerenciais do Escritório Regional de Saúde da Baixada Cuiabana. Análise estatística descritiva simples com a utilização do software Epi Info 3.5. Resultados: Captação precoce de 75,5%, das gestantes; consulta puerperal ocorreu em 17,1% das gestantes. Redução na realização dos exames básicos da 1ª para 2ª rotina; 64,6% das gestantes receberam a dose imunizante. Conclusão: Assistência pré-natal desenvolvida tem pontos fortes; ainda apresenta pontos que precisam ser revistos com vistas à prestação de uma assistência pré-natal de qualidade.

Objective: This study analyzes, in terms of the Prenatal and Birth Humanization Program, the prenatal care offered in Cuiabá-MT from SISPRENATAL data of the year 2010. Method: Quantitative. The sample consisted on data of 474 pregnant women. Data was collected through the management reports of the Health Regional Office of Baixada Cuiabana. A simple descriptive analysis was conducted on statistics from a database using Epi Info 3.5 software. Results: There was an early uptake of 75.5% of pregnant women; puerperal visit occurred in 17.1% of pregnant women.Reduction in the achievement of the core exams from 1st to 2nd routine, 64.6% of pregnant women received the immunizing dose or booster dose of tetanus vaccine. Conclusion: The developed prenatal care has strengths, however, it still presents issues that need to be reviewed aiming to provide a quality prenatal care.

Objetivo: Analizar, desde la perspectiva del Programa de Humanización del Prenatal y el Parto, el cuidado prenatal en Cuiabá-MT a partir de los datos del SISPRENATAL, en 2010. Método: Cuantitativo. La muestra está compuesta por los datos de 474 mujeres embarazadas. Datos fueran recogidos a través de los informes de gestión de la Oficina Regional de Salud de la Baixada Cuiabana. Análisis estadístico descriptivo simple utilizando el programa Epi Info 3.5. Resultados: Captación precoz de 75.5% de las mujeres embarazadas; la visita puerperal, se produjo en el 17,1% de las mujeres embarazadas. Reducción en la realización delos exámenes básicos de primero a segundo de rutina, el 64,6% de las mujeres embarazadas recibieron la dosis inmunizante . Conclusión: La atención prenatal presenta fortalezas, aún tiene problemas que necesitan ser revisados con el fin de proporcionar la calidad de la atención prenatal.