A clinical predictive score for mood disorder risk in low-income primary care settings.

BACKGROUND: Despite availability of validated screening tests for mood disorders, busy general practitioners (GPs) often lack the time to use them routinely. This study aimed to develop a simplified clinical predictive score to help screen for presence of current mood disorder in low-income primary care settings. METHODS: In a cross-sectional study, 197 patients seen at 10 primary care centers in Santiago, Chile completed self-administered screening tools for mood disorders: the Patient Health questionnaire (PHQ-9) and the Mood Disorder Questionnaire (MDQ). To determine participants' current-point mood disorder status, trained clinicians applied a gold-standard diagnostic interview (SCID-I). A simplified clinical predictive model (CM) was developed based on clinical features and selected questions from the screening tools. Using CM, a clinical predictive score (PS) was developed. Full PHQ-9 and GP assessment were compared with PS. RESULTS: Using multivariate logistic regression, clinical and demographic variables predictive of current mood disorder were identified for a simplified 8-point predictive score (PS). PS had better discrimination than GP assessment (auROC-statistic=0.80 [95% CI 0.72, 0.85] vs. 0.58 [95% CI 0.52, 0.62] p-value <0.0001), but not as good as the full PHQ-9 (0.89 [95% CI 0.85, 0.93], p-value=0.03). Compared with GP assessment, PS increased sensitivity by 50% at a fixed specificity of 90%. Administered in a typical primary care clinical population, it correctly predicted almost 80% of cases. LIMITATIONS: Further research must verify external validity of the PS. CONCLUSION: An easily administered clinical predictive score determined, with reasonable accuracy, the current risk of mood disorders in low-income primary care settings.

Factores de riesgo para el desarrollo de infección de injerto protésico infrainguinal en un Servicio de Cirugía Vascular en Medellín (Colombia) / Risk factors for developing an infrainguinal prosthetic graft infection in a Vascular Surgery Department in Medellin (Colombia)

Introducción: La infección de injerto vascular es una entidad que tiene alta mortalidad y morbilidad entre los pacientes con enfermedad arterial periférica sometidos a estos procedimientos. Debido a la poca información sobre el comportamiento de las infecciones de injerto vascular en nuestro medio, es importante identificar los factores de riesgo que se asocian a las infecciones de injerto protésico vascular en reconstrucciones infrainguinales. Métodos: Estudio retrospectivo de casos y controles en pacientes sometidos a reconstrucción infrainguinal en el Hospital Universitario San Vicente de Paúl, Medellín, con injerto protésico, tomando como caso a quienes desarrollan infección, y como control a quienes no, según la clasificación de Szilagyi. Resultados: Se obtuvo un total de 34 casos y 34 controles, con una tasa de infección en reconstrucción infrainguinal protésica del 25,75%. No hubo diferencias significativas en la distribución por sexo, edad y clasificación de ASA. La mayoría de los casos se clasificaron como Szilagyi II y III (19,5 y 23,5%). La mayoría de los diagnósticos de infección se realizaron en los primeros 30 días del postoperatorio, siendo los microorganismos más aislados S. aureus y E. Coli. Se constituyeron como factores de riesgo para el desarrollo de infecciones la presencia de complicaciones en la herida quirúrgica (OR: 77,5; IC: 93,4-99,73), reintervenciones (OR: 7,23; IC: 1,82 - 28,4), el hábito de fumar (OR: 4,04 IC: 1,37-11,86) y el tiempo operatorio (p=0,002; IC: 21,74-91,25). Variables como comorbilidades, tipo de injerto o cirugías concomitantes no tuvieron influencia sobre la aparición de infecciones en la población estudiada. Conclusión: Las complicaciones en la herida quirúrgica, las reintervenciones, el tiempo operatorio prolongado y el hábito de fumar se relacionan con un riesgo elevado de sufrir infección de injerto vascular en la población estudiada(AU)

Vascular graft infection has high mortality and morbidity among patients with peripheral arterial disease undergoing limb artery bypass. Due to there being little information available in Latin American centers on this complication, it is important to identify risk factors associated with infrainguinal prosthetic graft infections. Vascular graft infections are a serious complication, with reports of up to 17% mortality and a morbidity of 41%, the loss of the limb being the most frequent outcome (1).Although the incidence of vascular graft infection is reported to be from 1% to 6% in most series, some studies in Latin American centers show incidences between 4% and 11.6% Methods: A retrospective case-control study was conducted on patients undergoing infrainguinal reconstruction with prosthetic graft at the Hospital Universitario San Vicente Fundacion, Medellín, taking as case patients who developed an infection; and controls, patients who did not, according to the classification of Szilagyi. Results: A total of 34 cases and 34 controls, no differences in gender distribution or age, were obtained over a period of 10 years. The most frequently isolated microorganism was S. aureus, with a significant proportion of methicillin resistant S. aureus. The variables found to be associated with significant vascular graft infection in the bivariate analysis were, the presence of wound complications (OR: 77.7, 95% CI; 15.9 to 375, P=.000), re- interventions (OR 7.23, 95% CI; 1.84 to 28.40, P=.002), smoking (OR 4.04, 95% CI; 1.37 to 11.86, P=.009), surgical time greater than 75 percentile for the population studied (OR 6.61, 95% CI; 1.2 to 2.82, P=.012).Variables such as comorbidities, type of graft or concomitant surgery had no influence of the appearance of infections in the population studied(AU)

Conclusion: Surgical wound complications, re-interventions, longer operating time, and smoking are associated with an increased risk of suffering from a vascular graft infection in the population studied(AU)

Caso de Moniliformis Moniliformis (Acanthocephala) em criança na Cidade de Säo Paulo / Moniliformis moniliformis (Acanthocephala) from a child in Säo Paulo, Brazil

Em abril de 1994 foi encaminhado ao Laboratório de Enteroparasitoses do Instituto Adolfo Lutz, para identificaçäo, um verme eliminado por criança do sexo feminino, de 12 meses de idade, que vinha apresentando quadro de diarréia, vômito e perda de peso. O exemplar foi examinado em miscroscópio estereoscópio e após estudos biométricos morfológicos, foi classificado como fêmea do gênero Moniliformis moniliformis, Acanthocephala, parasita comum do rato e que pode, acidentalmente, parasitar o homem. O objetivo do presente trabalho é relatar o segundo caso de parasitismo humano no Brasil e chamar a atençäo para a ocorrência eventual do parasita em nosso meio.

Esparganose humana. Relato de um novo caso no Estado de Säo Paulo / Abdominal spargnosis in Brazil. A case report

O encontro de um novo caso de esparganose humana no Brasil é relatado em paciente do sexo feminino, 17 anos, natural de Ribeiräo Grande, Estado de Säo Paulo, que apresentava processo inflamátório na regiäo umbilical, dores abdominais, mal estar, máuseas, vômitos, e febre. Foi retirado da cicatriz umbilical da paciente um parasita com cerca de 40cm de comprimento, que mostrou tratar-se de larva em fase plerocercóide conhecida como "Sparganum" de cestódio do gênero Spirometra (Luheella).

[Occurrence of Strongyloides stercoralis in patients with acquired immunodeficiency syndrome (AIDS)]. / Ocorrência de Strongyloides stercoralis em pacientes portadores da síndrome de imunodeficiência adquirida (AIDS).

A comparative study on the occurrence of Strongyloides stercoralis larvae in 554 patients with AIDS and in 142 patients suffering from infectious diseases other than AIDS was conducted during the period from January 1987 to December 1988. The two groups was constituted by male individuals in-patients at Emílio Ribas Hospital--São Paulo. Faeces samples from 696 patients were submitted to spontaneous sedimentation method and Rugai method. The data obtained from the present investigation demonstrated a similar prevalence of Strongyloides stercoralis in both groups (p > 0.05) indicating no significant statistical differences.

Human leptospirosis in Brazil.

Serological data on the prevalence of human leptospiroses in certain regions of Brazil are presented. Out of 467 diseased and clinically healthy persons, 40 were positive in the Amazonia. The most frequent serotypes were grippotyphosa (27.5%), panama (25%), icterohaemorrhagiae (10%) and woffi (10%). In 1966 and 1970, 279 cases were identified in Recife (northeastern Brazil) during outbreaks subsequent to floods. Among these 92.5% belonged to the icterohaemorrhagiae serotype. From 1947 to 1972, in São Paulo City (southeastern Brazil), of 18,233 patients with clinical signs of leptospirosis, 2,237 were positive with 86.5% belonging to icterohaemorrhagiae. In all Brazil, 32 strains of leptospires were isolated, 27 of which belonged to the icterohaemorrhagiae serotype and one strain for each wolffi, canicola, grippotyphosa, andamana and alexi serotypes.

Incidência das leptospiroses humanas em São Paulo / Incidence of human leptospirosis in São Paulo

Inicialmente os autores fazem um retrospecto histórico sobre os casos de Moléstia de Weil referidos em São Paulo, a partir de 1929, quando Salles Gomes e Toledo Piza relataram 1 caso humano com reprodução experimental da moléstia em cobaio. Referem 1 caso de Almeida Prado e 33 outros observados no Hospital das Clínicas, a partir de 1947, por Alvares Corrêa e Alves Meira, sendo um deles o primeiro caso humano de febre canícola observado no Brasil. Passando à parte técnica, referem-se ao material estudado, em sua maioria consistindo de pacientes ictéricos do Hospital das Clínicas, da Santa Casa e do Hospital de Isolamento "Emílio Ribas". Descrevem os métodos laboratoriais utilizados para o diagnóstico das leptospiroses e que são os seguintes: a) exame direto do plasma em campo escuro; b) hemocultura; c) inoculação em cobaio; d) soro-aglutinação - com utilização, como antígeno, das amostras abaixo discriminadas: 1. L. icterohaemorrhagiae (Packchanian), 2. L. icterohaemorrhagiae (J. Tobie), 3. L. canicola (J. Tobie), 4. L. pomonae (Mezano 1), 5. L. australis (B. Zanoni), 6. L. bataviae ­ var. Oryzeti (Pavia 1), 7. L. sejröe (M. 84), 8. L. canicola (Alarik), 9. L. icterohaemorrhagiae (Bianchi 1), 10. L. icterohaemorrhagiae A e B (Zaan). Das soro-aglutinações efetuadas com sangue de 146 pacientes suspeitos, 45 foram positivas, sendo 44 para L. icterohaemorrhagiae e 1 para L. canicola. Inoculações em cobaio com material proveniente de 77 pacientes, demonstraram a existência da leptospira em 5 casos, sendo em 3 pelo exame de cortes histológicos dos rins dos cobaios inoculados; nos outros 2 casos foram isoladas e identificadas L. icterohaemorrhagiae (AU).

Incidência da leptospira em ratos nas cidades de São Paulo e Santos / Incidence of leptospira in rats in the cities of São Paulo and Santos

Os autores, em 1948, pesquisaram a incidência de leptospiras em 259 ratos pertencentes à espécie R. norvegicus na cidade de São Paulo, utilizando como processo diagnóstico o cultivo do rim em meio de Fletcher. Encontraram 39 ratos infectados o que corresponde à percentagem de positividade de 15,05%. Em 1949 examinaram 85 ratos capturados na cidade de Santos, pertencentes às espécies R.frugivurus, R. rattus e R. norvegicus, encontrando 6 animais infectados, correspondendo à percentagem de positividade de 6,35%. Todas as amostras isoladas foram identificadas, mediante provas de aglutinação, como pertencentes à espécie L. icterohaemorrhagiae (AU).

TheAA.,in 1948,searchedfor the frequencyof leptospiraein 259 ratsbelongingto the varietyR. norvegicus,in the city of São Paulo.As diagnosticmethodtheyemployedFletcher'smediumin whichkidneywasimplanted.Theyfound39 infestedratswhichcorrespondsto 15,05%positiveresults.In 1949the AA.examined85 ratscapturedin the cityof Santosandbelongingto the speciesR. jrugivurus,R. rattus,R. noroeqicus.Six of themwereinfested,therefore6,35%positivefindings.Everyone of the isolatedsamplesof leptospiraewas identifiedthroughagglutinationtestsandprovedto be of the L. icterohaemorrhagiaespecies (AU).