ABSTRACT
Objective: To analyse the impact of screening actions on the incidence and mortality rates of cervical cancer (CC) in the city of Belém, Brazil. Methods: Based on the cancer registry data from 1998 to 2017, collected from the Belém Population-Based Cancer Registry, combined with local population data for the interval 1998-2017, CC incidence and mortality were calculated. The Segi world population 1960 was used for age-standardised incidence/mortality rates. Results: In the period analysed, there were 4,469 new cases and 1,660 deaths from CC. The median age at diagnosis of invasive cases was 51 years. The age-adjusted incidence rate decreased from 18.65/100,000 in 1998 to 11.79/100,000 in 2017, despite the increase observed in the first 5 years of the historical series, while there was stability in mortality rates in the same time lapse. Conclusion: CC is still one of the most common malignant tumours that threaten public health in northern Brazil. The trend of the disease depends on comprehensive prevention and control strategies regarding the local situation and age groups, with emphasis on the organisation of the screening programme and vaccination against human papillomavirus.
ABSTRACT
The Brazilian Amazon has a specific epidemiological profile for cryptococcosis, considering its social and economic inequality, health reality, and low access to health services. Furthermore, Brazil and Colombia have the highest cryptococcosis incidence rates in Latin America. In this study, we identified the areas of risk for cryptococcosis in the state of Pará in the Brazilian Amazon. This was an ecological study of patients admitted to a referral hospital from 2008 to 2018, aged 13 years or older, and of both sexes. The spatial distribution was determined using ArcGis 10.3.1 software. Cryptococcosis was confirmed in 272 cases. The incidence rate was 3.41 cases/100,000 inhabitants. Spatial distribution was concentrated in the Metropolitana de Belém, Nordeste Paraense, and Marajó mesoregions. The sociodemographic profile consisted of 62% men, aged between 24 and 34 years (36%), without completed secondary education (64.7%), and with occupations varying between agricultural activities (13.8%) and household activities (22%). The mean hospitalization time was 39 days; the prevalent clinical form was neurological (89.7%). The mortality rate among patients with cryptococcosis was up to 40%. Knowledge of the real magnitude of the disease in the Brazilian Amazon makes it possible to identify areas with the greatest risks and to propose control and epidemiological surveillance programs.
ABSTRACT
The Amazon region or regional Amazon complex includes nine states of Brazil with an area of around 5.1 million km, which is almost 60% of the country's territory. The sanitary conditions in this region are reflected by illness resulting from substandard living conditions and limited access to prevention measures and health care, in addition to the epidemiological profile of cryptococcosis. This article aims to provide a comprehensive review of the literature on cryptococcosis in the Amazon region and its future prospects. Thus, the present study searched the Scientific Electronic Library Online, Latin American and Caribbean Health Sciences Literature, Medical Literature Analysis and Retrieval System, Virtual Health Library, PubMed, and CAPES Periodical Portal for studies on cryptococcosis in the Amazon region, with an established search period of 1999 to 2018, using the search terms "Cryptococcus," "cryptococcosis," and "Amazon" with the Boolean operator AND. Out of 275 articles found, 29 were selected according to the inclusion criteria and were categorized into clinical and environmental studies. Analysis of these studies verified the increased occurrence of infection by Cryptococcus gattii at younger ages in the supposedly immunocompetent and the predominance of C. neoformans in HIV-positive patients. No occurrence of Cryptococcus laurentii infection has been identified in the literature. The regional endemic molecular types included VNI, VNII, and VGII. Similarly, the strain sequence type (ST) allelic profiles, including ST5, 7, 20, and 264-268, were identified in C. gattii isolated in Amazonas state. VNI isolates are a genetically monotypic group, with ST93 being highly important in HIV individuals. In urban environments, cryptococcosis agents were isolated in samples collected fromtrees, wooden houses, and dove excrement. Due to the absence of a control program and specific epidemiological surveillance for the primary disease, cryptococcal meningitis has become a failure parameter in the treatment of HIV/AIDS patients. The findings of the present study underscore the need for programs to track cryptococcal antigens and identify high-risk populations in order to reduce the morbimortality of this disease.
