ANALYSIS OF OUTCOMES AND REASONS FOR REFUSING ORGANS FOR TRANSPLANTS IN BRAZIL / ANÁLISIS DE RESULTADOS Y MOTIVOS DE RECHAZO DE ÓRGANOS PARA TRASPLANTE EN BRASIL / ANÁLISE DE DESFECHOS E MOTIVOS DE RECUSAS DE ÓRGÃOS PARA TRANSPLANTES NO BRASIL

Introduction: In a scenario of insufficient organs to meet the total waiting list for transplants in Brazil, it is important to know the final outcome of the offers made by the National Transplant Center (CNT) of the Ministry of Health (MS) and the reason why the organs are refused by the transplantation teams, since only a small part of the offers made within the scope of the single national list are converted into transplants. General objective: To describe the outcomes and reasons for refusal of the organs offered for the single national list, managed by the CNT. Method: Descriptive retrospective cohort study, with a quali-quantitative approach, on the CNT solid organ offer outcome dataset and refusal reasons for solid organs, from 2014 to 2021. Results: Of the total of 22,824 organ offers in the period from 2014 to 2021 (n= 22,824), 8,483 (37%) were initially accepted and 14,341 (63%) were rejected by the transplant teams. Of the total number of organs accepted, 6,433 (76%) were effectively implanted and 2,050 (24%) were not used for transplantation. As for the outcome by type of organ, 511 hearts (16%), 212 lungs (12%), 2,149 livers (37%), 5,504 kidneys (54%) and 106 pancreas (5%) were accepted. 2631 hearts (84%), 1559 lungs (88%), 3617 livers (63%), 4677 kidneys (46%) and 1857 pancreas (95%) were rejected. 441 hearts (86%), 164 lungs (77%), 1738 livers (81%), 4014 kidneys (73%) and 76 pancreas (72%) were implanted. 2,050 organs were not used, 70 hearts (14%), 48 lungs (23%), 411 livers (19%), 1,491 kidneys (27%) and 30 pancreas (28%). Conclusion: In the evaluated period, the acceptance of the offered organ resulted in 37% of the total offers made for the national list, managed by the CNT. Of these, 76% had the effective implantation of the organ as an outcome and non-use in 24% of the outcomes. As for the type of organ offered, the highest rate of the "organ accepted" event corresponded to the kidneys (54%) followed by the liver (37%). The highest rate of the "organ refused" event was registered for the lung (88%), followed by the pancreas (95%). The highest rate of the "implanted organs" event was registered by the heart (86%) and the "unused organs" event was shown by the pancreas (28%), followed by the kidneys (27%). With regard to reasons for refusal, refusals due to logistics accounted for only 6% of the identified reasons. The highest rate of reasons for refusal was attributed to the group of events "donor conditions" (59%), followed respectively by "other reasons" unspecified (21%), "organ conditions" (9%) and "donor conditions". recipient" (5%), with refusals due to "logistics" corresponding to the penultimate place. With this work, it is concluded that the use of the organs offered at the national level can be enhanced, based on a better understanding of the real reasons for refusal and the identification of opportunities for rescuing initially refused donors. It is also inferred that the refinement of the reasons for refusal could reduce the rates of non-use of organs, in order to contribute to changing the shortage scenario. The current record of the outcome and reasons for refusal made by the CNT offers important information, however, other studies are needed to debug the reasons for refusal of the organs offered for the single national waiting list for transplants, aiming to contribute to the planning of strategies for better use. of the organs offered.

Introducción: En un escenario de órganos insuficientes para atender la lista total de espera para trasplantes en Brasil, es importante conocer el resultado final de las ofertas realizadas por el Centro Nacional de Trasplante (CNT) del Ministerio de Salud (MS) y el motivo por qué los órganos son rechazados por los equipos de trasplante, ya que solo una pequeña parte de las ofertas realizadas en el ámbito de la lista única nacional se convierten en trasplantes. Objetivo general: Describir los resultados y motivos de denegación de los órganos ofertados para la lista única nacional, gestionada por la CNT. Método: Estudio descriptivo retrospectivo de cohortes, con enfoque cuali-cuantitativo, sobre el conjunto de datos de resultados de oferta de órganos sólidos de CNT y motivos de rechazo de órganos sólidos, de 2014 a 2021. Resultados: Del total de 22.824 ofertas de órganos en el período de 2014 a 2021 (n= 22.824), 8.483 (37%) fueron aceptados inicialmente y 14.341 (63%) fueron rechazados por los equipos de trasplante. Del total de órganos aceptados, 6.433 (76%) fueron efectivamente implantados y 2.050 (24%) no fueron utilizados para trasplante. En cuanto al resultado por tipo de órgano, se aceptaron 511 corazones (16%), 212 pulmones (12%), 2149 hígados (37%), 5504 riñones (54%) y 106 páncreas (5%). Se rechazaron 2631 corazones (84%), 1559 pulmones (88%), 3617 hígados (63%), 4677 riñones (46%) y 1857 páncreas (95%). Se implantaron 441 corazones (86%), 164 pulmones (77%), 1738 hígados (81%), 4014 riñones (73%) y 76 páncreas (72%). No se utilizaron 2.050 órganos, 70 corazones (14%), 48 pulmones (23%), 411 hígados (19%), 1.491 riñones (27%) y 30 páncreas (28%). Conclusión: En el período evaluado, la aceptación del órgano ofertado supuso el 37% del total de ofertas realizadas para la lista nacional, gestionada por la CNT. De estos, el 76% tuvo como desenlace la implantación efectiva del órgano y la no utilización en el 24% de los desenlaces. En cuanto al tipo de órgano ofertado, la mayor tasa de evento "órgano aceptado" correspondió a los riñones (54%) seguido del hígado (37%). La tasa más alta de evento de "rechazo de órgano" se registró en el pulmón (88 %), seguido del páncreas (95 %). La tasa más alta del evento "órganos implantados" la registró el corazón (86%) y el evento "órganos no utilizados" la presentó el páncreas (28%), seguido de los riñones (27%). En cuanto a los motivos de denegación, las denegaciones por motivos logísticos representaron solo el 6% de los motivos identificados. La tasa más alta de motivos de rechazo se atribuyó al grupo de eventos "condiciones del donante" (59 %), seguido respectivamente de "otros motivos" no especificados (21 %), "condiciones del órgano" (9 %) y "condiciones del donante". destinatario" (5%), correspondiendo las negativas por "logística" al penúltimo lugar. Con este trabajo se concluye que se puede potenciar el uso de los órganos ofrecidos a nivel nacional, a partir de una mejor comprensión de las verdaderas razones de rechazo y la identificación de oportunidades de rescate de donantes inicialmente rechazados. También se infiere que el perfeccionamiento de los motivos de denegación podría reducir las tasas de no uso de órganos, con el fin de contribuir a cambiar el escenario de escasez. El registro actual de resultado y motivos de rechazo realizado por la CNT ofrece información importante, sin embargo, se necesitan otros estudios para depurar los motivos de rechazo de los órganos ofrecidos para la lista única nacional de espera para trasplantes, con el fin de contribuir a la planificación de estrategias para un mejor aprovechamiento de los órganos ofrecidos.

Introdução: Num cenário de manifestação de órgãos para atender ao total da lista de espera por transplantes no Brasil, é relevante conhecer o desfecho das ofertas feitas pela Central Nacional de Transplantes (CNT) do Ministério da Saúde (MS) e o motivo pelo qual os órgãos são recusados ​​​​​​pelas equipes transplantadoras, visto que apenas uma pequena parte das ofertas feitas no âmbito da lista única nacional, são convertidos em transplantes. Objetivo geral : Descrever os óbitos e motivos de recusa dos órgãos oferecidos para a lista única nacional, gerenciada pela CNT. Método:Estudo de coorte retrospectivo de caráter descritivo, com abordagem quali-quantitativa, sobre o conjunto de dados de ofertas de mortes de motivos e recusas de órgãos sólidos da CNT, no período de 2014 a 2021. Resultados: Do total de 22.824 ofertas de órgãos no período de 2014 a 2021 (n= 22.824), 8.483 (37%) foram inicialmente aceitos e 14.341 (63%) foram recusados ​​pelas equipes transplantadoras. Do total de órgãos aceitos, 6.433 (76%) foram efetivamente melhorados e 2.050 (24%) não foram utilizados para transplante. Quanto ao resultado por tipo de órgão, foram aceitos 511 corações (16%), 212 pulmões (12%), 2.149 fígados (37%), 5.504 rins (54%) e 106 pâncreas (5%).Foram recusados​​​​2.631 corações (84%), 1.559 pulmões (88%), 3.617 fígados (63%), 4.677 rins (46%) e 1.857 pâncreas (95%). Foram aprimorados 441 corações (86%), 164 pulmões (77%), 1.738 fígados (81%), 4.014 rins (73%) e 76 pâncreas (72%). Não foram utilizados 2.050 órgãos sendo, 70 corações (14%), 48 pulmões (23%), 411 fígados (19%), 1.491 rins (27%) e 30 pâncreas (28%). Conclusão: No período avaliado, o aceite do órgão oferecido teve como resultado 37% do total de ofertas feitas para a lista nacional, gerada pela CNT. Destes, 76% tiveram como resultado o implante efetivo do órgão e a não utilização em 24% dos resultados. Quanto ao tipo de órgão oferecido, a maior taxa do evento "órgão aceito" correspondeu aos rins (54%) seguido pelo fígado (37%).A maior taxa do evento "órgão recusado" foi registrada para o pulmão (88%), seguido do pâncreas (95%). A maior taxa do evento "órgãos aperfeiçoados" foi registrada pelo coração (86%) e do evento "órgãos não utilizados" foi mostrada pelo pâncreas (28%), seguida pelos enxágues (27%). Não que se refira aos motivos de recusa, pois as recusas por logística corresponderam a apenas 6% dos motivos identificados. A maior taxa de motivos de recusa foi atribuída ao grupo de eventos "condições do doador" (59%), seguidas respectivamente por "outros motivos" não especificados (21%), "condições do órgão" (9%) e "condições do receptor" (5%), sendo que as recusas pelo motivo "logística" corresponderam ao penúltimo lugar.Com este trabalho, conclui-se que o aproveitamento dos órgãos oferecidos a nível nacional pode ser potencializado, a partir do melhor entendimento dos reais motivos de recusa e da identificação de oportunidades de resgate de doadores inicialmente recusados. Depreende-se ainda, que o refinamento dos motivos de recusa poderia diminuir as taxas de não utilização de órgãos, de maneira a contribuir na alteração do cenário de escassez. O registro atual do abandono e motivos de recusas feito pela CNT oferece informações importantes, porém, outros estudos são necessários para depurar os motivos de recusa dos órgãos ofertados para a lista única nacional de espera por transplantes, visando contribuir no planejamento de estratégias para melhor aproveitamento dos órgãos ofertados.

Importância e aspectos clínicos da dermatite de contato por própolis / Importance and clinical aspects of propolis contact dermatitis

Objetivos: própolis é a substância resinosa que as abelhas coletam de plantas para a construção de suas colmeias. O objetivo dessa revisão foi ressaltar a importância do diagnóstico de dermatite de contato relacionada com própolis e aspectos clínicos relevantes dessa doença. Métodos: revisão narrativa da literatura realizada através da pesquisa nas bases de dados National Library of Medicine (PubMed) e Scientific Eletronic Library Online (SciELO). Resultados: foram encontrados 246 artigos e, após o processo de seleção e leitura, foram incluídas 32 publicações. Conclusões: a hipersensibilidade tardia ao própolis é de extrema importância pois a prevalência dessa alergia é crescente em diversas partes do mundo. Precisamos de estudos nacionais para avaliar nossa realidade. A comprovação de alta prevalência em nosso meio permitirá a inclusão desta substância em outras baterias de testes de contato em nosso país

Aims: propolis is the resinous substance that bees collect from plants to build their hives. The aim of this review was to highlight the importance of diagnosing propolis-related contact dermatitis and relevant clinical aspects of this disease. Methods: narrative literature review carried out by searching the National Library of Medicine (PubMed) and Scientific Electronic Library Online (SciELO) databases. Results: a total of 246 articles were found and, after the selection and reading process, 32 publications were included. Conclusions: delayed-type hypersensitivity to propolis is extremely important because the prevalence of this allergy is increasing in various parts of the world. We need national studies to assess our reality. Proof of the high prevalence in our country will allow this substance to be included in other patch tests series in our country

Severe varicella in a child immunosuppressed with methotrexate

Abstract Varicella is a common viral infection in childhood and usually has a benign evolution. However, the evolution can be severe in immunosuppressed children. Vaccination can prevent its occurrence and especially the development of severe and/or complicated cases. Methotrexate is a systemic therapeutic option for many inflammatory diseases, and its immunosuppressive action exposes its users to a higher susceptibility to infection. The present report describes a case of severe varicella infection in a child immunosuppressed with methotrexate.

Allergic contact cheilitis caused by propolis: case report.

Propolis is a lipophilic resin extracted from plants by bees. The purpose of this case report was to show the importance of this substance as cause of allergic contact cheilitis. A 21-year-old female patient complained of pruritic perioral eczema for 5 years. In the past months it also affected the neck. After diagnosing contact dermatitis, she was submitted to a patch test with a Latin American baseline series. The result was strongly positive for propolis (++) and weakly positive for perfume mix I (+). After the test, the patient revealed she had been using propolis drops, per oris, for 10 years. The worsening of the condition was due to increased dose, aiming "to improve immunity", during the coronavirus disease 2019 (COVID-19) pandemic. The contact allergy to propolis might be increasing due to the widespread use of natural products. Propolis is a sensitizer to be considered in patients with long-lasting cheilitis.

Severe varicella in a child immunosuppressed with methotrexate.

Varicella is a common viral infection in childhood and usually has a benign evolution. However, the evolution can be severe in immunosuppressed children. Vaccination can prevent its occurrence and especially the development of severe and/or complicated cases. Methotrexate is a systemic therapeutic option for many inflammatory diseases, and its immunosuppressive action exposes its users to a higher susceptibility to infection. The present report describes a case of severe varicella infection in a child immunosuppressed with methotrexate.

Allergic contact cheilitis caused by propolis: case report

ABSTRACT Propolis is a lipophilic resin extracted from plants by bees. The purpose of this case report was to show the importance of this substance as cause of allergic contact cheilitis. A 21-year-old female patient complained of pruritic perioral eczema for 5 years. In the past months it also affected the neck. After diagnosing contact dermatitis, she was submitted to a patch test with a Latin American baseline series. The result was strongly positive for propolis (++) and weakly positive for perfume mix I (+). After the test, the patient revealed she had been using propolis drops, per oris, for 10 years. The worsening of the condition was due to increased dose, aiming "to improve immunity", during the coronavirus disease 2019 (COVID-19) pandemic. The contact allergy to propolis might be increasing due to the widespread use of natural products. Propolis is a sensitizer to be considered in patients with long-lasting cheilitis.

Dermatite de contato agravada por outra sensibilidade em automedicação / Contact dermatitis aggravated by other sensitivity in self-medication

RESUMO: Dermatite alérgica de contato é uma doença cutânea inflamatória, não infecciosa, cuja base do tratamento é a identificação e eliminação do agente causal. Cocoamidopropil betaína é um surfactante muito utilizado nos produtos de uso pessoal, notadamente de uso capilar. Essa substância não está presente na bateria padrão brasileira. Neomicina é um antibiótico usado em preparações tópicas. Objetivamos mostrar paciente que desenvolveu alergia no couro cabeludo e que fez erroneamente automedicação com produto que continha substância a qual era ainda mais sensível. O caso é de uma mulher, 36 anos, evoluindo há dois meses com eczema pruriginoso, em áreas de implantação capilar e nuca. Relatava progressiva piora. Diante da suspeita de dermatite de contato, foi realizado teste de contato, utilizando-se da bateria padrão Latino-Americana. Com 96 horas (D4) evidenciou-se positividade leve (+) para cocoamidopropil betaína e forte (++) para neomicina. O resultado positivo para a neomicina foi intrigante, uma vez que a observação do rótulo dos produtos de uso pessoal não a continha. Diante do resultado do teste, após ser questionada novamente, ela confirmou a omissão da automedicação diária com pomada de neomicina. Em conclusão, mostramos a alergia a produtos de uso capilar. Reforçamos a necessidade de se fazer um teste de contato com bateria padrão atualizada. Por fim, alertamos sobre o risco da automedicação. (AU)

ABSTRACT: Allergic contact dermatitis is an inflammatory, non-infectious skin disease. The treatment is based on the identification and elimination of the causal agent. Cocamidopropyl betaine is a surfactant widely used in products for personal use, especially capillary use. This substance is not present in the Brazilian baseline series. Neomycin is an antibiotic used in topical preparations. We aimed to show a patient who developed na allergy in the scalp and mistakenly self-medicated with a product that contained a substance to which it was even more sensitive. The case is of a woman, 36 years old, evolving for 2 months with pruritic eczema, in areas of capillary and nape implantation. She reported progressive worsening. When contact dermatitis was suspected, a contact test was performed using the Latin American baseline series. At 96 hours (D4) there was mild positivity (+) for cocamidopropyl betaine and strong (++) for neomycin. The positive result for neomycin was intriguing, since the observation of the label of products for personal use did not contain it. In view of the test result, after being questioned again, she confirmed the omission of daily self-medication with neomycin ointment. In conclusion, we showed the allergy to hair products. We reinforced the need for an updated baseline series patch test. Finally, we warned about the risk of self-medication. (AU)

Alergia à Metilisotiazolinona: Relato de caso / Methylisothiazolinone Allergy: Case Report

A metilisotiazolinona (MI) é um conservante presente em produtos químicos de limpeza e cosméticos na forma isolada ou associada à metilclorotiazolinona (MCI/MI). Seu uso tem sido associado ao aumento progressivo de casos de dermatite alérgica de contato (DAC) no mundo, constituindo uma das principais causas dessa entidade. O diagnóstico padrão-ouro de DAC a essa substância é realizado pelo teste de contato. No Brasil, a bateria padrão contempla apenas o composto MCI/MI, não avaliando isoladamente a MI. Relatamos caso clínico de uma paciente com eczema crônico predominante em mãos, que possuía nexo ocupacional com utilização de produtos de limpeza, tendo apresentado teste de contato, através da bateria Latino-Americana, fortemente positivo (+++) à MI 0,2% e negativo para MCI/MI. Objetivamos demonstrar a importância da inclusão da metilisotiazolinona, de forma isolada, na bateria padrão brasileira para maior sensibilidade diagnóstica, além da necessidade de especificação da presença desse conservante em produtos de limpeza.

Methylisothiazolinone (MI) is a preservative present in cleaning and cosmetic products, in the isolated form or associated to methylchloroisothiazolinone (MCI/MI). Its use has been associated with the progressive increase in cases of allergic contact dermatitis (ACD) in the world, constituting one of the main causes of this entity. The gold standard diagnosis of ACD for this substance is performed by the patch test. In Brazil, the baseline series only includes the MCI / MI compound, not evaluating the MI alone. We case report of a patient with predominant chronic eczema on the hands, who had an occupational nexus with the use of cleaning products, having presented a patch test, through the Latin American series, extremely positive for 0.2% MI (+++) and negative for the MCI/MI. We aim to demonstrate the importance of including methylisothialzoninone, in isolation, in the Brazilian baseline series for greater diagnostic sensitivity, in addition to the need to specify the presence of this preservative in products.

Dermatite alérgica de contato revelada pela pandemia de COVID-19: relato de caso / Allergic contact dermatitis revealed by pandemic: case report

OBJETIVO: Dermatite de contato é doença inflamatória cutânea, não infecciosa, prevenível, que afeta a qualidade de vida do indivíduo, ocorrendo após exposição de substâncias prejudiciais à pele. Pode ser alérgica ou irritativa. É a principal causa de doença cutânea ocupacional. A pandemia de Covid-19 afeta as pessoas de diferentes maneiras mexendo com paradigmas laborais e recreacionais. Objetivamos alertar que importantes alergias inaparentes podem se manifestar pela alteração da rotina individual transformando hobby em atividade ocupacional decorrente da epidemia global causada pelo SARS-CoV-2. DESCRIÇÃO DO CASO: Relatamos um caso do sexo masculino que desenvolveu há 8 meses, intenso eczema de mãos após mudança de hábito relacionado ao isolamento social. Negava atopia. Clinicamente apresentava marcada dermatite com hiperemia, fissuras, erosões, num padrão conhecido como de pinçamento. Ele que exercia atividade laboral extradomiciliar, passou a ficar recluso trocando sua atividade anteriormente de lazer para atividade ocupacional. Feito teste de contato, utilizando-se da bateria padrão Latino-Americana, constatou-se forte reação em 48 e 96 horas para a resina epóxi de bisfenol A. CONCLUSÃO: Mostramos que a pandemia do Covid-19, mesmo indiretamente, é capaz de revelar alergias ocultas pela alteração das atividades ocupacionais desempenhadas pelos indivíduos.

AIMS: Contact dermatitis is a non-infectious, preventable skin inflammatory disease that affects the quality of life of the individual, occurring after exposure to substances harmful to the skin. It can be allergic or irritating. It is the main cause of occupational skin disease. The Covid-19 pandemic affects people in different ways by messing with occupational and recreational paradigms. We aim to warn that important unapparent allergies can manifest themselves by the alteration of the individual routine transforming hobby into occupational activity due to the global epidemic caused by SARS-CoV-2. CASE DESCRIPTION: We report a male case that developed eigth months ago, severe hand eczema after a habit change related to social isolation. He denied atopy. Clinically he presented marked dermatitis with hyperemia, cracks, erosions, in a pattern known as clamping. He, who exercised extradomic labor activity, became a recluse changing his previous activity from leisure to occupational activity. A patch test, using the Latin American baseline series, showed a strong reaction in 48 and 96 hours for the bisphenol A epoxy resin. CONCLUSION: We have shown that the Covid-19 pandemic, even indirectly, can reveal hidden allergies due to altered occupational activities performed by individuals.

A novel Sporothrix brasiliensis genomic variant in Midwestern Brazil: evidence for an older and wider sporotrichosis epidemic.

Sporotrichosis is a subcutaneous infection caused by fungi from the genus Sporothrix. It is transmitted by inoculation of infective particles found in plant-contaminated material or diseased animals, characterizing the classic sapronotic and emerging zoonotic transmission, respectively. Since 1998, southeastern Brazil has experienced a zoonotic sporotrichosis epidemic caused by S. brasiliensis, centred in the state of Rio de Janeiro. Our observation of feline sporotrichosis cases in Brasília (Midwestern Brazil), around 900 km away from Rio de Janeiro, led us to question whether the epidemic caused by S. brasiliensis has spread from the epicentre in Rio de Janeiro, emerged independently in the two locations, or if the disease has been present and unrecognized in Midwestern Brazil. A retrospective analysis of 91 human and 4 animal cases from Brasília, ranging from 1993 to 2018, suggests the occurrence of both sapronotic and zoonotic transmission. Molecular typing of the calmodulin locus identified S. schenckii as the agent in two animals and all seven human patients from which we were able to recover clinical isolates. In two other animals, the disease was caused by S. brasiliensis. Whole-genome sequence typing of seven Sporothrix spp. strains from Brasília and Rio de Janeiro suggests that S. brasiliensis isolates from Brasília are genetically distinct from those obtained at the epicentre of the outbreak in Rio de Janeiro, both in phylogenomic and population genomic analyses. The two S. brasiliensis populations seem to have separated between 2.2 and 3.1 million years ago, indicating independent outbreaks or that the zoonotic S. brasiliensis outbreak might have started earlier and be more widespread in South America than previously recognized.

A novel Sporothrix brasiliensis genomic variant in Midwestern Brazil: evidence for an older and wider sporotrichosis epidemic

Sporotrichosis is a subcutaneous infection caused by fungi from the genus Sporothrix. It is transmitted by inoculation of infective particles found in plant-contaminated material or diseased animals, characterizing the classic sapronotic and emerging zoonotic transmission, respectively. Since 1998, southeastern Brazil has experienced a zoonotic sporotrichosis epidemic caused by S. brasiliensis, centred in the state of Rio de Janeiro. Our observation of feline sporotrichosis cases in Brasília (Midwestern Brazil), around 900 km away from Rio de Janeiro, led us to question whether the epidemic caused by S. brasiliensis has spread from the epicentre in Rio de Janeiro, emerged independently in the two locations, or if the disease has been present and unrecognized in Midwestern Brazil. A retrospective analysis of 91 human and 4 animal cases from Brasília, ranging from 1993 to 2018, suggests the occurrence of both sapronotic and zoonotic transmission. Molecular typing of the calmodulin locus identified S. schenckii as the agent in two animals and all seven human patients from which we were able to recover clinical isolates. In two other animals, the disease was caused by S. brasiliensis. Whole-genome sequence typing of seven Sporothrix spp. strains from Brasília and Rio de Janeiro suggests that S. brasiliensis isolates from Brasília are genetically distinct from those obtained at the epicentre of the outbreak in Rio de Janeiro, both in phylogenomic and population genomic analyses. The two S. brasiliensis populations seem to have separated between 2.2 and 3.1 million years ago, indicating independent outbreaks or that the zoonotic S. brasiliensis outbreak might have started earlier and be more widespread in South America than previously recognized.

Queimaduras ocupacionais no Distrito Federal, Brasil: Estudo retrospectivo de 17 anos / Work-related burns in the Federal District, Brazil: A 17-year retrospective study

OBJETIVO: Avaliar a epidemiologia das queimaduras ocupacionais e as características sociodemográficas das vítimas de queimaduras internadas em um hospital público no período de 17 anos. MÉTODO: Estudo longitudinal, retrospectivo de abordagem quantitativa realizado na unidade de queimados de um hospital público no Brasil de janeiro de 2002 a dezembro de 2018. Entre 4201 queimados internados nesse período, 497 foram vítimas de queimaduras no ambiente de trabalho e tiveram seus prontuários médicos e de alta hospitalar avaliados retrospectivamente. RESULTADOS: A maioria dos pacientes era do sexo masculino (88,5%) e a média de idade foi de 35 anos (intervalo, 18-74). As causas mais frequentes de queimaduras foram eletricidade (41,1%), líquidos inflamáveis (27,5%) e chamas (11,7%). As ocupações mais comuns foram: eletricista (25,3%), cozinheiro (10,9%) e mecânico (8,2%). A superfície corporal queimada média foi de 15,4% e a taxa de mortalidade foi de 2,6%. Variações anuais foram observadas na frequência mensal de acidentes de trabalho, com aumento do número de queimaduras em maio e novembro, que são meses que precedem festividades culturais no Brasil. CONCLUSÃO: Poucas mudanças na epidemiologia e gravidade das queimaduras ocupacionais foram observadas no período de 17 anos de estudo, sugerindo que os programas de prevenção não foram eficazes na redução de queimaduras no ambiente de trabalho. Assim, novas iniciativas dos setores público e privado são necessárias, visando a prevenção de queimaduras de trabalho.

OBJECTIVE: To evaluate the epidemiology of work-related burns and sociodemographic characteristics of burn victims admitted to a public hospital over a period of 17 years. METHODS: This longitudinal, retrospective, quantitative study was conducted in the burn unit of a public hospital in Brazil from January 2002 to December 2018. Of the 4201 burn patients admitted to the hospital during the study period, 497 of them were victims of work-related burns, and therefore their hospital discharge summary and medical records were retrospectively reviewed. RESULTS: Most patients were men (88.5%) and the mean age was 35 years (range, 18-74). Electricity was the most frequent cause of burns (41.1%), followed by flammable liquids (27.5%) and flames (11.7%). The most common occupations were electricians (25.3%), cooks (10.9%), and mechanics (8.2%). The mean total body surface area involved was 15.4% and the mortality rate was 2.6%. Annual periodic variations were observed in the monthly frequency of work-related burns, with an increased number of burn accidents occurring in May and November, which are months that precede cultural festivities in Brazil. CONCLUSIONS: Few changes in the epidemiology and severity of work-related burns were observed during the 17-year study period, suggesting that prevention programs have not been effective in reducing burn accidents in the workplace. Thus, new initiatives from the public and private sectors aiming at preventing work-related burn injuries are necessary.

Depressão e sua relação com a adesão à farmacoterapia anti-hipertensiva em idosos / Depression and its relationship with adherence to antihypertensive pharmacotherapy in elderly

Objetivo: analisar a relação entre adesão ao tratamento medicamentoso anti-hipertensivo e a depressão em idosos hipertensos assistidos pela Estratégia Saúde da Família na cidade de Brazlândia, Distrito Federal. Método: Trata-se de estudo descritivo, transversal. Foi realizada entrevista estruturada e aplicação de questionários (EDG-15 e MMAS-8) em idosos hipertensos (n=261). Resultados: A análise mostrou 59% do sexo feminino, 90% de baixa escolaridade, 53% eram aposentados, 68% eram casados, 13% moravam sozinhos, 78% recebiam até 2 salários mínimos, 68% não faziam automedicação, 38% obtinham o medicamento no posto de saúde, 88% era sedentário, 81% não era tabagista, o medicamento mais usado foi o diurético 60%, 22% estava em monoterapia. Conclusão: A análise comparativa evidenciou que a medida de pressão arterial e a forma como adquire o medicamento são variáveis independentes da adesão ao tratamento. A prevalência de depressão foi de 37%. A razão de prevalência mostrou maior risco de depressão em pacientes com pressão arterial inadequada, com circunferência abdominal inadequada, com sobrepeso e que não aderem ao tratamento. A razão de prevalência mostrou menor risco de depressão nos homens e tabagistas.

Objective: To analyze the relationship between adherence to antihypertensive drug treatment and depression in hypertensive elderly assisted by the Family Health Strategy in the city of Brazlândia, Federal District. Method: This is a descriptive cross-sectional study. Structured interviews and questionnaires (EDG-15 and MMAS-8) were performed in hypertensive elderly (n = 261). Results: The analysis showed 59% female, 90% low educated, 53% were retired, 68% were married, 13% lived alone, 78% received up to 2 minimum wages, 68% did not self-medicate, 38% obtained 88% sedentary, 81% non-smoker, 60% diuretic, 22% monotherapy. Conclusion: The comparative analysis showed that the measurement of blood pressure and the way you buy the drug are independent variables of treatment adherence. The prevalence of depression was 37%. The prevalence ratio showed a higher risk of depression in patients with inadequate blood pressure, inadequate waist circumference, overweight and not adhering to treatment. The prevalence ratio showed lower risk of depression in men and smokers.

Mycetomas: an epidemiological, etiological, clinical, laboratory and therapeutic review.

Mycetoma is a chronic suppurative disease of the skin and subcutaneous tissue, characterized by a symptomatic triad: tumor, fistulas and grains. It can be caused by fungi (eumycetoma) and bacteria (actinomycetoma), with similar clinical features. Diagnosis is based on the clinical presentation and identification of the etiological agents in the tissue, by mycological/bacteriological, histopathological and immunohistochemical tests. It is important to specify the fungal or bacterial etiology, because the treatments are different. An approach that involves early diagnosis, the use of systemic antibiotics or antifungal agents, including surgical removal of lesions, is the basis for the treatment of these diseases. In this review, the most commonly used diagnostic methods and treatments will be discussed. Also, we will review the history of the disease through epidemiological and etiological aspects.

Aspectos epidemiológicos y fisiológicos en el tratamiento de adultos mayores quemados / Epidemiological and physiological aspects in the treatment of elderly burned / Aspectos epidemiológicos e fisiológicos no tratamento de idosos queimados

El objetivo de este trabajo fue realizar una revisión sobre los aspectos epidemiológicos, fisiológicos y de tratamiento del anciano quemado. Sitios predominantes: residencia (42-98%), cocina (17-65%). Principales agentes: fuego directo o líquido inflamable (36 al 74%) y escaldadura (17-66%). Lesión por inhalación: 12-41 % de los ancianos. Tasa global de mortalidad: 6 y el 65%. El paciente anciano quemado debe ser atendido por un equipe multidisciplinario.

The objective of this work was to perform a review on the epidemiological, physiological and treatment aspects of the burned elderly. Predominant sites: residence (42-98%), kitchen (17-65%). Main agents: direct fire or flammable liquid (36 to 74%) and scald (17 to 66%). Inhalation Injury: 12-41% of the elderly. Mortality rate: 6 and 65%. A multidisciplinary team must attend the burned elderly patient.

O objetivo deste trabalho foi realizar uma revisão sobre os aspectos epidemiológicos, fisiológicos e de tratamento do idoso queimado. Espaços predominantes: residência (68-98%), cocina (17-65%). Principais agentes: fogo direto ou líquido inflamável (36-74%) e escaldadura (17-66%). Lesão por inalação: 12-41% dos idosos. Mortalidade: 6 a 65% dos idoso queimados. O paciente idoso queimado deve ser assistido por equipe multidisciplinar.

Mycetomas: an epidemiological, etiological, clinical, laboratory and therapeutic review

Abstract: Mycetoma is a chronic suppurative disease of the skin and subcutaneous tissue, characterized by a symptomatic triad: tumor, fistulas and grains. It can be caused by fungi (eumycetoma) and bacteria (actinomycetoma), with similar clinical features. Diagnosis is based on the clinical presentation and identification of the etiological agents in the tissue, by mycological/bacteriological, histopathological and immunohistochemical tests. It is important to specify the fungal or bacterial etiology, because the treatments are different. An approach that involves early diagnosis, the use of systemic antibiotics or antifungal agents, including surgical removal of lesions, is the basis for the treatment of these diseases. In this review, the most commonly used diagnostic methods and treatments will be discussed. Also, we will review the history of the disease through epidemiological and etiological aspects.

Epidemiological profile of elderly patients with non-melanoma skin cancer seen at the dermatology outpatient clinic of a public hospital

Abstract: Basal cell carcinoma and Squamous cell carcinoma, referred to as non-melanoma skin cancer, are the most common malignancies in humans. Their incidence is increasing worldwide every year. In Brazil, even with the advent of educational campaigns on photoprotection and laws that banned tanning beds, they are the most frequent neoplasias, representing a public health problem recognized by the Ministry of health.

Stevens-Johnson syndrome and toxic epidermal necrolysis: epidemiological and clinical outcomes analysis in public hospitals.

BACKGROUND: Adverse drug reactions are harmful and involuntary responses to drugs that occur at doses normally used for a given condition. Among them are Stevens-Johnson syndrome and toxic epidermal necrolysis, both rare and potentially fatal conditions. OBJECTIVES: To analyze the epidemiological and clinical characteristics related to patients diagnosed with Stevens-Johnson syndrome and toxic epidermal necrolysis in public hospitals in the Federal District - Brazil. METHODS: Retrospective, cross-sectional and descriptive study, in which data were collected referring to patients hospitalized in the public healthcare system of the Federal District from 1999 to 2014. Results: Between 1999 and 2014, 86 cases of hospitalized patients with diagnosis of Stevens-Johnson syndrome and toxic epidermal necrolysis in the Federal District were reported. The majority of patients were women; the most affected age group was 0 to 10 years. Patients older than 60 years (elderly) represent 6.98% of the cases. Most patients admitted to the referral hospital were discharged. However, occurrence of deaths exceeded that of discharge in elderly patients. LIMITATIONS OF THE STUDY: There is fragility in the registry of hospitalization of patients, both in the hospital information system and in the medical records of the reference hospital. CONCLUSION: There is a need for greater production and better dissemination of information on the incidence of adverse drug reactions.

Stevens-Johnson syndrome and toxic epidermal necrolysis: epidemiological and clinical outcomes analysis in public hospitals

Abstract: Background: Adverse drug reactions are harmful and involuntary responses to drugs that occur at doses normally used for a given condition. Among them are Stevens-Johnson syndrome and toxic epidermal necrolysis, both rare and potentially fatal conditions. Objectives: To analyze the epidemiological and clinical characteristics related to patients diagnosed with Stevens-Johnson syndrome and toxic epidermal necrolysis in public hospitals in the Federal District - Brazil. Methods: Retrospective, cross-sectional and descriptive study, in which data were collected referring to patients hospitalized in the public healthcare system of the Federal District from 1999 to 2014. Results: Between 1999 and 2014, 86 cases of hospitalized patients with diagnosis of Stevens-Johnson syndrome and toxic epidermal necrolysis in the Federal District were reported. The majority of patients were women; the most affected age group was 0 to 10 years. Patients older than 60 years (elderly) represent 6.98% of the cases. Most patients admitted to the referral hospital were discharged. However, occurrence of deaths exceeded that of discharge in elderly patients. Limitations of the study: There is fragility in the registry of hospitalization of patients, both in the hospital information system and in the medical records of the reference hospital. Conclusion: There is a need for greater production and better dissemination of information on the incidence of adverse drug reactions.