Association of human papillomavirus and bacterial vaginosis with increased risk of high-grade squamous intraepithelial cervical lesions.

OBJECTIVE: To assess the rates of co-infections between human papillomavirus (HPV) and 13 key markers of bacterial vaginosis in cervical samples by multiplex polymerase chain reaction in a population with a high rate of abnormal cytology and a positive HPV test. METHODS: The study included a total of 213 women aged 18-72 years screened using Papanicolaou smears for determining cervical abnormalities and for HPV and bacterial vaginosis by single-target and multiplex polymerase chain reaction. RESULTS: A total of 83 (39%) women were negative for intraepithelial lesion or malignancy cytology and 130 (61%) had abnormal cytology. HPV-DNA prevalence was 69.9% and bacterial vaginosis was 72.7 %. Co-infections between bacterial vaginosis with HPV-DNA and high-risk HPV were associated with an increased risk for squamous intraepithelial lesions of low-grade cytology and high-grade squamous intraepithelial lesions plus cervical cancer. The most frequent bacterial vaginosis agent was Gardnerella vaginalis (33.8%), and co-infection with HPV-DNA and high-risk HPV increased the risk for squamous intraepithelial lesions of low grade cytology and high-grade squamous intraepithelial lesions plus cervical cancer. Co-infection between Megasphaera type I and high-risk HPV increased the risk for high-grade squamous intraepithelial lesions plus cervical cancer. CONCLUSIONS: Our results reinforce the hypothesis that some bacterial vaginosis agents may play a role as co-factors in HPV-mediated cervical carcinogenesis, at least in some populations.

Qualitative Determination of Human Chorionic Gonadotropin in Vaginal Washings for the Early Diagnosis of Premature Rupture of Fetal Membranes / Determinação qualitativa de gonadotrofina coriônica humana no lavado vaginal para o diagnóstico precoce de ruptura prematura de membranas fetais

Abstract Purpose This study aimed to evaluate and validate the qualitative human chorionic gonadotropin β subunit (β-hCG) test of the vaginal fluid washings of pregnant women with premature rupture of fetal membranes (PROM). Methods Cross-sectional study of pregnant women between gestational weeks 24 and 39 who underwent consultations in one of our institutions. They were divided into two groups: group A (pregnant women clinically diagnosed with PROM) and group B (pregnant women without loss of amniotic liquid). The patients were subjected to a vaginal fluid washing with 3 mL of saline solution, which was aspirated subsequently with the same syringe. The solution was immediately sent to the laboratory to perform the vaginal β-hCG test with cut-off points of 10 mIU/mL (β-hCG-10) and/or 25 mIU/mL (β-hCG-25). Results The β-hCG-10 test of the vaginal secretion was performed in 128 cases. The chi-squared test with Yates' correction showed a statistically significant difference between the 2 groups (p = 0.0225). The sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy parameters were 77.1%, 43.6%, 52.3%; 70.4%; and 58.6% respectively. The β-hCG-25 test of the vaginal washing was performed in 49 cases. The analysis by Fisher's exact test showed a statistically significant difference between the groups (p = 0.0175). The sensibility, specificity, PPV, NPV, and accuracy parameters were 44.4%, 87.1%, 66.6%; 72.9%; and 71.4% respectively. Conclusions The β-hCG-25 test showed better accuracy for the diagnosis of PROM, and can corroborate the early diagnosis of PROM because it is a simple and quick exam.

Resumo Objetivo Este estudo objetivou validar o exame qualitativo da subunidade β da gonadotrofina coriônica humana (β-hCG) em lavado vaginal de gestantes com ruptura prematura de membranas (RPM) fetais. Métodos Estudo transversal de gestantes com 24 a 39 semanas atendidas em um hospital de Maringá divididas em 2 grupos: grupo A (clinicamente diagnosticadas com RPM) e grupo B (gestantes sem perda de liquido amniótico). As pacientes foram submetidas a lavado vaginal com 3 mL de soro fisiológico, que logo em seguida foi aspirado de volta na mesma seringa e imediatamente enviado ao laboratório para a realização do exame de β-hCG vaginal com pontos de corte de 10 mIU/mL (β-hCG-10) e/ ou 25 mIU/mL (β-hCG-25). Resultados O teste de β-hCG-10 na secreção vaginal foi realizado em 128 casos, e o teste do qui-quadrado com correção de Yates mostrou diferença significante entre os dois grupos (p = 0,0225). Os parâmetros de sensibilidade, especificidade, valor preditivo positivo (VPP), valor preditivo negativo (VPN) e acurácia foram respectivamente 77,1%; 43,6%; 52,3%; 70,4%; e 58,6%. O teste de β-hCG-25 na secreção vaginal foi realizado em 49 casos, e a análise pelo teste exato de Fisher mostrou diferença significativa entre os grupos (p = 0,0175). Os parâmetros de sensibilidade, especificidade, VPP, VPN e acurácia foram respectivamente 44,4%; 87,1%; 66,6%; 72,9%; e 71,4%. Conclusões O β-hCG-25 apresentou melhor acurácia para o diagnóstico de RPM, e pode corroborar o diagnóstico precoce de RPM por se tratar de um exame simples e rápido.

Qualitative Determination of Human Chorionic Gonadotropin in Vaginal Washings for the Early Diagnosis of Premature Rupture of Fetal Membranes.

Purpose This study aimed to evaluate and validate the qualitative human chorionic gonadotropin ß subunit (ß-hCG) test of the vaginal fluid washings of pregnant women with premature rupture of fetal membranes (PROM). Methods Cross-sectional study of pregnant women between gestational weeks 24 and 39 who underwent consultations in one of our institutions. They were divided into two groups: group A (pregnant women clinically diagnosed with PROM) and group B (pregnant women without loss of amniotic liquid). The patients were subjected to a vaginal fluid washing with 3 mL of saline solution, which was aspirated subsequently with the same syringe. The solution was immediately sent to the laboratory to perform the vaginal ß-hCG test with cut-off points of 10 mIU/mL (ß-hCG-10) and/or 25 mIU/mL (ß-hCG-25). Results The ß-hCG-10 test of the vaginal secretion was performed in 128 cases. The chi-squared test with Yates' correction showed a statistically significant difference between the 2 groups (p = 0.0225). The sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy parameters were 77.1%, 43.6%, 52.3%; 70.4%; and 58.6% respectively. The ß-hCG-25 test of the vaginal washing was performed in 49 cases. The analysis by Fisher's exact test showed a statistically significant difference between the groups (p = 0.0175). The sensibility, specificity, PPV, NPV, and accuracy parameters were 44.4%, 87.1%, 66.6%; 72.9%; and 71.4% respectively. Conclusions The ß-hCG-25 test showed better accuracy for the diagnosis of PROM, and can corroborate the early diagnosis of PROM because it is a simple and quick exam.

Objetivo Este estudo objetivou validar o exame qualitativo da subunidade ß da gonadotrofina coriônica humana (ß-hCG) em lavado vaginal de gestantes com ruptura prematura de membranas (RPM) fetais. Métodos Estudo transversal de gestantes com 24 a 39 semanas atendidas em um hospital de Maringá divididas em 2 grupos: grupo A (clinicamente diagnosticadas com RPM) e grupo B (gestantes sem perda de liquido amniótico). As pacientes foram submetidas a lavado vaginal com 3 mL de soro fisiológico, que logo em seguida foi aspirado de volta na mesma seringa e imediatamente enviado ao laboratório para a realização do exame de ß-hCG vaginal com pontos de corte de 10 mIU/mL (ß-hCG-10) e/ou 25 mIU/mL (ß-hCG-25). Resultados O teste de ß-hCG-10 na secreção vaginal foi realizado em 128 casos, e o teste do qui-quadrado com correção de Yates mostrou diferença significante entre os dois grupos (p = 0,0225). Os parâmetros de sensibilidade, especificidade, valor preditivo positivo (VPP), valor preditivo negativo (VPN) e acurácia foram respectivamente 77,1%; 43,6%; 52,3%; 70,4%; e 58,6%. O teste de ß-hCG-25 na secreção vaginal foi realizado em 49 casos, e a análise pelo teste exato de Fisher mostrou diferença significativa entre os grupos (p = 0,0175). Os parâmetros de sensibilidade, especificidade, VPP, VPN e acurácia foram respectivamente 44,4%; 87,1%; 66,6%; 72,9%; e 71,4%. Conclusões O ß-hCG-25 apresentou melhor acurácia para o diagnóstico de RPM, e pode corroborar o diagnóstico precoce de RPM por se tratar de um exame simples e rápido.

Time series investigation of changes in seasonality of acute diarrhea hospitalizations before and after rotavirus vaccine in Southern Brazil.

Diarrhea by rotavirus is one of the main causes of mortality in children in developing countries, although the hospitalization rates (HR) for acute diarrhea have been found to have fallen since the introduction of the rotavirus vaccine. However, the patterns of the rotavirus are still not well understood and seasonal peaks occur throughout the year, with variations between countries and over time. The main objective of this study was to analyze the temporal behavior of HR caused by acute diarrhea in children under the age of one in the south of Brazil, between 2000 and 2011, and to explore changes in seasonality patters after the introduction of the vaccine against the rotavirus in 2006. Harmonic and multiscale wavelet analyses were used to detect seasonality and the points of change in the temporal scale. The statistical significance of each seasonality that was identified was tested using Fisher's test. The harmonic and wavelet analyses show annual seasonal and six-monthly patterns for HR, as well as a clear change after the introduction of the vaccine in 2006.

Time series investigation of changes in seasonality of acute diarrhea hospitalizations before and after rotavirus vaccine in Southern Brazil / Investigando alterações de sazonalidade nas internações por diarreia aguda antes e depois da introdução da vacina de rotavírus no Sul do Brasil / Investigando alteraciones de estacionalidad en los internamientos por diarrea aguda, antes y después de la introducción de la vacuna del rotavirus en el sur de Brasil

Abstract: Diarrhea by rotavirus is one of the main causes of mortality in children in developing countries, although the hospitalization rates (HR) for acute diarrhea have been found to have fallen since the introduction of the rotavirus vaccine. However, the patterns of the rotavirus are still not well understood and seasonal peaks occur throughout the year, with variations between countries and over time. The main objective of this study was to analyze the temporal behavior of HR caused by acute diarrhea in children under the age of one in the south of Brazil, between 2000 and 2011, and to explore changes in seasonality patters after the introduction of the vaccine against the rotavirus in 2006. Harmonic and multiscale wavelet analyses were used to detect seasonality and the points of change in the temporal scale. The statistical significance of each seasonality that was identified was tested using Fisher's test. The harmonic and wavelet analyses show annual seasonal and six-monthly patterns for HR, as well as a clear change after the introduction of the vaccine in 2006.

Resumo: A diarreia por rotavírus é uma das principais causas de mortalidade em crianças nos países em desenvolvimento, embora tenha sido observada a redução nas taxas de hospitalização (HR) por diarreias aguda desde que a vacina do rotavírus foi introduzida. A dinâmica do rotavírus, no entanto, ainda é mal compreendida e picos sazonais ocorrem durante todo o ano, com variações entre países e ao longo do tempo. O principal objetivo foi analisar o comportamento temporal das HR devido a diarreia aguda em crianças menores de um ano de idade no sul do Brasil, de 2000 a 2011, e investigar mudanças no padrão de sazonalidade após a introdução da vacina contra o rotavírus em 2006. Análises harmônica e multiescala wavelet foram utilizadas para detectar a sazonalidade e pontos de mudança na série temporal. A significância estatística de cada sazonalidade identificada foi testada pelo teste de Fisher. As análises harmônica e wavelet mostraram padrões sazonais anual e semestral das HR, bem como a nítida mudança após a introdução da vacina em 2006.

Resumen: La diarrea por rotavirus es una de las principales causas de mortalidad en niños en los países en desarrollo, aunque se haya observado una reducción en las tasas de hospitalización (HR) por diarreas agudas, desde que se introdujo la vacuna del rotavirus. La dinámica del rotavirus, no obstante, aunque está mal comprendida -y se producen picos estacionales- tiene lugar durante todo el año, con variaciones entre países y a lo largo del tiempo. El principal objetivo fue analizar el comportamiento temporal de las HR, debido a la diarrea aguda en niños menores de un año de edad en el sur de Brasil, de 2000 a 2011, e investigar cambios en el patrón de estacionalidad tras la introducción de la vacuna contra el rotavirus en 2006. Los análisis harmónico y multiescala wavelet se utilizaron para detectar la estacionalidad y puntos de cambio en la serie temporal. La significancia estadística de cada estacionalidad identificada fue testada por el test de Fisher. Los análisis harmónico y wavelet mostraron patrones estacionales anual y semestral de los HR, así como un nítido cambio tras la introducción de la vacuna en 2006.

Sensitive Detection of Thirteen Bacterial Vaginosis-Associated Agents Using Multiplex Polymerase Chain Reaction.

Bacterial vaginosis (BV) is characterized by a polymicrobial proliferation of anaerobic bacteria and depletion of lactobacilli, which are components of natural vaginal microbiota. Currently, there are limited conventional methods for BV diagnosis, and these methods are time-consuming, expensive, and rarely allow for the detection of more than one agent simultaneously. Therefore, we conceived and validated a multiplex polymerase chain reaction (M-PCR) assay for the simultaneous screening of thirteen bacterial vaginosis-associated agents (BV-AAs) related to symptomatic BV: Gardnerella vaginalis, Mobiluncus curtisii, Mobiluncus mulieris, Bacteroides fragilis, Mycoplasma hominis, Atopobium vaginae, Ureaplasma urealyticum, Megasphaera type I, Clostridia-like bacteria vaginosis-associated bacteria (BVABs) 1, 2, and 3, Sneathia sanguinegens, and Mycoplasma genitalium. The overall validation parameters of M-PCR compared to single PCR (sPCR) were extremely high, including agreement of 99.1% and sensitivity, specificity, and positive predictive values of 100.0%, negative predictive value of 97.0%, accuracy of 99.3%, and agreement with Nugent results of 100.0%. The prevalence of BV-AAs was very high (72.6%), and simultaneous agents were detected in 53.0%, which demonstrates the effectiveness of the M-PCR assay. Therefore, the M-PCR assay has great potential to impact BV diagnostic methods in vaginal samples and diminish associated complications in the near future.

Impact of oral human rotavirus vaccine on hospitalization rates for children / Impacto da vacina oral de rotavírus Humano nas taxas de hospitalizações em crianças

Objective: To evaluate the risk of hospitalization for acute diarrhea in children under five, in the period of ten years before and after the oral rotavirus vaccine. Methods: Eco-descriptive-analyticstudy of the rates of hospitalization for acute diarrhea. We used hospitalization rate and the Relative Variation Rate to quantify the difference between the median in the years pre- andpostvaccination. We used logistic regression, odds ratio and attributablerisk to assess for the proportion of cases that could be avoided if exposure was avoided. Results: During the study period, the hospitalization rate was 117.41 per 10,000 children. In the prevaccination period, the median rate of hospitalization was 124.2/10,000 children. After the introduction of the vaccine, hospitalization rates were lower when compared to the median of the pre-vaccination years. Conclusion: There was a reduction in the hospitalization rates for acute diarrhea, thereby suggesting that the use of the vaccine and other associated factors can reduce the number of cases.

Objetivo:Avaliar o risco de hospitalização por diarreias agudas em crianças menores de cinco anos no período de dez anos, antes e depois da vacina oral do rotavírus.Métodos:Estudo ecológico-descritivo-analítico das taxas de hospitalização por diarreias agudas. Utilizou-se a Taxa de Hospitalização e Taxa de Variação Relativa para quantificar a diferença entre a mediana dos anos pré-vacinais e pós-vacinais. Empregou-se a Regressão Logística, o Odds Ratio e Risco Atribuível para verificar a proporção de casos que poderiam ser evitados se a exposição fosse afastada.Resultados:No período estudado a taxa de hospitalização foi de 117,41 por 10.000 crianças. Observouse que, no período pré-vacinal, a mediana da taxa de hospitalização foi de 124,2/10.000 crianças. Após a introdução da vacina, as taxas de hospitalização foram menores quando comparadas à mediana dos anos pré-vacinal.Conclusão:Houve redução nas taxas de hospitalização por diarreias agudas, sugerindo que o uso da vacina e outros fatores associados podem reduzir os casos.

Perfil do tratamento profilático antirrábico humano no sul do Brasil / Profile of human anti-rabies prophylactic treatment in southern Brazil

O estudo objetivou analisar o perfil do tratamento profilático antirrábico de crianças e adolescentes de zero a 15 anos atendidas no município de Maringá-PR. Os dados foram coletados do Sistema de Informação de Agravos de Notificação (Sinan) no período de janeiro a dezembro de 2010. Realizaram-se frequências simples e absolutas para as variáveis categóricas, e, para associações de interesse, análises univariadas por meio do teste do qui-quadrado de Pearson, com intervalo de confiança de 95% e nível de significância <0,05 em todas as análises. Do total de 311 atendimentos realizados, 101 deles eram de fichas de atendimento antirrábico de crianças e adolescentes. Em relação ao tratamento indicado, das 101 indicações, 37 (36,6%) apresentaram-se entre zero a < dez anos e 64 (63,4%) entre os ≥ dez a <15 anos. O tratamento indicado apresentou associação estatisticamente significativa com a idade (p= 0,0288). É preciso um trabalho educativo com crianças, pais e a população em geral, conscientizando-os sobre os riscos e a gravidade da raiva, além da atualização e atenção para a indicação da conduta terapêutica aos profissionais da saúde

The present study aimed to analyze the profile of anti-rabies prophylactic treatment of children and adolescents aged between zero and 15 years old, in the city of Maringá, state of Paraná, Brazil. Data were collected on the Brazilian Notification Aggravation Information System (SINAN) from January to December 2010. Simple and absolute frequencies were performed for categorical variables, and, for associations of interest, univariate analyzes were carried out through Pearson's chi-square test, with confidence interval of 95% and level of confidence set at <0.05 for all analyzes. Among all 311 care services performed, 101 involved anti-rabies care records of children and adolescents. Regarding treatment prescriptions, out of 101, 37 (36.6%) were made to subjects aged between 0 and 10 years old, and 64 (63.4%) to those aged ≥ 10 and < 15 years old. The treatment prescribed presented statistically significant association with age (p= 0.0288). There is a need for an educative work with children, parents and the general population, toward raising their awareness on the risks and seriousness of rabies, besides the update of and attention to the therapeutic method employed by health professionals

Intervention analysis of introduction of rotavirus vaccine on hospital admissions rates due to acute diarrhea.

The aim of this study is to investigate the impact of rotavirus vaccine on hospitalization rates for acute diarrhea in children younger than 5 years old after the introduction of the vaccine in 2006. A descriptive analytical observational study was carried out of the hospitalization rates occurred between 2000 and 2011 in 22 Regional Health Centers of Paraná State, Brazil. The effect of the vaccine was assessed by applying the SARIMA/Box-Jenkins time series methodology of intervention analysis, which allows verifying the slopes of the series are different after the introduction of the vaccine and estimating the magnitude of these effects for children younger than five years of age, by age group, for each region center. It was verified a statistically significant reduction by center/month on hospitalization rates for children 1 year old and younger, with averages of 47% and 58%, respectively, in December 2011.

Intervention analysis of introduction of rotavirus vaccine on hospital admissions rates due to acute diarrhea / Análise de intervenção da introdução da vacina do rotavirus nas taxas de internação hospitalar por diarreia aguda / Análisis de intervención en la introducción de la vacuna contra el rotavirus en las tasas de hospitalización por diarrea aguda

The aim of this study is to investigate the impact of rotavirus vaccine on hospitalization rates for acute diarrhea in children younger than 5 years old after the introduction of the vaccine in 2006. A descriptive analytical observational study was carried out of the hospitalization rates occurred between 2000 and 2011 in 22 Regional Health Centers of Paraná State, Brazil. The effect of the vaccine was assessed by applying the SARIMA/Box-Jenkins time series methodology of intervention analysis, which allows verifying the slopes of the series are different after the introduction of the vaccine and estimating the magnitude of these effects for children younger than five years of age, by age group, for each region center. It was verified a statistically significant reduction by center/month on hospitalization rates for children 1 year old and younger, with averages of 47% and 58%, respectively, in December 2011.

O objetivo desse estudo é investigar o impacto da vacina do rotavírus nas taxas de internação por diarreia aguda em crianças menores de cinco anos após a introdução da vacina em 2006. Foi realizado um estudo analítico observacional descritivo das taxas de hospitalização ocorridas entre 2000 e 2011, em 22 Centros Regionais de Saúde do Estado do Paraná, Brasil. O efeito da vacina foi avaliado por séries temporais aplicando a metodologia SARIMA/Box-Jenkins com análise da intervenção, a qual permite verificar que os declives das séries são diferentes após a introdução da vacina, bem como estimar a magnitude desses efeitos para crianças menores de cinco anos de idade, por faixa etária, para cada região. Verificou-se redução estatisticamente significativa por centro/mês nas taxas de internação por diarreia aguda para as crianças menores de 1 ano de idade e de 1 ano de idade, com médias de 47% e 58%, respectivamente, em dezembro de 2011.

El objetivo de este estudio es investigar el impacto de la vacuna contra el rotavirus en las tasas de hospitalización, relacionadas con diarrea aguda en niños menores de 5 años, después de que se introdujese la vacuna en 2006. Se trata de un estudio observacional, analítico descriptivo de las tasas de hospitalización acaecidas entre 2000 y 2011 en 22 centros regionales de salud del estado de Paraná, Brasil. El efecto de la vacuna se evaluó mediante la aplicación de la serie de tiempo SARIMA/metodología de Box-Jenkins de análisis de intervención, lo que demuestra que los declives de las series son diferentes después de la introducción de la vacuna, con el fin de estimar la magnitud de estos efectos en los niños menores 5 años de edad, por grupos de edad para cada región. Se ha encontrado una reducción estadísticamente significativa de centro/mes en las tasas de hospitalización para niños menores de 1 año de edad y de 1 año de edad, con un promedio de 47% y 58%, respectivamente, en diciembre de 2011.

Adequabilidade da assistência ao pré-natal em duas Unidades de Saúde em Curitiba, Paraná / Adequacy of prenatal care at two health units in Curitiba, Paraná

Este estudo objetivou avaliar a adequabilidade do pré-natal, conforme Protocolo Mãe Curitibana em uma Unidade Básica de Saúde com Programa Saúde da Família (PSF) e outra unidade de saúde tradicional (UBS), com estudo transversal, retrospectivo com dados dos prontuários cadastrados entre fevereiro de 2010 a janeiro de 2011. Foram excluídas as gestantes que apresentaram abortamento e abandono do pré-natal, totalizando 158 gestantes, sendo 79 da unidade PSF e o restante da UBS. A média do início do pré-natal foi de 11±6,26 semanas, e a análise das médias dos registros no pré-natal para o PSF e UBS foi de 10,39 e 8,82 nas consultas, 9,87 e 8,57 para pressão arterial, 1,04 e 1,22 no tipo sanguíneo, 2,17 e 1,86 para glicemia, 1,32 e 1,05 para HbsAg, 2,35 e 1,89 para parcial de urina e 2,64 e 2,22 para cultura de urina com diferenças estatisticamente significativas (p<0,05) entre as unidades. Observaram-se diferenças na adequabilidade da assistência pré-natal entre as unidades PSF e UBS, com melhor desempenho no PSF. Alguns procedimentos como a verificação de altura uterina, batimentos cardiofetais, exames de urina e VDRL estão aquém dos percentuais esperados, necessitando rever e aperfeiçoar as práticas dos profissionais de saúde na atenção pré-natal.

This study aimed to evaluate the adequacy of prenatal care according to Protocol Mother Curitibana in a primary care unit with the Family Health Program (PSF) and other traditional health unit (UBS). Cross-sectional study with retrospective data from medical records registered between February 2010 and January 2011. We excludedwomen who had abortions and abandonment of prenatal care, totaling 158 pregnant women, 79 unit PSF and the rest of UBS. The average onset of prenatal care was 11± 6.26 weeks, and mean analysis of prenatal records for PSF and UBS for pregnant women were 10.39 and 8.82 for consultations, 9.87 and 8.57 for blood pressure, 1.04 and 1.22 for blood type, 2.17 and 1.86 for glucose, 1.32 and 1.05 for HBsAg, 2.35 and 1.89 for Partial Urine and 2.64 and 2.22 for Urine Culture with statistically significant differences (p <0.05) between the units. This study found differences in the adequacy of prenatal care between PSF and traditional models UBS highlighting the best performance of the model PSF. It also identified some procedures like verification of uterine height growth, beats fetal cardiac and urine analysis and VDRL short of the expected percentage, requiring review and improve practices of health professionals in prenatal care

Avaliação da profilaxia no primeiro atendimento pós-exposição ao vírus da raiva / Evaluation of primary care prophylaxis post-exposure to the rabies virus

OBJETIVO: Avaliar o tratamento profilático do primeiro atendimento anti-rábico pós-exposição. MÉTODOS: Estudo transversal, descritivo e analítico, com dados do Sistema de Informação de Agravos de Notificação. Analisados 39.087 atendimentos, excluídos 1.091 (2,79%) casos de re-exposição e préexposição, resultando em 37.996 atendimentos pós- exposição. Realizada análise de regressão logística para adequação de conduta. RESULTADOS: Observou-se predomínio da raça branca (83,93 %), sexo masculino (54,58 %), ensino fundamental (66,13%), idades entre 20-59 anos (45,0%), seguido por 0 a 12 anos (32,88%) e residentes na zona urbana (91,97%). Considerou-se 15.500 (41,56%) atendimentos inadequados 10.587 (28,11%) atendimentos deficitários, ou o paciente não recebeu o tratamento necessário, e 5.013 (13,44%) pacientes receberam atendimento mais do que o necessário para a profilaxia antirrábica. CONCLUSÃO: A profilaxia pós-exposição da raiva foi considerada inadequada necessitando de uma melhor abordagem na admissão e atenção no preenchimento dos registros de dados.

OBJECTIVE: To evaluate primary care prophylactic post-exposure anti-rabies treatment. METHODS: This was a cross-sectional, descriptive and analytical study, with data from the Information System for Notification of Diseases. It analyzed 39,087 visits, excluding 1,091 (2.79%) cases of re-exposure and pre-exposure, resulting in 37,996 post-exposure visits. A logistic regression analysis was performed for adjustment of the treatment. RESULTS: A predominance of Caucasians (83.93%), male (54.58%), primary school educational level (66.13%), ages between 20-59 years (45.0%) , followed by 0 to 12 years (32.88%), and residents in the urban area (91.97%) was observed. Among the visits, 15,500 (41.56%) were considered inadequate, 10,587 (28.11%) were deficient or the patient did not receive the necessary treatment, and 5,013 (13.44%) patients received more than what was necessary for rabies prophylaxis. CONCLUSION: The post-exposure prophylaxis for rabies was considered inadequate and requires a better approach on admission, and attention in completing the notification in the data record.

Avaliação da conduta conservadora na lesão intraepitelial cervical de alto grau / Evaluation of conservative management of high-grade cervical squamous intraepithelial lesion

OBJETIVO: Analisar a associação entre a conduta conservadora em lesão intraepitelial cervical de alto grau com o índice de recidiva da neoplasia e faixa etária. MÉTODOS: Estudo transversal e retrospectivo realizado com 509 mulheres (15-76 anos) atendidas no período de 1996 a 2006, com colpocitologia oncótica alterada, em um serviço público de referência em Maringá, PR. Os dados foram coletados dos prontuários médicos e estudadas as variáveis diagnóstico definitivo, tipos de tratamento, ocorrência da lesão e recidivas, analisados por meio de testes de associação de qui-quadrado de Pearson e teste exato de Fisher. RESULTADOS: A lesão intraepitelial cervical de alto grau ocorreu em 168 casos; destes, 31 mulheres foram submetidas à amputação cônica, 104 a cirurgias de alta frequência, nove histerectomizadas e 24 receberam conduta conservadora. Dentre as mulheres com lesão de alto grau e tratadas de forma conservadora, oito (33,3%) recidivaram, enquanto dentre as submetidas à conduta não conservadora dez (6,9%) recidivaram, sendo essa diferença estatisticamente significante (p = 0,0009), RP = 4,8 (IC95% 2,11;10,93). Para aquelas que fizeram o seguimento clínico-citológico, três (30,0%) e, dentre as cauterizadas, cinco (35,7%) recidivaram no prazo de três anos, sem diferença significante (p = 0,5611). A recidiva abaixo e acima de 30 anos ocorreu, respectivamente, em sete (13,8%) e 11 (12,2%) mulheres (p = 0,9955). CONCLUSÕES: A idade da mulher não influencia o prognóstico de recidiva. O tratamento conservador deve ser indicado como conduta de exceção, dada a alta taxa de recidiva, e o seguimento deve ser rigoroso, com acompanhamento citológico e colposcópico de até três anos, período em que ocorre a maioria das recidivas.

OBJECTIVE: To assess the association between conservative management of high-grade cervical squamous intraepithelial lesions and recurrence rates and age groups. METHODS: Cross-sectional, retrospective, analytical observational study of 509 women (aged 15 to 76) with abnormal Pap smears attending a public reference center in the city of Maringá, southern Brazil, from 1996 to 2006. Data was collected from medical records, and the variables definitive diagnosis, type of treatment provided, occurrence of high-grade cervical squamous intraepithelial lesions and recurrence were studied. Pearson's chi-square test and Fisher's exact test were used in the statistical analyses. RESULTS: There were 168 cases of cervical high-grade cervical squamous intraepithelial lesions, of these, 31 were treated with cold-knife conization, 104 loop electrosurgical excision procedure, 9 hysterectomy and 24 conservative treatment (i.e., clinical and cytological follow-up or cervical electrocoagulation). A total of 8 (33.3%) women receiving conservative and 10 (6.9%) receiving non-conservative management had recurrent disease and this difference was statistically significant (p=0.0009), PR = 4.8 (95%CI 2.11;10.93). Three (30.0%) women among those undergoing clinical and cytological follow-up and five 5 (35.7%) among those submitted to cervical electrocoagulation had recurrent disease within three years, but the difference was not significant (p=0.5611). Recurrent rates in those younger and older than 30 were 13.8% (7 women) and 12.2% (11 women) (p = 0.9955). CONCLUSIONS: Age is not a predictor of disease recurrence. Conservative treatment is only recommended in exceptional situations due to its high recurrence rates. Careful cytological and colposcopic follow-up is required for three years when most recurrences occur.

Evaluation of conservative management of high-grade cervical squamous intraepithelial lesion.

OBJECTIVE: To assess the association between conservative management of high-grade cervical squamous intraepithelial lesions and recurrence rates and age groups. METHODS: Cross-sectional, retrospective, analytical observational study of 509 women (aged 15 to 76) with abnormal Pap smears attending a public reference center in the city of Maringá, southern Brazil, from 1996 to 2006. Data was collected from medical records, and the variables definitive diagnosis, type of treatment provided, occurrence of high-grade cervical squamous intraepithelial lesions and recurrence were studied. Pearson's chi-square test and Fisher's exact test were used in the statistical analyses. RESULTS: There were 168 cases of cervical high-grade cervical squamous intraepithelial lesions, of these, 31 were treated with cold-knife conization, 104 loop electrosurgical excision procedure, 9 hysterectomy and 24 conservative treatment (i.e., clinical and cytological follow-up or cervical electrocoagulation). A total of 8 (33.3%) women receiving conservative and 10 (6.9%) receiving non-conservative management had recurrent disease and this difference was statistically significant (p=0.0009), PR = 4.8 (95%CI 2.11;10.93). Three (30.0%) women among those undergoing clinical and cytological follow-up and five 5 (35.7%) among those submitted to cervical electrocoagulation had recurrent disease within three years, but the difference was not significant (p=0.5611). Recurrent rates in those younger and older than 30 were 13.8% (7 women) and 12.2% (11 women) (p = 0.9955). CONCLUSIONS: Age is not a predictor of disease recurrence. Conservative treatment is only recommended in exceptional situations due to its high recurrence rates. Careful cytological and colposcopic follow-up is required for three years when most recurrences occur.

[Knowledge, acceptability and use of the Billings natural family planning method]. / Conhecimento, aceitabilidade e uso do método Billings de planejamento familiar natural.

This is an observational quantitative and analytical study aimed at verifying the knowledge, acceptability and use of natural family planning (NFP) by patients in a university hospital from July to November, 2008. The data were collected using a structured questionnaire and analyzed with the softwares Excel and Statistica 8.0. Of the 113s women interviewed, 70 (62%) accepted the method and 1 (0.9%) used it routinely. Acceptance was higher among those who wished to become pregnant in the future compared to those who did not wish it. Acceptability was statistically significant (p = 0.0147) among the 28 (80%) non-contraceptive users compared to 42 (53.8%) who used some contraceptive method. Factors such as age, education, number of living children and religion were not statiscally associated with the acceptability of NFP. The Billings ovulation method has an adequate acceptability, but has a low actual use because of the lack of information by health professionals of its real effectiveness and applicability.

Conhecimento, aceitabilidade e uso do método billings de planejamento familiar natural / El conocimiento, la aceptación y el uso del método Billings de planificación familiar natural / Knowledge, acceptability and use of the Billings natural family planning method

Estudo observacional, quantitativo analítico que objetivou verificar o conhecimento, a aceitabilidade e o uso do planejamento familiar natural (PFN) pelos pacientes em um hospital universitário no período de julho a novembro de 2008. Os dados foram coletados utilizando questionário estruturado e analisados através dos Programas Excel e Statistica 8.0. Das 113 mulheres entrevistadas, 70 (62 por cento) aceitavam o método e 1 (0,9 por cento) fazia o uso rotineiro. A aceitação foi maior entre as que desejavam engravidar no futuro quando comparadas aquelas que não desejavam engravidar. A aceitabilidade foi estatisticamente significativa (p=0,0147) entre as 28 (80 por cento) não usuárias de métodos contraceptivos comparadas a 42 (53,8 por cento) com algum método contraceptivo. Fatores como idade, escolaridade, número de filhos vivos e religião não apresentaram associação estatística com a aceitabilidade do PFN. A aceitabilidade do método de ovulação Billings é adequada, porém com pouco uso na prática por falta de informação pelos profissionais da saúde da verdadeira eficácia e aplicabilidade.

Estudio observacional, cuantitativo y analítico para verificar el conocimiento, la aceptación y el uso de la planificación familiar natural (PFN) en un hospital universitario en el periodo de julio a noviembre de 2008. Los datos fueron recolectados a través de cuestionario estructurado y analizados mediante los programas Excel e Statistica 8.0. De las 113 mujeres entrevistadas, 70 (62,0 por ciento) aceptaron el método y 1 (0,9 por ciento) tenían uso rutinario. Aceptación fue mayor entre las que deseaban futuros embarazos en comparación con aquellos que no desean quedar embarazadas. Aceptabilidad fue estadísticamente significativa (p=0,0147) entre 28 (80,0 por ciento) no usuarias de anticonceptivos en comparación con 42 (53,8 por ciento) con el método anticonceptivo. Factores como edad, escolaridad, número de hijos vivos y religión no se asoció estadísticamente con la aceptación de PFN. Aceptabilidad del método Billings es adecuada, pero con poca utilidad en la práctica por falta de información por parte de profesionales de salud de la efectividad y aplicabilidad.

This is an observational, quantitative and analytical study aimed at verifying the knowledge, acceptability and use of natural family planning (NFP) by patients in a university hospital from July to November, 2008. The data were collected using a structured questionnaire and analyzed with the softwares Excel and Statistica 8.0. Of the 113 women interviewed, 70 (62 percent) accepted the method and 1 (0.9 percent) used it routinely. Acceptance was higher among those who wished to become pregnant in the future compared to those who did not wish it. Acceptability was statistically significant (p = 0.0147) among the 28 (80 percent) non-contraceptive users compared to 42 (53.8 percent) who used some contraceptive method. Factors such as age, education, number of living children and religion were not statiscally associated with the acceptability of NFP. The Billings ovulation method has an adequate acceptability, but has a low actual use because of the lack of information by health professionals of its real effectiveness and applicability.

Prevalência de anemia em escolares de escolas públicas de Maringá-PR, 2008 / Prevalence of anemia in children of primary school in public institutions of Maringa-PR, 2008 / Prevalencia de anemia en escolares de las escuelas públicas de Maringá-PR, 2008

A anemia é um problema de saúde pública que afeta tanto países desenvolvidos quanto os em desenvolvimento. O objetivo deste estudo foi de estimar a prevalência de anemia em crianças que ingressaram no primeiro ano do Ensino Fundamental das escolas públicas do município de Maringá-PR, no ano de 2008 e os fatores associados à sua ocorrência. Estudo transversal realizado nas 57 escolas públicas de Maringá-PR, com população amostral probabilística constituída de 371 escolares. A dosagem de hemoglobina (Hb) foi feita pelo HemoCue, e a anemia classificada pelo critério estabelecido pela Organização Mundial da Saúde, Hb <11,5g/dL. Foram realizadas análises univariada e multivariada com regressão logística para as variáveis relacionadas ao evento. A prevalência da anemia foi de 39,3%. Foi verificada associação significativa entre anemia e número de filhos, verificando-se que em famílias com mais de 3 filhos a criança tem 8,6 vezes mais chance de ter a doença quando comparada à outras famílias. A prevalência da anemia nos escolares ingressantes foi elevada no município, evidenciando a necessidade de implementação e adoção de ações efetivas para sua prevenção e controle.

Anemia is a public health problem which affects urbanized countries as well as the ones under development. The aim was to estimate the prevalence of anemia in children in the beginning of a first grade of Elementary School from public schools of the municipal district of Maringá-PR, in 2007, and the factors associated to its occurrence. It was a transversal study, carried out in 57 public schools of Maringá-PR, with a sample population of 371 students. Blood was collected from the middle finger and the hemoglobin dosage (Hb) was obtained by HemoCue, and the anemia was classified by the World Health Organization established criterion, Hb <11,5g/dl. The univariate and multivariate analysis for the variables related to the event were accomplished. The prevalence of the anemia was 39.3%. A significant association was noticed between anemia and number of children, being verified that in families with more than 3 children a child has 8.6 times more chance of having the disease when compared to other families. The prevalence of the anemia in the beginners was elevated in the municipal district, evidencing the need to implement and adopt effective actions for its prevention and control.

La anemia es un problema de salud pública que afecta tanto países desarrollados como los en desarrollo. El objetivo fue estimar la prevalencia de anemia en niños que ingresaron en lo primero año de la Enseñanza Fundamental de las escuelas públicas del municipio de Maringá-PR, en el año de 2007 y los factores asociados a su ocurrencia. Se trata de un estudio transversal, en las 57 escuelas públicas de Maringá-PR, con población para muestra probabilística constituida de 371 escolares. La sangre fue cogida del dedo medio y la dosificación de hemoglobina (Hb) fue hecha por el HemoCue, y la anemia clasificada por el criterio establecido por la Organización Mundial de la Salud, Hb <11,5g/dl. Fueron realizadas análisis univariadas y multivariadas con regresión logística para las variables relacionadas al evento. La prevalencia de la anemia fue de 39,3%. Fue verificada asociación significativa entre anemia y número de hijos, verificándose que en familias con más de 3 hijos el niño tiene 8,6 veces más oportunidad de tener la enfermedad cuando comparada a las otras familias. La prevalencia de la anemia en los escolares ingresantes fue elevada en el municipio, evidenciando la necesidad de implementación y adopción de acciones efectivas para su prevención y control.

Gravidez complicada com osteoporose idiopática transitória e dermatite papulosa / Pregnancy complicated with transient idiopathic osteoporosis and dermatitis papulosa

Este relato descreve o caso de uma paciente de 25 anos que, durante a primeira gravidez, desenvolveu Dermatite Papulosa (DPP) em paralelo à osteoporose idiopática Transitória (OIT), sendo ambas doenças raras e com etiologias ainda mal esclarecidas. O diagnóstico da DPP se deu por biópsia de tecido, enquanto que o da OIT foi feito por exclusão. Seus sinais clínicos e radiológicos iniciais podem simular os de necrose asséptica, infecção ou neoplasia, entidades cujo diagnóstico pode necessitar de métodos invasivos. Neste trabalho são mostradas as diferenças clínicas e radiológicas que levaram ao diagnóstico da OIT, bem como, o tratamento indicado, uma vez que, estar atento aos sintomas iniciais desta doença pode poupar o paciente de procedimentos invasivos ou terapias desnecessárias.

This report describes the case of a 25 years old woman, during her first pregnancy, she developed Dermatitis Papulosa (DPP) in parallel with Idiopathic Transient Osteoporosis (ITO), both being rare diseases with unclear etiology. The diagnosis of DPP was made by skin biopsy, while the Idiopathic Transient Osteoporosis was made by exclusion. The initial clinical and radiological signals of ITO can mimic aseptic necrosis, infection or neoplasy, entities whose diagnosis may require invasive methods. This paper shows the clinical and radiological differences that led to the diagnosis of ITO, as well the recommended treatment, since being aware about the initial symptoms of this disease may save the patients from invasive procedures or unnecessary therapies.

[Quality and performance of pap smears in the cervical cancer screening program in a city of southern Brazil]. / Qualidade e desempenho das colpocitologias na prevenção de câncer de colo uterino.

OBJECTIVE: To estimate prevalence and analyze quality and performance of colpocytology carried out under the Cervical Cancer Screening Program in Maringá, Paraná, Brazil. METHODS: A retrospective study of the SIS-Colo database of the Brazilian Ministry of Health. Variables such as age, colpocytology result and origin were analyzed. Ages were divided into brackets; origin was distributed in five Regional Health Divisions of the city of Maringá; colpocytology was categorized according to the Bethesda System. Colpocytology, coverage was calculated by dividing the number of exams in the population between 25 and 59 years of age by the number of women in that same age group. RESULTS: The 17,664 colpocytology exams collected in 2005 by the public health system were distributed among women between 12 and 82 years of age, with 12,961 (73.4%) examinations in women between the ages of 25 and 59, considered at high risk for cancer. A total of 17,458 (98.84%) cytological examinations were negative for malignancy, and atypical results (ASCUS / AGUS, LSIL, HSIL and invasive cancer) totaled 206 (1.16%). The study found a prevalence of 0.85% (151) for ASCUS / AGUS, 1.14% (203/17.664) for atypical cells, and a 2.75 ASCUS / atypical cells ratio (151/55). CONCLUSION: The lower than expected prevalence of colpocytological and ASCUS alterations, the high ASCUS / atypical cells ratio and the insufficient population coverage by colpocytology jeopardized the performance of the cervical cancer prevention program. The low-income population requires special attention, and those more privileged should be advised about the frequency of examination and the age bracket with higher risks.

Qualidade e desempenho das colpocitologias na prevenção de câncer de colo uterino / Quality and performance of pap smears in the cervical cancer screening program in a city of southern Brazil

OBJETIVO: Estimar a prevalência e analisar a qualidade e o desempenho das colpocitologias realizadas no Programa de Prevenção de Câncer de Colo Uterino no município de Maringá-PR. MÉTODOS: Estudo retrospectivo dos dados do SIS-Colo do Ministério da Saúde. Foram analisadas as variáveis idade, resultado de colpocitologia e procedência. As idades foram categorizadas em faixas etárias, a procedência distribuída em cinco regionais de saúde do município de Maringá; a colpocitologia foi categorizada conforme o Sistema Bethesda. Calculou-se a cobertura de colpocitologia dividindo-se o número de exames na população de 25 a 59 anos pelo número de mulheres nesta mesma faixa etária. RESULTADOS: As 17.664 colpocitologias coletadas, no ano de 2005, pela rede pública se distribuíram entre as mulheres com idade mínima de 12 e máxima de 82 anos, sendo 12.961 (73,4 por cento) exames na faixa entre 25 e 59 anos, considerada de maior risco para o câncer. Foram negativos para neoplasia 17.458 (98,84 por cento) exames e as alterações celulares (ASCUS/AGUS, LIEBG, LIEAG e câncer invasor) totalizaram 206 (1,16 por cento). Encontrou-se prevalência de ASCUS de 0,85 por cento (151), de atipias celulares 1,14 por cento (203/17.664) e a relação ASCUS/atipias celulares 2,75 por cento (151/55). CONCLUSÃO: A prevalência das alterações colpocitológicas e da ASCUS abaixo dos índices esperados, a relação ASCUS/atipias celulares em níveis elevados, a cobertura populacional insuficiente de colpocitologia compromete o desempenho da prevenção de câncer de colo uterino. A população de baixa condição sócio-econômica requer uma atenção especial e a população mais privilegiada deve ser orientada quanto a periodicidade do exame e faixa etária de maior risco.

OBJECTIVE: To estimate prevalence and analyze quality and performance of colpocytology carried out under the Cervical Cancer Screening Program in Maringá, Paraná, Brazil. METHODS: A retrospective study of the SIS-Colo database of the Brazilian Ministry of Health. Variables such as age, colpocytology result and origin were analyzed. Ages were divided into brackets; origin was distributed in five Regional Health Divisions of the city of Maringá; colpocytology was categorized according to the Bethesda System. Colpocytology, coverage was calculated by dividing the number of exams in the population between 25 and 59 years of age by the number of women in that same age group. RESULTS: The 17,664 colpocytology exams collected in 2005 by the public health system were distributed among women between 12 and 82 years of age, with 12,961 (73.4 percent) examinations in women between the ages of 25 and 59, considered at high risk for cancer. A total of 17,458 (98.84 percent) cytological examinations were negative for malignancy, and atypical results (ASCUS / AGUS, LSIL, HSIL and invasive cancer) totaled 206 (1.16 percent). The study found a prevalence of 0.85 percent (151) for ASCUS / AGUS, 1.14 percent (203/17.664) for atypical cells, and a 2.75 ASCUS / atypical cells ratio (151/55). CONCLUSION: The lower than expected prevalence of colpocytological and ASCUS alterations, the high ASCUS / atypical cells ratio and the insufficient population coverage by colpocytology jeopardized the performance of the cervical cancer prevention program. The low-income population requires special attention, and those more privileged should be advised about the frequency of examination and the age bracket with higher risks.