[Epidemiology of prostate cancer (PCa) in French Guyana (FG) - Preliminary results]. / Épidémiologie du cancer de la prostate en Guyane française ­ Données préliminaires.

INTRODUCTION: Epidemiology of prostate cancer (PCa) in French Guyana (FG) is not well documented yet. It differs from the reported one in French West Indies due to a younger population, less exposed to agricultural pesticides with also much lower level of medical information and care. MATERIAL: The incidence and mortality rates available in the regional register of cancers are reported for the period 2010-2014. The characteristics of 242 consecutive prostate biopsy series performed between 2017 January and 2019 October for abnormal digital rectal examination (DRE) and/or PSA>4ng/mL are also described. RESULTS: PCa incidence in FG is 94.4°/°°°° and specific mortality 16.9°/°°°°. Among the biopsies, 77.7% (188/242) are positive with a mean PSA of 72.6ng/mL (1-4000) at a mean age of 66years (50-89), 34% (64/188) with an abnormal DRE, 12.3% (23/188) with a PSA>50ng/mL and 28.2% (53/188) with a Gleason score≥8. CONCLUSION: In spite of young population, less exposure to environmental risk factors and high rate of racial mixing, the early PCa diagnosis is still a challenge in FG. The observed incidence and mortality rates suggest underestimation of PCa cases and too late specific care what is also suggested by adverse pathological and biological characteristics of the tumors at the time of diagnosis. LEVEL OF EVIDENCE: 3.

Determinants associated with areas with higher tuberculosis mortality rates: an ecological study.

OBJECTIVE: To characterise tuberculosis deaths in a region of northeast Brazil during the period from 2006 to 2017 and to identify determinants associated with areas with higher tuberculosis mortality rates. METHODS: Ecological descriptive study of deaths from tuberculosis with multivariate mapping and logistic regression, carried out from 2006 to 2017 in the 75 municipalities of Sergipe, Brazil. The focus of the analysis was the mean mortality rate from tuberculosis, dichotomised according to the median. The independent variables were selected based on the conceptual model of the social determinants of health. RESULTS: Mortality due to tuberculosis in Sergipe, Brazil, was most prevalent among males, mixed-race people, and people over 40 years old and with a low level of education. Multivariate logistic regression identified the mean incidence rate for tuberculosis (aOR: 1.06), the proportion of HIV testing (aOR: 7.10), people without primary education and with informal occupation (aOR: 1.26) and people living in urban households without waste collection service (aOR: 0.10) as determinants associated to municipalities with higher tuberculosis mortality rates, with area under the ROC curve of 84% (P-value 0.000). Mapping revealed evident spatial variability. CONCLUSIONS: The tuberculosis epidemic in Brazil is determined by access to health services, especially the provision of HIV testing among those diagnosed with tuberculosis, accelerated urbanisation with large pockets of poverty and unsanitary housing conditions, corroborating global trends.

OBJECTIF: Caractériser les décès dus à la tuberculose dans une région du nord-est du Brésil au cours de la période de 2006 à 2017 et identifier les déterminants associés aux zones où les taux de mortalité par tuberculose sont plus élevés. MÉTHODES: Etude descriptive écologique des décès par tuberculose avec une cartographie multivariée et une régression logistique, réalisée de 2006 à 2017 dans les 75 municipalités de Sergipe, au Brésil. L'analyse était axée sur le taux moyen de mortalité par tuberculose, dichotomisé selon la médiane. Les variables indépendantes ont été sélectionnées sur la base du modèle conceptuel des déterminants sociaux de la santé. RÉSULTATS: La mortalité due à la tuberculose à Sergipe, au Brésil, était plus fréquente chez les hommes, les personnes métissées, les personnes de plus de 40 ans et avec un faible niveau d'éducation. La régression logistique multivariée a identifié le taux moyen d'incidence de la tuberculose (aOR: 1,06), la proportion des tests de dépistage du VIH (aOR: 7,10), les personnes sans éducation primaire et occupant une fonction informelle (aOR: 1,26) et les personnes vivant dans des ménages en milieu urbain sans service de collecte des déchets (aOR: 0,10) comme étant des déterminants associés aux municipalités avec des taux de mortalité par tuberculose plus élevés, avec une aire sous la courbe ROC de 84 % (p=0,000). La cartographie a révélé une variabilité spatiale évidente. CONCLUSIONS: L'épidémie de tuberculose au Brésil est déterminée par l'accès aux services de santé, en particulier la fourniture des tests de dépistage du VIH chez les personnes diagnostiquées avec la tuberculose, l'urbanisation accélérée avec de grandes poches de pauvreté et les conditions de logement insalubres, corroborant les tendances mondiales.

Leprosy in the North and Northeast regions of Brazil: an integrated spatiotemporal approach.

OBJECTIVE: To analyse the spatiotemporal patterns of leprosy occurrence in the North and Northeast regions of Brazil from 2001 to 2017. METHODS: Mixed population-based ecological study with spatial and temporal trend analysis of epidemiological indicators based on new cases reported to the Information System for Notifiable Diseases of the Ministry of Health occurring in individuals residing in North and Northeast states of Brazil. RESULTS: A total of 396 987 new cases were analysed; 9.2% of these involved children <15 years of age, and 5.4% involved individuals with grade 2 disability (G2D). The Northeast region recorded 66.4% of the new cases. Most cases involved males between 15 and 59 years of age and of brown race/colour. The temporal trend showed a reduction in most of the indicators and study variables. The G2D rate did not have trends over time in the Northeast Region, in individuals 0-14 years of age, or in municipalities with 'very high' social vulnerability indexes. The spatial and spatiotemporal analysis showed the presence of hyperendemic foci with high detection risk involving municipalities in the states of Tocantins, Pará and Maranhão. CONCLUSION: Leprosy in the North and Northeast regions of Brazil persists as a critical public health problem. Temporal and spatiotemporal patterns identified in this study confirm that leprosy remains epidemiologically relevant in vulnerable areas. Surveillance and control interventions are needed in municipalities with low detection in the general population, in children and in individuals with G2D, to reduce late diagnosis.

OBJECTIF: Analyser les profils spatiotemporels de l'apparition des cas de lèpre dans les régions du nord et du nord-est du Brésil de 2001 à 2017. MÉTHODES: Etude écologique mixte basée sur la population avec analyse des tendances spatiales et temporelles des indicateurs épidémiologiques sur la base des nouveaux cas rapportés dans le Système d'Information sur les Maladies à Déclaration Obligatoire du Ministère de la Santé, survenant chez des individus résidant dans les Etats du nord et du nord-est du Brésil. RÉSULTATS: 396.987 nouveaux cas ont été analysés; 9,2% d'entre eux concernaient des enfants de moins de 15 ans et 5,4% concernaient des personnes avec un handicap de grade 2 (G2D). La région du nord-est a enregistré 66,4% des nouveaux cas. La plupart des cas concernaient des hommes âgés de 15 à 59 ans et de race/couleur noire. La tendance temporelle a montré une réduction dans la plupart des indicateurs et des variables de l'étude. Le taux de G2D n'a pas évolué au cours du temps dans la région du nord-est, chez les individus de 0 à 14 ans ou dans les municipalités avec des indices de vulnérabilité sociale "très élevés". L'analyse spatiale et spatiotemporelle a montré la présence de foyers hyper endémiques à risque élevé de détection impliquant des municipalités dans les Etats de Tocantins, Pará et Maranhão. CONCLUSION: La lèpre dans les régions du nord et du nord-est du Brésil persiste comme problème critique de santé publique. Les schémas temporels et spatiotemporels identifiés dans cette étude confirment que la lèpre reste épidémiologiquement importante dans les zones vulnérables. Des interventions de surveillance et de contrôle sont nécessaires dans les municipalités à faible détection dans la population générale et chez les enfants, ainsi que chez les personnes atteintes de G2D, afin de réduire le diagnostic tardif.

Productos de tabaco calentado. Concepciones e Implicaciones para la Salud Pública / Products of heated tobacco. Conceptions and Implications for Public Health / Produits de tabac chauffé. Conceptions et Implications pour la santé publique / Produtos de tabaco aquecido. Conceções e Implicações para a Saúde Pública

Resumen: Objetivo: Explorar necesidades de conocimiento y posibles líneas futuras de investigación sobre los Productos de Tabaco Calentado, PTC (Heat-not-bum tobacco products), desde la literatura científica publicada y las fuentes en internet para el público. Métodos: Estudio mixto cualitativo/cuantitativo paralelo bajo tipología de revisiones de literatura por Grant & Booth y Pinto, y diseño de estudios de mapeo según Cooper. Exploración de bases de datos en motores de búsqueda, cotejo de títulos/resúmenes en cuatro idiomas de 2016-12-01 a 2017-12-31. Textos guardados en formatos MHT y PDF, acopiados en Dropbox y gestionados con Endnote X8. Definición de categorías agrupadas en cuatro dimensiones. Información analizada con Microsoft® Excel 2016 y Epi-INFO ® 7.2.2. Resultados: Cotejadas 46 páginas web, 63 referencias científicas, 99% en inglés; dos manuscritos con nota de retirada. En D1 (sumario): presentación del producto vs. aspectos toxicológicos o evaluativos de PTC. 48 artículos (76,2%) en digital o impreso (2017); por país: EUA: páginas web 23 (50%), 20 artículos (32%); Suiza: 22 artículos (35%), tres páginas web (7%). D2 (comercial): financiación por Phillip Morris International (PMI, 22; 33%) o universidades con fondos propios/gubernamentales (19, 30%); en páginas web predominaron PMI (60%), British American Tobacco y Japan Tobacco International (40%); relación con PMI ausente en 41 manuscritos (65%) y 36 páginas web (80%). D3 (metodológica): nivel de evidencia "experimental", laboratorial (26; 41,2%) o en humanos (4; 6,3%); investigación independiente en 36 (57%). D4 (interpretativa): principal interrogante en páginas web fue el carácter dañino o no de los PTC; en artículos científicos, los efectos de micro/nanopartículas de los PTC a mediano/largo plazo. Conclusiones: Se precisa que la comunidad científica complete los respectivos estudios de toxicidad y reducción del daño (harm reduction) relativos a los PTC y resuelva junto con el público y las autoridades, preguntas relativas a su seguridad a mediano y largo plazo.

Summary: Object: To explore knowledge gaps and possible future research line on Heat-not-burn tobacco products (HBT) from the published scientific literature and internet sources available to the population. Methods: Mixed methods qualitative/quantitative study under typology of literature reviews by Grant & Booth and Pinto, and mapping review study design by Cooper. Database search and check-in of titles/abstracts in 4 languages from 2016-12-01 to 2017-12-31. Texts saved in MHT and PDF formats, located in Dropbox and managed with Endnote X8. Category definitions grouped in 4 dimensions. Information analyzed with Microsoft® Excel 2016 and Epi-INFO® 7.2.2 Results: 46 webpages and 63 papers located, 99% in English; 2 manuscripts had withdrawal notes. In D1 (summary): product advertisement vs toxicological or evaluative aspects of the HBT. 48 papers (76,2%) in digital or printed (2017); by country, USA: webpages 23 (50%), 20 papers (32%); Switzertland: 22 papers (35%), 3 webpages (7%). D2 (commercial): financing by Phillip Morris International (PMI, 22, 33%) or universities with own or government funds (19, 30%); on webpages PMI (60%), British American Tobacco and Japan Tobacco International (40%); relation with PMI absent in 41 papers (65%) and 36 webpages (80%). D3 (methodological): evidence level "experimental", laboratory (26; 41,2%) or humans (4, 6,3%); independent research in 36 (57%). D4 (interpretative): main question on webpages was whether HBT products were harmful or not; on papers, the effects of HBT micro/nanoparticles at medium/long term. Conclusion: It is required from scientific community to finish their respective toxicity and harm reduction studies on HBT and to guide and solve questions related to HBT safety in medium/long term alongside population and authorities.

Résumé: Objectif: Explorer les besoins en connaissances et les éventuelles futures lignes de recherche sur les Produits de Tabac Chauffé, PTC (Heat- not-burn tobacco products), á partir de la littérature scientifique publiée et de sources Internet destinées au public. Méthodes: Étude mixte, qualitative / quantitative en paralléle, selon le tipe de revue de littérature proposé par Grant & Booth et Pinto, et conception d'études de cartographie selon Cooper. Exploration de bases de données á partir de moteurs de recherche, révision de titres / résumés en quatre langues du 01-12-2016 au 31-12-2017. Textes enregistrés aux formats MHT et PDF, stockés dans Dropbox et gérés avec Endnote X8. Définition de catégories regroupées en quatre dimensions. Information analysée avec Microsoft® Excel 2016 et Epi-INFO ® 7.2.2. Résultats: 46 pages Web révisées, 63 références scientifiques dont 99% en anglais; deux manuscrits avec acte de retrait. En D1 (résumé): présentation du produit vs aspects toxicologiques ou évaluatifs des PTC. 48 articles (76,2%) en version numérique ou imprimée (2017); par pays: États-Unis: 23 pages Web (50%), 20 articles (32%); Suisse: 22 articles (35%), trois pages Web (7%). D2 (commercial): financement par Phillip Morris International (PMI, 22, 33%) ou par des universités disposant de fonds propres/publics (19, 30%); dans les pages Web, ont prédominé PMI (60%), British American Tobacco et Japan Tobacco International (40%); la relation avec PMI était absente dans 41 manuscrits (65%) et 36 pages Web (80%). D3 (méthodologique): niveau de preuve «expérimental¼, de laboratoire (26, 41,2%) ou avec des humains (4, 6,3%); 36 recherches indépendantes (57%). D4 (interprétative): le principal questionnement dans les pages Web portait sur la nocivité ou non des PTC; dans les articles scientifiques, il portait sur les effets des micro/nanoparticules des PTC á moyen/long terme Conclusions: II est nécessaire que la communauté scientifique compléte les études respectives sur la toxicité et al.

Resumo: Objetivo: Explorar as necessidades de conhecimento e possíveis futuras linhas de investigação sobre os produtos de tabaco aquecido, PTC (Heat-not-burn tabaco), a partir da literatura científica publicada e fontes da Internet para o público. Métodos: Estudo misto qualitativo/quantitativo baseado na tipologia de revisao da literatura de Grant & Booth e Pinto, e no desenho de estudos de mapeamento de Cooper. A exploração de bases de dados em motores de busca realizou-se pelos títulos/resumos em quatro idiomas de 2016-12-01 a 2017-12-31. Os textos foram guardados em formatos MHT e PDF, armazenados no Dropbox e geridos com o Endnote X8. As categorias foram agrupadas em quatro dimensões. A informação foi analisada com o Microsoft® Excel 2016 e Epi-INFO ® 7.2.2. Resultados: Foram agrupados em 46 páginas web, 63 referências científicas, 99% em inglês; dois manuscritos com notas. Em D1 (resumo): verifica-se a apresentação do produto versus aspetos toxicológicos ou avaliativos do PTC. 48 artigos (76,2%) em formato digital ou em suporte papel (2017); por país: EUA: páginas da Web 23 (50%), 20 artigos (32%); Suíça: 22 artigos (35%), três páginas da web (7%). D2 (comercial): financiamento pela Phillip Morris International (PMI, 22, 33%) ou universidades com fundos próprios/governamentais (19, 30%); nas páginas web predominaram as PMI (60%), British American Tobacco e Japan Tobacco International (40%); a relação com PMI está ausente em 41 manuscritos (65%) e 36 páginas na web (80%). D3 (metodológico): nível de evidência "experimental", laboratorial (26, 41,2%) ou em humanos (4, 6,3%); pesquisa independente em 36 (57%). D4 (interpretativa): a principal questão nas páginas web foi a natureza nociva ou não do PTC; em artigos científicos, os efeitos das micro/nanopartículas do PTC no médio / longo prazo. Conclusoes: É necessário que a comunidade científica complemente os respetivos estudos de toxicidade e redução de danos (harm reduction) relacionados com o PTC e resolva, em conjunto com o público e as autoridades, questões relativas à sua segurança a médio e longo prazo.

Factores de riesgo para cáncer de tiroides. Estudio de casos y controles / Risk factors for thyroid cancer. Case-controls study / Facteurs de risque du cancer de la thyroïde. Étude cas-témoins / Fatores de risco para o cancro da tiroide. Estudo caso-controlo

Resumen: Objectivo: El presente estudio tuvo como objetivo la identificación de posibles factores de riesgo para el desarrollo de cáncer de tiroides en la población adscrita al Hospital San Rafael de Alajuela (HSRA) en Costa Rica. Material y Métodos: Se desarrolla un estudio de casos y controles, en la población adscrita al (HSRA). Se trabajó con la totalidad de la población adscrita a este hospital, a partir de esta, se seleccionaron los casos presentados entre enero del 2009 y diciembre del 2013 inclusive (un quinquenio). Resultados: La mayoría son mujeres tanto en casos (76%), como en controles (69%). La distribución por edad quinquenal, es similar entre ambos grupos. La población estudiada se mantiene la línea de presentación de la enfermedad afectando más a individuos con edad entre los 25 y 65 años, predominantemente en el sexo femenino; dentro de la valoración por posible cáncer de tiroides hay que tener presente el antecedente de sobrepeso y obesidad, además del antecedente heredofamiliar de patología tiroidea. Conclusiones: Se identificó el sexo como factor de riesgo para Ca de Tiroides, las demás variables analizadas no cuentan con una asociación estadísticamente significativa para ser consideraos como factores de riesgo.

Abstract: Objetive: This study aimed to identify potential risk factors for developing thyroid cancer in the population attached to the San Rafael de Alajuela Hospital (HSRA) in Costa Rica. Materials and methods: A case-control study was developed in the population attached to the HSRA. We worked with the entire population attached to this hospital, from this, the cases presented between January 2009 and even December 2013 (a five-year period) were selected. Results: Most are women in both cases (76%) and controls (69%). The five-year age distribution is similar between both groups. In the studied population the line of presentation of the disease is maintained affecting more individuals aged between 25 and 65 years, predominantly in females; within the assessment for possible thyroid cancer we must keep in mind the history of overweight and obesity besides hereditary familial history of thyroid disease. Conclusions: Sex was identified as a risk factor for thyroid Ca, the other variables analyzed do not have a statistically significant association to be considered as risk factors.

Résumé: Objectif: L'objectif de cette étude était d'identifier les facteurs de risque posibles pour le développement du cancer de la thyroïde dans la population rattachée à l'Hôpital San Rafael de Alajuela (HSRA) au Costa Rica. Matériel et méthodes: Une étude cas-témoins a été développée dans la population attribuée à la HSRA. Nous avons travaillé avec toute la population attachée à cet hôpital, de cela, les cas présentés entre janvier 2009 ont été sélectionnés et même décembre 2013 (une période de cinq ans). Résultats: La majorité sont des femmes chez les cas (76%) et les témoins (69%). La répartition par âge sur cinq ans est similaire entre les deux groupes. Dans la population étudiée, la ligne de présentation de la maladie est maintenue touchant davantage de personnes âgées de 25 à 65 ans, principalement dans le sexe féminin; au sein de l'évaluation pour le cancer de la thyroïde possible, il faut tenir compte de l'histoire du surpoids et de l'obésité. En plus de l'histoire familiale héréditaire de la maladie de la thyroïde. Conclusions: Le sexe a été identifié comme un facteur de risque de Ca thyroïdien, les autres variables analysées ne présentent pas d'association statistiquement significative à considérer comme facteurs de risque.

Resumo: Objetivo: Este estudo teve como objetivo identificar possiveis fatores de risco para o desenvolvimento do cancro de tireoide na populaçâo do Hospital San Rafael de Alajuela (HSRA) na Costa Rica. Materiais e métodos: Realizou-se um estudo de caso-controle na populaçâo de (HSRA). Trabalhou-se com toda a populaçâo vinculada a este hospital, a partir da qual selecionou-se os casos apresentados entre janeiro de 2009 e dezembro de 2013 inclusive (periodo de cinco anos). Resultados: A populaçâo estudada na maioria é mulheres tanto nos casos (76%) como nos controles (69%). A distribuiçâo pela idade quinquenal é semelhante nos dois grupos. A linha de apresentaçâo da doença afeta mais os individuos entre 25 e 65 anos, predominantemente no sexo feminino; na avaliaçâo de possivel cancro da tireoide deve-se ter em atençâo a histôria de sobrepeso e obesidade, além dos antecedentes familiares de patologia da tireoide. Conclusâo: Identificou-se a variâvel sexo como fator de risco para o cancro da tireoide, as outras variâveis analisadas nâo apresentam associaçâo estatisticamente significativa para serem consideradas como fatores de risco.

Human T-Cell Lymphotropic Virus Type 1 and associated diseases in Latin America.

This narrative review, which is based on a systematic literature search following the PRISMA guidelines, provides a general overview of Human T-cell Lymphotropic Virus type 1 (HTLV-1) and associated diseases: Adult T-cell Leukaemia-Lymphoma (ATLL) and HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP) in Latin America, focusing on epidemiology and prevention. Using the published information on HTLV-1, ATLL and HAM/TSP prevalence, we present comprehensive and accurate maps and tables, and developed an algorithm to assist in the prevention of HTLV-1 transmission through breastfeeding while considering socio-economic status. Latin America is an interesting scenario to study HTLV-1 because of the diverse origin of its population. Apart from the expected high prevalence in inhabitants of African ancestry, the presence of endemic foci affecting indigenous populations is particularly striking. ATLL prevention is the biggest challenge in this field. Most ATLL cases are transmitted through breastfeeding; thus, prevention methods to avoid ATLL in endemic countries have to be focused on this. In view of the high inequality in most Latin American countries, reduction in breastfeeding duration, freezing/thawing and pasteurisation of breastmilk can be suitable interventions in poor settings, considering that avoiding the risk of malnutrition and infant mortality must be the priority.

Cette revue narrative, qui repose sur une recherche bibliographique systématique conforme aux recommandations de PRISMA, fournit un aperçu général sur le virus lymphotropique des lymphocytes T humaines de type 1 (HTLV-1) et les maladies associées: Le lymphome leucémique des cellules T d'adulte (ATLL)) et la myélopathie/paraparésie spastique tropicale (HAM/TSP) associée à HTLV-1 en Amérique latine, en se focalisant sur l'épidémiologie et la prévention. En utilisant les informations publiées sur la prévalence de HTLV-1, ATLL et HAM/TSP, nous présentons des cartes et des tableaux complets et précis et avons développé un algorithme pour aider à la prévention de la transmission du HTLV-1 par l'allaitement tout en tenant compte du statut socioéconomique. L'Amérique latine est un scénario intéressant pour l'étude de HTLV-1 en raison de la diversité des origines de sa population. Outre la forte prévalence escomptée chez les habitants de descendance africaine, la présence de foyers endémiques affectant les populations autochtones est particulièrement frappante. La prévention de l'ATLL est le plus gros défi dans ce domaine. La plupart des cas d'ATLL sont transmis par l'allaitement. Ainsi, les méthodes de prévention pour éviter l'ATLL dans les pays d'endémie doivent être concentrées sur cela. Compte tenu de la forte inégalité qui règne dans la plupart des pays d'Amérique latine, la réduction de la durée de l'allaitement, la congélation/décongélation et la pasteurisation du lait maternel peuvent constituer des interventions appropriées dans les milieux pauvres, tout en considérant que la priorité est d'éviter les risques de malnutrition et de mortalité infantile.

Incidencia de fracturas de cadera según estación del año en el noroeste de Villa Clara / Incidence of hip fractures according to the season of the year in the northwest of Villa Clara

Introducción: El número de pacientes con fractura de cadera aumenta por año. Si en la década de los noventa se estimaba a nivel mundial 1,66 millones de personas con este padecimiento, se estima que para 2050 esta cifra se incremente a 6,26 millones de pacientes. Objetivo: Describir la incidencia de las fracturas de cadera y su relación con las estaciones del año. Métodos: Se realizó una investigación descriptiva. Se seleccionaron para el grupo estudio, de forma intencional, 117 pacientes mayores de 59 años, diagnosticados con fractura de cadera, quienes fueron atendidos en el Hospital Mártires del 9 de abril, del municipio Sagua la Grande, entre enero y diciembre de 2018. Se diseñó el instrumento para la recopilación de la información y la clave de calificación para las variables de estudio: edad, sexo, antecedentes patológicos familiares, procedencia, hora de ocurrencia, tipo lado de factura y estaciones del año. Los resultados obtenidos se procesaron y se calcularon los porcentajes. Resultados: La hipertensión arterial fue el antecedente patológico familiar predominante. Sobresalió la fractura intertrocanterica grado I, con ocurrencia en el lado izquierdo, motivada en los pacientes por la caída de sus pies, cama y alturas. Hubo mayor índice de fracturas en la primavera e invierno. Conclusiones: Se evidenció una elevada incidencia de las fracturas de cadera, la que estuvo asociada, además, con las estaciones del año primavera e invierno. Este resultado permite planificar recursos humanos, materiales y los medios necesarios para enfrentar el incremento de dicho padecimiento. También se pueden desarrollar campañas de comunicación social para que la población conozca en cuáles épocas del año hay incremento de fracturas de cadera(AU)

Introduction: The number of patients with hip fractures increases per year. If in the 1990s, 1.66 million people were estimated with this condition worldwide, it is estimated that by 2050 this figure will increase to 6.26 million patients. Objective: To describe the incidence of hip fractures and their relationship with the seasons of the years. Methods: A descriptive investigation was carried out in 117 patients over 59 years of age who had been diagnosed with hip fracture and who were intentionally selected for this study. They were treated at Mártires del 9 de Abril Hospital, Sagua la Grande municipality, from January to December 2018. The instrument for the compilation of the information was designed and the qualification code for the study variables were age, sex, family pathological background, origin, time of occurrence, type of invoice side and seasons of the year. The results obtained were processed and the percentages calculated. Results: Arterial hypertension was the predominant family pathological history. Grade I intertrochanteric fracture was more frequent with the occurrence on the left side, motivated by the fall from the patients´ feet, bed and heights. There was higher rate of fractures in spring and winter. Conclusions: High incidence of hip fractures was evidenced, which was also associated with the spring and winter seasons. This result allows to plan human resources, materials and the necessary means to face the increase of this suffering. Social communication campaigns can also be developed so that the population knows at when there is an increase in hip fractures(AU)

Introduction: Le nombre de patients atteints de fracture de hanche augmente de plus en plus. Si le chiffre estimé dans les années 90 était 1,66 millions de personnes touchées par cette affection au niveau mondial, on estime que ce chiffre augmentera à 6,26 millions de patients en 2050. Objectif: Décrire l'incidence des fractures de hanche et sa relation avec les saisons de l'année. Méthodes: Une étude descriptive a été réalisée. Pour le groupe expérimental, on a délibérément sélectionné 117 patients âgés de plus de 59 ans, diagnostiqués de fracture de hanche, et soignés à l'Hôpital Martires del 9 de abril, à Sagua la Grande (Villa Clara), entre janvier et décembre 2018. On a désigné un outil pour le recueil de données et un modèle de qualification pour les variables de l'étude telles que l'âge, le sexe, les antécédents familiaux, le lieu de provenance, l'heure de l'atteinte, le côté de la fracture, et la saison de l'année. L'analyse des résultats obtenus et l'estimation des pourcentages ont été effectuées. Résultats: L'hypertension artérielle a été l'antécédent familial prédominant. La fracture intertrochantérienne, grade I, au côté gauche, et due à des chutes de plain-pied, du lit et de hauteur, a été la plus fréquente. Le taux de fractures a été plus élevé en printemps et en hiver. Conclusions: On a constaté une haute incidence de fractures de hanche, étant associée au printemps et à l'hiver. Ce résultat permet de planifier les ressources humaines, les matériaux et les moyens nécessaires pour affronter l'accroissement de cette affection. Il permet aussi de développer des campagnes de communication sociale afin que la population puisse connaître en quelles saisons de l'année il y a une augmentation des fractures de hanche(AU)

Snakebite accidents in Rio Grande do Norte state, Brazil: Epidemiology, health management and influence of the environmental scenario.

OBJECTIVES: Brazil is home to large variety of snake species, of which about 17% are venomous. A large proportion of reported snakebite accidents in the country take place in northeast Brazil. We aimed to analyse the epidemiology of snakebites as a public health concern in Rio Grande do Norte state. METHODS: A retrospective epidemiologic analysis was performed using data from the Brazilian Case Registry Database pertaining to the period 2007-2016, and considering environmental climate characteristics as an influential factor. RESULTS: A number of 3909 cases were reported in total. Among those cases, 58% involved venomous species and more than 80% of these were caused by Bothrops species. An association between environmental characteristics and the incidence of reported cases was found. The Borborema Potiguar region was the most affected area. Apart from that, deficiencies in managing the victims were described. CONCLUSION: This study highlights snakebite accidents as a public health concern in Rio Grande do Norte state. Snake bites are most likely being influenced by climate change and human activities. Continuous training of involved medical personnel could help optimise patient care and avoid under reporting in the accident reporting system.

OBJECTIFS: Le Brésil abrite de très nombreuses espèces de serpents, dont environ 17% sont venimeuses. Une grande partie des accidents rapportés de morsures de serpent dans le pays ont lieu dans le nord-est du pays. Notre objectif était d'analyser l'épidémiologie des morsures de serpents en tant que problème de santé publique dans l'Etat du Rio Grande do Norte. MÉTHODES: Une analyse épidémiologique rétrospective a été réalisée à l'aide des données de la Base de Données du Registre Brésilien des cas couvrant la période 2007-2016 et prenant en compte les caractéristiques climatiques de l'environnement comme facteur d'influence. RÉSULTATS: 3.909 cas au total ont été rapportés. 58% concernaient des espèces venimeuses et plus de 80% d'entre elles étaient causées par l'espèce Bothrops. Une association entre les caractéristiques environnementales et l'incidence des cas rapportés a été mise en évidence. La région de Borborema Potiguar était la plus touchée. Outre cela, les déficiences dans la prise en charges des victimes ont été décrites. CONCLUSION: Cette étude souligne que les accidents causés par des morsures de serpent constituent un problème de santé publique dans l'Etat de Rio Grande do Norte. Les morsures de serpents sont très probablement influencées par les changements climatiques et les activités humaines. La formation continue du personnel médical impliqué pourrait aider à optimiser les soins prodigués aux patients et à éviter une sous-notification dans le système de notification des accidents.

Molecular epidemiology of methicillin-resistant Staphylococcus aureus in the Brazilian primary health care system.

OBJECTIVE: To evaluate the molecular epidemiology and to georeference Staphylococcus aureus isolated from wounds and nares of patients seen at Basic Health Units (BHUs) of a Brazilian city. METHODS: Observational, cross-sectional study conducted from 2010 to 2013. A total of 119 S. aureus strains isolated from the wounds and nares of 88 patients were studied. The isolates were characterised by identifying virulence genes encoding enterotoxins A-E, haemolysins α, ß and δ, exfoliatins A, B and D, biofilm production, Panton-Valentine Leukocidin and toxic shock syndrome toxin 1, and by pulsed-field gel electrophoresis (PFGE), multilocus sequence and spa typing. RESULTS: Eighteen methicillin-resistant Staphylococcus aureus (MRSA) (6 SCCmec type II and 12 SCCmec type IV) and 101 (85%) MSSA were identified. PFGE typing resulted in the formation of eight clusters, with STs 1, 5, 8, 30, 188, 1176 and 1635 and spa type t002 being the predominant types among MSSA. The 18 MRSA belonged to STs 5, 8 and 1176 and spa types t002 and t062. CONCLUSION: The results demonstrate widespread dissemination of MSSA and MRSA clones carrying haemolysin, biofilm and toxin genes. Kernel density estimation revealed the highest density of S. aureus in the 4, 5 and 8 BHUs.

OBJECTIF: Evaluer l'épidémiologie moléculaire et géoréférencer le Staphylococcus aureus isolé de plaies et de narines de patients vus dans les unités sanitaires de base (BHU) d'une ville brésilienne. MÉTHODES: Etude observationnelle transversale réalisée de 2010 à 2013. Au total, 119 souches de S. aureus isolées de plaies et de narines de 88 patients ont été étudiées. Les isolats ont été caractérisés par l'identification de gènes de virulence codant pour les entérotoxines AE, les hémolysines α, ß et δ, les exfoliatines A, B et D, la production de biofilm, la leucocidine de Panton-Valentine et la toxine 1 du syndrome de choc toxique, et par typage par électrophorèse sur gel en champ pulsé (PFGE), séquence multilocus et spa. RÉSULTATS: Dix-huit SARM (6 de type II SCCmec et 12 de type IV SCCmec) et 101 (85%) SASM ont été identifiés. Le typage PFGE a résulté à l'obtention de huit grappes, dont STs 1, 5, 8, 30, 188, 1176 et 1635 et le type spa t002 étant les types prédominants parmi les SASM. Les 18 SARM appartenaient aux STs 5, 8 et 1176 et aux types de spa t002 et t062. CONCLUSION: Les résultats démontrent une dissémination étendue des clones de SASM et de SARM portant les gènes de l'hémolysine, de biofilm et de toxine. L'estimation de la densité par noyau a révélé la densité la plus élevée de S. aureus dans les 4, 5 et 8 BHU.

Association of HIV status with infection by multiple HPV types.

OBJECTIVES: To identify the clinical and demographic characteristics of HIV-positive and HIV-negative women infected by multiple HPV types. METHODS: 1399 women participated in the study (240 HIV-positive and 1159 HIV-negative women). Samples were provided for Pap tests and for HPV detection and typing by PCR. Data were collected on HPV infection, frequency of multiple infection, and HPV type distribution. Odds ratios were reported from logistic regression models. RESULTS: Compared with HIV-negative women, HIV-positive women had higher frequencies of cervical abnormality (30% vs. 20.8%), higher HPV prevalence (68.3% vs. 51.3%) and were more commonly infected with multiple HPV types (78.7% vs. 44.3%). HPV-16 was the most common type detected in the study population, with other types showing variable associations with HIV status. Positive associations were observed between infection by multiple HPV types and HIV status, cervical abnormality and having had more than three pregnancies. The odds of multiple infection by HPV types were higher in HIV-positive women who used an intrauterine device, who had a history of abortions and who had HIV viral loads >100 000 copies/ml, whilst the odds were lower in women with >500 CD4 cells/mm3 . CONCLUSIONS: HIV immunosuppression favours infection by multiple high-risk HPV types, mainly in women affected by low-grade squamous intraepithelial lesions. Antiretroviral therapy had no effect on infection by multiple HPV types. Risk factors related to progressive damage to the cervix were positively associated with infection by multiple HPV types in women living with HIV.

Downscaling incidence risk mapping for a Colombian malaria endemic region.

OBJECTIVE: To map at a fine spatial scale, the risk of malaria incidence for the important endemic region is Urabá-Bajo Cauca and Alto Sinú, NW Colombia, using a new modelling framework based on GIS and remotely sensed environmental data. METHODS: The association between environmental and topographic variables obtained from remote sensors and the annual parasite incidence (API) for the years 2013-2015 was calculated using multiple regression analysis; subsequently, a model was constructed to estimate the API and to project it to the entire endemic region in order to design the risk map. The model was validated by relating the obtained API values with the presence of the three main Colombian malaria vectors, Anopheles darlingi, Anopheles albimanus and Anopheles nuneztovari. RESULTS: Temperature and Normalized Difference Water Index (NDWI) showed a significant correlation with the observed API. The risk map of malaria incidence showed that the zones at higher risk in the Urabá-Bajo Cauca and Alto Sinú region were located south-east of the region, while the northern area presented the lowest malaria risk. A method was generated to estimate the API for small urban centres, instead of the used reports at the municipality level. CONCLUSIONS: These results provide evidence of the utility of risk maps to identify environmentally vulnerable areas at a fine spatial resolution in the Urabá-Bajo Cauca and Alto Sinú region. This information contributes to the implementation of vector control interventions at the microgeographic scale at areas of high malaria risk.

Spatial analysis of reported new cases and local risk of leprosy in hyper-endemic situation in Northeastern Brazil.

OBJECTIVE: To analyse the spatial distribution of the incidence of leprosy and identify areas at risk for occurrences of hyper-endemic disease in Northeastern Brazil. METHODS: Ecological study using municipalities as the analysis unit. Data on new cases of leprosy came from the Health Hazard Notification System (SINAN). This study focused on Pernambuco and covered the years 2005 to 2014. Indicators for monitoring were calculated per 100 000 inhabitants. The local empirical Bayes method was used to minimise rate variance, and spatial autocorrelation maps were used for spatial pattern analysis (box maps and Moran maps). RESULTS: A total of 28 895 new cases were registered in the study period. The average incidence was 21.88/100 000; the global Moran's I index was 0.36 (P < 0.01), thus indicating the existence of spatial dependence; and the Moran map identified 20 municipalities with high priority for attention. The average incidence rate among individuals under 15 years of age was 8.78/100 000; the global Moran's I index showed the presence of positive spatial autocorrelation (0.43; P < 0.01), and the Moran map showed a main cluster of 15 hyper-endemic municipalities. The average rate of grade 2 physical disability at the time of diagnosis was 1.12/100 000; the global Moran index presented a positive spatial association (0.17; P < 0.01); and the Moran map located clusters of municipalities (high-high) in three mesoregions. CONCLUSION: Application of different spatial analysis methods made it possible to locate areas that would not have been identified by epidemiological indicators alone.

Dengue Fever and Aedes aegypti in indigenous Brazilians: seroprevalence, risk factors, knowledge and practices.

OBJECTIVE: Dengue remains an important public health problem in Brazil. We estimated the associated factors of dengue seroprevalence among native Indians of the Tremembé ethnic and their knowledge about the aspects related to the presence of mosquitoes of the genus Aedes. METHODS: An analytical cross-sectional study and a prospective environmental study to monitor the trapping of mosquito eggs monthly were performed. The serological portion of the study involved indigenous people living in the village of Tapera in northeastern Brazil. Ovitraps were monitored for 12 months. RESULTS: Two hundred and ninety of 350 indigenous people (82.9%) participated in the study, with an average age of 30.2 years. The seroprevalence was 22.1% and positivity increased with age, with rates of 4.2% in children under 15 years of age, 26.8% in 15 to 59-year-olds and 42.3% in those older than 59 (CI: 2.25-15.96; P < 0.001). A higher incidence of moving to the city and the presence of underlying diseases were associated with the occurrence of dengue (P < 0.001). Four serotypes were detected, with the highest prevalence of DENV-1 (77.8%), followed by DENV-2 (70.4%), DENV-3 (14.8%) and DENV-4 (11.1%). Eggs were collected in all months of the year and in the traps located in the vicinities of the domiciles (57%). CONCLUSIONS: We present the first seroepidemiological survey of dengue conducted among indigenous populations in Brazil. This lack of studies is likely due to the great bureaucratic challenge of working with indigenous populations, which may lead to greater negligence in the health of these populations.

Prevalence and correlates of screen time among Brazilian adolescents: findings from a country-wide survey.

The purpose of this study was to evaluate the distribution, prevalence, and correlates of excessive screen time (>2 h/day) among Brazilian adolescents. The Study of Cardiovascular Risks in Adolescents (ERICA) is a national, school-based, cross-sectional multicenter study. Information about time spent in front of screens was assessed by questionnaire. Poisson regression models were used to examine the associations between following correlates (region, sex, age, skin color, income, Internet access, and number of TVs at home) and excessive screen time. A total of 66 706 Brazilian adolescents (aged 12-17 years) were included. The overall mean time in front of screens was 3.25 h/day (95% confidence interval (95%CI): 3.20-3.31) and the prevalence of excessive screen time was 57.3% (95%CI: 55.9-58.6). Moreover, excessive screen time also differs across Brazilian regions, being higher in Southeast and South, respectively. In adjusted models stratified by region, the socioeconomic status was associated with excessive screen time in North, Northeast, and Midwest. In all regions, having a computer with Internet access was associated with higher prevalence of excessive screen time. In conclusion, prevalence of excessive screen time in Brazilian adolescents is high. It presents regional variations and facility for Internet access.

[Epidemiology of urolithiasis in French West Indies: A retrospective study]. / Épidémiologie de la lithiase urinaire aux Antilles françaises : étude rétrospective monocentrique.

INTRODUCTION: The incidence of urolithiasis is increasing with dietary changes especially in developed countries. Guadeloupe is a French department overseas where western diet meets traditional local food. The objective was to describe and analyze the epidemiology of urolithiasis in Guadeloupe. MATERIAL AND METHODS: We conducted a retrospective single-center study throughout the year 2015 on patients hospitalized for urolithiasis at University Hospital of Pointe-à-Pitre. Data of the patients, treatments performed and the types of stones were recorded. According to their mineral content, groups were composed. RESULTS: In total, 165 patients were included. The sex ratio was 1.61. The median body mass index (BMI) was 26.5kg/m2. The most common stone was oxalocalcic (64.7%). Mixed stones (24.7%) were in second place. There were only 3.5% of uric acid urolithiasis. Calcium oxalate stones were predominantly monohydrate. The oxalocalcic stones were significantly more frequent in men (80% versus 47.5%, P=0.01) and in the age group over 50 years old (72.2% versus 51.6%, P=0.04). There was no association between the type of stone and the BMI. CONCLUSION: Epidemiology of urolithiasis in our French Caribbean island is, therefore, similar to continental France. However, our population is distinguished by the proportion of women affected and by the different proportions among each type of stone. Other studies on larger samples are needed to study these specificities. LEVEL OF EVIDENCE: 4.

Comportamiento de la diabetes mellitus en Costa Rica / Diabetes mellitus behavior in Costa Rica / Comportamento da diabetes mellitus na Costa Rica / Comportement du diabete mellitus au Costa Rica

Resumen Objetivo: Describir el comportamiento de la diabetes en Costa Rica. Materiales y métodos: La población estuvo conformada por casos incidentes de DM a nivel nacional, reportados y procesados en el departamento de Estadística del Ministerio de Salud para un total en el periodo del 2012 al 2015 de 35, 837 personas y las proyecciones de uso de la consulta externa, de la Caja Costarricense del Seguro Social (CCSS) en el periodo del 2012 al 2015, para un total de 1, 781, 164 consultas. Se llevó a cabo un estudio de tipo descriptivo retrospectivo y transversal. Las variables estudiadas fueron, sexo, edad, mortalidad, egreso hospitalario, morbilidad (uso del servicio consulta externa), incidencia. Los datos recolectados fueron anotados en una matriz de datos utilizando el paquete Excel. Resultados: Tanto la incidencia como la mortalidad por Diabetes Mellitus mostró un aumento para el periodo en estudio. Se evidencia que conforme aumenta la edad es mayor la cantidad de casos que se presentan. Según el sexo, hay una relación de 3 mujeres por un hombre con DM. Respecto de la demografía, la provincia de San José presenta un mayor número de egresos. Sin embargo, se debe tomar en cuenta que en San José se concentra la mayor cantidad de población y donde se concentra el mayor número de hospitales clase A (especializados), los cuales reciben traslados de otros hospitales regionales de acuerdo con la condición del paciente. Por su parte, la provincia de Puntarenas presenta un aumentado de los egresos en relación con otras provincias del país. Conclusiones: La incidencia, así como la mortalidad por DM en Costa Rica son variables que muestran un aumento para el periodo en estudio (2012 2015), catalogándose a esta enfermedad como una epidemia a nivel mundial, por lo que se considera un reto para los sistemas de salud debido a las complicaciones que presenta.

Abstract Objective: To describe the behavior of diabetes in Costa Rica. Materials and methods: The population was made up of incident cases of DM nationally reported and processed in the Department of Statistics of the Ministry of Health for a total in the period 2012 to 2015 of 35, 837 people and projections of use of The external consultation, of the Costa Rican Social Security (CCSS) in the period 2012 to 2015, for a total of 1, 781, 164 consultations. A retrospective and cross-sectional descriptive study was carried out. The variables studied were sex, age, mortality, hospital exit, morbidity (use of external consultation service) and incidence. The collected data were annotated in an array of data using the Excel package. Results: Both the incidence and mortality for Diabetes Mellitus showed an increase for the study period. It is evidenced that as the age increases, the number of cases presented increases. According to sex, there is a ratio of 3 women to a man with DM. Regarding demography, the province of San José presents a greater number of discharges. However, it should be taken into account that in San José the largest population is concentrated and where the largest number of class A (specialized) hospitals is concentrated, which receive transfers from other regional hospitals according to the patient's condition. On the other hand, the province of Puntarenas presents an increase in the equity in relation to other provinces of the country. Conclusions: The incidence, as well as mortality by DM in Costa Rica, are variables that show an increase for the study period (2012-2015), cataloging to this disease as an epidemic globally, reason why it is considered a challenge for Health systems due to the complications it presents.

Resumo Objetivo: Descrever o comportamento da diabetes na Costa Rica. Materiais e métodos: A população tem-se revelado conformada com os casos de DM a nivel nacional, reportados y processados pelo Departamento de Estatística do Ministério de Saúde perante um total de 35 837 pessoas entre 2012 e 2015 e as percebes do uso da consulta externa da "Caja Costarricense de Seguro Social" (CCSS) no periodo de 2012 a 2015, para un total de 1 781 164 consultas. Foi desenvolvido um estudo de tipo descritivo retrospetivo e transversal. As variáveis estudadas foram o sexo, a idade, a mortalidade, o ingresso no hospital, a morbilidade (uso do servio de consulta externa) e a incidencia. Os dados recolhidos foram anotados numa matriz de dados utilizando o programa Excel. Resultados: Tanto a incidencia como a mortalidade por Diabetes Mellitus revelou un aumento para o período en estudo. A medida que aumenta a idade aumenta o número de casos. Em termos de sexo, há uma relação de 3 mulheres para um homen com DM. A provincia de San José presenta un maior número de despesas. É em San José que se encontra o maior número de pessoas e onde se concentra o maior número de hospitais de classe A (especializados). Por outro lado, a provincia de Puntarenas apresenta um aumento de despesas quando comparada com as outras provincias do país. Conclusões: A incidencia, assim como a mortalidade por DM na Costa Rica sao variáveis que mostram um aumento no período estudado (2012-2015), sendo uma doença que está relacionada com uma epidemia a nivel mundial, sendo um desafio para os sistemas de saúde, devido as complicações que representa.

Résumé Objectif: Décrire le comportement du diabete au Costa Rica. Matériaux et méthodes: La population était composée des cas incidents de DM, déclarés au niveau national et analysés par le Département de Statistique du Ministere de la Santé durant la période 2012-2015 pour un total de 35,837 personnes, et de l'estimation de consultations externes de la Caisse de Sécurité Sociale du Costa Rica (CCSS) pour la meme période, avec un total de 1,781,164 consultations. Une étude descriptive, rétrospective et transversale a été menée en prenant en compte les variables sexe, age, mortalité, sortie de l'hopital, morbidité (utilisation des services de consultation externe) et incidence. Les données ont été saisies dans une matrice avec le package Excel. Résultats: L'incidence et la mortalité liées au diabete mellitus ont augmenté durant la période a l'étude. Il a été mis en évidence que la quantité de cas augmente avec l'age. La proportion est de 3 femmes pour un homme. En ce qui concerne la démographie, la province de San José a un plus grand nombre de sorties de l'hopital. Cependant, il faut prendre en compte que c'est la que se concentrent la plus grande partie de la population et le plus grand nombre d'hopitaux de classe A (de spécialité), lesquels re9oivent des transferts d'autres hopitaux régionaux quand l'état du patient le justifie. Les dépenses ont augmenté d'avantage dans la province de Puntarenas qu'autre part. Conclusions: L'incidence et la mortalité par DM au Costa Rica ont augmenté durant la période 2012-2015. Cette maladie, cataloguée comme une épidémie mondiale, représente un défi pour les systemes de santé en raison des complications associées.

Trends in colorectal cancer in the Caribbean: A population-based study in Martinique, 1982-2011.

BACKGROUND: We aimed to describe incidence and mortality from colorectal cancer, and temporal trends between 1982 and 2011 in Martinique (French West-Indies). METHODS: This was a descriptive, longitudinal, observational study based on data from the Martinique cancer registry. The study included all incident cases of colorectal cancer between 1982 and 2011. We recorded sociodemographic data and clinical variables (histology, site according to the WHO classification). Cancer cases were recorded in strict conformity with the international standards. Annual rate of change was calculated, direct standardisation was used for incidence and mortality age standardised rates (ASR). The comparative incidence figure and comparative mortality figure (95% confidence intervals) were calculated. RESULTS: In total, 2530 patients were included in our study; 1243 died. In the period 2007-2011, a considerable increase in incidence was observed, making colorectal cancer the second leading cause of cancer deaths in both sexes (8.9% and 10.5%). In men, ASR for incidence increased from 9.6/100,000 person-years in the period 1982-1986 to 27.2/100,000 person-years in the period 2007-2011, with a notable acceleration of the increase. In women, ASR increased from 8.4 to 19.8/100,000 person-years over the same periods. For the latest period 2007-2011, mortality rates were 9.9 and 7.6/100,000 person-years for men and for women respectively. Regardless of the sex, there was a strong increase in the incidence of right colon cancer, which became the most common colorectal site in women in Martinique. CONCLUSION: Our findings confirm the increase in the incidence of colorectal cancer that started in the 2000s. Trends observed reflect a salient epidemiological transition of the Caribbean.

Epidemiology and fungal species distribution of superficial mycoses in Northeast Brazil.

OBJECTIVE: Dermatomycoses are superficial fungal infections which affect the skin, hair and nails of humans and animals. Male and female patients of all ages are affected by this condition. The main etiological agents of dermatomycoses are the dermatophytes fungi of the genera Trichophyton, Microsporum and Epidermophyton, while the main yeasts belong to the genera Candida, Malassezia and Trichosporon. The variation in the distribution of dermatomycoses worldwide justify the conduction of epidemiological studies in order to contribute for the better understanding of patterns of mycological cutaneous infections. This study was conducted from April 2013 to December 2014. MATERIAL AND METHODS: A total of 205 patients were evaluated, while 235 clinical specimens were obtained. From our positive cases of mycological examination, 73 (64.6%) patients were female, while 40 (35.4%) were male. Scales from the skin and nails were collected and observed at optical microscopy after potassium hydroxide clarification. Cultures were performed on Sabouraud Dextrose Agar added chloramphenicol. Identification was performed by classic methodology. RESULTS: We found that the glabrous skin was the largest source of dermatomycoses (30.11%), followed by toenails (27.4%) and fingernails (17.7%). Regarding onychomycosis, the most affected population was over 50 years old. Trichophyton rubrum was the dermatophyte fungal species more commonly found. Most of the patients with pityriasis versicolor were adults and female. Another important fact observed is that Candida parapsilosis was the most prevalent species. Finally, a high incidence of T. tonsurans in cases of superficial mycoses was observed. CONCLUSION: Our results clearly demonstrate peculiarities in terms of etiological agents of dermatophytoses distribution in a specific region of Brazil.

[Prevalence of symptoms and risk of obstructive sleep apnea syndrome assessed by the Berlin Questionnaire among professionals of a health facility]. / Prévalence des symptômes et du risque de syndrome d'apnée obstructive du sommeil évaluée par le questionnaire de Berlin parmi les professionnels d'un établissement de santé.

BACKGROUND: Few data exist on the prevalence of symptoms and risk of obstructive sleep apnea syndrome (OSAS) among professionals of a health facility, or they often work in shift schedule and night. Under these conditions, an undetected OSAS may affect alertness and attention in professional acts. The purpose of this study was to determine the prevalence and risk factors of OSAS among professionals of a health facility. METHODS: It is a descriptive cross-sectional study conducted among 773 participants working at the university hospital of Pointe-à-Pitre and volunteers to answer the Berlin questionnaire. We also collected among respondents, abdominal and neck circumference and medical history. RESULTS: Women accounted for 67% (n=520) of the sample and men 32.7% (n=253). The mean age was 42±11.1 years. We noted a high prevalence of OSAS symptoms (snoring at 69% to 26% daytime sleepiness) and SAS risk factors (hypertension reported to 18%, BMI>30kg/m2 to 13%). The prevalence of subjects at high OSAS risk was 23.5% (20.6-26.6%) in the overall study population; it was 22.4% in nursing staff, and 21.4% (17-26%) among in the shift schedule workers. The factors significantly associated with a high risk of OSAS in this population were: age>51 years (adjusted odds ratio [aOR]: 8.1, P<0.001), male gender (aOR: 4.1, P<0.001), the neck circumference>41cm (aOR: 2.9, P<0.01) and comorbidities (diabetes, high cholesterol and family history of SAOS). CONCLUSION: It seems interesting to propose to health workers who have risk factors for sleep apnea syndrome identified in this study, OSAS screening by the Berlin Questionnaire. This could be implemented for example as part of occupational medicine.

Altitude and regional gradients in chronic kidney disease prevalence in Costa Rica: Data from the Costa Rican Longevity and Healthy Aging Study.

OBJECTIVES: Recent studies in Central America indicate that mortality attributable to chronic kidney disease (CKD) is rising rapidly. We sought to determine the prevalence and regional variation of CKD and the relationship of biologic and socio-economic factors to CKD risk in the older-adult population of Costa Rica. METHODS: We used data from the Costa Rican Longevity and Health Aging Study (CRELES). The cohort was comprised of 2657 adults born before 1946 in Costa Rica, chosen through a sampling algorithm to represent the national population of Costa Ricans >60 years of age. Participants answered questionnaire data and completed laboratory testing. The primary outcome of this study was CKD, defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 . RESULTS: The estimated prevalence of CKD for older Costa Ricans was 20% (95% CI 18.5-21.9%). In multivariable logistic regression, older age (adjusted odds ratio [aOR] 1.08 per year, 95% CI 1.07-1.10, P < 0.001) was independently associated with CKD. For every 200 m above sea level of residence, subjects' odds of CKD increased 26% (aOR 1.26 95% CI 1.15-1.38, P < 0.001). There was large regional variation in adjusted CKD prevalence, highest in Limon (40%, 95% CI 30-50%) and Guanacaste (36%, 95% CI 26-46%) provinces. Regional and altitude effects remained robust after adjustment for socio-economic status. CONCLUSIONS: We observed large regional and altitude-related variations in CKD prevalence in Costa Rica, not explained by the distribution of traditional CKD risk factors. More studies are needed to explore the potential association of geographic and environmental exposures with the risk of CKD.