Prevalence of myopic eyes in private practice and public care services in Brazil: 11 years of retrospective analysis

ABSTRACT Purpose: This study aimed to examine the prevalence of myopic eyes over 11 years (2008-2018) in a private clinic and a public assistance service. Methods: We retrospectively evaluated 6332 individuals (12,664 eyes) between 5 and 25 years old, seen at a private clinic-CEMO (2,663 individuals) and a public service-HOIP (3,669 individuals) from 2008 to 2018. We evaluated the prevalence of myopic eyes (EE ≤-0.50) and high myopic eyes (EE ≤-6.00). Results: Sex and services did not show statistical differences. The variation in the prevalence of myopic and high myopic eyes showed a random pattern during the study period (this prevalence could not be increased). Prevalences ranged from 20.7% (in 2017) to 32.4% (in 2015) for myopic eyes and from 1.6% (in 2009 and 2016) to 3.3% (in 2015) for eyes with high myopia. The prevalence of myopia showed a statistically significant increase based on the age group. Conclusion: The prevalence of myopic eyes did not increase in our study. The mean prevalence of myopic eyes was similar in the private clinic and public service.

Retinoblastoma in Ceara: An epidemiological study in a Brazilian pediatric oncology referral center

ABSTRACT Purpose: Although Brazil has a high prevalence of retinoblastoma, there is a lack of epidemiological data on the disease. Thus, in this study, we aimed to evaluate the epidemiological profile of patients diagnosed with retinoblastoma in the ophthalmology department of a pediatric tertiary referral hospital in Ceara, Brazil. Methods: A descriptive and cross-sectional study was conducted by retrospectively analyzing the clinical and socioeconomic data from the medical records of pediatric patients followed-up at the hospital between 2007 and 2021. Retinoblastoma was diagnosed on the basis of a fundoscopic or histopathologic examination. Results: The data of 105 patients were included in the study, and the mean patient age at the time of diagnosis was 1.7 years. Most of the patients were women (50.5%) and hailed from rural areas (57.4%), which was associated with a higher tumor stage. Of the 150 patients, 57.1% initially presented with leukocoria. Ocular hyperemia was associated with more advanced stages of retinoblastoma (p=0.004). Bilateral involvement was observed in 25.7% of the patients and at a significantly younger age (p=0.009). The presence of retinal detachment, vascularized lesions, and vitreous seeds significantly increased the likelihood of requiring enucleation. Discussion: This study presents an epidemiological description of retinoblastoma in Brazil, which highlights the significance of early detection. Delayed diagnosis is associated with a poorer visual prognosis and higher mortality rate, particularly in patients with unilateral disease. Risk factors for a more severe disease were retinal detachment, vascularized lesions, and vitreous seeds. The correlation between histopathological features and clinical outcomes was limited. Conclusion: Further studies are required to assess the influence of ocular hyperemia, fundoscopic assessment, and histopathologic findings on the prognosis of retinoblastoma. Moreover, it is critical to devise interventions to reduce the time-to-diagnosis in rural areas.

Clinical, epidemiological, and care profile of hospitalized patients with retinoblastoma in Brazil

ABSTRACT Purpose: To describe the epidemiological and clinical profile of hospitalized patients with retinoblastoma in Brazil. Methods: Using data from the Hospital Cancer Registry of the Instituto Nacional de Câncer, patients with the morphological codes of retinoblastoma who were diagnosed between 2000 to 2018, aged 0-19 years, and followed up in registered hospitals (analytical cases) were selected. The relative and absolute frequencies of demographic, clinical, diagnostic, therapeutic, and outcome variables were described. Hospital performance indicators were calculated and compared between hospitals qualified and not qualified to treat pediatric oncology cases and between hospitals with different case volumes (<20, 20-75, >75 cases). Results: Of the 2,269 identified analytical cases from 86 institutions, 48% were from the Southeast, 54% were male, and 66% were aged <4 years. The proportion of missing data (NA) was too high for several variables. Approximately 84% of the patients were from the public health system, 40% had a positive family history, and 88% had unilateral involvement. The first treatment included surgery in 58.3% of the patients (NA=2), Approximately 36.6% of these patients achieved complete remission, 10.8% achieved partial remission, and 12.7% died (NA=59%). Hospital performance indicators were within the target in >90% of the patients. The median time between the first appointment and diagnosis (6 days, interquartile range [IQR] 1-14) was significantly lower and the median time to death was longer (343 days, IQR, 212-539) in high-volume hospitals (>75 cases) than in medium- and low-volume hospitals. Conclusions: Despite the high proportion of missing data, we found that the delay in diagnosis is due to prehospital factors. Additionally, there is a need for educational programs for healthcare professionals and families that emphasize early identification and referral to specialized centers. Future studies should focus on the impact of Hospital Cancer Registry data completeness on outcomes, causes of delay in diagnosis, regional inequalities, and barriers to accessing specialized services.

Prevalência de sintomas de doenças musculoesqueléticas na área de abrangência de uma Unidade Básica de Saúde / Prevalence of musculoskeletal disorders in an area covered by a Health Center / Prevalencia de síntomas de enfermedades musculoesqueléticas en el área de cobertura de una unidad básica de salud

Introdução: As doenças musculoesqueléticas (DMSQ) são causas importantes de incapacidade física que tem como consequências a redução da qualidade de vida e o aumento dos custos em saúde. Objetivo: Este estudo teve o objetivo de descrever a prevalência de sintomas de DMSQ e da incapacidade física associada a esses sintomas em uma área de abrangência de uma Unidade Básica de Saúde (UBS) da família em área periurbana, além de analisar a associação da presença desses sintomas com características demográficas e doenças crônicas mais frequentes. Métodos: Estudo transversal realizado na área de cobertura de uma UBS periurbana entre agosto de 2018 e fevereiro de 2019 na qual pessoas com mais de 15 anos, selecionadas ao acaso, foram entrevistadas com o questionário da primeira fase do Community Oriented Program for Control of Rheumatic Diseases (COPOCORD), traduzido e validado para a língua portuguesa. Essas pessoas também foram questionadas quanto à presença de outras doenças diagnosticadas e a medicações em uso. Além disso, foram realizadas medidas de peso, altura e circunferência da cintura de cada participante ­ os dois primeiros foram utilizados para cálculo do índice de massa corporal (IMC). Resultados: Neste estudo foram entrevistadas 372 pessoas com média de idade de 46,5 (±18,3) anos, sendo 212 (57%) do sexo feminino. A prevalência de indivíduos que apresentaram sintomas de DMSQ nos últimos sete dias foi de 66,4% (IC95% 61,6­71,2). Cerca da metade (48,6%) e quase um quarto (24,2%) dos participantes relataram sintomas de intensidade moderada e severa, respectivamente. Os locais mais afetados foram as costas (50,27%), o pescoço (34,9%) e os joelhos (30,64%). A maioria, 209/247 (84,6%), relatou dor em mais de um local e 129/247 (52.2%) relataram limitação física para atividades da vida diária. Das 247 pessoas, 102 (41,3%) procuraram assistência médica, a maioria, 70 (68,6%), na UBS. Indivíduos com sintomas de DMSQ tinham média de idade e de IMC significativamente mais elevada que indivíduos sem esses sintomas, além de apresentarem maior frequência de diabetes e ansiedade e/ou depressão. No entanto, em análise multivariada, nenhuma variável foi preditora independente de sintomas de DMSQ. Conclusões: Sintomas de DMSQ são prevalentes nessa comunidade e a atenção básica deve estar preparada para manejo e reabilitação das pessoas com essas doenças.

Introduction: Musculoskeletal disorders are important causes of physical disability that result in reduced quality of life and increased health costs. Objective: To describe the prevalence of symptoms of musculoskeletal disorders and the physical disability associated with these symptoms in an area covered by a Health Center in a peri-urban area. In addition, we analyzed the association of the presence of these symptoms with demographic characteristics and the most frequent chronic diseases. Methods: This is a cross-sectional study carried out in the area covered by a peri-urban Health Center between August 2018 and February 2019 in which people over 15 years of age, randomly selected, were interviewed using the questionnaire from the first phase of the Community Oriented Program for Control of Rheumatic Diseases (COPOCORD), translated and validated into Brazilian Portuguese. They were also asked about the presence of other chronic diseases and medications in use. In addition, each participant's weight, height, and waist circumference were measured. The first two were used to calculate the body mass index. Results: A total of 372 people were interviewed with a mean age of 46.5 (±18.3) years, 212 (57%) of whom were women. The prevalence of individuals who presented symptoms of musculoskeletal disorders in the last seven days was 66.4% (95%CI: 61.6­71.2). About half (48.6%) and almost a quarter (24.2%) interviewees reported symptoms of moderate and severe intensity, respectively. The most affected sites were the back (50.27%), the neck (34.9%), and the knees (30.64%). The vast majority, 209/247 (84.6%), reported pain in more than one site and 129/247 (52.2%) reported physical impairments in activities of daily living. Of the 247 individuals, 102 (41.3%) sought medical assistance, the majority, 70/102 (68.6%), at the Health Center. Individuals with symptoms of musculoskeletal disorders had a significantly higher mean age and body mass index than individuals without these symptoms. They also had a higher frequency of diabetes and anxiety and/or depression. However, in multivariate analysis, no variable was an independent predictor of symptoms of musculoskeletal disorders. Conclusions: Symptoms of musculoskeletal disorders are prevalent in this community and primary health care must be prepared for the management and rehabilitation of people with these disorders.

Introducción: Las enfermedades musculoesqueléticas son causas importantes de discapacidad física que resultan en una reducción de la calidad de vida y un aumento de los costos de salud. Objetivo: Este estudio tuvo como objetivo describir la prevalencia de síntomas de enfermedades musculoesqueléticas (EME) y la discapacidad física asociada a estos síntomas en un área cubierta por una unidad básica de salud de la familia (UBS) en un área periurbana. También analizamos la asociación de la presencia de estos síntomas con características demográficas y enfermedades crónicas más frecuentes. Métodos: Estudio transversal realizado en el área de cobertura de una UBS periurbana entre agosto de 2018 y febrero de 2019 en el que se entrevistó a personas mayores de 15 años, seleccionadas al azar, mediante la primera fase del cuestionario Community Oriented Program for Control Of Rheumatic Diseases (COPOCORD) traducido y validado al portugués. También se les preguntó sobre la presencia de otras enfermedades diagnosticadas y medicamentos en uso. Además, se tomaron medidas del peso, la altura y la circunferencia de la cintura de cada participante. Los dos primeros se utilizaron para calcular el índice de masa corporal (IMC). Resultados: Fueron entrevistadas 372 personas con una edad media de 46,5 (±18,3) años, de las cuales 212 (57%) eran mujeres. La prevalencia de individuos que presentaron síntomas de enfermedades musculoesqueléticas en los últimos siete días fue del 66,4% (IC 95%: 61,6-71,2). Aproximadamente la mitad (48,6%) y casi una cuarta parte (24,2%) informaron síntomas de intensidad moderada y grave, respectivamente. Las zonas más afectadas fueron la espalda (50,27%), el cuello (34,9%) y las rodillas (30,64%). La gran mayoría, 209/247 (84,6%) refirieron dolor en más de una localización y 129/247 (52,2%) refirieron limitaciones físicas en las actividades de la vida diaria. 102 de los 247 (41,3%) buscaron asistencia médica, la mayoría, 70/102 (68,6%), en la UBS. Las personas con síntomas de DMSQ tenían una edad media y un IMC significativamente más altos que las personas sin estos síntomas. También tenían una mayor frecuencia de diabetes y ansiedad y/o depresión. Sin embargo, en el análisis multivariado, ninguna variable fue un predictor independiente de los síntomas del EMS. Conclusiones: Los síntomas de las enfermedades musculoesqueléticas son prevalentes en esta comunidad y la atención primaria debe estar preparada para el manejo y rehabilitación de las personas con estas enfermedades.

Perfil epidemiológico dos acidentes por material biológico em médicos da atenção primária em Minas Gerais, de 2012 a 2021 / Epidemiological profile of accidents involving biological material among primary health care physicians in Minas Gerais, from 2012 to 2021 / Perfil epidemiológico de accidentes por material biológico en médicos de atención primaria en Minas Gerais, de 2012 a 2021

Introdução: Os acidentes ocupacionais com material biológico representam um problema de saúde pública. A exposição ocupacional dos profissionais da saúde configura-se como um risco de transmissão de diversos patógenos. Na literatura, há carência de estudos que analisem o perfil dos acidentes com material biológico nos médicos da atenção primária. Objetivo: Buscou-se compreender o perfil epidemiológico dos acidentes com material biológico em médicos da atenção primária em Minas Gerais. Métodos: Estudo epidemiológico descritivo com análise do perfil dos acidentes com material biológico em médicos da atenção primária em Minas Gerais, utilizando dados secundários. Resultados: No período analisado, foram registrados 111 acidentes com material biológico, dos quais 54% ocorreram somente em 2020 e 2021. A maioria dos casos deu-se em mulheres (59%), e os tipos mais frequentes de exposição foram mucosa (38%) e percutânea (33%). Dos médicos, 23% não possuíam esquema vacinal contra a hepatite B completo. Em média, em 36% dos acidentes os testes sorológicos foram negativos e em 61% não foram realizados ou o campo foi ignorado/deixado em branco. Em apenas 7,2% dos casos a quimioprofilaxia foi indicada, mas ressaltam-se os registros ignorados ou em branco. Mais da metade dos acidentados não emitiu a Comunicação de Acidente de Trabalho (CAT). Conclusões: Os acidentes com material biológico predominam em médicas e nas formas de exposição mucosa e percutânea. Investimentos em medidas de biossegurança e educação permanente são necessários para prevenir casos e estimular sua notificação.

Introduction: Occupational accidents with biological material represent a public health problem. The occupational exposure of health professionals represents a risk of transmission of various pathogens. In the literature, there is a lack of studies that analyze the profile of accidents with biological material among primary health care physicians. Objective: We aimed to understand the epidemiological profile of accidents involving biological material among primary health care physicians in Minas Gerais, Brazil. Methods: Descriptive epidemiological study that analyzed the profile of accidents with biological material among primary health care doctors in Minas Gerais, using secondary data. Results: In the period analyzed, 111 accidents with biological material were recorded, of which 54% occurred only in 2020 and 2021. Most cases occurred in women (59%) and the most frequent types of exposure were mucosal (38%) and percutaneous (33%). About a quarter (23%) of physicians did not have a complete immunization record for hepatitis B. On average, in 36% of accidents serological tests were negative and in 61% they were not performed or the field was ignored/left blank. In only 7.2% of cases, chemoprophylaxis was indicated, but ignored or blank records stood out. More than half of the victims did not fill out a work accident report. Conclusions: Accidents with biological material predominate in female doctors and in forms of mucosal and percutaneous exposure. Investments in biosafety measures and permanent education are necessary to prevent cases and encourage their notification.

Introducción: Los accidentes de trabajo con material biológico representan un problema de salud pública. La exposición ocupacional de los profesionales de la salud representa un riesgo de transmisión de varios patógenos. En la literatura faltan estudios que analicen el perfil de accidentes con material biológico en médicos de atención primaria. Objetivo: Buscamos comprender el perfil epidemiológico de los accidentes con material biológico en médicos de atención primaria en Minas Gerais. Métodos: Estudio epidemiológico descriptivo con análisis del perfil de accidentes con material biológico en médicos de atención primaria en Minas Gerais, utilizando datos secundarios. Resultados: En el período analizado se registraron 111 accidentes con material biológico, de los cuales el 54% ocurrió solo en 2020 y 2021. La mayoría de los casos ocurrieron en mujeres (59%) y los tipos de exposición más frecuentes fueron mucosa (38%) y percutánea (33%). El 23% de los médicos no disponía de un calendario completo de vacunación frente a la hepatitis B. En promedio, en el 36% de los accidentes, las pruebas serológicas fueron negativas y en el 61% no se realizó o se ignoró/dejó el campo en blanco. Solo en el 7,2% de los casos se indicó quimioprofilaxis, pero destacan los registros ignorados o en blanco. Más de la mitad de las víctimas no emitieron el CAT. Conclusiones: Predominan los accidentes con material biológico en médicas y en formas de exposición mucosa y percutánea. Son necesarias inversiones en medidas de bioseguridad y educación permanente para prevenir casos e incentivar su notificación.

Estratificación del riesgo de dengue - San José del Guaviare, Guaviare- Colombia, 2022 / Dengue risk stratification - San José del Guaviare, Guaviare- Colombia, 2022

Resumen Introducción: el dengue es una enfermedad endémica en el municipio de San José del Guaviare. En el 2010, el 2014, el 2018 y el 2022 se registraron epidemias. Sin embargo, a pesar de ser endémico, este no cuenta con una focalización que permita priorizar acciones. Objetivo: estratificar el riesgo de dengue en el municipio de San José del Guaviare en 2022, mediante el uso de variables epidemiológicas, entomológicas, socioeconómicas y ambientales para la planificación de acciones de prevención y control. Métodos: se realizó un estudio descriptivo de corte transversal. Se categorizó el nivel de riesgo para dengue de los barrios del municipio, integrando la persistencia e incidencia acumulada de dengue, índice pupal de Aedes aegypti, estrato socioeconómico y acceso de agua potable. La categorización de cada una de las variables se realizó por terciles, se calcularon medidas de tendencia central (promedio, mediana). Para su análisis la información fue procesada y organizadas en tablas y cartografía de riesgo. Resultados: en la variable entomológica, el 43,5% (10/23) de los barrios presentaron un alto índice de pupas Aedes aegypti. En la variable epidemiológica, el 52,3% (23/44) de los barrios se categorizaron en alta transmisión. En la variable ambiental, el 76,2% (32/42) de los barrios se categorizaron en nivel de riesgo medio. Según la variable socioeconómica, el 83,3% (35/42) de los barrios se categorizaron en riesgo alto. Al integrar las variables analizadas, los barrios se categorizaron para la transmisión de dengue en: riesgo muy alto 23,4% (11/47), riesgo alto 31,9% (15/47), riesgo medio 8,5% (4/47) y riesgo bajo 34,0% (16/47). Conclusiones: en la integración final de riesgo aquellos barrios que se clasificaron en muy alto y alto riesgo para la transmisión de dengue, se deben focalizar las acciones de control, promoción y prevención del municipio. Igualmente, se debe continuar con la estratificación en períodos estacionales por cambios en las condiciones ecológicas del vector y dinámicas de transmisión.

Background Dengue is an endemic disease in this municipality, epidemics were recorded in 2010, 2014, 2018 and 2022. Despite being endemic, it does not have a focus that allows prioritizing actions. The objective of this research was to stratify the risk of dengue in the municipality of San José del Guaviare in 2022, through the use of epidemiological, entomological, socioeconomic and environmental variables for the planning of prevention and control actions. Methods: A descriptive cross-sectional study was carried out. The level of risk for dengue in the neighborhoods of the municipality was categorized, integrating the persistence and cumulative incidence of dengue, Aedes aegypti pupal index, socioeconomic stratum, and access to drinking water. The categorization of each of the variables was carried out by tertiles, measures of central tendency (mean, median) were calculated. For its analysis, the information was processed and organized into tables and risk cartography. Results: In the entomological variable, 43.5% (10/23) of the neighborhoods had a high rate of Aedes aegypti pupae. In the epidemiological variable, 52.3% (23/44) of the neighborhoods were categorized as having high transmission. In the environmental variable, 76.2% (32/42) of the neighborhoods were categorized as a medium risk level. According to the socioeconomic variable, 83.3% (35/42) of the neighborhoods were categorized as high risk. By integrating the variables analyzed, the neighborhoods were categorized for dengue transmission as: very high risk 23.4% (11/47), high risk 31.9% (15/47), medium risk 8.5% (4 /47) and low risk 34.0% (16/47). Conclusions: In the final integration of risk, those neighborhoods that were classified as very high and high risk for dengue transmission should focus on the control, promotion and prevention actions of the municipality. Continue with the stratification in seasonal periods due to changes in the ecological conditions of the vector and transmission dynamics.

Rastreamento da síndrome metabólica em participantesdo programa Universidade Aberta da Terceira Idade / Metabolic syndrome screening in the participantsat the Open University of the Third Age

Hábitos alimentares inadequados, sedentarismo e a maior expectativa de vida da população contribuem significativamente para a prevalência da síndrome metabólica. Essa doença predispõe uma pessoa a desenvolver diabetes mellitus tipo 2 e doenças cardiovasculares, as quais têm um amplo impacto na saúde pública, induzindo sobrecarga no sistema de saúde e reduzindo a qualidade de vida dos indivíduos afetados. A síndrome metabólica é uma doença multifatorial e está relacionada ao processo de envelhecimento, contudo, ainda há uma lacuna significativa, em termos de estudos, sobre a prevalência da condição em populações idosas. Nesse contexto, o presente estudo objetivou rastrear a prevalência da síndrome metabólica em participantes da Universidade Aberta da Terceira Idade (UNATI), localizada em Francisco Beltrão, Paraná. Os critérios diagnósticos de síndrome metabólica abordados nesta pesquisa incluem: circunferência abdominal ≥ 90 cm para homens e ≥ 80 cm para mulheres, triglicerídeos ≥ 150 mg/dL, HDL ≤ 40 mg/dL para homens e ≤ 50 mg/dL para mulheres, pressão arterial sistólica ≥ 130 mmHg e/ou pressão arterial diastólica ≥ 85 mmHg ou estar em farmacoterapia para hipertensão, além de glicemia de jejum ≥ 100 mg/dL ou estar em tratamento farmacológico para diabetes. Um total de 44 idosos foram avaliados, apresentando uma média de idade de 66,9 ± 7,1 anos, com uma predominância de mulheres (88%). Os resultados revelaram uma prevalência alarmante de síndrome metabólica, atingindo 36,4% da amostra estudada. Além disso, observou-se uma alta prevalência de condições associadas, como hipertensão arterial (67,2%), sobrepeso (58,6%) e obesidade visceral (31%). Esses achados ressaltam a importância da implementação de medidas preventivas direcionadas à promoção da qualidade de vida saudável e ao controle dos fatores de risco metabólicos.

Inadequate dietary habits, sedentary lifestyle, and increased life expectancy significantly contribute to the prevalence of metabolic syndrome. This condition predisposes an individual to develop type 2 diabetes mellitus and cardiovascular diseases, which have a broad impact on public health, inducing a burden on the healthcare system and reducing the quality of life of affected individuals. Metabolic syndrome is a multifactorial disease and is related to the aging process; however, there is still a significant gap in terms of studies on the prevalence of the condition in elderly populations. In this context, this study aimed to screen the prevalence of metabolic syndrome in participants of the Open University for the Third Age (UNATI), located in Francisco Beltrão, Paraná. The diagnostic criteria for metabolic syndrome addressed in this research include: abdominal circumference ≥ 90 cm for men and ≥ 80 cm for women, triglycerides ≥ 150 mg/dL, HDL ≤ 40 mg/dL for men and ≤ 50 mg/dL for women, systolic blood pressure ≥ 130 mmHg and/or diastolic blood pressure ≥ 85 mmHg or being on pharmacotherapy for hypertension, in addition to fasting glucose ≥ 100 mg/dL or being on pharmacological treatment for diabetes. A total of 44 elderly individuals were evaluated, with a mean age of 66.9 ± 7.1 years, predominantly women (88%). The results revealed an alarming prevalence of metabolic syndrome, affecting 36.4% of the studied sample. Furthermore, a high prevalence of associated conditions was observed, such as arterial hypertension (67.2%), overweight (58.6%), and visceral obesity (31%). These findings underscore the importance of implementing preventive measures aimed at promoting healthy lifestyles and controlling metabolic risk factors.

Towards an update on the antimicrobial use in Adult Care Units in Brazil: insights from multi-hospital prevalence study.

Introduction. Efforts to understand the burden of antibiotic use in low- and middle-income countries such as Brazil are essential for developing strategies that are effective and appropriate in the context of endemic multidrug-resistant organisms.Aim. This study aims to determine antimicrobial-prescribing practices among patients hospitalized in intensive care units (ICUs) for adults in Brazil.Methodology. A 1-day point prevalence multicentre survey was conducted in 58 adult ICUs across the five regions of Brazil. The institutions were categorized according to their type and size. Detailed antimicrobial prescription data were prospectively provided to all patients hospitalized on the day of data collection.Results. A total of 620 patients were included in the study, of whom 63.9% were receiving at least one antimicrobial. Of these, 34.6% were treated for an infection, but only 39.9% of the cases were based on microbiological criteria. Empirical treatment was applied to 72.3% of the patients. Significant differences in antibiotic usage were observed across the different hospitals included in the study. Overall, treatment was most commonly directed towards pneumonia (51.8%) and bloodstream infections (29.6%). Glycopeptides (19.4%) and carbapenems (18.5%) were the most prescribed in teaching hospitals, while in non-teaching hospitals, carbapenems (17.8%) and broad-spectrum cephalosporins (16.8%) were most frequently used.Conclusion. Our study reveals alarming data on antibiotic use in adult ICUs in Brazil, with high frequencies of severe healthcare-associated infections acquired in these units, where patients are frequently subjected to empirical treatment.

Total dietary antioxidant capacity and food groups and their relationship with the sleep time of Brazilian graduates (CUME Study).

To investigate the association between the Dietary Total Antioxidant Capacity (dTAC) and the Total Antioxidant Capacity of food groups (fgTAC) with the sleep time of Brazilian graduates participating in the Cohort of Universities of Minas Gerais (CUME Study). This cross-sectional study analyzed 6,387 graduates (2,052 men, 4,335 women, 35.3 ± 9.3 years old) from the CUME Study. Data was collected online, and dTAC was obtained by the Ferric Reduction Antioxidant Power (FRAP) method. Daily sleep time was classified as short sleep, normal sleep, and long sleep (≤6, 7-8, and ≥9 h, respectively). Multinomial logistic regression models were used to estimate the Odds Ratio (OR) and its 95% Confidence Interval (95% CI) between short sleep and long sleep with quartiles of dTAC and the fgTAC. Lower odds of short sleep was observed for the third quartile of dTAC and for fourth quartile of fgTAC of fruits, beans, and lentils, and for the third quartile of fgTAC of vegetables and oils and fats. Higher odds of short sleep for the fourth quartile of fgTAC of teas and coffees. For long sleep, inverse associations were observed for the fourth quartile of fgTAC of oilseeds and the third quartile of fgTAC of teas and coffees. Higher odds of long sleep were observed for the third quartile of artificial juices and sodas. We cannot independently assert an association between higher dTAC and sleep time. In turn, the associations between sleep time and fgTAC show the importance of the food matrix that antioxidants are inserted, requiring longitudinal studies to observe the direction of associations.

Socioeconomic factors and COVID-19 mortality in immune-mediated rheumatic diseases patients: regional analysis from Argentina, Mexico and Brazil.

BACKGROUND: SARS-CoV-2 infection has become a major international issue, not only from a medical point of view, but also social, economic and political. Most of the available information comes from the United States, Europe, and China, where the population and the socioeconomic status are very different from Latin American countries. This study evaluates the effect of regional socioeconomic characteristics on mortality due SARS-CoV-2 infection in patients with immune-mediated rheumatic diseases (IMRD) from Argentina, Mexico and Brazil. METHODS: Data from three national registries, SAR-COVID (Argentina), CMR-COVID (Mexico) and ReumaCoV-Brasil (Brazil), were combined. Adult IMRD patients with SARS-CoV-2 infection were recruited. National data for each province/state, including population density, number of physicians per inhabitant, income, unemployment, GINI index, Municipal Human Development Index (MHDI), stringency index, vaccination rate and most frequent viral strains per period were assessed as risk factors for mortality due to COVID-19. RESULTS: A total of 4744 patients were included, 2534 (53.4%) from SAR-COVID, 1166 (24.6%) from CMRCOVID and 1044 (22.0%) from ReumaCoV-Brasil. Mortality due to COVID-19 was 5.4%. In the multivariable analysis, higher number of physicians per 1000 inhabitants and being infected during the vaccination period of each country were associated with lower mortality. After adjustment for socioeconomic factors, there was no association with country of residence and mortality. CONCLUSION: These findings corroborate the complex interplay between socioeconomic factors, rheumatic disease activity, and regional disparities as determinants of death due to COVID-19 in Argentina, Brazil and Mexico. Thus, this research provides valuable insights for guiding public health policies and clinical practice in the ongoing fight against the COVID-19 pandemic.

Microsporum audouinii: Emergence of an etiological agent of tinea capitis in Rio de Janeiro, Brazil (2012-2019).

The etiology of tinea capitis changes over time, mainly due to trends in migration. We report 19 cases of tinea capitis caused by Microsporum audouinii, an uncommon agent in South America, all of them confirmed by molecular methods. All patients were male. The average age was 6.1 years. Fifteen patients were residents of Rio de Janeiro city and four were from neighboring cities. Among the patients submitted to follow-up, griseofulvin was prescribed for eight of them. Due to medication shortages, terbinafine was prescribed for five patients, needing to be switched in three cases, with a bigger total average time until clinical improvement. The study reaffirms the emergence of a new etiological agent in Rio de Janeiro, Brazil.

The etiology of tinea capitis changes over time, mainly due to migratory flows. We report 19 cases of tinea capitis caused by Microsporum audouinii, an uncommon agent in South America, all of them confirmed by molecular methods. The study reaffirms the emergence of a new etiological agent in Rio de Janeiro, Brazil.

Physical Activity Report Card Indicators and the United Nations Sustainable Development Goals: Insights From Global Matrix 4.0.

BACKGROUND: The World Health Organization recognizes that physical activity (PA) during childhood is crucial for healthy development, aligning well with the achievement of several United Nations (UN) Sustainable Development Goals (SDGs). This study aimed to explore the associations between 10 key indicators of PA for children and adolescents assessed in the Global Matrix 4.0 project, and the UN SDGs. METHODS: Data from 57 countries/jurisdictions of the Global Matrix 4.0 project were used. The UN SDG indicators were sourced from the SDG Transformation Center, which publishes each country's performance on each of the 17 SDGs. Given the robust evidence supporting plausible links between PA and SDGs 3 (good health and well-being), 9 (industry, innovation, and infrastructure), 11 (sustainable cities and communities), 13 (climate action), and 16 (peace, justice, and strong institutions), these SDGs were investigated. RESULTS: Countries/jurisdictions with good and moderate performance in achieving SDG 3, SDG 9, SDG 11, and SDG 16 had higher grades than countries/jurisdictions with fair performance in achieving these SDGs for the following indicators: Organized Sports and PA, Community and Environment, and Government Investments and Strategies. However, countries/jurisdictions with good performance in achieving SDG 13 had lower grades than countries/jurisdictions with fair performance in achieving SDG 13 for the following indicators: Organized Sports and PA, Community and Environment, and Government Investments and Strategies. CONCLUSIONS: Organized Sports and PA, Community and Environment, and Government Investments and Strategies were the indicators that demonstrated differences between countries/jurisdictions with good and poor performance in achieving the SDGs.

Adherence to the EAT-Lancet sustainable diet and ultra-processed food consumption: findings from a nationwide population-based study in Brazil.

OBJECTIVE: To evaluate the association between ultra-processed food consumption and adherence to the EAT-Lancet diet in a representative sample of the Brazilian population. DESIGN: The study used data from the Brazilian National Dietary Survey 2017-2018 and employed linear regression models to evaluate the association between ultra-processed food consumption and adherence to the EAT-Lancet diet, as measured by the Nova food system and Planetary Health Diet Index (PHDI), respectively. SETTING: Nationally representative sample of the Brazilian population. PARTICIPANTS: The study included 46 164 Brazilians ≥ 10 years old. RESULTS: The average PHDI total score was 45·9 points (95 % CI 45·6, 46·1). The ultra-processed food consumption was, with dose-response, inversely associated with the adherence to the EAT-Lancet diet. The PHDI total score was 5·38 points lower (95 % CI -6·01, -4·75) in individuals in the highest quintile of consumption of ultra-processed foods, as compared to those in the first quintile. The PHDI score was also inversely associated with the share of processed culinary ingredients and processed foods and positively associated with the share of unprocessed or minimally processed foods. CONCLUSIONS: Our study showed an inverse relationship between the consumption of ultra-processed foods and the adherence to a healthy and sustainable diet.

Acute kidney injury developed in the intensive care unit: a population-based prospective cohort study in the Brazilian Amazon.

The Brazilian Amazon is a vast area with limited health care resources. To assess the epidemiology of critically ill acute kidney injury (AKI) patients in this area, a prospective cohort study of 1029 adult patients of the three intensive care units (ICUs) of Rio Branco city, the capital of Acre state, were evaluated from February 2014 to February 2016. The incidence of AKI was 53.3%. Risk factors for AKI included higher age, nonsurgical patients, admission to the ICU from the ward, higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores at ICU admission, and positive fluid balance > 1500 ml/24 hours in the days before AKI development in the ICU, with aOR of 1.3 (95% CI 1.03-1.23), 1.47 (95% CI 1.07-2.03), 1.96 (95% CI 1.40-2.74), 1.05 (95% CI 1.03-1.08) for each unit increase, and 1.62 (95% CI 1.16-2.26), respectively. AKI was associated with higher ICU mortality (aOR 2.03, 95% CI 1.29-3.18). AKI mortality was independently associated with higher age, nonsurgical patients, sepsis at ICU admission, presence of shock or use of vasoactive drugs, mechanical ventilation and mean positive fluid balance in the ICU > 1500 ml/24 hours, both during ICU follow-up, with aOR 1.27 (95% CI 1.14-1.43) for each 10-year increase, 1.64 (95% CI 1.07-2.52), 2.35 (95% CI 1.14-4.83), 1.88 (95% CI 1.03-3.44), 6.73 (95% CI 4.08-11.09), 2.31 (95% CI 1.52-3.53), respectively. Adjusted hazard ratios for AKI mortality 30 and 31-180 days after ICU discharge were 3.13 (95% CI 1.84-5.31) and 1.69 (95% CI 0.99-2.90), respectively. AKI incidence was strikingly high among critically ill patients in the Brazilian Amazon. The AKI etiology, risk factors and outcomes were similar to those described in high-income countries, but mortality rates were higher.

Virologic Failure, Clinical Characteristics, and Common Viral Mutations in HIV Patients From Southwestern Colombia: A Nested Case-Control Study.

Introduction Virologic failure due to antiretroviral drug resistance is a threat to efforts to control the human immunodeficiency virus (HIV) epidemic. Understanding the factors that influence the genetic and clinical expression of drug resistance is fundamental for infection control. Methods A nested case-control study was conducted on a cohort of adult HIV patients between 2016 and 2022. The cases were defined as patients with a confirmed diagnosis of virologic failure due to drug resistance, as indicated by a viral genotype result. The control group consisted of patients who had not experienced virologic failure or undergone any documented changes to their antiretroviral treatment. The incidence of virologic failure over a defined period was calculated. The characteristics of each group were documented in frequency tables and measures of central tendency. To identify risk factors, multiple logistic regression models were employed, and post hoc tests were conducted. All calculations were performed with 95% confidence intervals, and p-values less than 0.05 were considered significant. Results The incidence of virologic failure over the seven-year study period was 9.2% (95% CI: 7.5-11.2%). Low CD4 T-lymphocyte count (≤200 cells/mm³) at diagnosis (adjOR 14.2, 95% CI: 3.1-64.5), history of opportunistic infections (adjOR 3.5, 95% CI: 1.9-6.4), and late enrollment into an HIV program after diagnosis (>1 year) (adjOR 9.2, 95% CI: 3.8-22.2) were identified as independent predictors of virologic failure. The drugs with the highest rates of resistance were nevirapine (84.6%), efavirenz (82.4%), emtricitabine (81.3%), lamivudine (81.3%), and atazanavir (6.6%). The most prevalent major mutations identified were K103N, M184V, and M46I/M. Approximately 50% of the secondary mutations were identified in protease regions. Conclusions The incidence of virologic failure was low in the study population. The identified risk characteristics allow for the prediction of the profile of patients susceptible to failure and for the early optimization of treatment regimens.

Genus-targeted markers for the taxonomic identification and monitoring of coagulase-positive and coagulase-negative Staphylococcus species.

The Staphylococcus genus comprises multiple pathogenic and opportunistic species that represent a risk to public health. Epidemiological studies require accurate taxonomic classification of isolates with enough resolution to distinguish clonal complexes. Unfortunately, 16 S rRNA molecular analysis and phenotypic characterization cannot distinguish all species and do not offer enough resolution to assess intraspecific diversity. Other approaches, such as Multilocus Sequence Tagging, provide higher resolution; however, they have been developed for Staphylococcus aureus and a few other species. Here, we developed a set of genus-targeted primers using five orthologous genes (pta, tuf, tpi, groEs, and sarA) to identify all Staphylococcus species within the genus. The primers were initially evaluated using 20 strains from the Collection of Microorganisms of Interest in Animal Health from AGROSAVIA (CMISA), and their amplified sequences were compared to a set of 33 Staphylococcus species. This allowed the taxonomic identification of the strains even on close species and the establishment of intraspecies diversity. To enhance the scope and cost-effectiveness of the proposed strategy, we customized the primer sets for an Illumina paired-end amplicon protocol, enabling gene multiplexing. We assessed five genes across 177 strains, generating 880 paired-end libraries from the CMISA. This approach significantly reduced sequencing costs, as all libraries can be efficiently sequenced in a single MiSeq run at a fraction (one-fourth or less) of the cost associated with Sanger sequencing. In summary, this method can be used for precise identification and diversity analysis of Staphylococcus species, offering an advancement over traditional techniques in both resolution and cost-effectiveness.

V Brazilian Consensus on Rhinitis - 2024.

Since we published the "IV Brazilian Consensus on Rhinitis", in2017, several advances have been achieved and have enabled a further understanding of the different aspects of "Rhinitis". This new guideline, developed jointly by ASBAI, SBP and SBORL, represents a relevant milestone in the updated and integrated management of the different forms of the disease, and it aims to unify evidence-based approaches to improve the diagnosis and treatment of this common and often underestimated condition. The document covers a wide range of topics, including clear definitions of the different phenotypes and endotypes of rhinitis, risk factors, updated diagnostic criteria, and recommended methods for clinical and laboratory investigation. We stress the importance of detailed clinical history and objective assessment, as well as tools for control and assessing severity tools an accurate diagnostic approach to the disease. Regarding treatment, it emphasizes the treatment customization, considering the severity of symptoms, the presence of comorbidities and the impact on the patient's quality of life. We discuss different drug treatment, in addition to non-pharmacological measures, such as environmental control and specific immunotherapy; and the possible role of immunobiological agents. Furthermore, the consensus addresses issues related to patient education, prevention and management of special situations, such as rhinitis in children, in pregnant women and in the elderly. In short, the "V Brazilian Consensus on Rhinitis" represents a comprehensive and updated guide for healthcare professionals involved in the diagnosis and management of rhinitis, aiming to improve patients' quality of life through an integrated and evidence-based approach.

Trends in the incidence and prevalence of cirrhosis in Manitoba, Canada: A population-based study (2010-2019).

INTRODUCTION AND OBJECTIVES: The burden of chronic liver disease and cirrhosis continues to increase in North America. We sought to estimate the incidence and prevalence of cirrhosis in Manitoba, Canada over time and assess changes in trends between 2010-2019. MATERIAL AND METHODS: We performed a population-based study using Manitoba administrative health care data, and two validated case-finding algorithms. Annual incidence and prevalence rates were estimated using a generalized linear model with generalized estimating equations, adjusting for age and sex. Changes in estimates were tested using linear trend regression models. RESULTS: Two algorithms estimated the number of prevalent cirrhosis to be 16,140 and 29,943 respectively. The age- and sex-adjusted incidence rates increased over the study (from 149 to 264 cases per 100,000 population in 2010, to 177 to 388 cases per 100,000 population in 2019). Cirrhosis incidence increased annually by 2-6 %, with the largest increase (6-8 % 95 % CI 7-9 %, p <0.0001) in those aged 18-44 years. Irrespective of the algorithm used, females consistently exhibited higher cirrhosis incidence and prevalence compared to males over time (P <0.0001). Prevalence demonstrated an upward trend among all age groups over time for both algorithms (P < 0.0001). CONCLUSIONS: This population-based study highlights concerning temporal trends in cirrhosis, characterized by rising annual incidence and prevalence estimates, particularly among young adults and females. These findings underscore the urgent need for comprehensive strategies that encompass prevention, early detection, and the delivery of high-quality healthcare and public health initiatives to effectively tackle this escalating health burden.

An integrative analysis of SARS-CoV 2 during the first and second waves of COVID-19 in Salta, Argentina.

Wastewater surveillance has been extensively applied to provide information about SARS-CoV-2 circulation in the community. However, its applicability is limited in regions lacking adequate sewerage infrastructure, without wastewater treatment plants (WWTP) or with insufficient coverage. During the COVID-19 pandemic, from July 2020 to September 2021, comprehensive epidemiological data encompassing positive, recovered, and deceased cases were collected alongside precipitation records. Additionally, wastewater samples from 13 main sewersheds and river water from two points (up- and downstream the main WWTP), in the city of Salta, were gathered. A total of 452 water samples were analyzed for quantitative detection of SARS-CoV-2 using reverse transcription real-time PCR. Across the 62-week study period, two distinct waves of COVID-19 were identified. The dynamics of deceased cases showed peaks 10 and 28 days after the peaks of positive cases in the first and second waves, respectively. Downstream river water exhibited higher fecal contamination than the upstream samples, evincing the impact of the WWTP discharges. Viral concentration in river waters mirrored those from wastewater, reflecting the progression of cases. Despite the lower reported number of cases during the first wave in comparison to the second (5420 vs. 8516 cases at the respective peaks), higher viral concentrations were detected in water samples (1.97 × 107 vs. 2.36 × 106 gc/L, respectively), suggesting underreporting during the first wave, and highlighting the positive effect of vaccination during the second. To the best of our knowledge, this is the first study that simultaneously and systematically analyzed surface water and wastewater over a prolonged period, the effect of precipitations were considered for the variations in the concentrations, and the findings compared with epidemiological information. Environmental surveillance was demonstrated to be a great tool to obtain valuable information about the circulation patterns of SARS-CoV-2, especially under resource constraints to massively test the population, thus, underreporting cases. Furthermore, the methodology employed herein can be easily expanded to the community-level surveillance of other pathogens excreted in urine and feces, encompassing viruses, bacteria, and protozoa.

Refractive error and ocular alignment in school-aged children from low-income areas of São Paulo, Brazil.

BACKGROUND: Uncorrected refractive errors and amblyopia are reported as the two main causes of childhood visual impairment and blindness worldwide. Our purpose was to evaluate refractive status, ocular alignment and effective refractive error coverage (eREC) of school-aged children from low-income areas of Sao Paulo city, Brazil. METHODS: Data from the "Ver na Escola" Project were used for the current study. Children enrolled in the selected schools had an ophthalmic exam including eye alignment assessed by cover test, automatized and subjective dynamic and static refraction. The associations of demographic variables with occurrence and magnitude of refractive errors and eREC were investigated by multiple logistic regressions and multilevel mixed effect models. RESULTS: A total of 17,973 children (51.12% females) with mean ± sd age 8.24 ± 3.54 years old examined from July 2018 to July 2019, were included in the study. Most of the participants (73%) showed orthoposition of the visual axis for both distance and near. Heterophoria was found in about 25% of participants (N = 4,498), with 71.7% of them (N= 3,222) classified as exophoria. Less than 2% (N = 232) showed strabismus, most of them (N = 160) esotropia. Overall, 1,370 (7.70%) of participants had myopia and 577 (3.24%) had hyperopia. Age was found to be significantly associated with increasing static subjective refraction spherical equivalent (Coefficient: -0.18; 95% Confidence Interval (CI): -0.21 to -0.16; p < 0.001). Female sex (Odds Ratio (OR) = 1.13; 95%CI: 1.01-1.27; p = 0.027) and older age (OR = 1.17; 95%CI: 1.16-1.19; p < 0,001) were significantly associated with myopia diagnosis. Older age decreased the odds of hyperopia (OR = 0.95; 95%CI: 0.93-0.98; p < 0.001). The overall effective refractive coverage was 51.76% and was significantly associated with age group, ranging from 32.25% in children aged 3 to 7 years to 61.35% in children aged 8 to 12 years. CONCLUSIONS: Most children have shown eye alignment for both distance and near assessments and no refractive error. Myopia was observed in 7.70% of the population and it was associated with older age and female sex. Hyperopia was observed in 3.24% and was associated with younger age. The overall eREC was 51.76%, significantly associated with age.