Mortality by road transport injury in Brazilian municipalities between 2000 and 2018.

OBJECTIVES: This study aimed to investigate patterns of mortality by road transport injury (RTI) in Brazilian municipalities, focused on deaths of motorcyclists, between 2000 and 2018, and their relation with population size and economic status. STUDY DESIGN: This was an ecological epidemiological study with a descriptive and analytical nature. METHODS: The age-standardized RTI mortality rates were calculated for the Brazilian municipalities, referring to the 3-year periods of 2000/2002 (T1), 2009/2011 (T2), and 2016/2018 (T3). The rates were stratified according to macroregion and population size and were compared in terms of percentage variation from one 3-year period to another. The Moran Global and Local indices were used in the spatial point-pattern analysis of the rates. To verify the association with the gross domestic product (GDP) per capita, the Spearman correlation coefficient was applied. RESULTS: A decline in RTI mortality rates was found between 2000 and 2018, with the most significant declines observed in municipalities from the South and Southeast regions of Brazil. However, increases were observed among motorcyclists. Clusters of municipalities were detected, which presented high mortality rates among the motorcyclists in the Northeast region and in some states of the North and Midwest regions. The mortality rates showed a negative correlation with the GDP per capita of the Brazilian municipalities. CONCLUSIONS: Although there were decreases in RTI mortality rates between 1990 and 2018, there was a significant increase in deaths among motorcyclists, especially in the Northeast, North, and Midwest regions of the country. Such differences can be explained by unequal growth in the size of the motorcycle fleet in those regions, by less law enforcement capability, and by the implementation of educational actions.

Survival on waiting list for liver transplantation before and after introduction of the model for end-stage liver disease score.

BACKGROUND: Since July 2006, the Model for End-stage Liver Disease (MELD) score has served as the national basis for allocation of donor livers for transplantation in Brazil. Patients with higher MELD scores receive greater priority for allocation regardless of the time on the waiting list. PURPOSE: To investigate the impact of MELD score implementation on the survival of waiting list patients. METHODS: A retrospective study of patients registered at the national Organ Procurement Organization (OPO) for the liver transplantation waiting list between January 2004 and June 2006 (pre-MELD) and between July 2006 and December 2008 (post-MELD). RESULTS: We included listed patients awaiting liver transplantation in the pre-MELD era (n = 250, 48.4%) and in the post-MELD era (n = 266, 51.6%). The times awaiting transplant prior to and after the MELD system were 487.2 +/- 384.8 days and 183.9 +/- 157.2 days, respectively. Prior to the MELD score, waiting list survivals were greater when compared to rates in the current system. Early posttransplant patient survival rates were significantly reduced in the post-MELD era (83.4%) compared to the period before MELD implementation (93.2%). CONCLUSIONS: MELD score provides a transparent, objective system to drive allocation policy; however, it presents several important limitations. Constant need of changes and reevaluation are needed as an evolutionary process. Future changes in the present system may be addressed by adjusting the MELD system.

Pseudoaneurysm of cystic artery after laparoscopic cholecystectomy.

BACKGROUND: The formation of a pseudoaneurysm of the cystic artery is a rare occurrence after laparoscopic cholecystectomy. CASE OUTLINE: Seven weeks after laparoscopic cholecystectomy, a 31-year-old woman presented with a picture of obstructive jaundice. The diagnosis of cystic artery aneurysm was verified by arteriography, CT and MRCP. At laparotomy the pseudoaneurysm was found to be compressing the common bile duct. It was successfully managed by ligation of the right hepatic artery. DISCUSSION: Although this complication is rare, the surgeon must have a high index of suspicion to make the diagnosis.

[Differential patterns of neonatal and post-neonatal mortality rates in Goiânia, Brazil, 1992-1996: use of spatial analysis to identify high-risk areas]. / Diferenças no padrão de ocorrência da mortalidade neonatal e pós-neonatal no Município de Goiânia, Brasil, 1992-1996: análise espacial para identificação das áreas de risco.

The aim of this study was to investigate the spatial pattern of neonatal and post-neonatal mortality in the city of Goiânia, Central Brazil. Analyses were based on linked birth and death certificates relating to 101,000 in-hospital live births from mothers residing in the city of Goiânia over the 1992-1996 period. Overall neonatal and post-neonatal mortality probabilities were calculated using the linked database. The empirical Bayes method was applied to smooth the estimated rates and minimize random fluctuation. Spatial units of analysis were 65 urban districts, corresponding to the urban planning sectors. The following exploratory spatial analyses were applied: "global" Moran's I statistic, local Moran LISA map, and Gi* local statistics. For both neonatal and post-neonatal mortality there was statistically significant spatial autocorrelation. Results of post-neonatal mortality showed a high-risk cluster located on the outskirts of the city. For the neonatal period, a heterogeneous mortality pattern was found with high-risk districts in all regions, including central areas.

Anogenital warts in children: sexual abuse or unintentional contamination?

Anogenital warts (AGW) were recently recognized in children, and their significance as an index of childhood sexual abuse is controversial. We report our transdisciplinary approach (including a pediatric surgeon, psychologist, social worker, ethics expert, and occasionally law enforcement agents) and its results in a group of 17 children with AGW treated at the public pediatric referral hospital in Rio de Janeiro, Brazil, during a 3-year period (1996-1999). All children were treated by electrocauterization of the warts, tested for other STDs, and submitted to perineal examination under anesthesia. Families received psycho-social counseling as necessary and cases were referred to child protection and law enforcement agents when indicated according to Brazilian legislation. We identified a high incidence of sexual abuse (8 children, 5/7 > 5 years old), with 3 patients inconclusive as to sexual abuse and 7 cases of perinatal transmission (5/8 < 4 years old). We conclude that AGW are indeed a strong sign of suspicion for sexual abuse in children, especially but not exclusively > 5 years of age. However, strong support and a transdisciplinary approach to the children and their families is necessary to identify it.

[Risk factors for neonatal and post-neonatal mortality in the Central-West region of Brazil: linkage between live birth and infant death data banks]. / Fatores de risco para mortalidade neonatal e pós-neonatal na Região Centro-Oeste do Brasil: linkage entre bancos de dados de nascidos vivos e óbitos infantis.

This article focused on risk factors for neonatal and post-neonatal mortality by linking live births and infant death records. The study was conducted in the municipality of Goiânia, in the Central-West region of Brazil. A total of 20,981 live births and 342 infant deaths constitute the retrospective cohort. Neonatal and post-neonatal mortality risks were estimated in this cohort study of live births by logistic regression. In the neonatal period, the highest ORs were for delivery in public hospitals (OR = 2.28; 95% CI 1.57-3.32), pre-term neonates (OR = 8.94; 95% CI 5.85-13.67), and low birth weight (OR = 8.92; 95% CI 5.77-13.79). Cesarean delivery appeared as a protective factor (OR = 0.58; 95% CI 0.43-0.78). For post-neonatal mortality, the highest ORs were for illiterate mothers (OR = 6.25; 95% CI 1.25-31.27), low birth weight (OR = 3.12; 95% CI 1.67-5.84), and delivery in public hospitals (OR = 2.65; 95% CI 1. 13-6.23). The linkage identified socioeconomic variables that were more important risk factors for post-neonatal than neonatal mortality.

[Surveillance of endemic diseases in urban areas: the interface between census tract maps and morbidity data]. / Vigilância de doenças endêmicas em áreas urbanas: a interface entre mapas de setores censitários e indicadores de morbidade.

In this article we discuss the methodological issues associated with the creation of a surveillance system for endemic diseases in urban areas based on analysis of populations at risk and on spatially referenced epidemiological indicators. We comment on the system's basic requirements, selection criteria for socioeconomic variables, and methodological steps to combine these variables so as to construct a census-based deprivation index. We also present the ways we solved some operational problems related to generation of digitized census tracts maps and linkage of morbidity data from different sources. This approach, spatial organization into account in surveillance of endemic diseases, exemplified here by tuberculosis and leprosy, allows for the interaction of several official data sets from census and health services in order to geographically discriminate inner-city risk strata. Criteria for constructing these risk strata were considered a useful tool for health planning and management activities for the control of endemic diseases in cities.

Assessment of anti-PGL-I as a prognostic marker of leprosy reaction.

The anti-phenolic glycolipid-I (PGL-I) assay as currently applied for leprosy is conceived as an early marker of asymptomatic infection, early disease diagnosis and cure monitoring. Its use as a prognostic marker of reaction is still a matter of controversy. We conducted a case-control study to investigate whether IgM and IgG anti-PGL-I antibodies could discriminate patients at increased risk of developing reactions. Eligible cases were untreated leprosy patients at the onset of type 1 and type 2 reactions recruited from among 600 concurrent, newly detected, untreated leprosy patients attending an outpatient clinic in central Brazil. For the patients with reaction, approximately the same number of leprosy cases without reaction matched as to bacterial index (BI), age and gender were randomly selected. Individuals without clinical leprosy were evaluated as healthy controls. Sera from type 1 reaction (N = 43) and type 2 reaction (N = 26) patients were tested by an ELISA using PGL-I synthetic disaccharide-BSA antigen and 1:300 sera dilution (cut-off point > or = 0.2 OD). Antibody profiles were evaluated by exploratory data analysis and reverse cumulative distribution curves. The IgG anti-PGL-I response did not have a defined pattern, being detected only at low levels. Our results indicate that leprosy patients, independently of their reactional status, produce high levels of IgM anti-PGL-I, demonstrating a strong correlation between the magnitude of antibody response and the BI. Patients with a higher BI were at least 3.4 times more prone to produce an antibody response compared to healthy controls.

Spatial patterns of leprosy in an urban area of central Brazil.

Reported is the spatial variation of leprosy in an urban area of Brazil and its correlation with socioeconomic indicators. From November 1991 to October 1992 a total of 752 newly diagnosed leprosy patients who were attending all outpatient clinics in Goiânia city, central Brazil, were identified. A database o leprosy cases was set up linking patients' addresses to 64 urban districts. Leprosy cases were detected in 86% of the districts and three risk strata were identified. The highest-risk area for leprosy was in the outskirts of the city and detection rates increased on moving from more developed to poorer areas. The risk of detecting leprosy cases was 5.3-fold greater (95% CI: 3.8-7.4) in the outskirts of the town than in the central zone. Discussed are the methodological issues related to leprosy case ascertainment, completeness and reliability of information, and the interpretation of the spatial distribution of leprosy per unit area. Highlighted also are the lack of leprosy control activities in primary health care units and the usefulness of geographical analysis in planning health services.