Association between sickle cell disease and the oral health condition of children and adolescents.

BACKGROUND: Sickle cell disease (SCD) is the most prevalent monogenic hereditary pathology associated with the presence of hemoglobin SS in the world. It can affect individuals, leading to changes in the face and body, causing a deficiency in dental and bone tissue formation that can ultimately result in a higher level of predisposition to developing dental caries. This study aimed to evaluate the oral condition of children and adolescents with SCD in comparison with the condition of healthy controls. METHODS: This was a cross-sectional study of children and adolescents aged 5 to 18 of both sexes from a hematology center in Bahia, Brazil, and subjects without hemoglobinopathies from a public school of the same state (comparison group). There were 124 individuals, 63 in the comparison group and 61 in the disease group. Interviews, dental and periodontal exams using the DMFT and Periodontal Community Index, respectively, were performed, and the salivary buffer capacity and salivary flow rates of the entire sample population were evaluated. The categorical variables were compared using a chi-square test or Fisher's exact test. For comparison of means, the Student's-t test was used for independent samples that presented symmetrical distribution. RESULTS: The study showed that the DMFT was 2.08 (2.71) for the SCD group and 1.05 (1.67) for the comparison group (p = 0.013). For dmft, the values were 2.3 (2.6) and 0.88 (1.2), respectively, (p = 0.018). Exams of the periodontium showed the presence of gingival bleeding and dental calculus, with no statistical significance between groups (p = 0.984). When evaluating salivary flow and buffer capacity, no significant differences were observed for the flow rates (p = 0.485), but the SCD group presented a lower buffer capacity compared with the comparison group (p = 0.006). Individuals who used hydroxyurea had a dmft (2.50) higher than that of the comparison group (2.00), and salivary flow was lower than the normal rate in 70% of the children who did not use this medication. CONCLUSION: Children and teenagers with SCD had deficient oral health when compared with the comparison group, presenting a higher level of dental caries and lower buffer capacity.

Enzyme replacement therapy for Anderson-Fabry disease.

BACKGROUND: Anderson-Fabry disease is an X-linked defect of glycosphingolipid metabolism. Progressive renal insufficiency is a major source of morbidity, additional complications result from cardio- and cerebro-vascular involvement. Survival is reduced among affected males and symptomatic female carriers.This is an update of a Cochrane review first published in 2010, and previously updated in 2013. OBJECTIVES: To evaluate the effectiveness and safety of enzyme replacement therapy compared to other interventions, placebo or no interventions, for treating Anderson-Fabry disease. SEARCH METHODS: We searched the Cystic Fibrosis and Genetic Disorders Group's Inborn Errors of Metabolism Trials Register (date of the most recent search: 08 July 2016). We also searched 'Clinical Trials' on The Cochrane Library, MEDLINE, Embase and LILACS (date of the most recent search: 24 September 2015). SELECTION CRITERIA: Randomized controlled trials of agalsidase alfa or beta in participants diagnosed with Anderson-Fabry disease. DATA COLLECTION AND ANALYSIS: Two authors selected relevant trials, assessed methodological quality and extracted data. MAIN RESULTS: Nine trials comparing either agalsidase alfa or beta in 351 participants fulfilled the selection criteria.Both trials comparing agalsidase alfa to placebo reported on globotriaosylceramide concentration in plasma and tissue; aggregate results were non-significant. One trial reported pain scores measured by the Brief Pain Inventory severity, there was a statistically significant improvement for participants receiving treatment at up to three months, mean difference -2.10 (95% confidence interval -3.79 to -0.41; at up to five months, mean difference -1.90 (95% confidence interval -3.65 to -0.15); and at up to six months, mean difference -2.00 (95% confidence interval -3.66 to -0.34). There was a significant difference in the Brief Pain Inventory pain-related quality of life at over five months and up to six months, mean difference -2.10 (95% confidence interval -3.92 to -0.28) but not at other time points. Death was not an outcome in either of the trials.One of the three trials comparing agalsidase beta to placebo reported on globotriaosylceramide concentration in plasma and tissue and showed significant improvement: kidney, mean difference -1.70 (95% confidence interval -2.09 to -1.31); heart, mean difference -0.90 (95% confidence interval -1.18 to -0.62); and composite results (renal, cardiac, and cerebrovascular complications and death), mean difference -4.80 (95% confidence interval -5.45 to -4.15). There was no significant difference between groups for death; no trials reported on pain.Only two trials compared agalsidase alfa to agalsidase beta. One of them showed no significant difference between the groups regarding adverse events, risk ratio 0.36 (95% confidence interval 0.08 to 1.59), or any serious adverse events; risk ratio 0.30; (95% confidence interval 0.03 to 2.57).Two trials compared different dosing schedules of agalsidase alfa. One of them involved three different doses (0.2 mg/kg every two weeks; 0.1 mg/kg weekly and; 0.2 mg/kg weekly), the other trial evaluated two further doses to the dosage schedules: 0.4 mg/kg every week and every other week. Both trials failed to show significant differences with various dosing schedules on globotriaosylceramide levels. No significant differences were found among the schedules for the primary efficacy outcome of self-assessed health state, or for pain scores.One trial comparing agalsidase alfa to agalsidase beta showed no significant difference for any adverse events such as dyspnoea and hypertension.The methodological quality of the included trials was generally unclear for the random sequence generation and allocation concealment. AUTHORS' CONCLUSIONS: Trials comparing enzyme replacement therapy to placebo show significant improvement with enzyme replacement therapy in regard to microvascular endothelial deposits of globotriaosylceramide and in pain-related quality of life. There is, however, no evidence identifying if the alfa or beta form is superior or the optimal dose or frequency of enzyme replacement therapy. With regards to safety, adverse events (i.e., rigors, fever) were more significant in the agalsidase beta as compared to placebo. The long-term influence of enzyme replacement therapy on risk of morbidity and mortality related to Anderson-Fabry disease remains to be established. This review highlights the need for continued research into the use of enzyme replacement therapy for Anderson-Fabry disease.

Food Insecurity in Urban and Rural Areas in Central Brazil: Transition from Locally Produced Foods to Processed Items.

Aiming to investigate the effect of diet and food consumption with regard to health, environment, and economy in light of nutrition ecology, we studied the dimensions of nutrition and food security in urban and rural settings in the region of Chapada dos Veadeiros, Central Brazil. We tracked diet and food consumption through carbon and nitrogen stable isotope ratios in fingernails of these inhabitants together with food intake data as a proxy for their diet patterns. We estimated household food insecurity by using the Brazilian Food Insecurity Scale. Nutrition and food insecurity was observed in both urban and rural areas, but was accentuated in rural settings. The diet pattern had high δ(13)C values in fingernails and low δ(15)N. Both urban and rural areas have diets with low diversity and relying on low-quality processed food staples at the same time that nutrition and food insecurity is quite high in the region.

Exploring the role of the general interest in health on the perceptions of Healthy, Industrialized, and Ultra-processed foods among Brazilians.

Food processing includes operations that transform raw materials into new products, ensuring the preservation and supply of safe food; however, this view is not always understood by consumers who tend to associate any type of processing with something negative and harmful to health. Given this, the objective of this study was to explore the associations of Brazilian consumers in relation to healthy foods, industrialized foods, and ultra-processed foods, as well as to evaluate the role of socio-demographic characteristics and interest in health in these associations. To this end, 512 Brazilians completed a word association task on these three concepts and then answered a questionnaire about interest in health and socio-demographic issues. In general, participants associated "Healthy food" mainly with "Unprocessed products." Conversely, "Industrialized foods" and "Ultra-processed foods" were associated with "Processed products," "Negative perceptions," "Health harm," and "Industry". Despite this, it was found that "Industrialized foods" were also perceived positively, mainly due to convenience. Consumer associations were influenced (p ≤ 0.05) both by interest in health and by socio-demographic profile. Individuals with a high interest in health mainly associated "Industrialized foods" and "Ultra-processed foods" with the presence of preservatives, additives, and pesticides, and with diseases. As for those with low interest in health, there was a greater lack of knowledge of the concepts. Doubts and lack of knowledge were observed for "Industrialized foods" and "Ultra-processed foods," mainly among consumers with low educational level. The results indicate the need to develop communication strategies that reach consumers to facilitate understanding and, in this way, help them to make more conscious food choices.

Selpercatinib and capmatinib combination promotes sustained complete response in novel ISOC1-RET fusion lung cancer after resistance to RET inhibitor via MET amplification: Case Report.

RET fusions occur in 1-2% of non-small cell lung cancer. Selpercatinib and pralsetinib are selective RET inhibitors with significant improvement of outcome in patients with tumor harboring RET fusion; however, resistance mechanisms appear frequently, mainly driven by MAPK pathway bypass, secondary RET mutations, or in 5% via MET amplification. Co-inhibition of RET and MET is a compelling strategy for overcoming MET-dependent resistance to RET inhibitors and potentially other inhibitors. To our knowledge, this is the first report of a novel ISOC1-RET fusion lung cancer with a durable complete response to selpercatinib, with resistance via MET amplification, which was overcome by the successful combination of selpercatinib and capmatinib.

Effect of dietary supplementation with grape residue flour on weight gain, metabolic profile, leukogram, proteinogram and antioxidant response in suckling lambs.

The objective of this study was to determine whether the addition of grape residue flour (GRF) in the diet of suckling lambs would improve their health and consequently enhance their growth. We used 48 lambs, 30 days of age divided into four treatments with four repetitions each, with each repetition consisting of three animals. The groups were identified as follows: G-0%, used as a control (without GRF) and G-0.5%, G-1% and G-2% referring to treatment with grape residue flour in doses of 0.5%, 1%, and 2% of inclusion in the concentrate, respectively. Lambs in groups G-1% and G-2% had higher final body weights, weight gain and average daily gain (ADG) compared to the other groups. GRF dietary supplementation had good antioxidant potential, being able to stimulate glutathione S-transferase (GST) activity and consequently reduce levels of reactive oxygen species (ROS) in lambs that consumed the highest dose of GRF (G-2%). GRF supplementation improved humoral responses, with increased serum levels of heavy-chain and light-chain immunoglobulins; however, there was a reduction in serum ceruloplasmin levels in these lambs. We observed higher concentrations of glucose and triglycerides in lambs in the 2% group. There were lower lymphocyte counts in lambs that received GRF. Lambs supplemented with the highest doses of GRF (G-1% and G-2%) had lower total bacterial counts in the feces. We conclude that the use of GRF in the supplementation of suckling lambs improved animal health, as it stimulated the antioxidant and immune systems and consequently favored their growth.

Cross-Cultural Adaptation of the Physician Orders for Life-Sustaining Treatment Form to Brazil.

BACKGROUND: The Physician Orders for Life-Sustaining Treatment (POLST) paradigm is considered one of the most important strategies to respect patients' values at the end of life in the United States. The cross-cultural adaptation of POLST entailed several methodological considerations, which may be informative for international researchers who may also consider bringing POLST to their countries as a means to promote care at the end of life that is consistent with patients' preferences. OBJECTIVE: To report the methods and outcome of the cross-cultural adaptation of the POLST form to Brazil. DESIGN: Cross-cultural adaptation study. SETTING/SUBJECTS: Twenty physicians and 10 patients at a university hospital participated in the pilot tests. RESULTS: The cross-cultural adaptation process included choosing which existing POLST form(s) to use as a source, deciding the intended reading level, which healthcare professionals should be allowed to sign the form, and consultation with attorneys, bioethicists, and members of the National POLST Paradigm Task Force. Pilot tests occurred in two stages using different approaches. First, 20 physicians were trained about POLST and asked for any unclear aspects related to the form. Second, trained investigators completed POLST forms after engaging in advance care planning conversations with 10 hospitalized patients or patients' surrogates. CONCLUSIONS: This report provides a basis for future cross-cultural adaptations of POLST to other countries. The authors hope such new adaptations will broaden the possibilities of research using POLST and also may promote wider provision of care at the end of life that is consistent with patients' preferences.

Infarto agudo do miocárdio: Tempo é músculo / Acute myocardial infarction: Time is muscle

Objetivo: descrever a impotância de uma detecção precoce do Infarto Agudo do Miocárdio (IAM) por meio da equipe multidisciplinar de saúde e expor se o tempo interfere ou não na piora da lesão miocárdica. Método:Trata-se de uma revisão integrativa da literatura com artigos de 2015 e 2020. As bases utilizadas foram LILACS, MEDLINE, SCIELO, BDEFN e Google Acadêmico. Resulatdos: O tempo porta-balão <90 minutos é eficiente no manejo do paciente com IAM, pois quanto mais rápido atendimento melhor o prognóstico, mas ainda existem muitas dificuldades na realização desse manejo, pois muitos sintomas não são detectados precocemente, a busca pelo atendimento é demorada e as instituições não seguem os protocolos corretamente. Conclusão: Diante deste cenário a telemedicina surge como um aliado no prevenção, diagnóstico e tratamento e principalmente o menor tempo para o atendimento, pois trará mais saúde para o miocárdio e consequentemente para o paciente.(AU)

Objetivo: describir la importancia de la detección precoz del Infarto Agudo de Miocardio (IAM) a través del equipo multidisciplinario de salud y exponer si el tiempo interfiere o no en el empeoramiento de la lesión miocárdica. Método: Se trata de una revisión integrativa de la literatura con artículos de 2015 y 2020. Las bases de datos utilizadas fueron LILACS, MEDLINE, SCIELO, BDEFN y Google Scholar. Resultados: El tiempo puerta-balón < 90 minutos es eficiente en el manejo de los pacientes con IAM, pues cuanto más rápido el tratamiento, mejor el pronóstico, pero aún existen muchas dificultades para realizar este manejo, ya que muchos síntomas no se resuelven. detectada a tiempo, la búsqueda de atención lleva mucho tiempo y las instituciones no siguen correctamente los protocolos. Conclusión: Ante este escenario, la telemedicina surge como un aliado en la prevención, diagnóstico y tratamiento y sobre todo en el menor tiempo de atención, ya que traerá más salud al miocardio y consecuentemente al paciente.(AU)

Objective: to describe the importance of an early detection of Acute Myocardial Infarction (AMI) through the multidisciplinary health team and expose whether or not time interferes in the worsening of the myocardial injury. Method: This is an integrative literature review with articles from 2015 and 2020. The databases used were LILACS, MEDLINE, SCIELO, BDEFN and Google Scholar. Results: The door- to-balloon time <90 minutes is efficient in the management of patients with AMI, because the faster the treatment, the better the prognosis, but there are still many difficulties in carrying out this management, since many symptoms are not detected early, the search for care it is time consuming and institutions do not follow protocols correctly. Conclusion: Given this scenario, telemedicine emerges as an ally in prevention, diagnosis and treatment and especially the shortest time for care, as it will bring more health to the myocardium and consequently to the patient.(AU)

Development of an educational tool on tinnitus in a website format / Desenvolvimento de uma ferramenta educacional em formato de website sobre zumbido

ABSTRACT Objective: to develop an educational tool in a Virtual Learning Environment (VLE), in a website format, to supply information on tinnitus, additional content on hearing and to provide access links to other websites related to speech therapy and audiology, so as to promote public health. Methods: an experimental, descriptive study, involving, in its construction, 6 stages elaborated as follows: planning, adaptation, collection of testimonies, inclusion of content, review and dissemination. Results: the site was titled "Do you have tinnitus?" It was subdivided into others: "Home", "Tinnitus?" "Types of tinnitus," "Main causes," "What to do?" "Main forms of treatment," "Tips to relieve tinnitus," "Prevention," "News," "Testimonials," "About your hearing," "What is hearing loss?" "What are speech therapy and audiology?" "Other sites," "Contact" and "About." Illustrations and videos were inserted, and the information contained in any material was classified with easy readability. Conclusion: it was possible to develop a website entitled "Do you have tinnitus?" available at the electronic address: https://vocetemzumbido.wixsite.com/home, providing general information about tinnitus, in addition to additional information on hearing.

RESUMO Objetivo: desenvolver uma ferramenta educacional em um Ambiente Virtual de Aprendizagem (AVA), em formato de site, fornecendo informações sobre zumbido, além de conteúdos adicionais sobre audição e disponibilizar links de acesso a outros Websites relacionados a fonoaudiologia, visando a promoção de saúde do público-alvo. Métodos: trata-se de um estudo experimental, descritivo. Para a construção, foram elaboradas 6 etapas, são elas: planejamento, adequação, coleta dos depoimentos, inclusão do conteúdo, revisão e divulgação. Resultados: o site foi intitulado "Você tem zumbido?" E subdividido nos tópicos: "Início", "Zumbido?", "Tipos de zumbido", "Principais causas", "O que fazer?", "Principais formas de tratamento", "Dicas para aliviar o zumbido", "Prevenção", "Atualidades ", "Depoimentos", "Sobre sua audição", "O que é perda auditiva?", "O que é fonoaudiologia", "Outros sites", "Contato" e "Sobre". Foram inseridas ilustrações e vídeos, sendo que as informações contidas no material foram classificadas com legibilidade fácil. Conclusão: foi possível desenvolver um Website, intitulado "Você tem zumbido?", disponível no endereço eletrônico: https://vocetemzumbido.wixsite.com/home, disponibilizando informações gerais sobre o zumbido, além de informações adicionais sobre audição.

Differences between the real and the desired worlds in the results of clinical trials.

OBJECTIVE: We refer to the effectiveness (known as pragmatic or real world) and efficacy (known as explanatory or desired or ideal world) of interventions. However, these terms seem to be randomly chosen by investigators who design clinical trials and do not always reflect the true purpose of the study. A pragmatic-explanatory continuum indicator summary tool was thus developed with the aim of identifying the characteristics of clinical trials that distinguish between effectiveness and efficacy issues. We verified whether clinical trials used the criteria proposed by the indicator summary tool, and we categorized these clinical trials according to a new classification. METHOD: A systematic survey of randomized clinical trials was performed. We added a score ranging from 0 (more efficacious) to 10 (more effective) to each domain of the indicator summary tool and proposed the following classifications: high efficacy (<25), moderate efficacy (25-50), moderate effectiveness (51-75), and high effectiveness (<75). RESULTS: A total of 844 randomized trials were analyzed. No analyzed trials used the criteria proposed by the indicator summary tool. Approximately 44% of the trials were classified as having moderate effectiveness, and 43.82% were classified as having moderate efficacy. CONCLUSIONS: Most clinical trials used the term "efficacy" to illustrate the application of results in clinical practice, but the majority of those were classified as having moderate effectiveness according to our proposed score. The classification based on the 0-100 score is still highly subjective and can be easily misunderstood in all domains based on each investigator's own experiences and knowledge.

A systematic review and meta-analysis of cohort studies of echocardiographic findings in OSA children after adenotonsilectomy.

CONTEXT: There is evidence that OSA in children can be associated with acute and chronic effects on the cardiovascular system due to repetitive episodes of apnea and hypoxemia. OBJECTIVE: To assess whether there is an association between OSA and echocardiographic findings in children and whether that association persists after adenotonsillectomy. DATA SOURCES: A literature search was conducted based on PUBMED, EMBASE and LILACS. STUDY SELECTION: Children with OSA and children who did not have OSA, who were aged ≤12 years. DATA EXTRACTION: Two reviewers extracted data independently; the risk of bias was assessed by examining the selected sample, the recruitment method, completeness of follow up, and blinding. RESULTS: Seven studies met all the inclusion criteria and methodological requirements. There was a significant difference with elevated mean pulmonary arterial pressure levels in OSA participants compared to those without OSA at preoperative assessment [mean difference (MD) 8.67; confidential interval (CI) 95% 6.09, 11.25]. OSA participants showed a statistically significant increased interventricular septum (IVS) thickness (mm) [MD 0.60; CI 95% 0.09, 1.11]; and right ventricular (RV) dimension (cm/m) [MD 0.19; CI 95% 0.10, 0.28]. There was also a significant increase in right ventricular (RV) dimension (cm/m) [MD 0.10; CI 95% 0.05, 0.14] in OSA children. CONCLUSION: There is moderate quality evidence regarding possible association between OSA and right heart repercussions. More prognosis studies are needed, to allow the combination of results in a meta-analysis.

Oral conditions of pediatric patients with Williams-Beuren syndrome: two case reports / Condição Oral de paciente infantil com Síndrome de Williams-Beuren: dois casos clínicos

Objective: The objective of this paper was to describe the oral conditions of two children accompanied by their mothers who reported to the Department of Pediatric Dentistry of Fluminense Federal University with Williams-Beuren syndrome (WBS). Case report: The 9-year-old female patient had a family and medical history significant for placental abruption, caesarean section, delayed psychomotor development, learning disabilities, tendency to selfdistract and congenital heart disease. In contrast, the 7-year-old male patient had a normal birth and no gestational intercurrences. Discussion: Clinically, the female presented with mixed dentition, crowding in the maxillary and mandibular arches, prolonged retention of deciduous teeth, anterior and posterior cross-bite and Angle Class I malocclusion, while the male had mixed dentition and retarded psychomotor development. Due to the patients having congenital heart disease, a prophylactic antibiotic regimen was prescribed prior to the dental procedures in both of them. Conclusion: These patients had been followed up for 2 years and this case report underscores the importance of early dental evaluation and counselling for parents of WBS patients (AU)

Objetivo: O objetivo deste trabalho foi descrever as condições bucais de duas crianças acompanhadas por suas mães que relataram ao Departamento de Odontopediatria da Universidade Federal Fluminense com síndrome de Williams-Beuren (SWB). Caso clínico: Paciente do sexo feminino, 9 anos de idade, tinha história familiar de descolamento prematuro da placenta, cesariana, atraso no desenvolvimento psicomotor, dificuldades de aprendizado, tendência a auto-distribuição e cardiopatia congênita. Em contraste, o paciente de 7 anos de idade teve um parto normal e sem intercorrências gestacionais. Discussão: Clinicamente, a menina apresentava dentição mista, apinhamento nos arcos maxilar e mandibular, retenção prolongada dos dentes decíduos, mordida cruzada anterior e posterior e má oclusão de Classe I de Angle, enquanto o menino apresentava dentição mista e desenvolvimento psicomotor retardado. Devido à doença cardíaca congênita, um regime profilático de antibiótico foi prescrito antes dos procedimentos odontológicos em ambos. Conclusão: Esses pacientes foram acompanhados por dois anos e este relato de caso ressalta a importância da avaliação odontológica precoce e do aconselhamento para pais de pacientes com SWB. (AU)

Ergonomic and usability analysis on a sample of automobile dashboards.

This is a research study based on an analysis which sets out to identify and pinpoint ergonomic and usability problems found in a sample of automobile dashboards. The sample consisted of three dashboards, of three different makes and characterized as being a popular model, an average model and a luxury model. The examination was conducted by observation, with the aid of photography, notes and open interview, questionnaires and performing tasks with users, the bases of which are on the principles laid down by methodologies. From this it was possible to point to the existence of problems such as: complaints about the layout, lighting, colors, available area, difficult access to points of interaction, such as buttons, and the difficult nomenclature of dials. Later, the findings and recommendations presented show the need for a further, deeper study, using more accurate tools, a larger sample of users, and an anthropometric study focused on the dashboard, since reading and understanding it have to be done quickly and accurately, and that more attention be given to the study of automobile dashboards, particularly in the most popular vehicles in order to maintain the standards of usability, and drivers' comfort and safety.

Differences between the real and the desired worlds in the results of clinical trials

OBJECTIVE:We refer to the effectiveness (known as pragmatic or real world) and efficacy (known as explanatory or desired or ideal world) of interventions. However, these terms seem to be randomly chosen by investigators who design clinical trials and do not always reflect the true purpose of the study. A pragmatic-explanatory continuum indicator summary tool was thus developed with the aim of identifying the characteristics of clinical trials that distinguish between effectiveness and efficacy issues. We verified whether clinical trials used the criteria proposed by the indicator summary tool, and we categorized these clinical trials according to a new classification.METHOD:A systematic survey of randomized clinical trials was performed. We added a score ranging from 0 (more efficacious) to 10 (more effective) to each domain of the indicator summary tool and proposed the following classifications: high efficacy (<25), moderate efficacy (25-50), moderate effectiveness (51-75), and high effectiveness (<75).RESULTS:A total of 844 randomized trials were analyzed. No analyzed trials used the criteria proposed by the indicator summary tool. Approximately 44% of the trials were classified as having moderate effectiveness, and 43.82% were classified as having moderate efficacy.CONCLUSIONS:Most clinical trials used the term “efficacy” to illustrate the application of results in clinical practice, but the majority of those were classified as having moderate effectiveness according to our proposed score. The classification based on the 0-100 score is still highly subjective and can be easily misunderstood in all domains based on each investigator’s own experiences and knowledge.

Perfil biossocial dos indivíduos portadores de doença de chagas atendidos no ambulatório de infectologia do Hospital Couto Maia, Salvador, Bahia / Biosocial profile of patients with chagas disease addmitted at the department of infectious diseases at Couto Maia Hospital, Salvador, Bahia / Perfil biosocial de los individuos portadores de la enfermedad de chagas atendidos en el ambulatorio de enfermedades infecciosas del hospital Couto Maia, Salvador, Bahia

A doença de Chagas é uma zoonose causada pelo protozoário Trypanosoma cruzi, endêmica nas Américas Central e do Sul. O presente estudo teve como objetivo avaliar o perfil biossocial dos pacientes portadores da Doença de Chagas Humana (DCH) atendidos no ambulatório de infectologia do Hospital Couto Maia, unidade de referência localizado em Salvador, Bahia. Trata-se de um estudo de corte transversal, descritivo, realizado de março a junho de 2012, com aplicação de questionário respondido em um único momento por doentesprovenientes de Itaberaba, Bahia. Os resultados evidenciam que, dentre os 28 pacientes estudados, 53,6por cento eram do sexo feminino, com idade de 38 a 84 anos; 42,9por cento eram analfabetos; 87,5por cento responderam receber menos que dois salários mínimos, sendo a agricultura a principalfonte de renda (nenhum paciente referiu ter carteira assinada); 78,6por cento tinham familiares com doença. Encontrou-se ainda a falta assistência sanitária, educação, moradia e saúde para a população estudada. Concluiu-se que a pesquisa pôde reforçar a sustentação dos dados daliteratura a respeito do perfil biossocial dos portadores da doença de Chagas.

Chagas disease is a zoonosis caused by the protozoan Trypanosoma cruzi, endemic in Central and South Americas. The present study aimed to evaluate the bio-social profile of patients with Chagas disease admitted at the Infectious Disease sector at Hospital Couto Maia, a reference hospital located in Salvador, Bahia. This research was conducted between March and June 2012, a questionnaire answered in a single moment was used as method with patients from Itaberaba, Bahia, Brazil. The results show that 28 patients 53.6percent of females aged 38-84 years, 42.9percent were illiterate, 87.5percent answered they received less than two minimum wages (agriculture was their main source of their income), none of the patientsmade any reference to full time jobs with contracts and 78.6percent of respondents has family and relatives affected by the Chagas disease. It can be concluded that this research can reinforce the literature data regarding the socio-cultural profile of patients with Chagas disease.Key words: Chagas disease. Social profile. Epidemiology.

La enfermedad de Chagas es una zoonosis causada por el protozooTrypanosoma cruzi, que es endémica en América Central y del Sur. Este estudio tuvo como objetivo evaluar el perfil biosocial de los pacientes portadores de la Enfermedad de Chagas humana (ECH), atendido en un ambulatorio de enfermedades infecciosas del Hospital Couto Maia, unidad de referencia localizado en Salvador, Bahia. Estudio de enfoque transversal, descriptivo, realizado de marzo a Junio de 2012, con la aplicación de cuestionario respondido en un único momento, por enfermos provenientes de Itaberaba, Bahia. Los resultados muestran que de los 28 pacientes, el 53,6por ciento eran mujeres, con edad entre 38 a 84 años; el42,9por ciento era analfabeto, el 87,5por ciento respondió que reciben menos de dos sueldos base, teniendo la agricultura como principal fuente de renta (ningún paciente refirió poseer registro formal de trabajo) y el 78,6por ciento de los encuestados estaban familiarizados con la enfermedad. Se encontró, aún, que la población estudiada carece de asistencia sanitaria, educación, habitación y salud. Se concluye que la investigación refuerza lo que sostenido por la literatura, con respecto al perfil biosocial de los portadores de la enfermedad de Chagas.

Avaliação clínica na atenção primária e infectologia dos pacientes com doença de chagas na forma crônica / Clinical assessment in primary and infectious disease care in patients with cardiac form of chagas diseases / Evaluación clínica en primaria y infecciosas de pacientes com enfermedad de las heridas crónicas en forma

A doença de chagas é a terceira doença parasitária mais prevalente no mundo e ocorre, muitas vezes, em indivíduos mais jovens, implicando em incapacidade, aposentadoria precoce e morte. O objetivo deste artigo é descrever alterações clínicas, laboratoriais, eletrocardiográficas e de bioimagem de pacientes com doença de Chagas na forma crônica cardíaca na atenção primária e infectologia. A metodologia adotada é o corte transversal, com análise retrospectiva de prontuários dos pacientes atendidos em ambulatórios de Clínica Médica e Infectologia de janeiro a dezembro de 2008. Os resultados apontam que os dados demográficosdos 21 pacientes foram: 57,1 por cento do sexo feminino; 42,9 por cento do sexo masculino; idade média de 58,5 anos; comorbidades 57,1 por cento. A maior parte apresentava a forma crônica cardíaca recente e leve (B1) baseada no Consenso Brasileiro de Doença de Chagas da Sociedade Brasileira de Medicina Tropical. As alterações mais frequentes no Eletrocardiograma foram: bloqueio do ramo direito, alteração de repolarização ventricular, bloqueio divisional anterossuperior esquerdo e bradicardia sinusal. Na radiografia de tórax, 35,3 por cento apresentaram aumento do índice cardiotorácico. Ao Ecocardiograma bidimensional com doppler foi observada uma fração de ejeção média de 66,7 por cento; 64,7 por cento deles apresentaram as seguintes alterações: disfunção diastólica de ventrículo esquerdo e insuficiência de válvula mitral. Ao comparar os pacientes com e sem comorbidades, foi observado que os achados dos exames complementares não apresentaram diferenças significativas entre os grupos. Concluiu-se que os pacientes com Doença de Chagas na forma crônica cardíaca leve apresentam idade mais avançada. Houve uma elevada porcentagem de comorbidades, podendo-se inferir que as alterações eletrocardiográficas, ecocardiográficas e radiográficas podem não sofrer influência das comorbidades.

Chagas disease is the third most prevalent parasitic disease in the world and it often occurs in younger individuals, resulting in disability, early retirement, and death. The aim of this study was to describe clinical, laboratory, electrocardiographic and bioimage changes in patients with Chronic Chagas heart disease. The methodology adopted is a cross-sectional study with retrospective analysis of records of patients from the infectious disease and parasitological hospitals centers, between January and December of 2008. The results indicate that the demographic data of 21 patients were: female (57.1 percent), male (42.9 percent), the average agewas 58.5 years, and 57.1 percent with co-morbidities. Most of the population studied had recent and/or mild chronic cardiac (B1) manifestations based on the Brazilian Consensus on Chagas disease from the Brazilian Society of Tropical Medicine. The most frequent changes in the electrocardiogram (ECG) were: Right bundle branch block (RBBB), ST-T changes, Left BundleBranch Block and Sinus Bradycardia. The most frequent change in chest radiography was the enlargementf cardiothoracic index (35.3 percent). Through the bidimensional echocardiography we observed an ejection fraction with 66.7 percent average and 64.7 percent of the patients presented the following changes: Left Ventricular Diastolic Dysfunction and Mitral Valve Insufficiency. When comparing the patients with and without co-morbidities, the findings of the electrocardiogram, echocardiogram and chest radiography, did not provide significant difference between thegroups. It can be concluded that the patients with heart Chagas disease patients presented a higher age. There was a high percentage of co- morbidities in the studied population and it can be inferred that the electrocardiographic, echocardiographic and radiographic changesmay not be impacted by the co-morbidities.

La enfermedad de Chagas es la tercera enfermedad parasitaria más frecuente en el mundo y, con frecuencia, afecyta a individuos más jóvenes, resultando en incapacidad, jubilación anticipada y la muerte. El objetivo de este artículo es describir alteraciones clínicas, de laboratorio, electrocardiográficas y de bioimagen de pacientes con enfermedad deChagas en su forma crónica cardiaca en la atención primaria e infectología. La metodología adoptada es de enfoque transversal con análisis retrospectiva de los históricos clínicos de los pacientes atendidos, de enero a diciembre de 2008, en una Clínica Médica ambulatorial y Enfermedades Infecciosas. Con relación a datos demográficos, los resultados muestran que de los 21 pacientes: 57,1 por ciento eran del sexo femenino, el 42,9 por ciento del sexo masculino con edad media de 58,5 años, y el 57,1 por ciento, co-mórbidos. Co base en el Consenso brasileñobasado en Enfermedad de Chagas de la Sociedad Brasileña de Medicina Tropical, la mayor parte presentaba la forma crónica cardiaca, reciente y leve (B1). Las alteraciones más frecuentes en el electrocardiograma fueron: bloqueo de la rama derecha, alteraciones de la repolarización ventricular, bloqueo divisional anterosuperior izquierdo y bradicardiasinusal.