Sickle-Cell Disease and Stroke: Quality of Life of Patients in a Chronic Transfusion Regimen from the Caregivers' Perspective.

Strokes affect up to 10% of children with sickle-cell disease (SCD). The most commonly used strategy to prevent a first-time stroke or its recurrence is to perform periodic red blood cell transfusions. This article aims to evaluate the quality of life (QoL) of children and adolescents with SCD undergoing a chronic transfusion regimen (CTR) for stroke prophylaxis, according to their caregivers' perception. A cross-sectional study was conducted using a sociodemographic interview with an application of a validated instrument (Pediatric Quality of Life Inventory) involving 16 caregivers of patients with SCD aged <18 years undergoing CTR in a reference center. The data were processed using STATA version 13.0. The caregivers were predominantly the mothers of the minors that were part of the study cohort (87.5%), an income of <2 minimum wages (81.2% of cases) and >8 years of schooling (56.2%). The patients had a mean age of 10.4 years, 68.8% were male, 75% were mixed-race and came from small towns and rural areas (68.8%). The overall mean QoL was 45.8 (95% confidence interval [CI] 42.5-49.2). Female patients and those aged <12 years had lower levels of overall QoL. The emotional dimension of the children was the least compromised as per the caregivers' perception. The mean QoL of children with SCD on a CTR is lower than the estimated global mean QoL reported in the literature. It is possible that the occurrence of a stroke enhances the caregivers' negative perceptions about the QoL of patients with SCD.

Real-world disease activity and sociodemographic, clinical and treatment characteristics of moderate-to-severe inflammatory bowel disease in Brazil.

BACKGROUND: Understanding the treatment landscape of inflammatory bowel diseases (IBD) is essential for improving disease management and patient outcomes. Brazil is the largest Latin American country, and it presents socioeconomic and health care differences across its geographical regions. This country has the highest increase in IBD incidence and prevalence in Latin America, but information about the clinical and treatment characteristics of IBD is scarce. AIM: To describe the sociodemographic, clinical, and treatment characteristics of IBD outpatients in Brazil overall and in the Southeast, South and Northeast/Midwest regions. METHODS: Multicenter, cross-sectional study with a 3-year retrospective chart review component. Patients with moderate-to-severe Crohn's disease (CD) or ulcerative colitis (UC) were consecutively enrolled between October 2016 and February 2017. Active CD at enrollment was defined as a Harvey Bradshaw Index ≥ 8 or a CD Activity Index ≥ 220 or a calprotectin level > 200 µg/g or an active result based on colonoscopy suggestive of inadequate control during the previous year; active UC was defined as a partial Mayo score ≥ 5. Descriptive statistics were used to analyze all variables. RESULTS: In a total of 407 included patients, CD was more frequent than UC, both overall (264 CD/143 UC patients) and by region (CD:UC ratios of 2.1 in the Southeast, 1.6 in the South and 1.2 in the Northeast/Midwest). The majority of patients were female (54.2% of CD; 56.6% of UC), and the mean ages were 45.9 ± 13.8 years (CD) and 42.9 ± 13.0 years (UC). The median disease duration was 10.0 (range: 0.5-45) years for both IBD types. At enrollment, 44.7% [95% confidence interval (CI): 38.7-50.7] of CD patients and 25.2% (95%CI: 18.1-32.3) of UC patients presented with active disease. More than 95% of IBD patients were receiving treatment at enrollment; CD patients were commonly treated with biologics (71.6%) and immunosuppressors (67.4%), and UC patients were commonly treated with mesalazine [5-Aminosalicylic acid (5-ASA)] derivates (69.9%) and immunosuppressors (44.1%). More than 50% of the CD patients had ileocolonic disease, and 41.7% presented with stricturing disease. One-quarter of CD patients had undergone CD-related surgery in the past 3 years, and this proportion was lower in the Northeast/Midwest region (2.9%). CONCLUSION: In Brazil, there are regional variations in IBD management. CD outweighs UC in both frequency and disease activity. However, one-quarter of UC patients have active disease, and most are receiving 5-ASA treatment.

Systematic review of societal and health system cost of dengue in Latin America

Aim: to conduct a systematic literature review on dengue costs in Latin America, comparing study methodologies, disease costs and the economic impact of dengue in different countries. Methods: the literature search was carried out in the following electronic databases: MEDLINE/ PubMed, EMBASE and LILACS, for the period between 2004 and 2014. To make comparisons possible, the costs identified in the selected studies were converted to local currency values, adjusted to the consumer price index (2014) and converted to purchasing power parity (PPP). Results: 728 publications were identified in databases and 13 papers were selected for analysis. Nine of the thirteen studies were conducted from a societal perspective and three from a health system perspective. In most studies, indirect costs accounted for the largest percentage of total outpatient costs. In contrast, for hospitalized patients, direct medical costs showed the highest percentages. The economic impact of dengue was estimated at I$ 3.2 billion per year, ranging from I$ 1.4 to I$ 5.9 billion, when including the six sub-regions of the Americas. Conclusion: dengue represents a high cost for Latin American society and health system. Studies varied in terms of cost methodology (cost items included, such as direct medical and non-medical and indirect costs, and cost analysis) and the different epidemiological periods in which research was carried out (endemic and/or epidemic).

Inflammatory bowel disease in an underdeveloped region of Northeastern Brazil.

AIM: To evaluate the demographic characteristics and clinical phenotypes of inflammatory bowel disease (IBD) in a geographic area in Northeastern Brazil. METHODS: This retrospective study was conducted at the Hospital of the Federal University of Piauí in Northeastern Brazil. Demographic characteristics and clinical phenotypes of IBD were analyzed in relation to the time of diagnostic confirmation, which was defined as the date of disease onset. Data were collected between January 2011 and December 2012 and included all census patients 18 years of age or older during that period for whom there was diagnostic confirmation of Crohn's disease (CD), ulcerative colitis (UC), or unclassified colitis according to the Montreal criteria. We also analyzed the period of time between the onset of clinical manifestations and the diagnosis of IBD (delay in the diagnosis). Statistical analyses included means and standard deviations for numeric variables and the Pearson χ2 adherence test for nominal variables. The annual index occurrence and overall prevalence of IBD at our institution were also calculated, with P values<0.05 indicating statistical significance. This study was approved by the Institutional Ethics and Research Committee. RESULTS: A total of 252 patients with IBD were included, including 152 (60.3%) UC patients and 100 (39.7%) CD patients. The clinical and demographic characteristics of all patients with IBD showed a female to male ratio of 1.3:1.0 and a mean age of 35.2 (SD=14.5) years. In addition, the majority of patients were miscegenated (171, 67.9%), had received higher education (157, 62.4%), lived in urban areas (217, 86.1%), and were under the age of 40 years (97, 62.5%). For patients with CD, according to the Montreal classification, the predominant features present from the onset of disease were an age between 17 and 40 years (A2); colonic disease location (L2); and nonstricturing, nonfistulizing disease behavior (B1). However, approximately one-quarter of all CD patients demonstrated perineal involvement. We also observed considerable delay in the diagnosis of IBD throughout the entire study period (mean=35.5 mo). In addition, the annual index occurrence rose from 0.08 to 1.53 cases/10(5) inhabitants/year during the study period, and the prevalence rate was 12.8 cases/10(5) inhabitants in 2012. Over the last two decades, there was a noted increase in the frequency of IBD in the study area. CONCLUSION: In this study, there was a predominance of patients with UC, young people under 40 years of age, individuals with racial miscegenation, and low annual incomes.

Probióticos e prebióticos na diarreia aguda: revisão / Probiotic and prebiotic in acute diarrhea: review

O adequado controle terapêutico da diarreia aguda deve promover pronta e eficaz reidratação, oferecer suporte nutricional adequado, reduzir o número de evacuações e abreviar o tempo da doença. Esta revisão tem como objetivo apresentar os resultados de estudos recentes abordando a eficácia terapêutica de probióticos e prebióticos para as causas infecciosas de diarreia aguda.

Adequate therapeutic control of acute diarrhea should promote fast and effective rehydration, offer adequate nutritional support, reduce the number of bowel movements and shorten disease duration. The objective of this review is to present the results of recent studies regarding the therapeutic efficacy of probiotics and prebiotics for the treatment of infectious, acute diarrhea.