Reference intervals for serum immunoglobulins G, M and E levels in Brazilian children aged 1 to 10 years: a population-based study

Abstract Objective: To determine the reference intervals (RI) for serum levels of IgG, IgM, and IgE in healthy children aged 1-10 years living in central Brazil. Method: A sample of 1743 healthy children was randomly selected from kindergartens and public schools. Reference intervals were defined by non-parametric rank (Clinical Laboratory Standards Institute, USA), bootstrapping, and Horn's robust methods. Results: By the rank method, the IgG RI was 792-1771 mg/dL for children of both sexes aged 1-10 years. IgM RI were different for gender and age groups, being 45-196 mg/dL and 34-190 mg/dL for boys aged 1-2 years and 3-10 years, respectively. For girls, the IgM RI were 50-212 mg/dL and 39-212 mg/dL, for ages 1-4 and 5-10 years, respectively. The IgE RI for both sexes and ages 1-10 years was 6-1005 mg/dL. The bootstrap method showed RI similar to the rank method but with slightly different confidence intervals. Horn's robust method determined RI different from those obtained by previous methods. Conclusion: RI for serum concentrations of IgG, IgM, and IgE were established for Brazilian children aged 1-10 years. This definition will be useful for Brazilian physicians, who will have more adequate parameters for their clinical decision-making.

Validation of a Simple Instrument of Fast Application to Track Disability in Leprosy Patients / Validação de um instrumento simples e de aplicação rápida para rastrear incapacidade em pacientes com hanseníase

Abstract Objective To evaluate a simple and fast diagnostic instrument to be used by any health professional to track the disability presented by leprosy patients. Method Validation study of a diagnostic test performed in a sample of 156 leprosy patients to track functional disability through the shortened disabilities of arm, shoulder, and hand (QuickDASH) questionnaire. The simplified neurological assessment proposed by the World Health Organization was used as a reference. A receiver operating characteristic (ROC) curve was constructed to determine the cutoff point of QuickDASH that best discriminated patients with functional disability caused by leprosy. Results We identified 86 (55.5%) patients with functional disability by simplified neurological evaluation. The performance of the QuickDASH instrument showed that, at a cut-off point of 30 points, the sensitivity and specificity were 72.1% and 68.1% (accuracy of 70.3%), respectively, to identify functional disability, with a positive predictive value of 73.8%. Conclusion The QuickDASH instrument showed good accuracy to track functional disability in leprosy patients, and it may be useful in clinical practice of primary and general outpatient care, with the goal of identifying patients who need specialized reference for the prevention and treatment of this condition.

Resumo Objetivo Avaliar um instrumento diagnóstico simples e rápido a ser utilizado por qualquer profissional da saúde para rastrear a incapacidade apresentada por pacientes com hanseníase. Método Estudo de validação de teste de diagnóstico realizado em uma amostra de 156 pacientes com hanseníase para rastrear incapacidade funcional, por meio do questionário abreviado disabilities of arm, shoulder, and hand (QuickDASH). A avaliação neurológica simplificada proposta pela Organização Mundial da Saúde foi utilizada como referência. Construiu-se a curva de características operacionais do receptor (ROC) para determinação do ponto de corte do QuickDASH que melhor discriminou pacientes com incapacidade funcional provocada pela hanseníase. Resultados Foram identificados 86 (55,5%) pacientes com incapacidade funcional pela avaliação neurológica simplificada. O desempenho do QuickDASH mostrou que, em ponto de corte de 30 pontos, a sensibilidade e a especificidade foram de 72,1% e 68,1% (acurácia de 70,3%), respectivamente, para identificar incapacidade funcional, com um valor preditivo positivo de 73,8%. Conclusão O instrumento QuickDASH mostrou boa acurácia para rastrear incapacidade funcional no paciente com hanseníase, podendo ser útil na prática clínica da atenção básica e ambulatorial geral, com o objetivo de identificar pacientes que necessitam de referência especializada para sua prevenção e tratamento.

Reference intervals for serum TSH concentrations of healthy children from the Central Region of Brazil

ABSTRACT Objective: The objective of this study was to determine the serum thyroid-stimulating hormone (TSH) concentration reference intervals (RIs) of healthy children aged 1 to 10 years of both sexes, living in the Central Region of Brazil. Subjects and methods: 1,735 children [869 (50.1%) female; 866 (49.9%) male] enrolled in the morning shift of 47 pre- and 83 public elementary schools in the municipality of Cuiabá, Mato Grosso, were studied by gathering anthropometric and social data and their medical history. A blood sample was collected from each child to determine the TSH concentration using the electrochemiluminescence method on a Cobas® 6000 modular analyzer (Analyzer series, Roche Diagnostics). Results: The RIs were determined using the 2.5 and 97.5 percentile and the mean ± 2 standard deviations methods. After identifying the homoscedastic groups by age and sex, outliers higher or lower than three standard deviations were excluded. The distribution of serum TSH concentrations showed no significant age or sex differences. Based on the percentile method, TSH RI ranged from 0.93 to 5.86 μIU/mL. Based on the mean ± 2 standard deviations, TSH RI ranged from 0.30 to 5.29 μIU/mL. Conclusion: The normal serum TSH concentration of the Brazilian children evaluated in this study differ from those of populations from other countries. Other regional population studies may validate the RIs found in this study and enable its safer use in pediatric clinical practice.

Reference intervals for serum immunoglobulin A levels in Brazilian children aged 1 to 10 years: a population-based study

Abstract Objective: To determine reference intervals (Rl) for serum immunoglobulin A (IgA) levels in healthy children aged 1 to 1 0 years residing in the central region of Brazil. Methods: This cross-sectional study was conducted on 1,743 healthy children randomly selected from kindergartens and public schools in Cuiabá, MT, Brazil. The IgA RIs were defined using the statistical methods postulated by the guidelines of the United States Clinical and Laboratory Standards Institute, the nonparametric bootstrap method, and Horn's robust method after the correction of discrepancies by Tukey's, Dixon's, and Horn's methods, respectively. The results were defined based on the values contained between the 2.5th and 97.5th percentiles and their respective 95% confidence intervals. Results: Partition by sex was not necessary to determine the IgA Rl of the studied children. Homogeneous subgroups were identified among children aged 1-<2, 2-<5, and 5-<11 years, whose IgA-specific RIs were determined. Conclusion: The serum IgA RIs were established for three groups of Brazilian children aged 1-11 years, which differed from those currently applied in Brazilian pediatric practice and from those defined by international studies. This definition will help Brazilian pediatricians formulate an accurate diagnosis and facilitate decision-making.

Prevalence of molecular and serological tests of the new coronavirus (SARS-CoV-2) in Carlos Chagas laboratory - Sabin group in Cuiabá

SUMMARY BACKGROUND: Coronavirus disease 2019, which is caused by the new severe acute respiratory syndrome coronavirus 2, became a pandemic in 2020 with a mortality rate of 2% and high transmissibility, thus making studies with an epidemiological profile essential. OBJECTIVES: The aim of this study was to characterize the population that performed the severe acute respiratory syndrome coronavirus 2 molecular and serological tests in Carlos Chagas Laboratory - Sabin Group in Cuiabá. METHODS: A retrospective cross-sectional study was carried out with all the samples collected from nasal swab tested by RT-PCR and serological for severe acute respiratory syndrome coronavirus 2 IgM/IgG from the population served between April and December 2020. FINDINGS: In the analysis period, 23,631 PCR-coronavirus disease 2019 examinations were registered. Of this total number of cases, 7,649 (32.37%) tested positive, while 15,982 (66.31%) did not detect viral RNA and 374 of the results as undetermined. The peak of positive RT-PCR performed in July (n=5,878), with 35.65% (n=2,096). A total of 8,884 tests were performed on serological test SOROVID-19, with a peak of 1,169 (57.16%) of the positive tests for severe acute respiratory syndrome coronavirus 2 in July. MAIN CONCLUSIONS: Molecular positivity and serological tests, both peaked in July 2020, were mostly present in women aged 20-59 years, characterizing Cuiabá as the epicenter of the Midwest region in this period due to the high rate of transmissibility of severe acute respiratory syndrome coronavirus 2.

Hospitalizations of the elderly for reasons related to human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) infection, Rondônia, Brazil, 2010­2018 / Hospitalizações de idosos por motivos relacionados à infecção por vírus da imunodeficiência humana (HIV)/síndrome da imunodeficiência adquirida (AIDS), Rondônia, Brasil, 2010­2018

Introduction: For the elderly, cultural factors and social paradigms predispose to the rejection of condom use, which favors human immunodeficiency virus (HIV) transmission. The North region was the last area for the spread of HIV in Brazil. Rondônia, although with a slight decline in the HIV detection rate in recent years, is still among the states with high mortality rate due to HIV/acquired immunodeficiency syndrome (AIDS) in Brazil. Objective: To describe the demographic and clinical characteristics of the elderly patients who were hospitalized for reasons related to HIV infection in the state of Rondônia, Brazil. Methods: Descriptive study of secondary data recorded from 2010 to 2018. The cause of hospitalization was identified in the field referring to the main and secondary diagnoses of the hospitalization authorization form. Results: Between 2010 and 2018, Rondônia recorded 1,073,932 hospitalizations for any cause in the state's public hospitals. Out of these, 183,803 (17.1%) were of elderly patients over 60 years of age and 249 (0.13%) were due to HIV/AIDS. There was a progressive increase in the number of hospitalizations during the study period, as well as a predominance of younger elderly men (67.1±6.0 years old). The mean length of hospitalizations was 21.3±21.1 days and 57 (24.1%) elderly patients died. Conclusion: Despite all the progress made in HIV prevention and treatment, the state of Rondônia still has a progressive increase in hospitalizations of elderly people for reasons related to HIV/ AIDS. HIV transmission prevention strategies should be emphasized in the elderly population in the state.

Introdução: Fatores culturais e paradigmas sociais predispõem o idoso à rejeição do uso de preservativo, o que favorece a transmissão do vírus da imunodeficiência humana (HIV) nesse grupo. A região Norte foi a última área alvo da disseminação do vírus no Brasil. Rondônia, embora com discreto declínio na taxa de detecção nos últimos anos, encontra-se entre as unidades federativas com mortalidade superior à média nacional. Objetivo: Descrever as características demográficas e clínicas dos idosos que se internaram por motivos relacionados à infecção pelo HIV em hospitais públicos de Rondônia. Métodos: Estudo descritivo de dados secundários registrados no período de 2010 a 2018. A causa da hospitalização foi identificada nos campos referentes aos diagnósticos principal e secundário da autorização de internação hospitalar (AIH). Resultados: Entre 2010 e 2018, o estado de Rondônia registrou 1.073.932 internações por todas as causas nos hospitais públicos/conveniados do SUS. Desse total, 183.803 (17,1%) foram de idosos maiores de 60 anos, das quais apenas 249 (0,13%) foram motivadas por HIV/síndrome da imunodeficiência adquirida (AIDS). Embora de baixa magnitude, observou-se aumento progressivo do número das hospitalizações durante período estudado. Houve um predomínio de internações de idosos do sexo masculino e na sexta década de vida (67,1±6,0 anos). O tempo médio de internação foi de 21,3±21,1 dias e 57 (24,1%) dos idosos evoluíram para óbito. Conclusão: Apesar de todo o progresso obtido na prevenção e tratamento do HIV, o estado de Rondônia ainda apresenta elevação progressiva das hospitalizações de idosos por motivos relacionados ao HIV/AIDS. Estratégias de prevenção da transmissão do HIV devem ser enfatizadas para a população de idosos.

Simulation for teaching cardiorespiratory resuscitation by teams: setting and performance assessment / Simulación para la enseñanza de la reanimación cardiorrespiratoria por equipos: evaluación de escenarios y desempeño / Simulação para ensino de reanimação cardiorrespiratória por equipes: avaliação de cenários e desempenho

Abstract Objective: to evaluate the acquisition of cognitive knowledge in cardiorespiratory resuscitation through training mediated by health simulation and to verify satisfaction with the teaching methodology design. Method: a study of quasi-experimental intervention, of the before and after type, with only one group. Population composed of medical students in the internship phase, nurses and resident physicians, nursing technicians and nurses of the institution's effective staff. Convenience sampling consisting of 91 participants. Data collected through the Sociodemographic and Educational Questionnaire, Knowledge Test and Simulation Design Scale. Data was organized in tables and analyzed based on absolute frequencies, measures of central tendency and dispersion, Cronbach's alpha reliability test, Wilcoxon's test. Results: the increase in cognitive learning was 81.9%, being that for nursing technicians it was 117.8 %. Wilcoxon's test showed a significant increase (p<0.0001) in knowledge. The Simulation Design Scale, displayed 4.55 of global mean. Cronbach's alpha pointed good internal consistency (0.898). Conclusion: the health simulation was effective as a learning-teaching method in cardiorespiratory resuscitation, being effective in increasing knowledge in cardiorespiratory arrest, with a great level of design satisfaction.

Objetivo: evaluar la adquisición de conocimiento cognitivo en reanimación cardiorrespiratoria a través del entrenamiento mediado por simulación de salud y verificar la satisfacción con el diseño de la metodología de enseñanza. Método: estudio de intervención cuasiexperimental, del tipo antes y después, con un único grupo. Población compuesta por estudiantes de medicina en etapa de prácticas, enfermeros y médicos residentes, técnicos de enfermería y enfermeros del personal permanente de la institución. Muestreo de conveniencia compuesto por 91 participantes. Datos recolectados a través del Cuestionario Sociodemográfico y Educativo, prueba de conocimientos y Escala de Diseño de Simulación. Los datos fueron organizados en tablas y analizados con base en frecuencias absolutas, medidas de tendencia central y dispersión, prueba de confiabilidad alfa de Cronbach, y prueba de Wilcoxon. Resultados: el aumento del aprendizaje cognitivo fue del 81,9% y para los técnicos de enfermería fue del 117,8%. La prueba de Wilcoxon mostró un aumento significativo (p<0,0001) en el conocimiento. La Escala de Diseño de Simulación presentó una media global de 4,55. El alfa de Cronbach mostró buena consistencia interna (0,898). Conclusión: la simulación de salud resultó eficaz como método de enseñanza-aprendizaje en reanimación cardiorrespiratoria, siendo eficaz para incrementar el conocimiento en parada cardiorrespiratoria, con un excelente nivel de satisfacción con respecto al diseño.

Objetivo: avaliar a aquisição de conhecimento cognitivo em reanimação cardiorrespiratória por capacitação mediada por simulação em saúde e verificar a satisfação com o design da metodologia de ensino. Método: estudo de intervenção quase-experimental, do tipo antes-depois, com único grupo. População composta por estudantes de medicina em fase de internato, enfermeiros e médicos residentes, técnicos de enfermagem e enfermeiros do quadro efetivo da instituição. Amostragem por conveniência formada por 91 participantes. Dados coletados por meio do Questionário Sociodemográfico e Educacional, teste de conhecimento e Escala do Design da Simulação. Os dados foram organizados em tabelas e analisados com base em frequências absolutas, medidas de tendência central e dispersão, teste de confiabilidade alfa de Cronbach, teste de Wilcoxon. Resultados: o incremento de aprendizagem cognitiva foi de 81,9%, sendo que para técnicos de enfermagem foi de 117,8 %. Teste de Wilcoxon apontou incremento significativo (p<0,0001) no conhecimento. A Escala do Design da Simulação, apresentou 4,55 de média global. Alpha de Cronbach apontou boa consistência interna (0,898). Conclusão: a simulação em saúde foi eficaz como método de ensino-aprendizagem em reanimação cardiorrespiratória, sendo efetiva no incremento de conhecimento em parada cardiorrespiratória, com ótimo nível de satisfação quanto ao design.

New laboratory perspectives for evaluation of vivax malaria infected patients: a useful tool for infection monitoring

ABSTRACT In recent years, the number of cases with severe Plasmodium vivax malaria has shown an increasing trend. It is, therefore, important to identify routine laboratory markers that best characterize the acute disease phase and can serve as a tool for clinical follow-up of patients. In a cohort study, we followed 87 patients with acute P. vivax monoinfection acquired in an endemic region of the Brazilian Amazon. Forty-two different biochemical and hematological parameters frequently tested in clinical routine were evaluated at the acute phase and the convalescent phase. A total of 42 laboratory tests were performed: biochemical parameters measured were serum lipids levels, aminotransferases, bilirubin, amylase, glucose, urea, creatinine, albumin, globulin, uric acid, C-reactive protein, and alpha-1-acid glycoprotein. Hematological parameters included total and differential white blood cell and platelet counts, hemoglobin concentration, mean platelet volume, platelet width distribution, and plateletcrit. Our results show that several biochemical and hematological parameters were associated with acute phase P. vivax malaria and these parameters reverted to normal values in the convalescent phase. The use of these parameters during diagnosis and follow-up of the infection is a useful clinical tool to evaluate the clinical course and therapeutic response of patients with uncomplicated vivax malaria.

Prevalence of hepatitis B and D virus infection in a district of Mato Grosso, bordering Amazonas and Rondônia states

Abstract INTRODUCTION: Brazil's western Amazon basin has the highest prevalence of hepatitis B virus (HBV) infection in the country. Coinfection with hepatitis D virus (HDV) is also endemic. To estimate the prevalence of HBV and HDV markers in a population inhabiting the northwest portion of Mato Grosso state in the western Amazon. METHODS: We performed a cross-sectional study of the seroprevalence of antibodies against HBV core antigen (anti-HBc) in the Três Fronteiras District northwest of Mato Grosso. Anti-HBc-positive subjects were tested for HBV surface antigen (HBsAg). Those positive for this marker were tested for HDV antibodies. Anti-HBc-negative participants were tested for anti-HBsAg. All tests were performed by EIA. RESULTS: A total of 623 individuals in the community were assessed; the majority (67.6%) were male, with a mean age of 30.8 ± 15.4 years. Two hundred and fourteen individuals (34.3%) were anti-HBc-positive, and 47 (7.5%) were HBsAg carriers. Only one individual was anti-HDV-positive. Among the 409 individuals without HBV infection, 18.3% were anti-HBsAg-positive. There was no association between HBV infection and known risk factors. CONCLUSIONS: The study area had intermediate-to-high endemicity for HBV infection, but a low prevalence of HDV. Our serological results suggesting low vaccination-induced protection indicate a need for reinforced immunization programs in the populations of northwest Mato Grosso.

Ultrasound assessment of gastric antrum in term pregnant women before elective cesarean section / Ultrassom de antro gástrico em gestantes a termo antes de cesariana eletiva

Abstract Background and objectives: Pregnant women are considered patients at risk for pulmonary aspiration of gastric contents. The study aim was to evaluate the gastric antral cross-sectional area using ultrasound. Method: In this prospective study, 85 scheduled term pregnant women underwent gastric ultrasound. The outcomes were the measurement of the gastric antral cross-sectional area (main outcome), the estimated gastric volume, the incidence of pregnant women at risk for pulmonary aspiration, and the association between gastric antral cross-sectional area and clinical-demographic characteristics. Gastric antral cross-sectional area and gastric volume were compared according to body mass index <30 or ≥30. Results: The median (IIQ) for gastric antral cross-sectional area was 4 cm2 (2.8-6.3), for the estimated gastric volume it was 49.8 mL (33.7-87.2), and for the gastric volume estimated in mL.kg-1 it was 0.62 mL.kg-1 (0.39-0.95). The 95th percentile [95% confidence interval (CI)] of the gastric antral cross-sectional area and the estimated gastric volume were ≤10.3 cm2 (95% CI: 7.6-15.6) and 1.42 mL.kg-1 (95% CI: 1.20-2.64), respectively. The incidence of pregnant women at risk for pulmonary aspiration was 3.5% (CI: 3.5 (1.2-9.8)). There was a positive correlation between gastric antral cross-sectional area and weight, p < 0.001 and body mass index <0.001. Patients with a body mass index ≥30 had a gastric antral cross-sectional area and an estimated gastric volume greater than those with a body mass index <30, respectively, p < 0.01 and p < 0.02. Conclusion: Measuring the gastric antral cross-sectional area of pregnant women is feasible and easy. There was positive correlation between gastric antral cross-sectional area, body weight and body mass index. The estimation of gastric volume by measuring the gastric antral cross-sectional area can identify patients at risk for pulmonary aspiration. Obese patients had a gastric antral cross-sectional area and an estimated gastric volume greater than non-obese patients.

Resumo Justificativa e objetivos: As gestantes são consideradas pacientes de risco para aspiração pulmonar do conteúdo gástrico. O objetivo foi avaliar a área transversal do antro gástrico por meio de ultrassonografia. Método: Neste estudo prospectivo, 85 gestantes a termo agendadas foram submetidas à ultrassonografia do antro gástrico. Os desfechos foram a mensuração da área transversal do antro gástrico (desfecho principal), a estimativa do volume gástrico, a incidência de gestantes sob risco de aspiração pulmonar, a associação entre a área transversal do antro gástrico e características clínico-demográficas. A área transversal do antro gástrico e do volume gástrico foi comparada de acordo com o índice de massa corporal < 30 ou ≥ 30. Resultados: A mediana (IIQ) da área transversal do antro gástrico foi 4 cm2 (2,8-6,3), do volume gástrico estimado 49,8 mL (33,7-87,2) e do volume gástrico estimado em mL.kg-1 de 0,62 mL.kg-1 (0,39-0,95). O percentil 95 [intervalo de confiança (IC) 95%] da área transversal do antro gástrico e do volume gástrico estimado foi ≤ 10,3 cm2 (IC 95%: 7,6-15,6) e 1,42 mL.kg-1 (IC 95%: 1,20-2,64), respectivamente. A incidência de gestantes sob risco de aspiração pulmonar foi de 3,5% (IC: 3,5 (1,2-9,8). Houve correlação positiva entre a área transversal do antro gástrico e peso, p < 0,001 e índice de massa corporal p < 0,001. As pacientes com índice de massa corporal ≥ 30 apresentaram maior área transversal do antro gástrico, e do volume gástrico estimado, do que as com índice de massa corporal < 30, respectivamente p < 0,01 e p < 0,02. Conclusão: A mensuração da área transversal do antro gástrico de gestantes é factível e fácil. A área transversal do antro gástrico correlacionou-se positivamente com peso e índice de massa corporal. A estimativa do volume gástrico através da mensuração da área transversal do antro gástrico pode identificar pacientes sob risco de aspiração pulmonar. As pacientes obesas apresentaram área transversal do antro gástrico e volume gástrico estimado maior do que as não obesas.

Preliminary assessment of anti-α-Gal IgG and IgM levels in patients with patent Plasmodium vivax infection

Anti-α-Gal responses may exert a protective effect in falciparum malaria. However, the biological role of such antibodies is still unknown during Plasmodium vivax infections. We investigated IgG and IgM responses to α-Gal in individuals with vivax malaria. Anti-α-Gal IgG and IgM levels were higher in these patients than in controls, but no significant correlation was found between parasitaemia and anti-α-Gal response, nor between this response and ABO blood group status. This is the first study to investigate anti-α-Gal antibodies in P. vivax-infected patients; a larger survey is necessary to achieve a better understanding of host immune response during vivax malaria.

Decreased uric acid levels in the acute phase of Plasmodium vivax malaria

Abstract INTRODUCTION Uric acid is one of the compounds associated with the inflammatory process in malaria. It acts as an indicator of cellular damage by activating the immune response and inflammatory process. METHODS: We measured serum concentrations of uric acid in 60 symptomatic patients before and after treatment for malarial infections caused by Plasmodium vivax. RESULTS: Lower serum concentrations of uric acid were found during the acute phase of P. vivax malaria compared to those in its convalescent phase (p < 0.0001). CONCLUSIONS: Patients in the acute phase of malaria had lower uric acid levels than those in its convalescent phase.

Internações por condições sensíveis à atenção primária no estado de Rondônia: estudo descritivo do período 2012-2016 / Hospitalización por enfermedades sensibles a cuidados de atención primaria en el estado de Rondônia, Brasil: estudio descriptivo del período 2012-2016 / Hospitalization for ambulatory care-sensitive conditions in the state of Rondônia, Brazil: a descriptive study of the period 2012-2016

Objetivo: descrever a frequência e os motivos das internações por condições sensíveis à atenção primária à saúde (ICSAP) ocorridas em Rondônia, Brasil, entre 2012 e 2016, e analisar sua relação com a evolução da cobertura da Estratégia Saúde da Família (ESF). Métodos: estudo descritivo, com dados secundários do Sistema de Informações Hospitalares do Sistema Único de Saúde. Resultados: no período do estudo, foram autorizadas 133.958 ICSAP, correspondendo a uma taxa de 75 internações/1.000 hab.; registrou-se incremento anual paralelo da cobertura da ESF e tendência levemente decrescente das ICSAP autorizadas, embora não estatisticamente significante; em 2012, a frequência de ICSAP foi de 20,7% entre todas as hospitalizações ocorridas no estado, enquanto em 2016, esse indicador declinou para 16,7%. Conclusão: foi alta a frequência de ICSAP em Rondônia entre 2012 e 2016; embora tenha havido incremento na cobertura de ESF no mesmo período, esse aumento não foi acompanhado de mudança significativa na frequência de ICSAP registrada no estado.

Objetivo: describir la frecuencia y los motivos de las hospitalizaciones por enfermedades sensibles a cuidados de atención primaria en salud (HESCAP) en Rondônia, Brasil, entre 2012 y 2016. Métodos: estudio descriptivo, con datos del Sistema de Informaciones Hospitalarias del Sistema Único de Salud. Resultados: en el período del estudio se autorizaron 133.958 HESCAP, correspondiendo a una tasa de 75 internaciones/1.000 hab.; se registró un incremento anual de la cobertura de la Estrategia Salud de la Familia (ESF) y tendencia decreciente de las HESCAP, aunque no estadísticamente significativa; en 2012, la frecuencia de HESCAP fue del 20,7% entre todas las hospitalizaciones ocurridas en el estado, mientras que en 2016 ese indicador declinó al 16,7%. Conclusión: fue alta la frecuencia de HESCAP en Rondônia entre 2012 y 2016; aunque hubo un incremento en la cobertura de ESF en el mismo período, ese aumento no fue acompañado por un cambio significativo en la frecuencia de HESCAP registrada en el estado.

Objective: to describe the frequency and reasons for hospitalizations for ambulatory care-sensitive conditions (HACSC) in Rondônia, Brazil, between 2012 and 2016, and to analyze their relationship with the evolution of the coverage of the family health strategy (FHS) in the same period. Methods: this was a descriptive study of secondary data from the Brazilian National Health System's Hospital Information System. Results: during the period of the study 133,958 HACSC were authorized, corresponding to a rate of 75 hospitalizations/1,000 inhab.; there was a parallel annual increase in FHS coverage and a slightly decreasing trend of authorized HACSC, although this was not statistically significant; in 2012, HACSC frequency was 20.7% in relation to all hospitalizations that occurred in the state, while in 2016 this indicator declined to 16.7%. Conclusion: HACSC frequency in Rondônia was high between 2012 and 2016; although there was an increase in FHS coverage in the same period, this increase was not accompanied by a significant change in the frequency of HACSC registered in the state.

Avaliação da completude e da oportunidade das notificações de malária na Amazônia Brasileira, 2003-2012 / Evaluación de la integridad y reporte oportuno de las notificaciones de malaria en la Amazonia brasileña en el período de 2003 a 2012 / Evaluation of the completeness and timeliness of malaria reporting in the Brazilian Amazon, 2003-2012

OBJETIVO: avaliar a completude e oportunidade das notificações, do diagnóstico e do tratamento da malária na Amazônia Legal Brasileira. MÉTODOS: estudo descritivo, com dados de 23 campos das fichas de notificação registradas no Sistema de Informação de Vigilância Epidemiológica da Malária (Sivep-Malária) no período de 2003 a 2012. RESULTADOS: em 86,0% dos campos da ficha de notificação, a completude foi boa (≥90,0% de preenchimento); nas Secretarias Municipais de Saúde, 40,6% das notificações tiveram registro oportuno (0-7 dias após a notificação), e no Ministério da Saúde, 75,6% (0-30 dias após a notificação); o diagnóstico e o tratamento oportunos ocorreram em 44,6% e 45,4% dos pacientes, respectivamente. CONCLUSÃO: a maioria das notificações apresentou boa completude; a oportunidade no registro das notificações ficou aquém dos padrões internacionais; e a oportunidade no diagnóstico e no tratamento revelou-se abaixo das recomendações do Ministério da Saúde.

OBJETIVO: evaluar la integridad de los datos y reporte oportuno de las notificaciones, de diagnóstico y tratamiento de malaria en la Amazonía brasileña. MÉTODOS: estudio descriptivo, con datos de 23 ítems de las fichas de notificación registradas en el Sistema de Información de Malaria (Sivep-Malária), en el periodo 2003-2012. RESULTADOS: el 86,0% de los ítems de la ficha de notificación fueron completados adecuadamente (≥90,0% completado); en las secretarias municipales de salud, 40,6% de las notificaciones tuvieron registro oportuno (0-7 días después de la notificación) y en el Ministerio de Salud, 75,6% (0-30 días después de la notificación); el diagnóstico y tratamiento oportunos ocurrieron en 44,6% y 45,4% de los pacientes, respectivamente. CONCLUSIÓN: la mayoría de las notificaciones mostró una buena integridad; la tasa de registro oportuno de las notificaciones fue inferior a los estándares internacionales y el diagnóstico y tratamiento oportuno fue inferior a lorecomendado por el Ministerio de Salud.

OBJECTIVE: to evaluate the completeness and timeliness of malaria case reporting, diagnosis and treatment in the Brazilian Amazon. METHODS: this is a descriptive study using data from 23 fields of notification forms recorded on the Malaria Epidemiological Surveillance Information System (Sivep-Malaria) between 2003 and 2012. RESULTS: data completeness was good in 86,0% of fields (≥90,0% filled in); there was timely recording of 40,6% of notifications at the Municipal Health Departments (0-7 days following notification) and 75,6% at the Ministry of Health (0-30 days following notification); timely diagnosis and timely treatment occurred in 44,6% and 45,4% of patients, respectively. CONCLUSION: most notification forms had good completeness; timeliness in recording notifications was below international standards; timeliness of diagnosis and treatment was below the Ministry of Health recommendations.

The changing distribution of malaria in the Brazilian Amazon, 2003-2004 and 2008-2009

Introduction More than half of the malaria cases reported in the Americas are from the Brazilian Amazon region. While malaria is considered endemic in this region, its geographical distribution is extremely heterogeneous. Therefore, it is important to investigate the distribution of malaria and to determine regions whereby action might be necessary. Methods Changes in malaria indicators in all municipalities of the Brazilian Amazon between 2003-2004 and 2008-2009 were studied. The malaria indicators included the absolute number of malaria cases and deaths, the bi-annual parasite incidence (BPI), BPI ratios and differences, a Lorenz curve and Gini coefficients. Results During the study period, mortality from malaria remained low (0.02% deaths/case), the percent of municipalities that became malaria-free increased from 15.6% to 31.7%, and the Gini coefficient increased from 82% to 87%. In 2003, 10% of the municipalities with the highest BPI accumulated 67% of all malaria cases, compared with 2009, when 10% of the municipalities (with the highest BPI) had 80% of the malaria cases. Conclusions This study described an overall decrease in malaria transmission in the Brazilian Amazon region. As expected, an increased heterogeneity of malaria indicators was found, which reinforces the notion that a single ...

Factors associated with recurrent Plasmodium vivax malaria in Porto Velho, Rondônia State, Brazil, 2009 / Fatores associados às recidivas de malária causada por Plasmodium vivax no Município de Porto Velho, Rondônia, Brasil, 2009 / Fatores associados às recidivas de malária causada por Plasmodium vivax no Município de Porto Velho, Rondônia, Brasil, 2009 / Factores asociados a las recidivas de malaria, causada por Plasmodium vivax, en el municipio de Porto Velho, Rondônia, Brasil, 2009

This open retrospective cohort study aimed to describe the incidence of recurrent Plasmodium vivax malaria and associated factors in Porto Velho, Rondônia State, Brazil, in 2009. Data were collected from the National Information System for Malaria Epidemiological Surveillance. There were 23,365 reported P. vivax malaria cases in 2009, 23% of which were classified as relapses. Incidence density of P. vivax recurrence was 45.1/100 patient-years, mostly occurring between the 4th and 13th week after initiating treatment. Male gender, shorter time since onset of symptoms, and higher parasitemia in the initial infection increased the risk of relapse during the year, with a 10% reduction in relative risk for longer symptoms and 11% and 15% increases in relative risk for males and higher initial parasitemia, respectively. However, the results show low clinical relevance for these associations, thereby limiting their applicability to decision-making at the public health level.

Estudo de coorte histórica aberta, construída com informações registradas no Sistema de Informação de Vigilância Epidemiológica da Malária, com objetivo de descrever a incidência e os fatores associados à recidiva de malária causada pelo Plasmodium vivax em Porto Velho, Rondônia, Brasil. Foram notificados 23.365 casos de malária por P. vivax no município, sendo que 23% deles apresentaram recidiva no decorrer de 2009. A densidade de incidência de recidivas foi de 45,1/100 pacientes-ano, ocorrendo, principalmente, entre a 4a e a 13a semana após o início do tratamento. Ser homem, ter menos tempo de sintomas e ter maior nível de parasitemia na infecção inicial aumentaram o risco de recidiva no decorrer do ano, com 10% de redução relativa do risco para maior tempo de sintomas e de 11% e 15% de incremento relativo do risco para o sexo masculino e maiores níveis de parasitemia, respectivamente. Contudo, os resultados demonstram baixa relevância clínica das associações encontradas, comprometendo a sua aplicabilidade na tomada de decisão em nível de saúde pública.

Estudo de coorte histórica aberta, construída com informações registradas no Sistema de Informação de Vigilância Epidemiológica da Malária, com objetivo de descrever a incidência e os fatores associados à recidiva de malária causada pelo Plasmodium vivax em Porto Velho, Rondônia, Brasil. Foram notificados 23.365 casos de malária por P. vivax no município, sendo que 23% deles apresentaram recidiva no decorrer de 2009. A densidade de incidência de recidivas foi de 45,1/100 pacientes-ano, ocorrendo, principalmente, entre a 4a e a 13a semana após o início do tratamento. Ser homem, ter menos tempo de sintomas e ter maior nível de parasitemia na infecção inicial aumentaram o risco de recidiva no decorrer do ano, com 10% de redução relativa do risco para maior tempo de sintomas e de 11% e 15% de incremento relativo do risco para o sexo masculino e maiores níveis de parasitemia, respectivamente. Contudo, os resultados demonstram baixa relevância clínica das associações encontradas, comprometendo a sua aplicabilidade na tomada de decisão em nível de saúde pública. Recidiva; Plasmodium vivax; Malária.

Estudio de cohorte histórica abierta, construida con información registrada en el Sistema de Información de Vigilancia Epidemiológica de la Malaria, con el objetivo de describir la incidencia y los factores asociados a la reaparición de malaria, causada por el Plasmodium vivax, en Porto Velho, Rondônia, Brasil. Se notificaron 23.365 casos de malaria por P. vivax en el municipio, donde un 23% de ellos presentaron recidiva a lo largo del 2009. La densidad de incidencia de recidivas fue de 45,1/100 pacientes-año, produciéndose, principalmente, entre la 4ª y la 13ª semana tras el inicio del tratamiento. Ser hombre, tener menos tiempo síntomas y tener un mayor nivel de parasitemia en la infección inicial aumentaron el riesgo de recidiva a lo largo del año, con un 10% de reducción relativa del riesgo, para un mayor tiempo de síntomas, y de un 11% y 15% de incremento relativo del riesgo para el sexo masculino y mayores niveles de parasitemia, respectivamente. No obstante, los resultados demostraron baja relevancia clínica de las asociaciones encontradas, comprometiendo su aplicabilidad en la toma de decisiones dentro de la salud pública.

Adesão ao tratamento da malária e fatores contribuintes / Adherence to malaria treatment and its contributing factors / Adhesión al tratamiento de la malaria y factores contributivos

Estudo exploratório, descritivo, transversal. O objetivo foi estimar a frequência de adesão ao tratamento da malária no distrito de Três Fronteiras, município de Colniza, Mato Grosso, descrevendo os fatores que contribuem para a sua ocorrência. Participaram 27 pacientes selecionados na busca ativa. A coleta de dados foi por meio de entrevista e a medida de adesão ao tratamento deu-se pelo autorrelato e contagem de medicamentos. A frequência de adesão foi de 77,8%. Entre os fatores que contribuíram para a adesão ao tratamento da malária, destacaram-se os relacionados ao paciente, principalmente o desejo de melhorar e a confiança na efetividade dos medicamentos. A frequência de adesão encontrada foi ligeiramente inferior à de outros estudos realizados em regiões endêmicas do país. Concluindo, ações de educação em saúde sobre a necessidade de adesão ao tratamento devem ser enfatizadas e intensificadas para minimizar ou eliminar o abandono de tratamento.

This exploratory, descriptive and cross-sectional study was performed with the objective to estimate the frequency of adherence to malaria treatment in the Brazilian district of Três Fronteiras, belonging to the municipality of Colniza, in the state of Mato Grosso, and describe the contributing factors. Twenty-seven patients were selected by active search. Interviews were conducted for data collection, and treatment adherence was measured considering the patients' self report and by counting medication. The frequency of adherence was 77.8%. Among the factors that contributed to malaria treatment adherence, those related to the patient, particularly regarding the will to get better and the confidence in the effectiveness of the medication were the most prevalent. The identify adherence frequency rate was lower than that reported in previous studies performed in endemic regions of Brazil. In conclusion, health education actions addressing the importance of treatment adherence must be emphasized and intensified to minimize or eliminate treatment abandonment.

Estudio exploratorio, descriptivo, transversal. Se objetivó estimar la frecuencia de adhesión al tratamiento de la malaria en el distrito de Tres Fronteras, municipio de Colniza, Mato Grosso, describiendo los factores que contribuyen al hecho. Participaron 27 pacientes seleccionados en la búsqueda activa. Datos recolectados mediante entrevista, medida de adhesión al tratamiento establecida por autorrelato y recuento de medicamentos. La frecuencia de adhesión fue del 77,8%. Entre los factores que contribuyeron a la adhesión al tratamiento de la malaria, se destacaron los relativos al paciente; en especial, el deseo de mejorar y la confianza en la efectividad de los medicamentos. La frecuencia de adhesión hallada fue ligeramente inferior a la de otros estudios realizados en regiones endémicas del país. Concluyendo, deben enfatizarse e intensificarse las acciones de educación en salud acerca de la necesidad de adhesión al tratamiento, a fin de minimizar o acabar con el abandono del mismo.

Submicroscopic malaria parasite carriage: how reproducible are polymerase chain reaction-based methods?

The polymerase chain reaction (PCR)-based methods for the diagnosis of malaria infection are expected to accurately identify submicroscopic parasite carriers. Although a significant number of PCR protocols have been described, few studies have addressed the performance of PCR amplification in cases of field samples with submicroscopic malaria infection. Here, the reproducibility of two well-established PCR protocols (nested-PCR and real-time PCR for the Plasmodium 18 small subunit rRNA gene) were evaluated in a panel of 34 blood field samples from individuals that are potential reservoirs of malaria infection, but were negative for malaria by optical microscopy. Regardless of the PCR protocol, a large variation between the PCR replicates was observed, leading to alternating positive and negative results in 38% (13 out of 34) of the samples. These findings were quite different from those obtained from the microscopy-positive patients or the unexposed individuals; the diagnosis of these individuals could be confirmed based on the high reproducibility and specificity of the PCR-based protocols. The limitation of PCR amplification was restricted to the field samples with very low levels of parasitaemia because titrations of the DNA templates were able to detect < 3 parasites/µL in the blood. In conclusion, conventional PCR protocols require careful interpretation in cases of submicroscopic malaria infection, as inconsistent and false-negative results can occur.

In vitro antimalarial activity of tigecycline against Plasmodium falciparum culture-adapted reference strains and clinical isolates from the Brazilian Amazon

Introduction: We evaluated the in vitro antimalarial activity of tigecycline as an alternative drug for the treatment of severe malaria. Methods: A chloroquine-sensitive Plasmodium falciparum reference strain, a chloroquine-resistant reference strain, and three clinical isolates were tested for in vitro susceptibility to tigecycline. A histidine-rich protein in vitro assay was used to evaluate antimalarial activity. Results: The geometric-mean 50% effective concentration (EC50%) of tigecycline was 535.5 nM (confidence interval (CI): 344.3-726.8). No significant correlation was found between the EC50% of tigecycline and that of any other tested antimalarial drug. Conclusions: Tigecycline may represent an alternative drug for the treatment of patients with severe malaria. .