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1.
Rev Bras Enferm ; 75Suppl 2(Suppl 2): e20201084, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34787275

RESUMO

OBJECTIVES: to analyze knowledge production adherence from a master's course in nursing in the Amazon to care and health demands in the region, with an emphasis on neglected tropical diseases and traditional populations in the Amazon. METHODS: a descriptive study, with a quantitative approach and documentary basis, analyzing dissertations defended in a Graduate Program in Nursing at the Universidade do Estado do Pará in association with the Universidade Federal do Amazonas, from 2012-2019. A descriptive statistical analysis was performed. RESULTS: of the 105 dissertations analyzed, 30 (28.6%) were related to neglected tropical diseases. Of these, 11 (10.5%) dealt with Chagas disease, leishmaniasis, tuberculosis, malaria, and leprosy. Traditional populations in the Amazon participated in only 11 (10.5%) studies. CONCLUSIONS: knowledge production in a master's course has adherence to care and health demands in the region; however, it needs to enhance its production to strengthen its identity.


Assuntos
Educação de Pós-Graduação em Enfermagem , Cuidados de Enfermagem , Brasil , Humanos , Conhecimento , Recursos Humanos
2.
Artigo em Português | PAHOIRIS | ID: phr-55176

RESUMO

[RESUMO]. Objetivo. Avaliar o uso combinado de marcadores sorológicos e análise espacial para ampliar a sensibilidade da vigilância epidemiológica da hanseníase. Método. Este estudo transversal foi realizado com vizinhos de casos de hanseníase e familiares e vizinhos de escolares com sorologia positiva anti-glicolipídeo fenólico I (PGL-I) em Diamantina, Minas Gerais, Brasil. Definiram- se como vizinhos as pessoas que residiam em um raio de até 100 metros de escolares e de casos de hanseníase. Para a coleta de dados, foram realizados entrevista semiestruturada, exame dermatoneurológico e teste sorológico rápido ML Flow. Todos os endereços foram georreferenciados. Foram realizadas regressão multivariada e análise espacial, tendo a sororreatividade anti-PGL-I como variável dependente. Resultados. Foram estudadas 1 491 pessoas: 1 009 (67,7%) familiares e vizinhos dos escolares com sorologia positiva e 482 (32,3%) vizinhos dos casos de hanseníase. Do total, 421 (28,2%) apresentaram soropositividade anti-PGL-I. A chance de soropositividade foi maior entre familiares e vizinhos dos escolares soropositivos (P < 0,001), entre pessoas com renda familiar de 1 salário-mínimo (P < 0,001), entre os mais jovens (P < 0,001) e entre os que residiam em domicílios com um a cinco cômodos (P = 0,007). A taxa de soropositividade foi maior em área geográfica correspondente aos escolares soropositivos (P < 0,001), ou seja, houve divergência entre o foco de maior concentração de casos e o de maior soropositividade. Conclusões. O uso combinado de marcadores sorológicos e análise espacial possibilitou identificar fragilidades operacionais dos serviços e uma possível endemia oculta de hanseníase nos setores censitários urbanos do município. Atividades de rastreamento de contatos sociais e vizinhos, busca ativa, campanhas educativas, inquéritos escolares e análise do território facilitam o diagnóstico precoce da hanseníase.


ABSTRACT Objective. To evaluate the combined use of serologic markers and spatial analysis to increase the sensitivity of leprosy epidemiological surveillance. Method. This cross-sectional study was performed with neighbors of leprosy cases and neighbors and family members of schoolchildren with a positive anti-phenolic glycolipid I (PGL-I) test in Diamantina, state of Minas Gerais, Brazil. Neighbors were those living within a 100-m radius of schoolchildren or leprosy cases. Data collection included a semi-structured interview, dermatologic examination, and rapid ML Flow test. All residential addresses were georeferenced. Multivariate regression and spatial analysis were performed with anti-PGL-I seropositivity as the dependent variable. Results. The study included 1 491 individuals: 1 009 (67.7%) family members and neighbors of schoolchildren with positive serology test and 482 (32.3%) neighbors of leprosy cases. Of the total, 421 (28.2%) were positive for anti-PGL-I. Seropositivity was higher among family members and neighbors of seropositive schoolers (P < 0.001), among people with family income of 1 minimum wage (P < 0.001), among the youngest participants (P < 0.001), and among those living in homes with one to five rooms (P = 0.007). The seropositivity rate was higher in the geographic area corresponding to seropositive schoolchildren (P < 0.001), that is, the spot with the highest number of cases was different from the spot with the highest rate of seropositivity. Conclusions. The combined use of serologic markers and spatial analysis allowed us to easily identify operational weaknesses of services and a possible occult leprosy endemism in the municipality’s urban census tracts. Tracing of social contact and neighbors, active search, educational campaigns, school surveys, and territorial analyses facilitate the early diagnosis of leprosy.


[RESUMEN]. Objetivo. Evaluar el uso conjunto de los marcadores serológicos y del análisis espacial para ampliar la sensibilidad de la vigilancia epidemiológica de la lepra. Método. Este estudio transversal se realizó con vecinos de personas con casos de lepra y con familiares y vecinos de escolares con resultados positivos en las pruebas serológicas del antígeno glicolípido fenólico I (PGL-I) en Diamantina (Minas Gerais, Brasil). Se definieron como vecinos las personas residentes en un radio de hasta 100 metros de distancia de los escolares y de las personas con casos de lepra. Para la recopilación de datos se realizaron entrevistas semiestructuradas, exámenes dermatoneurológicos y pruebas serológicas rápidas ML Flow. Todas las direcciones se ubicaron por georreferencia. Se realizó una regresión multivariante y un análisis espacial, y se empleó la reactividad serológica anti-PGL-I como variable dependiente. Resultados. Se estudiaron 1 491 personas: 1 009 (67,7%) familiares y vecinos de escolares con resultados positivos en las pruebas serológicas y 482 (32,3%) vecinos de las personas con casos de lepra. Del total, 421 (28,2%) presentaron seropositividad anti-PGL-I. La posibilidad de presentar seropositividad fue mayor en los familiares y vecinos de los escolares seropositivos (P < 0,001), en las personas con ingresos familiares de un salario mínimo (P < 0,001), en las personas más jóvenes (P < 0,001) y en los residentes en domicilios con una a cinco habitaciones (P = 0,007). La tasa de seropositividad fue mayor en la zona geográfica correspondiente a los escolares seropositivos (P < 0,001), por lo que hubo divergencia entre el foco de mayor concentración de casos y el de mayor seropositividad. Conclusiones. El uso conjunto de los marcadores serológicos y del análisis espacial permitió determinar las fragilidades operativas de los servicios y una posible endemia oculta de lepra en los sectores urbanos del municipio incluidos en el censo correspondiente. Las actividades de rastreo de contactos sociales y cercanos, la búsqueda activa de casos, las campañas educativas, las encuestas escolares y el análisis del territorio facilitan el diagnóstico temprano de la lepra.


Assuntos
Hanseníase , Mycobacterium leprae , Monitoramento Epidemiológico , Sorologia , Análise Espacial , Brasil , Hanseníase , Monitoramento Epidemiológico , Sorologia , Análise Espacial , Brasil , Hanseníase , Monitoramento Epidemiológico , Sorologia , Análise Espacial
3.
Recurso na Internet em Português | LIS | ID: lis-48447

RESUMO

Um novo teste de diagnóstico desenvolvido por pesquisadores da Fundação Oswaldo Cruz (Fiocruz) pode contribuir para o enfrentamento da hanseníase


Assuntos
Hanseníase/diagnóstico , Técnicas de Diagnóstico Molecular/métodos , Brasil
4.
Einstein (Sao Paulo) ; 19: eAO5622, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34495085

RESUMO

OBJECTIVE: To analyze the prevalence of leprosy cases using as parameters the number of diagnosed cases, age group, sex, clinical form of the disease, degree of physical disability, affected nerves, and therapeutic methods. METHODS: This was a descriptive study. Data were collected in the Information System for Notifiable Diseases (Sistema de Informações de Agravos de Notificação) from 2014 to 2017 in the state of Mato Grosso (MT), Brazil. RESULTS: In the studied period, 11,388 cases were notified in the state, with a higher prevalence in the year 2017. Most cases were diagnosed in individuals older than 15 years with a slight predominance of men. During diagnosis, there was prevalence of zero degree of physical disability and among individuals with affected nerves, mostly had less than five nerves affected. CONCLUSION: Analyzing the prevalence and epidemiological profile of leprosy cases in the state of Mato Grosso (MT) turns to be essential for coping with the disease, as it helps in its management and treatment, with an emphasis on multidisciplinary approach for the recovery of existing cases and prevention of new cases, especially at hyperendemic states.


Assuntos
Surdez , Hanseníase , Adaptação Psicológica , Brasil/epidemiologia , Humanos , Hanseníase/epidemiologia , Masculino , Prevalência
5.
Rev Esc Enferm USP ; 55: e20200357, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34495209

RESUMO

OBJECTIVE: To explore the scientific evidence regarding the leprosy patients quality of life. METHOD: Scoping review according to the Joanna Briggs Institute methodology, with articles indexed in PubMed, Cochrane, LILACS, Embase, CINAHL, Scopus, Web of Science, PsyINFO, INFOLEP, and Google Scholar databases, published in full in Portuguese, English, or Spanish. RESULTS: Seventy-four studies were identified, with 71 of quantitative approach and 3 with a mixed method. There was a predominance of studies published in Brazil (58.1%), with an adult population, (97.3%) and recruited in reference centers for the treatment of leprosy (52.7%). There was greater use of the WHOQOL-bref (50%) and SF-36 (18.9%) instruments to assess quality of life. The study showed that the greatest impairment in quality of life was related to the delay in the diagnosis of the disease, to leprosy reactions, physical disabilities, neuropathic pain, and stigma. CONCLUSION: Most studies were developed in endemic countries, with adults, and based on observational studies, and the worst scores obtained were associated with physical domain impairment.


Assuntos
Hanseníase , Qualidade de Vida , Adulto , Brasil , Humanos
6.
Codas ; 33(5): e20200058, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34524350

RESUMO

PURPOSE: Verifying the association between clinical-functional vulnerability and vocal and auditory self-perception in seniors presenting a history of leprosy. METHODS: Cross-sectional study encompassing 117 elderly people from an old leprosy colony in southeastern Brazil. The research analyzed sociodemographic information and the following protocols: Clinical-Functional Vulnerability Index-20 (IVCF-20), Hearing Handicap Inventory for the Elderly Screening Version (HHIE-S), Screening for Vocal Change in the Elderly (RAVI) and Vocal Handicap Index 10 (IDV-10). For data analysis, the ordinal logistic regression model of proportional odds was used. RESULTS: 37.6% of the elderly were classified as robust, 35.0% at risk of fragility and 27.4% as frail. Vocal alteration (RAVI), vocal handicap (IDV-10) and restriction to auditory participation (HHIE-S) were observed in 65.8%, 24.8% and 48.7% respectively, in the studied population. In the multivariate analysis, it was found the oldest group (OR = 1.11; CI: 1.05-1.16) and those with vocal handicap (OR = 4.11; 95% CI: 1.77-9.56) were more likely to be classified as at risk of fragility or already fragile. The simultaneous presence of vocal handicap and restriction of auditory participation (46.9%) was larger among frail elderly people. CONCLUSION: The increasing age of the elderly and the presence of vocal handicap is associated with greater clinical-functional vulnerability. The high prevalence of both voice and hearing disorders reinforces the need for the speech therapist to be included in public policies, directed towards caring for people with a history of leprosy.


Assuntos
Audição , Hanseníase , Idoso , Brasil , Estudos Transversais , Humanos , Hanseníase/complicações , Autoimagem , Inquéritos e Questionários
7.
Cien Saude Colet ; 26(9): 4233-4242, 2021 Sep.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34586274

RESUMO

Drug utilization research to describe the control of thalidomide in Brazil and its use in Minas Gerais state. An online questionnaire was sent to the Brazilian federative units to collect data concerning distribution, dispensation, user registration, and thalidomide adverse events. Distribution (2011-2018) and dispensing (2015-2018) data in Minas Gerais were obtained through the pharmaceutical care management system. Analysis of variance and Tukey test were used for data comparisons. Of the 16 participating federative units, 100% and 50% used electronic distribution and dispensing systems, respectively, and about 43% registered users. Adverse event reporting systems were scarce. A 44% reduction was observed in the distribution in Minas Gerais for the period. Dispensing remained constant (mean 0.0004 DDD/1,000 inhabitants/day) and occurred mainly for erythema nodosum leprosum and multiple myeloma. Off-label use (2.2%) was increasing. Most users were male (mean age 56 years) and thirty percent of women were of childbearing age. Thalidomide surveillance is a public health challenge. Despite the increased use and mandatory control, there is no national standardization, and adverse event reporting is incipient.


Assuntos
Uso de Medicamentos , Talidomida , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Talidomida/efeitos adversos
8.
BMC Infect Dis ; 21(1): 916, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488660

RESUMO

BACKGROUND: Leprosy is a treatable disease; however, the release from treatment after completion of multidrug therapy (MDT) often does not equal absence of health problems. Consequently, sequelae interfere with the patient's perception of cure. The objective of this study was to analyze the factors associated with the perception of not being healed among people treated for leprosy in a highly endemic area in Brazil. METHOD: A cross-sectional study of perceived cure of leprosy in the post-release from treatment period was conducted in Cáceres in the state of Mato Grosso, Brazil. The study included a total of 390 leprosy patients treated with MDT and released after completion of treatment from 1 January 2000 to 31 December 2017. The dependent variable was self-reported cure of leprosy; the independent variables included clinical, operational and socioeconomic variables. RESULTS: Out of the 390 former leprosy patients, 304 (77.9%) perceived themselves as cured and 86 (22.1%) considered themselves unhealed. Among the latter, 49 (57.0%) reported muscle weakness and joint pains. Individuals with complaints related to leprosy post-release from treatment had a 4.6 times higher chance to self-report as unhealed (OR 4.6; 95% CI 2.5-8.5). Patients with physical disabilities (PD) grade 1 and 2 at the time of the study had a 3.1 (OR 3.1; 95% CI 1.3-7.4) and 8.8 (OR 7.7; 95% CI 3.5-21.9) times higher likelihood to self-identify as unhealed, respectively. CONCLUSION: Among successfully treated leprosy patients, a quarter self-report as unhealed of the disease. The factors associated with the perception of being unhealed are PD and complaints related to leprosy in the post-release from treatment phase.


Assuntos
Hansenostáticos , Hanseníase , Brasil , Estudos Transversais , Quimioterapia Combinada , Humanos , Hansenostáticos/uso terapêutico , Hanseníase/complicações , Hanseníase/tratamento farmacológico , Percepção
9.
An Bras Dermatol ; 96(6): 762-764, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34579963

RESUMO

Lobomycosis is a chronic granulomatous infection caused by the yeast Lacazia loboi, typically found in tropical and subtropical geographical areas. Transmission occurs through traumatic inoculation into the skin, especially in exposed areas, of men who work in contact with the soil. Lesions are restricted to the skin and subcutaneous tissue, with a keloid-like appearance in most cases. The occurrence of squamous cell carcinoma on skin lesions with a long evolution is well known; however, there are scarce reports of lobomycosis that developed into squamous cell carcinoma. The authors report a patient from the Brazilian Amazon region, with lobomycosis and carcinomatous degeneration, with an unfavorable outcome, due to late diagnosis.


Assuntos
Queloide , Lacazia , Lobomicose , Brasil , Humanos , Queloide/patologia , Lobomicose/patologia , Masculino , Pele/patologia
10.
Einstein (Sao Paulo) ; 19: eAO5936, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34431850

RESUMO

OBJECTIVE: To evaluate quality of life and associated factors in patients with leprosy. METHODS: A cross-sectional study with 63 people diagnosed as leprosy, seen at a reference service for the disease in the southeastern region of Mato Grosso, Brazil. The questionnaire World Health Organization Quality of Life Bref was used to evaluate quality of life. Simple and multiple linear regressions evaluated the association between sociodemographic variables and quality of life domains. RESULTS: The highest mean of quality of life was observed in the psychological domain (16.28±2.30), and the lowest in the environmental domain (13.86±2.21). Females, individuals with no partners, and people who owned their own house had the lowest quality of life means within the psychological domain. People who did not receive visits by Community Health Workers had the lowest means in quality of life within the environmental domain. Multivariate analysis revealed that the best quality of life was associated to self-reported white skin color within the environmental domain, and the worst quality of life was associated to less schooling within the physical domain. CONCLUSION: This study showed the influence of sociodemographic factors on the quality of life of patients with leprosy, and indicated the need for comprehensive health care, considering the social determinants of health.


Assuntos
Hanseníase , Qualidade de Vida , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Inquéritos e Questionários
11.
Cien Saude Colet ; 26(8): 3245-3254, 2021 Aug.
Artigo em Português | MEDLINE | ID: mdl-34378712

RESUMO

The article explores João de Barros Barreto's ideas and proposals for the field of the organization of health services in Brazil. Based on the proposal of the Capanema Reform (1937-1941), the text reveals the context of the formulation of the so-called district health model in Brazil historically, focusing on its logic, conceptual and theoretical principles and resources employed. The conclusion drawn is that Barros Barreto's professional career, contextualized in a specific scenario of ideas, state agenda and organizational perspectives, contributed decisively to the constitution of modeling achievements of relevant organizational arrangements in the trajectory of Brazilian public health.


Assuntos
Organizações , Saúde Pública , Brasil , Humanos
12.
Cad Saude Publica ; 37(7): e00130020, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34346981

RESUMO

Our study aims to describe trends in new case detection rate (NCDR) of leprosy in Brazil from 2006 to 2017 overall and in subgroups, and to analyze the evolution of clinical and treatment characteristics of patients, with emphasis on cases diagnosed with grade 2 physical disabilities. We conducted a descriptive study to analyze new cases of leprosy registered in the Brazilian Information System for Notificable Diseases (SINAN), from 2006-2017. We calculated the leprosy NCDR per 100,000 inhabitants (overall and for individuals aged < 15 and ≥ 15 years) by sex, age, race/ethnicity, urban/rural areas, and Brazilian regions, and estimated the trends using the Mann-Kendall non-parametric test. We analyzed the distributions of cases according to relevant clinical characteristics over time. In Brazil, there was a sharp decrease in the overall NCDR from 23.4/100,000 in 2006 to 10.3/100,000 in 2017; among children < 15 years, from 6.94 to 3.20/100,000. The decline was consistent in all Brazilian regions and race/ethnicity categories. By 2017, 70.2% of the cases were multibacillary, 30.5% had grade 1 (G1D) or 2 (G2D) physical disabilities at diagnosis and 42.8% were not evaluated at treatment completion/discharge; cases with G2D at diagnosis were mostly detected in urban areas (80%) and 5% of cases died during the treatment (leprosy or other causes). Although the frequency of leprosy NCDR decreased in Brazil from 2006 to 2017 across all evaluated population groups, the large number of cases with multibacillary leprosy, physical disabilities or without adequate evaluation, and among children suggest the need to reinforce timely diagnosis and treatment to control leprosy in Brazil.


Assuntos
Pessoas com Deficiência , Hanseníase Multibacilar , Hanseníase , Brasil/epidemiologia , Criança , Humanos , Hanseníase/diagnóstico , Hanseníase/epidemiologia , Grupos Populacionais
13.
Epidemiol Serv Saude ; 30(3): e2020585, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34406220

RESUMO

OBJECTIVE: To analyze the effect of sociodemographic and clinical characteristics of new leprosy cases as determinants in the performance of the evaluation of their contacts. METHODS: This was a cross-sectional study, with a temporal approach to the evaluation indicator of 100% of contacts examined of each new case (NC) registered in the state of Ceará, Brazil, on the Notifiable Diseases Information System (SINAN), in 2008-2019. Logistic regression was used to estimate odds ratio (OR) with 95% confidence intervals (95%CI). The temporal trends were analyzed using joinpoint regression. RESULTS: 23,675 NCs, 65.4% with contacts examined were analyzed. It was less likely to evaluate 100% of the registered contacts when the new cases were multibacillary (OR=1.19 - 95%CI 1.11;1.28) and with examination of contacts as an entry mode (OR=1.71 - 95%CI 1.35;2.18). There was an increasing temporal trend of the indicator (Annual Percentage Change: 2.1 - 95%CI 1.2;3.0). CONCLUSION: Distinct dimensions of individual and social vulnerability among new leprosy cases influenced the persistent unsatisfactory performance of the evaluation of contacts.


Assuntos
Hanseníase , Brasil/epidemiologia , Estudos Transversais , Demografia , Humanos , Sistemas de Informação , Hanseníase/epidemiologia
14.
BMC Infect Dis ; 21(1): 858, 2021 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-34425777

RESUMO

BACKGROUND: Diagnosing neuritis in leprosy patients with neuropathic pain or chronic neuropathy remains challenging since no specific laboratory or neurophysiological marker is available. METHODS: In a cross-sectional study developed at a leprosy outpatient clinic in Rio de Janeiro, RJ, Brazil, 54 individuals complaining of neural pain (single or multiple sites) were classified into two groups ("neuropathic pain" or "neuritis") by a neurological specialist in leprosy based on anamnesis together with clinical and electrophysiological examinations. A neurologist, blind to the pain diagnoses, interviewed and examined the participants using a standardized form that included clinical predictors, pain features, and neurological symptoms. The association between the clinical predictors and pain classifications was evaluated via the Pearson Chi-Square or Fisher's exact test (p < 0.05). RESULTS: Six clinical algorithms were generated to evaluate sensitivity and specificity, with 95% confidence intervals, for clinical predictors statistically associated with neuritis. The most conclusive clinical algorithm was: pain onset at any time during the previous 90 days, or in association with the initiation of neurological symptoms during the prior 30-day period, necessarily associated with the worsening of pain upon movement and nerve palpation, with 94% of specificity and 35% of sensitivity. CONCLUSION: This algorithm could help physicians confirm neuritis in leprosy patients with neural pain, particularly in primary health care units with no access to neurologists or electrophysiological tests.


Assuntos
Hanseníase , Neuralgia , Neurite (Inflamação) , Brasil , Regras de Decisão Clínica , Estudos Transversais , Humanos , Hanseníase/complicações , Hanseníase/diagnóstico , Neurite (Inflamação)/diagnóstico
15.
PLoS Negl Trop Dis ; 15(8): e0009716, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34415916

RESUMO

BACKGROUND: Regarding the leprosy transmission through the upper airways, overcrowded locations such as prisons can become a risk to get sick. Like the leprosy hidden endemic demonstrated in male prison population, being interesting to assess the leprosy scene also among confined women. METHODS: A prospective descriptive study conducted at Female Penitentiary, Brazil. Leprosy Suspicion Questionnaire (LSQ) were applied to the participants, and submitted to specialized dermatoneurological exam, peripheral nerve ultrasonography, and anti-PGL-I serology. FINDINGS: 404 female inmates were evaluated, 14 new cases were diagnosed (LG-leprosy group), a new case detection rate (NCDR) of 3.4%, 13 multibacillary, while another 390 constituted the Non-Leprosy group (NLG). Leprosy cases were followed up during multidrug therapy with clinical improvement. The confinement time median was 31 months in LG, similar to NLG, less than the time of leprosy incubation. Regarding LSQ, the neurological symptoms reached the highest x2 values as Q1-numbness (5.6), Q3-anesthetizes areas in the skin (7.5), Q5-Stinging sensation (5.8), and Q7-pain in the nerves (34.7), while Q4-spots on the skin was 4.94. When more than one question were marked in the LSQ means a 12.8-fold higher to have the disease than a subject who marked only one or none. The high 34% rate of anti-PGL-I seropositivity in the penitentiary, higher levels in LG than NLG. Three additional leprosy cases each were diagnosed on the second (n = 66) and third (n = 14) reevaluations 18 and 36 months after the initial one. Semmes-Weinstein monofilaments demonstrated lower limbs (32.2%) more affected than the upper limbs (25%) with improvement during the follow-up. INTERPRETATION: The NCDR in this population showed an hidden endemic of leprosy as well as the efficacy of a search action on the part of a specialized team with the aid of the LSQ and anti-PGL-I serology as an auxiliary tracking tools.


Assuntos
Hanseníase/diagnóstico , Prisões/estatística & dados numéricos , Adulto , Brasil/epidemiologia , Feminino , Seguimentos , Humanos , Hansenostáticos/efeitos adversos , Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Hanseníase/epidemiologia , Hanseníase/microbiologia , Pessoa de Meia-Idade , Mycobacterium leprae/efeitos dos fármacos , Mycobacterium leprae/fisiologia , Estudos Prospectivos , Adulto Jovem
16.
PLoS Negl Trop Dis ; 15(8): e0009700, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34432805

RESUMO

BACKGROUND: Leprosy remains concentrated among the poorest communities in low-and middle-income countries and it is one of the primary infectious causes of disability. Although there have been increasing advances in leprosy surveillance worldwide, leprosy underreporting is still common and can hinder decision-making regarding the distribution of financial and health resources and thereby limit the effectiveness of interventions. In this study, we estimated the proportion of unreported cases of leprosy in Brazilian microregions. METHODOLOGY/PRINCIPAL FINDINGS: Using data collected between 2007 to 2015 from each of the 557 Brazilian microregions, we applied a Bayesian hierarchical model that used the presence of grade 2 leprosy-related physical disabilities as a direct indicator of delayed diagnosis and a proxy for the effectiveness of local leprosy surveillance program. We also analyzed some relevant factors that influence spatial variability in the observed mean incidence rate in the Brazilian microregions, highlighting the importance of socioeconomic factors and how they affect the levels of underreporting. We corrected leprosy incidence rates for each Brazilian microregion and estimated that, on average, 33,252 (9.6%) new leprosy cases went unreported in the country between 2007 to 2015, with this proportion varying from 8.4% to 14.1% across the Brazilian States. CONCLUSIONS/SIGNIFICANCE: The magnitude and distribution of leprosy underreporting were adequately explained by a model using Grade 2 disability as a marker for the ability of the system to detect new missing cases. The percentage of missed cases was significant, and efforts are warranted to improve leprosy case detection. Our estimates in Brazilian microregions can be used to guide effective interventions, efficient resource allocation, and target actions to mitigate transmission.


Assuntos
Hanseníase/epidemiologia , Teorema de Bayes , Brasil/epidemiologia , Humanos , Incidência , Hanseníase/economia , Fatores Socioeconômicos
17.
PLoS Negl Trop Dis ; 15(8): e0009434, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34449765

RESUMO

Pyruvate kinase (PK), encoded by the PKLR gene, is a key player in glycolysis controlling the integrity of erythrocytes. Due to Plasmodium selection, mutations for PK deficiency, which leads to hemolytic anemia, are associated with resistance to malaria in sub-Saharan Africa and with susceptibility to intracellular pathogens in experimental models. In this case-control study, we enrolled 4,555 individuals and investigated whether PKLR single nucleotide polymorphisms (SNPs) putatively selected for malaria resistance are associated with susceptibility to leprosy across Brazil (Manaus-North; Salvador-Northeast; Rondonópolis-Midwest and Rio de Janeiro-Southeast) and with tuberculosis in Mozambique. Haplotype T/G/G (rs1052176/rs4971072/rs11264359) was associated with leprosy susceptibility in Rio de Janeiro (OR = 2.46, p = 0.00001) and Salvador (OR = 1.57, p = 0.04), and with tuberculosis in Mozambique (OR = 1.52, p = 0.07). This haplotype downregulates PKLR expression in nerve and skin, accordingly to GTEx, and might subtly modulate ferritin and haptoglobin levels in serum. Furthermore, we observed genetic signatures of positive selection in the HCN3 gene (xpEHH>2 -recent selection) in Europe but not in Africa, involving 6 SNPs which are PKLR/HCN3 eQTLs. However, this evidence was not corroborated by the other tests (FST, Tajima's D and iHS). Altogether, we provide evidence that a common PKLR locus in Africans contribute to mycobacterial susceptibility in African descent populations and also highlight, for first, PKLR as a susceptibility gene for leprosy and TB.


Assuntos
Malária/genética , Polimorfismo de Nucleotídeo Único , Piruvato Quinase/genética , Adulto , Brasil , Estudos de Casos e Controles , Feminino , Frequência do Gene , Predisposição Genética para Doença , Haplótipos , Humanos , Desequilíbrio de Ligação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Moçambique , Piruvato Quinase/deficiência , Adulto Jovem
18.
Rev Bras Epidemiol ; 24: e210039, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34231829

RESUMO

OBJECTIVE: To investigate the risk factors associated with leprosy in contacts of patients. METHOD: We carried out a systematic review and meta-analysis by searching the databases MEDLINE, Embase, Cochrane Library, CINAHL, LILACS, Scopus, and Web of Science until September 2019. Four reviewers carried out the selection, analysis, and evaluation of quality of studies. The random effects model was used to calculate the pooled relative risk (RR) and 95% confidence intervals (95% CI) when heterogeneity was greater than 50%. RESULTS: The search resulted in 2,148 references and included 24 reports. Most of the studies had been conducted in Brazil and India, had a cohort design and included household, neighbors, and social contacts. The risk factors associated with illness due to leprosy in contacts were: illiteracy (RR = 1,48; 95%CI 1,22 - 1,79), living in the same house (RR = 2,41; 95%CI 1,87 - 3,10) of a case of leprosy with high bacillary load (RR = 2.40; 95%CI 1.69 - 3.41), seropositivity to the Mycobacterium leprae PGL-1 (phenolic glycolipid-1) antigen (RR = 3.54; 95%CI 2.21 - 5.67), presence of the bacillus in the bloodstream (RR = 10.61; 95%CI 4.74 - 23.77) and negative Mitsuda reaction (RR = 2,68; 95%CI 1,76 - 4,07). Immunization with BCG (bacillus Calmette-Guérin) vaccine had a protective effect against leprosy. CONCLUSION: Leprosy in contacts of patients involves social determination, individual susceptibility, and difficulties in access to disease control actions, but modifiable risk factors are the main determinants of illness in this population.


Assuntos
Antígenos de Bactérias , Hanseníase , Brasil/epidemiologia , Glicolipídeos , Humanos , Hanseníase/epidemiologia , Mycobacterium leprae
19.
Environ Monit Assess ; 193(7): 458, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34213634

RESUMO

We use benthic foraminifera and hydrography as environmental indicators to characterize the estuarine channel of Bertioga (SP, Brazil). Salinity and temperature measured in four fixed stations (F1-F4) influence differentiation related to species habitat, fluvial discharge, and environmental quality. Tidal oscillation during neap and spring tides changes the Hansen and Rattray stratification-circulation classification from highly stratified (type 2b) to weakly stratified (type 2a). In the northern entrance close to Itapanhaú River, F1 is highly stratified environment (type 2b), with significant difference between bottom and surface salinities, presenting Pararotalia sp., Pseudononion atlanticum, Hanzawaia boueana, and Quinqueloculina lamarckiana as indicator species. F2 in summer is highly stratified (type 2b) with large difference between surface and bottom salinity, whereas in winter is partially mixed weakly stratified (type 2a) with small difference between salinities and the agglutinated Arenoparella mexicana, Haplophragmoides wilberti, and Trochammina inflata thrives. In summer and winter, F3 is partially mixed weakly stratified (type 2a) with A. mexicana, H. wilberti, Trochammina inflata, Ammobaculites sp., and Ammotium salsum. In the southern entrance, F4 in the winter, is partially mixed, weakly stratified system (type 2a) that changes to highly stratified (type 2b) with large difference between salinities. This indicated low influence of fluvial freshwater and high influence of saline and polluted waters from Santos Channel where Arenoparella mexicana, Gaudryina exilis, and Ammotium cassis inhabits. Presence of Quinqueloculina spp. and Triloculina sp. indicates high saline influence, and presence of Ammonia tepida and Elphidium spp. indicates mixohaline environments which salinity dilution occurs.


Assuntos
Foraminíferos , Brasil , Monitoramento Ambiental , Sedimentos Geológicos , Água
20.
PLoS Negl Trop Dis ; 15(7): e0009635, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34319982

RESUMO

BACKGROUND: Protective effects of Bacillus Calmette-Guérin (BCG) vaccination and clofazimine and dapsone treatment against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported. Patients at risk for leprosy represent an interesting model for assessing the effects of these therapies on the occurrence and severity of coronavirus disease 2019 (COVID-19). We assessed the influence of leprosy-related variables in the occurrence and severity of COVID-19. METHODOLOGY/PRINCIPAL FINDINGS: We performed a 14-month prospective real-world cohort study in which the main risk factor was 2 previous vaccinations with BCG and the main outcome was COVID-19 detection by reverse transcription polymerase chain reaction (RT-PCR). A Cox proportional hazards model was used. Among the 406 included patients, 113 were diagnosed with leprosy. During follow-up, 69 (16.99%) patients contracted COVID-19. Survival analysis showed that leprosy was associated with COVID-19 (p<0.001), but multivariate analysis showed that only COVID-19-positive household contacts (hazard ratio (HR) = 8.04; 95% CI = 4.93-13.11) and diabetes mellitus (HR = 2.06; 95% CI = 1.04-4.06) were significant risk factors for COVID-19. CONCLUSIONS/SIGNIFICANCE: Leprosy patients are vulnerable to COVID-19 because they have more frequent contact with SARS-CoV-2-infected patients, possibly due to social and economic limitations. Our model showed that the use of corticosteroids, thalidomide, pentoxifylline, clofazimine, or dapsone or BCG vaccination did not affect the occurrence or severity of COVID-19.


Assuntos
COVID-19/epidemiologia , COVID-19/terapia , Hanseníase/tratamento farmacológico , Hanseníase/epidemiologia , Corticosteroides/uso terapêutico , Vacina BCG/administração & dosagem , Brasil/epidemiologia , COVID-19/diagnóstico , COVID-19/tratamento farmacológico , Teste para COVID-19 , Clofazimina/uso terapêutico , Estudos de Coortes , Dapsona/uso terapêutico , Humanos , Pentoxifilina/uso terapêutico , Estudos Prospectivos , Fatores de Risco , SARS-CoV-2/isolamento & purificação , Análise de Sobrevida , Talidomida/uso terapêutico
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