[Self-medication profile in a city of south Brazil]. / Perfil da automedicação em município do Sul do Brasil.

OBJECTIVE: The characterization of drug users, especially as regards self-medication and the determination of its prevalence in the population studied. MATERIAL AND METHOD: About 413 people that had used drugs in the previous month were interviewed. RESULTS: From the interviewed, 69.9% used medicines and of those 76.1% were self medicated. Headache (28.8%) was the main complaint among the self-medicated group. Acetilsalicilic acid was the most frequently used medicine (25.4%). As regards the drugs utilized, 51.2% of the users had received a recommendation from a third party and 51.7% used old prescriptions, given in previous consultations. CONCLUSION: Age, schooling and absence of periodic medical consultation were significant statistical factors in self-medication.

Measles eradication: experience in the Americas.

In 1994, the Ministers of Health from the Region of the Americas targeted measles for eradication from the Western Hemisphere by the year 2000. To achieve this goal, the Pan American Health Organization (PAHO) developed an enhanced measles eradication strategy. First, a one-time-only "catch-up" measles vaccination campaign is conducted among children aged 9 months to 14 years. Efforts are then made to vaccinate through routine health services ("keep-up") at least 95% of each newborn cohort at 12 months of age. Finally, to assure high population immunity among preschool-aged children, indiscriminate "follow-up" measles vaccination campaigns are conducted approximately every 4 years. These vaccination activities are accompanied by improvements in measles surveillance, including the laboratory testing of suspected measles cases. The implementation of the PAHO strategy has resulted in a marked reduction in measles incidence in all countries of the Americas. Indeed, in 1996 the all-time regional record low of 2109 measles cases was reported. There was a relative resurgence of measles in 1997 with over 20,000 cases, due to a large measles outbreak among infants, preschool-aged children and young adults in São Paulo, Brazil. Contributing factors for this outbreak included: low routine infant vaccination coverage, failure to conduct a "follow-up" campaign, presence of susceptible young adults, and the importation of measles virus, apparently from Europe. PAHO's strategy has been effective in interrupting measles virus circulation. This experience demonstrates that global measles eradication is an achievable goal using currently available measles vaccines.

Eradication of wild poliovirus from the Americas: wild poliovirus surveillance--laboratory issues.

The Pan American Regional Poliomyelitis Laboratory Network, developed to support the program to eradicate indigenous wild poliovirus transmission in the Americas, included 10 laboratories, distributed in eight countries in the Americas, organized according to the diagnostic procedures they regularly performed. All laboratories isolated and typed virus in stool specimens, several did intratypic differentiation by nucleic acid probe hybridization, and 2 sequenced wild poliovirus isolates for molecular epidemiologic studies. High performance of the network was maintained through comprehensive training of virologists, continuous monitoring of laboratory performance, and prompt investigation of problems. Recommended field and laboratory procedures were regularly reviewed and revised to optimize sensitivity, specificity, and diagnostic efficiency. Close integration of field and laboratory surveillance was achieved through frequent meetings between virologists and epidemiologists, effective communication of program priorities, and the distribution of weekly surveillance reports.

Eradication of wild poliovirus from the Americas: acute flaccid paralysis surveillance, 1988-1995.

In May 1985, the Pan American Health Organization proposed the goal of interruption of wild poliovirus transmission in the Western Hemisphere. An important component of the polio eradication strategy was conducting surveillance for cases of acute flaccid paralysis. Reported cases were thoroughly investigated, including the collection of stool samples for testing for the presence of wild poliovirus. The last patient with poliomyelitis due to wild poliovirus in the Americas had onset of paralysis on 23 August 1991 in Peru. Since then, >9000 cases of acute flaccid paralysis have been reported and thoroughly investigated; none has been confirmed as paralytic poliomyelitis due to wild poliovirus. On 29 September 1994, the International Commission for the Certification of Poliomyelitis Eradication declared the Americas to be polio-free.

Measles vaccination and Guillain-Barré syndrome.

BACKGROUND: Guillain-Barré syndrome (GBS) has been associated with several infectious agents, and the possibility that the disorder may be caused by vaccination has been raised. We compared the numbers of cases of GBS observed immediately after mass measles vaccination campaigns with the numbers that would be expected from baseline rates, to assess whether there is a causal relation between measles vaccination and GBS. METHODS: We analysed data on 2296 cases of GBS reported to the Poliomyelitis Eradication Surveillance System of the Pan American Health Organization as cases of suspected poliomyelitis. These cases occurred among 73 million immunised children aged 9 months to 15 years in Argentina, Brazil, Chile, and Colombia, between January, 1990, and December, 1994. These children were targeted for mass measles vaccination campaigns (each lasting 1 month) in 1992 and 1993. The frequency of GBS cases observed during the vaccination campaigns or the next 42 days (the latent period) was compared with that during the rest of the study period, with the assumption of a Poisson distribution. FINDINGS: The average annual incidence of GBS was 0.62 per 100000 children aged 1-14 years. The number of cases that would be expected within any 72-day period would therefore be 92. The average observed number of cases during latent periods after measles vaccination was 97. The probability that 97 or more cases would occur during a period with an expected number of 92 was 0.31. INTERPRETATION: The average annual rates of GBS by age-group for the 5 years analysed were consistent with previous data; thus we are confident that the surveillance system is sufficiently sensitive. There was no statistically significant association between measles vaccination and GBS. If there is any causal relation, the number of GBS cases due to measles vaccination was so small that data from the vaccination of more than 70 million children were not sufficient to detect a rise in the number of observed GBS cases beyond the expected number.

[Value of EEG in the characterization and prognosis of neurological diseases in premature infants]. / Valor do EEG na caracterização e prognóstico de patologias neurológicas em recém-nascidos prematuros.

The importance of the EEG for the investigation of neurological diseases in the neonatal period has been largely discussed, since it is often the only way to approach cerebral function in newborns with severe pathologies or under drug effect. The present study was carried out with 85 newborns (NB) who presented perinatal dysfunctions and were submitted to neurological and electroencephalogram (EEG) or polysomnography (PS) evaluation. EEG/PS alterations, pathologies and prognosis were reported. The EEG were classified according to basal activity alterations, presence of paroxysmal activity and sleep stages organization and maturity. The most frequent pathology was perinatal asphyxia (40%) followed by intraventricular hemorrhage (HIV, 16%). The most frequent complaint for exam indication was apnea (71%) followed by convulsion (19%). Fifty-five percent of the exams exclusively required because apnea complaint were considered normal and out of all exams required because seizures only 31% were normal. The EEG alteration most frequently related to perinatal asphyxia, HIV and intrauterine growth delay was immaturity and in the NB with seizures immature EEG and abnormal paroxysms. Many different alterations were registered in the NB with nervous system infection. The EEG findings more correlated with unfavorable prognosis were isoelectricity and abnormal paroxysmal activity including positive sharp waves (100%).

Eradication of poliomyelitis: progress in the Americas.

In the span of 5 years since the eradication initiative was launched and only 3 years since external funds were made available, PAHO has been able to develop and implement a comprehensive program strategy for polio eradication that includes the following components: achievement and maintenance of high immunization levels (which include the supplemental strategies of national immunization days and mop-up operations); effective surveillance to detect all new cases; and a rapid response to the occurrence of new cases. Despite yearly increases in the number of cases of acute flaccid paralysis reported to the surveillance system, a decline in reported confirmed cases of polio has occurred since 1986 to record low levels in 1989. Cases in 1989 were reported from only 0.7% of the counties in the Americas. The occurrence of 24 wild-type virus isolates in 1989 were limited to only three geographic areas: northwestern Mexico; the northern Andean Region; and northeastern Brazil. At this writing the clock is ticking with only 3 months left to achieve the goal of interrupting transmission by the end of 1990. If the current level of effort is sustained and special efforts are directed at the remaining foci of infection, the eradication of the transmission of wild-type poliovirus from the Americas can be achieved. Continued external financial support will be critical if the effort is to succeed. The prospect of poliomyelitis eradication in the Americas led the 41st World Health Assembly of WHO to adopt a resolution in May, 1988, to eradicate the indigenous transmission of wild-type poliovirus from the world by the year 2000.(ABSTRACT TRUNCATED AT 250 WORDS)

Neonatal tetanus: countdown to 1995.

Progress in the campaign against neonatal tetanus in South and Central America and the Caribbean is reviewed. The main emphasis is on immunizing women of childbearing age who live in high-risk areas, although importance also attaches to routine tetanus toxoid treatment, adequate care during the prenatal period and delivery, and epidemiological surveillance.

PIP: In 1990, the Pan American Health Organization (PAHO) announced its strategy to reduce neonatal tetanus: immunize all 12-44 year old women in high risk areas with the tetanus toxoid. As of mid-1991, health workers in Bolivia, Colombia, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Peru, and Venezuela systematically reported neonatal tetanus cases. Only Guatemala had not yet began case investigations. Workers in Argentina, Brazil, Haiti, and Paraguay did not report neonatal tetanus cases. In fact, hospital searches were the only means to detect tetanus cases in Haiti. The number of reported cases/year fluctuated between 1300-1500 between 1985-90. PAHO defined a high risk area as an area that has a neonatal tetanus morbidity or mortality rate higher than the national average for the last 3-5 years. PAHO found 50% of all cases occurred in 5% of municipios. El Salvador, however, case occurrence did not differ from 1 region to another, PAHO proposed training traditional midwives how to vaccinate women with the tetanus toxoid and children with other vaccines as has been done in Bolivia's Department of Santa Cruz. They can also report tetanus cases and refer women to health facilities if they cannot vaccinate the women themselves. Before 1990, 78% of recorded neonatal tetanus cases occurred to women with at least 2 other children. This represented at least 2 missed opportunities for vaccination/woman. In 1990, only 17 of the 212 reported tetanus cases in the Americas were born in a hospital. In 1988, the incidence rate for deliveries in hygienic conditions averaged .11/1000 compared with .5 for all deliveries. 90% of mothers who had infants with tetanus in 1990 had not received any tetanus toxoid vaccinations, and only 22% of all mothers had received the 2nd dose. In addition to prenatal and delivery care, PAHO promoted effective epidemiological surveillance systems.

Neonatal tetanus: countdown to 1995

Progress in the campaign against neonatal tetanus in South and Central America and the Caribbean is reviewed. The main emphasis is on immunizing women of childbearing age who live in high-risk areas, although importance also attaches to routine tetanus toxoid treatment, adequate care during the prenatal period and delivery, and epidemiological surveillance. (AU)

[Giant insulinoma]. / Insulinoma gigante.

The authors present a case report of hypoglycemic tumor (insulinoma) of the pancreas. The tumor had benign histology and the greatest volume among the tumors of this type described in the literature.