Spatial distribution of Japanese encephalitis cases and correlated geo-environmental factors in southern and northern counties of China.

Japanese encephalitis (JE) is a mosquito-borne disease with a spatial distribution that is linked to geo-environmental factors. The spatial distribution of JE cases and correlated geo-environmental factors were investigated in two critical counties in southern and northern China. Based on maps, enhanced thematic mapper (ETM) remote sensing datasets from Landsat and spatial datasets of JE cases, spatial distribution and spatial cluster analyses of JE cases at the village scale were performed by using the standard deviational ellipse and Ripleys K-function. Global and regional spatial cluster analyses of JE cases were also performed by using Moran's index. Regression analysis was used to analyze the relationships between geo-environmental characteristics and the risk of JE cases. At the study sites, the JE cases were not spatially clustered at the village or district (global) level, whereas there was a spatial cluster at the district (local) level. Diversity-related features for JE patients at the district and village levels were detected at two sites. In the southern counties, the distance of a village from a road was related to the village-level JE risk (OR: 0.530, 95 CI: 0.297-0.947, P = 0.032), and the number of township-level JE cases was linked to the distance of the district center from the road (R =-0.467, P = 0.025) and road length (R = 0.516, P = 0.012) in the administrative area. In northern China, the modified normalized difference water index (MNDWI) in the 5 km buffer around the village was related to village-level JE risk (OR: 0.702, 95% CI: 0.524-0.940, P = 0.018), and the number of township-level JE cases was related to the MNDWI in the administrative region (R =-0.522, P = 0.038). This study elucidates the spatial distribution patterns of JE cases and risk, as well as correlated geo-environmental features, at various spatial scales. This study will significantly assist the JE control efforts of the local Centers for Disease Control and Prevention (CDC), which is the base-level CDC, particularly concerning the allocation of medicine and medical staff, the development of immunological plans, and the allocation of pesticides and other control measures for the mosquito vectors of JE.

Análise da internação e mortalidade por HIV no Brasil, 2016-2020 / Analysis of hospitalization and HIV mortality in Brazil, 2016-2020 / Análisis de la hospitalización y la mortalidad por VIH en Brasil, 2016-2020

Apesar dos avanços programáticos conquistados na atenção às pessoas que vivem com HIV no Brasil, os índices de morbimortalidade atribuídos à infecção ainda são altos e heterogêneos no território nacional. Destarte, entende-se que os aspectos epidemiológicos do HIV devam ser analisados em consonância com as características e delimitações geográficas. Este estudo objetivou analisar os coeficientes de internação hospitalar e de mortalidade por HIV, segundo regiões do Brasil, de 2016 a 2020. Tratou-se de um estudo ecológico das regiões brasileiras, com dados extraídos das plataformas públicas de informação, referentes ao período de 2016 a 2020. Procedeu-se a análise por meio de estatística descritiva e, baseado nos coeficientes regionais de internação hospitalar e mortalidade calculados, foram derivadas ilustrações geográficas por meio do software QGIS, a partir do mapa do Brasil, divisado por regiões. Os resultados apontaram que as internações por HIV apresentaram queda em todas as regiões ao longo do período, contudo, o Sudeste se manteve abaixo da média nacional. Com relação aos óbitos, a queda foi observada em todas as regiões, com menor variação no Nordeste e Norte. Ademais, as regiões Sul e Norte seguiram com os maiores coeficientes de mortalidade do país durante todo o período analisado, enquanto as demais ficaram abaixo da média nacional. Pontua-se a necessidade de novas investigações quanto às especificidades regionais de conformação e organização da rede de atenção no que se refere à oferta de ações e serviços de saúde, bem como das condições socioeconômicas e comportamentais que influem no curso da infecção pelo HIV.

A pesar de los avances programáticos alcanzados en la atención de las personas que viven con el VIH en Brasil, las tasas de morbilidad y mortalidad atribuidas a la infección aún son elevadas y heterogéneas en el territorio nacional. Así, se entiende que los aspectos epidemiológicos del VIH deben ser analizados de acuerdo con las características y límites geográficos. Este estudio tuvo como objetivo analizar los coeficientes de hospitalización y mortalidad por VIH, según regiones de Brasil, de 2016 a 2020. Se trata de un estudio ecológico de regiones brasileñas, con datos extraídos de plataformas de información pública, referentes al período de 2016 a 2020. El análisis se realizó mediante estadística descriptiva y, a partir de los coeficientes de ingreso hospitalario regional y mortalidad calculados, se derivaron ilustraciones geográficas utilizando el software QGIS, a partir del mapa de Brasil, dividido por regiones. Los resultados mostraron que las hospitalizaciones por VIH disminuyeron en todas las regiones en el período, sin embargo, el Sudeste se mantuvo por debajo del promedio nacional. En cuanto a las muertes, la caída se observó en todas las regiones, con menor variación en el Nordeste y Norte. Además, las regiones Sur y Norte continuaron presentando las tasas de mortalidad más altas del país durante todo el período analizado, mientras que las demás se ubicaron por debajo del promedio nacional. Existe la necesidad de mayores investigaciones sobre las especificidades regionales de conformación y organización de la red de atención en lo que se refiere a la provisión de acciones y servicios de salud, así como las condiciones socioeconómicas y conductuales que influyen en el curso de la infección por el VIH.

Despite the programmatic advances achieved in the care of people living with HIV in Brazil, the morbidity and mortality rates attributed to the infection are still high and heterogeneous in the national territory. Thus, it is understood that the epidemiological aspects of HIV should be analyzed in accordance with the characteristics and geographical boundaries. This study aimed to analyze the coefficients of hospitalization and mortality from HIV, according to regions of Brazil, from 2016 to 2020. This was an ecological study of Brazilian regions, with data extracted from public information platforms, referring to the period 2016 to 2020. The analysis was performed using descriptive statistics and, based on the calculated regional hospital admission and mortality coefficients, geographic illustrations were derived using the QGIS software, from the map of Brazil, divided by regions. The results showed that hospitalizations for HIV decreased in all regions over the period; however, the Southeast remained below the national average. Regarding deaths, the drop was observed in all regions, with less variation in the Northeast and North. Furthermore, the South and North regions continued to have the highest mortality rates in the country throughout the analyzed period, while the others were below the national average. There is a need for further investigations regarding the regional specificities of conformation and organization of the care network with regard to the provision of health actions and services, as well as the socioeconomic and behavioral conditions that influence the course of HIV infection.

Las Topográfias Médicas: una aportación de la Medicina Rural a la Salud Pública / Medical Topographies: A Contribution of Rural Medicine to Public Health

Las Topografías Médicas (TM) o Geografías Médicas, son un género de la literatura médica, cuyos orígenes pueden encontrarse en el tratado de Hipócrates, Sobre los aires, aguas y lugares. El objetivo básico de las TM fue simplemente describir la salud de la población de un lugar determinado, aunque pronto ampliaron su campo de acción, para investigar la influencia del entorno físico y social en las enfermedades que padece la población en zonas geográficas o localidades. El inicio de su desarrollo tiene lugar en el contexto de la Medicina de la Ilustración, y adquirirán su mayoría de edad durante el siglo xix y las primeras décadas del siglo xx, para finalizar su producción en los años setenta del pasado siglo. Las Reales Academias de Medicina tuvieron una importancia decisiva en el desarrollo de las TM, proponiendo una metodología y un contenido homogéneo para la redacción de las mismas y estableciendo premios anuales para las obras galardonadas, lo que permitió mejorar su calidad y homogeneidad. El texto de las TM incluía generalmente un esbozo histórico de la población, la geografía de la zona, la descripción de la flora y de la fauna, con frecuencia de forma muy detalladas, el estudio del clima, de las vías públicas y las viviendas, la descripción de las enfermedades más frecuentes y epidemias, así como la demografía y situación socioeconómica de la población, entre otros. ... En el presente artículo se describe la evolución histórica de las TM, sus contenidos principales, su distribución por autonomías y años, y algunos personajes ilustres relacionados con ellas; aportándose alguna iconografía y copias de los documentos más interesantes por su valor médico o artístico. (AU)

Medical Topographies (TM) or Medical Geographies, are a genre of medical literature, whose origins can be found in Hippocrates’ treatise, On Airs, Waters and Places. The initial objective of TM was simply to describe the health of the population of given place, although they soon expanded their field of action to investigate the influence of the physical and social environment on the diseases suffered by the population in geographical areas or localities. The beginning of their development took place in the context of Enlightenment Medicine, and they came of age during the 19th century and the first decades of the 20th century, ending their production in the seventies of the last century. The Royal Academies of Medicine had a decisive importance in the development of TM, proposing a methodology and homogeneous content for their writing and establishing annual prizes for the award-winning works, which allowed them to improve their quality and homogeneity. The text of the TM generally included a historical outline of the population, the geography of the area, the description of the flora and fauna, often in very detailed form, the study of the climate, public roads and homes, the description of the most frequent diseases and epidemics, as well as the demographics and socio-economic situation of the population, among others. ... This article describes the historical evolution of the TM, its main contents, its distribution by autonomies and years, and some illustrious people related to them, providing some iconography and copies of the most interesting documents due to their medical or artistic value. (AU)

Análisis de la ansiedad y la depresión durante la pandemia del COVID-19 mediante Google Trends / Analysis of anxiety and depression during the Covid-19 pandemic using Google Trends

Los trastornos de ansiedad y depresión tienen una alta prevalencia en la población, en algunas ocasiones generada por situaciones excepcionales como la pandemia del Covid-19. La prevalencia de estos trastornos mentales podría inferirse con Google Trends, una herramienta que analiza las tenencias de búsqueda en Internet por rangos de tiempo y localización geográfica. Con el objetivo de estudiar la relación entre las tendencias de búsqueda de los términos "Ansiedad" y "Depresión" y su prevalencia en España durante la pandemia del Covid-19, se realizó un análisis de búsqueda selectiva a partir de variables geográficas (Madrid, Andalucía, Cataluña) y temporales (semanas año 2020). Se tuvieron en cuenta las palabras "Ansiedad", "Depresión" y "Covid-19", para realizar las estimaciones de las tendencias de búsqueda en Google Trends. Los resultados mostraron diferencias significativas entre las comunidades autónomas en el interés por la búsqueda de información sobre depresión, así como una progresión temporal diferente, tanto en ansiedad como en depresión, que reflejaría las fluctuaciones en la evolución de los datos epidemiológicos en cada región geográfica. Herramientas como Google Trends permitirían a la comunidad sanitaria implementar estrategias de prevención ante la detección de picos de preocupación por determinados trastornos mentales en regiones y periodos temporales concretos. Esto resulta especialmente relevante si la prevalencia de estos trastornos en la población puede interferir negativamente con la eficacia de las políticas de prevención y contención sanitaria en situaciones de emergencia.(AU)

Anxiety and depression disorders have a high prevalence in the population, sometimes generated by exceptional situations such as the Covid-19 pandemic. The prevalence of these mental disorders could be inferred with Google Trends, a tool that analyzes Internet search holdings by time ranges and geographic location. In order to study the relationship between search trends for the terms "Anxiety" and "Depression" and their prevalence in Spain during the Covid-19 pandemic, a selective search analysis was carried out based on geographic variables (Madrid, Andalusia, Catalonia) and temporary (weeks in 2020). The words "Anxiety", "Depression" and "Covid-19" were taken into account to make the estimates of search trends in Google Trends. The results showed significant differences between the autonomous communities in their interest in searching for information on depression, as well as a different temporal progression, both in anxiety and depression, which would reflect the fluctuations in the evolution of epidemiological data in each geographic region. Tools such as Google Trends would allow the health community to implement prevention strategies in the event of the detection of peaks of concern for certain mental disorders in specific regions and time periods. This is especially relevant if the prevalence of these disorders in the population can negatively interfere with the effectiveness of prevention and health containment policies in emergency situations.(AU)

Guía para la elaboración de un croquis / Guide for drawing a sketch

Con esta guía se busca poder consolidar el ordenamiento territorial según los territorios y sectores, recabar información importante de la fuente directa, misma que será un insumo trascendental para definir el tipo de servicios que se necesitan brindar en cada ubicación, al contar con información importante del terreno, la distribución de las viviendas y de la población que son determinantes para la programación de las acciones intra y extramuros, así como para la promoción de acciones sanitarias. Este recurso es importante para implementar y definir la cartera de servicios de salud así como la estrategia de las Redes Integradas de Servicios de Salud dentro del marco de la Atención Primaria en Salud, con la cual se espera poder fortalecer la atención integral e integrada a la población en general. El Croquis es un recurso indispensable para la planificación, programación, organización y monitoreo de los servicios que entregan los equipos de salud.

Topography of the sentinel node according to the affected lobe in lung cancer

Purpose. The objective of this study is to describe the anatomic location of the sentinel lymph node (SLN) of patients with lung carcinoma and to analyze its relationship with the characteristics of the tumor. Patients and methods. 98 Stage I lung cancer patients were included in the study. SLN was marked just after performing the thoracotomy by injecting peritumorally 0.25 mCi of nanocolloid of albumin (Nanocol1) labeled with Tc-99 m in 0.3 ml, and later, it was resected. For SLN micrometastasis analysis, CEACAM5, BPIFA1, and CK7 gene expression at mRNA level was studied. Possible relation between tumor characteristics and SLN location was analyzed. Results. While most of the SLN were located in hilar area, we find a significantly higher number of SLN located in mediastinal stations when the lesion is in the left upper lobe (LUL). This difference disappears in the group of SLN with a positive result in the micrometastasis study. Regarding tumor size, squamous tumors and tumors located in the left lower lobe (LLL) were found significantly larger. Conclusion. The location of the SLN in patients with stage I lung cancer is predominantly hilar, being less consistent in the left hemithorax. The tumor size or histological type is not variables that affect this distribution. The distribution of SLNs with a positive result in the analysis of micrometastasis suggests further spread to the hilar areas when the lesion is in the LUL and to the mediastinal zones when it is in the LLL (AU)

No disponible

Snow's case revisited: new tool in geographic profiling of epidemiology

Abstract Geographic Profiling technique is used to find the origin of a series of crimes. The method was recently extended to other fields. One of the best renowned data in epidemiology is that by John Snow during an outburst of cholera in London. We wrote Python scripts to perform the analyses to apply the Geographic Profiling for individuating the starting origin of an infection by using the old Snow's data set. We modified the method by applying a weight to each point of the map where cases of cholera were reported. The weight was proportional to the number of cases in a given location.This modification of the Geographic Profiling method allowed to individuate in the map an area of maximum probability of the infection source, which was a few meters wide and including the historically known source of cholera, that is the "classical" water pump at Broad Street.The method appears to be a useful complement in order to individuate the source of epidemics when available data about the cases of the infections can be summarized on a map.

Corolario técnico del modelo estructural / Technical corollary of the structural model

El cambio de la teoría topográfica (primera tópica) a la estructural (segunda tópica) debió resultar en una modificación de la técnica psicoanalítica. Sin embargo, la consiguiente evolución de la "descodificación" directa de lo reprimido al análisis de las defensas fue lenta e incompleta. La adhesividad de la técnica primera puede explicarse por la gratificación que supone para las ideas de omniscencia del analista; por la elusión de unas percepciones realistas del analizado con portencial para herir el narcisismo del analista; por la facilitación nde interpretaciones contratransferenciales proyectivas; y por la evitación contrarresistencial de lso derivados pulsionales más naturales e intensos manifestados por el paciente. La técnica más coherente y jerarquizada del análisis de las defensas, descrita por Paul Gray hace cuarenta años como "Psicología del yo contemporánea", representa el último corolario del modelo estructural. Este método parece dar una cuenta más convincente del funcionamiento mental en el conflicto inconsciente. La "atención cercana al proceso" proporcionaría también mejores garantías para una investigación objetiva de los significados implícitos en el material clínico (AU)

The change from the topographical theory to the structural theory should have resulted in a modification of psychoanalytic technique. However, the subsequent evolution from the direct "deciphering" of the repressed to the practice of defence analysis was slow and incomplete. The adhesiveness of the first technique can be explained as due to the gratification of the analyst´s omnicient ideas; the avoidance of the analysand´s realistic perceptions with a potential to injure the analyst´s narcissism counterresistance to more natural and intensive drive derivatives manifested by the patient. The more coherent and hierarchical technique of defence analysis described by Paul Gray forty years ago as "Contemporary ego psychology" represents the las corollary of the structural model. This method seems to account more convincingly for the mental funtioning in unconscious conflict. "Close process attention" would also offer the best guarantee for an objective research of menings implicit in the clinical material (AU)

High Malaria Prevalence among Schoolchildren on Kome Island, Tanzania

In order to determine the status of malaria among schoolchildren on Kome Island (Lake Victoria), near Mwanza, Tanzania, a total of 244 schoolchildren in 10 primary schools were subjected to a blood survey using the fingerprick method. The subjected schoolchildren were 123 boys and 121 girls who were 6-8 years of age. Only 1 blood smear was prepared for each child. The overall prevalence of malaria was 38.1% (93 positives), and sex difference was not remarkable. However, the positive rate was the highest in Izindabo Primary School (51.4%) followed by Isenyi Primary School (48.3%) and Bugoro Primary School (46.7%). The lowest prevalence was found in Muungano Primary School (16.7%) and Nyamiswi Primary School (16.7%). These differences were highly correlated with the location of the school on the Island; those located in the peripheral area revealed higher prevalences while those located in the central area showed lower prevalences. Plasmodium falciparum was the predominant species (38.1%; 93/244), with a small proportion of them mixed-infected with Plasmodium vivax (1.6%; 4/244). The results revealed that malaria is highly prevalent among primary schoolchildren on Kome Island, Tanzania, and there is an urgent need to control malaria in this area.

Cartography of neoplasms in dogs from different regions of the city of São Paulo, SP, Brazil: a survey (2002-2003) of data from the Veterinary Hospital of the School of Veterinary Medicine and Animal Science of the University of São Paulo, Brazil / Cartografia das neoplasias em cães das diferentes regiões da cidade de São Paulo, SP, Brasil: um levantamento (2002-2003) dos dados do Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo, Brasil

Improvements in veterinary medicine have resulted in a significant benefit in the life of pets in the last 20 years, and increased pet life expectancy led to an increased prevalence of canine neoplasia. Cancer epidemiology and spatial analysis tools, although well developed for human oncology research, is just beginning to be explored in veterinary oncology. São Paulo city, capital of the state of São Paulo, Brazil, is divided into five regions: North, South, East, West and downtown. The Veterinary Hospital of the School of Veterinary Medicine and Animal Science, University of São Paulo (HOVET-SVMAS-USP), is located in the West region of São Paulo, Brazil, and admits cases of small and large animals. Canine mammary tumors are so numerous that they are not routinely treated at the HOVET. The aim of this work was to perform a cartographic study to describe the spatial distribution of prevalent cases of neoplasms in dogs from the HOVET. Of the 3,620 cases seen in 2002 and 2003, 380 cases (10.5%) were of dogs affected with benign and malignant neoplasms. No statistical difference was found for the 380 addresses distributed among the five regions of the city. These results showed that the HOVET receives canine patients from all regions of São Paulo and there is a homogeneous spatial distribution of neoplasms. Authors encourage additional broader studies, involving several veterinary hospitals, clinics or laboratories in order to obtain more accurate data on distribution of canine neoplasms in São Paulo, SP, Brazil.

Avanços na medicina veterinária resultaram em benefícios significativos na vida de animais de estimação nos últimos 20 anos, e o aumento da expectativa de vida para animais levou a uma maior prevalência de neoplasias em cães. A Epidemiologia do Câncer e as ferramentas de análise espacial, embora bem desenvolvidas na pesquisa oncológica humana, estão começando a serem exploradas na Oncologia Veterinária. A cidade de São Paulo, capital do estado de São Paulo, Brasil, é dividida em cinco regiões: Norte, Sul, Leste, Oeste e centro. O Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo (HOVET-SVMAS-USP) está localizado na região Oeste de São Paulo, Brasil, e admite casos de pequenos e grandes animais. Tumores mamários caninos são tão numerosos que não são tratados na rotina do HOVET. O objetivo deste trabalho foi realizar um estudo cartográfico para descrever a distribuição espacial dos casos prevalentes de neoplasias em cães a partir do HOVET. Dos 3.620 casos atendidos em 2002 e 2003, 380 (10,5%) casos eram de cães acometidos por tumores benignos e malignos. Não foi encontrada diferença estatística entre a distribuição dos 380 endereços entre as cinco regiões da cidade. Os resultados mostraram que o HOVET atende pacientes caninos de todas as regiões de São Paulo e que há uma distribuição espacial homogênea das neoplasias. Os autores incentivam estudos mais amplos, envolvendo vários hospitais veterinários, clínicas e laboratórios, a fim de obter dados mais precisos sobre a distribuição das neoplasias caninas em São Paulo, SP, Brasil.

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 ...

Tratamiento de la disfagia y la disglosia tras glosectomía total y reconstrucción con colgajo libre fasciocutáneo anterolateral de muslo: a propósito de un caso / Treatment of dysphagia and dysglossia after total glossectomy and reconstruction with anterolateral thigh fasciocutaneous free flap: a case report

La cirugía oncológica en lesiones extensas de carcinoma lingual obliga a realizar resecciones amplias que precisan reconstrucción con colgajo libre periférico. Los colgajos libres permiten un aspecto físico más semejante al normal, pero debido a la especialización de la lengua, no es fácil restituir su funcionalidad. Ello compromete la dinámica deglutoria en la fase oral y de transporte, además de la comunicación hablada. La terapia logopédica convencional precisa una media de 3-12 meses. Presentamos el caso clínico de un varón de 64 años con carcinoma epidermoide lingual estadio IVA (T4aN0M0) al que se le practicó glosectomía total con mandibulectomía marginal sinfisaria, reconstrucción con colgajo fasciocutáneo libre perforante anterolateral del muslo y vaciamiento ganglionar funcional bilateral. Precisó traqueostomía y sonda nasogástrica para alimentación. Valoramos al octavo día posquirúrgico e iniciamos rehabilitación por disfagia orofaríngea mecánica y disglosia precozmente a pie de cama. Los objetivos fueron: favorecer el sello labial, tragar saliva, manejo de secreciones, decanulación, coordinación neumofónica, inteligibilidad, deglución segura y eficaz, prevenir complicaciones y mejorar la calidad de vida. El paciente era capaz de comunicarse con su entorno directo en la sesión quinta y realizar una ingesta oral con dieta blanda y líquidos espesados en la octava sesión, siendo retirada la sonda nasogástrica y derivado a domicilio el día 20 del postoperatorio. Se concluye que la rehabilitación precoz e individualizada dentro de un equipo multidisciplinar es indispensable para restituir la deglución y el habla, mejorando la calidad de vida del paciente. Además, esta modalidad de actuación reduce los costes sociosanitarios (AU)

Oncological surgery in extensive lingual carcinoma lesions requires wide resection and reconstruction with a peripheral free flap. Free flaps can provide a fairly normal physical appearance but, due to the specialization of the tongue, it is not easy to restore its functionality. This compromises the dynamics of swallowing in the oral and transport phase and spoken communication. Conventional speech-language therapy requires an average of 3-12 months. We present the case of a 64-year-old man with lingual epidermoid carcinoma stage IVA (T4aN0M0) who underwent total glossectomy with marginal mandibulectomy of the symphysis, reconstruction with an anterolateral thigh fasciocutaneous free flap, and bilateral functional lymphadenectomy. The patient required tracheostomy and a nasogastric catheter for feeding. We evaluated the patient on the eighth postsurgical day and initiated rehabilitation of mechanical oropharyngeal dysphagia and dysglossia at the bedside. The objectives were to encourage labial seal, swallowing of saliva, handling of secretions, decannulation, breathing and speaking coordination, speech intelligibility, and safe and effective swallowing and to prevent complications and improve quality of life. The patient was able to communicate with his direct surrounding in the fifth session and was able to make an oral ingestion with a soft diet and thickened liquids in the eighth session. The nasogastric catheter was removed and the patient was sent home on the 20th postoperative day. We conclude that early and individualized speech-language therapy within a multidisciplinary team is indispensable to restore swallowing and speech, improving the patient's quality of life. In addition, this kind of intervention reduces social and healthcare costs (AU)

Fatores associados ao aleitamento materno nas diferentes Regiões do Brasil / Factors associated with maternal breastfeeding in different Regions of Brazil

Identificar os fatores que determinam o aleitamento materno nas diferentes regiões do país. Métodos: os dados fazem parte da Pesquisa de Orçamento Familiar de 2002-2003 realizada no Brasil. A amostra foi de 2958 crianças de zero a um ano, representativas da população nacional. Um modelo de regressão linear (GLM) com família binomial e ligação logarítmica foi criado para cada região, com um intervalo de confiança de 90 por cento. Resultados: o aumento do número de moradores no domicilio é o principal fator negativo para a amamentação em todas as regiões do Brasil. Foram considerados como fatores desfavoráveis, no conjunto da amostra: mães com idade avançada, ter quatro ou mais moradores no domicílio, maior renda, maior escolaridade materna e uso de creche. Os fatores favoráveis foram: ter dois ou mais filhos menores de cinco anos em casa e mães de cor preta ou parda. Conclusões: as regiões que apresentaram um número maior de fatores desfavoráveis ao aleitamento materno foram Sudeste e Sul, sendo que o maior número de moradores no domicílio foi a pior situação para a efetivação da amamentação nas regiões do Brasil...

To identify factors associated with maternal breastfeeding in different regions of the country. Methods: the data form part of the Brazilian 2002-2003 Family Budget Study. The sample comprised 2958 children aged between 0 and 1 year, representative of the national population. And linear regression model with a binomial family and logarithmic connection was created for each region, with a confidence interval of 90 percent. Results: an increase in the number of people living in a household is the principal negative factor for breastfeeding in all regions of Brazil. In this sample, negative factors were found to be: mothers of advanced age, having four or more people living in the household, higher income, higher level of education of the mother and the use of a crèche. Positive factors were having two or more children at home under the age of five years and being black or of mixed race. Conclusions: the regions that had the highest number of negative factors associated with maternal breastfeeding were the Southeast and the South, with a large number of household members being the worst situation for encouraging breastfeeding in all regions of Brazil...

Paracoccidioidomycosis in a western Brazilian Amazon State: Clinical-epidemiologic profile and spatial distribution of the disease

Introduction: Paracoccidioidomycosis (PCM) is a systemic infection caused by the fungus Paracoccidioides brasiliensis. PCM is considered one of the most important systemic mycoses in Latin America. Methods: This is a clinical, epidemiological, retrospective, quantitative study of PCM cases in patients attending the National Health Service in the State of Rondônia in 1997-2012. The examined variables included sex, age group, year of diagnosis, education level, profession, place of residence, diagnostic test, prior treatment, medication used, comorbidities and case progress. Results: During the study period, 2,163 PCM cases were registered in Rondônia, and the mean annual incidence was 9.4/100,000 people. The municipalities with the highest rates were located in the southeastern region of Rondônia, and the towns of Pimenteiras do Oeste and Espigão do Oeste had the highest rates in the state, which were 39.1/100,000 and 37.4/100,000 people, respectively. Among all cases, 90.2% and 9.8% were observed in men and women, respectively, and most cases (58.2%) were observed in patients aged between 40 and 59 years. Itraconazole was used to treat 91.6% (1,771) of cases, followed by sulfamethoxazole in combination with trimethoprim (4.4% [85] of cases). One hundred thirty-one (6%) patients died. Conclusions: The State of Rondônia has a high incidence of PCM, and the municipalities in the southeastern region of the state were found to have the highest incidence rates of this disease. Our findings suggest that Rondônia is the state in the northern region with the highest mortality rate for PCM. .

Origem e territorio de distribuição da artéria cerebral média em javali (Sus scrofa scrofa Linnaeus, 1758) / Origin and distribution of territory in middle cerebral artery wild boar (Sus scrofa scrofa Linnaeus, 1758)

Foram estudados 20 encéfalos de javali (Sus scrofa scrofa), adultos, 14 fêmeas e oito machos, com o sistema arterial corado com látex e fixados por solução aquosa de formaldeído a 10%. A artéria cerebral média em ambos os antímeros, originou-se no ramo rostral da artéria carótida do encéfalo (100%), sendo representado geralmente por dois a cinco vasos arteriais que dirigiram-se laterodorsalmente atingindo a região do trígono olfatório assim como o sulco rinal lateral, preenchendo, no entanto, a fissura transversa do cérebro e distribuindo-se nas porções lateral, dorsolateral, caudolateral e rostrolateral do hemisfério cerebral. O número de vasos arteriais relativos a artéria cerebral média, no antímero direito foi em dois modelos (10% ) a presença de duas artérias, em 13 modelos (65%) a presença de três artérias, em quatro modelos (20%) a presença de quatro artérias e em um modelo (5% ) a presença de cinco artérias. Já no antímero esquerdo encontraram-se em quatro modelos (20% ) a presença de duas artérias, em nove modelos (45%) a existência de três artérias, em seis modelos (30%) a presença de quatro artérias e em um modelo (5%) a presença de cinco artérias.

We studied 20 brains of wild boar (Sus scrofa scrofa), adults, 14 females and 08 males, colored latex and fixed in aqueous 10% formaldehyde. The middle cerebral artery on both the sides, has its origin in the rostral branch of the carotid artery of the brain (100%), and generally represented by two to five arteries who went laterodorsalmente reaching the region of the olfactory trigone and the rhinal sulcus lateral filling but the transverse fissure and distributing the lateral portions, dorsolateral, rostrolateral and caudolateral hemisphere. The number of blood vessels on the middle cerebral artery, was in the right antimere two models (10%) the presence of two arteries, 13 models (65%) the presence of three arteries in models (20%) the presence of four arteries and a model (5%) the presence of five arteries. In the left antimere met fourth models (20%) the presence of two arteries, 9 models (45%) the existence of three arteries, in the sixth models (30%) the presence of four arteries and a model (5 %) the presence of five arteries.

Prevalence of Intestinal Helminths among Inhabitants of Cambodia (2006-2011)

In order to investigate the status of intestinal helminthic infections in Cambodia, epidemiological surveys were carried out on a national scale, including 19 provinces. A total of 32,201 fecal samples were collected from schoolchildren and adults between 2006 and 2011 and examined once by the Kato-Katz thick smear technique. The overall egg positive rate of intestinal helminths was 26.2%. The prevalence of hookworms was the highest (9.6%), followed by that of Opisthorchis viverrini/minute intestinal flukes (Ov/MIF) (5.7%), Ascaris lumbricoides (4.6%), and Trichuris trichiura (4.1%). Other types of parasites detected were Enterobius vermicularis (1.1%), Taenia spp. (0.4%), and Hymenolepis spp. (0.2%). The northwestern regions such as the Siem Reap, Oddar Meanchey, and Banteay Meanchey Provinces showed higher prevalences (17.4-22.3%) of hookworms than the other localities. The southwestern areas, including Koh Kong and Preah Sihanouk Provinces showed higher prevalences of A. lumbricoides (17.5-19.2%) and T. trichiura (6.1-21.0%). Meanwhile, the central and southern areas, in particular, Takeo and Kampong Cham Provinces, showed high prevalences of Ov/MIF (23.8-24.0%). The results indicate that a considerably high prevalence of intestinal helminths has been revealed in Cambodia, and thus sustained national parasite control projects are necessary to reduce morbidity due to parasitic infections in Cambodia.

Breast cancer incidence and mortality in women under 50 years of age in Brazil / Incidência e mortalidade por câncer de mama em mulheres menores de 50 anos no Brasil / Incidencia y mortalidad por cáncer de mama en mujeres menores de 50 años en Brasil

Many countries have reported an increase in breast cancer incidence in young women. The current study's objective was to explore breast cancer distribution in women less than 50 years of age in Brazil. A descriptive study on breast cancer incidence (selected cities) and mortality (Brazil and selected cities) in 2002-2004 was carried out, and the results were compared with those from other countries. The study also analyzed the trend in hospital morbidity and incidence rates for breast cancer. Porto Alegre (Rio Grande do Sul State) showed the highest incidence rates (17.9 and 165.5/100,000 in the 15-39 and 40-49-year age strata, respectively). Regarding mortality, Belo Horizonte (Minas Gerais State) showed the highest rate in the 15-39-year group and Porto Alegre in the 40-49-year group (2.8 and 25.5/100,000). Hospital admissions and incidence rates for breast cancer suggest a change in epidemiological distribution. The results reveal an epidemiological pattern of breast cancer in young Brazilian women with regional distribution characteristics.

Um aumento na incidência de câncer de mama em mulheres jovens tem sido relatado em diversos países. O objetivo foi explorar a distribuição do câncer de mama em mulheres menores de 50 anos, no Brasil. Foi realizado um estudo descritivo da incidência (capitais selecionadas) e da mortalidade (Brasil e capitais selecionadas) por câncer de mama, no período de 2002-2004, sendo os resultados comparados com aqueles observados em outros países. Adicionalmente, analisou-se a evolução da morbidade hospitalar e das taxas de incidência. Porto Alegre (Rio Grande do Sul) possui as maiores taxas de incidência (17,9 e 165,5/100 mil, 15-39 e 40-49 anos, respectivamente). Em relação à mortalidade, Belo Horizonte (Minas Gerais) possui a maior taxa de 15-39 anos e Porto Alegre de 40-49 anos (2,8 e 25,5/100 mil). A proporção de hospitalizações do SUS e as taxas de incidência de câncer de mama sugerem um processo de mudança na distribuição epidemiológica. Os resultados retratam um padrão epidemiológico do câncer de mama em mulheres jovens no Brasil com características regionais de distribuição.

El aumento de la incidencia de cáncer de mama en mujeres jóvenes ha sido reportado en varios países. El objetivo fue explorar la distribución del cáncer de mama en mujeres menores de 50 años en Brasil. Se realizó un estudio descriptivo de la incidencia (capitales) y la mortalidad (Brasil y capitales seleccionadas) para el cáncer de mama en el período 2002-2004, los resultados fueron comparados con los observados en otros países. Además, se analizó la evolución de la morbilidad hospitalaria y las tasas de incidencia. Porto Alegre (Rio Grande do Sul) tiene las tasas de incidencia más altas (17,9 y 165,5/100.000, 15-39 y 40-49 años, respectivamente). En cuanto a la mortalidad, Belo Horizonte (Minas Gerais) tiene la mayor tasa de 15-39 años y 40-49 años en Porto Alegre (2,8 y 25,5/100.000). La proporción de hospitalizaciones en el SUS y las tasas de incidencia de cáncer de mama sugieren un proceso de cambio en la distribución epidemiológica. Los resultados muestran un patrón epidemiológico de cáncer de mama en mujeres jóvenes en Brasil con características regionales de distribución.

Modelado del efecto de la variabilidad climática local sobre la transmisión de dengue en Medellín (Colombia) mediante análisis de series temporales / Modelling the effect of local climatic variability on dengue transmission in Medellin (Colombia) by means temporary series analysis

ntroducción. El dengue es una enfermedad de transmisión vectorial de gran impacto en la salud pública. La transmisión del dengue es afectada por factores entomológicos, socioculturales y económicos. Además, la variabilidad climática juega un importante papel en la dinámica de transmisión. Un amplio consenso científico ha indicado que la fuerte asociación entre la enfermedad y las variables climáticas podría ser empleada para desarrollar modelos que expliquen la incidencia de la enfermedad. Objetivo. Desarrollar un modelo que permita comprender la dinámica de transmisión del dengue en Medellín y predecir incrementos en la incidencia de la enfermedad. Materiales y métodos. Se empleó la incidencia de dengue como variable dependiente y como variables independientes, los factores climáticos (temperatura máxima, media y mínima, humedad relativa y precipitación) registrados a escala semanal. Se utilizó el programa Expert Modeler para desarrollar un modelo que explique mejor el comportamiento de la enfermedad. Mediante modelos ARIMA, se seleccionaron las variables climáticas que tuvieron una relación significativa con la variable dependiente. Resultados. El 34 % de la variabilidad observada se explicó por el modelo. La precipitación fue la variable climática que mostró una asociación estadísticamente significativa con la incidencia del dengue, pero con un rezago de 20 semanas. Conclusiones. La transmisión del dengue en Medellín se vio afectada por la variabilidad climática, en particular, por la precipitación. La fuerte asociación entre el dengue y la precipitación permitió construir un modelo que ayuda a comprender la dinámica de transmisión, información que será de gran utilidad para el desarrollo de adecuadas y oportunas estrategias de control.

Introduction: Dengue fever is a major impact on public health vector-borne disease, and its transmission is influenced by entomological, sociocultural and economic factors. Additionally, climate variability plays an important role in the transmission dynamics. A large scientific consensus has indicated that the strong association between climatic variables and disease could be used to develop models to explain the incidence of the disease. Objective: To develop a model that provides a better understanding of dengue transmission dynamics in Medellin and predicts increases in the incidence of the disease. Materials and methods: The incidence of dengue fever was used as dependent variable, and weekly climatic factors (maximum, mean and minimum temperature, relative humidity and precipitation) as independent variables. Expert Modeler was used to develop a model to better explain the behavior of the disease. Climatic variables with significant association to the dependent variable were selected through ARIMA models. Results: The model explains 34% of observed variability. Precipitation was the climatic variable showing statistically significant association with the incidence of dengue fever, but with a 20 weeks delay. Conclusions: In Medellin, the transmission of dengue fever was influenced by climate variability, especially precipitation. The strong association dengue fever/precipitation allowed the construction of a model to help understand dengue transmission dynamics. This information will be useful to develop appropriate and timely strategies for dengue control.

Analysis of the detection coefficient for the association between leprosy and pregnancy in the integration region of Carajas, State of Para, Brazil

Introduction The association between leprosy and pregnancy is currently poorly understood and has been linked to serious clinical consequences. Methods A retrospective study between 2007 and 2009 was performed in the integration region of Carajás, Brazil on a population of pregnant lepers, with non-lepers of ages 12-49 years serving as the reference population. Results Twenty-nine pregnant lepers were studied during the study period. The detection rates (DRs) for the studied association were 4.7 in 2007, 9.4 in 2008, and 4.3 in 2009. Conclusions The Carajás region presented a medium pattern of endemicity during most of the study period, with a high DR found in 2008. .