Prevalence of adherence to pharmacological treatment in patients with type 2 diabetes mellitus

Introduction: Evidence in the literature indicates that patients with type 2 diabetes (T2D) have a very low level of adherence to pharmacological treatment and that despite several interventions to improve it, a number of obstacles to optimal care limit the extent to which such goals can be achieved. This study attemts to assess the sociodemographic profile of patients with T2D, and to identify the main reasons for nonadherence. Methods: This cross-sectional study evaluated patients with T2D for at least 6 months who are regularly followed at an endocrinology outpatient clinic or who have been admitted to a university hospital. Adherence was assessed by a modifed Morisky Green test and the Batalla test. Results: Ninety-six patients were included, mostly women (59%), white (76%), and with mean age of 52 ± 12 years. Only 49% of patients adhered to drug treatment according to the Batalla test, while 24% were classifed as high adherence, 41% as moderate adherence and 34% as low adherence to drug treatment according to the modifed Morisky Green test. Considering glycated hemoglobin levels as a reference method, only 37% of patients were within the currently recommended values, with higher adherence among women compared to men (44% vs. 23%, P = 0.044). Conclusions: The prevalence of adherence among patients with T2D was very low. Older age, insulin therapy and male sex were more strongly associated with worse adherence. The main barrier limiting treatment adherence was lack of motivation, especially due to difculties in adopting a healthy and balanced diet. (AU)

Tuberculose infantil: estudo retrospectivo / Tuberculosis in childhood: retrospective study

Introdução: a tuberculose (TB) infantil permanece como uma das doenças mais prevalentes e preocupantes no mundo, sobretudo em nações em desenvolvimento, onde as taxas são ainda mais elevadas e os casos descritos subestimados pela dificuldade em se estabelecer um diagnóstico definitivo. Dessa forma, este estudo tem como objetivo descrever o perfil clínico e epidemiológico dos pacientes com TB infantil pulmonar e extrapulmonar.Métodos: foram avaliados retrospectivamente, através de questionário, pacientes com idade de até 15 anos, internados no Serviço de Pediatria do Hospital de Clínicas de Porto Alegre (HCPA), no período de janeiro de 2002 a setembro de 2007. Resultados: dos 52 pacientes incluídos, 63% apresentavam TB pulmonar. Das formas extra-pulmonares, a meningoencefalite foi a mais prevalente (22%). Comorbidades foram detectadas em 31 (60%) pacientes, dos quais 15 (29%) apresentavam desnutrição grave, 9 (18%) HIV positivo e 7 (13%) pneumopatia crônica. Das manifestações clínicas, febre e tosse estavam presentes na maioria dos pacientes. O padrão radiológico predominante foi o de consolidação pulmonar (51%). A maioria dos pacientes referia história de contato com paciente bacilífero (64%). Conclusão: a TB pulmonar representa a principal forma de apresentação clínica da TB, sendo o diagnóstico feito de forma presuntiva na maioria dos casos. Os resultados do nosso estudo reforçam a importância da anamnese (história epidemiológica e vacinal) e achados clínicos e radiológicos para o diagnóstico de TB infantil. Tendo em vista que a TB em crianças é considerada um “evento sentinela”, indicando recente transmissão a partir de um adulto infectado, além da maior gravidade da doença nesta população, torna-se imperativo uma maior ênfase na prevenção e diagnóstico precoces.

Background: tuberculosis (TB) in childhood remains one of the most prevalent and disturbing diseases worldwide. This is especially true in developing countries, where TB rates are even higher and the number of cases is underestimated because of the difficulty to establish definitive diagnosis. Aim: the present study was to describe the clinical and epidemiological profile of children with pulmonary and extrapulmonary TB. Methods: we used a questionnaire to retrospectively evaluate patients aged up to 15 years admitted to the Pediatric Unit of HCPA from January 2002 to September 2007. Results: of the 52 patients included in the study, 63% had pulmonary TB. Among the extrapulmonary forms, meningoencephalitis was the most prevalent (22%). Comorbidities were detected in 31 (60%) patients, and 15 (29%) of them had severe malnutrition, 9 (18%) were positive for HIV, and 7 (13%) had chronic lung disease. Among the clinical manifestations, fever and cough were present in most patients. The predominant radiological pattern was pulmonary consolidation (51%). Most patients reported a history of contact with contagious TB patients (64%). Conclusion: pulmonary TB is the main clinical presentation of TB, and most patients receive a presumptive diagnosis. Our results reinforce the importance of anamnesis (epidemiological and vaccination history) and clinical and radiological findings to establish the diagnosis of TB in childhood. Considering that TB in children is a “sentinel event”, indicating recent transmission from an infected adult, and because of the greater severity of the disease in this population, it is crucial to emphasize prevention and early diagnosis.

Desnutrição calórico-proteica do tipo kwashiorkor desencadeada por alergia à proteína do leite de vaca / Kwashiorkor-type malnutrition due to cow's milk protein allergy

A enteropatia induzida por proteína alimentar, uma das formas de apresentação de hipersensibilidade alimentar, tem na alergia à proteína do leite de vaca a causa mais comum dessa síndrome. Ocorre comumente em lactentes, e o diagnóstico depende de uma anamnese minuciosa associada a uma resposta clínica favorável à retirada do antígeno. No presente relato, paciente do sexo feminino de 1 ano e 8 meses, interna para investigação de desnutrição calórico-proteica grave com história de vômitos, diarreia sanguinolenta e perda ponderal pronunciada a partir dos 8 meses de idade. Amamentação exclusiva no primeiro mês de vida e fórmula láctea do segundo ao quarto mês; desde então, com leite de vaca integral. Na admissão, chorosa, irritada, emagrecida, desidratada, cabelos despigmentados e quebradiços, em anasarca e com hepatomegalia. Exames laboratoriais revelaram anemia megaloblástica, leucocitose e hipoalbuminemia. Hipóteses diagnósticas: doença celíaca, fibrose cística e alergia à proteína do leite de vaca. Realizada endoscopia digestiva alta com biópsia: discreto aumento de eosinófilos na lâmina própria em mucosa gástrica e duodenal e esofagite crônica discreta com raros eosinófilos intraepiteliais. Teste do suor negativo. Estabelecido o diagnóstico de alergia à proteína do leite de vaca desencadeando um quadro de desnutrição calórico-proteica grave do tipo kwashiorkor e iniciada dieta com hidrolisado proteico. A alergia à proteína do leite de vaca é uma apresentação clínica frequente de alergia alimentar em lactentes e pré-escolares, sendo as repercussões gastrintestinais e nutricionais significativas nessa faixa etária. Dessa forma, o diagnóstico de alergia à proteína do leite de vaca deve ser considerado em pacientes com desnutrição calórico-proteica, uma vez que a desnutrição primária, por ingestão insuficiente, tenha sido excluída.

Dietary protein-induced enteropathy is one of the presentations of food allergy, and cow's milk protein allergy (CMPA) is its most common cause, frequently affecting infants. Diagnosis depends on thorough history associated with favorable clinical response to the antigen with drawal. This case report describes the case of a twenty-month-old female patient admitted to investigate protein-energy malnutrition (PEM) with severe vomiting, bloody diarrhea and significant weight loss since eight months of age. She was breastfed during the first month of life, receiving infant formula up to the fourth month and, since then, whole cow's milk. At admission, the patient was very irritable, crying, angry, dehydrated, with severe weight loss, brittle and depigmented hair, edema and hepatomegaly. Laboratory tests showed megaloblastic anemia, leukocytosis and hypoalbuminemia. Diagnostic hypotheses: celiac disease, cystic fibrosis and CMPA. Esophagogastroduodenoscopy with biopsy showed slight increase in intra-epithelial eosinophils in the duodenum and chronic mild esophagitis with rare eosinophil infiltrate. Sweat test was negative. Diagnosis of kwashiorkor-type malnutrition triggered by CMPA was made, and hydrolyzed protein diet was started with favorable clinical outcome. CMPA is a prevalent clinical presentation of food allergy in infants and preschool children, and nutritional consequences are also important in these age groups. Therefore, CMPA diagnosis should always be considered in patients with PEM, provided the primary malnutrition secondary to insufficient food intake is excluded.