Prevalência de diagnóstico médico de asma em adultos brasileiros: Pesquisa Nacional de Saúde, 2013 / Prevalence of asthma medical diagnosis among Brazilian adults: National Health Survey, 2013

RESUMO: Objetivo: Estimar a prevalência de diagnóstico médico de asma na população adulta brasileira (≥ 18 anos). Métodos: Estudo transversal de base populacional com dados da Pesquisa Nacional de Saúde (PNS), de 2013; processo amostral por conglomerado com três estágios de seleção: setor censitário, domicílio e indivíduo. Calculou-se a prevalência e intervalo de confiança de 95% (IC95%) do desfecho "diagnóstico médico de asma" relatado pelo entrevistado e sua distribuição conforme variáveis demográficas, socioeconômicas, macrorregiões e zona urbana ou rural do país. Ainda foi investigado o manejo da asma naqueles que responderam afirmativamente sobre o diagnóstico médico; as análises foram ponderadas. Resultados: Foram entrevistados 60.202 adultos. A prevalência do diagnóstico médico de asma foi de 4,4% (IC95% 4,1 - 4,7), maior no sexo feminino, nos de cor branca, com maior escolaridade e moradores na região Sul; entre aqueles com diagnóstico médico, observou-se percentual elevado (38,2%) de crises de asma nos últimos 12 meses, com cerca de 80% usando medicação e 15% com limitação severa às atividades diárias. Conclusões: Apesar da estabilidade da prevalência da asma comparada a estudos anteriores no país, ainda são necessárias políticas para melhor manejo da doença.

ABSTRACT: Objective: To estimate the prevalence of asthma medical diagnosis among the adult Brazilian population (aged ≥ 18 years). Methods: This is a cross-sectional, population-based study from the 2013 National Health Survey (NHS); it is a sampling cluster process with three stages of selection: census tracts, households, and individuals. The prevalence and 95% confidence interval for the outcome "asthma medical diagnosis" reported by the interviewed subjects were calculated, besides its distribution according to demographic and socioeconomic variables, macroregions, and urban or rural area of the country. Management of the disease was also evaluated among those who reported asthma medical diagnosis and the analyses were weighted. Results: A total of 60,202 adults were interviewed. The prevalence of asthma medical diagnosis was 4.4% (95%CI 4.1 - 4.7), and it was higher among the female subjects, the white skin-colored subjects, those with higher educational level, and those who lived in the south of Brazil. Among those who reported asthma medical diagnosis, a high percentage of asthma attacks were seen in the last 12 months, with around 80% using medication and about 15% referring severe limitation to their daily activities. Conclusions: Although it seems there is asthma diagnosis stability in the country when compared with other researches, we still need public policies for improving the disease management.

Oculo-peritoneal shunt: draining aqueous humor to the peritoneum / Derivação óculo-peritoneal: drenagem do humor aquoso para o peritônio

In 2010, there were estimated to be approximately 60.5 million people with glaucoma. This number is expected to increase to 79.6 million by 2020. In 2010, there were 8.4 million people with bilateral blindness caused by glaucoma, and this number is expected in increase to 11.2 million by 2020. Filtering implants are special devices that have been developed to reduce intraocular pressure in patients with refractory glaucoma. The success rate of these implants is relatively low, and they continue to fail over time. To avoid failure caused by the formation of scar tissue around the implants, attempts have been made to drain the aqueous humor to various sites, including the venous system, lacrimal sac, sinuses, and conjunctival fornix. Recently, a system to shunt aqueous humor from the anterior chamber to the peritoneum has been developed. The surgical technique involved in this system is a modification of the technique currently used by neurosurgeons for the treatment of hydrocephalus. We present the first case operated using this technique.

Calcula-se que em 2010 havia provavelmente 60,5 milhões de pessoas com glaucoma, com aumento previsto para 79,6 milhões em 2020; a cegueira bilateral por glaucoma era detectada em 8,4 milhões de pessoas, em 2010, e com aumento estimado para 11,2 milhões em 2020. Dispositivos especiais foram desenvolvidos para reduzir a pressão intraocular em pacientes com glaucoma refratário, chamados implantes de filtragem. A taxa de sucesso destes implantes é relativamente baixa, e sabe-se que elas continuam a diminuir ao longo do tempo. Para evitar as falhas produzidas pela cicatrização de tecido em torno dos implantes, foram feitas tentativas de drenagem do humor aquoso para diferentes locais, tais como o sistema venoso, saco lacrimal, os seios paranasais e fórnice conjuntival. Revendo o tratamento atual da hidrocefalia, uma técnica de derivação a partir da câmara anterior para o peritônio foi desenvolvida. A técnica cirúrgica desenvolvida é uma modificação da técnica atualmente utilizada por neurocirurgiões para o tratamento de hidrocefalia. Apresentamos o primeiro caso operado com esta técnica.

The family's role as a support network for people living with HIV/AIDS: a review of Brazilian research into the theme / A família como rede de apoio às pessoas que vivem com HIV/AIDS: uma revisão na literatura brasileira

The study of HIV transmission and the implementation of AIDS prevention actions recognize the importance of social networks in the transmission of the disease, the adherence to treatment and the quality of life of those infected. For this relevance there was a review of articles on social support networks to people living with HIV /AIDS available in the Virtual Health Library (VHL) were published in Brazil between 2002 and 2012. In this study 31 articles were used from journals covering the following áreas: Nursing (n = 15), Psychology (n = 6) and Science Health / Biomedica (n = 6), were included, which some principal authors were affiliated to higher education public institutions (n = 17). In relation to the methodology used, priority wasgiven to conducting: qualitative research (n = 18), cross-sectional studies (n = 19) and studies that involved talking to people living with HIV/AIDS (n = 13). Particular importance was placed on analytic categories related to: adherence to treatment (n = 6), the family (n = 4), vulnerability (n = 3) and support from social networks (n = 5). Within this paper we argue for more investments into studies that focus on the family, carers and their households, as well as deepening the theoretical study of the themes discussed and the use of developed theories for the analysis of Social Networks.

O estudo da transmissão do HIV e a implementação de ações de prevenção da AIDS reconhece a importância das redes sociais na contaminação, adesão ao tratamento e qualidade de vida das pessoas infectadas. Por tal relevância, realizou-se uma revisão de artigos sobre redes sociais de apoio às pessoas que vivem com HIV/ AIDS, disponíveis na Biblioteca Virtual em Saúde (BVS) e publicados no Brasil no período de 2002 a 2012. Encontraram-se 31 artigos em revistas de Enfermagem (n = 15), Psicologia (n = 6) e Ciências da Saúde/Biomédicas (n = 6), produzidos por primeiros autores associados a Instituições de Ensino Superior públicas (n = 17). Quanto à metodologia, priorizou-se o método qualitativo (n = 18), estudos transversais (n = 19) e a participação exclusiva de pessoas que vivem com HIV/AIDS (n = 13). Houve predomínio de categorias analíticas relacionadas à adesão ao tratamento (n = 6), família (n = 4), vulnerabilidade (n = 3) e apoio/suporte social/ rede de apoio (n = 5). Discute-se a necessidade de investimento em estudos que privilegiem familiares e cuidadores como participantes e seus domicílios como lócus de investigação, bem como maior aprofundamento teórico nos estudos das temáticas abordadas e utilização de teorias desenvolvidas para análise de Redes Sociais.

Clinical and epidemiological differences between septic arthritis of the knee and hip caused by oxacillin-sensitive and -resistant s. aureus

OBJECTIVE: To establish the risk factors for joint infection by oxacillin-resistant Staphylococcus aureus (MRSA) using clinical and epidemiological data. METHODS: All septic arthritis cases of the knee and hip diagnosed and treated in our institution from 2006 to 2012 were evaluated retrospectively. Only patients with cultures identified as microbial agents were included in the study. The clinical and epidemiological characteristics of the patients were analyzed, seeking the differences between populations affected by MRSA and oxacillin-sensitive Staphylococcus aureus (MSSA). RESULTS: S. aureus was isolated in thirty-five patients (46.0%) in our total sample, 25 in the knee and 10 in the hip. Of these 35 patients, 22 presented with MSSA and 13 presented with MRSA. Provenance from a health service-related environment, as described by the Centers for Disease Control and Prevention, was the only variable associated with oxacillin-resistant strains of this bacterium (p = 0.001). CONCLUSION: Provenance from a health service-related environment was associated with a higher incidence of MRSA-related septic arthritis, suggesting that this agent should be considered in the initial choice of antibiotic treatment. Previous surgeries of the knee or affected limb and the absence of leukocytes might also be related to infection with this agent. .

The antimicrobial screening of a Barbadian medicinal plant with indications for use in the treatment of diabetic wound infections / Tamizaje antimicrobiano de una planta medicinal Barbadense con indicaciones para su uso en el tratamiento de infecciones de heridas en diabéticos

OBJECTIVE: Diabetes mellitus is a chronic noncommunicable disease with high prevalence in the North American and Caribbean region. Diabetic Foot Syndrome which is an associated complication can lead to the development of wounds and ulcers which can become infected. Justicia secunda, a plant known locally in Barbados as Bloodroot used in folklore for wound healing, was selected to test its ability to aid diabetic wound healing by antimicrobial activity. It was therefore tested against the bacteria Staphylococcus aureus ATCC 25923, Pseudomonas aeruginosa ATCC 27853, and Enterococcus feacalis (clincal strain) which are commonly found in diabetic wounds. METHODS: The plant was collected by local users. Methanol and acetone extracts of the plant were prepared with use of soxhlet extraction. The antimicrobial activity was assessed with the use of a modified KirbyBaurer method. Concentrations of 200 mg/ml, 100 mg/ml, 10 mg/ml, and 1 mg/ml of the extract were used, with a standard ciprofloxacin 5 µg positive control, and a 5% dimethyl sulfoxide (DMSO) solution negative control. RESULTS: The J secunda methanol and acetone extracts with an extraction yield of 15.3% and 0.75%, respectively yielded no activity within the concentration range against the three strains of bacteria tested. In comparison with the positive control, relative inhibition zone diameter (RIZD) values of 0% resulted for both the negative control and the extracts, with the positive control having a value of 100%. CONCLUSION:The in vitro screen of the extracts prepared from J secunda, yielded no antimicrobial activity against the three strains of bacteria tested and therefore does not support the folklore claims by this mechanism of action.

OBJETIVO: La diabetes mellitus es una enfermedad crónica no transmisible, de alta prevalencia en la región de Norte América y el Caribea. El síndrome de pie diabético es una complicación asociada, que puede llevar al desarrollo de heridas y úlceras, con la consiguiente posibilidad de infección. Justicia segunda es una planta conocida localmente en Barbados como "bloodroot" (sanguinaria canadensis) y usada en la medicina folklórica para la curación de heridas. Esta planta fue seleccionada para analizar su capacidad de ayudar a curar las heridas de diabéticos por su actividad antimicrobiana. Por lo tanto, se la sometió a prueba frente a bacterias Staphylococcus aureus ATCC 25923, Pseudomonas aeruginosa ATCC 27853, y Enterococcus feacalis (cepa clínica) que normalmente se encuentran en las heridas del diabético. MÉTODOS: La planta fue proporcionada por usuarios locales. Usando un extractor Soxhlet, se prepararon extractos de metanol y acetona a partir de la planta. La actividad antimicrobiana se evaluó mediante el método de KirbyBauer modificado. Se usaron concentraciones de 200 mg/ml, 100 mg/ml, 10 mg/ml, y 1 mg/ml del extracto, con un control positivo de 5 µg de ciprofloxacina estándar, y un control negativo de una solución de dimetil sulfóxido (DMSO) al 5%. RESULTADOS: Los extractos de metanol y acetona de J secunda con un rendimiento de extracción de 15.3% y 0.75% respectivamente, no arrojaron actividad alguna dentro del rango de la concentración contra las tres cepas de bacterias sujetas a prueba. Comparado con el control positivo, el diámetro de la zona de inhibición relativa (RIZD) arrojó valores de 0%, tanto para el control negativo como para los extractos, con un valor de 100% para el control positivo. CONCLUSIÓN: El tamizaje in vitro de los extractos preparados de J secunda, no arrojó actividad antimicrobiana alguna contra las tres cepas de bacterias analizadas, y por consiguiente no sustenta la afirmación de la medicina folklórica en relación con este mecanismo de acción.

Frecuencia y susceptibilidad antibiótica del Staphylococcus aureus proveniente de hisopados nasales en una población urbano marginal de Lima, Perú / The frequency and antibiotic susceptibility of Staphylococcus aureus from nasal swabs in an suburban marginal population in Lima, Peru

Objetivos. Determinar la frecuencia y los factores asociados de la colonización nasal por Staphylococcus aureus, así como el patrón de susceptibilidad antibiótica en una población urbano marginal de Lima, Perú. Materiales y métodos. Estudio transversal en personas de cualquier edad provenientes de un distrito urbano marginal de la zona norte de la ciudad de Lima. El muestreo fue por conveniencia. A cada persona se le realizó una encuesta y se le tomó una muestra de hisopado de las narinas, las que fueron procesadas para la identificación de Staphylococcus aureus y determinación del patrón de susceptibilidad mediante el método de difusión de disco de Kirby Bauer. Resultados. De los 452 participantes reclutados, entre 1 y 84 años de edad, la frecuencia de colonización nasal de Staphylococcus aureus fue de 24,6%, de los cuales solo el 0,9% fue resistente a meticilina. El único factor asociado a la colonización nasal fue la edad menor o igual a 11 años (OR: 3,80; IC95%: 1,42 - 10,16). La mayoría de cepas fue resistente a la penicilina (96,4%) pero también se presentó a la eritromicina (10,9%), clindamicina (7,3%) y gentamicina (4,5%) en menor proporción. Conclusiones. La frecuencia de colonización nasal por Staphylococcus aureus fue similar a otros estudios a nivel mundial, con predominio de cepas meticilino sensibles.

Objectives. To determine the frequency and associated factors of nasal colonization by Staphylococcus aureus and its antibiotic susceptibility pattern in a marginal suburban population Lima, Peru. Materials and methods. A cross-sectional study was conducted among population of all ages from a marginal suburban district in northern Lima. The study used a convenience sample. Each person was surveyed and provided a swab sample of the nostrils. The swab samples were analyzed to identify Staphylococcus aureus, determining the susceptibility pattern by the Kirby Bauer disk diffusion method. Results. From the 452 participants recruited, ages between 1 and 84 years, the frequency of Staphylococcus aureus nasal colonization was 24.6%, with 0.9% of them resistant to methicillin. The only factor associated with nasal colonization was age equal or less than 11 years (OR: 3.80, 95% CI 1.42 to 10.16). Most strains were resistant to penicillin (96.4%) but also to erythromycin (10.9%), clindamycin (7.3%) and gentamicin (4.5%). Conclusions. The frequency of Staphylococcus aureus nasal colonization was similar to other studies worldwide, with predominance of methicillin-sensitive strains.

Length of exposure to the hospital environment is more important than antibiotic exposure in healthcare associated infections by methicillin-resistant Staphylococcus aureus: a comparative study

OBJECTIVES: Both total antimicrobial use and specific antimicrobials have been implicated as risk factors for healthcare-associated methicillin-resistant Staphylococcus aureus (HCA-MRSA) infection. The aims of this study were: (I) to explore predictors of a new HCA-MRSA infection in comparison with a new healthcare-associated methicillin-sensitive Staphylococcus aureus (HCA-MSSA); (II) to thoroughly assess the role of recent antibiotic use qualitatively and quantitatively. METHODS: The time-period for our study was from October 1997 through September 2001. Through applying strict criteria, we identified two groups of inpatients, one with a new HCA-MRSA infection and one with a new HCA-MSSA infection. We recorded demographic, clinical and antibiotic use-related data up to 30 days before the positive culture date. RESULTS: We identified 127 and 70 patients for each group, respectively. Two logistic regression models were carried out to assess the role of antimicrobial use (qualitatively and quantitatively). In model I, duration of hospital stay, presence of chronic wounds, aminoglycoside and fluoroquinolone use retained statistical significance. In model II, duration of hospital stay and history of intubation during the last month stood out as the only significant predictors of a subsequent HCA-MRSA infection. No significant differences in outcome were noted. CONCLUSIONS: The length of exposure to the hospital environment may be the best predictor of a new HCA-MRSA infection. Use of aminoglycosides and fluoroquinolones may also stand independently along with presence of chronic ulcers and surgical procedures. No independent association between quantitative antibiotic use and subsequent HCA-MRSA infection was documented.

Risk factors for Hospital-Acquired Pneumonia in nonventilated adults

Although most recent publications focus on Ventilator-associated Pneumonia, Non-Ventilator-associated Hospital-acquired pneumonia (NVHAP) is still worrisome. We studied risk factors for NVHAP among patients admitted to a small teaching hospital. Sixty-six NVHAP case patients and 66 controls admitted to the hospital from November 2005 through November 2006 were enrolled in a case-control study. Variables under investigation included: demographic characteristics, comorbidities, procedures, invasive devices and use of medications (Sedatives, Antacids, Steroids and Antimicrobials). Univariate and multivariable analysis (hierarchical models of logistic regression) were performed. The incidence of NVHAP in our hospital was 0.68 percent (1.02 per 1,000 patients-day). Results from multivariable analysis identified risk factors for NVHAP: age (Odds Ratio[OR]=1.03, 95 percent Confidence Interval[CI]=1.01-1.05, p=0.002), use of Antacids (OR=5.29, 95 percentCI=1.89-4.79, p=0.001) and Central Nervous System disease (OR=3.13, 95 percentCI=1.24-7.93, p=0.02). Although our findings are coherent with previous reports, the association of Antacids with NVHAP recalls a controversial issue in the physiopathology of Hospital-Acquired Pneumonia, with possible implications for preventive strategies.

Staphylococcus aureus en residentes de un hogar de ancianos de Cartagena / Staphylococcus aureus in residents from a nursing-home in Cartagena

Objetivos Determinar la prevalencia de colonización nasal de Staphylococcus aureus, la susceptibilidad a antibióticos de los aislamientos y su posible asociación con factores de riesgo, en los residentes del Hogar Asilo de Ancianos San Pedro Claver de la ciudad de Cartagena de Indias durante el segundo semestre del año 2007. Métodos Con el debido consentimiento informado, para cada sujeto participante se tomaron hisopados nasales por una única vez durante el estudio. Se identificaron cepas de Staphylococcus aureus usando métodos clásicos y se determinó la susceptibilidad a antibióticos de los aislamientos mediante el método de difusión por disco según los estándares del CLSI. La información recolectada de las historias clínicas y con ayuda de un cuestionario se utilizó para analizar la asociación con factores de riesgo potenciales usando el programa SPSS 13.0 para Windows. Resultados Se obtuvieron 11 aislamientos positivos para Staphylococcus aureus, de un total de 69 individuos participantes, lo que correspondió a una prevalencia de 15,9 por ciento. No se detectaron cepas resistentes a meticilina. La portación nasal de Staphylococcus aureus estuvo asociada significativamente con limitaciones en el nivel de movilidad y con la presencia de lesiones cutáneas. No se encontró asociación significativa con otros de los diferentes factores de riesgo analizados. Conclusiones. La portación nasal de S. aureus encontrada en este estudio es mucho más baja que las reportadas en estudios similares en Colombia y otros países, teniendo en cuenta que la población estudio es vulnerable a la colonización con este patógeno.

Objectives Determining Staphylococcus aureus nasal carriage, antibiotic susceptibility and association with potential risk factors in residents from the Hogar Asilo de Ancianos San Pedro Claver nursing-home in Cartagena during the second semester of 2007. Methods Nasal swabs were taken from each person participating in the study after they had signed an informed consent form. Staphylococcus aureus strains were identified by classical methods; antibiotic susceptibility was determined by disk diffusion methods, according to CLSI standards. SPSS for Windows 13.0 statistical package was used for analysing data collected from medical records and from a questionnaire for analysing association with potential risk factors. Results 11 Staphylococcus aureus isolates were obtained from 69 participants, corresponding to 15.9 percent prevalence. No methicillin-resistant strains were detected. Staphylococcus aureus nasal carriage was significantly associated with limited mobility and skin lesions. There was no significant association with the other risk factors analysed. Conclusions Staphylococcus aureus nasal carriage found in this study was lower than that reported from other similar studies in other countries, taking into account that this is a population at risk for colonisation by this pathogen.

Nasal carriage of methicillin-resistant and methicillin-susceptible Staphylococcus aureus in nursing home residents in Bolu, Turkey / Portación Nasal de Staphylococcus Aureus Resistentes a la Meticilina y Susceptible a la Meticilina en los Residentes del Hogar de Ancianos en Bolu, Turquía

BACKGROUND: This study aimed (a) to provide information on methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) Staphylococcus aureus colonization ratio in residents of nursing homes; (b) to determine the effect of hand-washing education given to nursing home residents and employees on nasal carriage of Staphylococcus aureus (NCSA) and (c) to obtain probable risk factors for MRSA colonization of residents in two nursing homes. METHODS: Seventy-nine volunteers (24 females and 55 males) from Bolu nursing homes were included in the study. Nasal samples were taken with sterile swabs from the anterior nares. Staphylococcus aureus strains were identified using classical methods and genotyping of methicillin resistant strains was done using Arbitrary Primed PCR (AP-PCR). Antibiotic susceptibilities were determined by disk diffusion methods according to NCCLS standards. After first nasal samples were taken, all employees and residents of nursing homes were educated about the methods of hand hygiene over two days. RESULTS: With hand-washing education, the decrease of NCSA rate (initially 43; after education, 21) was significant (p 0.05). MRSA carriage was significantly correlated with presence of skin lesions, prior hospitalization within the last six months, and antibiotics usage within the last six months. AP PCR results suggested that residents' carriage of MRSA was the result of the same source. CONCLUSION: MSSA and MRSA colonization rates were found to be 38and 5in nursing homes, respectively. These ratios can decrease with simple precautions like hand-washing after a short education period.

ANTECEDENTES: Este estudio tiene como propósito: (a) ofrecer información sobre la tasa de colonización Staphylococcus aureus resistentes a la meticilina (SARM) y el de Staphylococcus aureus susceptibles a la meticilina (SASM) de residentes en hogares de ancianos; (b) determinar el efecto de la educación del lavado de manos brindada a los residentes y empleados, sobre la portación nasal de Staphylococcus aureus (PNSA); y (c) obtener los factores de riesgo probables por la colonización de SARM en los residentes de dos hogares de ancianos. MÉTODOS: Setenta y nueve voluntarios (24 hembras y 55 varones) de los hogares de ancianos Bolu fueron incluidos en el estudio. Se tomaron muestras nasales con hisopos estériles, de 1/3 orificios nasales anteriores. Se identificaron cepas de Staphylococcus aureus usando métodos clásicos; y la genotipificación de las cepas resistentes a la meticilina se realizó por medio de la técnica de la reacción en cadena de la polimerasa con iniciadores arbitrarios (AP-PCR). Las susceptibilidades antibióticas se determinaron mediante métodos de difusión por disco de acuerdo con los estándares del NCCLS. Después que se tomaron las primeras muestras nasales, todos los empleados y los residentes de los hogares de ancianos recibieron instrucción sobre métodos de higiene de las manos durante dos días. RESULTADOS: Con la educación del lavado de manos, la disminución de la tasa de PNSA (inicialmente 43%; después del entrenamiento 21%) fue significativa (p < 0.05), mientras que la disminución de la tasa de portación de SARM (inicialmente 5%; después del entrenamiento 1%) no fue significativa (p > 0.05).