Pandemic influenza A/H1N1 vaccination coverage, adverse reactions, and reasons for vaccine refusal among medical students in Brazil

The aim of this cross-sectional study was to determine, among medical students at a public university in Rio de Janeiro, Brazil, the acceptance of the pandemic influenza A/H1N1 vaccine during the 2010 mass immunization campaign and the vaccine safety in this group and, among unvaccinated students, the reasons for refusing vaccination. Of a total of 858 students, 678 (79%) participated in the study. Vaccination coverage was 60.4% among students aged 20 to 39 years (an age group targeted for vaccination) and 43.8% among those who did not belong to this age group. The most frequent adverse reactions to the vaccine were pain at the injection site (8.7%) and fever (7.9%). There were no serious adverse reactions. Among students aged 20 to 39 years, the most common reasons for refusing the vaccine were "lack of time" (42.4%), "fear of adverse reactions" (41.9%), and "difficult access to the vaccine" (11.5%). Other reasons for vaccine refusal were "uncertainties about vaccine safety and efficacy" and "vaccination was not needed". To increase the acceptance of the influenza vaccine, a comprehensive immunization program should be offered to these students.

HEPATITIS B VACCINATION COVERAGE AND POSTVACCINATION SEROLOGIC TESTING AMONG MEDICAL STUDENTS AT A PUBLIC UNIVERSITY IN BRAZIL

The aim of this cross-sectional study was to determine the hepatitis B vaccination coverage among medical students at a public university in Rio de Janeiro, Brazil, and their compliance with the postvaccination serologic testing recommendations. Of the total of 858 students, 675 (78.7%) participated in the study. Among the participants, 48.9% (95% CI: 45.1% to 52.7%) were vaccinated against hepatitis B (received ≥ 3 doses of the vaccine), 31.6% were not (received 0, 1 or 2 doses), and 19.6% did not know their vaccination status. Hepatitis B vaccination coverage increased from 26.0% among first-year students to 70.6% among sixth-year students while the prevalence of unknown vaccination status decreased from 39.7% among first-year students to 2.4% among sixth-year students. The frequency of unvaccinated students ranged from 23.7% among fifth-year students to 34.4% among first-year students. Only 34.8% of the vaccinated students performed the anti-HBs testing after vaccination. Among these medical students, we found a low adherence to the hepatitis B vaccination and to the postvaccination serologic testing. A comprehensive hepatitis B immunization program should be offered to students at this medical school.

Incidência da cardiopatia chagásica em 15.000 necrópsias consecutivas e sua associação com os «megas»

Os AA. estudaram, a incidência da cardiopatia chagásica em 15.000 necrópsias consecutivas e sua associação com os megas. Em 875 cardiopatias chagásicas houve 145 casos de megas, ou seja, 16,56%, com predominância do sexo masculino. No branco houve maior incidência (55) de megas do que no mulato (53) e no negro (31) dentre 858 cardiopatias chagásicas. Em 848 cardiopatias chagásicas, 85,78% eram de indivíduos que faleceram entre 21 e 60 anos. O maior número de cardiopatias (120 ou 14,14%) e de "megas'' (21 ou 15,78%) foi encontrado nos indivíduos entre 36 a 40 anos. Os nossos resultados mostram uma incidência diferente da associação cardiopatia-mega, em comparação da observada em outras regiões do País e em outros países da América do Sul.

Therapeutic approach to patients complaining of high blood pressure in a cardiological emergency room

OBJECTIVE: To evaluate the management of patients complaining of high blood pressure (BP) in a cardiological emergency room. METHODS: Patients referred to the cardiological emergency room with the main complaint of high blood pressure were consecutively selected. The prescriptions and the choice of antihypertensive drugs were assessed. The classification of these patients as hypertensive emergencies or pseudoemergencies, according to the physician who provided initial care, was recorded. RESULTS: From a total of 858 patients presenting to the emergency room, 80 (9.3%) complained of high BP, and 61 (76.3%) received antihypertensive drugs. Sublingual nifedipine was the most commonly used drug (59%). One patient received intravenous medication, one patient was hospitalized and 6 patients (7.5%) were classified as hypertensive emergencies or pseudoemergencies. CONCLUSION: High BP could seldom be classified as a hypertensive emergency or pseudoemergency, even though it was a frequent complaint (9.3% of visits). Currently, the therapeutic approach is not recommended, even in specialized clinics.

Tratamento do tromboembolismo pulmonar maciço por fragmentação percutânea do trombo

OBJETIVOS: Avaliar a segurança e a eficácia da fragmentação percutânea do trombo (FPT) no tromboembolismo pulmonar (TEP) maciço em pacientes com contra-indicação à administração de trombolíticos. MÉTODOS: Entre julho de 1999 e agosto de 2005, 10 pacientes (7 homens, 3 mulheres, idade média de 57±18 anos) com TEP maciço e contra-indicação à administração de trombolíticos foram submetidos a FPT. A saturação arterial de oxigênio (Sat.O2), índice de Walsh (IW), pressão arterial pulmonar média (PAP), pressão arterial sistêmica média (PAS) e função ventricular direita (FVD) ao ecocardiograma Doppler transtorácico foram avaliados pré e pós-procedimento. Foi realizada análise estatística por meio do teste de Wilcoxon pareado, sendo p significativo quando < 0,05. RESULTADOS: Após o tratamento por FPT houve melhora da Sat. O2 [87,4±1,3% vs 92,3±3,1% (p<0,001)], do IW [6,4±1,07 vs 4,4±1,42 (p=0,003), PAP [31,8±4,6 mmHg vs 25,5±3,4 mmHg (p<0,001)] e PAS [73,9±8,7 vs 85±8,3 (p=0,001). A FVD pré-procedimento percutâneo era grave nos 10 pacientes, porém até o 10º dia após a FPT passou a ser normal ou discreta em 8 e moderada em 1. Não houve complicações técnicas ou do sítio vascular de acesso relacionadas a FPT. Houve 1 óbito hospitalar (10%). O paciente em questão foi o único em quem não se obteve sucesso com o procedimento. CONCLUSÃO: A FPT mostrou-se segura pela ausência de complicações relacionadas ao procedimento. A melhora na Sat.O2, no IW, na PAP, na PAS e na FVD em 90% dos casos, revelaram a eficácia do procedimento, sugerindo ser esse uma alternativa no tratamento do TEP maciço em pacientes com contra-indicação à trombolíticos sistêmicos.

A clinical trial for uniform multidrug therapy for leprosy patients in Brazil: rationale and design

Leprosy will continue to be a public health problem for several decades. The World Health Organization (WHO) recommends that, for treatment purposes, leprosy cases be classified as either paucibacillary or multibacillary (MB). A uniform leprosy treatment regimen would simplify treatment and halve the treatment duration for MB patients. The clinical trial for uniform multidrug therapy (U-MDT) for leprosy patients (LPs) in Brazil is a randomised, open-label clinical trial to evaluate if the effectiveness of U-MDT for leprosy equals the regular regimen, to determine the acceptability of the U-MDT regimen and to identify the prognostic factors. This paper details the clinical trial methodology and patient enrolment data. The study enrolled 858 patients at two centres and 78.4% of participants were classified as MB according to the WHO criteria. The main difficulty in evaluating a new leprosy treatment regimen is that no reliable data are available for the current treatment regimen. Relapse, reaction and impaired nerve function rates have never been systematically determined, although reaction and impaired nerve function are the two major causes of nerve damage that lead to impairments and disabilities in LPs. Our study was designed to overcome the need for reliable data about the current treatment and to compare its efficacy with that of a uniform regimen.

Microsatellite-dense genetic map: towards genome coverage in a tropical maize (Zea mays L.) population

Dense molecular genetic maps are used for an efficient quantitative trait loci (QTL) mapping and in the marker-assisted selection programs. A dense genetic map was generated with 139 microsatellite markers using 256 F2 plants generated by the crossing of two tropical maize inbred lines (L-02-03D and L-20-01F). This map presented 1,858.61 cM in length, where 10 linkage groups were found spanned, with an average interval of 13.47 cM between adjacent markers. Seventy seven percent of the maize genetic mapping bins were covered, which means an increase of 14% coverage in relation to the previous tropical maize maps. The results provide a more detailed and informative genetic map in a tropical maize population representing the first step to make possible the studies of genetic architecture to identify and map QTL and estimate their effects on the variation of quantitative traits, thus allowing the manipulation and use in tropical maize breeding programs.