Community-acquired methicillin-resistant Staphylococcus aureus carrying SCCmec type IV in southern Brazil

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen commonly associated with nosocomial infections. However, it has also been associated with community-acquired skin and soft tissue infections (CA-MRSA). There are few data on the identification and prevalence of CA-MRSA infections in Brazil. METHODS: This is a cross-sectional study of 104 patients with community-acquired skin infections attending two health care centers in Porto Alegre, southern Brazil. MRSA isolates were characterized by molecular methods, including detection of the mecA gene by PCR, gene SCCmec typing, Panton-Valentine leukocidin (PVL) detection, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST). RESULTS: From the 104 samples, 58 Staphylococcus aureus isolates were obtained, of which five (8.6%) had a CA-MRSA-resistant profile. All five isolates had the mecA gene and amplified to SCCmec type IV. Analysis of chromosomal DNA by PFGE revealed the presence of two clusters related to international clones (OSPC and USA 300), with a Dice similarity coefficient >80%. The study was complemented by MLST, which detected three different strains: ST30, ST8, and ST45, the latter not presenting any relation with the clones compared in PFGE. CONCLUSIONS: The presence of CA-MRSA reveals an important change in the epidemiology of this pathogen and adds new elements to the knowledge of the molecular biology of infections by MRSA with SCCmec type IV in southern Brazil.

Spatial distribution of leprosy in areas of risk in Vitoria, State of Espirito Santo, Brazil, 2005 to 2009

Introduction Leprosy remains a relevant public health issue in Brazil. The objective of this study was to analyze the spatial distribution of new cases of leprosy and to detect areas with higher risks of disease in the City of Vitória. Methods The study was ecologically based on the spatial distribution of leprosy in the City of Vitória, State of Espírito Santo between 2005 and 2009. The data sources used came from the available records of the State Health Secretary of Espírito Santo. A global and local empirical Bayesian method was used in the spatial analysis to produce a leprosy risk estimation, and the fluctuation effect was smoothed from the detection coefficients. Results The study used thematic maps to illustrate that leprosy is distributed heterogeneously between the neighborhoods and that it is possible to identify areas with high risk of disease. The Pearson correlation coefficient of 0.926 (p = 0.001) for the Local Method indicated highly correlated coefficients. The Moran index was calculated to evaluate correlations between the incidences of adjoining districts. Conclusions We identified the spatial contexts in which there were the highest incidence rates of leprosy in Vitória during the studied period. The results contribute to the knowledge of the spatial distribution of leprosy in the City of Vitória, which can help establish more cost-effective control strategies because they indicate specific regions and priority planning activities that can interfere with the transmission chain.

Leprosy and pregnancy in the State of Para: an epidemiological perspective

Introduction A few older publications describe leprosy associated with pregnancy, a situation that has been linked to leprosy exacerbation. This study aimed to describe the detection rate of this association in the State of Pará by county and Integration Region (IR) from 2007 to 2009 via an analysis of sociodemographic, epidemiological and operational indices. Methods This was a descriptive study using information generated by the SINAN. The Detection Coefficient of the Leprosy and Pregnancy Association (DCLP) epidemiological index was constructed to help interpret the endemicity parameters. The disease was considered hyperendemic when greater than two cases per 10,000 inhabitants were identified. Results During the study period, 149 associations were detected, with 14 hyperendemic counties: seven in 2007, five in 2008 and two in 2009. The Carajás Integrated Region displayed the highest DCLP index in the period. Eldorado dos Carajás had the single highest DCLP index (5.7/10,000 inhabitants, 2008), whereas the DCLP index in Conceição do Araguaia was very high in all three years. However, most counties displayed low or medium DCLP indices. The annual averages were 0.31 DCLP (2007), bass; 0.30 (2008), bass and 0.19 (2009), bass. The average DCLP index was 0.26, which is considered low. Three clusters of medium endemicity were identified by the average DCLP in the study period. Conclusions The analyses indicated that the surveillance program is still unsatisfactory in Pará. The interpretation of the endemicity parameters enabled qualitative and quantitative analyses to determine the epidemiological panorama of this association. The identification of high endemicity requires further clarification.

Classificação Internacional de Funcionalidade, Incapacidade e Saúde : uma dimensão do neurodesenvolvimento

RESUMO: Objetivo Principal • Determinar a consistência da utilização dos instrumentos de avaliação da capacidade intelectual – escalas de Griffiths e WISC III – no enquadramento dos domínios e dos qualificadores da CIF-CJ, restrita às funções mentais do corpo. Objetivo secundário: • Estudar a efetividade e concordância inter-observador da aplicação da CIF, com base na leitura dos dados obtidos em avaliação efetuada com os instrumentos referidos, por duas observadoras independentes, em contexto de articulação saúde, respetivamente educação e segurança social Métodos • Estudo observacional, descritivo, transversal e prospetivo. • Foi estudada uma amostra de conveniência 355 crianças, num período de três anos (Maio de 2010 a 30 de Abril de 2013), com patologia da área da pediatria do neurodesenvolvimento (total de 4000 consultas) no Centro de Desenvolvimento (CD) do Hospital de Dona Estefânia (HDE), Centro Hospitalar de Lisboa Central, EPE (CHLC, EPE). • Critérios de inclusão: crianças de ambos os sexos, observadas no CD do HDE, CHLC (primeiras consultas e consultas de reavaliação) com idade ≥12 meses e ≤17 anos e incapacidade intelectual definida de acordo com os critérios da DSM-IV-TR, DSM 5 e CID-10. • Critérios de exclusão: crianças com autismo, perturbações específicas da linguagem, hiperatividade, défice de atenção e concentração, défices sensoriais congénitos (baixa visão e ou audição), ou com outros diagnósticos de perturbações de neurodesenvolvimento. • O estudo teve duas fases: na primeira, a investigadora principal colheu ou atualizou a história clínica, observou clinicamente as crianças solicitando os exames complementares considerados necessários e foi efetuada avaliação psicológica com os instrumentos adiante descritos, pela mesma psicóloga clínica, devidamente credenciada, e com larga experiência nas escalas referidas. Com base nos dados colhidos, quer por observação direta, quer através dos resultados das escalas Griffiths e WISC – III, a investigadora aplicou a CIF-CJ, circunscrita aos domínios e funções (variáveis): 1. FUNÇÕESMENTAIS GLOBAIS (b110- Funções da consciência, b114- Funções da orientação no espaço e no tempo, b117 – Funções intelectuais, b122- Funções psicossociais globais, b125- Funções intrapessoais, b126- Funções do temperamento e da personalidade); 2.FUNÇÕES MENTAIS ESPECÌFICAS (b140- funções da atenção, b147- Funções psicomotoras, b152- Funções emocionais, b156- Funções da perceção, b163- Funções cognitivas básicas, b164- Funções cognitivas de nível superior, b167- Funções mentais da linguagem 3. FUNÇÕES DA VOZ E DA FALA (b320- Funções da articulação, b330- Funções da fluência e do ritmo da fala). Numa segunda fase, foi solicitada a colaboração de duas co-investigadoras, com formação específica nas escalas utilizadas e na CIF-CJ, a aplicação da CIF nos mesmos domínios e funções. Estas observadoras não efetuaram observações diretas das crianças envolvidas. • Para efetuar a análise estatística e analisar a relação entre os qualificadores (0 a 4) das variáveis da CIF em estudo (b117, b122, b147, b163, b164, b167, b320 e b330) e os instrumentos psicométricos (escalas de Griffiths e WISC III), que constitui a primeira parte do estudo, recorreu-se à técnica estatística não paramétrica do coeficiente de correlação de Spearman, que quantifica a intensidade e sinal da eventual correlação existente entre as variáveis em estudo. • Para determinar as correlações referentes à segunda parte do estudo, foram utilizados os programas SPSS®, (IBM SPSS Statistics) e Statistica® (StatSoft, Inc., 2011). STATISTICA (data analysis software system, version 10. www.statsoft.com.), tendo-se dado preferência aos gráficos deste último. Resultados 1. Observou-se um predomínio do sexo masculino (relação de 1:1,9); relativamente à idade no momento de avaliação, 242 crianças (68,1%) tinham entre zero e seis anos e, dentro destas, a maioria (189) situava-se entre os três e os seis anos. 2. De acordo com a DSM-IV e DSM-5, 261 (73,4%) crianças apresentavam incapacidade intelectual ligeira. 3. A avaliação da competência intelectual pelas escalas de Ruth Griffiths e WISC III (QI), revelaram correlação negativa predominantemente forte e muito forte (índice de Spearman) com os qualificadores das funções do corpo estudadas (funções mentais, mentais específicas e da voz). Os resultados obtidos pela co-investigadora A foram sobreponíveis aos da investigadora principal. Os resultados obtidos pela co-investigadora B revelaram correlação negativa moderada e forte, correlação inferior à da investigadora principal; Conclusões Os resultados permitem inferir que as escalas de Ruth Griffiths e WISC-III são instrumentos adequados para caracterizar a incapacidade intelectual na CIF-CJ; a concordância inter-observador, moderada, nos qualificadores atribuídos nas funções em análise pela investigadora e co-investigadoras, permite concluir que as escalas de Ruth Griffiths e WISC IIIl são bons instrumentos para caracterizar os qualificadores nos domínios e funções estudados, por diferentes grupos de profissionais ligados à infância. Subsistem dificuldades na diferenciação entre qualificadores, designadamente entre os qualificadores 1 e 2, o que tem necessariamente implicações na elegibilidade das crianças para os apoios preconizados pelo DL 3/2008. ------------------------ ABSTRACT: Main objective • To determine the consistency of the use of assessment tools for intellectual ability - Griffiths and WISC III scales - in the context of domains and qualifiers for the ICF-CY, restricted to the mental functions of the body. Secondary objective • Studying the effectiveness and inter-observer concordance concerning the application of the ICF, based on the data recovered from the assessment made with the mentioned instruments, carried out by two independent observers including their perspective on health, education and social security. Methods • Observational, descriptive, cross-sectional and prospective study. • A convenience sample of 355 children was studied over a period of three years (May 2010 to April 2013), with a pathology in the area of pediatric neurodevelopment – intellectual disability (total of 4000 consultations, including first consultations and revaluations) were observed in the Development Centre (CD) in Hospital de Dona Estefânia (HDE), Centro Hospitalar de Lisboa Central, EPE (CHLC). • Inclusion criteria: children of both sexes aged ≥12 months and years ≤17 and intellectual disability defined according to the criteria in the DSM-IV-TR, DSM 5 and ICD-10. • Exclusion criteria: children with autism; specific language impairment, hyperactivity; attention deficit disorder; severe birth sensory deficits (eg, impaired vision and hearing); amongst other diagnoses for neurodevelopmental disorders. • The study was conducted in two phases: in the first phase the principal investigator collected or updated medical history, clinically observed children requesting additional investigations if she deemed necessary. Psychological evaluation was performed by a single, duly licensed clinical psychologist with extensive experience in the referred scales using the instruments described below. Based on data collected, either by direct observation or through the results of Griffiths scales and WISC - III, the researcher applied the ICF-CY confined to the following fields and functions (variables): 1. GLOBAL MENTAL FUNCTIONS (b110- functions of consciousness, b114- Functions referring to space and time orientation , b117 - intellectual functions, b122- global psychosocial functions, b125- intrapersonal functions, b126- functions related to temperament and personality); 2. SPECIFIC MENTAL FUNCTIONS ( b140- attention functions, b147-psychomotor functions, b152- Emotional functions, b156- perception functions, b163- basic cognitive functions and cognitive functions b164- top level b167- language related mental functions. ) 3. VOICE AND SPEECH FUNCTIONS (b320-articulation functions, b330- fluency and rhythm of speech functions). • In the second phase, two co-investigators, with specific training on the scales used and the ICF-CY have applied the ICF in the domains and functions mentioned above, based on the scales results. These co-investigators did not make any direct observation of the studied children. • To perform the statistical analysis and analyze the relationship between the qualifiers (0-4) of the variables in the ICF study (b117, b122, b147, B163, B164, b167, b320 and B330) and psychometric instruments (Griffiths scale and WISC III), which is the first part of the study, the statistical technique of non-parametric Spearman correlation coefficient was used, which quantifies the strength and sign of the possible correlation between the variables under study. • For submission of correlations related to the second part of the study, SPSS (IBM SPSS) and Statistica (StatSoft, Inc., 2011) programs were used. STATISTICA (data analysis software system, version 10 www.statsoft.com.). Preference was given to graphs computed in Statistica. Results • Male predominated (ratio of 1: 1.9). 242 children (68.1% of the sample) were aged between zero and six years and, among these, the majority (189) was aged largest number between three and six years. • According to the DSM-IV and DSM-5, 261 (73.4%) children had mild intellectual disability. The correlation between the assessment of intellectual competence by Ruth Griffiths scales and WISC III (QI), was predominantly negative strong and very strong correlation with the qualifiers of body functions studied (specific mental functions, mental and voice functions using Spearman index). The levels of correlation obtained by the co-investigatores were in agreeance with the results from the principal investigator. The results obtained by co-investigator B showed moderate to strong negative correlation, levels that were lower to the those registered by the principal investigator; Conclusions These results indicate that Ruth Griffiths and WISC-III scales are adequate tools to characterize intellectual disability in the ICF-CY; moderate inter-observer agreement in the qualifiers assigned the functions under analysis by the researcher and co-researchers, shows that the scales are also good tools to measure CIF qualifyers by diferent technicians with different professional orientations, related to children. However, there are still difficulties in differentiating qualifiers, namely between qualifiers 1/2 and 3/4, which necessarily has implications for the eligibility of children for the state support advocated by the Portuguese Decret Law 3/2008.

Ontogeny of swimming capacity in plaice (Pleuronectes platessa) larvae

Little is known regarding the swimming ability of the larvae of European plaice (Pleuronectes platessa) in relation to changes in total length (TL), dry weight (DW) and developmental stage, which is surprising given the importance of transport processes to the recruitment dynamics of this species in the North Sea and elsewhere. We investigated ontogenetic changes in the critical swimming speed (Ucrit) of plaice from hatching to the onset of metamorphosis (50 days post-hatch, dph) at 8 °C. The mean (±SD) TL and DW growth rates were 1.59 ± 0.81 and 7.7 ± 0.35 % d−1, respectively. Larvae were unable to swim at against a minimum current speed of <0.5 cm s−1 until 10 dph (7 mm TL), after which Ucrit significantly increased with increasing TL until the onset of metamorphosis and subsequent settlement. Mean (±SD) Ucrit was 0.38(0.35), 1.59(0.54), 2.27(0.49) and 2.99(0.37) cm s−1 for stage I (6.61 ± 2.64 mm TL), stage II (7.75 ± 0.60 mm TL), stage III (9.10 ± 1.00 mm TL) and stage IV (11.59 ± 0.85 mm TL) larvae, respectively. Larval TL, DW, DNA content, RNA content and Ucrit significantly increased, whereas sRD significantly declined as larvae developed from stage I to V. Although inter-individual differences in Ucrit (coefficient of variation, CV = 33 %) were as large as those in biochemical and morphological condition (CV’s of 21–42 %), differences in Ucrit were not significantly related to those in nutritional condition and larvae with lower DNA/DW had also better swimming abilities. These estimates should be useful to ongoing efforts to create individual- based models of the transport, foraging and growth of plaice larvae in the North Sea.

Epidemiological and environmental aspects of visceral leishmaniasis in children under 15 years of age between 2007 and 2012 in the City of Araguaína, State of Tocantins, Brazil

Introduction Visceral leishmaniasis (VL) stands out as a zoonosis observed on four continents and also in urban expansion zones in several regions of Brazil. Methods A cross-sectional epidemiological study of VL cases in children under 15 years of age in the period from 2007 to 2012. Clinical data were gathered from medical reports; meteorological data were obtained at the Meteorological Measurement Department of UFT. Environmental variables were divided into two periods, rainy and dry. Results The study revealed no difference by gender (p=0.67) among the 821 patients. However, the most affected age group was between one and five years of age (58.6%; p<0.01); the highest prevalence of the disease (99.03%; p<0.01) occurred in urban zones; and the most affected ethnic group (85.5%; p<0.01) was mixed race. The highest incidence coefficients in this population occurred in 2007 and 2008 (578.39/100,000 inhabitants; 18.5/100,000 inhabitants, respectively), whereas the highest lethality coefficients occurred in 2008 and 2011 (0.85/100 deaths). There was no significant correlation between average rainfall and the number of VL cases. The correlation between temperature and number of VL cases was negative (r = -0.4039; p<0.01). Conclusions In Araguaína, visceral leishmaniasis in children under 15 years is an urban-based endemic disease distributed across all districts of the city wherein temperature as an environmental factor, a higher prevalence in mixed race children between one and five years of age, and a high incidence coefficient all strongly contribute to child mortality.

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 strategy may not bring about uniformly good outcomes. The geographic clustering of municipalities identified as problem areas might help to define better intervention methods.

Incidence of hepatitis C in Brazil

Abstract INTRODUCTION: Hepatitis C is a public health problem of global dimensions, affecting approximately 200 million people worldwide. The main objective of this study was to estimate the incidence rate of hepatitis C in Brazil during the period between 2001 and 2012. METHODS: An epidemiological, temporal, and descriptive study was performed using data from the Information System for Reportable Diseases. RESULTS: Between 2001 and 2012, a total of 151,056 hepatitis C cases were recorded, accounting for 30.3% of all hepatitis notifications in Brazil. The average gross coefficient for the analysis period was 6.7 new cases per 100,000 inhabitants. The regions with the highest rates were the Southeast region (8.7 new cases/100,000 inhabitants) and the South (13.9 new cases/100,000 inhabitants). There was a predominance of men with respect to the incidence rate (8.0 new cases/100,000 inhabitants) compared to women (5.5 new cases/100,000 inhabitants). Injection drug use was the most common source of infection, and members of the white race, residents of urban areas, and those aged 60 to 64 years had the highest incidences. CONCLUSIONS: Over the last 10 years, the incidence of hepatitis C in Brazil has increased, mainly in the South and Southeast. The adoption of fast, accurate diagnostic methods, together with epidemiological awareness, can facilitate early intervention measures for adequate control of the disease.

Diagnosis of latent Mycobacterium tuberculosis infection: tuberculin test versus interferon-gamma release

Abstract: INTRODUCTION: The treatment of individuals with active tuberculosis (TB) and the identification and treatment of latent tuberculosis infection (LTBI) contacts are the two most important strategies for the control of TB. The objective of this study was compare the performance of tuberculin skin testing (TST) with QuantiFERON-TB Gold In TUBE(r) in the diagnosis of LTBI in contacts of patients with active TB. METHODS: Cross-sectional analytical study with 60 contacts of patients with active pulmonary TB. A blood sample of each contact was taken for interferon-gamma release assay (IGRA) and subsequently performed the TST. A receiver operating characteristic curve was generated to assess the cutoff points and the sensitivity, predictive values, and accuracy were calculated. The agreement between IGRA and TST results was evaluated by Kappa coefficient. RESULTS: Here, 67.9% sensitivity, 84.4% specificity, 79.1% PPV, 75% NPV, and 76.7% accuracy were observed for the 5mm cutoff point. The prevalence of LTBI determined by TST and IGRA was 40% and 46.7%, respectively. CONCLUSIONS: Both QuantiFERON-TB Gold In TUBE(r) and TST showed good performance in LTBI diagnosis. The creation of specific diagnostic methods is necessary for the diagnosis of LTBI with higher sensitivity and specificity, preferably with low cost and not require a return visit for reading because with early treatment of latent forms can prevent active TB.

Sodium serum levels in hypoalbuminemic adults at general medical wards

Hypoalbuminemia may cause interstitial edema and hemodilution, which we hypothesized may influence serum sodium levels. Our purpose was to compare serum sodium levels of hospitalized adults with or without hypoalbuminemia. All sodium and albumin serum levels of 142 adults hospitalized at general medical wards over a six-month period were searched at a University Hospital mainframe computer. Relevant laboratory data and clinical details were also registered. Hypoalbuminemia was defined by serum albumin concentration < 3.3 g/dl Fisher, Mann-Whitney, and Student's t tests were applied to compare groups with or without hypoalbuminemia. Ninety-nine patients, classified as hypoalbuminemic, had lower blood hemoglobin (10.68 ± 2.62 vs. 13.54 ± 2.41), and sodium (135.1 ± 6.44 vs. 139.9 ± 4.76mEq/l) and albumin (2.74 ± 0.35 vs. 3.58 ± 0.28g/dl) serum levels than non-hypoalbuminemic (n=43). Pearson's coefficient showed a significant direct correlation between albumin and sodium serum levels (r=0.40) and between serum albumin and blood hemoglobin concentration (r=0.46). Our results suggest that hypoalbuminemic adults have lower serum sodium levels than those without hypoalbuminemia, a phenomenon that may be at least partially attributed to body water retention associated with acute phase response syndrome.

Interação do planeamento urbano com o envelhecimento ativo : percepção de acessibilidade pedonal dos adultos de 65 ou mais anos residentes no município de Setúbal

RESUMO - Introdução- O envelhecimento populacional expressa crescentes necessidades sociais e em saúde num sistema que se encontra em sobrecarga. Considerando que o meio envolvente influencia as atitudes e o estado de saúde dos indivíduos, é extremamente importante analisar as características físicas que, da perspetiva dos utilizadores, influenciam comportamentos determinantes para o seu bem-estar e qualidade de vida. Esse conhecimento traduz-se na planificação de estratégias adequadas às necessidades desta população mais vulnerável, inibindo iniquidades, estimulando a autonomia dos indivíduos e, prevenindo necessidades de cuidados de saúde. Objetivos- Conhecer qual a acessibilidade pedonal percebida por indivíduos de 65 ou mais anos, residentes no município de Setúbal e avaliar o grau de correlação existente entre a acessibilidade pedonal percebida e a qualidade de vida associada à saúde. Metodologia- Foi utilizada metodologia descritiva, observacional e transversal, tendo sido aplicados 3 questionários (PAP+65, EQ-5D e questionário de caracterização da população), aplicados por hetero-preenchimento. Resultados- Da aplicação do coeficiente de correlação de Spearman, observou-se presença de associação estatisticamente significativa entre a acessibilidade pedonal percebida e a qualidade de vida associada à saúde (0,219, para p <0,01). Após dicotomização dos resultados do total da escala PAP+65, verificou-se que 55,6% dos participantes consideram que existe elevada adequabilidade do seu bairro para caminhar, no município de Setúbal. Conclusão- Os resultados demonstraram objetivamente que a perceção da acessibilidade do bairro para caminhar tem associação com a qualidade de vida relacionada com a saúde, o que sugere que medidas que melhorem a acessibilidade pedonal para a população de maior idade traduzir-se-ão em ganhos em saúde para esta população.

Desigualdades na diabetes mellitus e hipertensão arterial: um estudo ao nível de freguesia

RESUMO - Introdução: A diabetes mellitus e a hipertensão arterial são problemas de saúde de elevada prevalência em Portugal. A sua distribuição geográfica e social é pouco conhecida, comprometendo o desenho e implementação de políticas de saúde. Assim, este estudo teve como objetivo avaliar a existência das desigualdades socioeconómicas na prevalência de diabetes mellitus tipo 2 e de hipertensão arterial, na população residente na região Norte de Portugal, no ano de 2013. Métodos: Foi realizado um estudo ecológico que analisou as 2028 freguesias da região Norte. Os dados foram obtidos através do Sistema de Informação das Administrações Regionais de Saúde e do Censos 2011. A associação entre os indicadores socioeconómicos e a prevalência destas doenças foi medida através da diferença de prevalências, do risco atribuível populacional, do índice relativo de desigualdades e pelo coeficiente de regressão. Resultados: A prevalência de diabetes mellitus tipo 2 e hipertensão arterial foi de 6,16% e 19,35%, respetivamente, e apresentou uma distribuição heterogénea entre freguesias (variando entre 0%-23,7% para a diabetes e 2,8%-66,7% para a hipertensão). A prevalência de ambas as doenças estava significativamente associada com o baixo nível educacional, baixa atividade em sector terciário, desemprego e baixo rendimento (com diferença de prevalências entre decis opostos de até 1,3% na diabetes e até 5,3% na hipertensão). Os determinantes socioeconómicos foram responsáveis até 20% da prevalência destas doenças na população. Conclusão: Estes resultados demonstram a existência de uma distribuição socioeconómica e geográfica heterogéneas e a necessidade de criação de políticas de saúde que atuem nas freguesias menos favorecidas.

Hyperhomocyst(e)inemia in chronic stable renal transplant patients

PURPOSE: Hyperhomocyst(e)inaemia is an important risk factor for atherosclerosis, which is currently a major cause of death in renal transplant patients. The aim of this study was to assess the influence of immunosuppressive therapy on homocyst(e)inemia in renal transplant recipients. METHODS: Total serum homocysteine (by high performance liquid chromatography), creatinine, lipid profile, folic acid (by radioimmunoassay-RIA) and vitamin B12 (by RIA) concentrations were measured in 3 groups. Group I patients (n=20) were under treatment with cyclosporine, azathioprine, and prednisone; group II (n=9) were under treatment with azathioprine and prednisone; and group III (n=7) were composed of renal graft donors for groups I and II. Creatinine, estimated creatinine clearance, cyclosporine trough level, lipid profile, folic acid, and vitamin B12 concentrations and clinical characteristics of patients were assessed with the aim of ascertaining determinants of hyperhomocyst(e)inemia. RESULTS: Patient ages were 48.8 ± 15.1 yr (group I), 43.3 ± 11.3 yr (group II); and 46.5 ± 14.8 yr (group III). Mean serum homocyst(e)ine (tHcy) concentrations were 18.07 ± 8.29 mmol/l in renal transplant recipients; 16.55 ± 5.6 mmol/l and 21.44 ± 12.1 mmol/l respectively for group I (with cyclosporine) and group II (without cyclosporine) (NS). In renal donors, tHcy was significantly lower (9.07 ± 3.06 mmol/l; group I + group II vs. group III, p<0.008). There was an unadjusted correlation (p<0.10) between age (r=0.427; p<0.005) body weight (r=0.412; p<0.05), serum creatinine (r=0.427; p<0.05), estimated creatinine clearance (r=0.316; p<0.10), and tHcy in renal recipients (group I +II). Independent regressors (r²=0.46) identified in the multiple regression model were age (coefficient= 0.253; p=0.009) and serum creatinine (coefficient=8.07; p=0.045). We found no cases of hyperhomocyst(e)inemia in the control group. In contrast, 38% of renal recipients had hyperhomocyst(e)inemia: 7 cases (35%) on cyclosporine and 4 (45%) without cyclosporine, based on serum normal levels. CONCLUSIONS: Renal transplant recipients frequently have hyperhomocyst(e)inemia. Hyperhomocyst(e)inemia in renal transplant patients is independent of the scheme of immunosuppression they are taking. The older the patients are and the higher are their serum creatinine levels, the more susceptible they are to hyperhomocyst(e)inemia following renal transplantation.

Comparison of the fluorescent polarization (TDx) and the enzymatic competitive (EMIT 2000) immune assays for the measurement of cyclosporin A blood concentration

Evaluation of Cyclosporin A (CyA) blood concentration is imperative in solid organ transplantation in order to achieve maximal immunosuppression with the least side effects. We compared the results of whole blood concentrations of CyA in 50 blood samples simultaneously evaluated by the fluorescent polarization immune assay (TDx) and the enzymatic competitive immune assay (EMIT 2000). There was a strong correlation between both kits for any range of CyA blood concentration (R=0.99, p<0.001). The within-run and between-days coefficient of variation were less than 4% for both assays. The cost for each CyA measurement was 50% lower for the EMIT assay when compared to the TDx assay. We concluded that the EMIT is as accurate as the TDx in measuring CyA blood concentration and has the advantage of a lower cost, as well as the possibility of widespread access to the EMIT methodology in contrast to the TDx equipment, allowing the laboratory to perform several routines within a working day.

Retrospective evaluation of bone pain palliation after samarium-153-EDTMP therapy

PURPOSE: The aim of this study was to evaluate the degree of metastatic bone pain palliation and medullar toxicity associated with samarium-153-EDTMP treatment. METHODS: Seventy-three patients with metastatic bone pain having previously undergone therapy with samarium-153-EDTMP (1 mCi/kg) were retrospectively evaluated. Routine follow-up included pain evaluation and blood counts for 2 months after treatment. Pain was evaluated using a subjective scale (from 0 to 10) before and for 8 weeks after the treatment. Blood counts were obtained before treatment and once a week for 2 months during follow-up. Dosimetry, based upon the urinary excretion of the isotope, was estimated in 41 individuals, and the resulting radiation absorbed doses were correlated with hematological data. RESULTS: Reduction in pain scores of 75% to 100% was obtained in 36 patients (49%), with a decrease of 50% to 75%, 25% to 50%, and 0% to 25% in, respectively, 20 (27%), 10 (14%), and 7 (10%) patients. There was no significant relationship between the pain response and location of the primary tumor (breast or prostate cancer). Mild to moderate myelosuppression was noted in 75.3% of patients, usually with hematological recovery at 8 weeks. The mean bone marrow dose was 347 ± 65 cGy, and only a weak correlation was found between absorbed dose and myelosuppression (Pearson coefficient = .4). CONCLUSIONS: Samarium-153-EDTMP is a valuable method for metastatic bone pain palliation. A mild to moderate and transitory myelosuppression is the main toxicity observed after samarium therapy, showing a weak correlation with dosimetric measures.