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Melanoma , Neoplasias Cutâneas , Humanos , Melanoma/mortalidade , Melanoma/terapia , Melanoma/patologia , Brasil/epidemiologia , Neoplasias Cutâneas/mortalidade , Neoplasias Cutâneas/patologia , Masculino , Feminino , Prognóstico , Pessoa de Meia-Idade , Idoso , Adulto , Estudos Retrospectivos , Idoso de 80 Anos ou mais , Adulto JovemRESUMO
Objetivos: Descrever e analisar o perfil socioepidemiológico e o desfecho dos casos de tuberculose associada com as comorbidades síndrome da imunodeficiência adquirida, alcoolismo, diabetes, doença mental e tabagismo no estado do Pará em populações residentes em três municípios situados na linha de fronteira internacional e em três municípios não fronteiriços, selecionados por suas populações equivalentes. Metodologia: trata-se de um estudo de natureza observacional, transversal, com abordagem descritiva e analítica. Os dados levantados foram obtidos do Sistema de informação de Agravos de Notificação (SINAN) para os casos de tuberculose nos municípios de Almeirim, Óbidos, Oriximiná, Juruti, Novo Repartimento e Tucumã no período de 2010 a 2019. Para a análise estatística aplicou-se o teste do Qui-quadrado. Resultados: Foram notificados 286 casos de tuberculose com comorbidades, sendo 177 casos (61,8%) ocorridos em municípios paraenses situados na fronteira com Guiana e Suriname. O alcoolismo (36,4%) e o tabagismo (28,9%) foram as comorbidades mais frequentes. O teste Qui-quadrado revelou significância estatística (p <0,05) para a localização do município (p= 0,0343), onde 53,5% dos pacientes que não obtiveram cura da tuberculose residiam em municípios na linha de fronteira internacional. Conclusão: O desfecho de cura para os casos de tuberculose com comorbidades são menores em pacientes residentes em municípios localizados na linha de fronteira internacional quando comparado ao desfecho dos casos em pacientes residentes em municípios não fronteiriços.
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Objetivo: Descrever a experiência após a realização de um projeto de intervenção baseado em ações educativas e assistenciais voltados aos pacientes hipertensos cadastrados no Programa Hiperdia da USF São José do município de Barcarena, Pará. Método: Relato de experiência baseado na execução de rodas de conversa sobre hipertensão arterial sistêmica (HAS), prevenção e tratamento; ações ressaltando a importância da atividade física no controle da doença, sobre educação alimentar e receitas saudáveis, respeitando a cultura local e alimentos regionais. O problema HAS foi escolhido com base na Matriz PES (Plano Estratégico Situacional). Foi realizada capacitação de toda a equipe, para abordagem dos pacientes de modo a melhorar a adesão destes ao tratamento medicamentoso e não medicamentoso. Resultados: Antes da execução da intervenção, observou-se que os pacientes vivenciavam um dia conturbado na UBS, de modo que seus níveis pressóricos eram elevados e estes tinham dificuldade em aderir ao tratamento. Após a intervenção, observou-se melhor engajamento da equipe de saúde, maior adesão ao tratamento pelos pacientes, melhor controle da PA durante as consultas e maior espaçamento entre as consultas de retorno, além de diminuírem as urgências hipertensivas. Conclusões: Espera-se dar continuidade ao projeto com criação de uma horta comunitária pela gestão para que a população tenha mais acesso a frutas e hortaliças, além de educador físico para supervisionar a prática de atividade aeróbica semanalmente. O acolhimento e a informação continuada sobre prevenção, tratamento medicamentoso e não medicamentoso da HAS, auxiliam para evitar eventos cardiovasculares incapacitantes.
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Objetivos: analisar a frequência de sintomas depressivos em pacientes acometidos por Hanseníase em uma unidade de referência no estado do Pará, além de correlacionar a incidência de sintomas depressivos em pacientes acometidos por Hanseníase com o grau de limitação de atividades e com o grau de incapacidade física. Metodologia: estudo transversal, observacional e descritivo, com o uso da escala de depressão de Beck e do Screening of Activity Limitation and Safety Awareness (Triagem de Limitação de Atividade e Consciência de Risco), que levou em consideração os pacientes acometidos pela hanseníase que fazem acompanhamento na Unidade de Referencia Especializada Marcello Candia. A casuística foi composta por 104 pacientes, de ambos os sexos. Resultados: presença de sintomas depressivos em 66,3% dos pacientes analisados, considerando um total de 14,4% com sintomas graves. Em relação à limitação de atividade, 73% dos pesquisados apresentavam algum grau de limitação de atividade, sendo que maior parte apresentava grau leve de limitação. Discussão: Houve correlação significativa entre o grau de incapacidade e a limitação física pela escala, visto que os pacientes com Grau II de incapacidade apresentavam uma média superior na escala quando comparados a pacientes com Grau 0. Conclusões: Os dados obtidos nesta pesquisa contribuem para que haja uma preocupação para além da integridade física do paciente com hanseníase, sinalizando a necessidade de um cuidado psicossocial e integral, o que deve incluir o rastreio de sintomas depressivos, além de intervenções clinicas e psicoterápicas no combate à depressão.Objetivos: analisar a frequência de sintomas depressivos em pacientes acometidos por Hanseníase em uma unidade de referência no estado do Pará, além de correlacionar a incidência de sintomas depressivos em pacientes acometidos por Hanseníase com o grau de limitação de atividades e com o grau de incapacidade física. Metodologia: estudo transversal, observacional e descritivo, com o uso da escala de depressão de Beck e do Screening of Activity Limitation and Safety Awareness (Triagem de Limitação de Atividade e Consciência de Risco), que levou em consideração os pacientes acometidos pela hanseníase que fazem acompanhamento na Unidade de Referencia Especializada Marcello Candia. A casuística foi composta por 104 pacientes, de ambos os sexos. Resultados: presença de sintomas depressivos em 66,3% dos pacientes analisados, considerando um total de 14,4% com sintomas graves. Em relação à limitação de atividade, 73% dos pesquisados apresentavam algum grau de limitação de atividade, sendo que maior parte apresentava grau leve de limitação. Discussão: Houve correlação significativa entre o grau de incapacidade e a limitação física pela escala, visto que os pacientes com Grau II de incapacidade apresentavam uma média superior na escala quando comparados a pacientes com Grau 0. Conclusões: Os dados obtidos nesta pesquisa contribuem para que haja uma preocupação para além da integridade física do paciente com hanseníase, sinalizando a necessidade de um cuidado psicossocial e integral, o que deve incluir o rastreio de sintomas depressivos, além de intervenções clinicas e psicoterápicas no combate à depressão.
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Nevo epidérmico verrucoso inflamatório linear e diagnóstico diferencial com a psoríase linear: a respeito de um caso RELATO DE CASOMaria Isabel Muniz Zemero1, Maria Amélia Lopes dos Santos1, Alena Margareth Darwich Mendes1, Carla Andrea Avelar Pires1,O nevo epidérmico verrucoso inflamatório linear (NEVIL) é uma variedade clínica rara de nevo epidérmico verrucoso, que se manifesta no início da infância, como lesões inflamatórias de superfície ceratósica, que coalescem e se distribuem em faixa, acompanhando as linhas de Blaschko. Faz diagnóstico diferencial com a psoríase linear, sendo difícil a diferenciação, dado os aspectos clínicos e histopatológicos comuns aos dois, enfantizando-se a necessidade de conhecer as características específicas de cada um. O objetivo deste relato é demonstrar uma afecção relativamente rara, descrita em uma menina de 5 anos, evoluindo desde os primeiros dias de vida com placas papuloceratósicas dispostas linearmente, acompanhadas de sinais inflamatórios e áreas erosadas ocupando grandes lábios, períneo e face interna e superior da coxa esquerda. Também pápulas e placas ceratósicas na região cervical posterior e borda lateral externa da planta do pé esquerdo, ascendendo ao longo da região posterior deste membro. Os critérios clínicos e histopatológicos corroboram o diagnóstico de NEVIL na diferenciação com a psoríase linear, ressaltando a importância do estabelecimento de critérios/ ferramentas que auxiliem na diferenciação destas duas dermatoses visando agilizar o diagnóstico, otimizar o tratamento e minimizar o desconforto para esses pacientes. O acompanhamento a longo prazo dos portadores é sugerido pela possibilidade ainda que mínima de malignização do NEVIL. (AU)
Inflammatory linear verrucous epidermal nevus and differential diagnosis with linear psoriasis: about a caseCASE REPORTMaria Isabel Muniz Zemero1, Maria Amélia Lopes dos Santos1, Alena Margareth Darwich Mendes1, Carla Andrea Avelar Pires1,Inflammatory Linear Verrucous Epidermal Nevus (ILVEN) is a rare clinical variety of verrucous epidermal nevus that manifests in early childhood as inflammatory lesions of keratosis surface, which coalesce and spread in band, following Blaschko lines. It makes a differential diagnosis with Linear Psoriasis; it is difficult to differentiate them given the clinical and histopathological aspects common to both, emphasizing the need to know the specific characteristics of each. The purpose of this report is to demonstrate a relatively rare affection, expressed in a 5-year-old girl, evolving from the first days of life with papulokeratosic plaques arranged linearly, followed by inflammatory signs and eroded areas, placed linearly, overtaking labia majora, perineum, the inner and upper face of the left thigh. Also, the patient showed keratotic papules and plaques in the posterior cervical region and external lateral border of the left foot plant, ascending along the posterior region of this limb. The clinical and histopathological criteria corroborate the diagnosis of ILVEN in differentiation with linear psoriasis, emphasizing the importance of establishing criteria/instruments to assist in distinguishing these two dermatoses in order to expedite the diagnosis, to optimize the treatment and minimize patients' discomfort. Long-term follow-up of patients with this disease is suggested due to the possibility, albeit minimal, of ILVEN malignancy. (AU)
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Humanos , Feminino , Pré-Escolar , Psoríase , Dermatopatias , Diagnóstico Diferencial , Ectromelia , Nevo Sebáceo de Jadassohn/diagnóstico , Genitália/patologia , CeratoseRESUMO
BACKGROUND: Brazil remains endemic for infection by the human immunodeficiency virus (HIV) and leprosy, having a major impact on public health and the life quality of affected patients. Although the relevance of this co-infection is recognized, several aspects, such as the immune response, are not yet fully understood. The objective of this study was to investigate the expression of FOXP3+ Treg cells in leprosy skin lesions and to correlate their clinical forms, laboratory characteristics (CD4, CD8, and CV), and the immune reconstitution syndrome in HIV-leprosy co-infection. METHODOLOGY/PRINCIPAL FINDINGS: An observational, cross-sectional, and analytical study was carried out comparing four groups of patients: those with concomitant diagnosis of leprosy and HIV infection without a leprosy reaction, those with leprosy and HIV co-infection patients with a reverse reaction (RR), those with leprosy without HIV and without reaction, and those with leprosywithout HIV and with RR. The patients were diagnosed at a dermatology outpatient clinic located in Belém, Pará, Brazil, from 2003 to 2017. In the sample studied, there was a positive correlation between FOXP3+ cell density and viral load, negative correlation with blood CD4+ (not statistically significant), significant positive correlation in CD8 count in patients with leprosy reaction, and positive relationship in patients with IRIS. The density of cells expressing FOXP3 was higher in the BL/LL forms in patients without HIV, although the difference was not statistically significant. However, the cell mean was higher in the TT/BT forms in patients co-infected with leprosy and HIV, showing contradictory results. CONCLUSIONS/SIGNIFICANCE: These findings support that higher activity of the HIV may stimulate or result in a higher expression of FOXP3-Tregs and that they may be involved in active immunosuppression observed at the infection site at the tissue level. This supports the need to expand studies on FOXP3+ Treg cells in co-infected patients.
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Coinfecção/genética , Fatores de Transcrição Forkhead/genética , Infecções por HIV/genética , Hanseníase/genética , Adolescente , Adulto , Idoso , Brasil , Linfócitos T CD8-Positivos/imunologia , Criança , Coinfecção/imunologia , Coinfecção/microbiologia , Coinfecção/virologia , Estudos Transversais , Feminino , Fatores de Transcrição Forkhead/imunologia , Infecções por HIV/imunologia , Infecções por HIV/virologia , HIV-1/genética , HIV-1/fisiologia , Humanos , Hanseníase/imunologia , Hanseníase/microbiologia , Masculino , Pessoa de Meia-Idade , Mycobacterium leprae/genética , Mycobacterium leprae/fisiologia , Carga Viral , Adulto JovemRESUMO
BACKGROUND: Pemphigus are rare chronic autoimmune blistering disorders with challenging therapeutic management. OBJECTIVE: To investigate the therapeutic outcomes of pemphigus patients admitted to a dermatology referral service in northern Brazil. MATERIALS AND METHODS: We conducted a retrospective analysis of 32 patients with histopathological diagnosis of pemphigus between 2010 and 2016. Clinical and epidemiological data were collected. Therapeutic outcome was evaluated according to the criteria proposed by the International Pemphigus Committee. Pemphigus Disease Area Index (PDAI) was used to quantify disease severity. RESULTS: Of the 32 patients, 68.75% had pemphigus vulgaris (PV) and 31.25% had pemphigus foliaceus (PF). Female-to-male ratio was 1:1. The average age was 49.5 years. All patients received oral prednisone as the first-line therapy. Adjuvant immunosuppressive drugs were gradually added in refractory and/or severe cases. After 24 months of treatment, disease control and complete remission rates were 37.5% and 25%, respectively. The mortality rate was 9.37%. PDAI score was significantly lower at 24 months of therapeutic follow-up (p < .0001). CONCLUSION: Therapeutic management with corticosteroids and/or immunosuppressive drugs was able to induce disease control/complete remission in most of patients. PDAI was a useful tool for objective assessment of disease severity during therapeutic follow-up.
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Pênfigo , Brasil/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pênfigo/tratamento farmacológico , Pênfigo/epidemiologia , Encaminhamento e Consulta , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Este artigo objetiva relatar a experiência após a realização de um projeto de intervenção de controle da Tuberculose na Estratégia da Saúde da Família (ESF) Curuçambá, município de Ananindeua, Pará. A metodologia se deu a partir da realização de diagnóstico situacional por meio de busca ativa de novos casos de Tuberculose (TB) e Infecção Latente da Tuberculose (ILTB) mediante consultas médicas e/ou visitas domiciliares dos familiares dos casos que foram diagnosticados entre os anos de 2016 a 2018. Também ocorreram encontros e rodas de conversas com o intuito de ampliar conhecimentos sobre a Tuberculose, buscando conhecer suas particularidades nesta comunidade. Verificou se que 4 famílias possuíam um caso índice, geralmente um idoso que escondia a doença da família, revelando quando já se encontrava em estado grave e aos poucos outros membros apresentavam se sintomáticos. As famílias moravam em casas tipo barracões, escuras e com pouca ventilação, propiciando a maior disseminação da tuberculose, fato relatado como uma necessidade devido a situação de violência da comunidade. Foram diagnosticados 5 novos casos de TB e 9 casos de ILTB, demonstrando número elevado se considerarmos a população em estudo. Percebemos que nesta comunidade, assim como demonstram os dados nacionais, a tuberculose incide principalmente onde há baixo poder aquisitivo e com graves problemas socioeconômicos. Porém diferentemente do que é visto nacionalmente, nenhum tinha associação da infeção TB/HIV, confirmando o caráter familiar da transmissão da doença. O acolhimento da comunidade com encontros, rodas de conversas e ações que levem diagnóstico e tratamento, resulta na quebra do ciclo e contágio da doença.
This article aims to report the experience after carrying out a tuberculosis control intervention project in the Family Health Strategy (FHS) Curuçambá, municipality of Ananindeua, Pará. The methodology was based on the realization of a situational diagnosis through the active search for new cases of tuberculosis (TB) and Latent Tuberculosis Infection (ILTB) through medical consultations and/or home visits by family members of the cases that were diagnosed in the years 2016 to 2018. There were also meetings and rounds of conversations in order to expand knowledge about Tuberculosis, seeking to know its particularities in this community. It was found that 4 families had an index case, usually an elderly person who hid the disease from the family, revealing when he was already in serious condition and little by little other members were symptomatic. The families lived in houses that looked like shacks, dark and with little ventilation, providing the greatest spread of tuberculosis, a fact reported as a necessity due to the situation of violence in the community. Five new TB cases and 9 ILTB cases were diagnosed, showing a high number if we consider the study population. We realized that in this community, as shown by national data, tuberculosis affects mainly where there is low purchasing power and with serious socioeconomic problems. However, differently from what is seen at national level, none had an association of TB / HIV infection, confirming the family character of the transmission of the disease. The welcoming of the community with meetings, conversation circles and actions that lead to diagnosis and treatment, results in the breaking of the cycle and contagion of the disease.
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A 37-year-old male patient, Fitzpatrick skin phototype IV, a student living in Belem, Amazon region, in 2015 had a confirmed diagnosis of acquired immunodeficiency virus (HIV) infection, but did not initiate antiretroviral treatment at his own option. Three years after the diagnosis, erythematous maculae appeared on the dorsum of the nose with rapid progression to the entire face, with posterior diffuse infiltration and appearance of nodules on the chin and shoulder. In December 2018, the patient presented with exacerbation of the condition with an increase in infiltrated violaceous plaques and disseminated violaceous nodules. A histopathological biopsy of the skin was performed, confirming the diagnosis of angiomatoid proliferation suggestive of Kaposi's sarcoma (KS), with an important dissemination of this disease to the noble organs. In addition, it is important to note that he only started antiretroviral therapy (ART) after the exacerbation of Kaposi (December 2018). In such cases, chemotherapy associated with ART is crucial for the treatment and follow-up of the patient, since Kaposi's sarcoma develops relatively low in patients who do not have immunodeficiency.
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Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/complicações , Sarcoma de Kaposi/etiologia , Neoplasias Cutâneas/etiologia , Adulto , Infecções por HIV/tratamento farmacológico , Compostos Heterocíclicos com 3 Anéis/administração & dosagem , Humanos , Lamivudina/administração & dosagem , Masculino , Oxazinas , Piperazinas , Piridonas , Sarcoma de Kaposi/diagnóstico , Tenofovir/administração & dosagemRESUMO
BACKGROUND: Leprosy has been treated with multidrug therapy, which has been distributed for free across the globe and regarded as highly efficient. However, the impossibility of growing Mycobacterium leprae in axenic media has historically impaired assessments of M. leprae resistance, a parameter only recently detectable through molecular methods. METHODS: A systematic, population-based search for M. leprae resistance in suspected leprosy relapse cases and contacts was performed in Prata Village, an isolated, hyperendemic, former leprosy colony located in the Brazilian Amazon. Results led to an extended active search involving the entire Prata population. Confirmed leprosy cases were investigated for bacterial resistance using a combination of in vivo testing and direct sequencing of resistance genes folP1, rpoB, and gyrA. A molecular epidemiology analysis was performed using data from 17 variable number tandem repeats (VNTR). RESULTS: Mycobacterium leprae was obtained from biopsies of 37 leprosy cases (18 relapses and 19 new cases): 16 (43.24%) displayed drug-resistance variants. Multidrug resistance to rifampicin and dapsone was observed in 8 relapses and 4 new cases. Single resistance to rifampicin was detected in 1 new case. Resistance to dapsone was present in 2 relapses and 1 new case. Combined molecular resistance and VNTR data revealed evidence of intra-familial primary transmission of resistant M. leprae. CONCLUSIONS: A comprehensive, population-based systematic approach to investigate M. leprae resistance in a unique population revealed an alarming scenario of the emergence and transmission of resistant strains. These findings may be used for the development of new strategies for surveillance of drug resistance in other populations.
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Hanseníase , Preparações Farmacêuticas , Brasil/epidemiologia , Farmacorresistência Bacteriana , Quimioterapia Combinada , Humanos , Hansenostáticos/farmacologia , Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Hanseníase/epidemiologia , Testes de Sensibilidade Microbiana , Mycobacterium leprae/genéticaRESUMO
BACKGROUND: Leprosy has been treated with multidrug therapy (MDT) distributed for free across the globe and regarded as highly efficient. However, the impossibility to grow M. leprae in axenic media has historically impaired assessment of M. leprae resistance, a parameter only recently detectable through molecular methods. METHODS: A systematic, population-based search for M. leprae resistance in suspected leprosy relapse cases and contacts was performed in Prata Village, an isolated, hyper-endemic former leprosy colony located in the Brazilian Amazon. Results led to an extended active search involving the entire Prata population. Confirmed leprosy cases were investigated for bacterial resistance using a combination of in vivo testing and direct sequencing of resistance genes folP1, rpoB and gyrA. Molecular epidemiology analysis was performed using data from 17 variable number tandem repeats (VNTR). RESULTS: M. leprae was obtained from biopsies of 37 leprosy cases (18 relapses and 19 new); 16 (43.24%) displayed drug-resistance variants. Multi-drug resistance to rifampicin and dapsone was observed in 8 relapses and 4 new cases. Single resistance to rifampicin was detected in one new case. Resistance to dapsone was present in two relapses and one new case. Combined molecular resistance and VNTR data revealed evidence of intra-familial primary transmission of resistant M. leprae. CONCLUSIONS: A comprehensive, population-based systematic approach to investigate M. leprae resistance in a unique population revealed an alarming scenario of emergence and transmission of resistant strains. These findings may be used for the development of new strategies for surveillance of drug resistance in other populations.
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Farmacorresistência Bacteriana/genética , Hanseníase/transmissão , Mycobacterium leprae/efeitos dos fármacos , BrasilRESUMO
BACKGROUND AND OBJECTIVE: In highly endemic areas, severe multibacillary forms of leprosy and reactional episodes are not rare in children. The objective of the present study was to describe the clinical and epidemiological aspects of leprosy reactions in children from the Brazilian Amazon. METHODS: This was a prospective cohort study of 34 leprosy patients aged under 15 years diagnosed at a health referral unit in northern Brazil between April 2014 and June 2015. Follow-up medical consultations were performed during multidrug therapy (MDT) and one year after the end of treatment. Participants underwent a simple neurologic examination and answered a structured questionnaire. RESULTS: Of the 34 recruited patients, 18 (52.9%) had leprosy reactions and/or neuritis. Among these, 10 (55.6%) had reactions at diagnosis, 13 (72.2%) had reactions after MDT, and 14 (77.8%) had two or more reactional episodes. Type I reactions occurred in 14 (77.8%) cases. Complications, such as disabilities, necrotizing erythema nodosum, or Cushing's syndrome, occurred in six (33.3%) patients. The following variables showed significant associations (p ≤ 0.05) with leprosy reactions: age 8-14 years, number of doctors seen (≥3), multibacillary classification, number of skin lesions (≥10), or borderline and lepromatous clinical forms. The high frequency of type I reactions resulted in prolonged corticosteroid therapy, which may cause deficient bone maturation in childhood. CONCLUSION: Older age in children, consulting many physicians for diagnosis, severe clinical forms, and numerous skin lesions were positively associated with reaction development. Reactions after MDT highlight the need for continuity in healthcare of children with leprosy.
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ABSTRACT BACKGROUND: Package leaflets of medicines need to be intelligible, but tools for their evaluation are scarce. OBJECTIVE: To validate a new tool for assessing subjects' satisfaction with medicine package leaflets (LiS-RPL). DESIGN AND SETTING: Cross-sectional descriptive study conducted in two regions of Portugal (Lisbon and Centre). METHODS: 503 participants (53.1% male) were selected according to convenience and homogenously distributed into three groups: 1 to 6; 7 to 12; and > 12 years of schooling. LiS-RPL was developed based on international regulation guidelines and was initially composed of 14 items. Twelve package leaflets were tested. Dimensionality calculations included: exploratory factor analysis and minimum rank factor analysis; Kaiser-Meyer-Olkin index and Bartlett's sphericity test to assess matrix adequacy for exploratory factor analysis; exploratory bifactor analysis with Schmid-Leiman solution to detect possible existence of a broad second-order factor; and Bentler's Simplicity Index and Loading Simplicity Index to assess factor simplicity. Diverse coefficients were calculated to assess reliability. RESULTS: Minimum rank factor analysis detected a two-factor or single-factor structure. Exploratory factor analysis with 12 items showed a two-factor structure, explaining 69.11% of the variance. These items were strongly correlated with each other (r = 0.80). Schmid-Leiman: all items seemed to represent the general factor (loadings above 0.50), which was 76.4% of the extracted variance. Simplicity indices were good (percentile 99): Bentler's Simplicity Index of 0.99 and Loading Simplicity Index of 0.48. Internal consistency indexes indicated good reliability. LiS-RPL was shown to be homogenous. CONCLUSION: LiS-RPL is a validated tool for evaluating subjects' satisfaction with medicine package leaflets.
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Humanos , Masculino , Feminino , Satisfação Pessoal , Inquéritos e Questionários/normas , Compreensão , Rotulagem de Medicamentos/normas , Informação de Saúde ao Consumidor/métodos , Portugal , Publicações/normas , Leitura , Estudos Transversais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Escolaridade , Informação de Saúde ao Consumidor/normas , Órgãos GovernamentaisRESUMO
Cutaneous leishmaniasis (CL) is caused by protozoa of Leishmania genus that are transmitted to humans through the bite of sand flies (Lutzomyia and Phlebotomus). The infection is classically manifested as multiple or single ulcers affecting cutaneous and/or mucosal areas of the body. Atypical lesions are relatively uncommon, being able to simulate a large variety of benign and malign dermatological disorders. In this article, we described a case of CL mimicking a clinical presentation of cutaneous lymphoma.
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BACKGROUND: Package leaflets of medicines need to be intelligible, but tools for their evaluation are scarce. OBJECTIVE: To validate a new tool for assessing subjects' satisfaction with medicine package leaflets (LiS-RPL). DESIGN AND SETTING: Cross-sectional descriptive study conducted in two regions of Portugal (Lisbon and Centre). METHODS: 503 participants (53.1% male) were selected according to convenience and homogenously distributed into three groups: 1 to 6; 7 to 12; and > 12 years of schooling. LiS-RPL was developed based on international regulation guidelines and was initially composed of 14 items. Twelve package leaflets were tested. Dimensionality calculations included: exploratory factor analysis and minimum rank factor analysis; Kaiser-Meyer-Olkin index and Bartlett's sphericity test to assess matrix adequacy for exploratory factor analysis; exploratory bifactor analysis with Schmid-Leiman solution to detect possible existence of a broad second-order factor; and Bentler's Simplicity Index and Loading Simplicity Index to assess factor simplicity. Diverse coefficients were calculated to assess reliability. RESULTS: Minimum rank factor analysis detected a two-factor or single-factor structure. Exploratory factor analysis with 12 items showed a two-factor structure, explaining 69.11% of the variance. These items were strongly correlated with each other (r = 0.80). Schmid-Leiman: all items seemed to represent the general factor (loadings above 0.50), which was 76.4% of the extracted variance. Simplicity indices were good (percentile 99): Bentler's Simplicity Index of 0.99 and Loading Simplicity Index of 0.48. Internal consistency indexes indicated good reliability. LiS-RPL was shown to be homogenous. CONCLUSION: LiS-RPL is a validated tool for evaluating subjects' satisfaction with medicine package leaflets.
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Compreensão , Informação de Saúde ao Consumidor/métodos , Rotulagem de Medicamentos/normas , Satisfação Pessoal , Inquéritos e Questionários/normas , Informação de Saúde ao Consumidor/normas , Estudos Transversais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Escolaridade , Feminino , Órgãos Governamentais , Humanos , Masculino , Portugal , Publicações/normas , LeituraRESUMO
BACKGROUND: Kaposi's sarcoma (KS) is a rare neoplasm with indolent progression. Since 1981, the Kaposi's sarcoma epidemic has increased as co-infection with HIV. OBJECTIVES: The study aimed to identify the clinical and demographic characteristics and therapeutic approaches in HIV/AIDS patients in a regional referral hospital. METHODS: We analyzed the medical records of 51 patients with histopathological diagnosis of Kaposi's sarcoma hospitalized at Hospital Universitário João de Barros Barreto (HUJBB) from 2004 to 2015. RESULTS: The study sample consisted of individuals 15 to 44 years of age (80.4%), male (80.4%), single (86.3%), and residing in Greater Metropolitan Belém, Pará State, Brazil. The primary skin lesions identified at diagnosis were violaceous macules (45%) and violaceous papules (25%). Visceral involvement was seen in 62.7%, mainly affecting the stomach (75%). The most frequent treatment regimen was 2 NRTI + NNRTI, and 60.8% were referred to chemotherapy. STUDY LIMITATIONS: We assumed that more patients had been admitted to hospital without histopathological confirmation or with pathology reports from other services, so that the current study probably underestimated the number of KS cases. CONCLUSION: Although the cutaneous manifestations in most of these patients were non-exuberant skin lesions like macules and papules, many already showed visceral involvement. Meticulous screening of these patients is thus mandatory, even if the skin lesions are subtle and localized.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Sarcoma de Kaposi/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/patologia , Adolescente , Adulto , Terapia Antirretroviral de Alta Atividade , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sarcoma de Kaposi/tratamento farmacológico , Sarcoma de Kaposi/patologia , Fatores Socioeconômicos , Centros de Atenção Terciária , Adulto JovemRESUMO
Abstract: Background: Kaposi's sarcoma (KS) is a rare neoplasm with indolent progression. Since 1981, the Kaposi's sarcoma epidemic has increased as co-infection with HIV. Objectives: The study aimed to identify the clinical and demographic characteristics and therapeutic approaches in HIV/AIDS patients in a regional referral hospital. Methods: We analyzed the medical records of 51 patients with histopathological diagnosis of Kaposi's sarcoma hospitalized at Hospital Universitário João de Barros Barreto (HUJBB) from 2004 to 2015. Results: The study sample consisted of individuals 15 to 44 years of age (80.4%), male (80.4%), single (86.3%), and residing in Greater Metropolitan Belém, Pará State, Brazil. The primary skin lesions identified at diagnosis were violaceous macules (45%) and violaceous papules (25%). Visceral involvement was seen in 62.7%, mainly affecting the stomach (75%). The most frequent treatment regimen was 2 NRTI + NNRTI, and 60.8% were referred to chemotherapy. Study limitations: We assumed that more patients had been admitted to hospital without histopathological confirmation or with pathology reports from other services, so that the current study probably underestimated the number of KS cases. Conclusion: Although the cutaneous manifestations in most of these patients were non-exuberant skin lesions like macules and papules, many already showed visceral involvement. Meticulous screening of these patients is thus mandatory, even if the skin lesions are subtle and localized.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Sarcoma de Kaposi/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Sarcoma de Kaposi/patologia , Sarcoma de Kaposi/tratamento farmacológico , Fatores Socioeconômicos , Brasil/epidemiologia , Estudos Transversais , Estudos Retrospectivos , Infecções Oportunistas Relacionadas com a AIDS/patologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Terapia Antirretroviral de Alta Atividade , Centros de Atenção TerciáriaRESUMO
O carcinoma de células escamosas cutâneo é resultante da proliferação maligna dos queratinócitos. Costuma surgir da evolução de lesões precursoras, mas pode crescer espontaneamente na pele normal ou cronicamente inflamada. O carcinoma de células escamosas invasivo corresponde à segunda forma mais comum de câncer da pele não melanoma e representa 20% de todas as neoplasias cutâneas. Este trabalho relata um caso clínico de carcinoma de células escamosas cutâneo, rapidamente progressivo e com metástases regionais, que mesmo com a ressecção completa e esvaziamento ganglionar, apresentou pouca resposta terapêutica e evoluiu a óbito.
Cutaneous squamous cell carcinoma (SCC) results from malignant proliferation of keratinocytes. It usually arises from the development of precursor lesions, however it may grow spontaneously on normal or chronically inflamed skin. Invasive SCC is the second most common type of non-melanoma skin cancer and accounts for 20% of all cutaneous neoplasms. The present paper reports a clinical case of cutaneous SCC, rapidly progressive and with regional metastases, which, even after complete resection of the tumor and regional lymph nodes, showed little therapeutic response and evolved to death.