RESUMO

OBJECTIVE: To establish short- and long-term adverse outcome frequencies related to a late diagnosis of congenital adrenal hyperplasia (CAH) in the absence of newborn screening (NBS) and to determine respective treatment costs, which have never been reported. DESIGN: A retrospective analysis of a CAH cohort diagnosed without NBS. METHODS: We evaluated medical record data concerning 195 patients (141 females) diagnosed with CAH through clinical suspicion and confirmed using hormonal and CYP21A2 analysis, who were followed from 1980 to 2016 at Sao Paulo University. We measured mortality, dehydration, mental impairment frequencies, and hospitalization length outcomes in the salt-wasting form; the frequency of genetic females raised as males in both forms, frequency of depot GnRh analog (GnRha) and GH therapies in the simple virilizing form, and related outcome costs were calculated. RESULTS: Mortality rates and associated costs, varying from 10% to 26% and from $2,239,744.76 to $10,271,591.25, respectively, were calculated using the Brazilian yearly live-births rate, estimated productive life years, and gross domestic product. In the salt-wasting form, 76% of patients were hospitalized, 8.6% were mentally impaired, and 3% of females were raised as males (total cost, $86,230/salt-wasting patient). GnRha and growth hormone were used for 28% and 14% of simple virilizing patients, respectively, and 18% of females were raised as males (preventable cost, $4232.74/simple virilizing patient). CONCLUSIONS: A late CAH diagnosis leads to high mortality and morbidity rates, notably increasing public health costs, and may result in physical and psychological damage that is not easily measurable.

RESUMO

RESUMEN El bajo peso al nacer representa en la actualidad uno de los problemas prioritarios de salud a nivel mundial, que aumenta el riesgo de morbimortalidad. Cuba presenta cifras bajas de bajo peso al nacer lo que la ubica entre los cinco países con indicadores más bajos a nivel mundial, pero a pesar de ello, el bajo peso al nacer, específicamente la restricción del crecimiento intrauterino constituye un problema de salud por las complicaciones que produce, por lo que su predicción precoz es vital para evitar la muerte. Por tal motivo los autores proponen como objetivo exponer los referentes teóricos relacionados con el valor predictivo de la flujometría doppler en la restricción del crecimiento intrauterino, basándose en los fundamentos teóricos más actualizados. Se concluye que la flujometría doppler combinada de las arterias uterinas y umbilicales, tiene valor predictor en la restricción del crecimiento intrauterino y en su manejo y seguimiento (AU).

ABSTRACT Low weight at birth is currently one of the priority health problems around the world, increasing the morbi-mortality risk. Cuba shows little quantities of low weight at birth, locating the country among the five ones with the lowest indicators in the world; nevertheless, low weight at birth, specifically the intrauterine growth restriction arises as a health problem due to the complications it produces, making its precocious prediction vital to avoid death. The authors of this work have the objective of exposing theoretical referents related with the predictive value of the Doppler flowmetry in the restriction of the intrauterine growth on the bases of updated theoretical fundaments. They arrive to the conclusion that combined Doppler flowmetry of the uterine and umbilical arteries has a predictive value in the restriction of intrauterine growth and its management and follow up (AU).

Assuntos

RESUMO

El síndrome de lisis tumoral es una constelación de alteraciones metabólicas descrita por primera vez en la literatura médica en el año 1929 e incrementándose su referencia desde el advenimiento de la quimioterapia en la década de 1960 y es de gran relevancia clínica debido a que es considerada la emergencia oncológica más frecuente siendo potencialmente letal. En los casi 90 años transcurridos desde su primera mención el saber médico ha progresado en cuanto a la comprensión de la fisiopatología pero sigue siendo discutida en diversos ámbitos su definición, clasificación y manejo terapéutico. El reconocimiento temprano de los pacientes en riesgo de padecerlo y el inicio veloz del tratamiento son esenciales. En este trabajo se realizará una actualización y revisión del tema con especial énfasis en aquellos aspectos que aún se encuentran en discusión y cuya falta de definición podrían ser responsables de la falta de información certera acerca de la incidencia de dicho síndrome y de sus implicancias clínicas en la morbi-mortalidad de los pacientes que lo padecen

El síndrome de lisis tumoral es una constelación de alteraciones metabólicas descrita por primera vez en la literatura médica en el año 1929 e incrementándose su referencia desde el advenimiento de la quimioterapia en la década de 1960 y es de gran relevancia clínica debido a que es considerada la emergencia oncológica más frecuente siendo potencialmente letal. En los casi 90 años transcurridos desde su primera mención el saber médico ha progresado en cuanto a la comprensión de la fisiopatología pero sigue siendo discutida en diversos ámbitos su definición, clasificación y manejo terapéutico. El reconocimiento temprano de los pacientes en riesgo de padecerlo y el inicio veloz del tratamiento son esenciales. En este trabajo se realizará una actualización y revisión del tema con especial énfasis en aquellos aspectos que aún se encuentran en discusión y cuya falta de definición podrían ser responsables de la falta de información certera acerca de la incidencia de dicho síndrome y de sus implicancias clínicas en la morbi-mortalidad de los pacientes que lo padecen

Assuntos

RESUMO

In the past 16 years, a variety of factors might have impacted traffic accidents in Chile. In order to identify and quantify differential rates of change over time this study employed a novel analytic method to assess temporal trends in traffic morbi-mortality. Overall death and injury rates and associated to alcohol per 100,000 inhabitants were monitored between 2000 and 2015. Joinpoint regression was used to calculate annual percent changes (APCs) and average APCs. Permutation tests were used to determine joinpoints. P < 0.05 was considered statistically significant. The rate of traffic deaths related to alcohol declined from 2006 until 2015 at a rate of 9.53% per year. The rate of traffic injuries related to alcohol decreased at a rate of 4.32% per year since 2008 to 2015. The use of the most sensitive approach to trend analysis brings new ele-ments to form the epidemiological analyses in Chile and similar countries.

Assuntos

RESUMO

Introdução: o Brasil, segundo critérios da Organização Mundial de Saúde, apresenta uma epidemia de aids registrando 474.273 casos no período de 1980 a junho/2007. Objetivo: posto isso, o estudo teve como objetivo analisar o perfil epidemiológico da aids nas 3a e 7a Coordenadorias Regionais de Saúde no Ceará, totalizando 13 municípios. Métodos: a metodologia foi do tipo descritiva exploratória. A fonte de dados envolveu as informações do Departamento de Informática do Sistema Único de Saúde. Encontramos como resultado 382 casos na 3a CRES e 149 na 7a CRES. Resultados: em Maracanaú, sede da 3a CRES, a prevalência foi 124,65/100 mil habitantes, a maior registrada nas duas áreas. Em 1985 surgiu o primeiro caso na 3a CRES, em Maracanaú, já na 7a CRES foi em 1987, no município de Aracati. A faixa etária predominante foi de 30 a 39 anos. Entretanto tivemos cinco municípios com prevalênci entre os jovens. A proporção em mulheres na idade fértil foi maior na 7a CRES, correspondendo a 31,43%. A razão de proporcionalidade entre sexos nas áreas ainda é maior entre os homens. A maior categoria de exposição é heterossexual, com valores acima de 34%. A transmissão vertical foi maior na 3a CRES, 3,31%. A proporção em homossexual foi maior na 7a CRES, 15,57%. Com relação aos óbitos, foram registrados 11 na 3a CRES, e Maracanaú contribuiu com 45,45% dos casos. Em 2004 na 7a CRES ocorreu o primeiro óbito, em Aracati. Conclusão: concluímos que há um declínio da doença na 3a CRES, enquanto na 7a CRES o processo é inverso.

Introduction: o Brazil according to the World Health Organization, is facing an aids epidemic of 474.273 cases registered in the period from 1980 tojune/2007. Objective: in that regard, the study has managed to analyse the profile of the aids Epidemiological on 3rd and 7th Regional Health Coordinationsin Ceará, a total of 13 cities. Methods: the methodology was descriptive exploratory type. The data source was obtained from the Information Department Sistema Único de Saúde. We found 382 cases in the 3rd CRES and 149 in the 7th CRES. Results: in Maracanaú, headquarters of the 3rd CRES, the prevalence was 124.65/100 thousand inhabitants, the largest recorded within the two areas. More than in CRES. The fi rst case in the 3rd CRES emerged in 1985 in Maracanaú, in the 7th CRES, it happened in 1987, in Aracati. The predominant age group was 30 to 39 years old, however, we have had fi ve cities where the majority of cases were in young people. The proportion of women in fertile age was higher in 7th CRES, representing 31.41%. The reason of proportionality between sexes in the areas is still higher among men. The largest category of exposure is heterosexual, with 34%. The vertical transmission was greater in the 3rd CRES, 3.31%. We had the 7th CRES a higher percentage of cases in homosexuals, 15.57%. Regarding the deaths, were registered 11 in 3rd CRES, and Maracanaú contributed 45.45%. In 2004 the 7th CRES was the first death in Aracati. Conclusion: we conclude that there is a decline of the disease in the 3rd CRES, while in the 7th CRES the process is reversed.

Assuntos