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BACKGROUND: Leprosy is a chronic infection with high morbidity in Brazil. Primary care physicians' lack of knowledge about the disease may play a significant role in underdiagnosis. This study aimed to assess primary care physicians' ability to identify typical leprosy skin lesions and their knowledge of the subject. METHODS: This cross-sectional study relied on a questionnaire in which participating doctors chose one main diagnostic hypothesis and two differential diagnoses for each skin lesion presented. Five leprosy lesions were included. Questions regarding management, follow-up, and diagnostic workup for the disease were also included. The questionnaire was sent to primary care physicians working in Curitiba, in the Southern Brazilian state of Paraná, and dermatologists, who constituted the control group. RESULTS: Thirty-two primary care physicians and 26 dermatologists agreed to participate in the study. Primary care physicians accurately identified a mean of 1.8 ± 1.2 of the five leprosy skin lesions, while dermatologists accurately identified 2.5 ± 0.9 (P = 0.009). The main misdiagnosed leprosy forms were the lepromatous and histoid variants. Among primary care physicians, 56.2% claimed to have little knowledge of the subject and a large share of participants was unaware of recent updates in treating paucibacillary forms, even within the dermatologist subgroup. CONCLUSIONS: Primary care physicians in Curitiba have little information regarding the diagnosis, treatment, and follow-up of leprosy. Even dermatologists had difficulties with treatment and patient management, emphasizing the constant need for education on this subject.
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OBJECTIVE: Peripheral neuropathy (PN) is one of the most common diseases of the peripheral nervous system. Symptoms range from mild sensory signs to severe neuropathic pain. Untreated PN is progressive and can lead to complications and impair quality of life (QoL). However, PN prevalence is underestimated in the general population and affected individuals often remain undiagnosed. This study aimed to contribute to the global generation of prevalence data and determine sociodemographic and disease-related characteristics of PN sufferers. METHODS: This cross-sectional study collected information on PN prevalence and associated factors in the adult population (40-65 years) of the Mexico City area. Participants were recruited in public places and screened for PN using the Michigan Neuropathy Screening Instrument (MNSI). Subjects with PN answered the Neuropathy Total Symptom Score-6 (NTSS-6), the Short Form-36 Health Survey (SF-36), and the QoL Pharmacoeconomic Questionnaire. Statistical analysis included descriptive methods and calculation of PN prevalence with 95% confidence intervals. RESULTS: Of 3066 participants, 448 had PN based on the MNSI physical examination. The overall PN prevalence was 14.6%, with the highest (18.9%) seen in subjects aged 61-65 years. PN was undiagnosed in 82.6%, and 62.9% had never heard of PN. Although half of all subjects had only mild PN symptoms, QoL was impacted in 91.8%. CONCLUSIONS: The results confirm that PN prevalence in the general population is high. Despite the disease burden, most affected persons are undiagnosed and unaware of the disease. Almost all felt their QoL was impacted. The data highlight the need to raise awareness and identify undiagnosed individuals to prevent complications.
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Despite its high prevalence and negative consequences, depression is often underdiagnosed. We aimed to estimate the prevalence and sociodemographic and health related factors associated with depression underdiagnosis among a nationally representative population-based sample in Brazil. METHOD: We used data from 70,806 participants (15-107 years old) of the Brazilian National Survey (PNS 2019). Depression underdiagnosis was considered for participants with a Patient Health Questionnaire-9 (PHQ-9) score >9 and with no diagnosis made by a health provider. Logistic regression models were performed to assess the crude and adjusted association between depression underdiagnosis and sociodemographic and health related factors. Population attributable risk fractions were calculated for significant predictors. RESULTS: The prevalence of depression (according the PHQ-9) was 11.2% (IC95% 10.8:11.7). Depression underdiagnosis prevalence was 63.6% (IC95% 62.0%:65.2%) and was more frequent among male, elderly population, those with lower income, lower schooling, living in the North/Central region of the country, with best health perception, lower number of chronic disease and medical appointments. A significant percentage of depression underdiagnosed cases in Brazil in 2019 would be prevent by improving education (10.18%), income (3.99%), access to health visits (5.59%) and addressing barriers for depression diagnosis among males (5.44%), elderlies (3.32%), and population from the North region (8.29%). CONCLUSION(S): depression underdiagnosis is common in Brazil. Preventive measures should target the sociodemographic and health related factors associated with depression underdiagnosis.
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Depressão , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos Transversais , Depressão/diagnóstico , Depressão/epidemiologia , Escolaridade , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto JovemRESUMO
Introdução: Leptospirose é uma zoonose transmitida principalmente por roedores e está relacionada com a situação socioambiental de uma população. A transmissão ocorre especialmente pela eliminação de urina do roedor, por exemplo, nas enchentes que aumentam o risco de contaminação. O artigo analisa a presença de leptospirose na cidade de Pelotas/RS, visando identificar fatores de risco para realizar de forma mais adequada o diagnóstico precoce e evitar possíveis consequências da doença. Objetivos: O estudo tem por objetivo analisar o perfil das pessoas que contraíram leptospirose e seu desfecho no município de Pelotas/RS no período de 2007 a 2017. Métodos: Estudo transversal em que foram analisados dados de prevalência de Leptospirose em Pelotas/RS, comparando zona de residência, sexo, raça, escolaridade, faixa etária e evolução da doença. Resultados: Foi possível observar que a prevalência da doença foi maior em indivíduos com baixa escolaridade, do sexo masculino, brancos e residentes de zona urbana. Metade dos casos evoluiu para a cura, e 2,34% evoluíram para óbito devido ao agravo da doença. Contudo, 53,9% não tiveram a evolução notificada, tendo seus resultados registrados como em branco/ignorado. Conclusão: A leptospirose é uma patologia potencialmente fatal, e ainda subdiagnosticada, e consequentemente subnotificada, tendo grande prevalência em locais com as características de Pelotas/RS. É de fundamental importância que haja uma reestruturação do registro da notificação compulsória com uma abrangência maior sobre dados epidemiológicos para haver um melhor planejamento de meios de prevenção, alcançando uma redução da incidência e melhorando o desfecho desses pacientes.
Introduction: Leptospirosis is a zoonosis transmitted mainly by rodents and is related with the socioenvironmental conditions of a population. Transmission occurs especially through rodents' urine, for example, risk for contamination increases in floods. The article analyzes the presence of leptospirosis in the municipality of Pelotas, Brazil, in order to identify risk factors so as to perform a more appropriate early diagnosis and to prevent possible disease consequences. Objectives: The study aimed to assess the profile of people who contracted leptospirosis and its outcome in the municipality of Pelotas, Brazil, from 2007 to 2017. Methods: Cross-sectional study that analyzed data on the prevalence of leptospirosis in Pelotas, Brazil, comparing area of residence, sex, race, schooling, age, and disease outcome. Results: It was observed that the prevalence of the disease was higher in individuals with little education, male, white, and living in the urban area. Half of the cases evolved to cure, and 2.34% evolved to death due to disease worsening. However, 53.9% of the cases did not have their outcome informed, being reported as blank/unknown. Conclusion: Leptospirosis a potentially lethal disease and is still underdiagnosed, and consequently underreported, being highly prevalent in place with the characteristics of Pelotas, Brazil. It is extremely importance to promote a restructuring in disease notification reporting, with a greater coverage on epidemiological data, in order to improve the planning of prevention strategies, achieving a reduction in disease incidence and improving patient outcomes.
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Lynch syndrome (LS) is the most common cause of hereditary colorectal cancer (CRC); however, it is still underrecognized and underdiagnosed. While international guidelines gravitate towards universal screening, the underuse of screening methods has been reported in real-world scenarios. This study aims to evaluate screening for LS among patients diagnosed with CRC in a public cancer center in Brazil and evaluate access to genetic counseling and testing for abnormal screens. For that purpose, all patients with CRC registered in our institution from July 2012 to December 2018 had their charts reviewed. Demographic and clinical characteristics were noted, as well as immunohistochemistry and microsatellite instability analysis results, when available. After applying exclusion criteria, a total of 1234 charts were reviewed. Among these, 257 patients were screened for LS, making up a 20.8% screening rate; when considering Jerusalem criteria, screening rate was 24.5%; for Bethesda criteria, it was 35.1%. Almost 80% of patients fulfilling Amsterdam criteria I/II were screened. There were 64 abnormal screens, from which 40 (62.5%) underwent genetic counseling and 12 (18.7%) underwent genetic testing. We concluded that overall screening rates for LS among CRC patients in a public cancer center in Brazil are low, and still very guided by stringent clinical criteria. Referral to genetic counseling and access to testing is limited, calling the whole process into question. Public policies aiming to raise awareness on hereditary cancer and include genetic testing in the public health system could help improve this scenario.
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La pancreatitis, aguda o crónica, es una enfermedad grave para los perros, debido a su potencial nocivo y a la existencia de infradiagnóstico. La enfermedad sigue siendo objeto de estudios en cuanto a su fisiopatología y mecanismos terapéuticos, debido a que los signos que presentan los animales son inespecíficos y van desde presentaciones leves a severas. Puede provocar cambios morfofuncionales en el páncreas y órganos adyacentes. El diagnóstico puede ser una tarea muy difícil, ya sea por los síntomas variables y la gravedad de la enfermedad, o por los callejones sin salida experimentados en el momento de los exámenes complementarios. El manejo terapéutico se define en base a los síntomas que presentan los animales, que van desde la infusión de líquidos para reposición de volumen, analgésicos, antieméticos, antibióticos, alimentos especiales, entre otros.(AU)
Pancreatitis, acute or chronic, is a serious disease for dogs, due to its harmful potential and the existence of underdiagnosis. The disease is still the target of studies regarding its pathophysiology and therapeutic mechanisms, because the signs presented by the animals are nonspecific, ranging from mild to severe presentations. It can cause morphofunctional changes in the pancreas and adjacent organs. The diagnosis can be a very difficult task, either due to the variable symptoms and severity of the disease, or the impasses experienced at the time of the complementary exams. Therapeutic management is defined based on the symptoms presented by the animals, ranging from fluid infusion for volume replacement, analgesics, antiemetics, antibiotics, special food, among others.(AU)
A pancreatite é uma doença grave para os cães, tanto pelo seu potencial deletério quanto pela existência de subdiagnósticos, e pode ser classificada em aguda ou crônica. A doença ainda é alvo de estudos no que diz respeito a sua patofisiologia e mecanismos terapêuticos, uma vez que os sinais apresentados pelos animais são inespecíficos, variando desde apresentações brandas a graves. Pode causar alteração morfofuncional do pâncreas e órgãos adjacentes. O diagnóstico pode ser uma tarefa bastante difícil, seja pela sintomatologia variável e gravidade da doença como também pelos impasses vivenciados no momento da realização dos exames complementares. O manejo terapêutico é definido com base na sintomatologia apresentada pelos animais, variando desde a infusão de fluidos para reposição volêmica, analgésicos, antieméticos, antibióticos, alimentação especial, entre outros.(AU)
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Animais , Cães , Pancreatite/diagnóstico , Pancreatite/fisiopatologia , Pancreatite/terapia , Pancreatite/veterinária , Infecções Assintomáticas , Gastroenteropatias/veterináriaRESUMO
BACKGROUND: we aim to estimate the prevalence of depression underdiagnosis among women and whether pregnant women are at higher risk STUDY DESIGN: we used data from the Brazilian National Survey (PNS 2013), a population-based study. All 22.455 women (18-49 years old) answered the Patient Health Questionnaire-9 (PHQ-9) and a questionnaire with sociodemographic, obstetric and clinical data. There were 2.605 (2.491 non-pregnant and 114 pregnant women) depressed women (PHQ-9 >8)with a clinical diagnosis of depression, in the last 30 days. Classification of depression underdiagnosis was made using the comparison between results obtained from the self-referred question evaluating clinical diagnosis of depression by providers and the results of the PHQ-9 application. Women with a PHQ-9 score > 8 and with a "No" answer in the clinical question were classified as depression underdiagnosis. Logistic regression models were performed to obtain crude and adjusted odds ratios (OR) and 95% confidence intervals (95%CI) RESULTS: Depression underdiagnosis prevalence was 71.2% and was more frequent among pregnant women in comparison with non-pregnant women (88.1% vs 68.0%; p = 0.002). In the adjusted analysis, being pregnant was significantly associated with depression underdiagnosis (aOR 3.55, 95% CI 1.66:7.60). Nonwhite skin color women were also at higher risk of depression underdiagnosis (aOR 1.53, 95% CI 1.09:2.14). LIMITATIONS: the cross-sectional design and the lack of medical records data about assessment of mental health CONCLUSION(S): in Brazil, depression underdiagnosis by providers is prevalent and pregnant women and minority women are at higher risk of not receiving a correct mental health diagnosis.
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Complicações na Gravidez , Gestantes , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Depressão/diagnóstico , Depressão/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Prevalência , Fatores de Risco , Adulto JovemRESUMO
OBJECTIVE: To estimate prenatal depression underdiagnosis prevalence and its associated sociodemographic and obstetric risk factors among a population-based sample of Brazilian pregnant women with depression. METHODS: We used data from the Brazilian National Survey (PNS 2013). Of the 22 445 women of reproductive age, 800 reported being pregnant. Participants answered the Patient Health Questionnaire-9 (PHQ-9) and a questionnaire with sociodemographic, obstetric, and clinical data. Classification of prenatal depression underdiagnosis was made using the comparison between results obtained from the self-referred question evaluating clinical diagnosis of depression and the results of the PHQ-9. Pregnant women with a PHQ-9 score greater than 8 and with a "No" answer in the clinical question were classified as prenatal depression underdiagnosis. Logistic regression models were performed to obtain crude and adjusted odds ratios (OR) between variables and prenatal depression underdiagnosis. RESULTS: Prevalence of prenatal depression underdiagnosis was 82.3% (74.8%-87.8%). Pregnant women with non-white skin color and pregnant women with an elementary school degree were more likely to be underdiagnosed with prenatal depression in comparison with women with white skin color (adjusted OR 2.42, 95% confidence interval [CI] 0.99-5.91) and with women with higher education (adjusted OR 4.07, 95% CI 2.05-8.09). CONCLUSION: Equitable mental health assistance for pregnant women should considered prenatal depression social risk factors.
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Depressão/epidemiologia , Complicações na Gravidez/epidemiologia , Gestantes/psicologia , Adolescente , Adulto , Brasil/epidemiologia , Depressão/diagnóstico , Escolaridade , Feminino , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Gravidez , Prevalência , Grupos Raciais , Fatores de Risco , Adulto JovemRESUMO
La pancreatitis, aguda o crónica, es una enfermedad grave para los perros, debido a su potencial nocivo y a la existencia de infradiagnóstico. La enfermedad sigue siendo objeto de estudios en cuanto a su fisiopatología y mecanismos terapéuticos, debido a que los signos que presentan los animales son inespecíficos y van desde presentaciones leves a severas. Puede provocar cambios morfofuncionales en el páncreas y órganos adyacentes. El diagnóstico puede ser una tarea muy difícil, ya sea por los síntomas variables y la gravedad de la enfermedad, o por los callejones sin salida experimentados en el momento de los exámenes complementarios. El manejo terapéutico se define en base a los síntomas que presentan los animales, que van desde la infusión de líquidos para reposición de volumen, analgésicos, antieméticos, antibióticos, alimentos especiales, entre otros.
Pancreatitis, acute or chronic, is a serious disease for dogs, due to its harmful potential and the existence of underdiagnosis. The disease is still the target of studies regarding its pathophysiology and therapeutic mechanisms, because the signs presented by the animals are nonspecific, ranging from mild to severe presentations. It can cause morphofunctional changes in the pancreas and adjacent organs. The diagnosis can be a very difficult task, either due to the variable symptoms and severity of the disease, or the impasses experienced at the time of the complementary exams. Therapeutic management is defined based on the symptoms presented by the animals, ranging from fluid infusion for volume replacement, analgesics, antiemetics, antibiotics, special food, among others.
A pancreatite é uma doença grave para os cães, tanto pelo seu potencial deletério quanto pela existência de subdiagnósticos, e pode ser classificada em aguda ou crônica. A doença ainda é alvo de estudos no que diz respeito a sua patofisiologia e mecanismos terapêuticos, uma vez que os sinais apresentados pelos animais são inespecíficos, variando desde apresentações brandas a graves. Pode causar alteração morfofuncional do pâncreas e órgãos adjacentes. O diagnóstico pode ser uma tarefa bastante difícil, seja pela sintomatologia variável e gravidade da doença como também pelos impasses vivenciados no momento da realização dos exames complementares. O manejo terapêutico é definido com base na sintomatologia apresentada pelos animais, variando desde a infusão de fluidos para reposição volêmica, analgésicos, antieméticos, antibióticos, alimentação especial, entre outros.
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Animais , Cães , Infecções Assintomáticas , Pancreatite/diagnóstico , Pancreatite/fisiopatologia , Pancreatite/terapia , Pancreatite/veterinária , Gastroenteropatias/veterináriaRESUMO
Resumen Objetivo: El Trastorno por Déficit de Atención con Hiperactividad/impulsividad (TDAH) es una de las dificultades de aprendizaje más comunes en las escuelas chilenas. Se caracteriza por un patrón de funcionamiento atípico en atención e inhibición, con fuerte compromiso de otras funciones ejecutivas. Uno de los desafíos que plantea este trastorno está referido al proceso de diagnosis, el cual no suele ser suficientemente preciso. Se pretende explorar las diferencias en la distribución de dos muestras de estudiantes con y sin TDAH diagnosticadas con una escala de observación conductual a través de la evaluación de las funciones ejecutivas de atención, inhibición y flexibilidad cognitiva. Método: En este estudio se evaluó a 132 escolares, 66 con TDAH y 66 sin TDAH, en las variables de atención, inhibición y flexibilidad cognitiva de un colegio de la ciudad de Concepción en Chile. Se contrastó el rendimiento cognitivo con los diagnósticos y se reagrupó a los estudiantes en los subtipos conocidos del trastorno. Resultados: La evaluación neuropsicológica mostró que en el grupo con TDAH había alumnos que no cumplían los criterios diagnósticos para estar incluidos en él. En el grupo sin TDAH se observó un fenómeno semejante. En ambos grupos la evaluación neuropsicológica de la atención y la inhibición resultaron útiles para diagnosticar con mayor certeza y para determinar el subtipo al que pertenecía cada estudiante con TDAH detectado. La flexibilidad cognitiva solo permitió diferenciar a los sujetos con y sin TDAH. Conclusiones: En ambos grupos estudiados fue posible encontrar sujetos mal diagnosticados; el sobrediagnóstico fue de 43,93 % en el grupo con TDAH, mientras que el infradiagnóstico fue de 42,42 % en el grupo sin TDAH.
Abstract Objective: Attention Deficit Hyperactivity/Impulsivity Disorder (ADHD) is one of the most common learning difficulties in Chilean schools. It is characterized by an atypical functioning pattern in attention and inhibition, strongly compromising other executive functions. One of the challenges posed by this disorder is the diagnosis process, which is often not sufficiently accurate. The intention is to study the distribution of two students samples, with and without ADHD, diagnosed by a behavioral observation scale through the evaluation of attention, inhibition, and cognitive flexibility executive functions. Method: This study evaluated 132 students, 66 with ADHD and 66 without ADHD, considering the attention, inhibition, and cognitive flexibility variables of a school in the city of Concepción in Chile. Cognitive performance was contrasted with the diagnoses, and students were regrouped in the disorder known subtypes. Results: The neuropsychological evaluation showed that in the ADHD group, there were students who did not meet the diagnostic criteria to be included in the group. A similar phenomenon was observed in the group without ADHD. In both the groups, the neuropsychological evaluation of attention and inhibition was useful in providing a more certain dignosis and in determining the subtype to which each student detected with ADHD belonged. Cognitive flexibility was only useful in differentiating betwen the subjects with and without ADHD. Conclusions: In both the groups studied, it was possible to find misdiagnosed subjects; the overdiagnosis was 43,93 % in the ADHD group, while the under-diagnosis was 42,42 % in the group without ADHD.
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Obesity and its comorbidities have become the most important public health problems for Latin America. In Mexico obesity has increased dramatically to the point where the government has declared it an epidemiological emergency. The most recent national data showed overweight and obesity affects 72.5% of adults, or around 56 million Mexicans. Most Mexican adults with obesity are undiagnosed. According to data derived from a national representative survey, only 20% of adults with BMI >30 kg/m2 were diagnosed with obesity by a health provider. Likewise, only 8% of individuals with obesity had received treatment for obesity. Interventions offered in the Mexican health care delivery system generally consist of traditional consultations with recommendations on diet and exercise, visits are monthly to quarterly, and validated behavior change protocols are not used. Evidence from clinical trials has shown that weight loss with this type of treatment is generally less than 1 kg per year. In contrast, intensive lifestyle interventions - protocols focusing on achieving changes in diet, physical activity, and moderate weight loss using behavioral strategies with weekly or bi-weekly sessions for the first 3 to 6 months, and a maintenance phase with trained interventionists - as implemented in the Diabetes Prevention Program and the Look AHEAD studies achieved weight loss of 7-9% at one year. Additionally, translation studies of these interventions to the community and to real-world clinical practice have achieved weight loss of around 4%. Adaptations of intensive lifestyle interventions have been implemented in the United States, both in clinical practice and in the community, and this type of intervention represents a potential model to combat obesity in Mexico and other Latin American countries. It is essential that primary care providers in Mexico implement clinical practice guidelines based on the best evidence available as discussed here to effectively treat obesity. The authors make recommendations to improve the treatment of obesity in the clinical care delivery system in Mexico using intensive lifestyle interventions.
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Objectives: To estimate the current prevalence of posttraumatic stress disorder (PTSD) and the diagnosis rate of this disorder ascertained by psychiatrists in training. Methods: We interviewed 200 adults under treatment in a university mental health outpatient clinic. The PTSD diagnoses obtained using the Structured Clinical Interview for DSM-IV (SCID-IV) were compared with the patients' medical records. Results: Forty-one patients (20.5%) were diagnosed with current PTSD, but only one of them (2.4%) had previously received this diagnosis. This study confirms that although PTSD is highly prevalent among mental health outpatients, it is remarkably underdiagnosed in teaching hospitals. Conclusions: These findings suggest that psychiatrists in training may be failing to investigate traumatic events and their consequences and strongly indicate that trauma-related issues should be given more prominence in psychiatry curricula and psychiatrist training.
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Humanos , Masculino , Feminino , Adulto , Idoso , Adulto Jovem , Psiquiatria/educação , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Fatores Socioeconômicos , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Brasil/epidemiologia , Saúde Mental/educação , Prevalência , Inquéritos e Questionários , Assistência Ambulatorial , Hospitais Universitários , Pessoa de Meia-IdadeRESUMO
The objective of the article was to establish the prevalence, underdiagnosis, and risk factors of chronic bronchitis (CB) in a general population in five Colombian cities. Cross-sectional study using a probabilistic sampling technique in five Colombian cities was adopted. The CB definition was "cough and expectoration for three or more months per year for at least two consecutive years." Underdiagnosis was considered in subjects with clinical definition without previous medical diagnosis. Univariate χ2 or Student's t-test and logistic regression analysis were used. The study included 5539 subjects. The prevalence was 5.5%, the underdiagnosis 50.3%, and 33.7% of the cases were in nonsmokers (53.6% in women vs. 16.9% in men, p < 0.001). The adjusted risk factors were living in Bogota, current smoking, male, age ≥ 64 years, low education, indoor wood smoke exposure, and occupational exposure to vapors, gases, dust, and fumes. CB is a common disease among adults in Colombia. The underdiagnosis was high and there were a large proportion of cases in nonsmokers, particularly in women. Our findings support the association of CB with indoor wood smoke and occupational exposures.
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Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Bronquite Crônica/epidemiologia , não Fumantes/estatística & dados numéricos , Exposição Ocupacional/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Idoso , Bronquite Crônica/complicações , Bronquite Crônica/diagnóstico , Cidades/epidemiologia , Colômbia/epidemiologia , Tosse/etiologia , Estudos Transversais , Poeira , Escolaridade , Feminino , Gases , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fumaça , Fumar/epidemiologiaRESUMO
Chronic obstructive pulmonary disease (COPD) is regarded as one of the leading causes of morbidity and mortality across the world, yet its proper diagnosis remains a challenge. Community-based population studies conducted in North and South America, Europe, Australia, and Asia have revealed that 10% to 12% of adults aged 40 years or older have evidence of persistent airflow limitation on spirometry, but only 20% to 30% of these subjects have been diagnosed with COPD. These studies collectively suggest that approximately 70% of COPD worldwide may be underdiagnosed. Conversely, other studies have shown that between 30% and 60% of patients with a previous physician diagnosis of COPD do not actually have the disease, and hence they have been overdiagnosed. In this review, we define under- and overdiagnosis and explore the prevalence and the burden of under- and overdiagnosis of COPD on both patients and healthcare systems. We further describe potential solutions to reduce the incidence of under- and overdiagnosis of COPD.
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Erros de Diagnóstico/estatística & dados numéricos , Uso Excessivo dos Serviços de Saúde/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Ásia , Austrália , Europa (Continente) , Humanos , Internacionalidade , América do Norte , América do Sul , EspirometriaRESUMO
Abstract Actinomycosis remains characteristically uncommon, but is still an important cause of morbidity. Its clinical presentation is usually indolent and chronic as slow growing masses that can evolve into fistulae, and for that reason are frequently underdiagnosed. Actinomyces spp is often disregarded clinically and is classified as a colonizing microorganism. In this review of literature, we concomitantly present 11 cases of actinomycosis with different localizations, diagnosed at a tertiary hospital between 2009 and 2016. We outline the findings of at least one factor of immunosuppression in > 90% of the reported cases.
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Humanos , Masculino , Feminino , Adulto , Idoso , Idoso de 80 Anos ou mais , Penicilinas/administração & dosagem , Actinomicose/tratamento farmacológico , Terapia de Imunossupressão , Amoxicilina/administração & dosagem , Antibacterianos/administração & dosagem , Actinomicose/diagnóstico , Actinomicose/patologia , Resultado do Tratamento , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Primary immunodeficiencies are inherited diseases that compromise numerous systems and whose clinical manifestation is varied. It is an underdiagnosed pathology in Colombia. OBJECTIVES: To characterize primary immunodeficiencies in patients younger than 16 years who attended the San Rafael Clinical University Hospital, Bogota, between January 1, 2010 and July 1, 2016, as well as to provide information that enriches local, national and international statistics. METHODS: Observational study of a cases series. All patients diagnosed with primary immunodeficiencies were analyzed, with a total of 75 patients. RESULTS: Patients between one and five years of age (33 % of all cases) were the most affected, followed by patients from six to 11 months, including 17 cases; 21 cases corresponded to patients under 1 year of age; 80 % of affected children were males. Antibody deficiency was the most common type of immunodeficiency (56 %), followed by T/B lymphocyte deficiency (38 %). CONCLUSIONS: Patients with primary immunodeficiencies of the analyzed hospital had the same age and gender distribution observed in international studies. The most common primary immunodeficiency was due to antibody defects.
Antecedentes: Las inmunodeficiencias primarias son enfermedades heredadas que comprometen numerosos sistemas y cuya manifestación clínica es variada. Es una patología subdiagnosticada en Colombia. Objetivos: Caracterizar las inmunodeficiencias primarias en pacientes menores de 16 años que acudieron al Hospital Universitario Clínica San Rafael, Bogotá, entre el 1 de enero de 2010 y el 1 de julio de 2016, así como proporcionar información que enriquezca las estadísticas locales, nacionales e internacionales. Métodos: Estudio observacional de una serie de casos. Se analizaron todos los pacientes con diagnóstico de inmunodeficiencias primarias, en total 75 pacientes. Resultados: Los pacientes entre uno y cinco años de edad (33 % de todos los casos) fueron los más afectados, seguidos de los pacientes de seis a 11 meses, incluidos 17 casos; 21 casos correspondieron a pacientes menores de un año de edad; 80 % de los niños afectados era del sexo masculino. La deficiencia de anticuerpos fue el tipo de inmunodeficiencia que con más frecuencia se presentó (56 %), seguida de la deficiencia de linfocitos T/B (38 %). Conclusiones: Los pacientes con inmunodeficiencias primarias del hospital analizado tuvieron la misma distribución de edad y sexo que en los estudios internacionales. La inmunodeficiencia primaria más frecuente se debió a defectos de anticuerpos.
Assuntos
Síndromes de Imunodeficiência/diagnóstico , Síndromes de Imunodeficiência/epidemiologia , Criança , Pré-Escolar , Colômbia/epidemiologia , Feminino , Hospitais/classificação , Humanos , Lactente , Masculino , Sistema de Registros , Fatores de Tempo , Saúde da População UrbanaRESUMO
BACKGROUND: COPD prevalence is highly variable and geographical altitude has been linked to it, yet with conflicting results. We aimed to investigate this association, considering well known risk factors. METHODS: A pooled analysis of individual data from the PREPOCOL-PLATINO-BOLD-EPI-SCAN studies was used to disentangle the population effect of geographical altitude on COPD prevalence. Post-bronchodilator FEV1/FVC below the lower limit of normal defined airflow limitation consistent with COPD. High altitude was defined as >1500 m above sea level. Undiagnosed COPD was considered when participants had airflow limitation but did not report a prior diagnosis of COPD. RESULTS: Among 30,874 participants aged 56.1 ± 11.3 years from 44 sites worldwide, 55.8% were women, 49.6% never-smokers, and 12.9% (3978 subjects) were residing above 1500 m. COPD prevalence was significantly lower in participants living at high altitude with a prevalence of 8.5% compared to 9.9%, respectively (p < 0.005). However, known risk factors were significantly less frequent at high altitude. Hence, in the adjusted multivariate analysis, altitude itself had no significant influence on COPD prevalence. Living at high altitude, however, was associated with a significantly increased risk of undiagnosed COPD. Furthermore, subjects with airflow limitation living at high altitude reported significantly less respiratory symptoms compared to subjects residing at lower altitude. CONCLUSION: Living at high altitude is not associated with a difference in COPD prevalence after accounting for individual risk factors. However, high altitude itself was associated with an increased risk of undiagnosed COPD.