Resumo em Espanhol:
Los glucocorticoides inhalados (GCI) constituyen hoy un tratamiento de primera línea del asma bronquial. Los efectos sistémicos de los GCI, como la supresión del eje hipotalámico- hipofisario-adrenal, son en general menores que los de los glucocorticoides orales. Sin embargo, existe el riesgo de efectos adversos sobre el hueso a largo plazo. El objetivo del presente trabajo fue revisar los datos publicados acerca de los efectos de los GCI sobre los marcadores del metabolismo óseo y la densidad mineral ósea en adultos y en pacientes pediátricos. Aunque los estudios examinados no proporcionan resultados uniformes, en términos generales sugieren que los GCI pueden afectar al metabolismo y a la densidad mineral ósea, en particular 1) cuando se administran a dosis elevadas (más de 400 µg/día en niños y más de 800 µg/día en adultos); 2) en pacientes pediátricos, en los que también pueden afectar al crecimiento en estatura; 3) en pacientes cuya ingesta de calcio y vitamina D es inadecuada, y 4) en mujeres postmenopáusicas sin terapia de reposición hormonal. En general, a dosis terapéuticamente equivalentes, la beclometasona tiene mayor efecto deletéreo sobre el hueso que la budesonida, y esta mayor que la fluticasona. Además de la precaución obvia de utilizar la menor dosis eficaz, se proponen como medidas preventivas: 1) la adecuada instrucción sobre el uso de los aerosoles; 2) el uso de cámaras de inhalación; 3) el enjuague bucal tras la administración de GCI, y 4) ajustes o suplementos dietéticos para asegurar una adecuada ingesta de calcio y vitamina D.Resumo em Inglês:
Inhaled glucocorticoids (IGs) are today the first-line treatment for bronchial asthma. The systemic effects of inhaled glucocorticoids, such as suppressing the hypothalamic-pituitary-adrenal axis, are generally less than those with oral glucocorticoids. However, there is a long-term risk of adverse effects on bone. The objective of this piece was to review the published data on the effects of IGs on bone metabolism markers and bone mineral density in adults and in pediatric patients. The reviewed studies do not provide uniform results. Nevertheless, in general they suggest that IGs can affect metabolism and bone mineral density, especially: 1) when high doses are administered (more than 400 µg/day in children and more than 800 µg/day in adults), 2) in pediatric patients, in whom growth in stature can also be affected, 3) in patients whose intake of calcium and vitamin D is inadequate, and 4) in postmenopausal women not undergoing hormone replacement therapy. In general, at therapeutically equivalent doses, beclomethasone has a greater deleterious effect on bone than does budesonide, which in turn has more of an effect than does fluticasone. In addition to the obvious precaution of using the lowest effective dose, other proposed preventive measures include: 1) adequate instruction on the use of aerosols, 2) the use of large volume spacer devices, 3) rinsing the mouth after administering IGs, and 4) dietary adjustments or supplements in order to ensure an adequate intake of calcium and vitamin D.Resumo em Espanhol:
En la actualidad, los únicos casos de poliomielitis por poliovirus descritos en Brasil y en otros países americanos son de etiología vacunal. Para la vigilancia epidemiológica y los programas de inmunización es importante investigar el perfil epidemiológico de los casos de poliomielitis paralítica asociada a la vacuna (PPAV) con el fin de establecer criterios para la definición de los casos y las estrategias de vacunación. Para investigar la PPAV en Brasil, se sometieron a un estudio descriptivo de los datos clínicos, epidemiológicos y de laboratorio 30 casos diagnosticados y clasificados como tal por el Ministerio de Salud entre 1989 y 1995. Además, con base en una cohorte de 3656 personas con parálisis flácida aguda, se estimó el riesgo de ocurrencia de PPAV en función de diferentes variables. Entre los individuos que recibieron la vacuna oral frente a la poliomielitis (VOP) 4 a 40 días antes del inicio de la parálisis flácida aguda, el riesgo relativo de PPAV fue de 8,88 (intervalo de confianza de 95%, IC95%: 4,37 a 18,03), en comparación con las personas que no habían sido vacunadas en el mismo intervalo de tiempo. Para los individuos que contrajeron PPAV en los 4 a 40 días siguientes a una campaña de vacunación nacional, el riesgo relativo estimado fue de 2,94 (IC95%: 1,44 a 6,00). Para la primera dosis de VOP administrada a la población general el riesgo estimado fue de un caso de PPAV por cada 2,39 millones de dosis; para el total de dosis de VOP, el riesgo fue de un caso por 13,03 millones de dosis. La mayor proporción de casos de PPAV ocurrió en niños con síntomas prodrómicos (fiebre y síntomas o signos gastrointestinales), aislamiento del poliovirus vacunal de tipo 2, parálisis de los miembros inferiores y promedio de un año de edad.Resumo em Inglês:
At the present time, the only poliovirus-caused poliomyelitis cases reported in Brazil and other countries of the Americas are of vaccine etiology. It is important for epidemiological surveillance and immunization programs to evaluate the epidemiological profile of cases of vaccine-associated paralytic poliomyelitis (VAPP) in order to establish criteria for case definition and vaccination strategies. To research VAPP in Brazil, 30 cases diagnosed and classified as such by the Ministry of Health between 1989 and 1995 were submitted to a descriptive study of clinical, laboratory, and epidemiological data. In addition, the risk of occurrence of VAPP was estimated in relation to determinants based on a cohort of 3 656 persons with acute flaccid paralysis. Among individuals who had received oral polio vaccine (OPV) from 4 to 40 days before the onset of paralysis, we found a relative risk of 8.88 (95% CI: 4.37-18.03) for VAPP as compared with persons who had not been vaccinated during the same time interval. For individuals who developed VAPP in the period following national vaccination days, the estimated relative risk was 2.94 (95% CI: 1.44-6.00). For the first dose of OPV administered to the general population the estimated risk was 1 case of VAPP for every 2.39 million doses; for total doses of OPV the risk was 1 case in 13.03 million doses. A major share of VAPP cases were related to children affected by prodromes (fever and gastrointestinal signs and/or symptoms), isolation of vaccine poliovirus type 2, paralysis of the lower limbs, and a mean age of 1 year.Resumo em Espanhol:
En el presente estudio se describen cuáles son los antígenos de Fasciola hepatica que están presentes en las heces de pacientes con fascioliasis crónica y de ratas infectadas experimentalmente con metacercarias de F. hepatica. Mediante el empleo de la técnica de inmunoelectrotransferencia (Western blot) con un suero hiperinmune obtenido frente a antígenos de excreción/secreción de adultos de F. hepatica, se pudo demostrar que en las heces de los pacientes se encuentran antígenos de posible interés para el diagnóstico con masas moleculares de 14, 19, 20, 23, 25, 32, 46, 51 y 62 kilodaltons (kDa). Además, se comprobó que algunos de estos péptidos (los de 14, 20, 23 y 51 kDa) son reconocidos también por la mayoría de los sueros de pacientes crónicos. Después de purificar por cromatografía de afinidad los antígenos presentes en heces de ratas con 6 a 12 semanas de infección, empleando para ello el anticuerpo monoclonal ES78 acoplado a Sepharosa 4B-CNBr, se identificaron seis polipéptidos de 11, 14, 26, 32, 47 y 51 kDa; otros tres polipéptidos, de 17, 24 y 66 kDa, solo se pudieron identificar en heces de ratas con 10 a 12 semanas de infección. Nuestros resultados sugieren que estos polipéptidos pueden ser antígenos comunes a ambos estadios parasitarios y constituir importantes marcadores de la fascioliasis aguda y crónica, en particular los de 14, 24, 26 y 51 kDa, puesto que reaccionaron con el inmunosuero, los sueros humanos y el anticuerpo monoclonal ES78.Resumo em Inglês:
This study describes which antigens of Fasciola hepatica are present in the feces of patients with chronic fascioliasis and in the feces of rats infected experimentally with F. hepatica metacercariae. Using a Western blot assay technique with hyperimmune serum obtained from excretory-secretory antigens of adult F. hepatica, we found in the patients' feces antigens of possible diagnostic interest, with molecular weights of 14, 19, 20, 23, 25, 32, 46, 51, and 62 kilodaltons (kDa). In addition, we showed that the peptides of 14, 20, 23, and 51 kDa are also recognized by the majority of the sera from chronic patients. We used affinity chromatography to purify the antigens present in the feces of rats that had been infected for 6 to 12 weeks, using ES78 monoclonal antibody bound to CNBr-activated Sepharose 4B. Through that approach, we identified six polypeptides, of 11, 14, 26, 32, 47, and 51 kDa; three more polypeptides, of 17, 24, and 66 kDa, could only be identified in the feces of rats that had been infected for 10 to 12 weeks. Our results suggest that these polypeptides could be antigens common to both parasitic stages. This is particularly true for the polypeptides of 14, 24, 26, and 51 kDa, because they reacted with the immune sera, the human sera, and the ES78 monoclonal antibody. These polypeptides could be important markers for acute and chronic fascioliasis.Resumo em Português:
A persistência de bacilos da tuberculose em pacientes curados, determinando a recidiva da doença, é uma questão importante. O presente estudo de caso-controle investigou os fatores de risco individuais e institucionais para recidiva mediante análise de variáveis independentes relacionadas ao paciente, ao uso de drogas antituberculose e ao atendimento pelos serviços de saúde. Foram entrevistados 56 casos e 105 controles, sendo a recidiva definida como um novo episódio depois de o paciente ter sido tratado com sucesso no passado. Os controles foram selecionados entre pessoas tratadas e curadas por formas pulmonares de tuberculose e que não recidivaram. Modelos de análise de regressão foram propostos para controlar a ação dos fatores de confusão ou modificadores de efeito. As variáveis identificadas como fatores de risco para recidiva foram aquelas relacionadas a irregularidades do paciente (faltas à consulta médica deixando de coletar a medicação, não ingestão das drogas, doses equivocadas) idade e estresse gerado por eventos de vida; efeitos adversos do uso de drogas antituberculose; problemas na organização dos serviços de saúde que implicaram no fornecimento de dose ou quantidade insuficiente de medicamentos. Receber informação sobre a duração do tratamento foi um fator de proteção. O reconhecimento desses fatores de risco deveria resultar em um acompanhamento mais intensivo e em uma supervisão direta do tratamento para prevenir a reativação da doença.Resumo em Inglês:
The persistence of tuberculosis bacilli in patients who are cured, thus causing recurrence, is an important issue. This case-control study investigated individual and institutional risk factors for relapse by analyzing independent variables related to the patient, the use of antituberculosis drugs, and the service delivered at health care institutions; 56 cases and 105 controls were interviewed. Recurrence was defined as a new tuberculosis episode after the patient had been successfully treated. Controls were selected from among patients who were treated and cured of pulmonary tuberculosis and who did not experience a relapse. Regression models were proposed to control confounding factors or effect modifiers. The variables identified as risk factors for relapse were those related to erratic patient behavior (missing medical appointments and therefore not picking up the medication, not taking the medication, taking the wrong dosage), age, and stress from life events; adverse reactions to antituberculosis drugs; and problems in the organization of health care services that resulted in patients receiving insufficient dosages or amounts of antituberculosis drugs. Receiving information regarding treatment duration provided protection against recurrence. The knowledge regarding these risk factors should result in more intensive follow-up and in more use of directly observed treatment of tuberculosis in order to prevent relapse.Resumo em Espanhol:
Este estudio investigó la excreción urinaria de fluoruro en escolares de 4 a 6 años de edad residentes en una comunidad rural del sur de Texas donde las concentraciones de fluoruro en el agua potable se encuentran generalmente cerca del nivel óptimo. Bajo supervisión, en la escuela se recolectó la orina de la mañana y la tarde, y en el domicilio la de la noche. Se registraron el inicio y el final de los tres períodos de recolección y se determinaron el volumen de orina y el flujo urinario de cada período. Se midió la concentración de fluoruro en orina y se calculó la excreción urinaria por hora. Los niños tomaron el desayuno y el almuerzo en la escuela, donde el agua potable contenía 1,0 a 1,3 mg/L de fluoruro. En los domicilios, el agua, procedente de pozos, tenía concentraciones de fluoruro que oscilaron entre 0,1 y 3,2 mg/L. Las concentraciones urinarias medias diurnas y nocturnas de fluoruro fueron similares y oscilaron entre 1,26 y 1,42 mg/L. La excreción media fue de 36,4 µg/h por la mañana, 45,6 µg/h por la tarde y 17,5 µg/h por la noche. La menor excreción nocturna se explica fácilmente por el menor flujo urinario nocturno. La excreción de fluoruro en 24 horas, extrapolada a partir de la orina recolectada en 15 horas, fue de 749 µg. Combinados con los datos de investigaciones similares, los resultados de este estudio contribuirán a establecer los límites superiores de la excreción de fluoruro que permitan evitar la fluorosis y, al mismo tiempo, proporcionen una protección óptima frente a la caries dental.Resumo em Inglês:
This study evaluated urinary fluoride excretion by school children 4-6 years old who were living in a south Texas rural community that had concentrations of fluoride in drinking water supplies generally around the optimal level. We took supervised collections of urine samples in the morning and afternoon at school, and parents of the participating students collected nocturnal samples. We recorded the beginning and end times of the three collection periods and then determined the urinary volume and urinary flow for each of the periods. We measured urinary fluoride concentrations and calculated the urinary excretion rate per hour. The children had breakfast and lunch provided at the school, where the drinking water contained 1.0-1.3 milligrams/liter (mg/L) fluoride. Fluoride concentrations in the tested household water supplies, from wells, ranged from 0.1 to 3.2 mg/L fluoride. The children's average urinary fluoride concentrations found for the day were similar to those for the night, with means ranging from 1.26 mg/L to 1.42 mg/L. Average excretion was 36.4 µg/h in the morning, 45.6 µg/h in the afternoon, and 17.5 µg/h at night. The lower nocturnal excretion rates are easily explained by low urinary flow at night. Based on the 15 hours of urine collected, the extrapolated 24-hour fluoride excretion was 749 µg. In conjunction with similar studies, the data from this study will help in developing upper limits for urinary fluoride excretion that are appropriate for avoiding unsightly fluorosis while providing optimal protection against dental decay.Resumo em Espanhol:
Se presenta una comparación de las tasas de participación y de las razones de la falta de respuesta en encuestas realizadas en cinco países de América Latina y el Caribe con el objetivo de medir la prevalencia de comportamientos de riesgo que determinan la transmisión del virus de la inmunodeficiencia humana. Dichas encuestas se basaron en muestras probabilísticas de la población de ambos sexos comprendida entre 15 y 49 años de edad, excepto en México, donde se estudió solo a los hombres. Se estimaron tres componentes de la participación: las proporciones de viviendas entrevistadas, de viviendas entrevistadas con personas elegibles y de personas elegibles que cumplimentaron la entrevista. Además, se calculó un índice global que combinaba los tres componentes. La tasa global de respuesta osciló entre 35,6% en México y 81,4% en Chile, y el componente de esta tasa con mayor variabilidad fue la participación de personas elegibles, que varió entre 50% en México y 95% en Cuba. Estos valores fueron más bajos de lo esperado, sobre todo en los hombres, y servirán de orientación para futuras encuestas, ya que se deberán considerar tasas de rechazo mayores de las previstas en el protocolo. Los resultados permiten inferir la validez de las estimaciones de la prevalencia de los diversos comportamientos de riesgo observados y establecen una referencia para calcular el tamaño muestral de futuras encuestas y mejorar la metodología de la investigación.Resumo em Inglês:
This study compares participation rates and reasons for nonresponse in surveys conducted in five countries of Latin America and the Caribbean. The objective of the surveys was to measure the prevalence of risk behaviors affecting the transmission of human immunodeficiency virus. The surveys were based on probability samples of the population of both sexes between 15 and 49 years old, except in Mexico, where only men were included. Proportions of three components of participation were estimated: residences interviewed, interviewed residences with eligible persons, and eligible persons who completed the interview. In addition, an overall index that combined the three components was calculated. The overall response rate ranged from 35.6% in Mexico to 81.4% in Chile. The component with the greatest variability was the participation of eligible persons, which ranged from 50% in Mexico to 95% in Cuba. These values were lower than what had been expected, especially among men, and will serve to guide future surveys, since rejection rates higher than the ones expected in the protocol should be considered. The results make it possible to infer the validity of the prevalence estimates for the various observed risk behaviors. The results also establish a benchmark to calculate the sample size in future surveys and to improve research methodology.Resumo em Português:
O atendimento a pacientes em serviços primários de saúde deveria compreender uma avaliação tanto física como psicológica; em muitos casos, o sucesso do tratamento depende da compreensão do indivíduo e de suas interações, em especial de sua interação na família. Portanto, é importante instrumentalizar os profissionais de saúde para que sejam capazes de trabalhar com os indivíduos nesse contexto social. Estudamos três escalas diagnósticas do funcionamento familiar consagradas na literatura internacional (FACES III, Beavers-Timberlawn e GARF), procurando validá-las para uso em nosso meio (Porto Alegre, Brasil). Comparamos os resultados do preenchimento das escalas com a avaliação clínica, feita através de entrevista familiar semi-estruturada, em 31 famílias clínicas. A escala auto-respondida FACES III também foi testada em 102 famílias na comunidade. A escala FACES III mostrou uma correlação linear positiva, porém fraca, entre coesão familiar e risco para doença mental, mas não em relação à adaptabilidade. As escalas BT e GARF demonstraram forte correlação positiva com a avaliação clínica. A escala FACES III não demonstrou ser adequada para uso em triagem de cuidados primários; entretanto, as escalas BT e GARF mostraram-se muito úteis na formulação e classificação do diagnóstico familiar.Resumo em Inglês:
Care provided to patients in primary health services should include both a physical and a psychological assessment. In many cases treatment success depends on understanding individuals and their interactions, especially within the family; it is important for health professionals to be trained in this area. We investigated the validity of three well-known diagnostic scales of family functioning from the United States of America (FACES III, Beavers-Timberlawn, and GARF) for use in our setting in Porto Alegre, Brazil. The three scales were used with 31 families and compared to the results from clinical evaluations (semistructured family interviews), which were considered the gold standard. FACES III was also used with a sample of 102 families in the community. The Beavers-Timberlawn and GARF scales were strongly and positively correlated with the clinical evaluations. In contrast, our results suggest that FACES III is not a useful screening tool in primary care to detect the risk of psychiatric disorders. The Beavers-Timberlawn and GARF instruments showed great usefulness for formulating and classifying diagnoses of family functioning.Resumo em Espanhol:
Según un estudio publicado recientemente por el American College of Physicians-American Society of Internal Medicine (ACP-ASIM), una de las principales organizaciones de especialistas médicos de los Estados Unidos de América, los individuos de ascendencia latinoamericana de este país tienen peores desenlaces de salud que otros grupos étnicos, en gran medida debido al hecho de que son muchos los que carecen de seguro de salud. Aunque los latinoamericanos solo representan 11,7% de la población del país, constituyen más de 25% de la población de los Estados Unidos sin seguro de salud. Como otras personas de este país sin seguro de salud, los latinoamericanos no asegurados tienen menos probabilidades de acceder a una fuente regular de atención sanitaria, de haber consultado con un médico en el último año, de haberse sometido a un examen médico de rutina, de calificar su propia salud como excelente o muy buena y de recibir atención ambulatoria y preventiva en el momento adecuado, lo cual aumenta la probabilidad de que posteriormente necesiten servicios más intensivos y caros. Debido a la ausencia de una relación regular con un médico, los hispanos son más propensos que los blancos no hispanos a utilizar las consultas externas o el servicio de pacientes ambulatorios de un hospital como fuente habitual de atención de salud.Resumo em Inglês:
Currently, emerging and reemerging infectious diseases are among the most challenging health problems being faced by countries of the Region. Some of these diseases have appeared in recent times; others have afflicted humanity in the past and are now reappearing, with renewed strength, in some cases as a result of the inadequate or unnecessary use of antibiotics on the part of the public at large and even of medical professionals. In light of the danger posed by these diseases, especially in poor countries where there are scant infrastructural and economic resources with which to combat them, in 1995 PAHO adopted a Regional Plan of Action and established a Task Force for the Surveillance of Emerging and Reemerging Infectious Diseases, with the aim of establishing effective and sustainable mechanisms for disease surveillance, diagnosis, prevention, and control in the entire American continent. The overall thrust of these measures and of the technical cooperation PAHO provides to the different countries is the subject of this report.