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Fatores associados ao diagnóstico tardio da Hanseníase em Sergipe: Um estudo transversal

2025-11-05T20:43:48Z

Título: Fatores associados ao diagnóstico tardio da Hanseníase em Sergipe: Um estudo transversal Autor(es): Pina, William Lucas Da Silva Mendes Abstract: Introduction: Leprosy, when diagnosed late, is associated with disabling and limiting conditions that affect individuals physically, socially, and economically, ultimately compromising their quality of life. Objective: To analyze the factors associated with delayed leprosy diagnosis in individuals treated at a reference center for the disease in Sergipe, Brazil. Methods: This cross-sectional study included individuals aged ≥15 years diagnosed with leprosy at the Leprosy Reference Center in Aracaju. Data were collected using an instrument that gathered demographic, clinical, and diagnostic delay-related information. Results: A total of 247 individuals participated in the study. Of these, 149 (60.3%) were male, 207 (83.81%) had between 0 and 4 years of education, 144 (58.3%) were of mixed ethnicity, and 180 (72.9%) lived in urban areas. Multibacillary leprosy was diagnosed in 216 (90.8%) individuals, with 151 (64.8%) testing positive on bacilloscopy and 102 (43.6%) presenting with the Virchowian clinical form. Most participants experienced leprosy reactions, with type 1 (reversal reaction) being the most common. Additionally, 128 (52%) did not seek healthcare services immediately after noticing initial symptoms, 201 (82%) never suspected they had leprosy, 79 (32%) were initially treated for other diseases, 157 (63.6%) were referred to other healthcare facilities, and 90 (34.01%) sought care at up to two different services before receiving a diagnosis. Poisson multivariate regression identified an increased risk of diagnostic delay among women (adjusted IRR: xx; 95% CI xx-xx), individuals aged 50-59 years (IRRa: xx; xx-xx), mixed-race individuals (IRRa: xx; xx xx), those with 5-8 years of education (IRRa: xx; xx-xx), rural residents (IRRa: xx; xx xx), and those with the tuberculoid clinical form of leprosy (IRRa: xx; xx-xx). Furthermore, diagnostic delay was associated with not seeking care early (IRRa: xx; xx-xx), lack of diagnosis at the first healthcare facility visited (IRRa: xx; xx-xx), personal suspicion of having leprosy (IRRa: xx; xx-xx), requiring multiple consultations (IRRa: xx; xx-xx) or services (IRRa: xx; xx-xx) for diagnosis confirmation, and an initial misdiagnosis (IRRa: xx; xx-xx). Conclusion: Delayed leprosy diagnosis was associated with sociodemographic factors such as female sex, age 50-59 years, mixed or white ethnicity, low educational attainment, and rural residence. Additionally, specific clinical forms, including tuberculoid, borderline, Virchowian, and indeterminate (were at greater risk of delayed diagnosis compared to the pure neural form). Failure to seek medical care promptly after symptom onset also contributed to delays. These findings highlight the urgent need for strategies to improve early disease detection and reduce barriers to diagnosis.

Análise temporal e aglomerados espaciais de elevado risco para a Doença de Chagas Aguda no Brasil: Estudo ecológico de base populacional

2025-11-05T20:37:33Z

Título: Análise temporal e aglomerados espaciais de elevado risco para a Doença de Chagas Aguda no Brasil: Estudo ecológico de base populacional Autor(es): Alexandre, Vinícius Torquato Alves Abstract: Introduction: Chagas disease (CD) is an anthropozoonosis with a variable clinical presentation, which can be both asymptomatic and a disease capable of causing cardiomyopathy, gastrointestinal dysfunction, and other symptoms, often associated with significant morbidity and loss of quality of life, potentially leading to death. Despite its great relevance, there are still few studies that prove its true impact on Brazilian public health. Objective: To analyze the temporal trend and spatial distribution of notifications of acute Chagas disease (ACD) in Brazil, from January 2010 to December 2022, considering spatial clusters and their relationships with socioeconomic indicators. This is a population-based ecological study referring to all cases of ACD that occurred in Brazil between January 2010 and December 2022. Information on ACD cases was obtained from the Notifiable Diseases Information System (SINAN). Data on the Social Vulnerability Index was obtained from the Institute for Applied Economic Research (IPEA) and population data extracted from the 2010 census. For the temporal analysis, the Seasonal-Trend Model (STM) method was used, while for the spatial analysis, after mapping the incidence per 100,000 inhabitants with data from the Brazilian Institute of Geography and Statistics (IBGE), the municipalities were grouped and stratified, and the Global Moran Index was then calculated to identify spatial correlations, with the Local Spatial Association Index (LISA) used later to quantify the degree of spatial association. To evaluate the correlation between the variables and the Social Vulnerability Index (SVI), the Bivariate Global Moran statistic was used, with the subsequent bivariate LISA, which resulted in Moran dispersion diagrams identifying critical correlation areas. Results: During the study period, an increasing trend in the incidence of ACD was noted, with seasonality in the incidence of ACD between August and November, as well as statistically significant spatial dependence between some of the studied municipalities. At the same time, it was also found that municipalities with a high SVI were associated with higher ACD incidence rates and that, currently, the main form of transmission of ACD is the oral transmission route, which is strongly associated with the North region of Brazil. Conclusion: Despite the great advances in the control of CD in recent times, mainly in vector-borne transmission, the incidence of new cases of CD is currently on the rise, being strongly linked to social vulnerability, especially regarding poor urban infrastructure.

Autocuidado de pacientes com insuficiência cardíaca após alta hospitalar no estado de Sergipe: ensaio clínico randomizado

2025-11-18T19:05:58Z

Título: Autocuidado de pacientes com insuficiência cardíaca após alta hospitalar no estado de Sergipe: ensaio clínico randomizado Autor(es): Sales, Vinícius Barbosa Dos Santos Abstract: Heart failure (HF) is the final common pathway of most heart diseases and is a complex clinical syndrome characterized by functional or structural heart disorder. As a way to improve the quality of life of individuals with this disease, good self-care practices can beneficially change this scenario. The study aims to evaluate the impact of an educational intervention on the self care of patients with decompensated HF after hospital discharge, as well as on the number of readmissions and mortality. This is a randomized and controlled clinical trial, registered as RBR-8dymr8 in Clinical Trials, guided by CONSORT, approved by the Ethics and Research Committee (opinion 5,565,107). The study was conducted in 6 hospitals in Sergipe. Eligible patients were randomized to the Control Group (CG) or Intervention Group (IG). Patients in the IG were monitored and guided by nurses in person (before discharge, 7, 30, and 60 days after discharge) and by telephone (15 and 45 days after discharge). Patients in the CG followed routine follow-up and assessment at 60 days after discharge. The intervention consisted of an educational booklet with guidelines on HF after hospital discharge, and a self-care questionnaire was also applied, considering it adequate when the score per section was ≥ 70 points. All statistical analyses were performed using the R programming environment (version 4.3.2) and the significance level adopted was 5%. The data correspond to the period from September 2022 to November 2024. During this period, 330 patients were hospitalized for decompensation, 201 were collected, 86 were randomized, and 60 completed the 60-day follow up, 31 in the CG and 29 in the IG. There was a predominance of men, over 60 years old, brown, married, hypertensive and diabetic, valvular or ischemic etiology, functional class II or III, with reduced ventricular ejection fraction. There were fewer readmissions in IG (CG 38% vs IG 28%), with longer time after discharge (CG 19±14 days vs IG 28±12 days), shorter readmission duration (CG 20±13 days vs IG 18±13 days) and predominance of non-cardiac cause (CG 80% vs IG 63%). There were 4 deaths, 2 in each group. The intervention was significantly effective for adequate self-care in sections A and C (Section A 76% vs 10%; Section C 66% vs 13%). It was not possible to evaluate the impact of the intervention on the mortality outcome. Patients followed in person and by telephone benefited from the adopted strategy and had fewer readmissions and improved self-care compared to the CG.

Marcadores de gravidade na covid-19: associação entre hiperlactatemia e desfechos clínicos na srag

2025-11-04T19:10:44Z

Título: Marcadores de gravidade na covid-19: associação entre hiperlactatemia e desfechos clínicos na srag Autor(es): Santana, Vanessa Larissa Abstract: Acute Severe Respiratory Syndrome (SARS) is a potentially serious respiratory disease capable of causing acute lung injury. Among the infectious agents involved are viruses (Influenza types A and B, Respiratory Syncytial Virus, SARS-CoV-2), bacteria, and fungi. With the Covid-19 pandemic, there was an exponential increase in the number of SARS cases, as well as in the admission rates to intensive care units. Studies show the relationship between elevated lactate levels and unfavorable outcomes in heterogeneous patients in the intensive care environment; however, analyzes on lactate measurement in patients with Covid-19 induced SARS are scarce. Therefore, the main objective of this work is to evaluate the impact of hyperlactatemia on the unfavorable clinical outcomes of patients with Severe Acute Respiratory Syndrome in the context of Covid-19 in intensive care units in Sergipe. The study is a retrospective cohort, carried out in ICUs of five hospitals in the state of Sergipe (public and private). Patients of both sexes aged eighteen years or over, with a minimum length of stay of 24 hours and who had a positive RT-PCR for Covid-19, were included. The data were obtained by reading the medical records of patients admitted from April 2020 to January 2022, completing a standardized collection instrument. There was data tabulation in an electronic spreadsheet and analysis using Jamovi 2.3.28 Software, using appropriate statistical tests. As a result, a significant association was observed between the admission lactate level and the increase in the chances of death (OR 1.804; p-value 0.028). By comparing the groups, it was possible to verify that patients with hyperlactatemia were more likely to die (RR 1.58) and presented a higher risk of developing cardiac complications (RR 1.79; p-value 0.016). The outcomes “acute kidney injury” and “need for dialysis” were not relevant when associated with lactate levels. On the other hand, the mean and median days of hospital and ICU stay were notably lower in patients with high lactate (mean 20.7 and 11.8 versus 29.9 and 26.9 - median 9.5 and 9 versus 15 and 11), as well as its survival time (p-value 0.009 and 0.002), indicating a higher risk of death in this population. Analyzing lactate clearance in 24 hours, the number of deaths exceeded the number of survivors for clearance < 30% (76.92%). In general, this study demonstrated that hyperlactatemia is associated with worse clinical outcomes in patients with Covid-19 and SARS, which reinforces its relevance as an essential marker in intensive care units.