Geographical information systems (GIS) have emerged as a group of innovative software components useful for projects in epidemiology and planning in Health Care System. This is an original study to investigate environmental and geographical influences on epidemiology of acromegaly in Brazil. We aimed to validate a method to link an acromegaly registry with a GIS mapping program, to describe the spatial distribution of patients, to identify disease clusters and to evaluate if the access to Health Care could influence the outcome of the disease. Clinical data from 112 consecutive patients were collected and home addresses were plotted in the GIS software for spatial analysis. The buffer spatial distribution of patients living in Brasilia showed that 38.1 % lived from 0.33 to 8.66 km, 17.7 % from 8.67 to 18.06 km, 22.2 % from 18.07 to 25.67 km and 22 % from 25.68 to 36.70 km distant to the Reference Medical Center (RMC), and no unexpected clusters were identified. Migration of 26 patients from 11 others cities in different regions of the country was observed. Most of patients (64 %) with adenomas bigger than 25 mm lived more than 20 km away from RMC, but no significant correlation between the distance from patient’s home to the RMC and tumor diameter (r = 0.45 p = 0.20) nor for delay in diagnosis (r = 0.43 p = 0.30) was found. The geographical distribution of diagnosed cases did not impact in the latency of diagnosis or tumor size but the recognition of significant migration denotes that improvements in the medical assistance network are needed.

Objective: To describe the clinical characteristics, management, and fetal outcomes of patients diagnosed with gestational diabetes mellitus (GDM) or overt diabetes (OD) during pregnancy who followed up at a public healthcare referral center in Brazil. Materials and methods: A retrospective cohort study based on the medical records of women diagnosed with dysglycemia during pregnancy between January 2015 and July 2017 was conducted. Results: Out of 224 pregnant women evaluated, 70% were overweight/obese. GDM was observed in 78.6% of pregnant women, while 21.4% presented with OD. Approximately 59% of patients could be diagnosed with GDM or OD by fasting plasma glucose (FPG) alterations alone. Exclusive diet therapy was used in 50.9% of patients. The need for insulin therapy was higher in OD patients (60.4%) than in GDM patients (38.1%) (p = 0.006). Women who needed insulin (n = 96) had a mean initial dose of 0.33 IU/kg (±0.27) and a final value of 0.39 IU/kg (±0.34). The cesarean rate was 74.3%. The fetal outcomes evaluated were macrosomia (2.15%), large for gestational age (LGA) fetus (15.83%), intensive care unit (ICU) need (4.32%), Apgar score ≤7 (6.47%), hypoglycemia (14.39%) and jaundice (16.55%). Conclusions: Patients with GDM and OD presented with several similar clinical features. Approximately half of the patients presented with adequate glycemic control only with diet management. Patients with OD presented a higher need for insulin therapy. Although overweight and obesity were frequent within both groups, they could possibly explain many of our findings.

Background Acromegaly is a rare, chronic and debilitating disease whose treatment places a high burden on health systems. In the reality of the Brazilian public health network, many patients are kept on drug treatment because of barriers to access to surgery. Objective The aim of this study was to estimate the costs and budget impact of routine transsphenoidal endoscopic surgery in relation to those of long-term drug treatment with octreotide long-acting release (LAR) from a cohort of patients followed at the referral medical centre for acromegaly treatment in the Federal District, Brazil. Methods Based on micro-costing data collected using mixed methods from a local perspective of the public health system, we performed a budget impact analysis (BIA) on a 3-year time horizon. Uncertainty was handled with deterministic (tornado and scenario) and probabilistic (Monte Carlo simulations) sensitivity analyses. Results Compared with the continued use of octreotide LAR at a dose of 30 mg every 28 days, the incremental budget impact of conducting two surgeries per month, considering a cure rate of 55%, could bring savings of approximately US$879,362.18 (95% CI 860,176.29–898,548.08) over 3 years. Depending on the key variable values, the savings amplitude ranged from US$431,836.39 to US$1,519,132.04. Conclusions Improving access to surgery could result in significant cost reductions in acromegaly treatment. The present study stands out for being the first to estimate the costs of transsphenoidal surgery in the context of the public health system in Brazil. Electronic supplementary material The online version of this article (10.1007/s41669-018-0103-2) contains supplementary material, which is available to authorized users.

Perfil microbiológico e desfechos clínicos de úlceras graves em pés Artigo Original PERFIL MICROBIOLÓGICO E DESFECHOS CLINICOS DE ÚLCERAS EM PÉS DE DIABÉTICOS INTERNADOS Microbiological profile and clinical outcome of severe foot ulcers of diabetic inpatients RESUMOObjetivos: Descrever o perfil microbiológico e os desfechos clínicos de úlceras graves em pés diabéticos de pacientes internados em um hospital universitário de atenção terciária no estado do Ceara, Brasil. Métodos: Conduziu-se uma análise retrospectiva de dados obtidos nos prontuários médicos de todos os pacientes diabéticos internados entre janeiro de 2006 a junho de 2007, nas enfermarias do Serviço de Endocrinologia e Diabetes do Hospital Universitário Walter Cantídio (Universidade Federal do Ceará), por úlceras graves em pés diabéticos, com no mínimo grau 2 da classificação de Wagner, refratárias ao tratamento ambulatorial. Dados clínicos (sexo, idade, tempo de diabetes e co-morbidades) de cada paciente assim como as características microbiológicas do material colhido das suas ulceras em pés ou das suas peças cirúrgicas (amputações) foram obtidos. Resultados: Foram identificados no período 17 diabéticos, todos tipo 2, com idade de 58,11±10,8 anos e 12,4±8,4 anos de doença, 58,8% homens. Das úlceras, 41,1% eram grau 2, 35,2% grau 3, 11,7% grau 4 e 11,7% grau 5 de Wagner, 64,7% com menos de 3 meses de evolução. Realizaram limpeza cirúrgica 82,3% dos pacientes e amputações 47%, sendo identificada osteomielite em 47% dos casos. Antibioticoterapia empírica foi iniciada em todos os pacientes, sendo ciprofloxacina/ metronidazol o esquema mais usado (76,5%). Houve cultura negativa em 12,5% das realizadas. Nas positivas, os germes mais freqüentes foram: S. aureus (57,1%); S. viridans (28,7%); P. aeruginosas (28,7%) e M. morganii (28,7%) A maioria (75%) dos S. aureus isolados eram meticilino-resistentes, mas sensíveis à vancomicina. Conclusão: Observouse a presença de flora polimicrobiana com grande número de patógenos multirresistentes e elevada prevalência de osteomielite e amputações em diabeticos portadores de úlceras graves, neuropatia e doença vascular periférica.

Objective:To evaluate the quality of life and its association with daily physical activity and disease control in acromegalic patients. Subjects and methods: A cross-sectional, case series study, composed of 42 patients recruited from the Neuroendocrinology Unit of the University Hospital of Brasilia. Level of physical activity was accessed by the International Physical Activity Questionnaire (IPAQ 6-short-form), which evaluates the weekly time spent on physical activity of moderate to vigorous intensity in different contexts of life. Quality of life was evaluated by The Medical Outcome Study Questionnaire Short Form (SF-36). Data was compared to growth hormone (GH) and insulin-like growth factor (IGF-1) levels. Students' t test and Fisher test were used, p < 0.05, SPSS 17.0. Results: Twenty--two women, aged 51.33 ± 14.33 and 20 men, aged 46.2 ± 13.18 were evaluated. Arthralgia was present in 83% of cases. In men, the most common sites of pain were the knees (73%), spine (47% lumbar, and 53% thoracic and cervical segments), hands and wrists (40%). Higher scores on SF-36 were observed in patients with intermediate or high levels of physical activity, in the domains social functioning (75 CI 57.3-92.6), general health (75.5 CI 60.4-90.5), mental health (70 CI 57.8-82.1). Conclusions: In this study, the presence and severity of physical disability and pain were not associated with initial GH and IGF-1 levels or time of exposure to GH excess. However, the patients considered controlled, with normal a normal age-adjusted IGF-1, presented higher scores in SF-36, in physical and emotional domains, compared with patients with persistent hypersomatotrophism. These findings suggest benefits of metabolic control in self-reported quality of life. Arq Bras Endocrinol Metab. 2013;57(7):550-7 Keywords Acromegaly; quality of life; functional capacity; activities in daily life RESUMO Objetivo: Avaliar a qualidade de vida e sua associação com a prática de vida diária e controle metabóli-co em pacientes portadores de acromegalia. Sujeitos e métodos: Estudo seccional de série de casos, composto por 42 pacientes recrutados na Unidade de Neuroendocrinologia do Hospital Universitário de Brasília. O nível de atividade física foi estimado pelo Questionário Internacional de Atividade Física (IPAQ-6), que avalia o tempo gasto semanalmente em atividades físicas que variam de intensidade em diferentes contextos de vida. A qualidade de vida foi avaliada pelo questionário SF-36. Os dados obtidos foram comparados aos níveis de hormônio do crescimento (GH) e fator de crescimento semelhante à insulina (IGF-1). Os testes t Students e Fisher foram aplicados e p < 0,05 foram considerados significativos, SPSS 17.0. Resultados: Avaliaram-se 22 mulheres com idades de 51,33 ± 14,33 e 20 homens com idades de 46,2 ±13,18. Artralgia foi relatada em 83% dos pacientes. Em homens, os sítios de dor mais comuns foram os joelhos (73%), coluna vertebral (47% lombar, 53% segmentos torácico e cervical), mãos e quadris (40%). Os maiores escores no SF-36 fo...