Mycobacterium leprae was first described as the bacillus that causes leprosy, a chronic granulomatous infectious disease, in 1873 by Amauer Hansen. Leprosy is part of a group of 10 neglected diseases and Bahia has endemic levels of this illness, varying between high and very high. The detection of 52 new cases of leprosy in children under 15 years old in Salvador in 2006 is alarming, and suggests an early contact with the disease. The aim of this review is to analyze the epidemiological situation, the detection rate and evaluate the clinical and epidemiological profile of leprosy in Salvador, in the period 2001-2009. A retrospective cross-sectional study was performed using secondary data collected at Notifiable Diseases Information System Database (SINAN) through the notification of patients with leprosy. Over these nine years 3,226 patients were reported, with a predominance of: females (51.5%), and clinical multibacillary forms in the general population (51.7%), but when we analyze those under 15 years old, paucibacillary forms (tuberculoid + indeterminate) prevailed. The tuberculoid form was the most diagnosed type of presentation. The annual detection rate in Salvador remained at a very high level of endemicity during the studied period and for those under 15 years old it ranged between high and very high. Grade 2 disabilities both at the time of diagnosis and at discharge after cure, varied between low and medium. Based on these data we conclude that the high levels of leprosy detection rates in the general population, plus the variation between high and very high levels in those under 15 years old, associated with the medium level of grade 2 disabilities at the time of diagnosis and discharge, demonstrate the need for improvement on the existing services, investment in active case finding and training of the healthcare professionals in Salvador.
BackgroundInstruments for field diagnosis of eczema are increasingly used, and it is essential to understand specific limitations to make best use of their strengths. Our objective was to assess the validity of ISAAC and UK Working Party criteria for field diagnosis of eczema in children.MethodsWe performed a cohort study in urban Brazil. Parents/guardians of 1,419 children answered ISAAC phase II questionnaire. Children were examined for skin lesions (UKWP protocol). Two dermatologists examined most cases of eczema (according to ISAAC or UKWP), and a sample without eczema.ResultsAgreement between repeat questionnaires on the filter question was poor (kappa = 0.4). Agreement between the 2 dermatologists was fair (kappa = 0.6). False positive reports included scabies in 39% of ISAAC cases and 33% of UKWP cases. Sensitivity and PPV were low (ISAAC: 37.1% and 16.1%; UKWP: 28.6% and 23.8%). Specificity and NPV were high (ISAAC: 90.0% and 96.6%; UKWP: 95.3% and 96.2%). One-year prevalence of eczema was 11.3% (ISAAC), 5.9% (UKWP) and 4.9% (adjusted dermatologist diagnosis). Point prevalence of scabies (alone or not) was 43%, 33% and 18%, in eczemas according to ISAAC, to UKWP and to dermatologists. The reasons why children with eczema were not identified by ISAAC or UKWP were wrongly denying dry skin, itchy rash or personal history of atopic diseases. A limitation is that questionnaire was already validated in Brazil, but not field tested in this specific setting.ConclusionsStudies using UKWP or ISAAC criteria should include a validation arm, to contribute to the understanding of potential limitations of their use in different contexts and to explore solutions. We list specific recommendations.
<span class="texto">O albinismo é um conjunto heterogêneo de distúrbios genéticos que afeta a produção de melanina, podendo levar à hipopigmentação da pele, dos pêlos, cabelos e olhos. O objetivo deste trabalho foi analisar aspectos genéticos e agravos à saúde decorrentes do albinismo oculocutâneo. Foi feita uma amostragem de conveniência, utilizando-se como instrumento de coleta de dados questionários semi-estruturados aplicados a 40 probandos (23 mulheres e 17 homens) de famílias associadas a APALBA (Associação dos Portadores de Albinismo da Bahia). Os albinos eram filhos de pais normalmente pigmentados, portadores do alelo recessivo mutante. A maioria (65%) refere hereditariedade, com mais de um caso na família, e origem étnica predominantemente negra. A ocorrência do albinismo está associada a dificuldades e desvantagens, conseqüências do distúrbio genético e da segregação social. O diagnóstico usual do albinismo segue critérios clínicos, embora já existam métodos laboratoriais que identificam algumas mutações. A falta de assistência aos afetados contribui para a baixa da visão e a ocorrência de câncer de pele. O estudo indica a necessidade de um novo modelo de atendimento ao albino, com medidas de prevenção aos danos à saúde, que também incluam, nos casos indicados, testes laboratoriais com técnicas da biologia molecular que possam contribuir para o aconselhamento genético da condição. </span>
<!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:AllowPNG /> </o:OfficeDocumentSettings> </xml><![endif]--> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><span style="line-height: 15px;">Introdução: A produção de melanina é uma forma de proteção natural da pele contra a radiação ultravioleta e seus efeitos </span><span style="line-height: 15px;">deletérios, tais quais cânceres de pele. Devido à sua reduzida produção, pessoas de pele clara apresentam maiores chances de </span><span style="line-height: 15px;">desenvolver tais quadros. Objetivo: O presente estudo teve o objetivo de relacionar os efeitos da exposição solar à ocorrência de </span><span style="line-height: 15px;">lesões cancerígenas na presença de hipopigmentação cutânea. Metodologia: Realizou-se pesquisa retrospectiva em centro público </span><span style="line-height: 15px;">de tratamento ao câncer, no estado da Bahia, referente ao atendimento de indivíduos com lesões cancerígenas cutâneas (22 albinos </span><span style="line-height: 15px;">e 30 com pigmentação normal), com complementação dos dados por entrevistas a membros da Associação dos Portadores de </span><span style="line-height: 15px;">Albinismo no Estado da Bahia, com prévia obtenção do consentimento informado. Resultados: A média de idade de indivíduos </span><span style="line-height: 15px;">albinos com neoplasias foi de 34,6 anos, e 65,1 anos para indivíduos não albinos, atendidos no centro de tratamento. Entre os </span><span style="line-height: 15px;">pacientes com tumores, 42,89% dos albinos e 80% dos pacientes não albinos referiam exposição solar de forma prolongada. Nos </span><span style="line-height: 15px;">albinos com câncer de pele, verificou-se que 56% apresentaram carcinoma basocelular, o tipo de câncer de pele mais comum no </span><span style="line-height: 15px;">Brasil e com maiores chances de cura. Conclusão: A exposição ao sol sem proteção constitui um fator de risco para a ocorrência </span><span style="line-height: 15px;">de lesões cancerígenas em indivíduos albinos.</span></p> <!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves /> <w:TrackFormatting /> <w:HyphenationZone>21</w:HyphenationZone> <w:PunctuationKerning /> <w:ValidateAgainstSchemas /> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF /> <w:LidThemeOther>PT-BR</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables /> <w:SnapToGridInCell /> <w:WrapTextWithPunct /> <w:UseAsianBreakRules /> <w:DontGrowAutofit /> <w:SplitPgBreakAndParaMark /> <w:EnableOpenTypeKerning /> <w:DontFlipMirrorIndents /> <w:OverrideTableStyleHps /> </w:Compatibility> 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<div>Introdução: A ausência congênita da melanina, um fator de proteção à exposição solar, confere aos indivíduos com albinismo um risco elevado de desenvolver tumores malignos de pele. O teste do micronúcleo destaca-se entre os ensaios biológicos para o monitoramento de indivíduos sob risco carcinogênico. Em células da mucosa oral, uma frequência elevada de micronúcleos é indicativa de altas taxas de mutação e tem sido relacionada ao desenvolvimento de carcinomas neste tecido. Objetivo: O objetivo deste trabalho foi avaliar a eficácia do ensaio de micronúcleos como bioindicador de genotoxicidade em indivíduos com albinismo</div><div>e relato pregresso de câncer de pele. Metodologia: Foram amostrados 6 indivíduos com albinismo óculocutâneo e histórico de câncer de pele, já apresentando cura clínica, comparados a grupos controles constituídos de 10 de indivíduos albinos sem histórico de câncer e oito indivíduos sem distúrbios de pigmentação, nem histórico pregresso de câncer. Em cada indivíduo foram analisadas</div><div>1000 células. Resultado: Verificou-se um aumento significativo (P=0.003) na frequência de micronúcleo em pessoas albinas com história de câncer em relação aos controles. Conclusão: A realização de testes de micronúcleo em sujeitos em fase de tratamento pode ser uma alternativa para validação do referido teste como indicativos de danos genotóxicos associados ao câncer.</div>
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