High Prevalence Of Cases Research Articles

Osteomielitis en Brasil: Un análisis epidemiológico de 2019-2023

Introduction Osteomyelitis is a bone infection characterized by the progressive destruction of cortical bone and medullary cavity, and is a relevant disease due to its probable deleterious consequences for patients. Objective: The study aims to investigate the epidemiology of osteomyelitis in Brazil, focusing on hospitalizations by the SUS (Unified Health System) and deaths between 2019 and 2023, to understand regional disparities. Methodology: A cross-sectional descriptive study, with a quantitative approach to the data, through secondary data collected in the Department of Computer Science of the SUS (DATASUS). The data refer to hospital morbidity due to osteomyelitis during the years from 2019 to 2023, with the period evaluated being from January 2019 to December 2023. Results: There were 71,817 hospitalizations for osteomyelitis in Brazil. The Southeast region had the highest prevalence of cases (40.59%) and reached a higher mortality rate than the other regions. It was noted that the ages most affected by the disease are between 40 and 49 years old. Finally, it was verified that in all regions the male sex is more affected than the female sex. Conclusion: Some risk groups were identified in the study; among them, the male sex, age between 40-49 years and the Southeast region due to the high mortality rate from the disease. The high prevalence of the disease and its high morbidity and mortality reinforce the need for early diagnosis and appropriate treatment.

Geospatial determinants and spatio-temporal variation of early initiation of breastfeeding and exclusive breastfeeding in Ethiopia from 2011 to 2019, a multiscale geographically weighted regression analysis

BackgroundBreastfeeding offers numerous benefits for infants, mothers, and the community, making it the best intervention for reducing infant mortality and morbidity. The World Health Organization (WHO) recommends initiating breastfeeding within one hour after birth and exclusively breastfeeding for the first six months. This study investigated the trend, spatio-temporal variation, and determinants of spatial clustering of early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) in Ethiopia from 2011 to 2019.MethodsData from the Ethiopian Demographic and Health Survey (EDHS), which was conducted in 2011, 2016, and 2019, were analyzed utilizing a weighted sample of 10,616 children aged 0–23 years for EIBF and 2,881 children aged 0–5 months for EBF. Spatial autocorrelation analysis was used to measure whether EIBF and EBF were dispersed, clustered, or randomly distributed and Kriging interpolation was employed to predict the outcome variables in the unmeasured areas. Spatial scan statistics were used to identify spatial clusters with a high prevalence of cases. Both global and local regression modeling techniques were employed to examine the spatial relationships between the explanatory variables and the dependent variables.ResultsThe trend analysis revealed a notable increase in the prevalence of EIBF from 51.8% in 2011 to 71.9% in 2019. Similarly, the prevalence of EBF increased from 52.7% in 2011 to 58.9% in 2019. Spatial analysis demonstrated significant spatial variation in both EIBF and EBF throughout the country. Cold spots or clusters with a low prevalence of EIBF were observed consistently in the Tigray and Amhara regions, and significant cold spot areas of EBF were observed consistently in the Afar and Somali regions. Multiscale geographically weighted regression analysis revealed significant predictors of spatial variations in EIBF, including the religious affiliation of being a follower of the orthodox religion, parity of 1–2, absence of antenatal care visits, and delivery via cesarean section.ConclusionsDespite the increase in both EIBF and EBF rates over time in Ethiopia, these rates still fall below the national target. To address this issue, the government should prioritize public health programs aimed at improving maternal healthcare service utilization and maternal education. It is essential to integrate facility-level services with community-level services to achieve optimal breastfeeding practices. Specifically, efforts should be made to promote breastfeeding among mothers who have delivered via cesarean section. Additionally, there should be a focus on encouraging antenatal care service utilization and adapting maternal healthcare services to accommodate the mobile lifestyle of pastoralist communities. These steps will contribute to enhancing breastfeeding practices and achieving better outcomes for maternal and child health.

RETROSPECTIVE STUDY OF RENAL OCCURRENCES IN THE HOSPITAL UNOESTE VETERINARY BETWEEN 2018 AND 2019 - PRESIDENTE PRUDENTE/SP

With the increase in the life expectancy of domestic animals, some diseases have become common in the veterinary routine, with chronic kidney disease (CKD) being one of these frequent pathologies. Chronic kidney disease is characterized by irreversible structural damage, which progresses progressively to uremia and renal failure. To establish clinical manifestations, IRIS (International Renal Interest Society) developed a guide for classifying the disease into 4 stages based on serum creatinine levels, proteinuria, clinical manifestations of disease progression. The present study aimed to make a retrospective study of the occurrence of chronic renal failure in the veterinary hospital of the Universidade do Oeste Paulista, campus of Presidente Prudente SP. Thus, a survey was carried out of the general registration data of patients seen in the years 2018 and 2019. Information on age, gender, anamnesis, blood count, serum biochemical tests and ultrasound examinations were obtained from the medical records. The patients were classified according to the stage of the disease, of the 217 files analyzed, 85 were in stage I, 18 in stage II, 46 in stage III and 47 in stage IV, a higher prevalence of cases was observed in animals over 9 years old deity. In addition, it was possible, through the evaluation of the records, to verify the importance of implementing a care and follow-up form for patients with suspected/diagnosed chronic kidney disease and thus be able to qualitatively evaluate routine cases.

Male rape in Brazil: A descriptive analysis from 2010 to 2022

Male rape is a relatively under-discussed topic in scientific literature, despite its significant relevance and prevalence worldwide, including in Brazil. To inform public health and safety policies, this study aimed to analyze cases of male rape using data from SINAN, the Information System for Notifiable Diseases, a division of the Brazilian Ministry of Health, for the years 2010–2022. Our findings reveal a 469 % increase in male rape cases in the country over the study period, with a predominance of cases in the state of São Paulo. Also, a higher prevalence of cases was observed among individuals aged 5–9 years. Furthermore, we identified a correlation between the occurrence of rape and certain factors, including individuals with less than 4 years of formal education if they were over the age of 50, and those who had a history of being sexually abused between the ages of 5 and 14. Additionally, this study reinforces the prevalence of rape cases occurring within domestic environments and perpetrated by individuals closely related to the victims. This study contributes to filling the gap in research on male rape in Brazil, laying the foundation for the development of strategies to prevent and combat rape in the country.

Social and economic variables explain COVID-19 diffusion in European regions

At the beginning of 2020, Italy was the country with the highest number of COVID-19 cases, not only in Europe, but also in the rest of the world, and Lombardy was the most heavily hit region of Italy. The objective of this research is to understand which variables have determined the prevalence of cases in Lombardy and in other highly-affected European regions. We consider the first and second waves of the COVID-19 pandemic, using a set of 22 variables related to economy, population, healthcare and education. Regions with a high prevalence of cases are extracted by means of binary classifiers, then the most relevant variables for the classification are determined, and the robustness of the analysis is assessed. Our results show that the most meaningful features to identify high-prevalence regions include high number of hours spent in work environments, high life expectancy, and low number of people leaving from education and neither employed nor educated or trained.

In vitro evaluation of Sporothrix brasiliensis biotherapic: complete results

Background: Sporothrix brasiliensis is a fungus that affects animals, mainly felines, and humans. The infection can present as subcutaneous or disseminated form in the organism. Rio de Janeiro, Brazil, is a state with high prevalence of cases in felines. Currently, the standard treatment is realized during a long period and using itraconazole, that causes important adverse effects. Objective: The aim of this research was to evaluate in vitro effect of Sporothrix brasiliensis biotherapic in the fungus used to prepare this medicine, also considering the association to itraconazole. Methodology: Yeast cells of S. brasiliensis (ATCC MYA 4823) were cultured in Brain Heart Infusion (BHI) during 3 to 5 days. The biotherapic 30 DH was prepared according to Brazilian Homeopathic Pharmacopoeia, using 5 x 107 yeasts/mL. Two biotherapics were prepared: using inactivated fungus by autoclave (Sb1) and viable yeasts (Sb2). Both biotherapics were evaluated individually and associated to itraconazole. The control groups were: water, diluted water, water 30 DH, and dimethylsulfoxide (vehicle to dissolve itraconazole), and itraconazole. The minimum inhibitory concentration (MIC) experiments were carried out, considering the CLSI (Clinical & Laboratory Standards Institute) guidelines. Results: The treatments using only biotherapic did not reduced the yeast viability, as observed in the controls. However, the higher concentrations of itraconazole and of this drug associated with biotherapic reduced the viability of S. brasiliensis. Then, the observed effect was attributed to itraconazole. Conclusion: As expected, it was not detected the effect of both biotherapic in the viability of microorganism itself, due to the integrality aspects of homeopathy, because the homeopathic medicine emphasizes the whole organism’s response to the symptoms presented. Then, the next step is to evaluate the biotherapic in an in vivo model, that will be a complete organism representing the host to this infection.

Covid-19 impacts: Ethnic and regional inequalities in sickle cell disease patient care in Brazil

Brazil is a continental country with significant socioeconomic and ethnic inequalities. It is important to understand how these differences are reflected in health care, especially during the COVID-19 pandemic. We investigated the potential impacts of the reduced number Transcranial Doppler Ultrasound (TCD) tests performed in Brazil during the COVID-19 pandemic, and its reflections according to region and race/color for patients with Sickle Cell Disease (SCD). This study performed data queries from the Brazilian Ministry of Health, literature research, and quantitative analysis using descriptive statistical analysis. We found evidence for a decrease in the number of TCD tests performed during the pandemic (−83 %) relative to the same non-pandemic period, and disparities in tests given in five regions in Brazil. Our data show, that in absolute numbers, most people with SCD are brown, but the highest prevalence of cases was among blacks. We also found evidence for racial discrimination when performing TCD test, which leads us to believe that the Brazilian Unified Health System (SUS) may be susceptible to racism when treating this disease. The implications of these findings serve as a warning to other countries with high indices of mixed ancestry in formulating health care policies for patients with SCD.

Appraisal of Health Sector Responses to Covid-19 at National and Sub-National Levels: Case Study of States with Highest Prevalence of Cases-Lagos, Kaduna and FCT Assessment of Health Sector Responses to Covid-19 at Selected States with Highest Prevalence of Cases

The Covid-19 pandemic is the largest and longest outbreak in modern times, with socio-economic, political, and educational disruptions. This study was to appraise the level of efforts and the impact of these interventions in the health sector. A mixed methodology approach involving quantitative research techniques. The study revealed that there was generally a high level of awareness and good compliance to government policies and guidelines on Covid-19 regulations being highest in Lagos state compared to FCT and Kaduna state. The public perception of the use of facemask and its enforcement and handwashing practices by health facilities was rated high across the three states. Client education and public perception of Covid-19 counselling was different across the three states, being highest in Lagos in comparison to FCT and Kaduna. Hence the study recommended refreshers training of health workers on awareness creation and counselling of clients at all levels of care. Keywords: Assessment, Covid-19, Health system strengthening.

Sociodemographic and obstetric profiles of fetal deaths due to intrauterine hypoxia and birth asphyxia in Brazil

This article aims to analyze the clinical and epidemiological data of mortality due to intrauterine hypoxia and birth asphyxia in Brazil, focusing on the social determinants of the health of fetuses and pregnant women. It is an epidemiologic, quantitative, cross-sectional, and descriptive study. Its object of study was the notifications of deaths by the above-mentioned condition in Brazil between January 1996 and December 2021. The data were collected from the database of the Sistema de Informações sobre Mortalidade (SIM). 219.850 deaths were recorded in Brazil. The Brazilian states with a high prevalence of cases are São Paulo, Rio de Janeiro, Bahia, Minas Gerais, and Pernambuco. The predominant social characteristics of the fetuses were male, and brown, with 500 and 999 grams. 74.25% of the deaths occurred before birth. Young pregnant women (between 15 and 29 years of age) with a medium level of education were the most predisposed. Pregnancies between 32 and 41 weeks, singleton pregnancies, and vaginal deliveries were relevant in determining mortality. 93.47% of deaths occurred in a hospital setting.

Outcomes of Helicobacter pylori (HP) infection in esophageal cancer (EC): A 5-year nationwide analysis.

e16079 Background: EC is a fatal condition, and recent literature suggests the association of HP with esophageal adenocarcinoma. In this study, we elucidate the outcomes of HP infection in EC. Methods: This is a retrospective longitudinal study from 2016-2020, using the nationwide inpatient sample database in the United States (US). Patients with EC with and without HP infection were selected. The baseline characteristics were compared using a T-test and Chi-Square. Multivariate regression analysis was applied to estimate the outcomes (length of hospital stay (LOS), mortality, and morbidity) while adjusting for patient and hospital confounders. We used STATA Version 17.0 for data analysis. The p-value was set at p < 0.05 for statistical significance. Results: In total, 69,144 patients with esophageal cancer were identified; among them, 0.3% (n= 220) had an HP infection. The highest prevalence of cases was seen in the Southern US (35.7%). The average LOS was 3.39 days (p = 0.01), and reduced mortality (p = 0.002). The Charlson comorbidity index (CCI) score was 3 or more for 74.2% (p=0.005). With regards to outcomes, 16.4% (p< 0.05) had esophageal obstruction, 20.2% (p< 0.05) had anemia, and 8% (p < 0.01) underwent esophagectomy. However, no significant differences in the rates of hematemesis 4.4% (p=0.15), melena 2.5% (p=0.28), or esophageal perforation 1.2% (p=0.45) were reported (Table 1). When compared to patients with HP infection, no statistically significant difference was found in the outcomes. Conclusions: Our study indicates a significantly increased prevalence of EC in the southern regions of the US, which may be attributed to regional differences in lifestyle, diet, and access to healthcare. The study population was predominantly admitted with a CCI score of 3, highlighting the burden of comorbid conditions. EC patients had decreased LOS and mortality trends in the past 5 years. Moreover, EC was associated with higher rates of esophageal obstruction and anemia. However, no effect on hematemesis, melena, and esophageal perforation was appreciated, and no statistically significant difference was found in the outcomes of EC with HP infection.[Table: see text]

Quantitative Polymerase Chain Reaction from Malaria Rapid Diagnostic Tests to Detect Borrelia crocidurae, the Agent of Tick-Borne Relapsing Fever, in Febrile Patients in Senegal.

In endemic malaria areas, Plasmodium is currently diagnosed mainly through the use of rapid diagnostic tests (RDTs). However, in Senegal, many causes of fever remain unknown. Tick-borne relapsing fever, an often-neglected public health problem, is the main cause of consultation for acute febrile illness after malaria and flu in rural areas. Our objective was to test the feasibility of extracting and amplifying DNA fragments by quantitative polymerase chain reaction (qPCR) from malaria-negative RDTs for Plasmodium falciparum (malaria Neg RDTs P.f) to detect Borrelia spp. and other bacteria. Between January and December 2019, malaria Neg RDTs P.f were collected on a quarterly basis in 12 health facilities in four regions of Senegal. The DNA extracted from the malaria Neg RDTs P.f was tested using qPCR and the results were confirmed by standard PCR and sequencing. Only Borrelia crocidurae DNA was detected in 7.22% (159/2,202) of RDTs. The prevalence of B. crocidurae DNA was higher in July (16.47%, 43/261) and August (11.21%, 50/446). The annual prevalence was 9.2% (47/512) and 5.0% (12/241) in Ngayokhem and Nema-Nding, respectively, health facilities in the Fatick region. Our study confirms that B. crocidurae infection is a frequent cause of fever in Senegal, with a high prevalence of cases in health facilities in the regions of Fatick and Kaffrine. Malaria Neg RDTs P.f are potentially a good source of pathogen sampling for the molecular identification of other causes of fever of unknown origin, even in the most remote areas.

Medicolegal Aspect Analysis of Burn Cases in Liaquat University Hospital, Hyderabad

Background: Owing to the high potential of physical injuries, disabilities and even deaths resulting from burn-related injuries, these are considered as injuries of medico-legal importance. The study aims to investigate the medico-legal aspects of selective cases of burn victims admitted to the Burn unit of Liaquat University Hospital, Hyderabad.
 Methodology: This study was conducted at the Burn unit of Liaquat University Hospital, Hyderabad. The information on burn patients was collected retrospectively from the record for the period of three years from January 2018 to December 2020 from the Burn unit. The data related to socio-demographic details, site, cause, severity and outcome of burn cases was recorded.
 Results: Total 418 victims record was evaluated; the highest prevalence of cases was in the age group of 0-10 years (60.6%). Majority; 58.8% of the victims were males. In more than half (52.6%) of the victims, 20% or less body area was burnt. In 34.2% cases, 21-40% area was burnt. About 48.1% of cases were of wet scalds and 40.2% dry flame burns. About 7.6% were cases of electrocution. Male and female burn victims demonstrated statistically significant difference (p<0.05) regarding site of burn, side, source, manner and survival from burn injuries.
 Conclusion: Males are more affected by burns than their counterpart while children ≤ 10 years are most commonly reported with burn injuries. Wet scald is the most common type of burn while most victims present with ≤20% burnt body area.
 Key Words: Accidental injuries, Burns, Suicide

SOCIALIZATION OF THE USE OF ANTIHYPERTENSIVE DRUGS IN THE INPATIENT INSTALLATION OF GRANDMED HOSPITAL LUBUK PAKAM

Hypertension is a chronic disease that is one of the causes of death in the world. Every year these cases are constantly increasing. It is estimated that by 2025 it is predicted that around 29% of the world's population will be affected by hypertension. WHO mentioned that in some developing economies it is around 40% while developed countries are 35% lower. Indonesia occupies an incidence percentage of 32% of the total population. Patients are often unaware of the rise in blood pressure before a physical examination is performed. In addition, patients suffering from this disease also have the potential for complications with other diseases. The high prevalence of cases causes the use of antihypertensive drugs to increase. Along with this, there are many cases of irrationality of treatment. Therefore, optimal therapy is needed in dealing with this disease so that we can suppress the incidence rate and the quality of life of patients can increase. Evaluation of the accuracy of the use of this drug is very necessary considering that it is very closely influential with the quality of life of the patient. Research has been conducted to see whether or not the rational use of hypertension drugs in hospitals has been carried out. Grandmed based on several criteria, namely the right patient, indications, medications, and the right dosage. The data is taken from the patient's medical record. Of the 36 obtained exactly 100% patients, the right indication 100%, the right drug 86% , and the exact dose 94%. This socialization is mainly aimed at pharmacy students so that it can be developed as a reference in hypertension therapy in the future.

Epidemiological profile of patients with malignant Brain tumors in Rio Grande do Sul state - Brazil

To determine the epidemiological profile of patients diagnosed with primary malignant brain tumors in the state of Rio Grande do Sul/RS, Brazil, from 2013 to 2019. This is a descriptive, retrospective study with a quantitative approach, carried out through analysis of secondary data collected at the Information Technology Department of the Unified Health System (DATASUS). One thousand five hundred and fifty-eight cases of malignant primary brain tumor were diagnosed. The highest prevalence of cases occurred among men (55.78%) and among individuals aged 40 to 59 years (28.34%). The macro-region with the highest incidence was the Metropolitan (45.64%). An expansion of the database is necessary, mainly in some pathological characteristics such as location of the neoplasm, histological type and morbidity and mortality and patient characteristics such as race to better predict risk factors, prevention and diagnosis.

Cold-Season Epidemic Dynamics of COVID-19 in Two Major Metropolitan Areas in Greece: Hypotheses and Implications for Public Health Interventions.

Many respiratory viruses, including coronaviruses, follow seasonal transmission dynamics. Analyzing the social and environmental mechanics of the emergence of SARS-CoV-2 over the first cold season provides insight into designing targeted interventions. We analyzed all fully anonymized SARS-CoV-2 case data in two metropolitan areas, Attika and Thessaloniki, diagnosed between September 1st and December 31st, 2020. The emergence of the second wave in Greece occurred in October-November. SARS-CoV-2 diagnoses in Thessaloniki increased quasi-exponentially in mid-October, coinciding with the increase in the proportion of diagnoses in young people aged 18–39. The same pattern was observed in Attika with an almost 2-week delay, even though Attika had a higher prevalence of cases throughout summer until the second wave. Crucially, the nighttime temperature in Thessaloniki dropped below 18°C 3 weeks earlier than that in Attika. Epidemic growth was independently associated with the proportion of cases attributed to the 18–39 age group as well as with the drop in nighttime temperature below 18°C in both metropolitan areas but with a time difference. This pattern can be explained by a shift of nighttime entertainment activities from open-air to closed spaces, which occurs as nighttime temperature drops. Vaccination of young individuals can be crucial in decelerating the cold-season dynamics of SARS-CoV-2.

PREVALENCE OF DENGUE HEMORRHAGIC FEVER IN BALI FROM 2015 TO 2020 AND DURING THE COVID-19 PANDEMIC

Background: Dengue hemorrhagic fever cases increased significantly during the COVID-19 pandemic phase. Purpose: This study defines, describes, and evaluates the dengue hemorrhagic fever incidence in Bali Province from 2015 to 2020 and in the context of the COVID-19 pandemic. Methods: The various types of descriptive study with case series design. The study used an environmental epidemiology approach to analyze the health profile of Bali Province. The number of DHF cases in 2015-2020, DHF-related morbidity and death rates, larva-free rates, climate, population and population density, and gender were variables in this study. The study took place in May and June 2021. Results: The prevalence of dengue hemorrhagic fever in the province of Bali fluctuated between 2015 and 2020. The highest number of dengue cases in 2016 was 20,306, and they fell from 2017 to 2019. Cases doubled in 2020, up by 12,173. The endemic areas with the highest prevalence of cases are in the districts of Buleleng and Badung. The highest incidence rate was in 2016 at 483/100,000 population, and for the last five years, it has not met the national target of 49/100,000 population. The highest CFR figure in 2020 was 0.43%, an increase of 1.5 times during the COVID-19 pandemic. Conclusion: The prevalence of dengue hemorrhagic fever cases in Bali in 2015 – 2020 fluctuated significantly, and mortality due to dengue during the COVID-19 pandemic experienced a significant increase.

Epidemiological characterization and spatial distribution of visceral leishmaniasis cases in Três Lagoas - MS, Brazil in the period of 2007-2021

This retrospective observational cross-sectional study aimed to analyze the distribution of visceral leishmaniasis (VL) cases in Três Lagoas registered between January 2007 and August 2021, through data processed by the Epidemiological Surveillance Service based on the notification of the National System of Diseases and Notifications. In this period, 231 cases were confirmed, being 137 male (59.3%) and 94 female (40.7%). Was observed a higher prevalence of cases between ages 0-4 years (30.8%), 20-39 (22.5%) and 40-59 (19.9%). Also was observed a higher percentage of infected Caucasian individuals (45.4%) and individuals with low education: elementary school II (22.1%). The most prevalent clinical manifestations were fever (85.3%), splenomegaly (76.6%), weakness (67.1%), weight loss (65.8%) and hepatomegaly (62.8%). It was found that 80.1% of patients received pharmacological treatment, mainly using pentavalent antimonials (56.7%), and that 26 patients (11.3%) died during the period due to complications caused by VL. The spatial analysis showed a homogeneous distribution of VL cases in the city's urban perimeter without predominant regions. Finally, it was observed that the incidence and mortality by VL has been decreasing in recent years, however maintaining high rates of lethality and transmissibility, placing the municipality in the third with the highest transmission rate in the state. In view of these aspects, we conclude that VL is still a serious public health problem in the city and that despite the slight drop in incidence and mortality rates, it still presents values higher than the national average and high dissemination of the disease in the urban area.

Influence Of HIV/AIDS Policy Implementation Factors on The Performance Of Aids Commission (KPA) In Nabire Regency

Papua Province comes first nationally with the highest number of HIV/AIDS cases in Indonesia. Meanwhile at the provincial level, Nabire Regency has the highest number of HIV and AIDS cases. The HIV epidemic in Nabire Regency is classified as a generalized epidemic with the highest prevalence of cases among women, which is said to be the highest in Papua Province. The problem of HIV / AIDS is not only a health problem, but also a social problem that needs to be addressed. This has led to the formulation of public policies in the form of HIV / AIDS prevention policies. The establishment of AIDS Commission in Nabire Regency (KPAK Nabire) is one of the government's efforts to involve the general public in helping to tackle HIV / AIDS cases in Nabire Regency. In connection with the phenomenon of the problem at hand, this study aims to analyze the influence of policy implementation factors on organizational performance.
 This study applied primary data obtained through questionnaires with a final sample of 80 respondents. Data analysis was done to describe the variables using SPSS Statistics, to evaluate the research model using the SEM (Structural Equation Modeling) technique, and to test the mediation effect using the Sobel test.
 The results showed that only resource factors, bureaucratic structure, communication and disposition of the implementors that directly and indirectly influence the performance of KPAK Nabire. Meanwhile, environmental conditions did not affect the performance of KPAK Nabire. The implementor disposition mediates the influence of the factors of policy implementation on organizational performance. The analysis results also show that disposition of the implementor is the most dominant predictor of KPAK Nabire's performance.

Aspectos epidemiológicos e distribuição de casos de esquistossomose no Nordeste brasileiro no período de 2010 a 2017

OBJETIVO: Analisar aspectos epidemiológicos de casos de esquistossomose na região do Nordeste brasileiro notificados no Sistema Nacional de Agravos e Notificação (SINAN) no período de 2010 a 2017. METODOLOGIA: Trata-se de estudo epidemiológico descritivo observacional. A coleta dos dados secundários foi realizada através do SINAN e submetidos a análise estatística descritiva, por meio de frequência absoluta e frequência relativa, apresentados na forma de gráficos e tabelas utilizando o Excel 2016. RESULTADOS: No período foram notificados 10.431 casos, sendo os anos de 2010 seguido de 2014 e 2015 que mais se destacaram. Os estados do Nordeste com maior número de casos foram Bahia com 5.183 casos, Pernambuco com 2.330, Paraíba com 857 e Sergipe com 769. A análise do perfil biológico dos infectados, no que se refere ao sexo, mostrou que a maior proporção de infectados é do sexo masculino (54%) e as faixas etárias com maiores índices de infecção, foram 20 a 39 anos com 34,68% e de 40 a 59 anos com 28,89%. CONCLUSÃO: A esquistossomose é um grande problema de saúde pública, portanto, é indispensável ações e divulgação das regiões endêmicas para construção de intervenções sobre o controle da doença, enfatizando o atendimento e fazendo busca ativa da população.

Has the time come to integrate genetic risk scores into clinical practice?

Abstract Background The risk for Coronary Artery Disease (CAD) is determined by both genetic and environmental factors, as well as by the interaction between them. It is estimated that genetic factors could account for 40% to 55% of the existing variability among the population (inheritability). Therefore, some authors have advised that it is time we integrated genetic risk scores into clinical practice. Aim The aim of this study was to evaluate the magnitude of the association between an additive genetic risk score (aGRS) and CAD based on the cumulative number of risk alleles in these variants, and to estimate whether their use is valuable in clinical practice. Methods A case-control study was performed in a Portuguese population. We enrolled 3120 participants, of whom 1687 were CAD patients and 1433 were normal controls. Controls were paired to cases with respect to gender and age. 33 genetic variants known to be associated with CAD were selected, and an aGRS was calculated for each individual. The aGRS was further subdivided into deciles groups, in order to estimate the CAD risk in each decile, defined by the number of risk alleles. The magnitude of the risk (odds ratio) was calculated for each group by multiple logistic regression using the 5th decile as the reference group (median). In order to evaluate the ability of the aGRS to discriminate susceptibility to CAD, two genetic models were performed, the first with traditional risk factors (TRF) and second with TRF plus aGRS. The AUC of the two ROC curves was calculated. Results A higher prevalence of cases over controls became apparent from the 6th decile of the aGRS, reflecting the higher number of risk alleles present (see figure). The difference in CAD risk was only significant from the 6th decile, increasing gradually until the 10th decile. The odds ratio (OR) for the last decile related to 5th decile (median) was 1.87 (95% CI:1.36–2.56; p<0.0001). The first model yielded an AUC=0.738 (95% CI:0.720–0.755) and the second model was slightly more discriminative for CAD risk (AUC=0.748; 95% CI:0.730–0.765). The DeLong test was significant (p=0.0002). Conclusion Adding an aGRS to the non-genetic risk factors resulted in a modest improvement in the ability to discriminate the risk of CAD. Such improvement, even if statistically significant, does not appear to be of real value in clinical practice yet. We anticipate that with the development of further knowledge about different SNPs and their complex interactions, and with the inclusion of rare genetic variants, genetic risk scores will be better suited for use in a clinical setting. Funding Acknowledgement Type of funding source: None