The control of American visceral leishmaniasis (AVL) is based on combating the vector and eliminating the domestic reservoir of the focus area - defined as 200 meters around human or canine cases. This paper discusses the use of spatial analysis techniques in the epidemiological surveillance of AVL in Araçatuba, São Paulo State, in order to propose a model for territorial epidemiological surveillance, reformulating current control strategies. The results showed that AVL transmission was not homogeneous; human cases were more frequent in areas with higher canine prevalence rates. Vector dispersion appeared to be restricted to a few houses, although it was not possible to model the vector density. In order to study the vector distribution and correlated covariates, a field study based on house sampling is being conducted. The results will aid the development of new spatial analysis tools and possibly redefine protocols and routines for the control of this endemic disease in urban areas.

Adolescent↗

PubMedDate not supplied

[Deaths caused by venomous snakes in the State of São Paulo: evaluation of 43 cases from 1988 to 1993].

UNLABELLED: The prognostic factors and the causes for obit occurrence in ophidian envenoming are yet not completely clear. PURPOSE: To determine the prognostic factors and the most probable causes for obit occurrence in ophidian envenoming. METHODS: In the State of São Paulo were notified 12,639 cases of accidents by venomous snakes from 1988 to 1993. There were 43 deaths (0.34%). The variables from the accident notification reports were compared with the promptuary notes and/or with the death records (in lethal cases). RESULTS: The snake genus was classified in 11,297 accidents and in 41 from the lethal ones. Bothrops was responsible for 9,828 (87%) accidents and 28 (68.3%) deaths, Crotalus for 1,359 (12.0%) accidents and 13 deaths (31.7%) and Micrurus for 110 (1%) accidents and no death (p < 0.05). The information regarding to sex and age of the patients was available, respectively, in 12,620 and 12,527 accidents and in all lethal ones. There were 9,783 (77.5%) male patients in the accidents and 35 (81.4%) in the lethal cases (p > 0.05). Regarding to age, 15.9% of the patients and 41.8% of the ones who died were 50 years-old or more (p < 0.05). The most frequently bitten anatomic regions were: foot (42.2%), hand (20.6%), leg (17.6%), and ankle (13.1%) in the accidents, and foot (35.7%) and leg (35.7%) in the lethal cases (p < 0.05). Coagulation disorders occurred in 34 (91.9%) from 37 patients who died (those where this datum was available). The information above was not available in non lethal cases. The most common manifestations and complications implicated as possible death causes were: acute renal failure (34-79.1%), acute respiratory failure (28-65.1%), shock (18-41.9%), and sepsis (18-41.9%). Among all lethal cases but one without information, 29.4% of the patients died within the first two days after bite and 67.6% within the first 5 days. Acute respiratory failure was most common among the patients who died owing to crotalic envenoming, and sepsis was only seen in bothropic envenoming. CONCLUSION: Most of the accidents and obits are caused by Bothrops; Crotalus envenoming, leg bites, and accidents in 50 year-old patients (or more) are frequently lethal; the most common complication in lethal cases is acute renal failure.

Adult↗

PubMedDate not supplied

Influence of an interdisciplinary diabetes specialist team on short-term outcomes of diabetes at a community health center.

OBJECTIVE: To assess the effect on short-term diabetes outcomes of intervention with an interdisciplinary diabetes specialist team at a primary-care community health center in East Harlem, New York City. METHODS: An interdisciplinary diabetes specialist team, consisting of a diabetologist, a bicultural certified diabetes nurse-educator, and a nutritionist, attended weekly clinics at a primary-care community health center in East Harlem. Emphasis was placed on communicating in the patient's primary language and providing nutritional counseling, diabetes education, and diabetes management. After 1 year, a retrospective review of medical records for patients seen by the diabetes team was performed to assess the influence of this intervention on performance of home glucose monitoring (HGM), frequency of hypoglycemia, and changes in diabetes treatment regimens. Of 70 patients referred to the diabetes team by their primary-care providers, 50 underwent follow-up for at least 6 months and were included in the statistical analysis. RESULTS: Of the 50 study patients, 94% had type 2 diabetes, with a mean duration of 11.2 years. Eighty-two percent were Hispanic, and 18% were Afro-American. The mean age was 54.6 years. Microvascular complications were present in 44%, and macrovascular complications were present in 22%. HGM was done by 13 patients (26%) before and 33 patients (66%) after diabetes team intervention (P<0.001). Before intervention by the diabetes team, 14 patients (28%) were having episodes of unrecognized hypoglycemia. Unrecognized hypoglycemia resolved after intervention in all but two patients with type 1 diabetes (P<0.001). Before intervention, diabetes treatment was dietary in 6 patients, a sulfonylurea in 19, and insulin in 25; after intervention, 5 patients had dietary management of their diabetes, 14 were taking a sulfonylurea, and 31 were receiving insulin (P<0.05). CONCLUSION: Providing access to an interdisciplinary diabetes specialist team at the site of primary care had a beneficial effect on short-term diabetes outcomes in inner-city Hispanic and Afro-American patients with diabetes. Providing specialty care in the primary-care setting may be one model for improving the quality and long-term outcomes of diabetes care, particularly in high-risk populations.

Journal Article↗

PubMedDate not supplied

Dentistry in the future roles and activities of hospitals.

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Dental Service, Hospital↗

PubMedDate not supplied

[Psychiatric hospital. The years 1935-1945. A computerized study].

Studying the files collected during a 11-years stay in a psychiatric hospital, the authors wonder about the patients' characteristics in those days, and especially about the recorded diagnoses. They show the patients' evolution and notably the fact that most of them became institutionalized. They also underline the huge percentage of psychotics as opposed to the small number of deteriorations resulting from age, times and rural environment allowing older people to continue their life at home.

Adult↗

PubMedDate not supplied

[Epidemiology of tetanus in São Paulo State (Brazil)].

Tetanus is a reportable disease in the State of São Paulo since 1978. The data from this source show a trend toward a decrease in the incidence of tetanus, although it is still higher than in the developed countries. There is a constantly high mortality rate. We have studied 133 cases of non-neonatal tetanus that had been reported to the Epidemiology Surveillance Center of the State of São Paulo in 1989. The data we analysed were obtained from the epidemiological report form routinely used during the investigation and confirmation of the cases. The incidence was 0.41 per 100.000 population and the mortality rate was 44.36%. It was possible to identify some groups under a higher risk like old-aged, those living in the western and north-western regions of the State and those classified occupationally as "domestic activities", "rural workers" and "pensioners". We propose that these groups deserve special attention, together with pregnant women and children. In 18.3% of the cases the incubation period could not be determined. The peak incidence occurred in May. We also compared the mortality rate in the group of patients in the Hospital das Clínicas da FMUSP (the only hospital in the State of São Paulo with an Intensive Unit Care designed exclusively to the treatment of the patients with tetanus) and the group of patients that were admitted to other hospitals. The mortality rate in the HC-FMUSP was 34.5% and in the other hospitals was 49.5%, but this was not statistically significant. The role of the medical facilities in the prognosis of the patient with tetanus specially the importance of considering at the same time the severity of the disease and the characteristics of the therapy deserve further study in order to contribute to the development of the medical assistance to the patients with tetanus.

Adolescent↗

PubMedDate not supplied

Clinical presentation of thoracic injuries.

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Drainage↗

PubMedDate not supplied

Vulvar lymphatics as demonstrated by vital dyes and lymphangiography.

Human and animal studies have demonstrated that vital dye technics can delineate vulvar lymphatic patterns, which vary from those occurring clinically because dye particles may traverse unblocked channels. Lymph blockage can change these patterns to those seen clinically. Deep pelvic nodes are seldom seen on foot lymphangiography, and the vulvar technic does not appear clinically feasible. Normal unblocked spread is over or under the mons, bilaterally into the pelvis through the obturator foramen, or the Space of Retzius. Blockage by pressure, disease or deformity changes this to a clinical pattern where the lymphatic pathways approach the perianal or the deep external pudendal basins, going laterally to the thigh and then to the deep femoral nodes, here to take the "usual" pathway. Spread is invariably bilateral, with the greatest dispersion not necessarily on the homologous side.

Female↗

PubMedDate not supplied

Screening for prostate cancer.

In an attempt to detect prostate cancer when the tumor is still confined to the prostate, a screening program was established. We studied the efficacy of digital rectal examination (DRE) and serum prostate-specific antigen (PSA) in the early detection of prostate cancer. One thousand men aged 50-75 years underwent DRE and serum PSA determination. Transrectal ultrasound-guided biopsies were obtained in each case of a suspicious DRE. Six systematic biopsies were performed if the PSA level was > 10 ng/ml, even if DRE and transrectal ultrasonography revealed no areas suspicious of cancer. A suspicious DRE was noted in 11.5% of the subjects; 16% had elevated levels of serum PSA (> 4 ng/ml) and 3.9% had serum PSA > 10 ng/ml. Biopsies were obtained from 90 patients, of which 31 were positive for prostate cancer. The cancer detection rate was 2.2% for DRE, 2.0% for PSA > 10 ng/ml, and 3.1% for the two methods combined. Clinical staging revealed that in 29 of the 31 patients with prostate cancer, the tumor was confined to the prostate: Stage A in 9 cases and stage B in 20 cases. Only two patients had clinically advanced cancer, and 22 patients underwent radical prostatectomy. Pathological examination disclosed biologically significant tumors in 91% of the cases in terms of tumor volume and grade. Although there is little evidence that screening will result in the reduction of the disease-specific mortality rate, early detection of prostate cancer by DRE, serum PSA, and transrectal ultrasound should be encouraged.

Aged↗

PubMedDate not supplied

[Atypical neuroleptic malignant syndrome].

Mr A ..., 38 years old, follow up for five years for an obsessional nevrosis, hospitalized for a serious breakdown with experiences of derealization, discordance and apragmatism, was treated with haloperidol (15 mg), cyamemazine (200 mg), aenethol trithione (25 mg), associated with clorazepate (150 mg), fluvoxamine (300 mg), trimipramine (200 mg). One month later, the appearance of an extrapyramidal syndrome induced a treatment with biperidone (2 mg). The following day, he was in a state of sub-confusion with temporo-spatial disorientation and anxious perplexity. The extrapyramidal syndrome was evident with major hypertonia and generalized shaking. The appearance of bedsores on the heels, and vesicular symmetrical lesions on the ear lobes evoked a toxidermia. A large muscular atrophy of the lower limbs inducing an important muscular weakness and rising of the seric C.P.K. up to 12300 UI/l complete the clinical picture. One could notice the absence of any general symptoms, particularly a persisting apyrexia. The paraclinical evaluation was normal with no indication of renal deficiency. The treatment with neuroleptics was stopped but in spite of the rising of biperidone (8 mg), then giving trihexyphenidyle (30 mg), the extrapyramidal syndrome regressed only after 2 months, the seric C.P.K. and the dermatologic lesions within a month. Through a brief review of literature, the authors question the unicity of the malignant syndrome. If hypertonia is quite constant, the rising of the seric C.P.K. is aspecific and hyperthermia is inconstant. A few theoric informations differentiate extrapyramidal symptoms with fever and neuroleptic malignant syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗