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[Evaluation of the knowledge of preventive measures for the diabetic foot in patients of Rio Branco, Acre].

The diabetic foot is one of the main complications of diabetes mellitus (DM) of high socio-economic impact, characterized by foot lesions resulting from neuropathy, ischemia and infection. To verify the knowledge of preventive measures for the diabetic foot in a public health institution in Rio Branco, Acre, between August 2002 and February 2003 patients with type 2 DM (n= 109 patients, 71.6% female) were evaluated regarding their clinical-epidemiological history, demographic attitudes towards DM control and preventive care of the feet, before and after attending an informative educational program. There was a significant improvement of knowledge of preventive measures for the diabetic foot after the program (p< 0.0001), as well as for the attitudes towards DM control (p< 0.0001). We conclude that the population sample evaluated is unaware of preventive measures for the diabetic foot and of attitudes related to glycemic control. The utilization of educational programs, easily implemented in health centers, might reduce the rates of lower extremity amputation in patients with DM.

Adult↗

[The prevalence of tuberculosis in the state of Acre].

It is a descriptive study with the aim of studying the prevalence of tuberculosis in the State of Acre from 1995 to 2001. The data were collected from the forms of the Program for Tuberculosis Control of the Health and Sanitation Office. The data show that the incidence has been maintaining an average of 343.7 new cases a year. The pulmonary type was the most prevalent one, accounting for 90.0%. Among the age groups, the 20-49 age range, with 1347 (56.0%) and the 60 and over-60 age range, with 412 (17.0%), stand out. From 1998 to 2001 the male sex was the most attacked one by the disease, when the year 2000 accounted for 58.2% of the cases. The average of the cure rate was 71.0% and abandonment of treatment was 14.8% in 2001 and 32.3% in 1995. The smallest percentage of death occurred in 1995 (1.0%) and the largest one in 1997 (7.0%). Five cases were notified for the occurrence of coinfection between TB/AIDS and HIV/TB. The program's population coverage was within 90% every year. From the 22 cities, 6 (27.3%) still do not have any action for controlling the disease.

Adult↗

[Inquiry on condoms in the basin of Rio Acre: carriage, package, use and the infection risk for STD].

Descriptive-exploratory type study, carried with 168 inhabitants of the basin of Rio Acre - Brazil, which aimed to investigate preservative use and the risk for Sexually Transmited Diseases. For data collection it was used an application form with spontaneous participation and anonymate guaranty. As result, stands out the 64.3% masculine gender, 75.0% married/joined, 57.1% had incomplete first degree and 31.0% were illiterate. At that time 78.0% did not bring preservative when coming to the city, and 6.0% just came out seeking for sexual activity; 62.0% had already used the masculine preservative, with 67.2% of acceptance and 77.8% had kept it in the back pocket of the pants, with danger of damaging and infection risk and undesired pregnancy; 8.9% had had venereal disease, being 80.0% for the gonorrhea. Of these, 46.7% had negotiated respectively with pharmacist and doctor. Thus, 89.3% considered the prevention campaigns as great/good.

Adolescent↗

[Culicidae (Diptera: Culicidae) of the Perus river basin, Acre, Amazonia (Brazil)].

Mosquito (Diptera: Culicidae) collections were made on the Pedro Peixoto Colonization Project in the State of Acre, Brazil. Four thousand, five hundred and eighty-eight (4,588) specimens were collected and fifty-three (53) species or group recognised. The occurrence of Anopheles (Nyssorhynchus) oswaldoi is given special emphasis.

Animals↗

[American cutaneous leishmaniasis in the State of Acre, Brazil].

OBJECTIVE: Present a statistical survey of American Cutaneous Leishmaniasis (ACL) in the State of Acre. METHODS: Data were obtained from the forms of the "Campaign against Leishmaniasis", from January 1992 to December 1997. Descriptive statistical analysis was applied. RESULTS: There were 2.557 registered cases. The highest prevalence was found at the microregion of Brasiléia (231.8 cases/10,000 inhab.). The predominant clinical form was cutaneous (84.05%). The disease occurred mostly among males (71.02%). Half of the cases were among people with 24 years of age or younger. Most cases were people with rural occupations. 83.97% of the cases were diagnosed by clinical examination. The longest period to seek medical treatment was registered in the mesoregion of Juruá Valley (10.37 months) CONCLUSION: The high number of cases suggests that it might be necessary to study the psychosocial implications of the disease and identify factors contributing to the delay in treatment.

Adolescent↗

Drug susceptibility of Plasmodium falciparum in the western Amazon region, State of Acre, Brazil.

Field studies in the western Amazon region (state of Acre, Brazil) indicate that the 4-aminoquinolines, as well as the combined regimen with sulfadoxine-pyrimethamine, can no longer be recommended for the treatment and prophylaxis of P. falciparum infections in this region. Quinine remains an effective drug when used correctly. However, compliance problems arise due to the often occurring side-effects during a ten day regimen. Prospects of overcoming these constraints by combining a short course of quinine with other drugs are limited, because of the lack of suitable partner compounds. For this reason quinine/clindamycin appears to be a more practical therapy of P. falciparum malaria. In vitro data from this study suggest that mefloquine is another effective alternative for the treatment of falciparum malaria in this Amazon region.

Animals↗

[Echinococcus vogeli cysts in paca liver (Cuniculus paca) native from the Acre State, Brazil].

Four of the patients with polycystic hydatid disease observed by us reported that they were aware of the presence of liver disease in the pacas hunted for food. The viscera of these animals were usually given to domestic dogs. All of our 7 patients reported contact with dogs that had previously ingested viscera of pacas. Examination of the liver considered to be diseased by one of the patients and removed from a paca killed in the same region (State of Acre, Brazil) from which the human cases originated showed the presence of hydatid cysts. The characteristics of the rostellar hooks of the protoscolex indicated that this was the larval form of Echinococcus vogeli. These observations confirm the participation of pacas in the biological cycle of E. vogeli and the pathway through which man may become an alternative intermediate host of this echinococcus.

Animals↗

[Polycystic hydatid disease: report of two cases from the city of Sena Madureira, Acre, in Brazilian Amazon].

Two cases of Polycystic hydatid disease (PH) are reported from the same municipal district of the Brazilian Amazon region (Sena Madureira, Acre). Both had a similar clinical presentation and course over two years of follow-up. Initially the patients complained of pain in the right hypochondrium or upper abdomen and presented obstructive jaundice, fever, increased abdominal volume and weight loss. By image analysis, in addition to splenomegaly, multiple and coalescent cysts were detected in the liver. Serum samples were reactive by counterimmunoelectrophoresis. Treatment with albendazole resulted in partial improvement, with symptomatic relief and reduction in size of the lesions. This report stresses the importance of performing clinical-epidemiological studies of polycystic hydatid disease in the Brazilian Amazon and especially in the municipality of Sena Madureira where many other cases of PH may remain undiagnosed.

Adolescent↗

[Clinical and epidemiological characteristics of snakebites in Rio Branco, Acre].

This study aimed to determine the clinical epidemiological profile of the snake bites attended at the reference hospital of Acre. One hundred-forty four patients were studied prospectively, from January to December 2002. One hundred-thirteen (78.5%) cases were classified as accidents by venomous snakes. The genera Bothrops, Lachesis and Micrurus were responsible, respectively, for 75.7%, 2.1% e 0.7% cases. The accidents predominated in males (78.5%), rural workers (51.4%) and between 10 and 29 years old (43.8%). The distribution according to the severity of poisoning by genera Bothrops was: moderate (48.6%), mild (31.2%) or severe (20.2%). Two cases of Bothrops accident did not receive serum therapy. However, the antivenom was administered in twenty-three patients without envenoming. In conclusion, the results obtained were different of the observed by another authors with respect to the severity of accidents and suitable treatment.

Adolescent↗

[Clinical and demographic characteristics of 99 episodes of rheumatic fever in Acre, the Brazilian Amazon].

OBJECTIVE: To report clinical manifestations and demographic characteristics of patients with rheumatic fever treated in a public hospital in the state of Acre. METHODS: A cross-sectional study was conducted of patients consecutively seen in the Cardiology Ward at FUNDHACRE Demographic, clinical and laboratory data were assessed through a questionnaire. The diagnosis of rheumatic fever was made based on Jones' criteria, associated with laboratory data, electrocardiography, chest X-ray, and bi-dimensional echocardiography. Patients with other heart diseases, diabetes, obesity, inflammatory disease, and infections were excluded. Those who smoked, were pregnant, or used anti-inflammatory medication or hormone therapy were also excluded. RESULTS: From July 2003 to February 2004, 99 patients with rheumatic fever were assessed (mean age, 11 years, SD= +/- 10.18) with a predominance of females (59.6%), and a racial phenotype of a mixture of Caucasian and Indian (60.6%). Three individuals were excluded because they did not meet the diagnostic criteria. Mean age was 9.1 years old, and in 30.4% of the patients, the disease was diagnosed at the first episode of rheumatic fever. The most frequent clinical manifestations were carditis (69.7%), arthritis (21.4%), and chorea (6.1%). Mitral regurgitation was the most common lesion (36.4%) followed by the association of mitral regurgitation and aortic regurgitation (9.1%). CONCLUSION: Rheumatic carditis was the most common manifestation of rheumatic fever, predominant in the group with a racial mixture of Caucasian and Indian (60.6%). Low compliance with antibiotic therapy contributed to the recurrence of the disease and to cardiac sequelae.

Acute Disease↗

Breastfeeding patterns in Rio Branco, Acre, Brazil: a survey of reasons for weaning.

This paper presents a preliminary profile of infant feeding practices in a peri-urban Amazonian community. A random sample of 180 households with at least one child under the age of five years were interviewed in 1996 as part of a maternal-child health survey conducted in a peri-urban neighborhood in Rio Branco, Acre, Brazil. Since some households had more than one child under the age of five, data were collected for a total of 250 children. The results of the survey indicate that initiation of breastfeeding is nearly universal, with 96.0% of women breastfeeding their infants at birth. However, many mothers terminate breastfeeding before the recommended age. Forty-five percent of infants are weaned before six months and 62.0% are weaned before 12 months. The survey also reveals that mothers give supplemental food and drink at an early age. Finally, while women give a variety of responses for why breastfeeding was terminated, the most common answer (42.0%) was that the infant refused the breast. The meaning and implications of this response merit further investigation.

Adolescent↗

Prevalence and spatial distribution of intestinal parasitic infections in a rural Amazonian settlement, Acre State, Brazil.

A population-based survey of the prevalence and spatial distribution of intestinal parasitism was carried out in an agricultural settlement in the Amazon Basin of Brazil (Granada, Acre State). More than half (53.4%) of the 429 stool specimens from subjects in all age groups, living in 113 households, had cysts, ova, or larvae of intestinal parasites. The most prevalent parasites were Giardia duodenalis (19.6%) and soil-transmitted helminths (12.7%); 105 (24.5%) subjects were infected with more than one species of parasite. Significant age-related differences in prevalence were only found for G. duodenalis (children < 1 year and adults > 30 years were less affected). Six households (5.3%), situated within a radius of 690m, comprised 48.1% of all subjects harboring soil-transmitted helminths in our study area. Households within this cluster were poorer and more crowded than those outside the cluster. The observed spatial clustering of infections with soil-transmitted helminths provides valuable information for the spatial targeting of sanitary interventions in this area.

Adolescent↗

[Sexual activity and sexually transmitted diseases in high school students in Rio Branco-Acre, Brazil].

This study was realized with 2.684 students of the high school in Rio Branco-Acre, Brazil, to verify aspects of the sexual activity and the occurrence of DST/AIDS. From the researched students, 48.9% had sexual intercourse, and the largest frequency was 34.3% for male sex, with the beginning at 13 years old, and for female sex 31.6%, with the beginning at 16 years old. The occurrence of mentioned DST/AIDS was: 58.4% for Hepatitis B, 39.4% for Monilíase and 2.2% for Gonorrhea. Among those ones who had their first sexual intercourse, 47.6% were with the boyfriend, 25.8% with the neighbor and 10.5% with the domestic maid. Concluding, the students who had sexual intercourse were 52.3% of private schools, 50.0% of federal ones, 45.7% of state ones and 41.8% of municipal ones.

Adolescent↗

Seroprevalence of hepatitis B and C in the Western Brazilian Amazon region (Rio Branco, Acre): a pilot study carried out during a hepatitis B vaccination program.

In 1999, on the occasion of the application of the first vaccine dose during the state vaccination campaign against hepatitis B virus (HBV), 390 individuals from the town of Rio Branco, Acre, aged two or more years were selected for the determination of the seroprevalence of HBV and HCV. HBV markers (HBsAg, anti-HBs, and anti-HBc IgG) were determined on this occasion and anti-HBs antibodies were also assessed 30 days after the third vaccine dose. At the time of vaccination, 39% of the individuals were still susceptible to HBV, while 61% presented serologic evidence of previous HBV contact or previous vaccination. The individuals with previous HBV contact were significantly older (p<0.001) than those without HBV markers. Of the 192 individuals who returned for reexamination, 30 days after the third dose, 158 (82.3%) had received three vaccine doses, and only 60 (31.2%) belonged to the group without HBV markers. In these individuals, the seroconversion rate after the third dose was 92% (55/60). In conclusion, we found considerable HBV in this population, indicating the need for pursuing the immunization programs. We also found high rates of vaccination coverage in the Western Brazilian Amazon region.

Adolescent↗

The central auditory conduction at term date and three months after birth. I. Composite group averages of brainstem (ABR), middle latency (MLR) and auditory cortical responses (ACR).

We are investigating the maturation of auditory evoked responses, as a potential diagnostic tool for the neurological examination of premature infants at the Intensive Care Unit for Prematures. In this communication we report the group composite averages of the BMC-ARs in a group of 25 mature and healthy newborns with a follow-up at 3 months of age. The ABRs showed a remarkable variability in wave I latency, with a relatively stable I-V central conduction time (CCT) of the brainstem. The ipsilateral II-V CCT does not differ appreciably from the contralateral II-V CCT. The MLR components NoPoNa and Nb, Nc, Nd are easy to identify in the group averages. Voltage asymmetry between stimulated versus non-stimulated side is slight but persistent in the newborn period as well as at 3 months of age. The group averaged ACRs, show an early complex within the latency reach of 100 ms and a slow W-shaped late complex, most distinct at 3 months. The results indicate that the protocol as applied constitutes a tool for the testing of conduction function of the auditory afference in newborns, even beyond the level of the brainstem. Group averaging offers a method to determine the intragroup stability of evoked potentials under investigation.

Acoustic Stimulation↗

Overcoming unit dose drug distribution system logistical problems on a 32-acre campus.

The literature contains numerous articles regarding the implementation of unit dose drug distribution systems, but little has been written concerning the logistical problems sometimes encountered with such systems. This article describes the implementation of a drug distribution system at a psychiatric institution at which the inpatient units are scattered throughout a 32-acre campus.

Hospital Bed Capacity, 100 to 299↗

Differences in understanding and application of 1987 ACR criteria for rheumatoid arthritis and 1991 ESSG criteria for spondylarthropathy. A pilot survey.

OBJECTIVES: To determine areas of agreement and disagreement among experts in the interpretation of the published criteria for RA (ACR) and spondylarthropathies ( ESSG). METHODS: Thirty-two experts (16 from France and 16 from 10 other countries) replied anonymously to a mailed questionnaire. RESULTS: Tenosynovitis and 'sausage-like' painless swelling of the toes were considered as criteria for RA by 18 and 14 experts, respectively. The definition of symmetry differed widely among experts (symmetry of only one group of joints was sufficient for 13). Twenty-five experts considered erosions of other joints than the wrists and fingers as a criterion for RA, 17 thought that fulfilment of criteria could be achieved cumulatively, and 19 would appreciate clarifications of the current criteria. Among possible clarifications for RA, it was frequently recommended that morning stiffness and nodules be eliminated and that new marker antibodies, X-rays of the feet, and exclusion criteria be added. Twenty-three of the 29 experts who gave an opinion (79%) agreed with the notion of SP in the absence of axial signs and sacroiliitis, 26/31 (84%) indicated that a patient can have both RA and SP, and 19/30 (63%) thought that RA and SP could be regarded as syndromes more than diseases. Only 5/32 experts relied more on the criteria than on their clinical judgement in diagnosing RA. CONCLUSIONS: There would seem to be a needfor the optimisation of RA and ESSG criteria, particularly within the context of early arthritis.

Arthritis, Rheumatoid↗

Aggressive rheumatoid arthritis registry in Italy. Characteristics of the early rheumatoid arthritis subtype among patients classified according to the ACR criteria.

The Italian Society of Rheumatology in the year 2000 decided to sponsor the creation of a data base (Registry) of consecutive patients who fulfilled the diagnosis of rheumatoid arthritis (RA) according to the American College of Rheumatology (ACR) criteria. The registry is designed to collect data on the "aggressive" type of RA all over the country in order to determine the percentage of patients who satisfy the established criteria among incident cases of RA and to define the therapeutic approach according to the characteristics of the enrolled patients. Predefined criteria set up by eight recognized opinion leaders on the disease were used by all the centers to create the database. The GIARA registry (Gruppo Italiano Artrite Reumatoide Aggressiva) has now enrolled 706 patients who will be followed up for 24 months. They have been divided into two major subsets--patients with early (< 4 months' disease duration) and late (> 4 months) RA--with the aim of establishing whether differences in clinical, serological, radiographic and therapeutic (DMARDs: disease modifying antirheumatic drugs) parameters may distinguish the two subsets. The major conclusion of this preliminary analysis is that an overall tendency to undertreatment is discernable.

Adult↗