Detecção de casos e educação em saúde relacionada à hanseníase em uma região endêmica: um relato de experiência

Leprosy is considered a public health challenge. Its persistent presence in certain regions demands innovative approaches focused on awareness, detection, and treatment. In this scenario, the present study aims to describe an experience focused on leprosy detection and education in a region endemic for this disease. This is a qualitative study structured as an experience report, carried out from the experiences lived by four professors with training in the health area, when developing the project “Roda-Hans/Carreta da Saúde – Hanseníase”, during its passage through the municipality of Paulo Afonso, Bahia. In total, 26 health professionals were involved in the 93 consultations performed. Of these, 11 (11.8%) individuals were diagnosed with leprosy. During the training and care actions, a significant interaction was observed between different professionals and health sectors, promoting knowledge and fostering cooperative and collaborative learning in the identification of new cases. Also noteworthy is the commitment of health professionals, the exchange of experiences, as well as the consolidation of a leprosy assistance network in Primary Health Care (PHC). The actions resulting from the arrival of the mobile health unit in the municipality enabled the identification of hidden cases in the region, as well as the expansion and strengthening of partnerships among healthcare services, educational institutions, and the reference facility. Ultimately, the training and discussions promoted an enhancement of diagnostic, treatment, and prevention skills within the PHC.A hanseníase emerge como um desafio à saúde pública. Sua persistente presença em determinadas regiões exige abordagens inovadoras e voltadas para a conscientização, detecção e tratamento. Neste contexto, o presente estudo tem por objetivo descrever uma experiência na detecção e na educação relacionadas à hanseníase em uma região endêmica. Trata-se de um estudo de abordagem qualitativa, do tipo relato de experiência, realizado a partir da vivência experenciada por quatro docentes com formação na área da saúde, ao desenvolver o projeto “Roda Hans/Carreta da Saúde – Hanseníase”, durante a sua passagem pelo município de Paulo Afonso, Bahia. Ao todo, 26 profissionais da saúde estiveram envolvidos nos 93 atendimentos realizados, dentre os quais 11 (11,8%) indivíduos assistidos foram diagnosticados com hanseníase. Percebeu-se, durante as ações de capacitação e de atendimento, uma maior interação entre diferentes profissionais e setores de saúde, ao promoverem conhecimento e ao fomentarem uma aprendizagem cooperativa e colaborativa na identificação dos novos casos. Destaca-se, ainda, o comprometimento dos profissionais de saúde, a troca de experiências e vivências, bem como a consolidação de uma rede de assistência à hanseníase na Atenção Primária à Saúde (APS). As ações advindas da chegada da carreta ao município possibilitaram a identificação de casos ocultos na região, a ampliação e o fortalecimento das parcerias entre os serviços de saúde, as instituições de ensino e o serviço de referência. Por fim, a capacitação e as discussões promoveram um aprimoramento das habilidades de diagnóstico, bem como de tratamento e de prevenção na APS

Tuberculose em área endêmica na Bahia, Brasil: análise de tendência de uma década

Objetivo: Descrever os casos de tuberculose, com base no perfil clínico-epidemiológico e na distribuição geográfica, no período de 2010 a 2020, em uma área endêmica da Bahia, Brasil. Método: Estudo realizado a partir de dados secundários obtidos mediante consulta às fichas de notificação de tuberculose de um centro de referência no município de Paulo Afonso, Bahia, Brasil. Os casos notificados de tuberculose entre 2010 e 2020 foram incluídos e submetidos à análise estatística e distribuição espacial. Resultados: Dos 391 casos, 90,8% foram diagnosticados como tuberculose pulmonar, com média de 25,9 casos por 100.000 habitantes na série histórica. Do total de casos, 69,8% eram do sexo masculino, 49,6% tinham idade entre 31 e 59 anos, média de idade 43,4 ± 17.7 anos, 62,1% eram bacilíferos e a maioria dos pacientes foram categorizados como casos novos (81,6%). Ao final do tratamento da TB, 75,7% apresentaram um resultado bem-sucedido (curado) e 48,8% dos casos receberam terapia diretamente observada. Na distribuição espacial, observou-se aglomerados nas macrozonas insular e sul no município de Paulo Afonso. Conclusão: A tuberculose persiste como significativo problema de saúde pública no município e medidas para melhorar o diagnóstico precoce e o tratamento são essenciais, principalmente após a pandemia da COVID-19, considerando o perfil epidemiológico e a distribuição espacial da doença.Objective: To describe the tuberculosis cases, based on clinical-epidemiological profile and geographic distribution, from 2010 to 2020 in an endemic area in Bahia, Brazil. Method: It was a study based on secondary data obtained of individual tuberculosis reporting forms from a reference center in Paulo Afonso municipality, Bahia, Brazil. Reported tuberculosis cases between 2010 and 2020 were included and submitted to statistical analysis and spatial distribution. Results: Among the 391 cases, 90.8% had a pulmonary form with a mean of 25.9 cases per 100,000 inhabitants in the historical series. Of all cases, 69.8% were male, 49.6% were aged between 31 and 59 years, mean age 43.4 ± 17.7 years, 62.1% were smear-positive and most of the cases were new (81.6%). At the end of TB treatment, 75.7% had a successful outcome (cured) and 48.8% patients received directly observed therapy. In the spatial distribution, we observed agglomerates in the insular and south macrozones in Paulo Afonso municipality. Conclusion: Tuberculosis remains a significant public health problem in the municipality, and measures to improve early diagnosis and treatment are crucial, especially following the onset of the COVID-19 pandemic, considering the epidemiological profile and spatial distribution of the disease

Análise da cobertura vacinal por BCG nos 20 municípios mais populosos da Bahia: uma série histórica de 2011 a 2021

Introdução: Tuberculose (TB), doença crônica infectocontagiosa causada por Mycobacterium tuberculosis, é considerada um grave problema de saúde pública. Em 2021, estima-se que a TB foi responsável por, aproximadamente, 1,6 milhões de óbitos no mundo. Diante desse cenário, percebe-se a importância das medidas de prevenção e controle da doença, como a vacinação com o bacilo de Calmette-Guérin (BCG). Objetivo: avaliar a cobertura vacinal (CV) do BCG e analisar as taxas de incidência e mortalidade decorrentes da TB em menores de 1 ano de idade. Metodologia: o estudo possui caráter descritivo ecológico-espacial, em que foram analisadas as taxas de CV nos 20 municípios mais populosos da Bahia, no período de 2011 a 2021. Resultados: observou-se uma CV média de 103% ± 18,5%. No entanto, nove (45%) municípios apresentaram tendência decrescente na CV, especialmente em Feira de Santana (P<0,0001). A partir de 2015, observa-se uma queda considerável das CV e da homogeneidade entre os municípios, acentuando-se após 2019. Em relação à incidência, o município com maior número de casos de TB foi Candeias, com 85 casos por 100.000 habitantesem menores de um ano de idade. Por fim, apenas três municípios relataram a presença de óbitos por TB extrapulmonar, sendo a maior taxa registrada em Ilhéus com 2,7%. Conclusão: o estudo evidencia uma importante redução e heterogeneidade nas CV dos municípios analisados, e fomenta a importância de ações mais efetivas de vacinação e controle da TB baseadas nas necessidades locais de cada município

Motivos de exclusão para a cirurgia de estimulação cerebral profunda na doença de Parkinson

Abstract de comunicação apresentada no Congresso SPDMov 2022 - Parkinsonismos Atípicos: Clássicos e Atípicos. Luso, 1-2 Abril 2022N/

SARS-CoV-2 introductions and early dynamics of the epidemic in Portugal

Genomic surveillance of SARS-CoV-2 in Portugal was rapidly implemented by the National Institute of Health in the early stages of the COVID-19 epidemic, in collaboration with more than 50 laboratories distributed nationwide. Methods By applying recent phylodynamic models that allow integration of individual-based travel history, we reconstructed and characterized the spatio-temporal dynamics of SARSCoV-2 introductions and early dissemination in Portugal. Results We detected at least 277 independent SARS-CoV-2 introductions, mostly from European countries (namely the United Kingdom, Spain, France, Italy, and Switzerland), which were consistent with the countries with the highest connectivity with Portugal. Although most introductions were estimated to have occurred during early March 2020, it is likely that SARS-CoV-2 was silently circulating in Portugal throughout February, before the first cases were confirmed. Conclusions Here we conclude that the earlier implementation of measures could have minimized the number of introductions and subsequent virus expansion in Portugal. This study lays the foundation for genomic epidemiology of SARS-CoV-2 in Portugal, and highlights the need for systematic and geographically-representative genomic surveillance.We gratefully acknowledge to Sara Hill and Nuno Faria (University of Oxford) and Joshua Quick and Nick Loman (University of Birmingham) for kindly providing us with the initial sets of Artic Network primers for NGS; Rafael Mamede (MRamirez team, IMM, Lisbon) for developing and sharing a bioinformatics script for sequence curation (https://github.com/rfm-targa/BioinfUtils); Philippe Lemey (KU Leuven) for providing guidance on the implementation of the phylodynamic models; Joshua L. Cherry (National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health) for providing guidance with the subsampling strategies; and all authors, originating and submitting laboratories who have contributed genome data on GISAID (https://www.gisaid.org/) on which part of this research is based. The opinions expressed in this article are those of the authors and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government. This study is co-funded by Fundação para a Ciência e Tecnologia and Agência de Investigação Clínica e Inovação Biomédica (234_596874175) on behalf of the Research 4 COVID-19 call. Some infrastructural resources used in this study come from the GenomePT project (POCI-01-0145-FEDER-022184), supported by COMPETE 2020 - Operational Programme for Competitiveness and Internationalisation (POCI), Lisboa Portugal Regional Operational Programme (Lisboa2020), Algarve Portugal Regional Operational Programme (CRESC Algarve2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF), and by Fundação para a Ciência e a Tecnologia (FCT).info:eu-repo/semantics/publishedVersio

A search for ultra-high-energy photons at the Pierre Auger Observatory exploiting air-shower universality

The Pierre Auger Observatory is the most sensitive detector to primary photons with energies above ∼0.2 EeV. It measures extensive air showers using a hybrid technique that combines a fluorescence detector (FD) with a ground array of particle detectors (SD). The signatures of a photon-induced air shower are a larger atmospheric depth at the shower maximum (X$_{max}$) and a steeper lateral distribution function, along with a lower number of muons with respect to the bulk of hadron-induced background. Using observables measured by the FD and SD, three photon searches in different energy bands are performed. In particular, between threshold energies of 1-10 EeV, a new analysis technique has been developed by combining the FD-based measurement of X$_{max}$ with the SD signal through a parameter related to its muon content, derived from the universality of the air showers. This technique has led to a better photon/hadron separation and, consequently, to a higher search sensitivity, resulting in a tighter upper limit than before. The outcome of this new analysis is presented here, along with previous results in the energy ranges below 1 EeV and above 10 EeV. From the data collected by the Pierre Auger Observatory in about 15 years of operation, the most stringent constraints on the fraction of photons in the cosmic flux are set over almost three decades in energy

Study on multi-ELVES in the Pierre Auger Observatory

Since 2013, the four sites of the Fluorescence Detector (FD) of the Pierre Auger Observatory record ELVES with a dedicated trigger. These UV light emissions are correlated to distant lightning strikes. The length of recorded traces has been increased from 100 μs (2013), to 300 μs (2014-16), to 900 μs (2017-present), to progressively extend the observation of the light emission towards the vertical of the causative lightning and beyond. A large fraction of the observed events shows double ELVES within the time window, and, in some cases, even more complex structures are observed. The nature of the multi-ELVES is not completely understood but may be related to the different types of lightning in which they are originated. For example, it is known that Narrow Bipolar Events can produce double ELVES, and Energetic In-cloud Pulses, occurring between the main negative and upper positive charge layer of clouds, can induce double and even quadruple ELVES in the ionosphere. This report shows the seasonal and daily dependence of the time gap, amplitude ratio, and correlation between the pulse widths of the peaks in a sample of 1000+ multi-ELVES events recorded during the period 2014-20. The events have been compared with data from other satellite and ground-based sensing devices to study the correlation of their properties with lightning observables such as altitude and polarity