Uso do Coding Causes of Death in HIV na classificação de óbitos no Nordeste do Brasil

OBJECTIVE Describe the coding process of death causes for people living with HIV/AIDS, and classify deaths as related or unrelated to immunodeficiency by applying the Coding Causes of Death in HIV (CoDe) system. METHODS A cross-sectional study that codifies and classifies the causes of deaths occurring in a cohort of 2,372 people living with HIV/AIDS, monitored between 2007 and 2012, in two specialized HIV care services in Pernambuco. The causes of death already codified according to the International Classification of Diseases were recoded and classified as deaths related and unrelated to immunodeficiency by the CoDe system. We calculated the frequencies of the CoDe codes for the causes of death in each classification category. RESULTS There were 315 (13%) deaths during the study period; 93 (30%) were caused by an AIDS-defining illness on the Centers for Disease Control and Prevention list. A total of 232 deaths (74%) were related to immunodeficiency after application of the CoDe. Infections were the most common cause, both related (76%) and unrelated (47%) to immunodeficiency, followed by malignancies (5%) in the first group and external causes (16%), malignancies (12 %) and cardiovascular diseases (11%) in the second group. Tuberculosis comprised 70% of the immunodeficiency-defining infections. CONCLUSIONS Opportunistic infections and aging diseases were the most frequent causes of death, adding multiple disease burdens on health services. The CoDe system increases the probability of classifying deaths more accurately in people living with HIV/AIDS.OBJETIVO Descrever o processo de codificação das causas de morte em pessoas vivendo com HIV/Aids, e classificar os óbitos como relacionados ou não relacionados à imunodeficiência aplicando o sistema Coding Causes of Death in HIV (CoDe). MÉTODOS Estudo transversal, que codifica e classifica as causas dos óbitos ocorridos em uma coorte de 2.372 pessoas vivendo com HIV/Aids acompanhadas entre 2007 e 2012 em dois serviços de atendimento especializado em HIV em Pernambuco. As causas de óbito já codificadas a partir da Classificação Internacional de Doenças foram recodificadas e classificadas como óbitos relacionados e não relacionados à imunodeficiência pelo sistema CoDe. Foram calculadas as frequências dos códigos CoDe das causas do óbito em cada categoria de classificação. RESULTADOS Ocorreram 315 (13%) óbitos no período do estudo; 93 (30%) tinham como causa uma doença definidora de Aids da lista do Centers for Disease Control and Prevention. No total 232 óbitos (74%) foram relacionados à imunodeficiência após aplicar o CoDe. As infecções foram as causas mais comuns, tanto nos óbitos relacionados (76%) como não relacionados (47%) à imunodeficiência, seguindo-se de malignidades (5%) no primeiro grupo e de causas externas (16%), malignidades (12%) e doenças cardiovasculares (11%) no segundo. A tuberculose compreendeu 70% das infecções definidoras de imunodeficiência. CONCLUSÕES Infecções oportunistas e doenças do envelhecimento foram as causas mais frequentes de óbito, imprimindo carga múltipla de doenças aos serviços de saúde. O sistema CoDe aumenta a probabilidade de classificar os óbitos com maior precisão em pessoas vivendo com HIV/Aids

Use of the Coding Causes of Death in HIV in the classification of deaths in Northeastern Brazil

ABSTRACT OBJECTIVE Describe the coding process of death causes for people living with HIV/AIDS, and classify deaths as related or unrelated to immunodeficiency by applying the Coding Causes of Death in HIV (CoDe) system. METHODS A cross-sectional study that codifies and classifies the causes of deaths occurring in a cohort of 2,372 people living with HIV/AIDS, monitored between 2007 and 2012, in two specialized HIV care services in Pernambuco. The causes of death already codified according to the International Classification of Diseases were recoded and classified as deaths related and unrelated to immunodeficiency by the CoDe system. We calculated the frequencies of the CoDe codes for the causes of death in each classification category. RESULTS There were 315 (13%) deaths during the study period; 93 (30%) were caused by an AIDS-defining illness on the Centers for Disease Control and Prevention list. A total of 232 deaths (74%) were related to immunodeficiency after application of the CoDe. Infections were the most common cause, both related (76%) and unrelated (47%) to immunodeficiency, followed by malignancies (5%) in the first group and external causes (16%), malignancies (12 %) and cardiovascular diseases (11%) in the second group. Tuberculosis comprised 70% of the immunodeficiency-defining infections. CONCLUSIONS Opportunistic infections and aging diseases were the most frequent causes of death, adding multiple disease burdens on health services. The CoDe system increases the probability of classifying deaths more accurately in people living with HIV/AIDS

Neck circumference predicts mortality in hospitalized COVID-19 patients

We aimed to determine whether neck circumference predicts mortality among hospitalized COVID-19 patients with respiratory failure. We performed a prospective multicenter (Italy and Brasil) study carried out from March to December 2020 on 440 hospitalized COVID-19 patients with respiratory failure. Baseline neck circumference was measured. The study outcome was 30-and 60-days mortality. Female and male participants were classified as “large neck” when exceeding fourth-quartile. Patients had a median age of 65 years (IQR 54–76), 68% were male. One-quarter of patients presented with grade-1 or higher obesity. The median neck circumference was 40 cm (IQR 38–43): 38 cm (IQR 36–40) for female and 41 cm (IQR 39–44) for male subjects. “Large neck” patients had a significantly higher prevalence of hypertension (63 vs. 48%), diabetes (33 vs. 19%), obesity (26 vs. 14%), and elevated C-reactive protein (CRP) (98 vs. 88%). The cumulative mortality rate was 13.1% (n = 52) and 15.9% (n = 63) at 30 and 60 days, respectively. After adjusting for age, BMI, relevant comorbidities, and high C-reactive protein to albumin ratio, “large neck” patients showed a significantly increased risk of death at 30-(adjusted HR 2.50; 95% CI 1.18–5.29; p = 0.017) and 60-days (adjusted HR 2.26; 95% CI 1.14–4.46; p = 0.019). Neck circumference is easy to collect and provides additional prognostic information to BMI. Among hospitalized COVID-19 patients with respiratory failure, those with large neck phenotype had a more than double risk of death at 30 and 60 days

The utility of erythrocyte indices and serum ferritin to prescribe iron-therapy and to predict the therapeutic efficacy of oral iron during pregnancy: the inappropriateness of the normal Gaussian-concept to manage maternal iron-deficiency anaemia cases

Made available in DSpace on 2015-06-08T13:58:13Z (GMT). No. of bitstreams: 2 155.pdf: 5653487 bytes, checksum: be63d2f9e69d72ff23acc6591d1a66b5 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2013Objective: to estimate the accuracy of the erythrocyte indices (red blood cell count, haemoglobin concentration-Hb, haematocrit-HTC, mean corpuscular volume-MCV, mean corpuscular haemoglobin-MCH, mean corpuscular haemoglobin concentration-MCHC, red blood cell distribution width-RDW, reticulocyte count) and the serum ferritin (SF) for iron deficiency diagnosis in pregnant women. Methods: the thesis comprised three studies. The first study evaluated the baseline data from 347 pregnant women before the iron supplementation of a clinical trial performed between May 2000 and June 2001, and determined the distribution curves of the erythrocyte indices and their accuracy parameters versus SF 12 ng/mL. The second study examined longitudinal data from the 140 women enrolled for the preceding trial to receive 60 mg of oral iron (weekly, twice a week or daily) and each treatment group was subdivided into strata with and without iron deficiency (SF 12 ng/mL) to compare the therapeutic responses (means of differences-MD between pre and post-treatment Hb) in absolute values (g/dL) and in Z-scores (standard deviation-SD). The original trial of this thesis was carried out between August 2011 and October 2012 and had a phase III validation design with 144 anemic pregnant women (Hb 11 g/dL) treated with 80 mg of elemental iron daily during 28 to 90 days, to calculate the accuracy parameters of erythrocyte indices and SF pre-treatment versus the gold-standard responsiveness to therapeutic test with oral iron, which was measured by the differences between the Hb Z-scores before-and-after the trial. Results: the mean value of red blood cell count (3.7 1012 cells/L), HTC (32.9 por cento) and Hb (10.8 g/dL) were below their reference cutoff points. The curves of morphological indices were not adjusted to the Normal distribution with the following mean values: MC

Anemia e ferropenia em gestantes: dissensos de resultados de um estudo transversal Anemia and iron deficiency in pregnant women: disagreements among the results of a cross-sectional study

OBJETIVOS: descrever as freqüências de anemia e ferropenia em gestantes de baixo risco, de acordo com a ferritina sérica e diferentes pontos de corte da concentração de hemoglobina (Hb). MÉTODOS: estudo transversal, utilizando-se banco de dados com 318 gestantes atendidas no período de maio de 2000 a junho de 2001, no Instituto Materno Infantil Prof. Fernando Figueira-IMIP, em Recife, Pernambuco. Determinou-se a freqüência de anemia e/ou ferropenia em função da ferritina e dois diferentes pontos de corte da Hb (11,0 e 10,5g/dL). Os dados foram analisados nos programas Epi-Info 6.04b e Minitab v.14.2. O projeto foi aprovado pelo Comitê de Ética em Pesquisa do IMIP. RESULTADOS: as freqüências de anemia (HbOBJECTIVES: to describe the frequency of anemia and iron deficiency anemia, using two cutoff points for hemoglobin concentration (Hb) as well as serum ferritin levels in women with low-risk pregnancies. METHODS: a cross-sectional study was carried out based on the database records of 318 pregnant women at the Instituto Materno Infantil Professor Fernando Figueira-IMIP, in the city of Recife, State of Pernambuco, Brazil, between May 2000 and June 2001. The frequency of anemia and/or iron deficiency anemia were determined using two Hb cutoff points (<11.0 and <10.5g/dL) in addition to serum ferritin levels. Data were analyzed using the Epi-Info 6.04b and Minitab v.14.2 software programs. The project was approved by the Research Ethics Committee. RESULTS: the frequency of anemia (Hb<11.0g/dL) and the frequency of iron deficiency anemia (Hb<11.0g/dL; ferritin<12ng/mL) were 56.6% and 10.7%, respectively. When the Hb cutoff point was changed to 10.5g/dL, the frequency of anemia fell to 37.4% and the frequency of iron deficiency anemia to 7.9%. Higher serum ferritin levels were found in anemic patients than in non-anemic patients, regardless of the Hb cutoff point used. CONCLUSIONS: the frequency of anemia was acceptable, but the proportion of iron deficiency anemia was far lower than expected. Ferritin levels seemed to behave in a way that contradicts the theoretical literature on the subject

Interferon-gamma gene diplotype (AA-rs2069716 / AG-rs2069727) may play an important role during secondary outcomes of severe dengue in Brazilian patients: Interferon-gamma gene diplotype (AA-rs2069716 / AG-rs2069727) may play an important role during secondary outcomes of severe dengue in Brazilian patients

Dengue is a global and growing health threat, especially in Southeast Asia, West Pacific and South America. Infection by the dengue virus (DENV) results in dengue fever, which can evolve to severe forms. Cytokines, especially interferons, are involved in the immunopathogenesis of dengue fever, and so may influence the disease outcomes. The aim of this study was to investigate the association between severe forms of dengue and two single nucleotide polymorphisms (SNPs) in the interferon-gamma gene (IFNG): A256G (rs2069716) and A325G (rs2069727). We included 274 patients infected with DENV serotype 3: 119 cases of dengue without warning signs (DWoWS), and 155 with warning signs (DWWS) or severe dengue (SD). DNA was extracted, and genotyped with Illumina Genotyping Kit or real time PCR (TaqMan probes). We estimated the adjusted Odds Ratios (OR) by multivariate logistic regression models. When comparing with the ancestral AA/AA diplotype (A256G/A325G), we found a protective association of the AA/AG against DWWS/SD among patients with secondary dengue (OR 0.51; 95% IC 0.24-1.10, p = 0.085), adjusting for age and sex. The variant genotype at locus A325G of the IFNG, in combination with the ancestral genotype at locus A256G, can protect against severe clinical forms of secondary dengue in Brazilian DENV3-infected patients

Use of the Coding Causes of Death in HIV in the classification of deaths in Northeastern Brazil

ABSTRACT OBJECTIVE Describe the coding process of death causes for people living with HIV/AIDS, and classify deaths as related or unrelated to immunodeficiency by applying the Coding Causes of Death in HIV (CoDe) system. METHODS A cross-sectional study that codifies and classifies the causes of deaths occurring in a cohort of 2,372 people living with HIV/AIDS, monitored between 2007 and 2012, in two specialized HIV care services in Pernambuco. The causes of death already codified according to the International Classification of Diseases were recoded and classified as deaths related and unrelated to immunodeficiency by the CoDe system. We calculated the frequencies of the CoDe codes for the causes of death in each classification category. RESULTS There were 315 (13%) deaths during the study period; 93 (30%) were caused by an AIDS-defining illness on the Centers for Disease Control and Prevention list. A total of 232 deaths (74%) were related to immunodeficiency after application of the CoDe. Infections were the most common cause, both related (76%) and unrelated (47%) to immunodeficiency, followed by malignancies (5%) in the first group and external causes (16%), malignancies (12 %) and cardiovascular diseases (11%) in the second group. Tuberculosis comprised 70% of the immunodeficiency-defining infections. CONCLUSIONS Opportunistic infections and aging diseases were the most frequent causes of death, adding multiple disease burdens on health services. The CoDe system increases the probability of classifying deaths more accurately in people living with HIV/AIDS

Anemia como problema de saúde pública: uma realidade atual Anemia as a public health problem: the current situation

Em 1990, as Nações Unidas promoveram a Reunião de Cúpula de Nova Iorque, onde foram traçadas metas para o decênio vindouro, dentre as quais, a redução de um terço na prevalência das anemias nas mulheres em idade fértil. Porém, apesar de percentual modesto, indícios epidemiológicos apontam no sentido inverso, ou seja, indicam a crescente e grave ocorrência de anemia em diferentes regiões do mundo, inclusive no Brasil. Ao reunir esses informes, constata-se que a anemia continua, desde a antiguidade, a ser uma das entidades nosológicas mais prevalentes e difundidas nas populações humanas. A partir daí surge uma série de questionamentos ainda sem respostas em relação às reais prevalência e etiopatogenia do problema, ao grau de implantação e à efetividade das medidas de controle.<br>In 1990, the United Nations held a World Summit in New York, in which goals for the upcoming decade were established. One of these goals was a one-third reduction in the prevalence of anemia among women at childbearing age. Despite this modest percentage, epidemiological indicators point to the opposite direction, indicating an increasing occurrence of anemia in different regions of the world, including in Brazil. These data show that anemia has continued since the antiquity to be one of the most prevalent and widespread diseases in human populations. Thus, a number of questions without answers arise regarding the actual prevalence and etiopathogenesis of the problem as well as with respect to the degree of implantation and the effectiveness of control measures

Engaging local health research communities to enhance long-term capacity building in Brazil

The ‘2019 Research Capacity Network (REDe) workshop series’ was an initiative led by Brazil-based REDe coordinators and The Global Health Network (TGHN) in partnership with Brazilian researchers interested in arboviruses. This workshop initiative has provided crucial training to the local research community offering transferable skills to effectively respond to health emergencies, with an impact beyond arboviral diseases, as evidenced by further activities undertaken during the COVID-19 pandemic. The success of this approach resulted from several factors, especially the workshops’ local leadership and the combination of in-person training with online sharing of the resources generated in the local language. Analytics data from REDe online platform evidenced the wider reach of the shared resources to a larger audience than the workshop attendees. Importantly, the impact of this approach extends beyond the workshop series per se, with workshop participants afforded access to wider training, career development and collaborative opportunities through REDe and TGHN platforms. In addition, this initiative design resulted in the development of new collaborations between the workshop leaders and other local researchers, who have been jointly writing research projects and applying for grants. As a result, REDe has become a highly dynamic community of practice for health researchers in the region, strengthening the research culture and improving connectivity. Here, we describe the design and implementation of this initiative and demonstrate the value of integrating local expertise, and a practical workshop series format with digital dissemination of research resources and training materials to generate a vibrant and robust community of practice