O perfil de saúde do hipertenso com transtorno depressivo maior: uma revisão integrativa

Introdução: a Hipertensão Arterial Sistêmica (HAS) tem elevada prevalência no Brasil, atingindo 36 milhões de brasileiros. Observa-se ainda sua relação com o Transtorno Depressivo Maior, apresentando elevada prevalência mundial. Objetivo: identificar evidências científicas sobre o perfil de saúde do hipertenso com transtorno depressivo maior. Método: trata-se de uma revisão integrativa da literatura, na qual as buscas foram realizadas nas bases de dados MEDLINE via PubMed, CINAHL, EMBASE, Web of Science, LILACS e BDENF. E para a estratégia de busca, utilizou-se os descritores “Hypertension”, “Depressive Disorder, Major”, “Depression” “Health Profile” e “Quality of Life”, com a combinação dos operadores booleanos “AND” e “OR”. Para a seleção dos artigos foram considerados os seguintes critérios de inclusão: artigos publicados de 2015 até dezembro de 2020, com texto completo disponível, e nos idiomas: inglês, espanhol e português. E quanto aos critérios de exclusão: artigos duplicados, editoriais, documentos de conferência, teses, dissertações, monografias, livros e capítulos de livros. Resultados e Discussão: foram incluídos 9 estudos, dos quais 3 publicados no ano de 2019, 2 no ano de 2016 e 1 nos respectivos anos de 2015, 2017, 2018 e 2020. Quanto a origem, identificou-se 4 estudos no Brasil e os demais na Austrália, China, Holanda, Moçambique e Peru. Na análise do perfil de saúde, os achados evidenciados foram: a relação da HAS e TDM: aspectos fisiológicos e psicológicos; fatores socioeconômicos e comportamentais do hipertenso depressivo; déficit no autocuidado e manejo da HAS e TDM. Considerações finais: foi possível evidenciar que há uma associação direta entre as duas doenças, assim como seus fatores de risco para o agravo da condição patológica. O mecanismo fisiopatológico do hipertenso depressivo é bidirecional, ou seja, uma doença influencia na outra. A elevação da pressão arterial pode desencadear alterações químicas humorais, assim como, sob o aspecto psicológico, o fato de estar doente é um gatilho para episódios depressivos. Além disso, aspectos socioeconômicos como: gênero, vulnerabilidade econômica e nível de escolaridade, impactam diretamente na qualidade de vida do hipertenso depressivoIntroduction: Arterial Hypertension (HT) has a high prevalence in Brazil, reaching 36 million Brazilians. Its relationship with Major Depressive Disorder is also observed, presenting a high worldwide prevalence. Objective: to identify scientific evidence on the health profile of hypertensive patients with major depressive disorder. Method: It is an integrative literature review, in which searches were carried out in the followings databases: MEDLINE via PubMed, CINAHL, EMBASE, Web of Science, LILACS and BDENF. As for the search strategy, the descriptors "Hypertension", "Depressive Disorder, Major", "Depression", “Health Profile” and "Quality of Life" were used, with the combination of the Boolean operators "AND" and "OR". For the selection of articles, the following inclusion criteria were considered: articles published from 2015 to December 2020, with full text available, and in the languages: English, Spanish and Portuguese. What about the exclusion criteria: duplicate articles, editorials, conference documents, theses, dissertations, monographs, books and book chapters. Results and Discussion: 9 studies were included, of which 3 published in the year 2019, 2 in the year 2016 and 1 in the respective years 2015, 2017, 2018 and 2020. As to the origin, 4 studies were identified in Brazil and the too others in Australia, China, the Netherlands, Mozambique and Peru. In the analysis of the health profile, the findings evidenced were: the relationship between HT and MDD: physiological and psychological aspects; socioeconomic and behavioral factors of hypertensive depressive; deficit in self-care and management of HT and MDD. Conclusions: it was possible to show that there is a direct association between the two diseases, as well as their risk factors for the worsening of the pathological condition. The pathophysiological mechanism of depressive hypertension is bidirectional, in other words, one disease influences the other. The elevation of BP can trigger chemical humoral changes, as well, from the psychological point of view, the fact of being sick is a trigger for depressive episodes. In addition, socioeconomic aspects, such as: gender, economic vulnerability and education level, directly impact the quality of life of depressed hypertensive patient

Characteristics of women diagnosed with mpox infection compared to men: A case series from Brazil

Background: Cisgender men were mostly affected during the 2022 mpox multinational outbreak, with few cases reported in women. This study compares the characteristics of individuals diagnosed with mpox infection according to gender in Rio de Janeiro. Methods: We obtained surveillance data of mpox cases notified to Rio de Janeiro State Health Department (June 12 to December 15, 2022). We compared women (cisgender or transgender) to men (cisgender or transgender) using chi-squared, Fisher's exact, and Mood's median tests. Results: A total of 1306 mpox cases were reported; 1188 (91.0%) men (99.8% cisgender, 0.2% transgender), 108 (8.3%) women (87.0% cisgender, 13.0% transgender), and 10 (0.8%) non-binary persons. Compared to men, women were more frequently older (40+years: 34.3% vs. 25.1%; p < 0.001), reported more frequent non-sexual contact with a potential mpox case (21.4% vs. 9.8%; p = 0.004), fewer sexual partnerships (10.9 vs. 54.8%; p < 0.001), less sexual contact with a potential mpox case (18.5% vs. 43.0%; p < 0.001), fewer genital lesions (31.8% vs. 57.9%; p < 0.001), fewer systemic mpox signs/symptoms (38.0% vs. 50.1%; p = 0.015) and had a lower HIV prevalence (8.3% vs. 46.3%; p < 0.001), with all cases among transgender women. Eight women were hospitalized; no deaths occurred. The highest number of cases among women were notified in epidemiological week 34, when the number of cases among men started to decrease. Conclusions: Women diagnosed with mpox presented differences in epidemiological, behavioral, and clinical characteristics compared to men. Health services should provide a comprehensive assessment that accounts for gender diversity

Ambulatory and hospitalized patients with suspected and confirmed mpox: an observational cohort study from BrazilResearch in context

Summary: Background: By October 30, 2022, 76,871 cases of mpox were reported worldwide, with 20,614 cases in Latin America. This study reports characteristics of a case series of suspected and confirmed mpox cases at a referral infectious diseases center in Rio de Janeiro, Brazil. Methods: This was a single-center, prospective, observational cohort study that enrolled all patients with suspected mpox between June 12 and August 19, 2022. Mpox was confirmed by a PCR test. We compared characteristics of confirmed and non-confirmed cases, and among confirmed cases according to HIV status using distribution tests. Kernel estimation was used for exploratory spatial analysis. Findings: Of 342 individuals with suspected mpox, 208 (60.8%) were confirmed cases. Compared to non-confirmed cases, confirmed cases were more frequent among individuals aged 30–39 years, cisgender men (96.2% vs. 66.4%; p < 0.0001), reporting recent sexual intercourse (95.0% vs. 69.4%; p < 0.0001) and using PrEP (31.6% vs. 10.1%; p < 0.0001). HIV (53.2% vs. 20.2%; p < 0.0001), HCV (9.8% vs. 1.1%; p = 0.0046), syphilis (21.2% vs. 16.3%; p = 0.43) and other STIs (33.0% vs. 21.6%; p = 0.042) were more frequent among confirmed mpox cases. Confirmed cases presented more genital (77.3% vs. 39.8%; p < 0.0001) and anal lesions (33.1% vs. 11.5%; p < 0.0001), proctitis (37.1% vs. 13.3%; p < 0.0001) and systemic signs and symptoms (83.2% vs. 64.5%; p = 0.0003) than non-confirmed cases. Compared to confirmed mpox HIV-negative, HIV-positive individuals were older, had more HCV coinfection (15.2% vs. 3.7%; p = 0.011), anal lesions (45.7% vs. 20.5%; p < 0.001) and clinical features of proctitis (45.2% vs. 29.3%; p = 0.058). Interpretation: Mpox transmission in Rio de Janeiro, Brazil, rapidly evolved into a local epidemic, with sexual contact playing a crucial role in its dynamics and high rates of coinfections with other STI. Preventive measures must address stigma and social vulnerabilities. Funding: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz)