MORTALIDADE POR CAUSAS EXTERNAS EM CRIANÇAS DE 0 A 12 ANOS: UMA ANÁLISE DOS REGISTROS DE ÓBITOS / EXTERNAL CAUSES OF MORTALITY IN CHILDREN FROM 0 TO 12 YEARS OLD: AN ANALYSIS OF DEATH RECORDS

Introdução: Estudos recentes revelam que causas externas são fatores, cada vez, mais importantes no quadro da mortalidade de crianças. Objetivo: Analisar o perfil epidemiológico dos óbitos por causas externas, na faixa etária de zero a doze anos, registrados no Instituto Médico Legal (IML) de São Luís, Maranhão, nos anos de 2009 a 2011. Métodos: Trata-se de estudo do tipo retrospectivo e observacional. As informações sobre a mortalidade por causas externas foram coletadas em laudos denecropsia do Instituto Médico Legal de São Luís (MA) e classificados de acordo com a Classificação Internacional de Doenças (CID). Resultados: Dos 101 óbitos estudados, 39,6% foram por acidente de trânsito, 25,7% por afogamentos, 8,9% por homicídios e 25,8% por outros acidentes; o coeficiente de mortalidade por causas externas foi mais expressivo no ano de 2010 (15,3 óbitos por 100 mil habitantes). Das vítimas, 54 eram do sexo masculino (53,5%) e 47 eram do sexo feminino (46,5%). Quando analisada a distribuição de sexo dentro de cada grupo de idade, destaca-se o predomínio do sexo masculino em todas as faixas etárias, à exceção da faixa etária de 1 a 4 anos em que o predomínio do sexo feminino foi maioria. Os meses de julho e agosto apresentaram os maiores percentuais de óbitos com 11,9% cada. Conclusão: Os óbitos por causas externas foram decorrentes, principalmente, de acidentes de trânsito. Os achados contribuem para ampliar o conhecimento epidemiológico de tais eventos, reforçando a necessidade da prevenção.Palavras-chave: Criança. Causas Externas. Mortalidade. Violência.AbstractIntroduction: Recent studies have shown that external causes are factors increasingly more important in the context of children mortality. Objective: To analyze the epidemiology profile of deaths due to external causes of 0-12 years old children in the Medicolegal Office of São Luís, Maranhão, from 2009 to 2011. Methods: This is a retrospective and observational study. Information about mortality due to external causes was collected from necropsy reports of the Medicolegal Office of São Luís. The classification of these causes was made according to the International Classification of Diseases. Results: Out of deaths studied, 39.6% were due to traffic accident, 25.7% by drowning, 8.9% by homicides and 25.8% by other accidents. The mortality rate from external causes was more significant in 2010 (15.3 deaths per 100.000 inhabitants). Of all victims, 54 were male (53.5%) and 47 were female (46.5%). When we analyzed the sex distribution in each age group, the percentage of males in all age groups is predominant, except for the age group 1-4 years in which the predominance of females was evident. The months of July and August had the highest percentages of deaths with 11.9% each. Conclusion: Deaths by external causes were due to mainly traffic accidents. The findings contribute to increasing epidemiological knowledge of such events, which reinforces the need for prevention.Keywords: Child. External Causes. Mortality. Violence

INFECÇÃO PELO VÍRUS INFLUENZA A H1N1 EM GESTANTES / INFLUENZA A H1N1 VIRUS INFECTION IN PREGNANT WOMEN

Introdução: Gestantes têm um risco aumentado para infecção pelo vírus influenza e suas complicações. Objetivo: Avaliar o comprometimento sistêmico e o tratamento de gestantes infectadas pelo vírus Influenza A H1N1. Métodos: Estudo descritivo e retrospectivo do tipo documental. Foram analisados os aspectos radiológicos, clínicos e demográficos de todos os casos de gestantes infectadas pelo vírus Influenza A H1N1 internadas no Serviço de Obstetrícia e Ginecologia do Hospital Universitário da Universidade Federal do Maranhão - HUUFMA. Resultados: Foram avaliados 10 casos de gestantes infectadas pelo vírus Influenza A H1N1. A média de idade foi de 20,9 ± 4,7, variando entre 14 e 30 anos. No início dos sintomas, 5 (50%) mulheres estavam no terceiro trimestre de gestação, sendo que dessas, 4 (80%) evoluíram com complicações. Febre foi o sintoma mais comum, estando presente em todos os casos. Cinco (50%) mulheres apresentaram, além da gestação, pelo menos um fator de risco para complicações. Sete (70%) gestantes apresentaram complicações, sendo que 3 (42,9%) tinham fatores de risco. Duas (20%) pacientes evoluíram para o óbito. Cinco (50%) pacientes iniciaram tratamento específico para o vírus após 48 horas de início dos sintomas, sendo que todas (100%) tiveram complicações. As radiografias do momento da internação evidenciaram infiltrado intersticial peri-hilar e consolidação. Conclusão: O presente estudo sugere que as características da infecção pelo vírus H1N1 nas gestantes admitidas no HUUFMA se assemelham às características de outras gestantes estudadas em pesquisas nos diversos lugares do mundo.Palavras-chave: Gestantes. Vírus da Influenza A, subtipo H1N1. Febre. Fatores de risco.AbstractIntroduction: Pregnant women are at increased risk for influenza and its complications. Objective: Evaluate the systemic involvement and the treatment of pregnant women infected with Influenza A virus, H1N1 subtype. Methods: Descriptive and retrospective study, documentary type. We reviewed the radiological, clinical and demographic aspects of all cases of pregnant women infected with H1N1 virus hospitalized in the Obstetrics and Gynecology Sector of University Hospital of the Federal University of Maranhão. Results: Ten cases of pregnant women infected with H1N1 virus were analyzed. The average age of patients was 20,9 ± 4,7, ranging between 14 e 30 years. At the onset of symptoms, 5 (50%) women were in the third trimester of pregnancy, and of these amount, 4(80%) had complications. Fever was the most common symptom, being present in all cases. Five (50%) women had, in addition to pregnancy, at least one risk factor to develop complications. Seven (70%) patients had complications, of which 3 (42,9%) had risk factors. Two (20%) patients subsequently died. Five (50%) patients started specific treatment for the virus 48 hours after the onset of symptoms, and from these amount, all (100%) of them had complications. Interstitial perihilar infiltrate and consolidation were seen in radiographs at admission. Conclusion: The present study suggest that the characteristics of the infection due to H1N1 I pregnant women, admitted in HUUFMA are similar to the characteristics in other pregnant women observed in a variety of other researches around the world.Keywords: Pregnant women. Influenza A virus, H1N1 subtype. Fever. Risk Factors

Evaluation of laboratory markers of progression of HIV disease to death

INTRODUCTION: One of the important current problems in HIV/AIDS infection is the establishment of epidemiological and laboratorial prognostic parameters during patient follow-up. This study aimed at analyzing the evolution of laboratory tests: CD4 lymphocyte count, viral load, hemoglobin (Hb), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and the epidemiological variables sex and age as prognostic factors for survival in progression to death among AIDS patients. METHODS: A retrospective study was conducted using analysis of medical records, and prospective 24-month follow-up of patients with HIV/ AIDS attended at the President Vargas Hospital Outpatient Clinic, a reference center in HIV/ AIDS attendance in the State of Maranhão, Brazil. The study analyzed patients aged 10 to 60 years old, who manifested AIDS and who were not using antiretroviral therapy or had used it for less than 5 years. The Chi-square test was used for statistical analysis. RESULTS: The sample included 100 patients - 57 were current outpatients, and 43 had died. The variables viral load (p=0.726), ALT (p=0.314), sex (p=0.687), and age (p=0.742) were analyzed, and no evidence of association between them and worst prognosis was observed. CONCLUSIONS: A significant relation was verified between low Hb levels (p=0.000) and CD4 (p=0.000) and shorter survival

Relationship between rainfall and temperature: observations on the cases of visceral leishmaniasis in São Luis Island, State of Maranhão, Brazil

INTRODUCTION: Visceral leishmaniasis is a serious public health problem that requires global control strategies, especially with respect to factors that may intervene in reducing the incidence of endemicity. In this work, rainfall density and temperature were correlated with the incidence of human cases in an area endemic for leishmaniasis in São Luis do Maranhão, Northeastern Brazil. METHODS: Notification of human cases by the National Health Foundation/Regional Coordination of Maranhão (FUNASA/COREMA) from 2002 to 2010 was used. Ecological data (mean temperature and rainfall density) were provided by the Meteorological Office of State. RESULTS: A significant association was verified between the number of VL cases and rainfall rate but not in the analysis concerning mean temperatures. CONCLUSIONS: These data suggest that the control actions in visceral leishmaniasis should be performed during rainy season in the State of Maranhão, which is in the first half of the year