RESUMO
BACKGROUND: PIDs are a heterogeneous group of genetic illnesses, and delay in their diagnosis is thought to be caused by a lack of awareness among physicians concerning PIDs. The latter is what we aimed to evaluate in Brazil. METHODS: Physicians working at general hospitals all over the country were asked to complete a 14-item questionnaire. One of the questions described 25 clinical situations that could be associated with PIDs and a score was created based on percentages of appropriate answers. RESULTS: A total of 4026 physicians participated in the study: 1628 paediatricians (40.4%), 1436 clinicians (35.7%), and 962 surgeons (23.9%). About 67% of the physicians had learned about PIDs in medical school or residency training, 84.6% evaluated patients who frequently took antibiotics, but only 40.3% of them participated in the immunological evaluation of these patients. Seventy-seven percent of the participating physicians were not familiar with the warning signs for PIDs. The mean score of correct answers for the 25 clinical situations was 48.08% (±16.06). Only 18.3% of the paediatricians, 7.4% of the clinicians, and 5.8% of the surgeons answered at least 2/3 of these situations appropriately. CONCLUSIONS: There is a lack of medical awareness concerning PIDs, even among paediatricians, who have been targeted with PID educational programmes in recent years in Brazil. An increase in awareness with regard to these disorders within the medical community is an important step towards improving recognition and treatment of PIDs.
Assuntos
Competência Clínica/estatística & dados numéricos , Síndromes de Imunodeficiência/epidemiologia , Médicos/estatística & dados numéricos , Brasil , Estudos Transversais , Cirurgia Geral , Hospitais Gerais , Humanos , Síndromes de Imunodeficiência/diagnóstico , Medicina Interna , Pediatria , Papel do Médico , Prática Profissional , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: The incidence of the acquired immunodeficiency syndrome (AIDS) has increased in Santa Catarina State in Brazil over the last years, with a high number of infected women and children. The purpose of this study was to establish the main characteristics of the children from this State whose HIV serologic tests were positive. METHODS: This was a descriptive study of 176 children with positive serologic tests to HIV, conducted in the Hospital Infantil Joana de Gusmão, Florianópolis City, Santa Catarina State, Brazil. RESULTS: Most of the children (105 cases, 59.6%) were born in Florianópolis, Capital of Santa Catarina State, and Itajaí (22 cases, 12.5%). Vertical transmission of HIV was observed in 167 patients (94.9%). Among 167 HIV-positive mothers, 77 (46.1%) of them acquired the virus by sexual transmission and 35 (21.0%) by use of injectable drugs. However, among 89 HIV-positive fathers, 63 (70.7%) of them used to take drugs. The average age of the HIV-positive children whose serologic tests became negative was 10.5 months. Among 103 symptomatic patients, 87 (84.5%) presented hepatomegaly, 81 (78.6%) lymphadenopathy, 66 (64.0%) splenomegaly, 59 (57.3%) skin bruises, 54 (52.4%) recurrent bronchopneumonia and 50 cases (48.5%) recurrent diarrhea. The most frequent opportunistic infection was mucocutaneous candidiasis that occurred in 41 children (39.8%). CONCLUSIONS: The characteristics were similar to those reported in the literature. A great concentration of HIV infected persons was observed in the coast area where there are three harbor towns, an elevated number of injectable drug users and presence of many tourists.
RESUMO
In order to study placental transfer of IgG subclasses, paired blood samples were collected from mothers and umbilical cord of preterm (N = 69) and full-term (N = 68) newborns. The full-term group was further divided into 3 subgroups: appropriate for gestational age (AGA, N = 43), large for gestational age (LGA, N = 13) and small for gestational age (SGA, N = 12), according to birth weight. IgG subclasses (IgG1, IgG2, IgG3 and IgG4) were measured by the single radial immunodiffusion technique using monoclonal antibodies. IgG1 and IgG3 newborn subclass concentrations (10.17 and 0.57 g/l, respectively) increased with increasing gestational age and reached maternal levels (IgG1 = 8.86; IgG3 = 0.67 g/l) during the 37th week of pregnancy. Low levels of these subclasses were found in premature newborns. IgG2 from newborns were always lower than maternal levels (P<0.05). LGA and SGA newborns had equivalent levels of IgG1 and IgG2 compared with AGA. SGA newborns had higher levels of IgG3 and lower levels of IgG4 than LGA and AGA newborns.
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Imunização Passiva , Imunoglobulina G/sangue , Recém-Nascido Prematuro/sangue , Placenta/fisiologia , Recém-Nascido/sangue , Imunoglobulina G/classificação , Placenta/imunologia , Receptores FcRESUMO
O forcipe e instrumento do arsenal obstetrico desde ha centurias. No decorrer dos tempos foi sendo aprimorado sob varios angulos. As codificacoes de Magalhaes e o postulado De Lee deram a pinca de Chamberlen novo conceito Nao pode, e nao deve ser proscrito visto que e de grande serventia em determinadas indicacoes materno-fetais. E tao prestimoso que ha servicos, mormente nos Estados Unidos, onde seu emprego e a basto na abreviacao do periodo expulsivo. Os A.A. estudam-no e comentam as 175 aplicacoes do forcipe na Maternidade Carmela Dutra, num total de 5436 partos ocorridos desde lo. de janeiro ate 31 de dezembro de 1980, na incidencia de 3,2%