Objetivo: Correlacionar o manejo diagnóstico terapêutico da Neurotoxoplasmose ao desfecho de morbimortalidade nos indivíduos portadores de Síndrome da Imunodeficiência Humana. Revisão bibliográfica: A toxoplasmose é uma doença provocada pelo Toxoplasma gondii, parasita intracelular semeado pelo Brasil, que pode se instalar e gerar infectividade ao Sistema Nervoso Central (SNC). Em razão da imunodeficiência marcante do dinamismo fisiopatológico do HIV, esses indivíduos são inoperantes no controle da expansão e diferenciação do patógeno possibilitando reativação e menos frequentemente uma infecção aguda com repercussões no SNC como cefaleia, confusão mental, convulsões e alterações de força. Como pilar essencial do diagnóstico ancora-se a história clínica epidemiológica a Ressonância Magnética do Crânio com lesão hipo/isodensa com captação anelar do contraste e efeito de massa exercido. Considerações finais: Nessa perspectiva, com a maior facilidade de acesso à Terapia Antiretroviral atualmente é possível observar, ao longo dos anos, uma queda significativa da incidência de neurotoxoplasmose no Brasil. No entanto, a neurotoxoplasmose ainda é uma causa significativa de morbidade e mortalidade em pacientes imunossuprimidos, sendo importante reconhecer, conseguir diagnosticar e tratar tal patogenia de maneira efetiva, pois o intervalo de tempo entre o diagnóstico e o início do tratamento é determinante na morbimortalidade.
Objective: To evaluate the relationship between the main cardiovascular (CV) risk factors and socioeconomic indicators in a population of young adults provided by a Primary Healthcare Center in a large urban area of Brazil. Methods: Cross-sectional population study that included adults aged between 20- and 50-years old provided by a Primary Healthcare Center in Rio de Janeiro, Brazil. Demographic data (gender and age), socioeconomic data (education level, occupation, employment), CV risk factors (smoking, sedentary lifestyle, obesity, hypertension, diabetes, dyslipidemia) were recorded. The metabolic profile was evaluated through laboratory tests. Those who studied up to high school were considered poorly educated. Results: A total of 604 individuals were enrolled [39% male, mean age: 38.8 ± 8,9 years]. The median of schooling was 12 years. In addition, 288 individuals had high schooling, of which 44.5% were male. A total of 130 individuals did not study or work. Women with low education had a higher risk of smoking, hypertension, and obesity, with no difference regarding labor or study activities. Otherwise, men with low education had higher risk of sedentary lifestyle and hypertension. Among men, not working or studying increased the risk of smoking and hypertension. Conclusions: We found an inverse association between socioeconomic status and the prevalence of CV risk factors. Women are more affected by low schooling, while men are more affected by their working occupation. The study suggests that socioeconomic factors influence the CV risk, affecting men and women differently, pointing to the need for public policies to reverse this situation.
Objective: To evaluate the relationship between the main CV risk factors and socioeconomic indicators in a population of adults registered in a Family Health Care (FHC) unit in the center of Rio de Janeiro. Design and method: Cross-sectional population study that included adults aged between 20 and 50 years living in the area covered by the FHC in Rio de Janeiro. Demographic data (gender and age), socioeconomic data (education level, profession, employment), CV risk factors (smoking, sedentary lifestyle, obesity, hypertension, diabetes, dyslipidemia) were recorded. The metabolic profile is evaluated through laboratory tests. Those who studied up to high school were considered poorly educated. Results: 604 individuals were enrolled [39% male, mean age: 38.8 ± 8,9 years] The median of schooling was 12 years. 288 individuals had high schooling, 44.5% were male. A total of 130 individuals did not study or work. Women with low education had a higher risk of smoking, obesity and hypertension with no difference regarding labor or study activities. Otherwise, men with low education had higher risk of sedentary lifestyle and hypertension. Among men, not working or studying increased the risk of smoking and hypertension. Conclusions: We found an inverse association between socioeconomic conditions and the prevalence of CV risk factors. Women are more affected by low schooling, while men are more affected by their working occupation. The study suggests that socioeconomic factors influence the CV risk, affecting men and women differently, pointing to the need for public policies to reverse this situation.
Background The new hypertension (HT) guidelines recommend the use of out-of-office blood pressure (BP) measures for its diagnosis however, in the scope of public health in Brazil, it is still based on office BP (OBP) for logistical and financial reasons. Furthermore, in our country, it is not yet clear whether the use of out-of-office BP would really be more reliable for the diagnosis. Objective To evaluate the importance of using Home Blood Pressure Monitoring (HBPM) in diagnosing HT in a young adult population in primary care in Brazil. Methods A cross-sectional population study enrolled adults between 20 and 50 years in a primary healthcare unit in Rio de Janeiro. Office BP was the mean value of 2 measures, while the HBPM followed a 7-day protocol. It was considered normal a Home BP < 135x85 mmHg and OBP <140x90 mmHg. Patients were classified into 4 phenotypes: normotension (controlled OBP and HBPM); white coat HT (uncontrolled OBP and controlled HBPM); masked HT (controlled OBP and uncontrolled HBPM) and sustained HT (uncontrolled OBP and HBPM). Results A total of 462 individuals were enrolled [38% males; mean age 36±9 years]. Sedentary lifestyle (43%), dyslipidemia (38%) and obesity (28%) were the main CV risk factors. OBP, the prevalence of HT was 13%, HBPM it was 19%, with low concordance between them (kappa=0.472). After HBPM, 17% changed the diagnosis, being 6% of them white-coat HT and 11% masked HT. The variables that were independently associated with HT diagnosed by OBP were male gender (OR 1.83,CI95%:1.01-3.33,p=0.04) and increased neck circumference (OR 3.77,CI95%:1.59-8.93,p=0.003), whilst by HBPM they were obesity (OR 2.18,CI95%:1.27-3.76,p=0.005) and increased neck circumference (OR 2.37,CI95%:1.05-5.33,p=0.04). Conclusions If the diagnosis was based only in the office BP values, 17% of the subjects would've had an erroneous diagnosis of hypertension, suggesting the importance of implementing out-of-office BP measurements in primary care. Key messages Home monitoring blood pressure corrected the diagnosis of hypertension of 17% of patients, allocating them correctly into white-coat HT and masked HT. Increased neck circumference was independently associated with the diagnosis of hypertension by both methods.
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