Epidemiological and geographical distribution profile of urban sporotrichosis in the city of São Paulo

BackgroundSporotrichosis is the most frequent subcutaneous mycosis in Latin America, where it is considered endemic. At the end of the 20th century, the first cases of zoonotic transmission were described in Rio de Janeiro, triggering an epidemic outbreak that spread to other regions of Brazil. The lack of disease notification omits its real occurrence in the country, which happens in its most populous city, São Paulo.ObjectiveTo evaluate the epidemiological aspects of the patients seen at a hospital in São Paulo aiming at establishing the geographic distribution of this disease.MethodsThis is a retrospective study that analyzed data from medical records of patients with a clinical and laboratory diagnosis of sporotrichosis attended at a tertiary hospital in the city of São Paulo between 2012 and 2020.ResultsTwenty patients were included. As for zoonotic surveillance, 30% denied contact with an animal, and 70% reported previous contact with a sick cat, with no other animals being mentioned. One case was allochthonous and the others autochthonous, showing a dissemination behavior from a focus in the eastern area of the capital.Study limitationsThe present study was based on data from only one hospital. Studies that include data from other hospitals and other regions must be carried out to obtain a complete picture of this disease.ConclusionsAs in other regions of the country, zoonotic sporotrichosis presents itself as an endemic disease with an increase in the number of cases. The findings highlight epidemiological characteristics of great importance so that public health policies can contain disease progression.     

Epidemiology of Kaposi's sarcoma in patients with acquired immunodeficiency syndrome in São Paulo, Brazil

Background Kaposi's sarcoma (KS) is the most frequent neoplasm in patients with acquired immunodeficiency syndrome (AIDS). Although many studies on KS epidemiology have been performed in other countries, few have been carried out in Brazil despite the high incidence of AIDS. Methods One hundred and seven KS patients seen in São Paulo, Brazil, between August 1995 and November 1998 were studied. The patients were followed for 1 year with assessment of the immunologic status, improvement of the lesions, treatment, and causes of death at the end of this period. Results KS occurred mainly in men (94.4%) with a mean age of 37 years, and 25.2% of these patients were found to be human immunodeficiency virus (HIV) seropositive through KS. HIV was acquired mainly through homosexual contact. The patients presented an average of 15.9 KS lesions at the first visit and the mean duration of KS lesions before the first visit was 15.5 months. The clinical presentation was predominantly papules and plaques, and 33.6% presented with mucosal and/or visceral disease. KS affected mainly the lower limbs. The mean time since the diagnosis of HIV infection was 42.4 months. The CD4+ cell count was lower than 200 cell/mm³ in 60.8% of patients, but patients with a complete response showed an improvement in immune status after 1 year. Patients who did not show progression received a protease inhibitor as part of highly active antiretroviral therapy (HAART). Patients treated exclusively with HAART presented a complete response (61.6%), partial response (23%) or progression (15.4%) of KS. Conclusions An improvement in immune status and the use of HAART were the most important prognostic features.     

Quality of life in leprosy: a comparative analysis between patients in the Amazon region and patients in Santo André in the ABC region of São Paulo, Brazil

This study analyzed the quality of life of individuals with leprosy and compared quality of life indexes of patients in two different socioeconomic scenarios. The study was conducted at the leprosy clinic of the ABC School of Medicine, S?o Paulo, Brazil and during visits to the populations living along the Purus River in the Brazilian state of Amazonas. The Dermatology Life Quality Index (DLQI) was used to evaluate the patients. Quality of life was found to be impaired in 76.9% of the patients evaluated in the Amazon compared to 19% of the patients in Santo André. In the group of patients in the Amazon who had sequelae of the disease, quality of life was impaired.     

Prevalence of weathering nodules of the ear in patients treated at the state civil servant's hospital of S?o Paulo,Brazil

BACKGROUND

Weathering nodules of the ear are pale yellow, asymptomatic lesions which predominate on the helices of the ears. Although their pathogenesis remains unknown, there is an association with chronic exposure to ultraviolet radiation, age and thermal injuries. Few studies have been conducted to date, and these involved a very small number of patients.

OBJECTIVE

Study the prevalence of weathering nodules of the ear in patients treated in the Dermatology Service of the State Civil Servant''s Hospital of São Paulo, and evaluate their probable relationship with sun exposure, age and phototypes I and II.

METHODS

Four hundred patients older than 20 years of age were examined between July 2008 and December 2008. A questionnaire evaluating age, sex, place of birth, origin, occupation and history of sun exposure was applied. All patients were examined and evaluated for the presence of lesions by only one person.

RESULTS

The data showed that 155 (38.8%) patients had a lesion in at least one of the ears. The Chi-Square Test was used for the comparative analysis between the groups of patients with and without lesions. In the group of patients with lesions, 29% were 70 to 79 years old, 78.1% had a history of sun exposure and 45.1% belonged to FITZPATRICK skin phototypes I and II (p<0.05%).

CONCLUSION

The findings suggest relevant prevalence, probable association with chronic sun exposure, advanced age and phototypes I and II.     

Cutaneous sarcoidosis: clinico–epidemiological profile of 72 patients at a tertiary hospital in São Paulo,Brazil

BackgroundSarcoidosis is a multisystem disease of unknown cause that is characterized by the presence of granulomas in various organs. Cutaneous involvement is common and the reported incidence has varied from 9% to 37%. Studies on cutaneous sarcoidosis in Brazil are lacking.ObjectivesTo describe the clinical and epidemiological aspects of patients with cutaneous sarcoidosis diagnosed at the Department of Dermatology of the University of São Paulo, from May 1994 to March 2018.MethodsClinical data of patients with confirmed cutaneous sarcoidosis were retrospectively reviewed and classified according to gender, ethnicity, age at diagnosis, cutaneous presentation, systemic involvement and treatment.ResultsCutaneous sarcoidosis was diagnosed in 72 patients with a female predominance (74%). The mean age at diagnosis was 49.6 years and most of the patients were white (61%). Papules and plaques were the most common lesions. Systemic sarcoidosis was detected in 81% of patients, affecting mainly the lungs and thoracic lymph nodes (97%). Typically, cutaneous lesions were the first manifestation (74%). Systemic therapy was necessary for 72% of patients; the dermatologist managed many of these cases. Oral glucocorticoids were the most commonly used systemic medication (92%). The mean number of systemic drugs used was 1.98 per patient.LimitationsInsufficient data in medical records.ConclusionsThis series highlights the dermatologist role in recognizing and diagnosing cutaneous sarcoidosis, evaluating patients for systemic disease involvement and treating the skin manifestations. Cutaneous sarcoidosis was once considered exceedingly infrequent in Brazil in comparison to infectious granulomatous diseases; however, the present series seems to suggest that the disease is not so rare in this region.     

Home-based self-sampling and self-testing for sexually transmitted infections: acceptable and feasible alternatives to provider-based screening in low-income women in São Paulo, Brazil

OBJECTIVE: The objective of this study was to determine whether home-based screening for sexually transmitted infections (STIs) is acceptable, feasible, and increases the proportion of women screened among low-income women in S?o Paulo, Brazil. STUDY DESIGN: Eight hundred eighteen women were randomized to receive a clinic appointment or a kit for home-based STI self-collection and testing. All participants collected 2 vaginal swabs, one for polymerase chain reaction detection of chlamydia, gonorrhea, and trichomoniasis and another for a self-conducted rapid test for trichomoniasis. RESULTS: Slightly more women responded to the initiative within 2 weeks in the home group (80%) than in the clinic group (76%) with younger women showing improved response to home-based screening. Ninety-four percent of home group participants successfully completed self-collection and self-testing on their first attempt. CONCLUSIONS: Home-based self-collection and self-testing was acceptable, feasible, and resulted in a slightly higher response rate. Home sampling and testing provide promising alternatives to clinic-based STI screening across diverse contexts.     

Zoonotic sporotrichosis. Transmission to humans by infected domestic cat scratching: report of four cases in São Paulo, Brazil

BACKGROUND: Sporotrichosis is a chronic, granulomatous, deep mycosis caused by the dimorphic fungus Sporothrix schenckii that usually results in indolent cutaneous lesions. OBJECTIVE: To describe four cases of human sporotrichosis transmitted by domestic cats in south-eastern Brazil. METHODS: Confirmation of the diagnosis was performed by histopathology, culture, and/or inoculation of hamsters. RESULTS: In all cases, the clinical findings in both cat and human groups were highly distinctive of the disease. In all human cases, there was a previous history of cat scratching before the development of lymphocutaneous lesions. Histopathology of the human lesions demonstrated the classical granulomatous and exudative pattern with scarce or absent fungal elements. Conversely, in cats, the cutaneous lesions were multiple, extensive, necrotic, exudative, and ulcerated. Histopathology revealed a widespread histiocytic reaction with a large number of fungal organisms. Disseminated lymphatic and visceral mycotic infection was observed in two necropsied cats. CONCLUSIONS: Domestic cats may be an important carrier of agents of sporotrichosis to humans.     

Characterization of sporotrichosis cases treated in a dermatologic teaching unit in the state of S?o Paulo - Brazil, 2003 - 2013

We conducted a transversal retrospective study with secondary data collection from 25cases of sporotrichosis, treated at a teaching unit in inner São Paulo (Brazil),between the years 2003-2013. We found that the prevalence was higher in men (72%),rural workers (44%) and those living in rural areas (60%), with an average age of42.48 years. The median between the onset of lesions and diagnosis was six weeks.Lesions predominated in the upper limbs (92%), and were classified as lymphocutaneous(80%) and fixed cutaneous (20%) forms. Clinical cure was observed in 62.5% of thecases treated with potassium iodide and 100% of cases treated with itraconazole.     

What is the incidence of medical device-related pressure injuries in adults within the acute hospital setting? A systematic review

Medical devices provide effective therapeutic care for patients. However, medical device-related pressure injuries (MDRPI) are caused by prolonged pressure or shear from a medical device on any location on the body, including mucosal cavities. The primary outcome of this quantitative systematic review was to identify the incidence of MDRPIs in adults within the acute hospital setting. Secondary outcomes include grading, anatomical location and devices that caused such injuries. Electronic databases (CINAHL Plus with Full Text, MEDLINE, EBSCO Host, Health Business Elite Web of Science, PsychINFO, Google Scholar, and Research Gate) were searched for all potential primary studies between November 2019–January 2020. Studies were refined to the English language only, had no time limit from publication, and had to include participants over the age of 18 years with an MDRPI in the acute hospital setting and 720 potential primary studies were identified. Fourteen articles were identified that matched the predefined criteria and were included in the review. All included studies were critically appraised using the evidence-based librarianship critical appraisal tool and data analysis and narrative synthesis were completed. The incidence of MDRPIs in adults within the acute care setting was 28.1% (SD: 29.1%, min: 1.14%, max: 100%). 71.3% of studies documented anatomical locations of MDRPIs, 36.2% included grading of MDRIs, and 71.4% studies documented the offending medical devices. The mean quality appraisal percentage of all included studies was 76.67% (SD: 4.61%; min: 66.6%, max: 83.3%). Despite the heterogeneity of the studies, the review has identified that MDRPIs are prevalent among individuals cared for within the acute hospital setting. Thus, given the morbidity associated with these wounds, it is important to develop strategies to reduce the scope of this problem.