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Núñez MDRR, Engel FD, Cardoso M, Castro RG, Montoya JAG, de Mello ALSF. Oral hygiene prior to cardiac surgery to prevent infections: Randomized clinical trial. Int J Dent Hyg 2024; 22:384-393. [PMID: 36546871 DOI: 10.1111/idh.12661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT It is not clear if an oral hygiene protocol to control biofilm applied before cardiac surgery can reduce infection rates. OBJECTIVE We aim to verify the effectiveness of an oral hygiene protocol in reducing postoperative infections when compared to usual practices, in patients admitted to a cardiology unit, prior to cardiac surgery. DESIGN, SETTING AND PARTICIPANTS Randomized, blind, controlled clinical trial, with 107 participants who expected to undergo cardiac surgery, randomized into two groups: Experimental Group (EG) standardized oral hygiene protocol (54) and Control Group (CG), usual practices performed in patients admitted (53). INTERVENTION a standardized oral hygiene protocol, 1 day before surgery: professional prophylaxis with a portable ultrasound device, tooth brushing and flossing plus a 0.12% chlorhexidine gluconate solution (0.12% CHX) mouth rinsing. When applicable, removable prostheses cleaning. PRIMARY OUTCOME the presence of infection. RESULTS The occurrence of postoperative infection was higher in CG = 7 (13.2%) than in EG = 5 (9.3%); but no statistical difference was found between protocols (p = 0.518). The length of stayed from surgery to discharge presented a statistical difference (p = 0.047; RR = 4.9; CI = 1.01-24.33); the percentage of postoperative infection was almost five times higher in those participants who stayed 11 or more days. CONCLUSION The standardized oral hygiene protocol with mechanical and chemical cleaning, 1 day before cardiac surgery, was not more effective than the usual practices performed regarding the reduction of postoperative infections. Other interventions regarding oral hygiene procedures before cardiac surgery must be studied to contribute to the reduction of adverse post-surgical events. CLINICAL TRIAL REGISTRATION Site Ensaclinicos.gov.br number U1111-1214-2862. DESCRIPTORS Healthcare Associated Infections, Cardiovascular Diseases, Periodontal Diseases, Dental Biofilm, Cardiovascular Surgery.
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Warmling CM, Spin-Neto R, Palma LZ, Silva-Junior MF, Castro RG, Finkler M, Baldani MH, Bitencourt FV. Impact of the COVID-19 Pandemic on the Oral Health Workforce: A Multicenter Study from the Southern Region of Brazil. Int J Environ Res Public Health 2023; 20:1301. [PMID: 36674057 PMCID: PMC9859153 DOI: 10.3390/ijerph20021301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
The aim of this study was two-fold: (1) to describe the surveillance and biosafety measures adopted by dentists, dental hygienists, and dental assistants who worked in the Southern Region of Brazil and (2) to evaluate access to information in the context of the COVID-19 pandemic. This was a multicenter and cross-sectional design, using a self-applied and validated online questionnaire. The availability of health-care-related supplies and the adoption of biosafety measures recommended by the Technical Note of the National Health Surveillance Agency No. 04/2020 were analyzed. A total of 2560 Brazilian workers participated (75.8% dentists, 15.7% dental assistants and 8.5% dental hygienists), 52.7% from the public and 37.7% from the private sector. Approximately 70% of the individuals reported being away from work during the pandemic. The surveillance measures adopted with higher mean scores were the investigation of respiratory infection symptoms when scheduling appointments and the adoption of distancing in the waiting room. Of the biosafety measures to avoid aerosols, the procedures with lower compliance were those related to the use of intraoral radiographs and rubber dams. Moreover, the correct use of personal protective equipment at work seems to be related to self-perceived stress and anxiety. Worryingly, high access to information through non-governmental documents was observed. Permanent health education policies should reinforce safe practices and encourage workers to implement biosafety and surveillance measures in health services.
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Affiliation(s)
- Cristine Maria Warmling
- Graduate Program Teaching in Health, Federal University of Rio Grande do Sul, Porto Alegre 90010-150, RS, Brazil
| | - Rubens Spin-Neto
- Department of Dentistry and Oral Health, Section for Oral Radiology, Aarhus University, 8000 Aarhus, Denmark
| | - Luciana Zambillo Palma
- Graduate Program Teaching in Health, Federal University of Rio Grande do Sul, Porto Alegre 90010-150, RS, Brazil
| | | | - Renata Goulart Castro
- Department of Dentistry, Federal University of Santa Catarina, Florianópolis 88040-900, SC, Brazil
| | - Mirelle Finkler
- Department of Dentistry, Federal University of Santa Catarina, Florianópolis 88040-900, SC, Brazil
| | - Márcia Helena Baldani
- Department of Dentistry, State University of Ponta Grossa, Ponta Grossa 84010-330, PR, Brazil
| | - Fernando Valentim Bitencourt
- Department of Dentistry and Oral Health, Section for Periodontology, Aarhus University, 8000 Aarhus, Denmark
- Steno Diabetes Center Aarhus, 8200 Aarhus, Denmark
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Böhm da Costa C, da Silva Peralta F, Aurelio Maeyama M, Goulart Castro R, Lúcia Schaefer Ferreira de Mello A. Teledentistry System in Dental Health Public Services: A Mixed-Methods Intervention Study. Int J Med Inform 2021; 153:104533. [PMID: 34303136 DOI: 10.1016/j.ijmedinf.2021.104533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Health information and communication technologies, such as Teledentistry, can help expand access to dental health public services making it more effective. OBJECTIVE To analyze the factors that affect the implementation of a Teledentistry system in dental health public services. METHODS The study follows the Implementation Research methodological framework. A mixed-method approach was applied using a triangulation design-sequential model to collect, analyze, and interpret qualitative and quantitative data about the implementation of a Teledentistry system. A compulsory teleconsultation from the general dentist was planned to access periodontics specialized care. The study was developed in a South Brazilian capital city and the platform of the Santa Catarina Telehealth Center was used. Qualitative and quantitative data were collected sequentially to achieve a better understanding of implementation research issues. RESULTS In seven months, 68 teleconsulting was performed by 22% of the general dentists, prior to the referrals on periodontics. Only one reported not needing to refer the patient to the periodontist as a result of the teleconsulting guidance. Teledentistry system implementation and usage were influenced by the managers' political and administrative awareness to deploy and maintain the intervention. Lack of sufficient resource investment, lack of system integration, and internet failures were relevant limiting factors. The teleconsultant guidelines contributed to general dentistry's better decision-making regarding treatment, urgency of case management, and prioritization of referrals to the periodontists CONCLUSION: Identifying the factors that influence the implementation and finding solutions to overcome them, can prevent future failures and improve usage of the system.
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Affiliation(s)
- Christine Böhm da Costa
- Health Department, Joinville Municipality, Santa Catarina, Brazil. Address: Rua Dr. João Colin, 2700 - Santo Antônio. CEP, 89218-035 Joinville, SC, Brazil.
| | - Felipe da Silva Peralta
- Health Department, Joinville Municipality, Santa Catarina, Brazil. Address: Rua Dr. João Colin, 2700 - Santo Antônio. CEP, 89218-035 Joinville, SC, Brazil.
| | - Marcos Aurelio Maeyama
- Vale do Itajaí University, Itajaí, Santa Catarina, Brazil. Address: Rua Uruguai, 458 - Centro. CEP, 88302-901 Itajaí, SC, Brazil.
| | - Renata Goulart Castro
- Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. Address: Campus Universitário João David Ferreira Lima. Post Graduation Program in Dentistry. Centro de Ciências da Saúde - Trindade. CEP 88040-900 Florianópolis, SC, Brazil.
| | - Ana Lúcia Schaefer Ferreira de Mello
- Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. Address: Campus Universitário João David Ferreira Lima. Post Graduation Program in Dentistry. Centro de Ciências da Saúde - Trindade. CEP 88040-900 Florianópolis, SC, Brazil.
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Oliveira GV, Metsavaht LD, Kadunc BV, Jedwab SKK, Bressan MS, Stolf HO, Castro RG, Bezerra SMFMC, Calil DA, Addor FAZ, Fraga JCS, Reis CMS, Reis-Filho E, Silva MR, Ramos-E-Silva M, Hexsel DM. Treatment of keloids and hypertrophic scars. Position statement of the Brazilian expert group GREMCIQ. J Eur Acad Dermatol Venereol 2021; 35:2128-2142. [PMID: 34263958 DOI: 10.1111/jdv.17484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/31/2021] [Indexed: 12/23/2022]
Abstract
Keloids (K) and hypertrophic scars (HS) are abnormal responses to wound healing that occur as the result of dermal inflammation. Despite the advances on their treatment, many patients still suffer from the negative effects of excessive scarring; its approach is impaired by the lack of objective data on different treatments and the large genetic variability among patients and the difficulties in producing multicentre studies. Their incidence among the Brazilian population is high, as the result of an admixture of Amerindians, Europeans and Africans ancestral roots. With the aim of producing multicentre studies on K and HS, a panel of senior Brazilian dermatologists focused on their treatment was invited to contribute with the K and HS Treatment Brazilian Guidelines. In the first part of this study, different treatment modalities for keloids and HS are fully reviewed by the panel. The second part of the study presents a consensus recommendation of treatment for different types of lesions. More than a literature review, this article aims to show the pitfalls and pearls of each therapeutic option, as well as a therapeutic approach by the Panel of Experts on keloids and Scars on a highly mixed population, providing simple guidelines.
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Affiliation(s)
- G V Oliveira
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Mario Penna/Luxemburgo Hospital, Keloids and Scars Ambulatory, Belo Horizonte, Brazil
| | - L D Metsavaht
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Santa Casa de Misericórdia, Rio de Janeiro, Brazil
| | - B V Kadunc
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Surgical and Cosmetic Dermatology, São Paulo, Brazil
| | - S K K Jedwab
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Skinlaser Director, São Paulo, Brazil
| | - M S Bressan
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Maura Bressan Dermatology, Campinas, Brazil
| | - H O Stolf
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,UNICAMP, Campinas, Brazil
| | - R G Castro
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, Brazil
| | - S M F M C Bezerra
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Federal University of Pernambuco, Recife, Brazil
| | - D A Calil
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Brazilian Society of Dermatology, São Paulo Session, São Paulo, Brazil
| | - F A Z Addor
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Albert Einstein Hospital, São Paulo, Brazil
| | - J C S Fraga
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Military Hospital, Belo Horizonte, Brazil
| | - C M S Reis
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Dermatology Residency Program, ESCS-DF, Brasilia, Brazil
| | - E Reis-Filho
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Dermatology Residency Program, ESCS-DF, Brasilia, Brazil
| | | | - M Ramos-E-Silva
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Dermatology Residency Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - D M Hexsel
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,International Society for Dermatologic Surgery (ISDS), Hexsel Dermatology Clinics and Brazilian Center for Studies in Dermatology, Porto Alegre, Brazil
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Ruiz Núñez MDR, da Luz Raulino M, Goulart Castro R, Schaefer Ferreira de Mello AL. Dental plaque control strategies for the elderly population: A scoping review. Int J Dent Hyg 2021; 20:167-181. [PMID: 33829631 DOI: 10.1111/idh.12497] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 03/23/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To review the scientific literature and identify dental plaque control strategies focussed on elderly people that improve plaque indices. DESIGN Scoping review (Joanna Briggs protocol). DATA SOURCES Individual search strategies developed for six databases. The selection of the manuscripts in two phases: title and abstract review, and complete review. ELIGIBILITY CRITERIA Studies on interventions for plaque control in elderly people (60y+). Epidemiological studies and those focussed on caregivers, health professionals and periodontal maintenance therapies were excluded. RESULTS The initial search yielded 2803 studies, 26 were included. The results were classified into: exclusively chemical (10), educational (9), exclusively mechanical (6), and combined mechanical and chemical (1). The studies reported different types of interventions: sugarless chewing gum, chlorhexidine (CHX) in different preparations and concentrations, mouthwash based on essential oils, stannous/sodium fluoride dentifrice and lactoferrin/lactoperoxidase tablets. Additionally, conventional and alternative toothbrushes and professional brushing were tested. Educational interventions included oral hygiene guidance, verbal information, and demonstrations of dental and denture cleaning procedures, and lifestyle changes. Many studies have reported strategies that improve dental plaque indices but without statistical significance when compared to control groups. Promising results were found with the use of CHX, sugarless chewing gum, professional brushing and educational strategies with demonstration, but the results were not long-lasting. CONCLUSION The literature reports that mechanical, chemical and educational strategies have some efficacy in dental plaque control in the elderly population. The results should be viewed with caution, considering the type of intervention (isolated or combined) and the maintenance of the results obtained.
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Affiliation(s)
| | | | - Renata Goulart Castro
- Post-Graduation Program in Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil
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Godoi H, Castro RG, Santos JLGD, Moyses SJ, Mello ALSFD. [Obstacles to public governance and their influence on oral healthcare in the state of Santa Catarina, Brazil]. CAD SAUDE PUBLICA 2020; 36:e00184719. [PMID: 33237203 DOI: 10.1590/0102-311x00184719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 04/17/2020] [Indexed: 11/22/2022] Open
Abstract
The study aimed to analyze public governance in the regionalized healthcare network in the state of Santa Catarina, Brazil, and its influence on decision-making in the organization of oral healthcare. This was an exploratory analytical study with a qualitative approach, with the methodology based on Grounded Theory. Thirty in-depth interviews were held with managers from the Regional Inter-Managers Commissions and Bipartite Commissions (CIR and CIB, respectively, in Portuguese), under the State Health Department, representatives from the State Health Councils, and administrators of specialized oral healthcare services, in two sample groups, in addition to non-participant observation in CIB meetings. After comparative data analysis, the theoretical model was formulated in which the central category was expressed in the title Influence of Failures in Governance on the Oral Healthcare Network: The Erratic Expansion of Services by Vertical Induction and Confirmation of the Peripheral Status Assigned to Oral Health. The governance practiced in the Santa Catarina State Health System displays well-established formal support structures, such as the consolidation of the CIR. However, weaknesses were identified that reveal problems in the governance systems' legitimacy. The situation perpetuates the peripheral status assigned to the structuring of oral healthcare in network format and the erratic expansion of services, characterized by vertical induction and without contextualized recognition of oral health problems as guidance for planning the services. There is a need for greater public awareness and the inclusion of professionals and managers that can advocate for the importance of oral health as a major priority in public health policies.
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Affiliation(s)
- Heloisa Godoi
- Universidade Federal de Santa Catarina, Florianópolis, Brasil
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Del Rosario Ruiz Núñez M, Finkler M, Castro RG, Carcereri DL, Ferreira de Mello ALS. Teaching undergraduate geriatric dentistry in five South America countries. Gerodontology 2019; 36:180-187. [PMID: 30821854 DOI: 10.1111/ger.12400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/13/2019] [Accepted: 02/09/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to qualitatively analyse undergraduate geriatric dentistry (GD) teaching characteristics identified by geriatric dentistry teachers and senior students in five South American countries. BACKGROUND GD involves the knowledge and skills required to provide oral health care for older people. METHODS Exploratory-descriptive research with a qualitative approach developed in the undergraduate context of public universities in Chile, Argentina, Brazil, Colombia and Peru. Nine dental schools were intentionally selected. The participants were GD module teachers (20) and their senior students (30). Data were collected through open interviews via Skype® conducted between May and August 2015 and were analysed using a content analysis technique with ATLAS.ti® software, resulting in four categories. RESULTS GD modules are theoretical or a theoretical-practical mix. Most teachers are prosthodontists without specific training in GD. Their motivations to teach GD are related to personal, family, professional and social reasons. Humanity, sensitivity and knowledge of older people are considered fundamental characteristics of a GD teacher. CONCLUSIONS Students' first contact with an older person usually occurs during clinical activities. The participants mentioned insufficient hours for GD modules in the curricula and exclusively theoretical modules that do not allow students to learn typical specificities of older people. In the context of this study, the undergraduate GD teaching-learning process presented some weaknesses regarding educational methods, professor training and the interaction between older people and students. Diversification of learning scenarios and GD professor training are highly recommended.
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Chrun ES, Modolo F, Vieira D, Borges-Júnior Á, Castro RG, Daniel FI. Immunoexpression of HDAC1, HDAC2, and HAT1 in actinic cheilitis and lip squamous cell carcinoma. Oral Dis 2017; 23:505-510. [PMID: 28107582 DOI: 10.1111/odi.12641] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Acetylation and deacetylation are the most studied covalent histone modifications resulting in transcriptional regulation with histone deacetylases (HDAC) and histone acetyltransferases (HAT) as the main associated enzymes. These enzymes overexpression induces abnormal transcription of key genes that regulate important cellular functions, such as proliferation, cell cycle regulation, and apoptosis. Thus, the expression of different HATs and HDACs has been evaluated in various cancers. OBJECTIVE To investigate HDAC1, HDAC2 and HAT1 expression in lip squamous cell carcinoma (LSCC) and actinic cheilitis (AC) and to demonstrate their correlation with DNA metyltransferases (DNMTs). MATERIAL AND METHODS Thirty cases of lip squamous cell carcinoma (LSCC), thirty cases of actinic cheilitis (AC), and 28 cases of non-neoplastic epithelium as control were selected for immunohistochemical investigation. RESULTS Nuclear HDAC2 immunopositivity was significantly higher in AC (75.07% ± 29.70) when compared with LSCC (51.06% ± 39.02). HDAC1 and HAT1 nuclear immunostaining were higher in AC, with no statistical significance. When comparing data with our previous study, we found a positive correlation between HDAC1 X DNMT1/DNMT3b, HDAC2 X DNMT3b, and HAT1 X DNMT1/DNMT3b for certain studied groups. CONCLUSION This study showed higher levels of nuclear HDAC2 immunopositivity in AC, possibly indicating that this enzyme plays a key role in lip photocarcinogenesis early stages.
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Affiliation(s)
- E S Chrun
- Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - F Modolo
- Pathology Department and Dentistry Graduate Program, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Dsc Vieira
- Pathology Department, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Áls Borges-Júnior
- Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - R G Castro
- Dentistry Department, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - F I Daniel
- Pathology Department and Dentistry Graduate Program, Federal University of Santa Catarina, Florianopolis, SC, Brazil
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Abstract
In 1986, surveillance of acute flaccid paralysis (AFP) cases among children <15 years of age was implemented in Latin America as part of the initiative to eradicate poliomyelitis from the Western Hemisphere. Data on AFP, including Guillain-Barré syndrome (GBS), could be analyzed from a regional registry system and from specific GBS studies in seven countries. Between 1989 and 1991, 3112 cases of GBS were reported in Latin America, representing 52% of all nonpolio AFP cases. From the studies in seven countries, a total of 1527 GBS cases (49%) were studied, representing an overall annual incidence rate of 0.91/100,000 children <15 years old. Follow-up investigations showed a persistent muscular weakness at 60 days, 6 months, and 1 year after onset in 61%, 14%, and 10% of children, respectively. This study confirms that with the disappearance of polio, GBS arises as the most common cause of AFP.
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Affiliation(s)
- J M Olivé
- Special Program for Vaccines and Immunization, Pan American Health Organization, Washington, DC 20037, USA
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