OBJECTIVES: To better understand how diabetes care and control are being administered by general practitioners/nonspecialists in private practice in nine countries of Latin America, and to identify the most significant patient- and physician-related barriers to care. METHODS: A multicenter, cross-sectional, epidemiological survey was conducted in nine countries in Latin America: Argentina, Brazil, Chile, Costa Rica, Ecuador, Guatemala, Mexico, Peru, and Venezuela. General practitioners in private practice were asked to provide care and control data for patients 18 to 75 years of age with type 2 diabetes mellitus (T2DM), including demographics, medical and medication history, laboratory exams, and information on the challenges of patient management. RESULTS: Of the 3 592 patient questionnaires returned by 377 physicians, 60% of the patients had a family history of diabetes, 58% followed a poor diet, 71% were sedentary, and 79% were obese or overweight. Poor glycemic control (fasting blood glucose > 110 mg/dL) was observed in 78% of patients. The number of patients with HbA1c < 7.0% was 43.2%. Glycemic control decreased significantly with increased duration of T2DM. Comorbid conditions associated with T2DM were observed in 86% of patients; insulin use and comorbid conditions, especially those associated with microvascular complications, increased significantly disease duration. Ensuring compliance with recommended diet and exercise plans was the most-cited patient management challenge. CONCLUSIONS: Blood glucose levels are undercontrolled in T2DM patients in the private health care system in Latin America, particularly among those who have had the disease the longest (>15 years). Considering the differences between private and public health care in Latin America, especially regarding the quality of care and access to medication, further studies are called for in the public setting. Overall, a more efficient and intensive program of T2DM control is required, including effective patient education programs, adjusted to the realities of Latin America.

OBJETIVOS: Comprender mejor cómo los médicos generales/no especialistas del sector privado atienden y controlan la diabetes en nueve países de América Latina e identificar los principales problemas relacionados con el paciente y el médico, que obstaculizan la atención. MÉTODOS:Se realizó un estudio epidemiológico, multicéntrico, transversal, en nueve países de América Latina: Argentina, Brasil, Chile, Costa Rica, Ecuador, Guatemala, México, Perú y Venezuela. Se pidió a los médicos generales del sector privado la información sobre la atención y el control de sus pacientes de 18 a 75 años de edad con diabetes mellitus tipo 2 (DMT2), así como los datos demográficos, la historia clínica y de medicación, las pruebas de laboratorio e información sobre los retos relacionados con la atención del paciente. RESULTADOS: De los 3 592 cuestionarios de pacientes entregados por 377 médicos, 60% de los pacientes tenían antecedentes familiares de diabetes, 58% seguían una dieta inadecuada, 71% eran sedentarios y 79% presentaban obesidad o sobrepeso. Se observó un inadecuado control glucémico (glucemia en ayunas > 110 mg/dL) en 78% de los pacientes. La proporción de pacientes con HbA1c < 7,0% fue de 43,2%. El control glucémico se redujo significativamente al aumentar la duración de la DMT2. En 86% de los pacientes se encontraron enfermedades concurrentes asociadas con la DMT2; el uso de insulina y las enfermedades concurrentes -especialmente las asociadas con complicaciones microvasculares- incrementaron significativamente la duración de la diabetes. En cuanto al tratamiento de los pacientes, el reto más frecuentemente citado fue garantizar la adhesión a la dieta y al plan de ejercicios recomendados. CONCLUSIONES: Los niveles de glucemia no están suficientemente controlados en los pacientes con DMT2 que se atienden en el sistema privado de salud de América Latina, particularmente en los pacientes que han tenido la enfermedad por más tiempo (> 15 años). Tomado en cuenta las diferencias entre la atención sanitaria privada y la pública en América Latina, especialmente en lo concerniente a la calidad de la atención y el acceso a los medicamentos, se requieren estudios adicionales en el sector público. En general, se necesita un programa más eficiente e intensivo de control de la DMT2 y programas eficaces de educación de los pacientes, ajustados a las realidades de América Latina.

Apresentação de um caso de paracoccidioidomicose com comprometimento do sistema nervoso central, manifestando-se por movimento involuntário do tipo tremor rubral. São discutidas, ainda, as outras formas de apresentação desta afecção relatadas na literatura.

A case of paracoccidioidomycoses of the central nervous system and movement disorders is reported in this paper, and neurological aspects are discussed.

Estudou-se a prevalência de marcadores para a hepatite B (HBsAg, AntiHBc e AntiHBs) em profissionais de saúde, a fim de identificar grupos de maior risco onde estaria indicada a vacinação pré-exposição. Comparando-os com os funcionários administrativos do mesmo hospital, observamos índices significativamente superiores em grupos como cirurgiões (40,0%) e profissionais de hemodiálise (36,4%), que apresentaram taxas deferimentos no trabalho, de, respectivamente, 93,3% e 77,3%. Outros grupos mostraram grande aumento da prevalência em função do maior tempo de atuação profissional, comprovando seu risco. Outras formas de transmissão, como transfusão e contato íntimo com portadores de hapatite, não tiveram significância. Os autores concluíram que a vacinação está indicada em cirurgiões e profissionais de hemodiálise, bem como dentistas e técnicos de laboratório.

The authors studied the prevalence of HBV markers among health care personnel of the Univer- sity Hospital of the Federal University of Rio de Janeiro. The aim ofstudy was to identify the high risk groups, in order to counsel vaccínation of those groups at risk as a routine. As a control group, a group of office workers of the hospital were chosen. A significant difference of incidence of HBV markers, mainly in surgeons (40%) and hemodialysis unit personnel (36.4%) when compared to the control group, was observed (p < 0.05). The incidence increased with age and the time spent in the profession. The authors concluded that vaccination is indicated in surgeons hemodialy sis personnel, dentists and laboratory personnel.