Aldosari, Muath Abdullah; Tavares, Mary Angela; Matta-Machado, Antônio Thomaz Gonzaga; Abreu, Mauro Henrique Nogueira Guimarães
To assess factors associated with patients' satisfaction with the treatment by dentists in primary health care (PHC) in Brazil. The dataset was part of a nationwide cross-sectional survey for evaluating PHC teams conducted by the Brazilian Ministry of Health. Patients from each of 16,202 oral health teams were interviewed. In addition to sociodemographic information, the questionnaire included information about patient experience domains: access and booking of dental appointments, bonding and accountability, welcoming of the patient, and their perception of dental facilities. The dependent variable was the answer to the question 'From 0 to 10, how would you grade your satisfaction with treatment received from the dentist?' Negative binomial regression models were used to estimate the unadjusted and adjusted rate ratios and corresponding 95% confidence interval. The mean patient satisfaction was 9.4 (±2.3). Higher patient satisfaction with PHC was associated with lower education and the patient's perception of the clinic conditions. Moreover, higher satisfaction was associated with positive reception and hospitality, enough time for treatment, and instructions that met patients' needs. Lower satisfaction with PHC was associated with patients who have jobs compared to those who do not work. Patient satisfaction is increased with friendly and understanding PHC staff. Moreover, meeting patient expectations by taking time to understand the needs and giving the right instructions is associated with higher satisfaction.
Full Text Available OBJECTIVES: To determine whether kidney disease and hemolysis are associated with bone mass density in a population of adult Brazilian patients with sickle cell disease. INTRODUCTION: Bone involvement is a frequent clinical manifestation of sickle cell disease, and it has multiple causes; however, there are few consistent clinical associations between bone involvement and sickle cell disease. METHODS: Patients over 20 years of age with sickle cell disease who were regularly followed at the Hematology and Hemotherapy Center of Campinas, Brazil, were sorted into three groups, including those with normal bone mass density, those with osteopenia, and those with osteoporosis, according to the World Health Organization criteria. The clinical data of the patients were compared using statistical analyses. RESULTS: In total, 65 patients were included in this study: 12 (18.5% with normal bone mass density, 37 (57% with osteopenia and 16 (24.5% with osteoporosis. Overall, 53 patients (81.5% had bone mass densities below normal standards. Osteopenia and osteoporosis patients had increased lactate dehydrogenase levels and reticulocyte counts compared to patients with normal bone mass density (p<0.05. Osteoporosis patients also had decreased hemoglobin levels (p<0.05. Hemolysis was significantly increased in patients with osteoporosis compared with patients with osteopenia, as indicated by increased lactate dehydrogenase levels and reticulocyte counts as well as decreased hemoglobin levels. Osteoporosis patients were older, with lower glomerular filtration rates than patients with osteopenia. There was no significant difference between the groups with regard to gender, body mass index, serum creatinine levels, estimated creatinine clearance, or microalbuminuria. CONCLUSION: A high prevalence of reduced bone mass density that was associated with hemolysis was found in this population, as indicated by the high lactate dehydrogenase levels, increased
Cardena, M M S G; Ribeiro-Dos-Santos, A K; Santos, S E B; Mansur, A J; Bernardez-Pereira, S; Santos, P C J L; Pereira, A C; Fridman, C
There is a high prevalence of heart failure (HF) in the general population, but it is more common in black people. We evaluated the association between genomic ancestry and mitochondrial haplogroups (mt-haplogroups) with HF etiology in 503 Brazilian patients. We elicited Mt-haplogroups by analyzing the control region of mitochondrial DNA, and genomic ancestry, by using 48 autosomal insertion-deletion ancestry informative markers. Hypertensive (28.6%, n=144) and ischemic (28.4%, n=143) etiologies of HF were the most prevalent herein. Our results showed that 233 individuals (46.3%) presented African mitochondrial (mt)-haplogroups, and the major contribution in the genomic ancestry analysis was the European ancestry (57.5% (±22.1%)). African mt-haplogroups were positively associated with a diagnosis of hypertensive cardiomyopathy (odds ratio, OR 1.55, confidence interval, CI 95% 1.04-2.44, P=0.04) when compared with European mt-haplogroups. Regarding the genomic ancestry, the African ancestry variant had higher risks (OR 7.84, 95% CI 2.81-21.91, Pancestry variant had lower risks (OR 0.14, 95% CI 0.04-5.00, Pancestry showed an OR of 4.05 (CI 95% 1.53-10.74, P=0.005), whereas African ancestry showed an OR of 0.17 (CI 95% 0.06-0.48, P=0.001) for developing ischemic etiology. In conclusion, this study supports the importance of using ancestry informative markers and mitochondrial DNA to study the genetics of complex diseases in admixed populations to improve the management, treatment and prevention of these illnesses. Therefore, the ancestry informative markers and mt-haplogroups could provide new biomarkers to be associated with HF etiologies and be used as a premise for more specific management.
Pereira, Weendelly Nayara; Ferraz, Mariane Avante; Zabaglia, Luanna Munhoz; de Labio, Roger William; Orcini, Wilson Aparecido; Bianchi Ximenez, João Paulo; Neto, Agostinho Caleman; Payão, Spencer Luiz Marques; Rasmussen, Lucas Trevizani
Only a few Helicobacter pylori-infected individuals develop severe gastric diseases and virulence factors of H. pylori appear to be involved in such clinical outcomes. Duodenal ulcer promoting gene A (dupA) is a novel virulence factor of Helicobacter pylori that is associated with duodenal ulcer development and reduced risk for gastric carcinoma in some populations. The aims of the present study were to determine the presence of dupA gene and evaluate the association among dupA and other virulence factors including cagA and vacA in Brazilian patients. Gastric biopsies were obtained from 205 dyspeptic patients (100 children and 105 adults). DNA was extracted and analyzed for the presence of H. pylori and its virulence factors using the polymerase chain reaction method. Patients with gastritis tested positive for H. pylori more frequently. The dupA gene was detected in 41.5% of them (85/205); cagA gene was found in 98 isolates (47.8%) and vacA genotype s1/m1 in 50.2%, s1/m2 in 8.3%, s2/m2 in 36.6%, s2/m1 in 0.5% and s1/s2/m1/m2 in 4.4%. We also verified a significant association between cagA and dupA genes [p = 0.0003, relative risk (RR) 1.73 and confidence interval [CI] = 1.3-2.3]. The genotypes s1/m1 were also associated with dupA gene (p = 0.0001, RR: 1.72 and CI: 1.3-2.2). The same associations were found when analyzing pediatric and adult groups of patients individually. Ours results suggest that dupA is highly frequent in Brazilian patients and is associated with cagA gene and vacA s1/m1 genotype, and it may be considered an important virulence factor in the development of gastric diseases in adults or children.
Macedo, Luciana Conci; de Cesare Quintero, Fernanda; Pagliari-E-Silva, Sara; Pagnano, Katia Borgia Barbosa; Rodrigues, Camila; de Alencar, Josiane Bazzo; Sell, Ana Maria; Visentainer, Jeane Eliete Laguila
The classical chromosome Philadelphia-negative myeloproliferative neoplasms (MPNs) are a group of disorders that share clinical, hematological, and histological features. Proinflammatory cytokines such as tumor necrosis factor-α (TNF-α) are elevated in patients with MPN. The aim of this study was to verify the association between the polymorphisms of TNF gene (-308G/A and -238 G/A) in BCR-ABL-negative MPN in our population. Blood samples obtained from MPN patients were genotyped for the JAK2V617F mutation and both TNF polymorphisms using PCR-RFLP. Thirty three (26.8%) patients with polycythemia vera (PV), 35 (28.7%) essential thrombocythemia (ET), 22 (17.7%) primary myelofibrosis (PMF), and 33 (26.8%) with unclassifiable MPN (MPNu) were included in the study. The JAK2 V617F mutation was detected in 94 (76.42%) patients. Were observed a significant increase on the frequency of the TNF-238 GA genotype in MPN patients compared to controls (OR=2.21, 95% CI=1.02-4.80, P<0.04). The distribution of the genotypes and allelic frequencies of TNF-308 was significantly different among the MPNs, JAK2V617F positive, PV and PMF, and controls. Our data has demonstrated that the polymorphisms on TNF-238 GA, TNF-308 GA were associated to MPN development in this population, triggered by JAK2 V617F mutation. Copyright © 2015. Published by Elsevier Inc.
Aperecida da Silva, Maria; Cordeiro, Quirino; Louza, Mario; Vallada, Homero
Objective: To investigate a possible association between a 3'UTR VNTR polymorphism of the dopamine transporter gene (SLC6A3) and ADHD in a Brazilian sample of adult patients. Method: Study Case-control with 102 ADHD adult outpatients ("DSM-IV" criteria) and 479 healthy controls. The primers' sequence used were: 3'UTR-Forward: 5' TGT GGT…
Macedo, Luciana Conci; de Cesare Quintero, Fernanda; Pagliari-E-Silva, Sara; Pagnano, Katia Borgia Barbosa; Rodrigues, Camila; de Alencar, Josiane Bazzo; Sell, Ana Maria; Visentainer, Jeane Eliete Laguila
The classical chromosome Philadelphia-negative myeloproliferative neoplasms (MPNs) are a group of disorders that share clinical, hematological, and histological features. Proinflammatory cytokines such as tumor necrosis factor-α (TNF-α) are elevated in patients with MPN. The aim of this study was to verify the association between the polymorphisms of TNF gene (-308G/A and -238 G/A) in BCR-ABL-negative MPN in our population. Blood samples obtained from MPN patients were genotyped for the JAK2V...
Lana, Tamires Prates; da Silva Costa, Sueli Matilde; Ananina, Galina; Hirata, Fábio Endo; Rim, Priscila Hae Hyun; Medina, Flávio MacCord; de Vasconcellos, José Paulo Cabral; de Melo, Mônica Barbosa
Age-related macular degeneration is a multifactorial disease that can lead to vision impairment in older individuals. Although the etiology of age-related macular degeneration remains unknown, risk factors include age, ethnicity, smoking, hypertension, obesity, and genetic factors. Two main loci have been identified through genome-wide association studies, on chromosomes 1 and 10. Among the variants located at the 10q26 region, rs11200638, located at the HTRA1 gene promoter, has been associated with age-related macular degeneration in several populations and is considered the main polymorphism. We conducted a replication case-control study to analyze the frequency and participation of rs11200638 in the etiology of age-related macular degeneration in a sample of patients and controls from the State of São Paulo, Brazil, through polymerase chain reaction and enzymatic digestion. The frequency of the A allele was 57.60% in patients with age-related macular degeneration and 36.45% in controls (p value age-related macular degeneration group compared to the control group (p = 1.21 e-07 and 0.0357, respectively). No statistically significant results were observed after stratification in dry versus wet types or advanced versus non-advanced forms. To our knowledge, this is the first time the association between rs11200638 and overall age-related macular degeneration has been reported in South America.
Ballut, Priscilla C; Siqueira, Andre M; Orlando, Aline C B; Alexandre, Marcia A A; Alecrim, Maria Graças C; Lacerda, Marcus V G
Chloroquine-induced pruritus has been described as a common adverse event in African patients being treated for Plasmodium falciparum malaria, and has been associated with treatment discontinuation in this setting. In Latin America, where Plasmodium vivax is the most common species causing malaria and chloroquine is still used as the first-line schizonticidal for treating this parasite infection, there are no reports on chloroquine-induced pruritus. This study aimed to estimate the frequency of pruritus and associated risk factors in P. vivax-infected patients treated with chloroquine in a reference centre in the Brazilian Amazon. In this cross-sectional study, patients who were prescribed with chloroquine for the treatment of microscopy-confirmed P. vivax infection in the past five days were actively asked about the occurrence of any level of pruritus and potential risk factors were investigated. Univariable and multivariable logistic regression was performed for the analysis of possible risk factors in two sets of patients: (1) all the patients interviewed and (2) restricted to patients with previous use of chloroquine. Among the 510 patients interviewed, 20.4% (95%CI: 16.9-23.9%) developed any level of pruritus during treatment with chloroquine. Most episodes of pruritus occurred during the first two days of treatment and the most common location was hands and feet. In multivariate analysis performed in the entire population, the only risk factors independently associated to pruritus were allergy history (adjusted odds ratio [AOR]: 1.83; 95%CI 1.02-3.31; p=0.044) and high parasitaemia (AOR: 1.96: 95%CI 1.22-3.13; p=0.005). In the analysis restricted to the 215 patients with previous use of chloroquine, previous chloroquine-induced pruritus was a strong predictor of pruritus occurrence (AOR: 11.84: 95%CI 3.15-44.47; pAmazon. Host-parasite interaction may play a relevant role in the development of pruritus and concurs with the finding of strong association of
Marques, T; Patente, T A; Monteiro, M B; Cavaleiro, A M; Queiroz, M S; Nery, M; de Azevedo, M J; Canani, L H; Parisi, M C; Moura-Neto, A; Passarelli, M; Giannella-Neto, D; Machado, U F; Corrêa-Giannella, M L
Mesangial cells subject to high extracellular glucose concentrations, as occur in hyperglycaemic states, are unable to down regulate glucose influx, resulting in intracellular activation of deleterious biochemical pathways. A high expression of GLUT1 participates in the development of diabetic glomerulopathy. Variants in the gene encoding GLUT1 (SLC2A1) have been associated to this diabetic complication. The aim of this study was to test whether polymorphisms in SLC2A1 confer susceptibility to diabetic nephropathy (DN) in Brazilian type 1 diabetes patients. Four polymorphisms (rs3820589, rs1385129, rs841847 and rs841848) were genotyped in a Brazilian cohort comprised of 452 patients. A prospective analysis was performed in 155 patients. Mean duration of follow-up was 5.6 ± 2.4 years and the incidence of renal events was 18.0%. The rs3820589 presented an inverse association with the prevalence of incipient DN (OR: 0.36, 95% CI: 0.16 - 0.80, p=0.01) and with progression to renal events (HR: 0.20; 95% CI: 0.03 - 0.70; p=0.009). AGGT and AGAC haplotypes were associated with the prevalence of incipient DN and the AGAC haplotype was also associated with the prevalence of established/advanced DN. In conclusion, rs3820589 in the SLC2A1 gene modulates the risk to DN in Brazilian patients with inadequate type 1 diabetes control. Copyright © 2015 Elsevier B.V. All rights reserved.
Gomes, Luciana I; Rocha, Gifone A; Rocha, Andreia M C; Soares, Taciana F; Oliveira, Celso A; Bittencourt, Paulo F S; Queiroz, Dulciene M M
Duodenal ulcer-promoting gene (dupA) was recently described as a new putative Helicobacter pylori virulence marker associated with an increased risk for duodenal ulcer and reduced risk for gastric carcinoma in Japan and Korea. Since differences regarding the association among H. pylori markers and H. pylori-associated diseases have been demonstrated around the world, we evaluated the presence of the gene in 482 strains from Brazilian children (34 with duodenal ulcer and 97 with gastritis) and adults (126 with duodenal ulcer, 144 with gastritis and 81 with gastric carcinoma) by PCR using the described primers and an additional set of primers based on Brazilian strain sequences. The results were confirmed by sequencing. The presence of cagA was investigated by PCR and also included in the analysis. dupA was present in 445 (92.32%) and absent in 29 (6.02%) strains. All samples from children with and without duodenal ulcer were dupA-positive (p=1.0). No association was observed among the strains from adults with gastritis (92.36%), duodenal ulcer (87.30%, p=0.30) and gastric carcinoma (87.65%, p=0.31). Conversely, cagA-positve status remained independently associated with duodenal ulcer (children: odds ratios (OR)=5.58, 95% confidence intervals (CI)=1.67-18.50; adults: OR=3.33, 95% CI=2.14-5.19) and gastric carcinoma (OR=6.58, 95% CI=3.51-12.30) in multivariate analyses. The presence of dupA was significantly higher in strains from children than in those from adults (p=0.01). In conclusion, dupA is highly frequent and not associated with H. pylori-associated diseases in both Brazilian adults and children, which points to regional differences in the distribution of the gene.
De Ameida Melo, Mariella; De Vasconcelos-Valença, Rodrigo José; Neto, Fidelis Manes; Borges, Rafael Soares; Costa-Silva, Danylo Rafhael; Da Conceição Barros-Oliveira, Maria; Borges, Umbelina Soares; Alencar, Airlane Pereira; Silva, Vladimir Costa; Da Silva, Benedito Borges
At present, there is controversy regarding the efficacy of tamoxifen in breast cancer patients who are carriers of cytochrome P450 2D6 (CYP2D6) gene polymorphisms, in terms of recurrence and overall survival. Thus, the aim of the present study was to investigate the association of the CYP2D6 *4, *10 and *17 gene polymorphisms with breast cancer recurrence in a Brazilian population. The cohort comprised 40 receptor-positive breast cancer patients without recurrence and 40 with distant recurrence. A 3-ml sample of peripheral blood was collected from each patient to determine the presence of the *4, *10 and *17 single nucleotide polymorphisms of the CYP2D6 gene by quantitative polymerase chain reaction analysis. There was no statistically significant difference between the two groups regarding the polymorphism frequency (P=0.246). The results revealed that intermediate metabolizers occurred in 5% of patients without recurrence and in 15% of those with distant recurrence. Poor metabolizers occurred in only 1 patient (2.5%) per group, and there was no significant difference between the groups (P=0.789). The present study concluded that the CYP2D6 gene polymorphism in women with hormone-sensitive breast cancer treated with tamoxifen was not associated with disease recurrence. PMID:27882219
Krieger José E
Full Text Available Abstract Background Reactive oxygen species have been implicated in the physiopathogenesis of hypertensive end-organ damage. This study investigated the impact of the C242T polymorphism of the p22-phox gene (CYBA on left ventricular structure in Brazilian hypertensive subjects. Methods We cross-sectionally evaluated 561 patients from 2 independent centers [Campinas (n = 441 and Vitória (n = 120] by clinical history, physical examination, anthropometry, analysis of metabolic and echocardiography parameters as well as p22-phox C242T polymorphism genotyping. In addition, NADPH-oxidase activity was quantified in peripheral mononuclear cells from a subgroup of Campinas sample. Results Genotype frequencies in both samples were consistent with the Hardy- Weinberg equilibrium. Subjects with the T allele presented higher left ventricular mass/height2.7 than those carrying the CC genotype in Campinas (76.8 ± 1.6 vs 70.9 ± 1.4 g/m2.7; p = 0.009, and in Vitória (45.6 ± 1.9 vs 39.9 ± 1.4 g/m2.7; p = 0.023 samples. These results were confirmed by stepwise regression analyses adjusted for age, gender, blood pressure, metabolic variables and use of anti-hypertensive medications. In addition, increased NADPH-oxidase activity was detected in peripheral mononuclear cells from T allele carriers compared with CC genotype carriers (p = 0.03. Conclusions The T allele of the p22-phox C242T polymorphism is associated with higher left ventricular mass/height2.7 and increased NADPH-oxidase activity in Brazilian hypertensive patients. These data suggest that genetic variation within NADPH-oxidase components may modulate left ventricular remodeling in subjects with systemic hypertension.
Luiz Fábio Magno Falcão
Full Text Available The aim of this study was to compare computed tomography (CT scans of chest and lung function among patients with Human T-Lymphotropic Virus Type 1 (HTLV with and without HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP. In this cross-sectional study performed between January 2013 and June 2016, we included 48 patients with HAM/TSP (19 women and 11 men and without HAM/TSP (12 women and 6 men. We compared CT findings and lung functions of these groups. Patients who had HAM/TSP had abnormal CT findings (P = 0.000, including more frequent bronchiectasis (P = 0.049, parenchymal bands (P = 0.007, interlobular septal thickening (P = 0.035, and pleural thickening (P = 0.009. In addition, neither patients with HAM/TSP (9/30; 30% nor the controls (0/18; 0% had obstructive or restrictive lung disease (P = 0.009. HTLV diagnosis should be considered in all patients with abnormal CT findings in whom no other cause is apparent. It is important to remember that lung disease increases the rates of morbidity and mortality in developing countries.
Macedo, L C; Santos, B C; Pagliarini-e-Silva, S; Pagnano, K B B; Rodrigues, C; Quintero, F C; Ferreira, M E; Baraldi, E C; Ambrosio-Albuquerque, E P; Sell, A M; Visentainer, J E L
This study aimed to verify the association between the JAK2 46/1 haplotype (V617F positive) and some hematological parameters in BCR-ABL-negative chronic myeloproliferative neoplasms (cMPNs) in our population. The blood samples obtained from the patients with cMPN were genotyped for the JAK2 V617F mutation and JAK2 rs10974944 SNP screening using a PCR-RFLP assay. The JAK2 V617F mutation was detected in 80.15% of patients. The G variant of rs10974944 was more frequent in all MPNs, especially those that were JAK2 V617F positive, than in the control population. We also compared the 46/1 haplotype status in each MPN disease entity, polycythemia vera (PV), essential thrombocythemia (ET), primary myelofibrosis (PMF), and MPNu with controls. The G allele frequency relative to controls was significantly enriched in patients with PV and ET, but not in those with PMF and MPNu. PV and ET patients especially, all of whom had the JAK2 V617F mutation, showed significant excess of the G allele. The frequency of JAK2 V617F mutation was associated with elevated hematological parameters, but when we analyze the occurrence of the mutation and the presence of the G allele, just the high hemoglobin was significantly. In agreement with previous reports, JAK2 46/1 haplotype for JAK2 V617F was associated with cMPN positive in Brazilian patients. © 2015 John Wiley & Sons Ltd.
Full Text Available Inosine triphosphatase (ITPA single nucleotide polymorphisms (SNPs are strongly associated with protection against ribavirin (RBV-induced anaemia in European, American and Asian patients; however, there is a paucity of data for Brazilian patients. The aim of this study was to evaluate the ITPA SNP (rs7270101/rs1127354 frequency in healthy and hepatitis C virus (HCV-infected patients from Brazil and the association with the development of severe anaemia during antiviral therapy. ITPA SNPs were determined in 200 HCV infected patients and 100 healthy individuals by sequencing. Biochemical parameters and haemoglobin (Hb levels were analysed in 97 patients who underwent antiviral therapy. A combination of AArs7270101+CCrs1127354 (100% ITPase activity was observed in 236/300 individuals. Anaemia was observed in 87.5% and 86.2% of treated patients with AA (rs7270101 and CC genotypes (rs1127354, respectively. Men with AA (rs7270101 showed a considerable reduction in Hb at week 12 compared to those with AC/CC (p = 0.1475. In women, there was no influence of genotype (p = 0.5295. For rs1127354, men with the CC genotype also showed a sudden reduction in Hb compared to those with AC. Allelic distribution of rs7270101 and rs1127354 shows high rates of the genotypes AA and CC, respectively, suggesting that the study population had a great propensity for developing RBV-induced anaemia. A progressive Hb reduction during treatment was observed; however, this reduction was greater in men at week 12 than in women.
Eugênia Ribeiro Valadares
Results and discussion: Age at diagnosis was between 10 and 32 months and the severity of the disease correlated with the increasing of age at diagnosis. The predominant symptoms were vomiting, weight loss, and hepatomegaly. Severe renal tubular acidosis manifested in one child. All patients had remission of symptoms after dietary modification. The sequencing of the ALDOB gene identified one homozygous patient for the mutation c.524C>A (p.A175D, while the others were compound heterozygous for c.360_363delCAAA (p.N120KfsX32, c.178C>T (p.R60X mutations, c.448G>C (p.A150P and c.524C>A (p.A175D. Clinical improvement of patients after dietary treatment is suggestive of the diagnosis, confirmed by molecular analysis. The prevalence of mutations found in our Brazilian patients is different from those of international literature.
Maniglia, Maurício Pereira; Ribeiro, Maria Estela Bellini; Costa, Nauyla Miranda da; Jacomini, Marta Lúcia Gabriel; Carvalho, Thiago Bittencourt Ottoni de; Molina, Fernando Drimel; Piatto, Vânia Belintani; Maniglia, José Victor
Juvenile nasopharyngeal angiofibroma (JNA) is a vascular tumor of the nasopharynx that accounts for 0.5% of all cancers of the head and neck. It primarily affects males aged 14-25 years. Of the many genes that mediate the development of JNA, GSTM1 has been most frequently associated with this vascular tumor. The loss of expression of GSTM1 (null genotype) is linked to the development of these tumors. The aim of this cross-sectional case study was to examine the prevalence of the GSTM1-null genotype in Brazilian patients with JNA. DNA was extracted from the leukocytes of blood samples from 10 patients. GSTM1 genotypes were analyzed using a PCR-based assay that was designed to identify the wild-type allele of GSTM1. All 10 patients (100%) were males, with a mean age of 17.8 years. The null genotype for GSTM1 was noted in 4 patients (40%)-1 (10%) at Fisch stage I, 1 (10%) at stage III, and 2 (20%) at stage II. No patient with this genotype had stage IV disease. There was no correlation between Fisch classification and GSTM1 genotype (P = .5695). The correlation between age at diagnosis and GSTM1 genotype was not significant (P = .728). The present findings indicate that there is evidence of an association between the GSTM1-null genotype and JNA in this studied Brazilian population.
Heglayne Pereira Vital da Silva
Full Text Available Abstract: Considering that environmental risk factors substantially contribute to the etiology of orofacial clefts and that knowledge about the characteristics and comorbidities associated with oral clefts is fundamental to promoting better quality of life, this study aimed to describe the risk factors, main characteristics, and comorbidities of a group of patients with cleft lip and/or cleft palate (CL/P from Rio Grande do Norte (RN, Brazil. Data were obtained from 173 patients with CL/P using a form from the Brazilian database on Orofacial Clefts. Most patients were male with cleft lip and palate and had a normal size and weight at birth; presented few neonatal intercurrent events; and had anemia and respiratory and cardiovascular diseases as main associated comorbidities. They also required timely surgical rehabilitation and multidisciplinary care to stimulate their neuropsychomotor development. In addition, a high frequency of familial recurrence and of parental consanguinity was evidenced in the studied population, especially for the cleft lip and cleft palate type. Other relevant findings were the considerable maternal exposure to alcohol, infections, smoking, and hypertension, as well as low supplementation with vitamins and minerals and deliberate consumption of analgesics, antibiotics, and antihypertensives during pregnancy. Characterization of the CL/P patient profile is essential for the planning of health services and integration among the health professionals involved in the diagnosis and treatment of these malformations. Our results reinforce the need for additional research to confirm the association between environmental factors and the development of orofacial clefts.
Ferreira, Regicely Aline Brandão; Benicio, Maria Helena D'Aquino
To determine the influence of reproductive history on the prevalence of obesity in Brazilian women and the possible modifying effect of socioeconomic variables on the association between parity and excess weight. A retrospective analysis of complex sample data collected as part of the 2006 Brazilian National Survey on Demography and Health, which included a group representative of women of childbearing age in Brazil was conducted. The study included 11 961 women aged 20 to 49 years. The association between the study factor (parity) and the outcome of interest (obesity) was tested using logistic regression analysis. The adjusted effect of parity on obesity was assessed in a multiple regression model containing control variables: age, family purchasing power, as defined by the Brazilian Association of Research Enterprises (ABEP), schooling, and health care. Significance level was set at below 0.05. The prevalence of obesity in the study population was 18.6%. The effect of parity on obesity was significant (P for trend parity and age. Family purchase power had a significant odds ratio for obesity only in the unadjusted analysis. In the adjusted model, this variable did not explain obesity. The present findings suggest that parity has an influence on obesity in Brazilian women of childbearing age, with higher prevalence in women vs. without children.
Association analysis of anti-Epstein-Barr nuclear antigen-1 antibodies, anti-cyclic citrullinated peptide antibodies, the shared epitope and smoking status in Brazilian patients with rheumatoid arthritis
Michel Alexandre Yazbek
Full Text Available INTRODUCTION: Epstein-Barr virus exposure appears to be an environmental trigger for rheumatoid arthritis that interacts with other risk factors. Relationships among anti-cyclic citrullinated peptide antibodies, the shared epitope, and smoking status have been observed in patients with rheumatoid arthritis from different populations. OBJECTIVE: To perform an association analysis of anti-Epstein-Barr nuclear antigen-1 antibodies, anti-cyclic citrullinated peptide antibodies, the shared epitope, and smoking status in Brazilian patients with rheumatoid arthritis. METHODS: In a case-control study, 140 rheumatoid arthritis patients and 143 healthy volunteers who were matched for age, sex, and ethnicity were recruited. Anti-Epstein-Barr nuclear antigen-1 antibodies and anti-cyclic citrullinated peptide antibodies were examined using an enzyme-linked immunosorbent assay, and shared epitope alleles were identified by genotyping. Smoking information was collected from all subjects. A comparative analysis of anti-Epstein-Barr nuclear antigen-1 antibodies, anti-cyclic citrullinated peptide antibodies, the shared epitope, and smoking status was performed in the patient group. Logistic regression analysis models were used to analyze the risk of rheumatoid arthritis. RESULTS: Anti-Epstein-Barr nuclear antigen-1 antibodies were not associated with anti-cyclic citrullinated peptide antibodies, shared epitope alleles, or smoking status. Anti-cyclic citrullinated peptide antibody positivity was significantly higher in smoking patients with shared epitope alleles (OR = 3.82. In a multivariate logistic regression analysis using stepwise selection, only anti-cyclic citrullinated peptide antibodies were found to be independently associated with rheumatoid arthritis (OR = 247.9. CONCLUSION: Anti-Epstein-Barr nuclear antigen-1 antibodies did not increase the risk of rheumatoid arthritis and were not associated with the rheumatoid arthritis risk factors studied. Smoking
Full Text Available Patients with chronic renal insufficiency (CRI have reduced hemoglobin levels, mostly as a result of decreased kidney production of erythropoietin, but the relation between renal insufficiency and the magnitude of hemoglobin reduction has not been well defined. Hereditary hemochromatosis is an inherited disorder of iron metabolism. The importance of the association of hemochromatosis with treatment for anemia among patients with CRI has not been well described. We analyzed the frequency of the C282Y and H63D mutations in the HFE gene in 201 Brazilian individuals with CRI undergoing hemodialysis. The analysis of the effects of HFE mutations on iron metabolism and anemia with biochemical parameters was possible in 118 patients of this study (hemoglobin, hematocrit, ferritin levels, transferrin saturation, and serum iron. A C282Y heterozygous mutation was found in 7/201 (3.4% and H63D homozygous and heterozygous mutation were found in 2/201 (1.0% and 46/201 (22.9%, respectively. The allelic frequencies of the HFE mutations (0.017 for C282Y mutation and 0.124 for H63D mutation did not differ between patients with CRI and healthy controls. Regarding the biochemical parameters, no differences were observed between HFE heterozygous and mutation-negative patients, although ferritin levels were not higher among patients with the H63D mutation (P = 0.08. From what we observed in our study, C282Y/H63D HFE gene mutations are not related to degrees of anemia or iron stores in CRI patients receiving intravenous iron supplementation (P > 0.10. Nevertheless, the present data suggest that the H63D mutation may have an important function as a modulating factor of iron overload in these patients.
Macedo, L C; Santos, B C; Pagliarini-e-Silva, S; Pagnano, K B B; Rodrigues, C; Quintero, F C; Ferreira, M E; Baraldi, E C; Ambrosio-Albuquerque, E P; Sell, A M; Visentainer, J E L
This study aimed to verify the association between the JAK2 46/1 haplotype (V617F positive) and some hematological parameters in BCR-ABL-negative chronic myeloproliferative neoplasms (cMPNs) in our population. The blood samples obtained from the patients with cMPN were genotyped for the JAK2 V617F mutation and JAK2 rs10974944 SNP screening using a PCR-RFLP assay. The JAK2 V617F mutation was detected in 80.15% of patients. The G variant of rs10974944 was more frequent in all MPNs, especially t...
Barreto, Sandhi Maria; Giatti, Luana; Casado, Leticia; de Moura, Lenildo; Crespo, Claudio; Malta, Deborah
Background Very few studies have examined the role of school, household and family contexts in youth smoking in middle-income countries. Methods This work describes smoking exposure among 59 992 high school students who took part in the Brazilian Survey of School Health and investigates contextual factors associated with regular smoking, defined as smoking cigarettes at least once in the past 30 days. The explaining variables were grouped into: socio-demographic characteristics, school contex...
João Gabriel Silva Souza
Full Text Available Abstract Objective: To describe the prevalence of dental pain in Brazilian preschoolers, as well as its associated factors, considering a representative sample of that population group in Brazil. Methods: Cross-sectional study that used the analytical data from national oral health survey (SB Brazil carried out in 2010. A representative sample of Brazilian preschoolers aged 5 years was considered. Interviews were carried out (answered by parents/tutors, as well as clinical examinations in children. Descriptive, bivariate and mutiple analyzes were performed, described in odds ratios and 95% confidence interval (OR/95%CI. Results: 7280 preschoolers were included. Of these, 1520 (21.1% had dental pain in the last 6 months. The chance of the occurrence of dental pain was higher among those who used dental services (1.51/1.02–2.23, with tooth decay (3.08/2.08–4.56, that self-perceveid the need for dental treatment (3.96/2.48–6.34, whose parents reported dissatisfaction by children with their teeth and mouth (1.47/1.04–2.10 and those who reported impact of oral problems on quality of life (5.76/3.90–8.49. Conclusions: The prevalence of dental pain among Brazilian preschool children was relatively high, being associated with the use of dental services and the normative and subjective oral health status.
Pereira,Claudio Maranhão; Pires,Fábio Ramôa; Corrêa,Maria Elvira Pizzigatti; di Hipólito Júnior,Osvaldo; Almeida,Oslei Paes de
Hemophilia is a common hereditary hemorrhagic disorder, however little is known about the oral microflora of hemophilic patients. The aim of this study was to quantify the Candida and identify its species in non-stimulated saliva of hemophilic patients, and consider its relationship with clinical factors influencing Candida carriage. This study comprised evaluation of 86 hemophilic patients of the Hematology Center/UNICAMP and 43 healthy subjects as controls. All patients were submitted to an...
Mayra Isabel Correia Pinheiro
Full Text Available We examined 11 pediatric patients with eosinophilic esophagitis with a tardy diagnosis. The symptoms were initially thought to be related to other diseases, leading to the use of inadequate therapeutic approaches. The patients were between 3 and 17 years old (mean 7.8 ± 3.8 years, and 8 of the patients were male. Common symptoms included abdominal pain, regurgitation, difficulty in gaining weight, vomiting, dysphagia, and coughing. The mean age for the onset of symptoms was 4.3 ± 2.9 years. Endoscopic findings included normal mucosa in five (45% patients, thickening of the mucosa with longitudinal grooves in three (27%, erosive esophagitis in two (18%, and a whitish stippling in one (9% patient. Treatment included the use of a topical corticosteroid for 10 patients. In eight (73% cases, the treatment made the symptoms disappear. Ten patients underwent histopathological management after treatment, with a decrease in the number of eosinophils.
Souza, João Gabriel Silva; Martins, Andrea Maria Eleutério de Barros Lima
To describe the prevalence of dental pain in Brazilian preschoolers, as well as its associated factors, considering a representative sample of that population group in Brazil. Cross-sectional study that used the analytical data of the national oral health survey (SB Brazil) carried out in 2010. A representative sample of Brazilian preschoolers aged 5 years was considered. Interviews were carried out (answered by parents/tutors), as well as clinical examinations in children. Descriptive, bivariate and multivariate analyzes were performed, described in odds ratios and 95% confidence interval (OR/95%CI). 7,280 preschoolers were included. Of these, 1520 (21.1%) had had dental pain in the last 6 months. The chance of the occurrence of dental pain was higher among those who used dental services (1.51 / 1.02 to 2.23), with tooth decay (3.08 / 2.08 to 4.56), that realized the need for dental treatment (3.96 / 2.48 to 6.34), whose parents reported dissatisfaction by children with their teeth and mouth (1.47 / 1.04 to 2.10) and those who reported impact of oral problems on quality of life (5.76 / 3.90 to 8.49). The prevalence of dental pain among Brazilian preschool children was relatively high, being associated with the use of dental services and the normative and subjective oral health status. Copyright © 2016 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.
Full Text Available Mood disorders cause many social problems, often involving family relationships. Few studies are available in the literature comparing patients with bipolar, unipolar, dysthymic, and double depressive disorders concerning these aspects. In the present study, demographic and disease data were collected using a specifically prepared questionnaire. Social adjustment was assessed using the Disability Adjustment Scale and family relationships were evaluated using the Global Assessment of Relational Functioning Scale. One hundred patients under treatment for at least 6 months were evaluated at the Psychiatric Outpatient Clinic of the Botucatu School of Medicine, UNESP. Most patients were women (82% more than 50 (49% years old with at least two years of follow-up, with little schooling (62% had less than 4 years, and of low socioeconomic level. Logistic regression analysis showed that a diagnosis of unipolar disorder (P = 0.003, OR = 0.075, CI = 0.014-0.403 and dysthymia (P = 0.001, OR = 0.040, CI = 0.006-0.275 as well as family relationships (P = 0.002, OR = 0.953, CI = 0914-0.992 played a significant role in social adjustment. Unipolar and dysthymic patients presented better social adjustment than bipolar and double depressive patients (P < 0.001, results that were not due to social class. These patients, treated at a teaching hospital, may represent the severest mood disorder cases. Evaluations were made knowing the diagnosis of the patients, which might also have influenced some of the results. Social disabilities among mood disorder patients are very frequent and intensive.
Pereira, Claudio Maranhão; Pires, Fábio Ramôa; Corrêa, Maria Elvira Pizzigatti; di Hipólito Júnior, Osvaldo; Almeida, Oslei Paes de
Hemophilia is a common hereditary hemorrhagic disorder, however little is known about the oral microflora of hemophilic patients. The aim of this study was to quantify the Candida and identify its species in non-stimulated saliva of hemophilic patients, and consider its relationship with clinical factors influencing Candida carriage. This study comprised evaluation of 86 hemophilic patients of the Hematology Center/UNICAMP and 43 healthy subjects as controls. All patients were submitted to anamnesis, intraoral examination and unstimulated saliva collection. Candida counts and species identification were performed in salivary samples. Candida was present in 64% of the hemophilic patients and in 44% of the healthy controls. C. albicans represented 65% and 68% of the isolated species, in hemophiliacs and control group respectively, and C. tropicalis was the second most common species in both groups. These results indicate that hemophilic patients carry Candida more frequently and in higher counts than healthy controls, independently of oral clinical parameter considered, as viral infections, complete dentures, transfusions of hemoderivatives, and salivary flow.
Full Text Available The association between HLA specificities and leprosy was investigated in a Southern Brazilian population. One hundred and twenty-one patients and 147 controls were typed for HLA-A, B, Cw, DR and DQ. Patients were subdivided into the following subgroups, according to clinical, histological and immunological criteria: lepromatous (N = 55, tuberculoid (N = 32, dimorphous (N = 20, and indeterminate (N = 14. The frequencies of HLA specificities were compared between the total group of patients and controls, and between the same controls and each subgroup of patients. After correction of the probabilities, deviations were not significant, except for the DR2 specificity, which presented a frequency of 44.2% in the total group of patients and 56.3% in the subgroup of individuals with the tuberculoid form of the disease, compared to 23.3% in the controls. Stratified analysis showed that the increased DR2 frequency in the total group of patients was due to the subgroups with the tuberculoid and dimorphous forms. The relative risk of tuberculoid leprosy for DR2-positive individuals was 4.2, and the etiologic fraction of DR2 was 0.429. In conclusion, a positive association of the DR2 specificity with the tuberculoid form of leprosy, but not with the lepromatous, dimorphous, or indeterminate forms, was demonstrated in this Southern Brazilian population
Breast cancer screening: updated recommendations of the Brazilian College of Radiology and Diagnostic Imaging, Brazilian Breast Disease Society, and Brazilian Federation of Gynecological and Obstetrical Associations
Linei Augusta Brolini Dellê Urban
Full Text Available Abstract Objective: To present the current recommendations for breast cancer screening in Brazil, as devised by the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Breast Disease Society, and the Brazilian Federation of Gynecological and Obstetrical Associations. Materials and methods: We analyzed scientific studies available in the Medline and Lilacs databases. In the absence of evidence, the recommendations reflected the consensus of a panel of experts. Recommendations: Annual mammography screening is recommended for women 40-74 years of age. Among women ≥ 75 years of age, annual mammography screening should be reserved for those with an expected survival > 7 years. Complementary ultrasound should be considered for women with dense breasts. Complementary magnetic resonance imaging is recommended for women at high risk. When available, an advanced form of mammography known as tomosynthesis can be considered as a means of screening for breast cancer.
Brandão, Ajacio Bandeira de Mello; Mariante-Neto, Guilherme
Patients infected with the human immunodeficiency virus (HIV) have generally been excluded from consideration for liver transplantation. Recent advances in the management and prognosis of these patients suggest that this policy must be reevaluated. To identify the current position of Brazilian transplant centers concerning liver transplantation in asymptomatic HIV-infected patients with end-stage liver disease. A structured questionnaire was submitted by e-mail to Brazilian groups who perform liver transplantation and were active in late 2003, according to the Brazilian Association of Organ Transplantation. Of the 53 active groups, 30 e-mail addresses have been found of professionals working in 41 of these groups. Twenty-one responses (70%) were obtained. Most of the professionals (62%) reported that they do not include HIV-infected patients in waiting lists for transplants, primarily on account of the limited world experience. They also reported, however, that this issue will soon be discussed by the group. Those who accept these patients usually follow the guidelines provided by the literature: patients must fulfill the same inclusion criteria as the other patients with end-stage liver diseases, present low or undetectable HIV viral load, and a CD4 count above 250/mm3. They reported that there are 10 HIV-infected patients in waiting list and that only one patient has received a liver transplant in the country. Most centers do not accept in waiting lists for liver transplantation patients with HIV infection, even asymptomatic ones. However, advances in the management of HIV-infected patients suggest that this policy must be reevaluated. In Brazil, there is practically no experience in liver transplantation in HIV-positive patients.
Rosemeyre França de Paula FIUZA
Full Text Available ABSTRACT Objective To analyze the prevalence and factors associated with breakfast skipping among adolescents. Methods Cross-sectional study, with adolescents aged 10-17 years, evaluated between 2009 and 2011, belonging to a cohort study in the Central-West region of Brazil. Breakfast skipping was considered as not having breakfast every day. Demographic, socioeconomic, and lifestyle factors were evaluated through a questionnaire. Anthropometric assessment included measurement of weight and height, which were used to classify weight status using body mass index. Poisson regression was used to assess the association of breakfast skipping with demographic and socioeconomic variables, lifestyle factors, and weight status. Results Among 1,716 Brazilian adolescents evaluated, 36.2% reported not consuming breakfast every day, with the highest prevalence among girls (p=0.03. After adjusting for age and economic class, breakfast skipping was associated with not consuming breakfast with parents and morning shift at school, in both genders, and with obesity only in boys. Lifestyle factors such as alcohol consumption, physical activity, diet quality, and smoking were not associated with skipping breakfast. Conclusion The omission of breakfast was observed in more than a third of adolescents, being associated with demographic and lifestyle factors. In the public health perspective, the importance of encouraging the consumption of this meal is highlighted, with actions involving the school environment and the family.
Yára Dadalti Fragoso
Full Text Available OBJECTIVE: To assess the impact of multiple sclerosis (MS on the professional life of Brazilian patients. METHOD: One hundred MS patients were randomly selected from the database of the Brazilian Multiple Sclerosis Association (ABEM. An individual interview was carried out by telephone by a member of ABEM, who collected data on the patients' clinical status, educational level and professional lives. RESULTS: Complete data were obtained from 96 patients (27 males and 69 females aged 55.0±14.1 years, with average disease duration of 4.6±4.0 years. Eighty percent had eleven or more years of schooling. Among the whole group, 66% did not present limitations on walking. The longer the disease duration and the older the patient were, the higher the chances were that the patient was retired or receiving workers' compensation benefits. However, even among patients with MS for less than five years, the rate of non-participation in the workforce was 47.7%. Fatigue, paresthesia, cognitive dysfunction and pain were often cited as the motives for not working. CONCLUSION: MS patients presented high levels of unemployment, retirement and receipt of workers' compensation benefits, despite their high schooling levels. Age, disease duration and disability influenced these results for the whole group. However, even among younger patients with shorter disease duration and low disability, this finding remained.
Tavares, Mary Angela; Matta-Machado, Antônio Thomaz Gonzaga
Objective To assess factors associated with patients’ satisfaction with the treatment by dentists in primary health care (PHC) in Brazil. Materials and methods The dataset was part of a nationwide cross-sectional survey for evaluating PHC teams conducted by the Brazilian Ministry of Health. Patients from each of 16,202 oral health teams were interviewed. In addition to sociodemographic information, the questionnaire included information about patient experience domains: access and booking of dental appointments, bonding and accountability, welcoming of the patient, and their perception of dental facilities. Statistical analysis The dependent variable was the answer to the question ‘From 0 to 10, how would you grade your satisfaction with treatment received from the dentist?’ Negative binomial regression models were used to estimate the unadjusted and adjusted rate ratios and corresponding 95% confidence interval. Results The mean patient satisfaction was 9.4 (±2.3). Higher patient satisfaction with PHC was associated with lower education and the patient’s perception of the clinic conditions. Moreover, higher satisfaction was associated with positive reception and hospitality, enough time for treatment, and instructions that met patients’ needs. Lower satisfaction with PHC was associated with patients who have jobs compared to those who do not work. Conclusion Patient satisfaction is increased with friendly and understanding PHC staff. Moreover, meeting patient expectations by taking time to understand the needs and giving the right instructions is associated with higher satisfaction. PMID:29145438
Lima, Daniela Braga; Damiani, Lucas Petri; Fujimori, Elizabeth
To analyze the variables associated with vitamin A deficiency (VAD) in Brazilian children aged 6 to 59 months, considering a hierarchical model of determination. This is part of the National Survey on Demography and Health of Women and Children, held in 2006. Data analysis included 3,417 children aged from six to 59 months with retinol data. Vitamin A deficiency was defined as serum retinol Poisson regression analysis were performed, with significance level set at 5%, using a hierarchical model of determination that considered three conglomerates of variables: those linked to the structural processes of community (socioeconomic-demographic variables); to the immediate environment of the child (maternal variables, safety and food consumption); and individual features (biological characteristics of the child). Data were expressed in prevalence ratio (PR). After adjustment for confounding variables, the following remained associated with VAD: living in the Southeast [PR=1,59; 95%CI 1,19-2,17] and Northeast [PR=1,56; 95%CI 1,16-2,15]; in urban area [RP=1,31; 95%CI 1,02-1,72]; and mother aged ≥36 years [RP=2,28; 95%CI 1,37-3,98], the consumption of meat at least once in the last seven days was a protective factor [PR=0,24; 95%CI 0,13-0,42]. The main variables associated with VAD in the country are related to structural processes of society and to the immediate, but not individual, environment of the child.
Full Text Available Apolipoprotein E (protein: apo E; gene: APOE plays an important role in the multifactorial etiology of both Alzheimer's disease (AD and lipid level concentrations. The polymerase chain reaction (PCR was used to investigate the APOE gene polymorphism in 446 unrelated Caucasians, among them 23 AD patients, and 100 Afro-Brazilians living in Porto Alegre, Brazil. The frequencies of the APOE*2, APOE*3 and APOE*4 alleles were 0.075, 0.810 and 0.115 in Caucasians and 0.075, 0.700 and 0.225 in Afro-Brazilians, respectively (c2 = 8.72, P = 0.013. A highly significant association was observed between the APOE*4 allele and AD in this population-based sample. The APOE*4 frequency in AD patients (39% was about four times higher than in the general Caucasian population (11.5%. The influence of each of the three common APOE alleles on lipid traits was evaluated by the use of the average excess statistic. The E*2 allele is associated with lower levels of triglycerides and of total and non-HDL cholesterol in both men and women. Conversely, the E*4 allele is associated with higher levels of these traits in women only. The effect of APOE alleles was of greater magnitude in women.
Borges, Camila Aparecida; Marchioni, Dirce Maria Lobo; Levy, Renata Bertazzi; Slater, Betzabeth
The present study aims to identify the dietary patterns of adolescents and associate these patterns with overweight. We analyzed food-consumption data from 6784 adolescents in the age group 10-18 years old collected in the Household Budget Survey 2008-2009. Dietary patterns were assessed through exploratory factor analysis. Logistic regression models were used in order to associate dietary patterns with overweight. Four dietary patterns were recorded: Traditional Brazilian Pattern, Snacks Pattern, Fast Food Pattern, and the Milk, Fruit and Cereal Breakfast Pattern. Results were adjusted according to the sociodemographic variables and showed that the higher the adherence to Snacks (OR: 1.50 fifth quintile vs first (95% CI: 1.13, 1.99) p linear trend <0.001) and Fast Food patterns (OR: 1.55 fifth quintile vs first (95% CI = 1.12, 2.12) p linear trend <0.001), the higher the chances of becoming overweight. These data indicate that the local public health and nutrition policies focused on adolescents should be more attentive to the eating habits of this population in Brazil, since the current research related regular poor nutritional quality dietary patterns to increased overweight among adolescents. In addition, understanding adolescents' eating habits according to their dietary patterns may guide the development of healthy dietary recommendations based on the combination between food and food groups, rather than only on nutrients or nutritional adequacy. Copyright © 2018 Elsevier Ltd. All rights reserved.
Fernández, María Raquel; Goettems, Marília Leão; Demarco, Flávio Fernando; Corrêa, Marcos Britto
This cross-sectional study aimed to determine the association between dental caries and weight status, and between dental caries and physical activity in Brazilian schoolchildren aged 8 to 12 years. A multi-stage sample of children enrolled in 20 private and public schools in 2010 in Pelotas, Southern Brazil, were invited to participate in the study. Socioeconomic data were collected from parents, and data regarding children characteristics were collected from children using a questionnaire and anthropometric measures. The Body Mass Index was obtained, and children were classified as overweight/obese considering age and sex. Dental examinations were performed to assess the presence of gingival inflammation, dental caries prevalence (DMFT≥1) and dental caries experience (mean DMFT). Multivariate Poisson Regression was used to assess factors associated with dental caries prevalence and experience. A total of 1,210 children were included in the study. Dental caries prevalence was 32.4% (95% CI 29.7-35.2), while the mean DMFT was 0.64 (± SD 1.00). Children who practiced less than 300 minutes per week of physical activity and overweigh/obese children had lower prevalence of dental caries, while children with obesity or overweight presented lower dental caries experience. Obesity/overweight and physical activity level presented an inverse relationship with dental caries. Longitudinal studies investigating the complexity of this relationship are required.
Full Text Available Schizophrenia is a severe psychotic disorder with recurrent relapse and functional impairment. It results from a poorly understood gene-environment interaction. The Taq1A polymorphism (located in the gene cluster NTAD is a likely candidate for schizophrenia. Its rs1800497 polymorphism was shown to be associated with DRD2 gene expression. Therefore the present work aims to investigate a possible association between schizophrenia and such polymorphism. The compared distribution of the alleles and genotypes of the studied polymorphism was investigated in a Brazilian sample of 235 patients and 834 controls. Genotypic frequencies were in Hardy-Weinberg equilibrium. There was a trend of allelic association between the Taq1A polymorphism (rs1800497 with schizophrenia in the studied sample. However no statistically differences were found between cases and controls when analyzed by gender or schizophrenia subtypes.
Franco, Ana L; Fernandes, Giovana; Gonçalves, Daniela A G; Bonafé, Fernanda S S; Camparis, Cinara M
To verify whether headaches (HAs) are associated with temporomandibular disorders (TMD) in young Brazilian adolescents. From a population sample, 3117 public school children (12 to 14 y) were randomly invited to participate in this study. TMD was assessed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I, in addition to questions #3, #4, and #14 of Axis II history questionnaire. HAs were investigated with question #18 of RDC/TMD Axis II. Chronic TMD pain was considered as pain that has persisted for 6 months or more, as proposed by the International Association for the Study of Pain. The statistical analysis consisted of χ tests, odds ratio (OR), and logistic regression models, adopting a significance level of 5%. The sample included 1307 individuals (a response rate of 41.93%), and 56.8% (n=742) were girls. Overall, 330 adolescents (25.2%) were diagnosed with painful TMD and 595 (45.5%) presented with HAs. Individuals presenting with HAs were more likely to present painful TMD (OR=4.94; 95% confidence interval [CI], 3.73-6.54, P<0.001), especially combined muscle and joint painful TMD (OR=7.58; 95% CI, 4.77-12.05, P<0.001). HAs also increased the risk to a higher magnitude for chronic TMD pain (OR=6.12; 95% CI, 4.27-8.78, P<0.0001). All estimated ORs remained essentially unchanged after adjusting for sex. HAs were a potential risk factor for TMD in adolescents, and the risk was particularly higher for painful and chronic TMD. When HAs are present in young adolescents, a complete examination is strongly recommended with regard to the presence of painful TMD, and vice versa.
Bruna de Oliveira Ascef
Full Text Available ABSTRACT OBJECTIVE To analyze the Health-Related Quality of Life (HRQoL of patients of the primary health care of the Brazilian Unified Health System (SUS and its associated factors. METHODS This is a cross-sectional study with data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015. Data were collected with a questionnaire that included the EuroQol 5 Dimensions (EQ-5D instrument. Patients from the five regions of Brazil were interviewed. Multiple linear regression was used to analyze their Health-Related Quality of Life and its associated factors. RESULTS Of the total of 8,590 patients, the most frequent dimensions were pain/discomfort (50.7% and anxiety/depression (38.8%. About 10% of the patients reported extreme problems in these dimensions. The following factors were significantly associated with a worse quality of life: being female; having arthritis, osteoarthritis, or rheumatism; cerebrovascular accident; heart disease; depression; health self-assessment as poor or very poor; drinking alcoholic beverages once or more per month; dieting to lose weight, avoiding salt consumption, and reducing fat intake. Significant association was observed between a better quality of life and: living in the North and Southeast regions of Brazil; practicing physical activities; and having a higher educational level. No association was observed with factors related to the health services. CONCLUSIONS The Health-Related Quality of Life of patients was influenced by demographic and socioeconomic factors that were related to health conditions and lifestyle, being useful to guide specific actions for promoting health and the integral care to patients of the Brazilian Unified Health System.
Bittencourt, Paulo Lisboa; Marin, Maria Lúcia Carnevale; Couto, Cláudia Alves; Cançado, Eduardo Luiz Rachid; Carrilho, Flair José; Goldberg, Anna Carla
Approximately one-half of Brazilian patients with hereditary hemochromatosis (HH) are neither homozygous for the C282Y mutation nor compound heterozygous for the H63D and C282Y mutations that are associated with HH in Caucasians. Other mutations have been described in the HFE gene as well as in genes involved in iron metabolism, such as transferrin receptor 2 (TfR2) and ferroportin 1 (SCL40A1). To evaluate the role of HFE, TfR2 and SCL40A1 mutations in Brazilian subjects with HH. Nineteen male subjects (median age 42 [range: 20-72] years) with HH were evaluated using the Haemochromatosis StripAssay A. This assay is capable of detecting twelve HFE mutations, which are V53M, V59M, H63D, H63H, S65C, Q127H, P160delC, E168Q, E168X, W169X, C282Y and Q283, four TfR2 mutations, which are E60X, M172K, Y250X, AVAQ594-597del, and two SCL40A1 mutations, which are N144H and V162del. In our cohort, nine (47%) patients were homozygous for the C282Y mutation, two (11%) were heterozygous for the H63D mutation, and one each (5%) was either heterozygous for C282Y or compound heterozygous for C282Y and H63D. No other mutations in the HFE, TfR2 or SCL40A1 genes were observed in the studied patients. One-third of Brazilian subjects with the classical phenotype of HH do not carry HFE or other mutations that are currently associated with the disease in Caucasians. This observation suggests a role for other yet unknown mutations in the aforementioned genes or in other genes involved in iron homeostasis in the pathogenesis of HH in Brazil.
Alexandre Wagner Silva de Souza
Full Text Available Abstract The purpose of these recommendations is to guide the appropriate induction treatment of antineutrophil cytoplasmic antibody-associated vasculitis (AAV patients with active disease. The recommendations proposed by the Vasculopathies Committee of the Brazilian Society Rheumatology for induction therapy of AAV, including granulomatosis with polyangiitis, microscopic polyangiitis and renal-limited vasculitis, were based on systematic literature review and expert opinion. Literature review was performed using Medline (PubMed, EMBASE and Cochrane database to retrieve articles until October 2016. PRISMA guidelines were used for the systematic review and articles were assessed according to the Oxford levels of evidence. Sixteen recommendations were made regarding different aspects of induction therapy for AAV. The purpose of these recommendations is to serve as a guide for therapeutic decisions by health care professionals in the management of AAV patients presenting active disease.
Goes, E.G.; Borges, J.C.; Covas, D.T.; Motta, I.
Transfusion-associated graft-versus-host disease (TA-GVHD) is a usually complication of transfusion of blood component containing T lymphocytes what recently has also involved immunocompetent patient. Gamma irradiation of cellular blood components has been the mainstay against TA-GVHD, nevertheless there is little information in the literature about current transfusion medicine practices regarding gamma irradiation of blood products. This work presents an overview of the Brazilian reality and suggests policies to optimize TA-GVHD prevention. (Author)
Goes, E.G.; Borges, J.C. [EE/COPPE-UFRJ (Brazil); Covas, D.T. [Faculdade deMedicina-USP-RP (Brazil); Motta, I. [Instituto Nacional do Cancer- Rio deJaneiro (Brazil)
Transfusion-associated graft-versus-host disease (TA-GVHD) is a usually complication of transfusion of blood component containing T lymphocytes what recently has also involved immunocompetent patient. Gamma irradiation of cellular blood components has been the mainstay against TA-GVHD, nevertheless there is little information in the literature about current transfusion medicine practices regarding gamma irradiation of blood products. This work presents an overview of the Brazilian reality and suggests policies to optimize TA-GVHD prevention. (Author)
Gomes Felden, Érico Pereira; Barbosa, Diego Grasel; Junior, Geraldo Jose Ferrari; Santos, Manoella De Oliveira; Pelegrini, Andreia; Silva, Diego Augusto Santos
The aim of this study was to investigate the factors associated with short sleep duration on southern Brazilian high school students. Our study was comprised of 1,132 adolescents aged 14 to 19 years, enrolled in public high schools in São José, Brazil. The students answered a questionnaire about working (work and workload), health perception, smoking, school schedule, sleep (duration and daytime sleepiness), and socio-demographics data. The results showed that more than two thirds of adolescent workers had short sleep duration (76.7%), and those with a higher workload (more than 20 hours) had a shorter sleep duration (7.07 hours) compared to non-workers (7.83 hours). In the analysis of factors associated with short sleep duration, adolescents who worked (OR = 2.12, 95% CI 1.53 to 2.95) were more likely to have short sleep duration compared to those who did not work. In addition, older adolescents (17-19 years) and students with poor sleep quality were 40% and 55% more likely to have short sleep duration compared to younger adolescents (14-16 years) and students with good sleep quality, respectively. Adolescents with daytime sleepiness were more likely to have short sleep duration (OR = 1.49, 95% CI 1.06 to 2.07) compared to those without excessive daytime sleepiness. In addition students of the morning shift (OR = 6.02, 95% CI 4.23 to 8.57) and evening shift (OR = 2.16, 95% CI 1.45 to 3.22) were more likely to have short sleep duration compared to adolescents of the afternoon shift. Thereby adolescents who are workers, older, attended morning and evening classes and have excessive daytime sleepiness showed risk factors for short sleep duration. In this sense, it is pointed out the importance of raising awareness of these risk factors for short sleep duration of students from public schools from São José, located in southern Brazil.
Malacarne, Jocieli; Rios, Diana Patricia Giraldo; Silva, Cosme Marcelo Furtado Passos da; Braga, José Ueleres; Camacho, Luiz Antonio Bastos; Basta, Paulo Cesar
Recent studies have shown a high incidence and prevalence of latent tuberculosis infection (LTBI) in indigenous populations around the World. We aimed to estimate the prevalence and annual risk of infection (ARI) as well as to identify factors associated with LTBI in an indigenous population from the Brazilian Amazon. We conducted a cross-sectional study in 2011. We performed tuberculin skin tests (TSTs), smears and cultures of sputum samples, and chest radiographs for individuals who reported cough for two or more weeks. Associations between LTBI (TST ≥5mm) and socio-demographic, clinical, and epidemiological characteristics were investigated using Poisson regression with robust variance. Prevalence ratio (PR) was used as the measure of association. We examined 263 individuals. The prevalence of LTBI was 40.3%, and the ARI was 2.4%. Age ≥15 years [PR=5.5; 95% confidence interval (CI): 3.5-8.6], contact with tuberculosis (TB) patients (PR=3.8; 95% CI: 1.2-11.9), previous TB history (PR=1.4; 95% CI: 1.2-1.7), and presence of Bacillus Calmette-Guérin (BCG) scar (PR=1.9, 95% CI: 1.2-2.9) were associated with LTBI. Although some adults may have been infected years prior, the high prevalence of infection and its strong association with age ≥15 years, history of TB, and recent contact with TB patients suggest that the TB transmission risk is high in the study area.
Danielle Fernandes Durso
Full Text Available The Brazilian population was formed by extensive admixture of three different ancestral roots: Amerindians, Europeans and Africans. Our previous work has shown that at an individual level, ancestry, as estimated using molecular markers, was a poor predictor of color in Brazilians. We now investigate if SNPs known to be associated with human skin pigmentation can be used to predict color in Brazilians. For that, we studied the association of fifteen SNPs, previously known to be linked with skin color, in 243 unrelated Brazilian individuals self-identified as White, Browns or Blacks from Rio de Janeiro and 212 unrelated Brazilian individuals self-identified as White or Blacks from São Paulo. The significance of association of SNP genotypes with self-assessed color was evaluated using partial regression analysis. After controlling for ancestry estimates as covariates, only four SNPs remained significantly associated with skin pigmentation: rs1426654 and rs2555364 within SLC24A5, rs16891982 at SLC45A2 and rs1042602 at TYR. These loci are known to be involved in melanin synthesis or transport of melanosomes. We found that neither genotypes of these SNPs, nor their combination with biogeographical ancestry in principal component analysis, could predict self-assessed color in Brazilians at an individual level. However, significant correlations did emerge at group level, demonstrating that even though elements other than skin, eye and hair pigmentation do influence self-assessed color in Brazilians, the sociological act of self-classification is still substantially dependent of genotype at these four SNPs.
Paloma de Oliveira, Bruna; Câmara, Andréa Cruz; Aguiar, Carlos Menezes
The aim of the present study was to determine the prevalence of asymptomatic apical periodontitis (AAP) and its association with coronary artery disease (CAD) in a Brazilian subpopulation, and to examine the correlation of AAP with gender, age and most frequently affected dental elements. The data were collected from medical records of the patients (n = 1346) treated at the Specialization in Endodontics Clinic of the Federal University of Pernambuco in the period between 2003 and 2010. From each patient, the following variables were recorded: gender, age, endodontically compromised teeth, endodontic diseases diagnosed and the history of CAD. The data were analyzed using Pearson's chi-square test adopting a significance level of 5%. AAP was diagnosed in 574 patients (42.6%), corresponding to 641 teeth (40.1%). Both genders (p = 0.082), and all age groups (p = 0.190) were affected similarly. The upper incisors (52.8%, p <0.001) had a higher prevalence of AAP. The patients with AAP showed 1.45 times more chance of exhibiting CAD (p = 0.307). The results pointed out that the prevalence of AAP in this population was high and similar to that observed in other countries. A positive association, but not statistically significant, between AAP and CAD was found.
Andréa Cruz Câmara
Full Text Available Objective: The aim of the present study was to determine the prevalence of asymptomatic apical periodontitis (AAP and its association with coronary artery disease (CAD in a Brazilian subpopulation, and to examine the correlation of AAP with gender, age and most frequently affected dental elements. Methods: The data were collected from medical records of the patients (n = 1346 treated at the Specialization in Endodontics Clinic of the Federal University of Pernambuco in the period between 2003 and 2010. From each patient, the following variables were recorded: gender, age, endodontically compromised teeth, endodontic diseases diagnosed and the history of CAD. The data were analyzed using Pearson’s chi-square test adopting a significance level of 5%. Results: AAP was diagnosed in 574 patients (42.6%, corresponding to 641 teeth (40.1%. Both genders (p = 0.082, and all age groups (p = 0.190 were affected similarly. The upper incisors (52.8%, p <0.001 had a higher prevalence of AAP. The patients with AAP showed 1.45 times more chance of exhibiting CAD (p = 0.307. Conclusions: The results pointed out that the prevalence of AAP in this population was high and similar to that observed in other countries. A positive association, but not statistically significant, between AAP and CAD was found.
Freire, MDCM; Sheiham, A.; Bino, Y. A.
Objective: To investigate the oral hygiene habits of Brazilian adolescents and their relation with gender and socioeconomic status. Methods: Secondary data analyzed were from a cross-sectional study using self-completion questionnaires among 664 15-year-old schoolchildren randomly selected from public and private schools and their mothers, in Goiânia-GO, Brazil. Results: 51.8% of the sample comprised girls and 48.2% boys; 48.9% were from a high social class and 51.1% from a low social class. ...
Paulo Lisboa Bittencourt
Full Text Available BACKGROUND: Approximately one-half of Brazilian patients with hereditary hemochromatosis (HH are neither homozygous for the C282Y mutation nor compound heterozygous for the H63D and C282Y mutations that are associated with HH in Caucasians. Other mutations have been described in the HFE gene as well as in genes involved in iron metabolism, such as transferrin receptor 2 (TfR2 and ferroportin 1 (SCL40A1. AIMS: To evaluate the role of HFE, TfR2 and SCL40A1 mutations in Brazilian subjects with HH. PATIENTS AND METHODS: Nineteen male subjects (median age 42 [range: 20-72] years with HH were evaluated using the Haemochromatosis StripAssay A®. This assay is capable of detecting twelve HFE mutations, which are V53M, V59M, H63D, H63H, S65C, Q127H, P160delC, E168Q, E168X, W169X, C282Y and Q283, four TfR2 mutations, which are E60X, M172K, Y250X, AVAQ594-597del, and two SCL40A1 mutations, which are N144H and V162del. RESULTS: In our cohort, nine (47% patients were homozygous for the C282Y mutation, two (11% were heterozygous for the H63D mutation, and one each (5% was either heterozygous for C282Y or compound heterozygous for C282Y and H63D. No other mutations in the HFE, TfR2 or SCL40A1 genes were observed in the studied patients. CONCLUSIONS: One-third of Brazilian subjects with the classical phenotype of HH do not carry HFE or other mutations that are currently associated with the disease in Caucasians. This observation suggests a role for other yet unknown mutations in the aforementioned genes or in other genes involved in iron homeostasis in the pathogenesis of HH in Brazil.
Marco Antonio Araujo Leite
Full Text Available Myocardial scintigraphy with meta-iodo-benzyl-guanidine (123I cMIBG has been studied in Parkinson's disease (PD, especially in Asian countries, but not in Latin America. Most of these studies include individuals with PD associated to a defined dysautonomia. Our goal is to report the cardiac sympathetic neurotransmission in de novo Brazilian patients with sporadic PD, without clinically defined dysautonomia. We evaluated retrospectively a series of 21 consecutive cases with PD without symptoms or signs of dysautonomia assessed by the standard bedside tests. This number was reduced to 14 with the application of exclusion criteria. 123I cMIBG SPECT up-take was low or absent in all of them and the heart/mediastinum ratio was low in 12 of 14. We concluded that 123I cMIBG has been able to identify cardiac sympathetic neurotransmission disorder in Brazilian de novo PD patients without clinically defined dysautonomia.
Full Text Available Cytokines play an essential role during active tuberculosis disease and cytokine genes have been described in association with altered cytokine levels. Therefore, the aim of this study was to verify if IFNG, IL12B, TNF, IL17A, IL10, and TGFB1 gene polymorphisms influence the immune response of Brazilian patients with pulmonary tuberculosis (PTB at different time points of antituberculosis treatment (T1, T2, and T3. Our results showed the following associations: IFNG +874 T allele and IFNG +2109 A allele with higher IFN-γ levels; IL12B +1188 C allele with higher IL-12 levels; TNF −308 A allele with higher TNF-α plasma levels in controls and mRNA levels in PTB patients at T1; IL17A A allele at rs7747909 with higher IL-17 levels; IL10 −819 T allele with higher IL-10 levels; and TGFB1 +29 CC genotype higher TGF-β plasma levels in PTB patients at T2. The present study suggests that IFNG +874T/A, IFNG +2109A/G, IL12B +1188A/C, IL10 −819C/T, and TGFB1 +21C/T are associated with differential cytokine levels in pulmonary tuberculosis patients and may play a role in the initiation and maintenance of acquired cellular immunity to tuberculosis and in the outcome of the active disease while on antituberculosis treatment.
de Barros Reis, Carla; Knust, Renata Erthal; de Aguiar Pereira, Claudia Cristina; Portela, Margareth Crisóstomo
The present study estimated the cost of advanced non-small cell lung cancer care for a cohort of 251 patients enrolled in a Brazilian public hospital and identified factors associated with the cost of treating the disease, considering sociodemographic, clinical and behavioral characteristics of patients, service utilization patterns and survival time. Estimates were obtained from the survey of direct medical cost per patient from the hospital's perspective. Data was collected from medical records and available hospital information systems. The ordinary least squares (OLS) method with logarithmic transformation of the dependent variable for the analysis of cost predictors was used to take into account the positive skewness of the costs distribution. The average cost of NSCLC was US$ 5647 for patients, with 71% of costs being associated to outpatient care. The main components of cost were daily hospital bed stay (22.6%), radiotherapy (15.5%) and chemotherapy (38.5%). The OLS model reported that, with 5% significance level, patients with higher levels of education, with better physical performance and less advanced disease have higher treatment costs. After controlling for the patient's survival time, only education and service utilization patterns were statistically significant. Individuals who were hospitalized or made use of radiotherapy or chemotherapy had higher costs. The use of these outpatient and hospital services explained most of the treatment cost variation, with a significant increase of the adjusted R 2 of 0.111 to 0.449 after incorporation of these variables in the model. The explanatory power of the complete model reached 62%. Inequities in disease treatment costs were observed, pointing to the need for strategies that reduce lower socioeconomic status and population's hurdles to accessing cancer care services.
Brasil, Larissa W; Barbosa, Laila R A; de Araujo, Felipe J; da Costa, Allyson G; da Silva, Luan D O; Pinheiro, Suzana K; de Almeida, Anne C G; Kuhn, Andrea; Vitor-Silva, Sheila; de Melo, Gisely C; Monteiro, Wuelton M; de Lacerda, Marcus V G; Ramasawmy, Rajendranath
Toll-interacting protein is a negative regulator in the TLR signaling cascade, particularly by impeding the TLR2 and, TLR4 pathway. Recently, TOLLIP was shown to regulate human TLR signaling pathways. Two common TOLLIP polymorphisms (rs5743899 and rs3750920) were reported to be influencing IL-6, TNF and IL-10 expression. In this study, TOLLIP variants were investigated to their relation to Plasmodium vivax malaria in the Brazilian Amazon. This cohort study was performed in the municipalities of Careiro and, Manaus, in Western Brazilian Amazon. A total of 319 patients with P. vivax malaria and, 263 healthy controls with no previous history of malaria were included in the study. Genomic DNA was extracted from blood collected on filter paper, using the QIAamp ® DNA Mini Kit, according to the manufacturer's suggested protocol. The rs5743899 and rs3750920 polymorphisms of the TOLLIP gene were typed by PCR-RFLP. Homozygous individuals for the rs3750920 T allele gene had twice the risk of developing malaria when compared to individuals homozygous for the C allele (OR 2.0 [95% CI 1.23-3.07]; p = 0.004). In the dominant model, carriers the C allele indicates protection to malaria, carriers of the C allele were compared to individuals with the T allele, and the difference is highly significant (OR 0.52 [95% CI 0.37-0.76]; p = 0.0006). The linkage disequilibrium between the two polymorphisms was weak (r 2 = 0.037; D' = 0.27). These findings suggest that genes involved in the TLRs-pathway may be involved in malaria susceptibility. The association of the TOLLIP rs3750920 T allele with susceptibility to malaria further provides evidence that genetic variations in immune response genes may predispose individuals to malaria.
Salmazo, Péricles Sidnei; Bazan, Silméia Garcia Zanati; Shiraishi, Flávio Gobbis; Bazan, Rodrigo; Okoshi, Katashi; Hueb, João Carlos
AIDS as well as atherosclerosis are important public health problems. The longer survival among HIV-infected is associated with increased number of cardiovascular events in this population, and this association is not fully understood. To identify the frequency of subclinical atherosclerosis in HIV-infected patients compared to control subjects; to analyze associations between atherosclerosis and clinical and laboratory variables, cardiovascular risk factors, and the Framingham coronary heart disease risk score (FCRS). Prospective cross-sectional case-control study assessing the presence of subclinical atherosclerosis in 264 HIV-infected patients and 279 controls. Clinical evaluation included ultrasound examination of the carotid arteries, arterial stiffness by pulse wave velocity (PWV) and augmentation index (AIx), laboratory analysis of peripheral blood, and cardiovascular risk according to FCRS criteria. The significance level adopted in the statistical analysis was p media thickness was higher in the HIV group than in controls (p media thickness, was not associated with carotid plaque frequency, and did not alter the mechanical characteristics of the arterial system (PWV and AIx). HIV-infected patients are at increased risk of atherosclerosis in association with classical cardiovascular risk factors. Treatment with protease inhibitors does not promote functional changes in the arteries, and shows no association with increased frequency of atherosclerotic plaques in carotid arteries. The FCRS may be inappropriate for this population.
Mourão, Aline Mansueto; Gomez, Rodrigo Santiago; Barbosa, Luiz Sergio Mageste; Freitas, Denise da Silva; Comini-Frota, Elizabeth Regina; Kummer, Arthur; Lemos, Stella Maris Aguiar; Teixeira, Antonio Lucio
The aims of the current study were 1) to evaluate the reliability and validity of the Brazilian version of the 15-item Myasthenia Gravis Quality of Life Scale and 2) to investigate the quality of life of Brazilian patients with myasthenia gravis and its determinants. This cross-sectional study included 69 patients with myasthenia gravis who underwent neurological evaluation and completed questionnaires regarding quality of life (the 36-item Short Form of the Medical Outcomes Study and the 15-item Myasthenia Gravis Quality of Life Scale), anxiety and depressive symptoms. The Brazilian version of the 15-item Myasthenia Gravis Quality of Life Scale showed high internal consistency and good concurrent validity with the 36-item Short Form of the Medical Outcomes Study and its subscales. Determinants of quality of life in Brazilian patients with myasthenia gravis included the current status of myasthenia gravis as assessed by the Myasthenia Gravis Composite, the current prednisone dose and the levels of anxiety and depression. The Brazilian version of the 15-item Myasthenia Gravis Quality of Life Scale is a valid instrument. Symptom severity, prednisone dosage and anxiety and depression levels impact the quality of life of patients with myasthenia gravis.
Simone Berger Calic
Full Text Available ABSTRACT. Calic S.B., Rocha C.M.B.M, Bruhn F.R.P., Barros R.A. & Leite R.C. [Factors associated to cases of Brazilian Spotted Fever, Minas Gerais, 1995- 2002.] Fatores associados aos casos de Febre Maculosa Brasileira frente aos suspeitos não confirmados, Minas Gerais, 1995 a 2002. Revista Brasileira de Medicina Veterinária, 37(3:239-244, 2015. Instituto Otávio Magalhães, Fundação Ezequiel Dias, Rua Conde Pereira Carneiro, 80, Gameleira, Belo Horizonte, MG 30510- 010, Brasil. E-mail: firstname.lastname@example.org The aim of this study was to evaluate factors and symptoms associated with confirmed cases of FMB in Minas Gerais. For this, was conducted a retrospective study using epidemiological records received by the Central Laboratory (LACEN of MG in the period 1995-2002. Cases were suspected patients after clinical and epidemiological assessment for BSF and seropositive for Rickettsia ricketsii (IFAT 1:64 in at least one serum sample. As negative suspects were those that have no seroconversion in two consecutive samples to BSF. After adjustment of multiple logistic regression analysis, only the occurrence of rash and seizures were associated with symptoms FMB. Using analysis of main components symptoms that characterized the cases were: rash, convulsions and coma. Moreover cases have a high relation with hospitalization and lack of similar cases. The FMB in Minas Gerais is a serious disease and need early diagnosis.
Camila Maciel de Oliveira
Full Text Available Recently, some studies have evaluated the role of adiposity measures in the prediction of hypertension risk, but the results are conflicting. Thus, the aim of this study was to compare which of the four indicators of adiposity (waist circumference-WC, body mass index-BMI, body adiposity index-BAI, and visceral adiposity index-VAI were better associated with hypertension in a Brazilian population.For this study, were selected 1627 individuals (both genders, and aged over 18 years resident in the municipality of Baependi, a city located in the Southeast of Brazil. WC, BMI, BAI and VAI were determined according to a standard protocol. Hypertension was defined as mean systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg, and/or antihypertensive drug use. The indicators of adiposity WC, BMI, BAI, and VAI were higher in hypertensive when compared to non-hypertensive individuals. In addition, WC and BMI were most strongly associated with hypertension in men and women, respectively. The area under the curve (AUC of WC was significantly higher than VAI in men. In women, both AUC of BMI and WC showed higher discriminatory power to predict hypertension than BAI and VAI.The indicators of adiposity WC and BMI were better associated with hypertension than BAI and VAI, in both genders, and it could be a useful tools for the screening of hypertensive patients.
Priscila Nicolao Mazzola
Conclusions: Brazilian PKU patients do not show differences in body composition and nutritional status in comparison with controls, regardless metabolic control. Although similar to controls, PKU patients may be in risk of disturbed nutritional and metabolic markers as seen for the general population.
Full Text Available Propolis contains a variety of bioactive components and possesses many biological properties. This study was designed to evaluate potential effects of Brazilian green propolis on glucose metabolism and antioxidant function in patients with type 2 diabetes mellitus (T2DM. In the 18-week randomized controlled study, enrolled patients with T2DM were randomly assigned to Brazilian green propolis group (900 mg/day (n = 32 and control group (n = 33. At the end of the study, no significant difference was found in serum glucose, glycosylated hemoglobin, insulin, aldose reductase or adiponectin between the two groups. However, serum GSH and total polyphenols were significantly increased, and serum carbonyls and lactate dehydrogenase activity were significantly reduced in the Brazilian green propolis group. Serum TNF-α was significantly decreased, whereas serum IL-1β and IL-6 were significantly increased in the Brazilian green propolis group. It is concluded that Brazilian green propolis is effective in improving antioxidant function in T2DM patients.
Camila Aparecida Borges
Full Text Available Associations between dietary patterns (DP and socioeconomic factors have been little explored in adolescents. The aim of this study was to identify DP in European and Brazilian adolescents and to investigate their associations with a range of socioeconomic indicators. Adolescents from the HELENA-study and the Household Budget Survey were analyzed. Factor analysis was used to obtain DP. Linear regression was used to examine the association between DP and SES. In Europeans, the Western DP was associated with low education of the mother, high socioeconomic status (boys, older age (boys, and living in cities of the Northern Europe; in Brazilians, the Western DP was associated with high secondary education of the mother, high socioeconomic status and living in Southern areas of the country. The Traditional European DP, in both genders, was associated with high secondary education of the mother and inversely associated with a high socioeconomic status; the Traditional Brazilian DP, was associated with university level education of the mother and older age (boys. The association between DP and socioeconomic factors is relevant for the understanding of food-related practices and highlight the importance of performing a complete assessment of the socioeconomic influence in adolescent’s DP from developed and developing countries.
Ribeiro, Amanda Gomes; Mill, José Geraldo; Cade, Nágela Valadão; Velasquez-Melendez, Gustavo; Matos, Sheila Maria Alvim; Molina, Maria Del Carmen Bisi
Recent studies have suggested the possible effect of dairy product intake on cardiovascular risk markers, including arterial stiffness. Our aim was to investigate whether dairy food intake is associated with arterial stiffness, which we assessed by carotid-femoral pulse wave velocity (cfPWV) and pulse pressure (PP) in a cross-sectional analysis of baseline data (2008⁻2010; n = 12,892) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Dairy consumption was evaluated with a validated food-frequency questionnaire (FFQ) by computing servings per day for total and subgroups of dairy products. Dairy consumption was described in four categories (≤1 serving/day to >4 servings/day). Covariance analysis (ANCOVA) was used to compare cfPWV across increasing intake of dairy food, adjusting for confounding factors, including non-dairy food groups. The intake of total dairy was inversely associated with cfPWV and PP (-0.13 m/s and -1.3 mmHg, from the lowest and to the highest category of dairy intake). Low-fat dairy, fermented dairy and cheese showed an inverse relationship with cfPWV and PP. These findings suggest a beneficial effect of dairy consumption to reduce arterial stiffness. However, further evidence from longitudinal studies or long-term intervention is needed to support reduction of cfPWV and PP mediating the beneficial effects of dairy products on cardiovascular health.
Amanda Gomes Ribeiro
Full Text Available Recent studies have suggested the possible effect of dairy product intake on cardiovascular risk markers, including arterial stiffness. Our aim was to investigate whether dairy food intake is associated with arterial stiffness, which we assessed by carotid-femoral pulse wave velocity (cfPWV and pulse pressure (PP in a cross-sectional analysis of baseline data (2008–2010; n = 12,892 of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil. Dairy consumption was evaluated with a validated food-frequency questionnaire (FFQ by computing servings per day for total and subgroups of dairy products. Dairy consumption was described in four categories (≤1 serving/day to >4 servings/day. Covariance analysis (ANCOVA was used to compare cfPWV across increasing intake of dairy food, adjusting for confounding factors, including non-dairy food groups. The intake of total dairy was inversely associated with cfPWV and PP (−0.13 m/s and −1.3 mmHg, from the lowest and to the highest category of dairy intake. Low-fat dairy, fermented dairy and cheese showed an inverse relationship with cfPWV and PP. These findings suggest a beneficial effect of dairy consumption to reduce arterial stiffness. However, further evidence from longitudinal studies or long-term intervention is needed to support reduction of cfPWV and PP mediating the beneficial effects of dairy products on cardiovascular health.
Michelle Nigri Levitan
Full Text Available Objective: To present the most relevant findings regarding the Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder. Methods: We used the methodology proposed by the Brazilian Medical Association for the Diretrizes Project. The MEDLINE (PubMed, Scopus, Web of Science, and LILACS online databases were queried for articles published from 1980 to 2012. Searchable questions were structured using the PICO format (acronym for “patient” [or population], “intervention” [or exposure], “comparison” [or control], and “outcome”. Results: We present data on clinical manifestations and implications of panic disorder and its association with depression, drug abuse, dependence and anxiety disorders. In addition, discussions were held on the main psychiatric and clinical differential diagnoses. Conclusions: The guidelines are proposed to serve as a reference for the general practitioner and specialist to assist in and facilitate the diagnosis of panic disorder.
Berutti, Mariangeles; Nery, Fabiano G; Sato, Rodrigo; Scippa, Angela; Kapczinski, Flavio; Lafer, Beny
To compare clinical characteristics of bipolar disorder (BD) in patients with and without a family history of mood disorders (FHMD) in a large sample from the Brazilian Research Network of Bipolar Disorders. Four-hundred eighty-eight DSM-IV BD patients participating in the Brazilian Research Network of Bipolar Disorders were included. Participants were divided between those with FHMD (n=230) and without FHMD (n=258). We compared these two groups on demographic and clinical variables and performed a logistic regression to identify which variables were most strongly associated with positive family history of mood disorders. BD patients with FHMD presented with significantly higher lifetime prevalence of any anxiety disorder, obsessive-compulsive disorder, social phobia, substance abuse, and were more likely to present history of suicide attempts, family history of suicide attempts and suicide, and more psychiatric hospitalizations than BD patients without FHMD. Logistic regression showed that the variables most strongly associated with a positive FHMD were any comorbid anxiety disorder, comorbid substance abuse, and family history of suicide. Cross-sectional study and verification of FHMD by indirect information. BD patients with FHMD differ from BD patients without FHMD in rates of comorbid anxiety disorder and substance abuse, number of hospitalizations and suicide attempts. As FHMD is routinely assessed in clinical practice, these findings may help to identify patients at risk for particular manifestations of BD and may point to a common, genetically determined neurobiological substrate that increases the risk of conditions such as comorbidities and suicidality in BD patients. Copyright © 2014 Elsevier B.V. All rights reserved.
Silvia Marinho Ferolla
Full Text Available OBJECTIVE: Recent evidence suggests that non-alcoholic fatty liver disease is associated with diet. Our aim was to investigate the dietary patterns of a Brazilian population with this condition and compare them with the recommended diet. METHODS: A cross-sectional study was conducted on 96 non-alcoholic fatty liver disease patients before any dietetic counseling. All patients underwent abdominal ultrasound, biochemical tests, dietary evaluations, and anthropometric evaluations. Their food intake was assessed by a semi-quantitative food-frequency questionnaire and 24-hour food recall. RESULTS: The median patient age was 53 years, and 77% of the individuals were women. Most (67.7% participants were obese, and a large waist circumference was observed in 80.2% subjects. Almost 70% of the participants had metabolic syndrome, and 62.3% presented evidence of either insulin resistance or overt diabetes. Most patients (51.5, 58.5, and 61.7%, respectively exceeded the recommendations for energy intake, as well as total and saturated fat. All patients consumed less than the amount of recommended monounsaturated fatty acids, and 52.1 and 76.6% of them consumed less polyunsaturated fatty acids and fiber, respectively, than recommended. In most patients, the calcium, sodium, potassium, pyridoxine, and vitamin C intake did not meet the recommendations, and in 10.5-15.5% of individuals, the tolerable upper limit intake for sodium was exceeded. The patients presented a significantly high intake of meats, fats, sugars, legumes (beans, and vegetables and a low consumption of cereals, fruits, and dairy products compared with the recommendations. CONCLUSIONS: Although patients with non-alcoholic fatty liver disease exhibited high energy and lipid consumption, most of them had inadequate intake of some micronutrients. The possible role of nutrient-deficient intake in the development of non-alcoholic fatty liver disease warrants investigation.
Brazilian guidelines on prevention of cardiovascular disease in patients with diabetes: a position statement from the Brazilian Diabetes Society (SBD), the Brazilian Cardiology Society (SBC) and the Brazilian Endocrinology and Metabolism Society (SBEM).
Bertoluci, Marcello Casaccia; Moreira, Rodrigo Oliveira; Faludi, André; Izar, Maria Cristina; Schaan, Beatriz D; Valerio, Cynthia Melissa; Bertolami, Marcelo Chiara; Chacra, Ana Paula; Malachias, Marcus Vinicius Bolivar; Vencio, Sérgio; Saraiva, José Francisco Kerr; Betti, Roberto; Turatti, Luiz; Fonseca, Francisco Antonio Helfenstein; Bianco, Henrique Tria; Sulzbach, Marta; Bertolami, Adriana; Salles, João Eduardo Nunes; Hohl, Alexandre; Trujilho, Fábio; Lima, Eduardo Gomes; Miname, Marcio Hiroshi; Zanella, Maria Teresa; Lamounier, Rodrigo; Sá, João Roberto; Amodeo, Celso; Pires, Antonio Carlos; Santos, Raul D
Since the first position statement on diabetes and cardiovascular prevention published in 2014 by the Brazilian Diabetes Society, the current view on primary and secondary prevention in diabetes has evolved as a result of new approaches on cardiovascular risk stratification, new cholesterol lowering drugs, and new anti-hyperglycemic drugs. Importantly, a pattern of risk heterogeneity has emerged, showing that not all diabetic patients are at high or very high risk. In fact, most younger patients who have no overt cardiovascular risk factors may be more adequately classified as being at intermediate or even low cardiovascular risk. Thus, there is a need for cardiovascular risk stratification in patients with diabetes. The present panel reviews the best current evidence and proposes a practical risk-based approach on treatment for patients with diabetes. The Brazilian Diabetes Society, the Brazilian Society of Cardiology, and the Brazilian Endocrinology and Metabolism Society gathered to form an expert panel including 28 cardiologists and endocrinologists to review the best available evidence and to draft up-to-date an evidence-based guideline with practical recommendations for risk stratification and prevention of cardiovascular disease in diabetes. The guideline includes 59 recommendations covering: (1) the impact of new anti-hyperglycemic drugs and new lipid lowering drugs on cardiovascular risk; (2) a guide to statin use, including new definitions of LDL-cholesterol and in non-HDL-cholesterol targets; (3) evaluation of silent myocardial ischemia and subclinical atherosclerosis in patients with diabetes; (4) hypertension treatment; and (5) the use of antiplatelet therapy. Diabetes is a heterogeneous disease. Although cardiovascular risk is increased in most patients, those without risk factors or evidence of sub-clinical atherosclerosis are at a lower risk. Optimal management must rely on an approach that will cover both cardiovascular disease prevention in
Sauer Liberato, Ana Carolina; Cunha Matheus Rodrigues, Roberta; Kim, MyoungJin; Mallory, Caroline
This study examined the reliability and validity of the Brazilian Portuguese version of the Treatment Satisfaction Questionnaire for Medication (version 1.4) among patients with hypertension. Understanding the patient experience with treatment satisfaction will contribute to improved medication adherence and control of hypertension. Hypertension is a serious problem in Brazil that is associated with chronic illness controlled, in part, by consistent adherence to medications. Patient satisfaction with medication treatment is associated with adherence to medication. The Treatment Satisfaction Questionnaire for Medication (version 1.4) is a promising instrument for measuring medication; however, to date there has been no report of the reliability and validity of the instrument with Portuguese-speaking adults with hypertension in Brazil. Cross-sectional descriptive exploratory study. A convenience sample of 300 patients with hypertension in an outpatient setting in the southeast region of São Paulo state in Brazil completed the Treatment Satisfaction Questionnaire for Medication (version 1.4). The instrument, comprised of four subscales, was evaluated for reliability using correlation analyses and internal consistency. Confirmatory factor analysis was used to determine factorial validity. Correlational analyses, internal consistency (Cronbach's alpha) and hierarchical confirmatory factor analysis demonstrate adequate support for the four-factor dimensionality, reliability and factorial validity of the Treatment Satisfaction Questionnaire for Medication (version 1.4). This study provides modest evidence for internal consistency and factorial validity of the Treatment Satisfaction Questionnaire for Medication (version 1.4) in Portuguese-speaking adult Brazilians with hypertension. Future testing should focus on extending reliability testing, discriminant validity and potential translation and literacy issues in this population. Within known limitations, clinicians will
Moreira, Tiago Ricardo; Giatti, Luana; Cesar, Cibele Comini; Andrade, Eli Iola Gurgel; Acurcio, Francisco de Assis; Cherchiglia, Mariângela Leal
ABSTRACT OBJECTIVE To examine whether the level of complexity of the services structure and sociodemographic and clinical characteristics of patients in hemodialysis are associated with the prevalence of poor health self-assessment. METHODS In this cross-sectional study, we evaluated 1,621 patients with chronic terminal kidney disease on hemodialysis accompanied in 81 dialysis services in the Brazilian Unified Health System in 2007. Sampling was performed by conglomerate in two stages and a structured questionnaire was applied to participants. Multilevel multiple logistic regression was used for data analysis. RESULTS The prevalence of poor health self-assessment was of 54.5%, and in multivariable analysis it was associated with the following variables: increasing age (OR = 1.02; 95%CI 1.01–1.02), separated or divorced marital status (OR = 0.62; 95%CI 0.34–0.88), having 12 years or more of study (OR = 0.51; 95%CI 0.37–0.71), spending more than 60 minutes in commuting between home and the dialysis service (OR = 1.80; 95%CI 1.29–2.51), having three or more self-referred diseases (OR = 2.20; 95%CI 1.33–3.62), and reporting some (OR = 2.17; 95%CI 1.66–2.84) or a lot of (OR = 2.74; 95%CI 2.04–3.68) trouble falling asleep. Individuals in treatment in dialysis services with the highest level of complexity in the structure presented less chance of performing a self-assessment of their health as bad (OR = 0.59; 95%CI 0.42–0.84). CONCLUSIONS We showed poor health self-assessment is associated with age, years of formal education, marital status, home commuting time to the dialysis service, number of self-referred diseases, report of trouble sleeping, and also with the level of complexity of the structure of health services. Acknowledging these factors can contribute to the development of strategies to improve the health of patients in hemodialysis in the Brazilian Unified Health System. PMID:27143610
Tiago Ricardo Moreira
Full Text Available ABSTRACT OBJECTIVE To examine whether the level of complexity of the services structure and sociodemographic and clinical characteristics of patients in hemodialysis are associated with the prevalence of poor health self-assessment. METHODS In this cross-sectional study, we evaluated 1,621 patients with chronic terminal kidney disease on hemodialysis accompanied in 81 dialysis services in the Brazilian Unified Health System in 2007. Sampling was performed by conglomerate in two stages and a structured questionnaire was applied to participants. Multilevel multiple logistic regression was used for data analysis. RESULTS The prevalence of poor health self-assessment was of 54.5%, and in multivariable analysis it was associated with the following variables: increasing age (OR = 1.02; 95%CI 1.01–1.02, separated or divorced marital status (OR = 0.62; 95%CI 0.34–0.88, having 12 years or more of study (OR = 0.51; 95%CI 0.37–0.71, spending more than 60 minutes in commuting between home and the dialysis service (OR = 1.80; 95%CI 1.29–2.51, having three or more self-referred diseases (OR = 2.20; 95%CI 1.33–3.62, and reporting some (OR = 2.17; 95%CI 1.66–2.84 or a lot of (OR = 2.74; 95%CI 2.04–3.68 trouble falling asleep. Individuals in treatment in dialysis services with the highest level of complexity in the structure presented less chance of performing a self-assessment of their health as bad (OR = 0.59; 95%CI 0.42–0.84. CONCLUSIONS We showed poor health self-assessment is associated with age, years of formal education, marital status, home commuting time to the dialysis service, number of self-referred diseases, report of trouble sleeping, and also with the level of complexity of the structure of health services. Acknowledging these factors can contribute to the development of strategies to improve the health of patients in hemodialysis in the Brazilian Unified Health System.
Metsavaht, Leonardo; Leporace, Gustavo; Riberto, Marcelo; Sposito, Maria Matilde M; Del Castillo, Letícia N C; Oliveira, Liszt P; Batista, Luiz Alberto
Clinical measurement. To translate and culturally adapt the Lower Extremity Functional Scale (LEFS) into a Brazilian Portuguese version, and to test the construct and content validity and reliability of this version in patients with knee injuries. There is no Brazilian Portuguese version of an instrument to assess the function of the lower extremity after orthopaedic injury. The translation of the original English version of the LEFS into a Brazilian Portuguese version was accomplished using standard guidelines and tested in 31 patients with knee injuries. Subsequently, 87 patients with a variety of knee disorders completed the Brazilian Portuguese LEFS, the Medical Outcomes Study 36-Item Short-Form Health Survey, the Western Ontario and McMaster Universities Osteoarthritis Index, and the International Knee Documentation Committee Subjective Knee Evaluation Form and a visual analog scale for pain. All patients were retested within 2 days to determine reliability of these measures. Validation was assessed by determining the level of association between the Brazilian Portuguese LEFS and the other outcome measures. Reliability was documented by calculating internal consistency, test-retest reliability, and standard error of measurement. The Brazilian Portuguese LEFS had a high level of association with the physical component of the Medical Outcomes Study 36-Item Short-Form Health Survey (r = 0.82), the Western Ontario and McMaster Universities Osteoarthritis Index (r = 0.87), the International Knee Documentation Committee Subjective Knee Evaluation Form (r = 0.82), and the pain visual analog scale (r = -0.60) (all, Pcoefficient = 0.957) of the Brazilian Portuguese version of the LEFS were high. The standard error of measurement was low (3.6) and the agreement was considered high, demonstrated by the small differences between test and retest and the narrow limit of agreement, as observed in Bland-Altman and survival-agreement plots. The translation of the LEFS into a
Kasuki, Leandro; de Azeredo Lima, Carlos Henrique; Ogino, Liana; Camacho, Aline H S; Chimelli, Leila; Korbonits, Márta
Aryl hydrocarbon receptor-interacting protein (AIP) gene mutations (AIPmut) are the most frequent germline mutations found in apparently sporadic pituitary adenomas (SPA). Our aim was to evaluate the frequency of AIPmut among young Brazilian patients with SPA. We performed an observational cohort study between 2013 and 2016 in a single referral center. AIPmut screening was carried out in 132 SPA patients with macroadenomas diagnosed up to 40 years or in adenomas of any size diagnosed until 18 years of age. Twelve tumor samples were also analyzed. Leukocyte DNA and tumor tissue DNA were sequenced for the entire AIP-coding region for evaluation of mutations. Eleven (8.3%) of the 132 patients had AIPmut, comprising 9/74 (12%) somatotropinomas, 1/38 (2.6%) prolactinoma, 1/10 (10%) corticotropinoma and no non-functioning adenomas. In pediatric patients (≤18 years), AIPmut frequency was 13.3% (2/15). Out of the 5 patients with gigantism, two had AIPmut, both truncating mutations. The Y268* mutation was described in Brazilian patients and the K273Rfs*30 mutation is a novel mutation in our patient. No somatic AIP mutations were found in the 12 tumor samples. A tumor sample from an acromegaly patient harboring the A299V AIPmut showed loss of heterozygosity. In conclusion, AIPmut frequency in SPA Brazilian patients is similar to other populations. Our study identified two mutations exclusively found in Brazilians and also shows, for the first time, loss of heterozygosity in tumor DNA from an acromegaly patient harboring the A299V AIPmut. Our findings corroborate previous observations that AIPmut screening should be performed in young patients with SPA. PMID:29074612
Paula Bruna Araujo
Full Text Available Aryl hydrocarbon receptor-interacting protein (AIP gene mutations (AIPmut are the most frequent germline mutations found in apparently sporadic pituitary adenomas (SPA. Our aim was to evaluate the frequency of AIPmut among young Brazilian patients with SPA. We performed an observational cohort study between 2013 and 2016 in a single referral center. AIPmut screening was carried out in 132 SPA patients with macroadenomas diagnosed up to 40 years or in adenomas of any size diagnosed until 18 years of age. Twelve tumor samples were also analyzed. Leukocyte DNA and tumor tissue DNA were sequenced for the entire AIP-coding region for evaluation of mutations. Eleven (8.3% of the 132 patients had AIPmut, comprising 9/74 (12% somatotropinomas, 1/38 (2.6% prolactinoma, 1/10 (10% corticotropinoma and no non-functioning adenomas. In pediatric patients (≤18 years, AIPmut frequency was 13.3% (2/15. Out of the 5 patients with gigantism, two had AIPmut, both truncating mutations. The Y268* mutation was described in Brazilian patients and the K273Rfs*30 mutation is a novel mutation in our patient. No somatic AIP mutations were found in the 12 tumor samples. A tumor sample from an acromegaly patient harboring the A299V AIPmut showed loss of heterozygosity. In conclusion, AIPmut frequency in SPA Brazilian patients is similar to other populations. Our study identified two mutations exclusively found in Brazilians and also shows, for the first time, loss of heterozygosity in tumor DNA from an acromegaly patient harboring the A299V AIPmut. Our findings corroborate previous observations that AIPmut screening should be performed in young patients with SPA.
Full Text Available Apolipoprotein E (apoE - e2, e3, e4 alleles plays a role in the regulation of lipid metabolism, with the e4 considered to be a risk factor for coronary artery disease (CAD. We aimed to evaluate the apoE polymorphisms in Brazilians with CAD and their influence on the lipid profile and other risk factors (hypertension, diabetes mellitus, smoking. Two hundred individuals were examined: 100 patients with atherosclerosis confirmed by coronary angiography and 100 controls. Blood samples were drawn to determine apoE polymorphisms and lipid profile. As expected, the e3 allele was prevalent in the CAD (0.87 and non-CAD groups (0.81; P = 0.099, followed by the e4 allele (0.09 and 0.14, respectively; P = 0.158. The e3/3 (76 and 78% and e3/4 (16 and 23% were the most common genotypes for patients and controls, respectively. The lipid profile was altered in patients compared to controls (P < 0.05, independently of the e4 allele. However, in the controls this allele was prevalent in individuals with elevated LDL-cholesterol levels only (odds ratio = 2.531; 95% CI = 1.028-6.232. The frequency of risk factors was higher in the CAD group (P < 0.05, but their association with the lipid profile was not demonstrable in e4 carriers. In conclusion, the e4 allele is not associated with CAD or lipid profile in patients with atherosclerosis. However, its frequency in the non-CAD group is associated with increased levels of LDL-cholesterol, suggesting an independent effect of the e4 allele on lipid profile when the low frequency of other risk factors in this group is taken into account.
Giovana T. Torrezan
Full Text Available Pathogenic variants in known breast cancer (BC predisposing genes explain only about 30% of Hereditary Breast Cancer (HBC cases, whereas the underlying genetic factors for most families remain unknown. Here, we used whole-exome sequencing (WES to identify genetic variants associated to HBC in 17 patients of Brazil with familial BC and negative for causal variants in major BC risk genes (BRCA1/2, TP53, and CHEK2 c.1100delC. First, we searched for rare variants in 27 known HBC genes and identified two patients harboring truncating pathogenic variants in ATM and BARD1. For the remaining 15 negative patients, we found a substantial vast number of rare genetic variants. Thus, for selecting the most promising variants we used functional-based variant prioritization, followed by NGS validation, analysis in a control group, cosegregation analysis in one family and comparison with previous WES studies, shrinking our list to 23 novel BC candidate genes, which were evaluated in an independent cohort of 42 high-risk BC patients. Rare and possibly damaging variants were identified in 12 candidate genes in this cohort, including variants in DNA repair genes (ERCC1 and SXL4 and other cancer-related genes (NOTCH2, ERBB2, MST1R, and RAF1. Overall, this is the first WES study applied for identifying novel genes associated to HBC in Brazilian patients, in which we provide a set of putative BC predisposing genes. We also underpin the value of using WES for assessing the complex landscape of HBC susceptibility, especially in less characterized populations.
Natalia Pereira Machado
Full Text Available ABSTRACT Objectives: Innate immunity is involved in the physiopathology of ankylosing spondylitis (AS, with the participation of Gram-negative bacteria, modulation of human leukocyte antigen (HLA B27 and the involvement of pattern recognition receptors, such as Toll-like receptors (TLRs. The aim of this study was to investigate the clinical characteristics and frequency of TLR4 polymorphisms (Asp299Gly and Thr 399Ile in a cohort of Brazilian patients with AS. Methods: A cross-sectional study was carried out involving 200 patients with a diagnosis of AS and a healthy control group of 200 individuals. Disease activity, severity and functional capacity were measured. The study of TLR4 polymorphisms was performed using the restriction fragment length polymorphism method. HLA-B27 was analyzed by conventional polymerase chain reaction. The IBM SPSS Statistics 20 program was used for the statistical analysis, with p-values less than 0.05 considered significant. Results: Mean age and disease duration were 43.1 ± 12.7 and 16.6 ± 9.2 years, respectively. The sample was predominantly male (71% and non-Caucasian (52%. A total of 66% of the group of patients were positive for HLA-B27. The sample of patients was characterized by moderate functional impairment and a high degree of disease activity. No significant association was found between the two TLR4 polymorphisms and susceptibility to AS. Conclusions: TLR4 polymorphisms 399 and 299 were not more frequent in patients with AS in comparison to the health controls and none of the clinical variables were associated with these polymorphisms.
Ribas, Marcelo Romanovitch; Oliveira Netto, Zair Candido; Salgueirosa, Fabiano; Fernandes, Priscila; Matos, Oslei de; Bassan, Julio Cesar
ABSTRACT Introduction: By associating genetics and sport, it is possible to identify subjects with greater capacity to adapt to training, and lower chances of injury. Objective: The investigation evaluated the genotypic and allelic distribution of ACTN3 R577X and ACE I/D polymorphisms in Brazilian high-performance athletes in wrestling and percussion combat sports. Methods: The study included 37 male athletes ranked from first to third place in world scenarios, divided into two groups: wrestl...
Pereira, Ana Paula Dias; Sanchez, Zila M
A school is a learning environment that contributes to the construction of personal values, beliefs, habits and lifestyles, provide convenient settings for the implementation of drug use prevention programs targeting adolescents, who are the population group at highest risk of initiating drug use. The objective of the present study was to investigate the prevalence of factors associated with implementing drug use prevention programs in Brazilian public and private middle and high urban schools. The present population-based cross-sectional survey was conducted with a probability sample of 1151 school administrators stratified by the 5 Brazilian administrative divisions, in 2014. A close-ended, self-reported online questionnaire was used. Logistic regression analysis was used to identify factors associated with implementing drug use prevention programs in schools. A total of 51.1% of the schools had adopted drug use prevention programs. The factors associated with program implementation were as follows: belonging to the public school network; having a library; development of activities targeting sexuality; development of "Health at School Program" activities; offering extracurricular activities; and having an administrator that participated in training courses on drugs. The adoption of drug use prevention practices in Brazilian schools may be expanded with greater orchestration of schools through specialized training of administrators and teachers, expansion of the School Health Program and concomitant development of the schools' structural and curricular attributes.
Padoveze, Maria Clara; Fortaleza, Carlos Magno Castelo Branco; Kiffer, Carlos; Barth, Afonso Luís; Carneiro, Irna Carla do Rosário Souza; Giamberardino, Heloisa Ilhe Garcia; Rodrigues, Jorge Luiz Nobre; Santos Filho, Lauro; de Mello, Maria Júlia Gonçalves; Pereira, Milca Severino; Gontijo Filho, Paulo; Rocha, Mirza; de Medeiros, Eduardo Alexandrino Servolo; Pignatari, Antonio Carlos Campos
Minimal structure is required for effective prevention of health care-associated infection (HAI). The objective of this study was to evaluate the structure for prevention of HAI in a sample of Brazilian hospitals. This was a cross-sectional study from hospitals in 5 Brazilian regions (n = 153; total beds: 13,983) classified according to the number of beds; 11 university hospitals were used as reference for comparison. Trained nurses carried out the evaluation by using structured forms previously validated. The evaluation of conformity index (CI) included elements of structure of the Health Care-Associated Prevention and Control Committee (HAIPCC), hand hygiene, sterilization, and laboratory of microbiology. The median CI for the HAIPCC varied from 0.55-0.94 among hospital categories. Hospitals with >200 beds had the worst ratio of beds to sinks (3.9; P hospitals with hospitals (3.3; P hospitals were more likely to have their own laboratory of microbiology than other hospitals. This study highlights the need for public health strategies aiming to improve the structure for HAI prevention in Brazilian hospitals. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Viana, Melissa Machado; Frasson, Maria; Galvão, Henrique; Leão, Letícia Lima; Stofanko, Martin; Gonçalves-Dornelas, Higgor; da Silva Cunha, Pricila; Burle de Aguiar, Marcos José
Williams-Beuren Syndrome (WBS) is a multisystem disorder caused by the deletion of contiguous genes on chromosome 7q11.23. Ophthalmologic abnormalities and deficits in visual motor integration are important features of WBS. Here we describe our experience with Brazilian WBS patients and their ophthalmologic features. Sixteen patients with confirmed WBS went through thorough ophthalmologic examination. The most frequent ocular findings in our group of patients were stellate iris pattern (81.2%), hyperopic astigmatism (50%), hyperopia (37.5%), tortuosity of retinal vessel (37.5%) and strabismus (18.7%). This is the second report of ophthalmologic abnormalities in a group of Brazilian individuals with WBS. It is extremely valuable that specific populations are studied so that clinical diagnosis can be refined and management of patients can be driven to the most common presentations of the disease.
da Silva, Fabio José; Felli, Vanda Elisa Andres; Martinez, Maria Carmen; Mininel, Vivian Aline; Ratier, Ana Paula Pelegrini
Impaired work ability is associated with work-related illnesses, early retirement and rising pension costs. To investigate the association between work ability and fatigue in nursing workers. Cross-sectional study conducted with 100 nursing workers from two inpatient units at a public teaching hospital in Sao Paulo, Brazil. The data were collected by means of a socio-demographic profile questionnaire, Work Ability Index (WAI) and Chalder Fatigue Scale. The data were analyzed by means of descriptive and analytical statistical methods, tests of association and multiple linear regression. The study population was mainly composed of women (88% ), exhibited a high educational level (76% ), average age 39.4 years old (SD = 9.5) and 15 years of professional experience, on average. The average score on WAI was good (39.4 points, SD = 6.0) but surprisingly, 35% of the participants exhibited moderate to poor work ability. Fatigue was found in 52% of the participants. The score on WAI decreased in association with fatigue (p work in the same workplace (p = 0.001), as well as among nursing technicians compared to nurses (p = 0.040). Fatigue, longer length of work in the same workplace and work category nursing technician were associated with decreased work ability, which emphasizes the need for investment in health and quality of work life.
da Silva, Daniela Wosiack; de Andrade, Selma Maffei; Soares, Dorotéia Fátima Pelissari de Paula; Mathias, Thais Aidar de Freitas; Matsuo, Tiemi; de Souza, Regina Kazue Tanno
The objective of the study was to identify factors associated with reports of road accidents, among motorcycle couriers in two medium-sized municipalities in southern Brazil. A self-administered questionnaire was answered by motorcycle couriers that had worked for at least 12 months in this profession. The outcomes analyzed were reports on accidents and serious accidents over the 12 months prior to the survey. Bivariate and multivariate analyses by means of logistic regression were carried out to investigate factors that were independently associated with the outcomes. Seven hundred and fifty motorcycle couriers, of mean age 29.5 years (standard deviation = 8.1 ), were included in the study. Young age (18 to 24 years compared to ≥25 years, odds ratio [OR] = 1.77) speeding (OR = 1.48), and use of cell phones while driving (OR = 1.43) were factors independently associated with reports of accidents. For serious accidents, there was an association with alternation of work shifts (OR = 1.91) and speeding (OR = 1.67). The characteristics associated with accidents—personal (young age), behavioral (use of cell phones while driving and speeding), and professional (speeding and alternation of work shifts)—reveal the need to adopt wide-ranging strategies to reduce these accidents, including better work conditions for these motorcyclists. PMID:22629158
da Silva, Daniela Wosiack; de Andrade, Selma Maffei; Soares, Dorotéia Fátima Pelissari de Paula; Mathias, Thais Aidar de Freitas; Matsuo, Tiemi; de Souza, Regina Kazue Tanno
The objective of the study was to identify factors associated with reports of road accidents, among motorcycle couriers in two medium-sized municipalities in southern Brazil. A self-administered questionnaire was answered by motorcycle couriers that had worked for at least 12 months in this profession. The outcomes analyzed were reports on accidents and serious accidents over the 12 months prior to the survey. Bivariate and multivariate analyses by means of logistic regression were carried out to investigate factors that were independently associated with the outcomes. Seven hundred and fifty motorcycle couriers, of mean age 29.5 years (standard deviation = 8.1 ), were included in the study. Young age (18 to 24 years compared to ≥ 25 years, odds ratio [OR] = 1.77) speeding (OR = 1.48), and use of cell phones while driving (OR = 1.43) were factors independently associated with reports of accidents. For serious accidents, there was an association with alternation of work shifts (OR = 1.91) and speeding (OR = 1.67). The characteristics associated with accidents-personal (young age), behavioral (use of cell phones while driving and speeding), and professional (speeding and alternation of work shifts)-reveal the need to adopt wide-ranging strategies to reduce these accidents, including better work conditions for these motorcyclists.
Reis Alessandra Diehl
Full Text Available OBJECTIVE: Although there is a considerable amount of data in the literature regarding the association between alcohol consumption and injuries treated in emergency rooms, little is known about the relationship between such injury and the use of other substances. The objective of this study was to estimate the prevalence of substance use in patients admitted to the emergency room for non-fatal injuries. METHOD: A prospective cross-sectional study assessing all patients admitted to the emergency room within 6 hours after a non-fatal injury was conducted over a three-month period. The following were used as measures of alcohol and drug use: a standardized World Health Organization questionnaire; a self-administered questionnaire related to drug consumption within the 24 hours preceding contact; the Drug Abuse Screening Test; urine screens for cannabis, cocaine and benzodiazepines; and determination of blood alcohol concentration. Descriptive analyses were performed and the confidence interval used was 95%. RESULTS: A total of 353 patients were included. Cannabis and cocaine screens were conducted for 242 patients and benzodiazepine screens were conducted for 166. Blood alcohol concentrations reached the level of positivity in 11% (n = 39, and 10% (n = 33 presented some degree of intoxication. Among the 242 patients screened, 13.6% (n = 33 tested positive for cannabis, and 3.3% (n = 8 tested positive for cocaine, whereas 4.2% (n = 7 of the 166 patients screened tested positive for benzodiazepines. CONCLUSIONS: Substance use was highly prevalent among these individuals. In this sample, the frequency for the use of cannabis (an illicit drug was comparable to that of alcohol. More studies are needed in order to characterize such use among Brazilians and to develop proper approaches to such cases, with the aim of reducing substance use and its consequences.
da Silva, Daniela Wosiack; Andrade, Selma Maffei de; Soares, Dorotéia Fátima Pelissari de Paula; Mathias, Thais Aidar de Freitas; Matsuo, Tiemi; de Souza, Regina Kazue Tanno
The objective of the study was to identify factors associated with reports of road accidents, among motorcycle couriers in two medium-sized municipalities in southern Brazil. A self-administered questionnaire was answered by motorcycle couriers that had worked for at least 12 months in this profession. The outcomes analyzed were reports on accidents and serious accidents over the 12 months prior to the survey. Bivariate and multivariate analyses by means of logistic regression were carried ou...
Dos Santos, Beatriz Ferraz; Madathil, Sreenath; Zuanon, Angela Cristina Cilense; Bedos, Christophe; Nicolau, Belinda
The aims of this study were to investigate dental students' attitudes toward people living in poverty and the extent to which their perceptions were associated with their willingness to treat those patients in their future practice. All 910 dental students enrolled in three Brazilian public universities in 2010 were invited to take part in a cross-sectional survey. A total of 766 students (83.7% response rate) completed the self-administered questionnaire on their perceptions of and attitudes about poverty and their intention to provide dental care to poor people. The responding students showed slightly positive attitudes about people living in poverty; however, a high percentage (35%) reported thinking they were different from the rest of the population. Nevertheless, most of these students expressed willingness to provide care to underserved populations in their future practice; this willingness was found to be associated with their beliefs about poverty (OR 1.65; 95% CI=1.41-1.94). Overall, the study found that these dental students had altruistic views toward people living in poverty. However, they seemed to lack a deep understanding of poverty that may prevent them from acting on their good intentions.
Carlini, Claudia; Andreoni, Solange; Sanchez, Zila M
The purpose of this study was to identify environmental factors associated with patterns of psychotropic drug use in nightclubs. Mixed methods were used to investigate psychotropic drugs consumption among patrons of 31 nightclubs in São Paulo, Brazil. A total of 1822 patrons at the entrance and exit of the venues and 30 staff members of the nightclubs were interviewed. The observational data were collected through 307 h of observational research using a structured guide to register environmental measures. Psychotropic drug use in nightclubs was classified into three categories (1: no drugs; 2: legal drugs [e.g., alcohol and tobacco]; or 3: illicit drugs regardless of alcohol and tobacco use). Illicit drugs used were self-reported by patrons, and alcohol use was measured using a breathalyzer. The data were analyzed in clusters using correlated multinomial logistic regression models. The following environmental variables were associated with illicit drug use in nightclubs: all-you-can-drink service (adjusted odds ratio (aOR) = 11.84, 95%CI [4.06;34.57]) and light effects, such as laser and "disco lights" (aOR = 24.49, 95%CI [8.48;70.77]). The number of bouncers per capita × 100 and the presence of two or more dance floors were inversely associated with the use of illicit drugs (aOR = 0.26, 95%CI [0.11;0.65], and aOR = 0.13, 95%CI [0.06;0.29], respectively). Legal drug use was associated with all-you-can-drink service (aOR = 2.17, 95%CI [1.43;5.04]), the presence of two or more dance floors (aOR = 2.06, 95%CI [1.40;3.05]), and the number of bouncers per capita × 100 (aOR = 1.39, 95%CI [1.22;1.59]). These findings suggest that this is a multivariate phenomenon that would require an integrated approach involving the venue owners, staff members, patrons, local governments, and law enforcement agencies.
Eduardo José Grin
Full Text Available The article analyzes the Development Educational Arrangements as ways of territorial association which, in Brasil, since the 2000s, have been one more alternative for municipal consortia. The object of analysis is formed by two cases: the Corredor da Vale (Maranhão and the Chapada Diamantina (Bahia. The research was implemented based on secondary data and a field investigation that interviewed educational municipal managers and representatives from state governments. The selected cases were based on the diverse case methodology that analyzes, controlling variables, different effects of independent variable over dependent variable. The central argument tested is that Educational Arrangements are the independent variables that produce effect on educational territorial governance like dependent variable. We concluded that the larger success in baiano case it was due to factor like regional leadership, social control, path and context of its construction, what didn't happen in the maranhense case.
Thiago M. Fidalgo
Full Text Available Objective: The effects of exposure to violent events in adolescence have not been sufficiently studied in middle-income countries such as Brazil. The aims of this study are to investigate the prevalence of psychiatric disorders among 12-year-olds in two neighborhoods with different socioeconomic status (SES levels in São Paulo and to examine the influence of previous violent events and SES on the prevalence of psychiatric disorders. Methods: Students from nine public schools in two neighborhoods of São Paulo were recruited. Students and parents answered questions about demographic characteristics, SES, urbanicity and violent experiences. All participants completed the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS to obtain DSM-IV diagnoses. The data were analyzed using weighted logistic regression with neighborhood stratification after adjusting for neighborhood characteristics, gender, SES and previous traumatic events. Results: The sample included 180 individuals, of whom 61.3% were from low SES and 39.3% had experienced a traumatic event. The weighted prevalence of psychiatric disorders was 21.7%. Having experienced a traumatic event and having low SES were associated with having an internalizing (adjusted OR = 5.46; 2.17-13.74 or externalizing disorder (adjusted OR = 4.33; 1.85-10.15. Conclusions: Investment in reducing SES inequalities and preventing violent events during childhood may improve the mental health of youths from low SES backgrounds.
Carolinie Batista Nobre da Cruz
Full Text Available Shigellosis is a global human health problem and the incidence is highest among children. In the present work, main Shigella virulence genes was examined by PCR and compared to symptoms of pediatric shigellosis. Thirty Shigella isolates were identified from an etiologic study at which 1,339 children ranging 0–10 years old were enrolled. S. flexneri was the most frequent species reaching 60.0% of isolates, 22.2% were S. sonnei, and 6.6% were both S. dysenteriae and S. boydii. All Shigella infected children had diarrhea, but not all were accompanied by others symptoms of bacillary dysentery. Among major virulence genes, the PCR typing revealed ipaBCD was present in all isolates, followed by IpaH7.8, set-1A, set-1B, sen/ospD3, virF, and invE. The pathogenic potential of the ShET-1B subunit was observed in relation to dehydration (P<0.001 and ShET-2 related to the intestinal injury (P=0.033 evidenced by the presence of bloody diarrhea. Our results show associations among symptoms of shigellosis and virulence genes of clinical isolates of Shigella spp.
Vinholes, Daniele B; Melo, Ione M F; Machado, Carlos Alberto; de Castro Chaves, Hilton; Fuchs, Flavio D; Fuchs, Sandra C
Dietary pattern plays a causative role in the rising of noncommunicable diseases. The SESI (Serviço Social da Indústria) study was designed to evaluate risk factors for noncommunicable diseases. We aimed to describe food items consumed by Brazilian workers and to assess their association with socioeconomic status. Cross-sectional study was carried out among Brazilian industrial workers, selected by multistage sampling, from 157 companies. Interviews were conducted at the work place using standardized forms. 4818 workers were interviewed, aged 35.4 ± 10.7 years, 76.5% were men. The workers had an average of 8.7 ± 4.1 years of schooling and 25.4 ± 4.1 kg/m² of BMI. Men and individuals with less than high school education were less likely to consume dairy products, fruits, and vegetables daily, even after control for confounding factors. Men consumed rice and beans daily more often than women. In comparison to workers aged 50-76 years, those under 30 years old consumed less fruits and green leafy vegetables daily. The food items consumed by Brazilian workers show that there are insufficient consumption according to the guidelines of healthy foods, particularly of dairy products, vegetables, and fruits.
Herkrath, Fernando José; Vettore, Mario Vianna; Werneck, Guilherme Loureiro
Inequalities in the utilisation of dental services in Brazil are remarkable. The aim of this study was to evaluate the association of contextual and individual factors with the utilisation of dental services by Brazilian adults using the Andersen's behavioural model. Individual-level data from 27,017 adults residents in the State capitals who were interviewed in the 2013 Brazilian National Health Survey were pooled with contextual city-level data. The outcomes were non-utilisation of dental services and last dental visit over 12 months ago. Individual predisposing variables were age, sex, race/skin colour, schooling and social network. Individual enabling variables included income, health insurance and registration in primary health care. Individual need variables were self-perceived dental health and self-reported missing teeth. Multilevel logistic regression models were performed to estimate odds ratio (OR) and 95% confidence intervals (95% CIs) of the association of contextual and individual predisposing, enabling and need-related variables with dental services outcomes. Predisposing (OR = 0.89; 95% CI 0.81-0.97) and enabling (OR = 0.90; 95% CI 0.85-0.96) contextual factors were associated with non-utilisation of dental services. Individual predisposing (sex, race/skin colour, schooling), enabling (income, health insurance) and need (self-perceived oral health, missing teeth) were associated with non-utilisation of dental services and last dental visit over 12 months ago. The latter was also associated with other individual predisposing (age, social network) and need (eating difficulties due to oral problems) characteristics. Individual and contextual determinants influenced dental services utilisation in Brazilian adults. These factors should be on the policy agenda and considered in the organisation of health services aiming to reduce oral health inequalities related to access and utilisation of dental services.
Full Text Available This cross-sectional study aimed to estimate the prevalence of hyperuricemia and associated risk factors among Japanese-Brazilians. We obtained data on demographic, health history, food intake, and laboratory variables. Chi-square and prevalence ratios were used as measures of association. 35.3% of the subjects presented hyperuricemia, which was more frequent in smokers, males, age > 55 years, with co-morbidities, individuals on uric acid-increasing medication, serum creatinine > 1.4mg/dL, high alcohol consumption, and low consumption of milk and dairy products. In the multivariate analysis, the associations remained significant with gender, overweight, central obesity, hypertriglyceridemia, and use of specific drugs. Among males, low intake of saturated fat was associated with hyperuricemia. Individuals with hypertension showed a negative association with dairy product consumption. The high hyperuricemia prevalence suggests that changes in nutritional profile and control of associated co-morbidities could help minimize occurrence of this condition.
Janaína P. Jaeger
Full Text Available The CB1 cannabinoid receptor and its endogenous ligands, the endocannabinoids, are involved in energy balance control, stimulating appetite and increasing body weight in wasting syndromes. Different studies have investigated the relationship between polymorphisms of the cannabinoid receptor 1 (CNR1 gene and obesity with conflicting results. In the present study, we investigated the 1359G/A (rs1049353, 3813A/G (rs12720071 and 4895A/G (rs806368 polymorphisms in the CNR1 gene in a Brazilian population of European descent. To verify the association between these variants and obesity-related traits in this population, 756 individuals were genotyped by PCR-RFLP methods. The 4895G allele was associated with waist to hip ratio (WHR (P = 0.014; P = 0.042 after Bonferroni correction. An additive effect with the GAA haplotype was associated with WHR (P = 0.028, although this statistical significance disappeared after Bonferroni correction (P = 0.084. No significant association was observed between the genotypes of the 1359G/A and 3813A/G polymorphisms and any of the quantitative variables investigated. Our findings suggest that CNR1 gene polymorphism is associated with central obesity in this Brazilian population of European ancestry.
Garofolo, Luciana, E-mail: email@example.com [Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Ferreira, Sandra Roberta G. [Faculdade de Saúde Pública - Universidade de São Paulo (USP), São Paulo, SP (Brazil); Miranda, Fausto Junior [Departamento de Cirurgia - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil)
Cardiovascular diseases are the major cause of morbidity and mortality in developed and emerging countries. Their main etiology, atherosclerosis, is a disseminated disease that affects the coronary, cerebral and peripheral territories. The peripheral arterial disease (PAD), as well as its consequences, indicates the involvement of the coronary territory. Therefore, its better understanding enables proper treatment, delaying local and long-term complications, reducing the cost to the health system. This study estimates the percentage of PAD in Japanese-Brazilians from Bauru (SP), recognized by the high prevalence of metabolic disorders such as hypertension (43%), diabetes mellitus (33%) and hypercholesterolemia (60%), and examines the association with risk biomarkers. This cross-sectional population study evaluated 1,330 Japanese-Brazilians of both genders aged ≥ 30 who underwent a complete physical examination, anthropometric measurements, laboratory tests and ankle-brachial index (ABI). Participants with ABI ≤ 0.90 were diagnosed as having PAD. After applying the exclusion criteria, 1,038 individuals were part of the analysis. We used Poisson regression to analyze associations with PAD. The mean age was 56.8 years and the percentage of PAD was 21.1%, equal among the genders. PAD was associated with smoking (PR 2.16 [1.33 to 3.48]) and hypertension (PR 1.56 [1.12-2.22]). The percentage of PAD in Japanese-Brazilians was similar to other populations of adverse cardiometabolic profile (US PARTNERS and POPADAD). The independent association of PAD with smoking and hypertension, but not with other classical risk factors, may depend on the very high frequencies of metabolic disorders in this population.
Garofolo, Luciana; Ferreira, Sandra Roberta G.; Miranda, Fausto Junior
Cardiovascular diseases are the major cause of morbidity and mortality in developed and emerging countries. Their main etiology, atherosclerosis, is a disseminated disease that affects the coronary, cerebral and peripheral territories. The peripheral arterial disease (PAD), as well as its consequences, indicates the involvement of the coronary territory. Therefore, its better understanding enables proper treatment, delaying local and long-term complications, reducing the cost to the health system. This study estimates the percentage of PAD in Japanese-Brazilians from Bauru (SP), recognized by the high prevalence of metabolic disorders such as hypertension (43%), diabetes mellitus (33%) and hypercholesterolemia (60%), and examines the association with risk biomarkers. This cross-sectional population study evaluated 1,330 Japanese-Brazilians of both genders aged ≥ 30 who underwent a complete physical examination, anthropometric measurements, laboratory tests and ankle-brachial index (ABI). Participants with ABI ≤ 0.90 were diagnosed as having PAD. After applying the exclusion criteria, 1,038 individuals were part of the analysis. We used Poisson regression to analyze associations with PAD. The mean age was 56.8 years and the percentage of PAD was 21.1%, equal among the genders. PAD was associated with smoking (PR 2.16 [1.33 to 3.48]) and hypertension (PR 1.56 [1.12-2.22]). The percentage of PAD in Japanese-Brazilians was similar to other populations of adverse cardiometabolic profile (US PARTNERS and POPADAD). The independent association of PAD with smoking and hypertension, but not with other classical risk factors, may depend on the very high frequencies of metabolic disorders in this population
Sarmento, Roberta Aguiar; Riboldi, Bárbara Pelicioli; da Costa Rodrigues, Ticiana; de Azevedo, Mirela Jobim; de Almeida, Jussara Carnevale
To investigate the association between dietary components and development of chronic diabetic complications, the dietary evaluation should include a long period, months or years. The present manuscript aims to develop a quantitative food frequency questionnaire (FFQ) and a portfolio with food photos to assess the usual intake pattern of Brazilian patients with type 2 diabetes to be used in future studies. Dietary data using 3-day weighed diet records (WDR) from 188 outpatients with type 2 diabetes were used to construct the list of usually consumed foods. Foods were initially clustered into eight groups: "cereals, tubers, roots, and derivatives"; "vegetables and legumes"; "fruits"; "beans"; "meat and eggs"; "milk and dairy products"; "oils and fats", and "sugars and sweets". The frequency of food intake and the relative contribution of each food item to the total energy and nutrient intakes were calculated. Portion sizes were determined according to the 25th, 50th, 75th, and 95th percentiles of intake for each food item. A total of 62 food items were selected based on the 3-day WDR and another 27 foods or how they are prepared and nine beverages were included after the expert examination. Also, a portfolio with food photos of each included food item and portion sizes was made to assist the patients in identifying the consumed portion. We developed a practical quantitative FFQ and portfolio with photos of 98 food items covering those most commonly consumed in the past 12 months, to assess the usual diet pattern of patients with type 2 diabetes in Southern Brazil.
Coelho, Rafael Corrêa; Reinert, Tomás; Campos, Franz; Peixoto, Fábio Affonso; de Andrade, Carlos Augusto; Castro, Thalita; Herchenhorn, Daniel
The aim of this study was to assess the impact of sunitinib treatment in a non-screened group of patients with metastatic renal cell cancer (mRCC) treated by the Brazilian Unified Health System (SUS) at a single reference institution. Retrospective cohort study, which evaluated patients with mRCC who received sunitinib between May 2010 and December 2013. Fifty-eight patients were eligible. Most patients were male 41 (71%), with a median age of 58 years. Nephrectomy was performed in 41 (71%) patients with a median interval of 16 months between the surgery and initiation of sunitinib. The most prevalent histological subtype was clear cell carcinoma, present in 52 (91.2%) patients. In 50 patients (86%), sunitinib was the first line of systemic treatment. The main adverse effects were fatigue (57%), hypothyroidism (43%), mucositis (33%) and diarrhea (29%). Grade 3 and 4 adverse effects were infrequent: fatigue (12%), hypertension (12%), thrombocytopenia (7%), neutropenia (5%) and hand-foot syndrome (5%). Forty percent of patients achieved a partial response and 35% stable disease, with a disease control rate of 75%. Median progression free survival was 7.6 months and median overall survival was 14.1 months. Sunitinib treatment was active in the majority of patients, especially those with low and intermediate risk by MSKCC score, with manageable toxicity. Survival rates were inferior in this non-screened population with mRCC treated in the SUS. Copyright© by the International Brazilian Journal of Urology.
Full Text Available OBJECTIVE: To evaluate the effectiveness of the Brazilian Cardioprotective Diet Program in reducing blood pressures, fasting glucose levels and body mass indices in patients with established atherothrombotic disease. METHOD: This randomized controlled pilot trial included outpatients who were over 45 years of age with atherothrombotic cardiovascular disease. Group A, who received the Brazilian Cardioprotective Diet Program, had weekly sessions with dietitians. Groups B and C received the usual dietary therapy that is given to patients with cardiovascular diseases as proposed by the Brazilian guidelines. This diet had the same nutrient profile as that given to Group A, but it was customized by the integration of typical Mediterranean foods. The difference between Groups B and C was the number of sessions with the dietitian. Group B received weekly sessions, while group C only had monthly sessions. ClinicalTrials.gov: NCT 01453166. RESULTS: There was a greater reduction in systolic (7.8% and diastolic (10.8% blood pressures in Group A compared with Group B (2.3% and 7.3%, and Group C (3.9% and 4.9%, respectively. Fasting glucose decreased by 5.3% and 2% in Groups A and B, respectively. Fasting glucose increased by 3.7% in Group C. The BMIs decreased by 3.5% and 3.3% in Groups A and B, respectively. Group C did not present with any changes in BMI. However, none of these data showed statistical differences between the groups, which is methodologically acceptable in pilot trials. CONCLUSIONS: The Brazilian Cardioprotective Diet Program seems to be more effective in reducing blood pressures, fasting glucose levels, weights and BMIs in patients with previous cardiovascular disease compared with the diet that has been proposed by the Brazilian guidelines.
Cardoso, F; Veado, C C; de Oliveira, J T
The clinical features of 32 patients (24 males) with Tourette's syndrome in Brazil were studied. The mean age at onset was 7.1 years, tics being the first symptom in 71% and hyperactivity in 29%. Blinking, grimacing, and shoulder elevation were the most common motor tics and sniffing, throat clearing, and grunting noises, the most frequent vocal tics. Coprolalia was present in 28%, echolalia in 16%, palilalia in 9%, and copropraxia in 25% of patients. Attention deficit and hyperactivity disorder was diagnosed in 63%, and obsessive compulsive behaviour in 44% of patients. In 84% of patients there was a family history of tics whereas attention deficit and hyperactivity disorder and obsessive compulsive behaviour were respectively present in relatives of 19% and 53% of the patients studied. These data suggest that Tourette's syndrome in Brazil is not clinically different from other countries, supporting the notion that genetic factors play the most important part in its aetiology. PMID:8708658
Sanches, S B; Osório, F L; Louzada-Junior, P; Moraes, D; Crippa, J A S; Martín-Santos, R
Anxiety disorders may be associated with several non-psychiatric disorders. Current literature has been investigating the association between anxiety and joint hypermobility (JHM), with special interest in non-articular symptoms that may be related to autonomic dysfunction. This study investigated the association between anxiety and JHM in a sample of Brazilian university students. Data were cross-sectionally collected in two Brazilian universities (N=2600). Participants completed three validated self-rating anxiety scales: Beck Anxiety Inventory (BAI), Social Phobia Inventory (SPIN) and the brief-version of SPIN (Mini-SPIN). They also answered the self-rating screening questionnaire for JHM: the Five-part Questionnaire for Identifying Hypermobility. Hypermobile women showed significantly higher scores in all the anxiety scales, when compared with men: BAI total score (t=3.77; panxiety and JHM in women, showing specific gender-related features in this field. It also directs attention to non-articular symptoms that may be enrolled in this association. Copyright © 2014 Elsevier Inc. All rights reserved.
de Oliveira Machado, Evelyn; Lima, Carlos Henrique Azeredo; Ogino, Liana Lumi; Kasuki, Leandro; Gadelha, Mônica R
Acromegaly is associated with significant morbidity and increased mortality, but has a variable severity phenotype. The presence of the exon 3-deleted isoform of the growth hormone receptor (d3-GHR) may influence the disease phenotype and treatment outcomes, including the frequency of biochemical discordance after medical treatment. The objective of this study was to analyze the influence of the d3-GHR isoform on clinical and biochemical characteristics and in the treatment outcomes of Brazilian multiethnic acromegaly patients. We retrospectively analyzed our acromegaly outpatient clinic databank and collected demographic, clinical, biochemical and treatment outcome data from those patients who agreed to participate in the study. A blood sample was collected from all patients, the DNA was extracted and the GHR isoforms were evaluated by PCR, with the full length (fl)-GHR represented by a 935-bp fragment and the d3-GHR represented by a 532-bp fragment. A total of 121 patients were included. Fifty-six patients (46.3 %) were full-length homozygous (fl/fl), 48 (39.7 %) were heterozygous (fl/d3) and 17 (14.0 %) were d3-GHR homozygous (d3/d3). There was no difference between patients homozygous for the fl isoform and those harboring at least one d3-GHR allele in the demographic, clinical and biochemical data or in the treatment outcomes, including somatostatin receptor ligands (SRL) monotherapy, combination therapy with SRL and cabergoline and pegvisomant treatment. There was also no difference between the groups for the frequency of GH and IGF-I discordance after medical treatment. GHR exon 3 genotyping appears to have no clinical significance, at least in Brazilian acromegaly patients.
Costa, Ana Lucia Siqueira; Heitkemper, Margaret M; Alencar, Gizelton Pereira; Damiani, Lucas Petri; Silva, Rodrigo Marques da; Jarrett, Monica E
The well-being of patients undergoing chemotherapy treatment for colorectal cancer (CRC) is affected by psychological effects associated with cancer treatment. However, little is known about the impact of these psychological factors in Brazilian patients with CRC. The aim of this study was to determine whether perceived stress, social support, and resilience are associated with quality of life in urban Brazilian patients receiving chemotherapy treatment for CRC. This was a cross-sectional study conducted with 144 Brazilian CRC patients in an ambulatory oncology clinic. The participants completed 5 questionnaires: Demographics, Perceived Stress Scale 14, Social Support Satisfaction Scale, Resilience Scale, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (C30 and CR29). Confirmatory factor analysis modeling and Cronbach's α were used to examine construct validity and internal consistency. We used the MPlus 3.0 to construct and validate the structural model. There was a moderate and positive effect of resilience on the physical, social, and emotional aspects of quality of life. Social support had a strong and positive direct effect on quality of life (ie, social, physical, social, and emotional). Social support had a negative effect on stress perception. Resilience was also negatively related to stress perception. Family support and professional social support are important factors for Brazilian CRC patients. Resilience is an important ally for patients. It is important for nurses to consider this when developing educational and psychological interventional strategies to reduce stress and ultimately improve quality of life in this population. Psychological factors that improve quality of life should be evaluated in patients undergoing treatment for cancer.
Livia L. Correa
Full Text Available Introduction Published data suggest that patients with acromegaly have an increased prevalence of prostate disorders. Objective To evaluate prostatic disorders in acromegalic patients comparing these results after one year of treatment of acromegaly and with a group of healthy men. Materials and Methods This study was composed of two parts: sectional study comparing patients with healthy controls (baseline and prospective, longitudinal study (at baseline and after one year of treatment. Forty acromegalic patients were enrolled and evaluated at baseline and after one year with the application of international prostatic symptoms score (IPSS, digital rectal examination, measurements of growth hormone (GH, insulin-like growth factor-I (IGF-I, insulin-like growth factor-binding protein-3 (IGFBP-3, sex hormone-binding globulin (SHBG, prolactin, luteinizing hormone (LH, follicle-stimulating hormone (FSH, total testosterone, total and free prostate-specific antigen (PSA levels and prostate ultrasonography (US. Thirty healthy men were selected as control group. Results We stratified patients and controls according to age, considering 40 years-old as cut off. Healthy controls under 40 had IPSS values lower than acromegalic patients. When considering only older patients and controls prostate hyperplasia and structural abnormalities were more frequent in acromegalics. After one year of treatment there was significant decrease in GH, IGF-I and prostate volume in acromegalics over 40 years-old. Conclusions Acromegalics under 40 have more urinary symptoms according to IPSS and above 40 years-old higher frequency of structural changes and increased prostate volume than healthy men. Significant reduction of GH and IGF-I levels during treatment of acromegaly leads to decrease in the prostate volume.
Luciano Grüdtner Buratto
Full Text Available The emotional content of words can affect both true and false memory performance. One hypothesis suggests that the effects of emotion on memory stem from the semantic cohesion of these words. Emotional words are better remembered because they are more inter-related than neutral words (semantic cohesion hypothesis. Although support for this assumption has been found in tasks that measure true memory, less is known about how the structure of lexical knowledge affects emotional false memories. This is partially due to the scarcity of norms that capture the pre-existing knowledge structure of verbal materials commonly used to investigate emotional false memories, such as the Deese/Roediger-McDermott word lists. In this study, we present inter-item association norms for the 44 lists of the Brazilian version of the DRM paradigm. Free-association responses were collected from a sample of 1,042 undergraduates and were used to estimate the level of connectivity among the words present in the DRM lists. Connectivity measures were then used to test the semantic cohesion hypothesis. No significant correlations were found between the emotional measures (valence and arousal and the connectivity measures. The results do not give support to the semantic cohesion hypothesis and suggest that, for the Brazilian version of DRM lists, inter-item association and emotionality can be independently manipulated.
Marcelo Romanovitch Ribas
Full Text Available ABSTRACT Introduction: By associating genetics and sport, it is possible to identify subjects with greater capacity to adapt to training, and lower chances of injury. Objective: The investigation evaluated the genotypic and allelic distribution of ACTN3 R577X and ACE I/D polymorphisms in Brazilian high-performance athletes in wrestling and percussion combat sports. Methods: The study included 37 male athletes ranked from first to third place in world scenarios, divided into two groups: wrestling (23 wrestlers, being 11 of Judo, 4 of Greco-Roman style, 8 of Brazilian Jiu Jitsu, with mean age of 27.3 ± 6.9 years and percussion combat sports (14 athletes with a mean age of 25.7±4.4 years, being 6 of Karate, 3 of Muay Thai, 4 of Taekwondo, 1 Boxing. Genotyping of ACTN3 and ACE I/D polymorphisms was performed by polymerase chain reaction (PCR from the genomic DNA. Genotypic and allelic distributions were compared with control populations and athletes by Chi-square test and Fisher’s exact test; all analyzes considered p ≤ 0.05. Results: The genotypic distributions and allelic frequencies of ACTN3 RR=46%, RX=38% and XX=16%; R=65% and X=35%, and ACE I/D DD=47.7%, ID=34.3% and II=20%; D=62.9% and I=37.1% did not differ from the control population; however, when compared with wrestling athletes a significant difference was observed. Conclusion: These results suggest an association of ACTN3 R577X and ACE I/D genes with Brazilian high-performance wrestling athletes.
Trindade, Aline Heloísa; Meira, Henrique Côrtes; Pereira, Igor Figueiredo; de Lacerda, Julio César Tanos; de Mesquita, Ricardo Alves; Santos, Vagner Rodrigues
Paracoccidioidomycosis (PCM) is a rare fungal infection in the world, but endemic and acquired exclusively in Latin America, with the highest prevalence in South America and Brazil, particularly. Changes in oral cavity are common and constitute the first clinical manifestation in many patients. The aim of this study was to describe the prevalence of oral PCM and analyse the profile of the disease and patients. Retrospective research, consisting of information present in the medical records in the period 1998-2015, whose histopathological diagnosis was oral PCM. Fifty-five oral PCM cases were confirmed. Of these patients, 90.9% were males and 9.1% were females. The average age was 49.66 years and the most reported occupation was rural workers. The painful symptomatology was present in 61.82% of patients. Erythematous lesions were predominant in 73% of them. In single lesions (22 cases), the most common locations were jugal mucosa and tongue. In multiple involvement (30 cases), the most affected regions were lips, jugal mucosa and alveolar ridge. Epidemiology of PCM, was similar to several other studies, especially in Brazil. This is the most important fungal infection in Latin America and the recognition of oral lesions is extremely important, as is often the first and in many cases the only manifestation of the disease. © 2017 Blackwell Verlag GmbH.
Gisele Ferreira Paris
Full Text Available Abstract OBJECTIVE To verify the association between complicated grief and sociodemographic, reproductive, mental, marital satisfaction, and professional support characteristics in women after stillbirth. METHOD Cross-sectional study with 26 women who had stillbirth in 2013, living in the city of Maringá, Brazil, and eight women who attended the Centre d'Études et de Rechercheen Intervention Familiale at the University of Quebec en Outaouais, in Canada. The instrument was administered as an interview to a small number of mothers of infants up to three months (n=50, who did not participate in the validation study. RESULTS By applying the short version of the Perinatal Grief Scale, the prevalence of complicated grief in Brazilian women was found to be higher (35% in relation to Canadian women (12%.Characteristics of the Brazilian women associated with the grief period included the presence of previous pregnancy with live birth, absence of previous perinatal loss, postpartum depression, and lack of marital satisfaction. For the Canadians it was observed that 80% of the women presenting no grief made use of the professional support group. In both populations the occurrence of complicated grief presented a higher prevalence in women with duration of pregnancy higher than 28 weeks. CONCLUSION The women that must be further investigated during the grief period are those living in Brazil, making no use of a professional support group, presenting little to no marital satisfaction, having no religion, and of a low educational level.
Siegel, Pamela; da Motta, Pedro Mourão Roxo; da Silva, Luis G; Stephan, Celso; Lima, Carmen Silvia Passos; de Barros, Nelson Filice
The purpose of this pilot study was to explore whether individualized Reiki given to cancer patients at a Brazilian hospital improved symptoms and well-being. Data from 36 patients who received 5 Reiki sessions were collected using the MYMOP and were compared before and after their treatment and also with 14 patients who did not receive Reiki and who acted as a comparison group. Twenty-one patients reported feeling better, 12 felt worse, and 3 reported no change. Of the comparison group, 6 patients reported feeling better and 8 felt worse. The Reiki practice delivered as part of the integrative care in oncology did produce clinically significant effects, although not statistically significant results, for more than half of the patients undergoing cancer treatment.
Zangiacomi Martinez, Edson; Dos Santos Almeida, Rodrigo Guimarães; Garcia Braz, Ana Carolina; Duarte de Carvalho, Antonio Carlos
The aim of this study was to examine the association between religiousness and blood donation among postgraduate students. The Portuguese-language version of the Duke University Religion Index was administered to a sample of 226 Brazilian students with ages ranging from 22 to 55 years. All study participants had completed undergraduate courses in health-related areas. In the present study, 23.5% of the students were regular donors. Organizational religiousness was found to be associated with attitudes related to blood donation. This study also shows evidence that regular blood donors have a higher intrinsic religiousness than subjects who donate only once and do not return. This study shows that the attitudes concerning blood donation may have some association with religiosity. Copyright © 2014 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. Published by Elsevier Editora Ltda. All rights reserved.
Edson Zangiacomi Martinez
Full Text Available OBJECTIVE: The aim of this study was to examine the association between religiousness and blood donation among postgraduate students.METHODS: The Portuguese-language version of the Duke University Religion Index was administered to a sample of 226 Brazilian students with ages ranging from 22 to 55 years. All study participants had completed undergraduate courses in health-related areas.RESULTS: In the present study, 23.5% of the students were regular donors. Organizational religiousness was found to be associated with attitudes related to blood donation. This study also shows evidence that regular blood donors have a higher intrinsic religiousness than subjects who donate only once and do not return.CONCLUSION: This study shows that the attitudes concerning blood donation may have some association with religiosity.
Marcelo T O Carlucci
Full Text Available BACKGROUND: Little information on the factors influencing intraoperative cardiac arrest and its outcomes in trauma patients is available. This survey evaluated the associated factors and outcomes of intraoperative cardiac arrest in trauma patients in a Brazilian teaching hospital between 1996 and 2009. METHODS: Cardiac arrest during anesthesia in trauma patients was identified from an anesthesia database. The data collected included patient demographics, ASA physical status classification, anesthesia provider information, type of surgery, surgical areas and outcome. All intraoperative cardiac arrests and deaths in trauma patients were reviewed and grouped by associated factors and also analyzed as totally anesthesia-related, partially anesthesia-related, totally surgery-related or totally trauma patient condition-related. FINDINGS: Fifty-one cardiac arrests and 42 deaths occurred during anesthesia in trauma patients. They were associated with male patients (P<0.001 and young adults (18-35 years (P=0.04 with ASA physical status IV or V (P<0.001 undergoing gastroenterological or multiclinical surgeries (P<0.001. Motor vehicle crashes and violence were the main causes of trauma (P<0.001. Uncontrolled hemorrhage or head injury were the most significant associated factors of intraoperative cardiac arrest and mortality (P<0.001. All cardiac arrests and deaths reported were totally related to trauma patient condition. CONCLUSIONS: Intraoperative cardiac arrest and mortality incidence was highest in male trauma patients at a younger age with poor clinical condition, mainly related to uncontrolled hemorrhage and head injury, resulted from motor vehicle accidents and violence.
Pilonetto, Daniela V; Pereira, Noemi F; Bonfim, Carmem M S; Ribeiro, Lisandro L; Bitencourt, Marco A; Kerkhoven, Lianne; Floor, Karijn; Ameziane, Najim; Joenje, Hans; Gille, Johan J P; Pasquini, Ricardo
Fanconi anemia (FA) is a predominantly autosomal recessive disease with wide genetic heterogeneity resulting from mutations in several DNA repair pathway genes. To date, 21 genetic subtypes have been identified. We aimed to identify the FA genetic subtypes in the Brazilian population and to develop a strategy for molecular diagnosis applicable to routine clinical use. We screened 255 patients from Hospital de Clínicas, Universidade Federal do Paraná for 11 common FA gene mutations. Further analysis by multiplex ligation-dependent probe amplification (MLPA) for FANCA and Sanger sequencing of all coding exons of FANCA , -C , and - G was performed in cases who harbored a single gene mutation. We identified biallelic mutations in 128/255 patients (50.2%): 89, 11, and 28 carried FANCA , FANCC , and FANCG mutations, respectively. Of these, 71 harbored homozygous mutations, whereas 57 had compound heterozygous mutations. In 4/57 heterozygous patients, both mutations were identified by the initial screening, in 51/57 additional analyses was required for classification, and in 2/57 the second mutation remained unidentified. We found 52 different mutations of which 22 were novel. The proposed method allowed genetic subtyping of 126/255 (49.4%) patients at a significantly reduced time and cost, which makes molecular diagnosis of FA Brazilian patients feasible.
Full Text Available Type 1 diabetes, as an autoimmune disease, presents several islet cell-specific autoantibodies such as islet cell antibody (ICA, anti-insulin, anti-glutamic acid decarboxylase (GAD and the antibody (Ab against tyrosine phosphatase (PTP-like protein known as ICA-512 (IA-2. In order to determine the frequency of the anti-GAD and anti-IA-2 autoantibodies in Brazilian type 1 diabetes patients we studied 35 diabetes mellitus (DM type 1 patients with recent-onset disease (£12 months and 37 type 1 diabetes patients with long-duration diabetes (>12 months who were compared to 12 children with normal fasting glucose. Anti-GAD65 and anti-IA-2 autoantibodies were detected with commercial immunoprecipitation assays. The frequency of positive results in recent-onset DM type 1 patients was 80.0% for GADAb, 62.9% for IA-2Ab and 82.9% for GADAb and/or IA-2Ab. The long-duration type 1 diabetes subjects presented frequencies of 54.1% for GADAb and IA-2Ab, and 67.5% for GAD and/or IA-2 antibodies. The control group showed no positive cases. Anti-GAD and IA-2 assays showed a high frequency of positivity in these Brazilian type 1 diabetes patients, who presented the same prevalence as a Caucasian population.
Vanessa Fernanda Goes
Full Text Available Alzheimer’s disease (AD is characterized by disorders that can impair the nutrition of the patient and lead to weight loss and nutritional deficits during the course of the disease. The aim of this study was to assess the nutritional status and food intake of Brazilian patients with Alzheimer’s disease at 3 different stages of the disease. The sample consisted of 30 subjects of both genders, mean age 77 years, with probable AD. Subjects were assessed by collecting anthropometric data, the Mini Nutritional Assessment (MNA, serum albumin content, Mini Mental State Examination and 24-hour records of food and drink. Although a steady decrease in average weight was observed as the disease progressed (CDR1: 70.8±15.9 kg; CDR2: 61.4±15.7 kg; CDR3: 56.1± 8.4 kg, the differences were not significant. MNA and serum albumin both fell during the progression of the disease (p = 0.042; p = 0.047, respectively and, at the severe stage, half the patients were found to be undernourished and the other half at risk of undernutrition. According to their body mass index, 23.3% of patients were overweight. The nutritional value of the food consumed was similar across the stages of AD. In conclusion, the majority of Brazilian patients with AD in this study exhibited cognitive decline and malnutrition. However, food intake was similar among the stages of the disease, thus having no direct association with the progression of AD.
Melo, B; Rezende, L; Machado, P; Gouveia, N; Levy, R
Although both consumption of ultra-processed products and asthma are common during adolescence, the epidemiological evidence in regarding their association is unclear. We investigated the associations of ultra-processed products consumption with asthma and wheezing in a representative sample of Brazilian adolescents. We used data from a representative sample of 109,104 Brazilian adolescents enrolled in the National Survey of School Health, 2012. The consumption of ultra-processed products was based on the weekly consumption (0-2, 3-4, ≥5 days/week) of sweet biscuits, salty biscuits, ultra-processed meats, sweets/candies, soft drinks, and packaged snacks over the previous seven days. We also calculated an ultra-processed consumption score by adding partial scores corresponding to weekly frequency intake of each ultra-processed product. The ultra-processed consumption score ranged from 0 to 42, the higher score, the higher the intake of these products. Presence of wheezing in the previous 12 months and asthma at any time in the past were self-reported. The adjusted odds ratios of asthma comparing the extreme categories ranged from 1.08 (95% CI 1.03-1.13) for sweets/candies to 1.30 (1.21-1.40) for ultra-processed meats. Similar magnitude of associations was found for wheezing outcome. The ultra-processed consumption score was positively associated with presence of asthma and wheezing in a dose-response manner. The adjusted OR of asthma and wheezing comparing highest to lowest quintile of ultra-processed consumption score were 1.27 (95% CI 1.15-1.41) and 1.42 (1.35-1.50), respectively. The consumption of ultra-processed products was positively associated with the presence of asthma and wheezing in adolescents. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Priscila Lucelia Moreira
Full Text Available Objective: dietary pattern evaluation is often used in order to determine wheter a diet is healthy, as well as to predict the onset of diseases. This study aimed to identify dietary patterns, and to examine their associations with general (body mass index and central (waist circumference and waist-to-hip ratio obesity in community-living elderly in a Brazilian city. Methods: this cross-sectional study included 126 elderly subjects aged 60 or older (57.1% females and mean age 74.2 ± 6.46 years. Anthropometric variables, weight, height, waist (WC and hip (HC circumferences, were measured. Body mass index (BMI and waist-to-hip ratio (WHR were calculated. Answers to a Food Frequency Questionnaire were interpreted by Principal Component Analysis in order to identify dietary patterns. Results: five dietary patterns were identified and named as prudent (fruit, vegetables and meat, sweets and fats (pastries, sugary foods, fatty foods, whole milk, typical Brazilian (fried eggs, cooked beans, beef, candy, string beans, fried cassava, Mediterranean (fruit, vegetables, olive oil and nuts and traditional meal (rice and beans. Moderate and high adherences to the Mediterranean pattern were protective factors to general and central obesity (WHR. High adherence to prudent was also protective to central obesity (WC. Conclusion: adherences to the dietary patterns prudent and Mediterranean were protective factors to general and central obesity in elderly.
Moura, Luciana Ramos de; Torres, Lilian Machado; Cadete, Matilde Meire Miranda; Cunha, Cristiane de Freitas
Identifying knowledge about factors associated with health risk behaviors among Brazilian adolescents. An integrative review of the literature conducted in the Cochrane, IBECS, LILACS, MEDLINE and SciELO databases in relation to risk behaviors recommended by the Centers for Disease Control and Prevention. Thirty-seven (37) studies were analyzed, with a predominance of risky sexual behavior, tobacco use and violent behavior. Advancing age favored unprotected sex, alcohol and tobacco use. Family and friends influence was related to smoking and alcoholism. Males were more involved in situations of violence and the female gender was associated with physical inactivity. Belonging to a lower economic class was related to unprotected sex, physical inactivity, unhealthy dietary behaviors and violence. Studying in private school was related to unhealthy dietary behavior. Risk behaviors were related to social, economic and family factors and they tend to agglomerate.
Priscilla de Laet Sant'Ana
Full Text Available Oropharyngeal candidiasis continues to be considered the most common opportunistic disease in Aids patients. This study was designed to investigate species distribution, serotype and antifungal susceptibility profile among Candida spp. isolated from the oral cavity of Aids patients recruited from six Brazilian university centers. Oral swabs from 130 Aids patients were plated onto CHROMagar Candida medium and 142 isolates were recovered. Yeast isolates were identified by classical methods and serotyped using the Candida Check® system-Iatron. Antifungal susceptibility testing was performed according to the NCCLS microbroth assay. C. albicans was the most frequently isolated species (91%, and 70% of the isolates belonged to serotype A. We detected 12 episodes of co-infection (9%, including co-infection with both serotypes of C. albicans. Non-albicans species were isolated from 12 episodes, 50% of them exhibited DDS or resistance to azoles. Otherwise, only 8 out 130 isolates of C. albicans exhibited DDS or resistance to azoles. Brazilian Aids patients are infected mainly by C. albicans serotype A, most of them susceptible to all antifungal drugs.
Full Text Available ABSTRACT Background International studies have demonstrated an increase in the prevalence of boys and a decrease of patients’ age at the beginning of outpatient treatment for eating disorders (ED. Objective To evaluate if these changes are also present in the Brazilian population participating in the PROTAD, a Brazilian ED program, and to discuss its clinical implication for treatment. Methods Cross-sectional study. We evaluated 150 medical records of patients under 18 years diagnosed with ED (DSM IV-TR. Patients were divided into two groups: G1 (2001-2007 (n = 77 and G2 (2008-2014 (n = 73. The girl/boy proportion and the mean age of patients were compared. Results In G1, six boys (7.8% were admitted (girl/boy proportion: 11.8:1, while in G2, 16 (22% boys were admitted (girl/boy proportion: 3.5:1 (p 0.05. Discussion The increase in the number of boys treated for EDs reported in international studies was also found at the PROTAD. Contrary to what has been reported in international studies, the mean age of patients at the PROTAD did not decrease significantly. Gender and sexual orientation issues, clinical presentation, prior overweight history and culture/media impact on boys should be addressed by the healthcare team to increase the therapeutic efficacy.
Ada Ávila Assunção
Full Text Available ABSTRACT OBJECTIVE To describe the prevalence of work-related musculoskeletal disorder (WMSD and analyze the factors associated with this outcome in the Brazilian population. METHODS In this cross-sectional, population-based study, we use data from the National Survey on Health (PNS of 2013. The sample was composed of 60,202 Brazilians aged 18 years or older. The outcome variable was the occurrence of self-reported WMSD. Sociodemographic and occupational characteristics, personal resources, and health conditions were investigated as explanatory variables. Analyses were performed with the software Stata 12.0 and considered the weighting imposed by the sampling design of the study. Then, univariate and multivariate binary logistic models were carried out, considering a significance level of 5%. RESULTS The results obtained indicated that the prevalence of WMSD in the Brazilian population was of 2.5%, ranging from 0.2% (Acre to 4.2% (Santa Catarina. The factors associated with a greater chance of occurrence of WMSD were: female sex (OR = 2.33; 95%CI 1.72–3.15; be temporarily away from work (OR = 2.44; 95%CI 1.41–4.23; be exposed to noise at the workplace (OR = 2.16; 95%CI 1.68–2.77; seniority equal to or greater than 4.5 years at the current job (OR = 1.37; 95%CI 1.09–1.72; participate in volunteer work (OR = 1.65; 95%CI 1.25–2.17; report medical diagnosis of arthritis or rheumatism (OR = 2.40; 95%CI 1.68–3.44; and depression (OR = 2.48; 95%CI 1.86–3.31. On the other hand, factors associated with less chance of WMSD were: not having a partner (OR = 0.73; 95%CI 0.37–0.71 and working in an open environment (OR = 0.51; 95%CI 0.37–0.71. CONCLUSIONS The associated factors and the prevalence found indicate regional and gender differences. Special attention to comorbidities and environmental noise monitoring would benefit the health of workers in the Country.
Carla Thais Rosada PERUCHI
Full Text Available Abstract The aim of this study was to investigate the association between oral health status and central obesity (CO in Brazilian independent-living elderly. A cross-sectional study was carried out in a sample of 489 elderly, who were participants of the Study on Aging and Longevity, in Londrina, state of Parana. The number of natural teeth and use of prostheses were evaluated according to the World Health Organization criteria. The presence of CO was assessed using measures of waist circumference (WC and waist-hip ratio (WHR. Information concerning sociodemographic profile and some systemic conditions was also collected. Data were analyzed using stepwise logistic regression, α=5%. According to WC and WHR measures, the prevalence of central obesity was 79.3% and 76.1%, respectively. CO according to WC was not associated with oral status. Considering the WHR measure, the following oral conditions were associated to CO: having fewer natural teeth (OR = 2.61; 95%CI = 1.17–5.80, being edentulous and wearing both upper and lower complete dentures (OR = 2.34; 95%CI = 1.11–4.93, and being edentulous wearing only the upper complete denture (OR = 2.64; 95%CI = 1.01–6.95. Traditional risk factors for CO such as gender, dyslipidemia, hypertension and diabetes were associated with both measures. A poor oral health due to extensive tooth loss, whether partial or complete, even if rehabilitated by removable prostheses, may be considered a good predictor of CO in Brazilian independent-living elderly.
Filogônio Cintia B
Full Text Available Abstract Background In the period of adolescence physical appearance takes on significant importance in the construction of personal identity, including one's relationship with one's own body. A variety of social, cultural, psychological and personal factors influences the self-perception of dental appearance and the decision to undergo orthodontic treatment. Adolescents who seek orthodontic treatment are concerned with improving their appearance and social acceptance. The aim of the present study was to determine factors associated to the desire for orthodontic treatment among Brazilian adolescents and their parents. Methods The sample consisted of 403 subjects aged 14 to 18 years, selected randomly from a population of 182,291 schoolchildren in the same age group. The outcome variable "desire for orthodontic treatment" was assessed through a questionnaire. Self-perception of dental aesthetics was assessed using the Oral Aesthetic Subjective Impact Scale (OASIS and the Dental Aesthetic Index (DAI was used for clinical assessment. Statistical analysis involved the chi-square test as well as both simple and multiple logistic regression analyses. Results The majority (78% of the Brazilian adolescents desired orthodontic treatment and 69% of the parents reported that their children were not in orthodontic treatment due to the high costs involved. There was significant association (p ≤ 0.05 between the desire for orthodontic treatment and most types of malocclusion. However, there was no significant association between the desire for orthodontic treatment and the variables gender and age. Conclusions The following were considered factors associated to the desire for treatment: upper anterior crowding ≥ 2 mm and parents' perception of their child's need for treatment.
Background In the period of adolescence physical appearance takes on significant importance in the construction of personal identity, including one's relationship with one's own body. A variety of social, cultural, psychological and personal factors influences the self-perception of dental appearance and the decision to undergo orthodontic treatment. Adolescents who seek orthodontic treatment are concerned with improving their appearance and social acceptance. The aim of the present study was to determine factors associated to the desire for orthodontic treatment among Brazilian adolescents and their parents. Methods The sample consisted of 403 subjects aged 14 to 18 years, selected randomly from a population of 182,291 schoolchildren in the same age group. The outcome variable "desire for orthodontic treatment" was assessed through a questionnaire. Self-perception of dental aesthetics was assessed using the Oral Aesthetic Subjective Impact Scale (OASIS) and the Dental Aesthetic Index (DAI) was used for clinical assessment. Statistical analysis involved the chi-square test as well as both simple and multiple logistic regression analyses. Results The majority (78%) of the Brazilian adolescents desired orthodontic treatment and 69% of the parents reported that their children were not in orthodontic treatment due to the high costs involved. There was significant association (p ≤ 0.05) between the desire for orthodontic treatment and most types of malocclusion. However, there was no significant association between the desire for orthodontic treatment and the variables gender and age. Conclusions The following were considered factors associated to the desire for treatment: upper anterior crowding ≥ 2 mm and parents' perception of their child's need for treatment. PMID:20021649
Zander Neves, Camila; Devicari Bueno, Claudine; Pires Felden, Giovana; Costa Irigaray, Mariane; Rivadeneira, María Fernanda; Oenning, Nágila Soares Xavier; Goulart, Bárbara N G
To study the association between aspects of mental health and the family context with tobacco experimentation and consumption among Brazilian schoolchildren. A cross-sectional study using data from the National Survey of Schoolchildren's Health in Brazil conducted on 109,104 schoolchildren from the ninth year of elementary school, day scholars in public and private schools in all Brazilian state capitals and the Federal District. Descriptive analysis of variables, bivariate and multivariate analyses were performed with logistic regression estimates, adjusted for socioeconomic variables, obtaining the odds ratio (OR) and 95% confidence interval (95%CI). Among the participants, 52.2% were female. Twenty point nine percent of the students reported having experimented with cigarettes at least once. Adolescents who experienced more often feelings of loneliness (OR: 2.07; 95%CI: 1.98-2.16), difficulty sleeping (OR: 2.37; 95%CI: 2.52-2.48) and lower social interaction (OR: 1.27; 95%CI: 1.26-1.32), were more likely to smoke, regardless of socioeconomic status. The schoolchildren of parents or caregivers (OR: 2.39; 95%CI: 2.29-2.49) who did not know what their children did in their free time (OR: 1.52; 95%CI: 1.46-1.59) were associated with more frequent cigarette smoking. An association was seen between aspects of mental health and the family context with the experimentation and consumption of tobacco in adolescents enrolled in the study in Brazil. These associations are independent of school type, sex and skin colour. It is important that programmes for the prevention of tobacco use in adolescence emphasise these findings. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.
de Almeida Santana, Carla Caroliny; Farah, Breno Quintella; de Azevedo, Liane Beretta; Hill, James O; Gunnarsdottir, Thrudur; Botero, João Paulo; do Prado, Edna Cristina; do Prado, Wagner Luiz
Obesity has been associated with poor academic achievement, while cardiorespiratory fitness (CRF) has been linked to academic success. To investigate whether CRF is associated with academic performance in Brazilian students, independently of body mass index (BMI), fatness and socioeconomic status (SES). 392 5th and 6th grade students (193 girls) (12.11 ± 0.75 years old) were evaluated in 2012. Skinfold thickness measures were performed, and students were classified according to BMI-percentile. CRF was estimated by a 20-meter shuttle run test, and academic achievement by standardized math and Portuguese tests. Multiple linear regression analyses were conducted to explore the association between academic performance and CRF, adjusted for SES, skinfold thickness or BMI-percentile. Among girls CRF was associated with higher academic achievement in math (β = 0.146;p = .003) and Portuguese (β = 0.129;p = .004) in crude and adjusted analyses. No significant association was found among boys. BMI was not associated with overall academic performance. There was a weak negative association between skinfold thickness and performance in mathematics in boys (β =- 0.030;p = .04), but not in girls. The results highlight the importance of maintaining high fitness levels in girls throughout adolescence a period commonly associated with reductions in physical activity levels and CRF.
Alexsandra Rodrigues de Mendonça Favacho
Full Text Available Brazilian spotted fever (BSF is the most important and frequent rickettsial disease in Brazil. A fatal case of BSF is reported in a 32-year-old black man, who died of irreversible shock after five days of fever, severe headache and abdominal pain with no rash. Spleen, kidney and heart samples collected at autopsy were positive for Rickettsia rickettsii by PCR and sequencing. The authors emphasize the need for a high index of diagnostic suspicion for spotted fever in black patients. Absence of a skin rash should not dissuade clinicians from considering the possibility of BSF and initiating empirical therapy.
Full Text Available AIM: To determine the main visual symptoms in a Brazilian population sample, associated to refractive errors (REs and spectacle need to suggest priorities in preventive programs. METHODS: A cross-sectional study was conducted in nine counties of the southeast region of Brazil, using a systematic sampling of households, between March 2004 and July 2005. The population was defined as individuals aged between 1 and 96y, inhabitants of 3600 residences to be evaluated and 3012 households were included, corresponding to 8010 subjects considered for participation in the survey, of whom 7654 underwent ophthalmic examinations. The individuals were evaluated according their demographic data, eye complaints and eye examination including the RE and the need to prescribe spectacles according to age. Statistical analysis was performed using SPSS software package and descriptive analysis using 95% confidence intervals (P<0.05. RESULTS: The main symptom detected was asthenopia, most frequent in the 2nd and 3rd decades of life, with a significant decline after the 4th decade. Astigmatism was the RE most associated with asthenopia. Reduced near vision sight was more frequent in those ≥40y with a progressive decline thereafter. Spectacles were most frequently required in subjects of ≥40 years of age. CONCLUSION: The main symptom related to the vision was asthenopia and was associated to astigmatism. The greatest need for spectacles prescription occurred after 40’s, mainly to correct near vision. Subjects of ≥40 years old were determined to be at high risk of uncorrected REs. These observations can guide intervention programs for the Brazilian population.
Paulo Roberto Lima Carreiro
Full Text Available OBJECTIVE: Show the steps of a Trauma Registry (TR implementation in a Brazilian public hospital and evaluate the initial data from the database.METHODS: Descriptive study of the a TR implementation in João XXIII Hospital (Hospital Foundation of the state of Minas Gerais and analysis of the initial results of the first 1,000 patients.RESULTS: The project was initiated in 2011 and from January 2013 we began collecting data for the TR. In January 2014 the registration of the first 1000 patients was completed. The greatest difficulties in the TR implementation were obtaining funds to finance the project and the lack of information within the medical records. The variables with the lowest completion percentage on the physiological conditions were: pulse, blood pressure, respiratory rate and Glasgow coma scale. Consequently, the Revised Trauma Score (RTS could be calculated in only 31% of cases and the TRISS methodology applied to 30.3% of patients. The main epidemiological characteristics showed a predominance of young male victims (84.7% and the importance of aggression as a cause of injuries in our environment (47.5%, surpassing traffic accidents. The average length of stay was 6 days, and mortality 13.7%.CONCLUSION: Trauma registries are invaluable tools in improving the care of trauma victims. It is necessary to improve the quality of data recorded in medical records. The involvement of public authorities is critical for the successful implementation and maintenance of trauma registries in Brazilian hospitals.
Carreiro, Paulo Roberto Lima; Drumond, Domingos André Fernandes; Starling, Sizenando Vieira; Moritz, Mônica; Ladeira, Roberto Marini
Show the steps of a Trauma Registry (TR) implementation in a Brazilian public hospital and evaluate the initial data from the database. Descriptive study of the a TR implementation in João XXIII Hospital (Hospital Foundation of the state of Minas Gerais) and analysis of the initial results of the first 1,000 patients. The project was initiated in 2011 and from January 2013 we began collecting data for the TR. In January 2014 the registration of the first 1000 patients was completed. The greatest difficulties in the TR implementation were obtaining funds to finance the project and the lack of information within the medical records. The variables with the lowest completion percentage on the physiological conditions were: pulse, blood pressure, respiratory rate and Glasgow coma scale. Consequently, the Revised Trauma Score (RTS) could be calculated in only 31% of cases and the TRISS methodology applied to 30.3% of patients. The main epidemiological characteristics showed a predominance of young male victims (84.7%) and the importance of aggression as a cause of injuries in our environment (47.5%), surpassing traffic accidents. The average length of stay was 6 days, and mortality 13.7%. Trauma registries are invaluable tools in improving the care of trauma victims. It is necessary to improve the quality of data recorded in medical records. The involvement of public authorities is critical for the successful implementation and maintenance of trauma registries in Brazilian hospitals.
Full Text Available The hypothesis of the role of iron overload associated with HFE gene mutations in the pathogenesis of nonalcoholic steatohepatitis (NASH has been raised in recent years. In the present study, biochemical and histopathological evidence of iron overload and HFE mutations was investigated in NASH patients. Thirty-two NASH patients, 19 females (59%, average 49.2 years, 72% Caucasians, 12% Mulattoes and 12% Asians, were submitted to serum aminotransferase and iron profile determinations. Liver biopsies were analyzed for necroinflammatory activity, architectural damage and iron deposition. In 31 of the patients, C282Y and H63D mutations were tested by PCR-RFLP. Alanine aminotransferase levels were increased in 30 patients, 2.42 ± 1.12 times the upper normal limit on average. Serum iron concentration, transferrin saturation and ferritin averages were 99.4 ± 31.3 g/dl, 33.1 ± 12.7% and 219.8 ± 163.8 µg/dl, respectively, corresponding to normal values in 93.5, 68.7 and 78.1% of the patients. Hepatic siderosis was observed in three patients and was not associated with architectural damage (P = 0.53 or with necroinflammatory activity (P = 0.27. The allelic frequencies (N = 31 found were 1.6 and 14.1% for C282Y and H63D, respectively, which were compatible with those described for the local population. In conclusion, no evidence of an association of hepatic iron overload and HFE mutations with NASH was found. Brazilian NASH patients comprise a heterogeneous group with many associated conditions such as hyperinsulinism, environmental hepatotoxin exposure and drugs, but not hepatic iron overload, and their disease susceptibility could be related to genetic and environmental features other than HFE mutations.
Moraes, Augusto César Ferreira de; Falcão, Mário Cícero
Lifestyle variables have a key role in the development of abdominal obesity (AO). The objective of this study was to identify lifestyle factors and socioeconomic variables associated with AO in adolescents. This study carried out a school-based survey in the Brazilian city of Maringá in Paraná. The representative sample was of 991 adolescents (54.5% girls) from both public and private high schools selected through multi-stage random sampling. AO was classified according to waist circumference value. The independent variables studied were: gender, age, socioeconomic level, parental and household characteristics, smoking, alcohol use, physical inactivity, sedentary behaviour and nutrition-related habits. Poisson regression was used with robust variance adjustment to analyse the associations. The analysis was stratified by sexes. The prevalence of AO was 32.7% (girls = 36.3%, boys = 28.4%). In girls, excessive intake of fried foods was inversely associated with AO and excessive consumption of soda was positively associated. In boys, the results demonstrated a negative association with excessive consumption of sweets and soda. It is concluded that the prevalence of AO among adolescents was higher in both sexes. AO is associated with different eating habits in females and males and these relationships are mediated by familial contexts.
Full Text Available Fanconi anemia is a rare hereditary disease showing genetic heterogeneity due to a variety of mutations in genes involved in DNA repair pathways, which may lead to different clinical manifestations. Phenotypic variability makes diagnosis difficult based only on clinical manifestations, therefore laboratory tests are necessary. New advances in molecular pathogenesis of this disease led researchers to develop a diagnostic test based on Western blot for FANCD2. The objective of the present study was to determine the efficacy of this method for the diagnosis of 84 Brazilian patients with Fanconi anemia, all of whom tested positive for the diepoxybutane test, and 98 healthy controls. The FANCD2 monoubiquitinated isoform (FANCDS+/FANCD2L- was not detected in 77 patients (91.7%. In 2 patients (2.4%, there was an absence of both the monoubiquitinated and the non-ubiquitinated proteins (FANCD2S-/FANCD2L- and 5 patients (5.9% had both isoforms (FANCD2S+/FANCD2L+. This last phenotype suggests downstream subtypes or mosaicism. All controls were diepoxybutane negative and were also negative on the FANCD2 Western blot. The Western blot for FANCD2 presented a sensitivity of 94% (79/84 and specificity of 100% (98/98. This method was confirmed as an efficient approach to screen Brazilian patients with deleterious mutations on FANCD2 (FANCD2S-/FANCD2L- or other upstream genes of the FA/BRCA pathway (FANCDS+/FANCD2L-, to confirm the chromosome breakage test and to classify patients according to the level of FA/BRCA pathway defects. However, patients showing both FANCD2 isoforms (FANCD2S+/FANCD2L+ require additional studies to confirm mutations on downstream Fanconi anemia genes or the presence of mosaicism.
Medeiros, Priscila; da Silva, Weber Laurentino; de Oliveira Gimenez, Bruna Beatriz; Vallezi, Keren Bastos; Moraes, Milton Ozório; de Souza, Vânia Niéto Brito; Latini, Ana Carla Pereira
Leprosy outcome is a complex trait and the host-pathogen-environment interaction defines the emergence of the disease. Host genetic risk factors have been successfully associated to leprosy. The 10p13 chromosomal region was linked to leprosy in familial studies and GATA3 gene is a strong candidate to be part of this association. Here, we tested tag single nucleotide polymorphisms at GATA3 in two case-control samples from Brazil comprising a total of 1633 individuals using stepwise strategy. The A allele of rs10905284 marker was associated with leprosy resistance. Then, a functional analysis was conducted and showed that individuals carrying AA genotype express higher levels of GATA-3 protein in lymphocytes. So, we confirmed that the rs10905284 is a locus associated to leprosy and influences the levels of this transcription factor in the Brazilian population. Copyright © 2016 Elsevier B.V. All rights reserved.
Silva Vilma A da
Full Text Available OBJECTIVES: To investigate developmental and environmental factors associated to substance misuse in adolescents seen at a university day-hospital in Brazil and to verify the correlations between those factors and adherence to treatment. To compare factors associated to substance misuse in adolescents with the available scientific literature and to suggest specific preventive interventions for a national policy in Brazil. METHODS: Eighty-six adolescent's guardians were evaluated at admission to the service by using a semistructured interview including sociodemographic data, family relationship, perinatal and pregnancy histories, psychomotor and educational development, social relations, history of previous illnesses and family diseases, including drug abuse. RESULTS: The sample was predominantly male (90%. Adolescents referred from the criminal justice were older than those originating from other sources (16.4 x 15.4 years old p=.00. Forty-four percent of adolescents reported school failure, a level which is two times higher than Brazilian statistics. Forty percent of the sample had criminal involvement, mainly drug dealing. Cannabis was the most prevalent reported drug. Living with both parents was protective, delaying the age of initiation by one year. Domestic violence was more frequent among parents with illicit drugs abuse (38.1% x 12.5%, p<.05. Alcoholism and drug addiction in parents and relatives were about four times higher than those reported for the Brazilian population. No correlation was found between the investigated factors and adherence to treatment. CONCLUSION: Our results indicate that the programs must include treatment of adults and education of parents and parents to be. Withdrawal of treatment occurs in the first month, and seems to be related to factors extrinsic to the adolescent.
Sandra Maria Sampaio Enes
Full Text Available Abstract OBJECTIVE To identify the presence of phlebitis and the factors that influence the development of this complication in adult patients admitted to hospital in the western Brazilian Amazon. METHOD Exploratory study with a sample of 122 peripheral intravenous catheters inserted in 122 patients in a medical unit. Variables related to the patient and intravenous therapy were analyzed. For the analysis, we used chi-square tests of Pearson and Fisher exact test, with 5% significance level. RESULTS Complication was the main reason for catheter removal (67.2%, phlebitis was the most frequent complication (31.1%. The mean duration of intravenous therapy use was 8.81 days in continuous and intermittent infusion (61.5%, in 20G catheter (39.3%, inserted in the dorsal hand vein arc (36.9 %, with mean time of usage of 68.4 hours. The type of infusion (p=0.044 and the presence of chronic disease (p=0.005 and infection (p=0.007 affected the development of phlebitis. CONCLUSION There was a high frequency of phlebitis in the sample, being influenced by concomitant use of continuous and intermittent infusion of drugs and solutions, and more frequent in patients with chronic diseases and infection.
Borges, Carolina Marques; Cascaes, Andreia Morales; Fischer, Tatiana Konrad; Boing, Antonio Fernando; Peres, Marco Aurélio; Peres, Karen Glazer
The aim of this study was to estimate the prevalence of dental and gingival pain and associated factors among Brazilian adolescents (15-19 years of age). Data from 16,126 adolescents who participated in the Brazilian Oral Health Survey SB-Brazil 2002-2003 were used. The outcome measured was dental and gingival pain in the last six months. Independent variables were per capita income, schooling, school enrollment, gender, skin color, age, area of residence, time since last dental appointment, type of dental service, DMFT index and its components, dental calculus, and Dental Aesthetic Index. Simple and multiple Poisson regression analyses were performed. Prevalence of dental and gingival pain was 35.6% (95%CI: 34.8-36.4). Increased prevalence of pain was associated with: female gender, low income, non-students, students enrolled in public schools, and grade-for-age lag. In addition, adolescents with high levels of dental caries and dental calculus also reported higher prevalence of dental pain. Dental and gingival pain can be considered a relevant public health problem, suggesting the need for preventive measures.
Associação do HLA-DRB5*01 com proteção contra manifestação cutânea da vasculite reumatoide em pacientes brasileiros Association of HLA-DRB5*01 with protection against cutaneous manifestations of rheumatoid vasculitis in Brazilian patients
Wester Eidi Nishimura
Full Text Available OBJETIVO: Avaliar a frequência do HLA classes I e II e sua associação com a manifestação cutânea da vasculite reumatoide (VR em pacientes brasileiros. PACIENTES E MÉTODOS: Durante um ano foram selecionados 130 pacientes com artrite reumatoide (AR, classificados de acordo com os critérios do American College of Rheumatology de 1987. Os pacientes foram submetidos a um questionário clínico e laboratorial para exclusão de outras causas de vasculopatia cutânea (neoplasia, infecções, uso de drogas ilícitas, diabetes mellitus e tabagismo. Setenta e três foram excluídos por apresentarem algum fator de risco para outras causas de vasculopatias. Cinquenta e sete foram incluídos no estudo sem fator de risco para outras causas de vasculopatia, dos quais 17 apresentavam VR de acordo com os critérios de 1984 de Scott e Bacon. Foram analisados dados demográficos, tempo de diagnóstico de AR, atividade da doença (DAS28 e presença de fator reumatoide e de anticorpos antipeptídeo citrulinado cíclico. Alelos HLA foram tipificados usando-se a reação em cadeia da polimerase-DNA amplificada por hibridização de baixa resolução com sequências específicas de sondas. RESULTADOS: A comparação entre os 40 pacientes sem VR e os 17 pacientes com VR demonstrou uma frequência aumentada do HLA-B*14 (Pc = 0,168 e do HLA-Cw*08 (Pc = 0,084 em pacientes com VR, e uma frequência aumentada do HLA-DRB5*01 (Pc = 0,048 em pacientes sem VR. CONCLUSÃO: O HLA-DRB5*01 pode conferir proteção contra essa manifestação extra-articular da AR.OBJECTIVE: To evaluate the frequency of HLA classes I and II and their association with the cutaneous manifestation of rheumatoid vasculitis (RV in Brazilian patients. PATIENTS AND METHODS: During one year we selected 130 patients with rheumatoid arthritis (RA classified according to the American College of Rheumatology, 1987. All patients underwent a clinical and laboratory questionnaire to exclude other causes of
Rafael Corrêa Coelho
Full Text Available ABSTRACT Purpose: The aim of this study was to assess the impact of sunitinib treatment in a non-screened group of patients with metastatic renal cell cancer (mRCC treated by the Brazilian Unified Health System (SUS at a single reference institution. Material and Methods: Retrospective cohort study, which evaluated patients with mRCC who received sunitinib between May 2010 and December 2013. Results: Fifty-eight patients were eligible. Most patients were male 41 (71%, with a median age of 58 years. Nephrectomy was performed in 41 (71% patients with a median interval of 16 months between the surgery and initiation of sunitinib. The most prevalent histological subtype was clear cell carcinoma, present in 52 (91.2% patients. In 50 patients (86%, sunitinib was the first line of systemic treatment. The main adverse effects were fatigue (57%, hypothyroidism (43%, mucositis (33% and diarrhea (29%. Grade 3 and 4 adverse effects were infrequent: fatigue (12%, hypertension (12%, thrombocytopenia (7%, neutropenia (5% and hand-foot syndrome (5%. Forty percent of patients achieved a partial response and 35% stable disease, with a disease control rate of 75%. Median progression free survival was 7.6 months and median overall survival was 14.1 months. Conclusion: Sunitinib treatment was active in the majority of patients, especially those with low and intermediate risk by MSKCC score, with manageable toxicity. Survival rates were inferior in this non-screened population with mRCC treated in the SUS.
Braga, Ana Paula Gasparini; Barreto, Sandhi Maria; Martins, Andréa Maria Eleutério de Barros Lima
This study estimated the prevalence of bad/very bad self-rated mastication and investigated associated factors among Brazilian adults. The sample included 13,431 adults examined and interviewed in the SBBrazil project. Self-rated mastication was combined in three categories: good/ very good (the reference), fair, and bad/very bad. Multinomial logistic regression was performed to measure the association between fair and bad/very bad self-rated mastication and all independent variables included in the analysis, with significance set at p mastication as good/very good, 24.9% as fair, and 19.5% as bad/very bad. In the final multivariate analysis, factors associated with bad or fair self-rated mastication were: receiving no information on how to avoid oral problems; presenting fewer than 23 remaining teeth; requiring total or partial prosthesis; bad/very bad self-rated oral health; gingival pain and/or toothache in the previous year; and need of dental treatment. In conclusion, various factors were associated with self-rated mastication, especially subjective conditions, thus emphasizing its importance as an oral health indicator.
Hercílio Paulino ANDRÉ
Full Text Available ABSTRACT Objective To evaluate factors associated with the iron nutritional status of Brazilian children aged 4 to 7 years in the city of Viçosa, Minas Gerais state, Brazil. Methods This is a cross-sectional study of 357 children aged 4-7 years who had been followed-up up for during their first six months of life by the Breastfeeding Support Program. Socioeconomic and demographic characteristics, feeding practices, nutritional status (height-for-age and body mass index-for-age, and serum ferritin and hemoglobin concentrations were evaluated. Multiple linear regression analysis was carried out to evaluate factors independently associated with iron nutritional status (hemoglobin and ferritin, considering α=0.05 as the significance level. Results The prevalence of anemia and iron deficiency was (34 9.52% and (11 11.00%, respectively. The factors independently associated with anemia were younger child age, low maternal education, low height-for-age Z-scores, and children of single and separated mothers or widows. Iron deficiency was associated with child younger age and consumption of chocolates and chocolate flavored milk. Conclusion The results obtained allow us to conclude that anemia among children 4-7 years of age is a public health problem in the city of Viçosa, Minas Gerais. Therefore, there is a need for intervention measures targeting children in this age group. These measures can be implemented through food and nutritional education by encouraging the consumption of iron-rich foods.
Paranaiba, Lívia Máris Ribeiro; Coletta, Ricardo D; Swerts, Mário Sérgio Oliveira; Quintino, Rafaela Pacífico; de Barros, Letízia Monteiro; Martelli-Júnior, Hercílio
Objective : Many studies have demonstrated a high frequency of dental anomalies in patients with cleft lip and/or palate. Because dental anomalies may complicate dental treatment, we investigated the prevalence of dental anomalies in a group of Brazilian patients with nonsyndromic cleft lip and/or palate. Design, Participants, Setting : Retrospective analysis was performed using clinical records of 296 patients aged between 12 and 30 years with repaired nonsyndromic cleft lip and/or palate without history of tooth extraction and orthodontic treatment. Associations between oral clefts and presence of dental anomalies outside the cleft area were investigated. Results : Dental anomalies were identified in 39.9% of the nonsyndromic cleft lip and/or palate patients, and tooth agenesis (47.5%), impacted tooth (13.1%), and microdontia (12.7%) were the most common anomalies. Cleft lip patients were less affected by dental anomalies compared with cleft palate or cleft lip and palate patients (p = .057). Specifically, patients with unilateral cleft lip and palate were significantly more affected by dental anomalies than those with bilateral cleft lip and palate (p = .00002), and individuals with unilateral complete cleft lip and palate (p = .002) and complete cleft palate (p = .01) were significantly more affected by tooth agenesis than other cleft types. Agenesis of the premolars (p = .043) and maxillary lateral incisors (p = .03) were significantly more frequent in patients with unilateral complete cleft lip and palate. Conclusions : The present study revealed a high frequency of dental anomalies in nonsyndromic cleft lip and/or palate patients and further demonstrated that patients with unilateral cleft lip and palate were frequently more affected by dental anomalies than those with bilateral cleft lip and palate. Moreover, our results demonstrate that dental anomalies should be considered during dental treatment planning for
Fernanda D.B. Abadio Finco
Full Text Available The purpose of this study was to investigate the nutritional situation of rural adults in the Brazilian Amazon. Anthropometric measurements (height, weight and waist circumference were taken from all participants. BMI was calculated. Dietary intake was assessed by 24 h recall and food patterns were assessed by food frequency questionnaires (FFQ. Energy expenditure was calculated from the resting metabolic rate multiplied by an activity factor based on physical activity. Linear regression was applied to assess variables associated to BMI. Participants of the study comprised 58 men and 50 women. The mean (±standard deviation age of the study population was 44.0 ± 12 years for women and 47.0 ± 15.0 year for men. The BMI for normal weight men was 22.16 ± 1.57 whereas for the overweight group was 28.33 ± 2.58 kg. Overweight and obese adults together comprise 60.2% of the study sample and therefore were considered as one group. Normal weight individuals had higher values of PAL (physical activity level than overweight persons for both sex. There was no statistical difference between the groups concerning the intake of protein, kilocalories from protein and percentage of energy from protein. The physical activity level of participants describes a sedentary profile for women in the rural communities for both groups. The food pattern of surveyed people is based on rice, beans and meat as daily food. The prevalence of overweight and obesity altogether is comparable to that reported by other studies for Brazilian rural areas. The dietetic assessment revealed that energy expenditure was significantly different between normal weight and overweight women. Physical activity was shown to be a relevant factor for overweight in the two rural communities. The food pattern of the two communities expresses a monotonous diet.
Amanda Vansan Marangon
Full Text Available The genetic variability of the host contributes to the risk of human papillomavirus (HPV-related cervical disease. Immune response genes to HPV must be investigated to define patients with the highest risk of developing malignant disease. The aim of this study was to investigate the association of polymorphic immune response genes, namely KIR, HLA class I and II, and single-nucleotide polymorphisms (SNPs of cytokines with HPV-related cervical disease. We selected 79 non-related, admixed Brazilian women from the state of Paraná, southern region of Brazil, who were infected with high carcinogenic risk HPV and present cervical intraepithelial neoplasia grade 3 (CIN3, and 150 HPV-negative women from the same region matched for ethnicity. KIR genes were genotyped using an in-house PCR-SSP. HLA alleles were typed using a reverse sequence-specific oligonucleotide technique. SNPs of TNF −308G>A, IL6 −174G>C, IFNG +874T>A, TGFB1 +869T>C +915G>C, and IL10 −592C>A −819C>T −1082G>A were evaluated using PCR-SSP. The KIR genes were not associated with HPV, although some pairs of i(inhibitoryKIR-ligands occurred more frequently in patients, supporting a role for NK in detrimental chronic inflammatory and carcinogenesis. Some HLA haplotypes were associated with HPV. The associations of INFG and IL10 SNPs potentially reflect impaired or invalid responses in advanced lesions.
Marangon, Amanda Vansan; Guelsin, Gláucia Andreia Soares; Visentainer, Jeane Eliete Laguila; Borelli, Sueli Donizete; Watanabe, Maria Angélica Ehara; Consolaro, Márcia Edilaine Lopes; Caleffi-Ferracioli, Katiany Rizzieri; Rudnick, Cristiane Conceição Chagas; Sell, Ana Maria
The genetic variability of the host contributes to the risk of human papillomavirus (HPV)-related cervical disease. Immune response genes to HPV must be investigated to define patients with the highest risk of developing malignant disease. The aim of this study was to investigate the association of polymorphic immune response genes, namely KIR, HLA class I and II, and single-nucleotide polymorphisms (SNPs) of cytokines with HPV-related cervical disease. We selected 79 non-related, admixed Brazilian women from the state of Paraná, southern region of Brazil, who were infected with high carcinogenic risk HPV and present cervical intraepithelial neoplasia grade 3 (CIN3), and 150 HPV-negative women from the same region matched for ethnicity. KIR genes were genotyped using an in-house PCR-SSP. HLA alleles were typed using a reverse sequence-specific oligonucleotide technique. SNPs of TNF −308G>A, IL6 −174G>C, IFNG +874T>A, TGFB1 +869T>C +915G>C, and IL10 −592C>A −819C>T −1082G>A were evaluated using PCR-SSP. The KIR genes were not associated with HPV, although some pairs of i(inhibitory)KIR-ligands occurred more frequently in patients, supporting a role for NK in detrimental chronic inflammatory and carcinogenesis. Some HLA haplotypes were associated with HPV. The associations of INFG and IL10 SNPs potentially reflect impaired or invalid responses in advanced lesions. PMID:23936772
Walter J. Gomes
Full Text Available Abstract Objective: To report the early results of the BYPASS project - the Brazilian registrY of adult Patient undergoing cArdiovaScular Surgery - a national, observational, prospective, and longitudinal follow-up registry, aiming to chart a profile of patients undergoing cardiovascular surgery in Brazil, assessing the data harvested from the initial 1,722 patients. Methods: Data collection involved institutions throughout the whole country, comprising 17 centers in 4 regions: Southeast (8, Northeast (5, South (3, and Center-West (1. The study population consists of patients over 18 years of age, and the types of operations recorded were: coronary artery bypass graft (CABG, mitral valve, aortic valve (either conventional or transcatheter, surgical correction of atrial fibrillation, cardiac transplantation, mechanical circulatory support and congenital heart diseases in adults. Results: 83.1% of patients came from the public health system (SUS, 9.6% from the supplemental (private insurance healthcare systems; and 7.3% from private (out-of -pocket clinic. Male patients comprised 66%, 30% were diabetics, 46% had dyslipidemia, 28% previously sustained a myocardial infarction, and 9.4% underwent prior cardiovascular surgery. Patients underwent coronary artery bypass surgery were 54.1% and 31.5% to valve surgery, either isolated or combined. The overall postoperative mortality up to the 7th postoperative day was 4%; for CABG was 2.6%, and for valve operations, 4.4%. Conclusion: This first report outlines the consecution of the Brazilian surgical cardiac database, intended to serve primarily as a tool for providing information for clinical improvement and patient safety and constitute a basis for production of research protocols.
Zucoloto, Miriane Lucindo; Maroco, João; Duarte Bonini Campos, Juliana Alvares
To evaluate the psychometric properties of the Multidimensional Pain Inventory (MPI) in a Brazilian sample of patients with orofacial pain. A total of 1,925 adult patients, who sought dental care in the School of Dentistry of São Paulo State University's Araraquara campus, were invited to participate; 62.5% (n=1,203) agreed to participate. Of these, 436 presented with orofacial pain and were included. The mean age was 39.9 (SD=13.6) years and 74.5% were female. Confirmatory factor analysis was conducted using χ²/df, comparative fit index, goodness of fit index, and root mean square error of approximation as indices of goodness of fit. Convergent validity was estimated by the average variance extracted and composite reliability, and internal consistency by Cronbach's alpha standardized coefficient (α). The stability of the models was tested in independent samples (test and validation; dental pain and orofacial pain). The factorial invariance was estimated by multigroup analysis (Δχ²). Factorial, convergent validity, and internal consistency were adequate in all three parts of the MPI. To achieve this adequate fit for Part 1, item 15 needed to be deleted (λ=0.13). Discriminant validity was compromised between the factors "activities outside the home" and "social activities" of Part 3 of the MPI in the total sample, validation sample, and in patients with dental pain and with orofacial pain. A strong invariance between different subsamples from the three parts of the MPI was detected. The MPI produced valid, reliable, and stable data for pain assessment among Brazilian patients with orofacial pain.
De Marchi, Renato José; Hugo, Fernando Neves; Hilgert, Juliana Balbinot; Padilha, Dalva Maria Pereira
Evidence suggests that older people with partial tooth loss and edentulism change their diet and lack specific nutrients, but few studies have assessed whether poor oral status is associated with risk of malnutrition and malnutrition in independent-living older people. We evaluated if poor oral status was associated with risk of malnutrition and malnutrition in this population. A random sample of 471 south Brazilians > or =60 y of age was evaluated. Measurements included a questionnaire to assess sociodemographic, behavioral, general, and oral health data; nutritional status assessment, according to the Mini-Nutritional Assessment (MNA); and oral status assessment, by means of oral examinations assessing the number of teeth and use of dental prostheses. Correlates of risk of malnutrition/malnutrition according to the MNA were assessed by means of multivariate logistic regression. Participants who reported dissatisfaction with their gingival health and edentulous persons wearing only one denture were more likely to be at risk of malnutrition, according to the screening MNA. Dissatisfaction with gingival health was a risk indicator, whereas having one to eight natural teeth was protective against the risk of malnutrition/malnutrition according to the full MNA. In the present study, older people with a compromised oral status had higher odds for risk of malnutrition. The maintenance of a few teeth had a crucial role in increasing the chance of maintaining an adequate nutritional status in the studied population. In cases where edentulism was present, complete dental prosthetic use was associated with better nutritional status.
Leite, Claudia C.; Lucato, Leandro T.; Martin, Maria G.M.; Ferreira, Lucio G.; Resende, Maria B.D.; Carvalho, Mary S.; Marie, Suely K.N.; Reed, Umbertina C.; Jinkins, J.Randy
Merosin-deficient congenital muscular dystrophy (CMD) is characterized clinically by hypotonia and muscular weakness and, on imaging studies, by white matter (WM) abnormality. To evaluate MRI findings in Brazilian patients with merosin-deficient CMD. Twenty-five patients were evaluated using MRI. Three patients presented with partial merosin deficiency and 22 with total merosin deficiency. Follow-up examinations were done in 7 cases. T1- and T2-weighted images were performed in all examinations, and fluid-attenuated inversion recovery (FLAIR) was performed in 15. Enhanced images were done in 11 cases. The WM involvement was classified according to location and severity. From 1991 to 2004, 32 MRI examinations were performed. Severe involvement was found in 23 patients in the frontal and temporal lobes, in 18 patients in the parietal lobes, and in 7 patients in the occipital lobes. The brain stem (n=5), cerebellum (n=6), internal capsules (n=1), and external capsules (n=5) were also affected. One patient had occipital pachygyria, and one had cerebellar vermian hypoplasia. No gadolinium enhancement was noted. Follow-up MRI showed no interval change (n=4), progression (n=1), or improvement of the findings (n=2). (orig.)
Baptista, Deise Regina; Thieme, Rubia Daniela; Reis, Walleri Christini Torelli; Pontarolo, Roberto; Correr, Cassyano Januário
Diabetes and its complications are substantial causes of morbidity and mortality, and caused approximately 5.1 million deaths worldwide in 2013. Early detection and treatment of diabetes complications can prevent their progression. This study compared the proportions of patients with type 1 and 2 diabetes mellitus (T1DM and T2DM, respectively) who achieved the goals of good clinical control. Adults and elderly patients with T1DM and T2DM at a public outpatient endocrinology service in Brazil were retrospectively evaluated between 2012 and 2013. Clinical and socio demographic data were obtained from medical records and evaluated in accordance with the Brazilian Diabetes Society Guidelines. Care process measures, outcomes indicators, and supporting process measures were evaluated. A total of 1031 records were analyzed: 29 and 71 % of patients had T1DM and T2DM, respectively. T2DM patients had significantly higher BMI than T1DM patients (overweight and obesity in 85.1 vs. 47.5 %, p achieved all targets, and 1.1 % did not achieve any. The achievement of goals of good clinical practice varies among the parameters evaluated. Almost no patients achieved all targets. Many patients are overweight and do not achieve targets for HbA1c, lipid profile, or blood pressure control.
Ferreira, Fábio Netto; Crispim, Daisy; Canani, Luís Henrique; Gross, Jorge Luiz; dos Santos, Kátia Gonçalves
Diabetic retinopathy (DR) is a common chronic complication of diabetes and remains the leading cause of blindness in working-aged people. Hyperglycemia increases glucose flux through the polyol pathway, in which aldose reductase converts glucose into intracellular sorbitol, which is subsequently converted to fructose by sorbitol dehydrogenase (SDH). The accelerated polyol pathway triggers a cascade of events leading to retinal vascular endothelial dysfunction and the eventual development of DR. Polymorphisms in the gene encoding aldose reductase have been consistently associated with DR. However, only two studies have analyzed the relationship between polymorphisms in the gene encoding SDH (SORD) and DR. In this case-control study, we investigated whether the -888G > C polymorphism (rs3759890) in the SORD gene is associated with the presence or severity of DR in 446 Caucasian-Brazilians with type 2 diabetes (241 subjects with and 205 subjects without DR). The -888G > C polymorphism was also examined in 105 healthy Caucasian blood donors, and the genotyping of this polymorphism was carried out by real-time PCR. The genotype and allele frequencies of the -888G > C polymorphism in patients with type 2 diabetes were similar to those of blood donors (G allele frequency = 0.16 in both groups of subjects). Similarly, the genotype and allele frequencies in patients with DR or the proliferative form of DR were similar to those of patients without this complication (P > 0.05 for all comparisons). Thus, our findings suggest that the -888G > C polymorphism in the SORD gene is not involved in the pathogenesis of DR in type 2 diabetes. Copyright © 2013 Elsevier Ltd. All rights reserved.
D'Elia, Priscila Queiroz; dos Santos, Aline Amaro; Bianco, Bianca; Barbosa, Caio Parente; Christofolini, Denise Maria; Aoki, Tsutomu
The aim of this study was to investigate the association between MTHFR gene polymorphisms and IVF outcomes in Brazilian women undergoing assisted reproduction treatment. A prospective study was conducted in the Human Reproduction Department at the ABC University School of Medicine and the Ideia Fertility Institute between December 2010 and April 2012. The patient population was 82 women undergoing assisted reproduction cycles. The MTHFR polymorphisms C677T and A1298C were evaluated and compared with laboratory results and pregnancy rates. The C677T variant was associated with proportions of mature (P=0.006) and immature (P=0.003) oocytes whereas the A1298C variant was associated with number of oocytes retrieved (P=0.044). The polymorphisms, whether alone or in combination, were not associated with normal fertilization, good-quality embryo or clinical pregnancy rates. This study suggests that the number and maturity of oocytes retrieved may be related to the MTHFR polymorphisms C677T and A1298C. It is believed that folate has a crucial function in human reproduction and that folate deficiency can compromise the function of the metabolic pathways it is involved in, leading to an accumulation of homocysteine. The gene MTHFR encodes the 5-MTHFR enzyme, which is involved in folate metabolism, and C677T/A1298C polymorphisms of this gene are related to decreased enzyme activity and consequent changes in homocysteine concentration. Folate deficiency and hyperhomocysteinaemia can also compromise fertility and lead to pregnancy complications by affecting the development of oocytes, preparation of endometrial receptivity, implantation of the embryo and pregnancy. In folliculogenesis, hyperhomocysteinaemia can activate apoptosis, leading to follicular atresia and affecting the maturity of oocytes and the quality of embryos cultured in vitro. This study was performed to investigate the association between MTHFR polymorphisms and IVF outcomes in women undergoing assisted
Héber Salvador de Castro Ribeiro
Full Text Available CONTEXT: Liver metastases are a common event in the clinical outcome of patients with colorectal cancer and account for 2/3 of deaths from this disease. There is considerable controversy among the data in the literature regarding the results of surgical treatment and prognostic factors of survival, and no analysis have been done in a large cohort of patients in Brazil. OBJECTIVES: To characterize the results of surgical treatment of patients with colorectal liver metastases, and to establish prognostic factors of survival in a Brazilian population. METHOD: This was a retrospective study of patients undergoing liver resection for colorectal metastases in a tertiary cancer hospital from 1998 to 2009. We analyzed epidemiologic variables and the clinical characteristics of primary tumors, metastatic disease and its treatment, surgical procedures and follow-up, and survival results. Survival analyzes were done by the Kaplan-Meier method and the log-rank test was applied to determine the influence of variables on overall and disease-free survival. All variables associated with survival with P<0.20 in univariate analysis, were included in multivariate analysis using a Cox proportional hazard regression model. RESULTS: During the period analyzed, 209 procedures were performed on 170 patients. Postope-rative mortality in 90 days was 2.9% and 5-year overall survival was 64.9%. Its independent prognostic factors were the presence of extrahepatic disease at diagnosis of liver metastases, bilateral nodules and the occurrence of major complications after liver surgery. The estimated 5-year disease-free survival was 39.1% and its prognostic factors included R1 resection, extrahepatic disease, bilateral nodules, lymph node involvement in the primary tumor and primary tumors located in the rectum. CONCLUSION: Liver resection for colorectal metastases is safe and effective and the analysis of prognostic factors of survival in a large cohort of Brazilian patients
Full Text Available Abstract Introduction: Sarcopenia has been currently considered a public health problem, affecting a large portion of the elderly and making them more susceptible to the risk of falls. Objective: To estimate the prevalence and factors associated with sarcopenia in the elderly from a Brazilian capital. Methods: This is an epidemiological study with cross-sectional design involving data of 439 elderly people from Florianópolis city, Santa Catarina state. The factors potentially associated with sarcopenia (sex, age, weight status were tested using binary logistic regression, estimating the Odds Ratio and the respective confidence intervals. Results: The prevalence of sarcopenia was 33.3% (95% CI: 28.9, 36.9. Older women (75 years or more showed less muscle mass in relation to other age groups (p < 0.05. Elderly men, individuals that are 75 years or more, and those with low weight were the subgroups at higher risk for sarcopenia. Obese individuals were less likely to have the outcome. Conclusion: More than one-third of elderly people were diagnosed with sarcopenia. Men, individuals who are older, and those with low weight had a higher risk of having sarcopenia.
Galli, Rosangela; Moriguchi, Emílio Hideyuki; Bruscato, Neide Maria; Horta, Rogerio Lessa; Pattussi, Marcos Pascoal
Active aging is the process of optimizing opportunities for health, participation and security, aiming to improve quality of life as people age. A series of studies had demonstrated that a lower prevalence of depression is found among more active elderly. To evaluate the association between indicators of active aging and depressive symptoms among the elderly (aged 60 years or more). A population-based cross-sectional study was conducted with 1,006 elderly people (aged 60 years or over) from a small-sized Brazilian municipality. Depressive symptoms were assessed using the Geriatric Depression Scale - 15, with cutoff point ≥ 6 symptoms. Active aging was evaluated using indicators such as: active occupational situation, manual work, reading and physical activities. Data analyses used modified Poisson regression to obtain crude and adjusted prevalence ratios (PR). Most of the elderly people were: white, women and aged between 60 and 74 years. All the indicators of active aging were associated with the outcome. After controlling for socioeconomic, demographic and health variables, elderly people who worked, participated in groups, did manual work and maintained interests such as reading and talking to friends had lower prevalence of depressive symptoms compared to those not doing these activities. Active aging approaches may serve as a valuable mental health promotion strategy aimed at the elderly.
Full Text Available Abstract Background Cotton blue disease (CBD, an important global cotton crop pathology responsible for major economic losses, is prevalent in the major cotton-producing states of Brazil. Typical CBD symptoms include stunting due to internodal shortening, leaf rolling, intense green foliage, and yellowing veins. Atypical CBD symptoms, including reddish and withered leaves, were also observed in Brazilian cotton fields in 2007. Recently, a Polerovirus named Cotton leafroll dwarf virus (CLRDV was shown to be associated with CBD. Results To understand the distribution and genetic diversity of CLRDV in Brazil, we analyzed 23 CBD-symptomatic plants from susceptible cotton varieties originating from five of the six most important cotton-growing states, from 2004–2007. Here, we report on CLRDV diversity in plants with typical or atypical CBD symptoms by comparing viral coat protein, RNA polymerase (RdRp, and intergenic region genomic sequences. Conclusion The virus had a widespread distribution with a low genetic diversity; however, three divergent isolates were associated with atypical CBD symptoms. These divergent isolates had a CLRDV-related coat protein but a distinct RdRp sequence, and probably arose from recombination events. Based on the taxonomic rules for the family Luteoviridae, we propose that these three isolates represent isolates of a new species in the genus Polerovirus.
Silva, T F; Corrêa, R L; Castilho, Y; Silvie, P; Bélot, J-L; Vaslin, M F S
Cotton blue disease (CBD), an important global cotton crop pathology responsible for major economic losses, is prevalent in the major cotton-producing states of Brazil. Typical CBD symptoms include stunting due to internodal shortening, leaf rolling, intense green foliage, and yellowing veins. Atypical CBD symptoms, including reddish and withered leaves, were also observed in Brazilian cotton fields in 2007. Recently, a Polerovirus named Cotton leafroll dwarf virus (CLRDV) was shown to be associated with CBD. To understand the distribution and genetic diversity of CLRDV in Brazil, we analyzed 23 CBD-symptomatic plants from susceptible cotton varieties originating from five of the six most important cotton-growing states, from 2004-2007. Here, we report on CLRDV diversity in plants with typical or atypical CBD symptoms by comparing viral coat protein, RNA polymerase (RdRp), and intergenic region genomic sequences. The virus had a widespread distribution with a low genetic diversity; however, three divergent isolates were associated with atypical CBD symptoms. These divergent isolates had a CLRDV-related coat protein but a distinct RdRp sequence, and probably arose from recombination events. Based on the taxonomic rules for the family Luteoviridae, we propose that these three isolates represent isolates of a new species in the genus Polerovirus.
Souza, Jonas Gordilho; Apolinario, Daniel; Farfel, José Marcelo; Jaluul, Omar; Magaldi, Regina Miksian; Busse, Alexandre Leopold; Campora, Flávia; Jacob-Filho, Wilson
To translate, adapt and evaluate the properties of a Brazilian Portuguese version of the Spoken Knowledge in Low Literacy Patients with Diabetes, which is a questionnaire that evaluate diabetes knowledge. A cross-sectional study with type 2 diabetes patients aged ≥60 years, seen at a public healthcare organization in the city of Sao Paulo (SP). After the development of the Portuguese version, we evaluated the psychometrics properties and the association with sociodemographic and clinical variables. The regression models were adjusted for sociodemographic data, functional health literacy, duration of disease, use of insulin, and glycemic control. We evaluated 129 type 2 diabetic patients, with mean age of 75.9 (±6.2) years, mean scholling of 5.2 (±4.4) years, mean glycosylated hemoglobin of 7.2% (±1.4), and mean score on Spoken Knowledge in Low Literacy Patients with Diabetes of 42.1% (±25.8). In the regression model, the variables independently associated to Spoken Knowledge in Low Literacy Patients with Diabetes were schooling (B=0.193; p=0.003), use of insulin (B=1.326; p=0.004), duration of diabetes (B=0.053; p=0.022) and health literacy (B=0.108; p=0.021). The determination coefficient was 0.273. The Cronbach a was 0.75, demonstrating appropriate internal consistency. This translated version of the Spoken Knowledge in Low Literacy Patients with Diabetes showed to be adequate to evaluate diabetes knowledge in elderly patients with low schooling levels. It presented normal distribution, adequate internal consistency, with no ceiling or floor effect. The tool is easy to be used, can be quickly applied and does not depend on reading skills. Traduzir, adaptar e avaliar as propriedades de uma versão, em português do Brasil, do Spoken Knowledge in Low Literacy Patients with Diabetes, um questionário que avalia conhecimento em diabetes. Estudo transversal, em diabéticos tipo 2, com idade ≥60 anos de uma instituição pública de saúde, em São Paulo (SP
Janmille Valdivino da Silva
Full Text Available ABSTRACT OBJECTIVE To analyze how individual characteristics and the social context, together, are associated with self-perception of the oral health. METHODS A multilevel cross-sectional study with data from the Brazilian National Health Survey 2013, the United Nations Development Program, and the National Registry of Health Establishments. The explanatory variables for the “oral health perception” outcome were grouped, according to the study framework, into biological characteristics (sex, color, age, proximal social determinants (literacy, household crowding, and socioeconomic stratification, and distal (years of schooling expectancy at age 18, GINI, Human Development Index, and per capita income. The described analysis was performed, along with bivariate Poisson analysis and multilevel Poisson analysis for the construction of the explanatory model of oral health perception. All analyzes considered the sample weights. RESULTS Both the biological characteristics and the proximal and distal social determinants were associated with the perception of oral health in the bivariate analysis. A higher prevalence of bad oral health was associated to lower years of schooling expectancy (PR = 1.31, lower per capita income (PR = 1.45, higher income concentration (PR = 1.41, and worse human development (PR = 1.45. Inversely, oral health services in both primary and secondary care were negatively associated with oral health perception. All the biological and individual social characteristics, except reading and writing, made up the final explanatory model along with the distal social determinants of the Human Development Index and coverage of basic care in the multilevel analysis. CONCLUSIONS Biological factors, individual and contextual social determinants were associate synergistically with the population’s perception of oral health. It is necessary to improve individual living conditions and the implementation of public social policies to improve
Silva, Janmille Valdivino da; Oliveira, Angelo Giuseppe Roncalli da Costa
To analyze how individual characteristics and the social context, together, are associated with self-perception of the oral health. A multilevel cross-sectional study with data from the Brazilian National Health Survey 2013, the United Nations Development Program, and the National Registry of Health Establishments. The explanatory variables for the "oral health perception" outcome were grouped, according to the study framework, into biological characteristics (sex, color, age), proximal social determinants (literacy, household crowding, and socioeconomic stratification), and distal (years of schooling expectancy at age 18, GINI, Human Development Index, and per capita income). The described analysis was performed, along with bivariate Poisson analysis and multilevel Poisson analysis for the construction of the explanatory model of oral health perception. All analyzes considered the sample weights. Both the biological characteristics and the proximal and distal social determinants were associated with the perception of oral health in the bivariate analysis. A higher prevalence of bad oral health was associated to lower years of schooling expectancy (PR = 1.31), lower per capita income (PR = 1.45), higher income concentration (PR = 1.41), and worse human development (PR = 1.45). Inversely, oral health services in both primary and secondary care were negatively associated with oral health perception. All the biological and individual social characteristics, except reading and writing, made up the final explanatory model along with the distal social determinants of the Human Development Index and coverage of basic care in the multilevel analysis. Biological factors, individual and contextual social determinants were associate synergistically with the population's perception of oral health. It is necessary to improve individual living conditions and the implementation of public social policies to improve the oral health of the population.
Freitas, Noélle de Oliveira; Forero, Carlos García; Caltran, Marina Paes; Alonso, Jordi; Dantas, Rosana A Spadoti; Piccolo, Monica Sarto; Farina, Jayme Adriano; Lawrence, John W; Rossi, Lidia A
Currently, there is no questionnaire to assess perceived stigmatization among people with visible differences in Brazil. The Perceived Stigmatization Questionnaire (PSQ), developed in the United States, is a valid instrument to assess the perception of stigmatizing behaviours among burn survivors. The objective of this cross-sectional and multicentre study was to assess the factor structure, reliability and validity of the Brazilian Portuguese version of the PSQ in burn patients. A Brazilian version of the 21-item PSQ was answered by 240 adult burn patients, undergoing rehabilitation in two burns units in Brazil. We tested its construct validity by correlating PSQ scores with depression (Beck Depression Index-BDI) and self-esteem (Rosenberg Self-Esteem Scale-RSE), as well as with two domains of the Revised Burn Specific Health Scale-BSHS-R: affect and body image, and interpersonal relationships. We used Confirmatory Item Factor Analysis (CIFA) to test whether the data fit a measurement model involving a three-factor structure (absence of friendly behaviour; confusing/staring behaviour; and hostile behaviour). We conducted Exploratory Factor Analyses (EFA) of the subscale in a 50% random sample of individuals (training split), treating items as ordinal categorical using unweighted least squares estimation. To assess discriminant validity of the Brazilian version of the PSQ we correlated PSQ scores with known groups (sex, total body surface area burned, and visibility of the scars) and assessed its reliability by means of Cronbach's alpha and using test-retest. Goodness-of-fit indices for confirmatory factor analysis were satisfactory for the PSQ, but not for the hostile behaviour subscale, which was modified to improve fit by eliminating 3 items. Cronbach's alphas for the PSQ refined version (PSQ-R) ranged from 0.65 to 0.88, with test-retest reliability 0.87 for the total score. The PSQ-R scores correlated strongly with depression (0.63; p self-esteem (-0.57; p
Eduardo P. Mattos
Full Text Available Campomelic dysplasia (CD is an autosomal, dominantly inherited, skeletal abnormality belonging to the subgroup of bent bone dysplasias. In addition to bowed lower limbs, CD typically includes the following: disproportionate short stature, flat face, micrognathia, cleft palate, bell-shaped thorax, and club feet. Up to three quarters of 46, XY individuals may be sex-reversed. Radiological signs include scapular and pubic hypoplasia, narrow iliac wings, spaced ischia, and bowed femora and tibiae. Lethal CD is usually due to heterozygous mutations in SOX9, a major regulator of chondrocytic development. We present a detailed clinical and molecular characterization of nine Brazilian CD patients. Infants were either stillborn (n = 2 or died shortly after birth and presented similar phenotypes. Sex-reversal was observed in one of three chromosomally male patients. Sequencing of SOX9 revealed new heterozygous mutations in seven individuals. Six patients had mutations that resulted in premature transcriptional termination, while one infant had a single-nucleotide substitution at the conserved splice-site acceptor of intron 1. No clear genotype-phenotype correlations were observed. This study highlights the diversity of SOX9 mutations leading to lethal CD, and expands the group of known genetic alterations associated with this skeletal dysplasia.
Gonçalves, M S; Queiroz, I L; Cardoso, S A; Zanetti, A; Strapazoni, A C; Adorno, E; Albuquerque, A; Sant'Ana, A; dos Reis, M G; Barral, A; Barral Netto, M
Sickle cell disease has a worldwide distribution and is a public health problem in Brazil. Although vaso-occlusive crisis (VOC) is one of the most important clinical features of the disease, there are still several steps of its pathogenesis which are unknown. The increase of the chemotactic factor interleukin 8 (IL-8) has been reported to be involved in sickle cell disease crisis, but this has not been demonstrated conclusively. In the present study we analyzed serum IL-8 levels by ELISA and hematological parameters and hemoglobin patterns by standard techniques in 23 (21 SS and 2 SC) Brazilian patients with sickle cell syndromes during VOC caused by different inducing factors, 22 (21 SS and 1 SC) sickle cell patients out of crisis, and 11 healthy controls. Increased IL-8 levels were observed in 19 of 23 VOC patients (79.2%), 3 of them with more than 1,000 pg/ml. Seventeen of 22 (77.3%) non-crisis patients showed low IL-8 levels (less than 15 pg/ml). Healthy controls had low IL-8 levels. A significant difference in serum IL-8 levels was observed between crisis and non-crisis sickle cell patients (Pcrisis-inducing factor. We conclude that in the studied population, IL-8 concentration may be a useful VOC marker, although the mechanism of the pathogenic process of sickle cell VOC syndromes remains unclear.
Moreira, D C F; de Sá, J S M; Cerqueira, I B; Oliveira, A P F; Morgano, M A; Amaya-Farfan, J; Quintaes, K D
While enteral diets for hospitalized patients normally follow nutrient composition guidelines, more than 90% of hospitalized patients receive oral diets with unknown mineral composition. To evaluate the mineral contents and adequacy of three types of oral diets (regular, blend and soft) and complementary snacks offered to patients of a Brazilian hospital. The amount of minerals was determined in two non-consecutive days in duplicate samples of breakfast, collation, lunch, snack, dinner, supper and a complementary snack meal. Dietary Reference Intakes (DRIs) were used to determine the adequacy of the daily amounts served to patients. The regular diet met the RDA (Recommended Dietary Allowances) requirements only for Mn, P and Se, while the blend diet was deficient in Ca, K and Mg, and the soft diet met RDA requirements only for P and Zn. Iron was below the RDA requirement in all diets for women in fertile age, and Na was above the safe limit of intake (UL) in all the diets. The use of complementary snack was effective in meeting RDA requirements for Cu in the regular diet, and Mn and Se in the soft diet, but promoted overconsumption of Na. Evident nutritional imbalances have been detected at a key interphase between nutrition and public health services, but a solution does not appear to be insurmountable. A permanent nutritional evaluation of hospital oral diets should be an integral part of routine health care in order to speed the recovery of the hospitalized patient and dispel eventual risks due to critical mineral imbalances.
Paulo S. Young
Full Text Available Basead on extensive collections of cnidarians from Brazilian shallow-water marine environments, new occurrences of four species of associated barnacles are cited, the first three being redescribed; Tne archaeobalanid Conopea galeata, asssociated with the gorgonians Muriceopsis sulphurea, Lophogorgia punicea and Heterogorgia sp from the States of Paraíba, Bahia, Rio de Janeiro and São Paulo; the balanid Megabalanus stultus, associated with the hydrozoans Millepora spp from Paraíba to Alagoas and from the south of Bahia to Rio de Janeiro; the pyrgomatids Megatrema madreporarum, associated with the scleractinian corals Agaricia spp from Paraíba to Alagoas and the south of Bahia, and Ceratoconcha floridanum, associated with the seleractinian coral Mussismilia hispida from Atol das Rodas and Rio de Janeiro.Com base em extensas coleções de cnidários de ambientes marinhos rasos do Brasil, novas ocorrências de quatro espécies da cracas a eles associadas são citadas, e destas três são redescritas: o arqueobalanídeo Conopea galeata, associado às gorgônias Muriceopsis sulphurea, Lophogorgia punicea e Heterogorgia sp , dos Estados da Paraíba, Bahia, Rio de Janeiro e São Paulo; o balanídeo Megabalanus stltus, associado aos hidrozoários Millepora spp, da Paraíba e Alagoas e ao sul da Bahia até o Rio de Janeiro; os pirgomatídeos Megatrema madreporarum, associado aos corais escleractíneos Agaricia sp , da Paraíba e Alagoas e sul da Bahia, e Ce atoconcha floridanum, associado ao coral escleractíneo Mussismilia hispida, do Atol das Rocas e Rio de Janeiro
Eduardo F. Da Silva
Full Text Available Coffee has been associated with reductions in the risk of non-communicable chronic diseases (NCCD, including diabetes mellitus. Because differences in food habits are recognizable modifying factors in the epidemiology of diabetes, we studied the association of coffee consumption with type-2 diabetes in a sample of the adult population of the Federal District, Brazil. This cross-sectional study was conducted by telephone interview (n = 1,440. A multivariate analysis was run controlling for socio-behavioural variables, obesity and family antecedents of NCCD. A hierarchical linear regression model and a Poisson regression were used to verify association of type-2 diabetes and coffee intake. The independent variables which remained in the final model, following the hierarchical inclusion levels, were: first level—age and marital status; second level—diabetes and dyslipidaemias in antecedents; third level—cigarette smoking, supplement intake, body mass index; and fourth level—coffee intake (£100 mL/d, 101 to 400 mL/day, and >400 mL/day. After adjusting hierarchically for the confounding variables, consumers of 100 to 400 mL of coffee/day had a 2.7% higher (p = 0.04 prevalence of not having diabetes than those who drank less than 100 mL of coffee/day. Compared to coffee intake of £100 mL/day, adults consuming >400 mL of coffee/day showed no statistically significant difference in the prevalence of diabetes. Thus, moderate coffee intake is favourably associated with self-reported type-2 diabetes in the studied population. This is the first study to show a relationship between coffee drinking and diabetes in a Brazilian population.
Chronic kidney disease: information on southern brazilian patients with kidney disease - 10.4025/actascihealthsci.v34ispec.16048 Chronic kidney disease: information on southern brazilian patients with kidney disease - 10.4025/actascihealthsci.v34ispec.16048
Maria Dalva de Barros Carvalho
Full Text Available The profile of patients undergoing haemodialysis in the dialysis unit of Hospital Santa Casa de Maringá, Maringá PR Brazil, is provided. A questionnaire on social and economic data and underlying diseases prior to the Chronic Kidney Disease (CKD identified the patients’ profile. The project was approved by the Ethics Committee of the institution. Eighty-three patients, with 54.21% males, were interviewed. Age bracket ranged between 20 and 59 years in 65.06% of patients. Only 27.71% maintained jobs after the diagnosis and the start of treatment; 63.86% had an average personal income between 1 and 3 minimum wages; 63.85% did not practice any physical activity. Moreover, 53.01% belonged to the European-Brazilian white group; 20.48% to the Afro-Brazilian brown group; 19.28% to the Afro-Brazilian Negro group; 6.02% to other ethnic groups. Further, 85.54% patients reported having an underlying disease prior to the CKD, namely, 61.45% were hypertensive; 31.33% were diabetics and 20.48% had other diseases. Results show the need of a greater attention to these patients’ health care to reduce the negative impacts related to the chronic disease focused.The profile of patients undergoing haemodialysis in the dialysis unit of Hospital Santa Casa de Maringá, Maringá PR Brazil, is provided. A questionnaire on social and economic data and underlying diseases prior to the Chronic Kidney Disease (CKD identified the patients’ profile. The project was approved by the Ethics Committee of the institution. Eighty-three patients, with 54.21% males, were interviewed. Age bracket ranged between 20 and 59 years in 65.06% of patients. Only 27.71% maintained jobs after the diagnosis and the start of treatment; 63.86% had an average personal income between 1 and 3 minimum wages; 63.85% did not practice any physical activity. Moreover, 53.01% belonged to the European-Brazilian white group; 20.48% to the Afro-Brazilian brown group; 19.28% to the Afro-Brazilian Negro
Bôtto-Menezes, Camila; Bardají, Azucena; dos Santos Campos, Giselane; Fernandes, Silke; Hanson, Kara; Martínez-Espinosa, Flor Ernestina; Menéndez, Clara; Sicuri, Elisa
Background Information on costs associated with malaria in pregnancy (MiP) in low transmission areas where Plasmodium vivax predominates is so far missing. This study estimates health system and patient costs of MiP in the Brazilian Amazon. Methods/Principal Findings Between January 2011 and March 2012 patient costs for the treatment of MiP were collected through an exit survey at a tertiary referral hospital and at a primary health care centre in the Manaus metropolitan area, Amazonas state. Pregnant and post-partum women diagnosed with malaria were interviewed after an outpatient consultation or at discharge after admission. Seventy-three interviews were included in the analysis. Ninety-six percent of episodes were due to P. vivax and 4% to Plasmodium falciparum. In 2010, the total median costs from the patient perspective were estimated at US $45.91 and US $216.29 for an outpatient consultation and an admission, respectively. When multiple P. vivax infections during the same pregnancy were considered, patient costs increased up to US $335.85, representing the costs of an admission plus an outpatient consultation. Provider direct and overhead cost data were obtained from several sources. The provider cost associated with an outpatient case, which includes several consultations at the tertiary hospital was US $103.51 for a P. vivax malaria episode and US $83.59 for a P. falciparum malaria episode. The cost of an inpatient day and average admission of 3 days was US $118.51 and US $355.53, respectively. Total provider costs for the diagnosis and treatment of all malaria cases reported in pregnant women in Manaus in 2010 (N = 364) were US $17,038.50, of which 92.4% (US$ 15,741.14) due to P. vivax infection. Conclusion Despite being an area of low risk malaria transmission, MiP is responsible for a significant economic burden in Manaus. Especially when multiple infections are considered, costs associated with P. vivax are higher than costs associated with P
Full Text Available Information on costs associated with malaria in pregnancy (MiP in low transmission areas where Plasmodium vivax predominates is so far missing. This study estimates health system and patient costs of MiP in the Brazilian Amazon.Between January 2011 and March 2012 patient costs for the treatment of MiP were collected through an exit survey at a tertiary referral hospital and at a primary health care centre in the Manaus metropolitan area, Amazonas state. Pregnant and post-partum women diagnosed with malaria were interviewed after an outpatient consultation or at discharge after admission. Seventy-three interviews were included in the analysis. Ninety-six percent of episodes were due to P. vivax and 4% to Plasmodium falciparum. In 2010, the total median costs from the patient perspective were estimated at US $45.91 and US $216.29 for an outpatient consultation and an admission, respectively. When multiple P. vivax infections during the same pregnancy were considered, patient costs increased up to US $335.85, representing the costs of an admission plus an outpatient consultation. Provider direct and overhead cost data were obtained from several sources. The provider cost associated with an outpatient case, which includes several consultations at the tertiary hospital was US $103.51 for a P. vivax malaria episode and US $83.59 for a P. falciparum malaria episode. The cost of an inpatient day and average admission of 3 days was US $118.51 and US $355.53, respectively. Total provider costs for the diagnosis and treatment of all malaria cases reported in pregnant women in Manaus in 2010 (N = 364 were US $17,038.50, of which 92.4% (US$ 15,741.14 due to P. vivax infection.Despite being an area of low risk malaria transmission, MiP is responsible for a significant economic burden in Manaus. Especially when multiple infections are considered, costs associated with P. vivax are higher than costs associated with P. falciparum. The information generated may
Daniela de Rossi Figueiredo
Full Text Available Abstract: This study aimed to explore the relations between adverse oral outcomes and socioeconomic, demographic, and self-rated oral health variables and to describe their distribution. Principal component analysis was conducted on data from adolescents in the Brazilian National Oral Health Survey (N = 5,445. Higher loadings were found for crowding (0.6, maxillary and mandibular irregularities (0.5, and count of communitary periodontal index (CPI sextants with bleeding and dental calculus (0.5. The mean rates for periodontal and occlusal disorders were at least two times higher in adolescents from lower income families and those reporting the need for dental prostheses, as well as those dissatisfied with their dental and overall oral health. Increased mean rates of occlusal disorders were associated with schooling delay and history of toothache in the previous six months. The mean scores suggested accumulation of at least one of the negative oral health indicators in the lower income strata, among adolescents with schooling delay, and in those reporting dental needs. The results suggest priorities for planning and monitoring as a function of oral health requirements.
Figueiredo, Daniela de Rossi; Bastos, João Luiz; Peres, Karen Glazer
This study aimed to explore the relations between adverse oral outcomes and socioeconomic, demographic, and self-rated oral health variables and to describe their distribution. Principal component analysis was conducted on data from adolescents in the Brazilian National Oral Health Survey (N = 5,445). Higher loadings were found for crowding (0.6), maxillary and mandibular irregularities (0.5), and count of communitary periodontal index (CPI) sextants with bleeding and dental calculus (0.5). The mean rates for periodontal and occlusal disorders were at least two times higher in adolescents from lower income families and those reporting the need for dental prostheses, as well as those dissatisfied with their dental and overall oral health. Increased mean rates of occlusal disorders were associated with schooling delay and history of toothache in the previous six months. The mean scores suggested accumulation of at least one of the negative oral health indicators in the lower income strata, among adolescents with schooling delay, and in those reporting dental needs. The results suggest priorities for planning and monitoring as a function of oral health requirements.
Freitas, Marly S; Monteiro, Julius Caesar S; Camelo-Nunes, Inês C; Solé, Dirceu
To determine the prevalence of asthma symptoms among schoolchildren living on two different Brazilian Amazon islands and to identify the risk factors related to this condition. A cross-sectional study of 400 schoolchildren (5-8 years old) using written questionnaires produced by the International Study of Asthma and Allergies in Childhood, a skin prick test (allergic sensitization), and a stool examination (for helminthic infection). Nonparametric tests were carried out, and the risk factors were identified by logistic regression. The prevalence of active asthma symptoms was markedly higher in children living on Outeiro Island (OI) than those living on Combú Island (CBI) (30.5% and 16.5%, respectively). The logistic regression identified several risk factors of asthma symptoms on CBI: parental history of asthma, night coughing in the past year, and "currently have a cat". On OI, the major risk factors were parental history of asthma, personal history of eczema, having two or more older siblings, and night coughing in the past year. The risk factors in common on both the islands were night coughing in the past year and parental history of asthma. The prevalence of asthma symptoms was higher in those with a lifestyle closer to that observed in urban areas (i.e., better sanitation and hygiene), reinforcing the protective effect of a rural environment. Different risk factors were associated with asthma symptoms in schoolchildren living on OI and on CBI. This fact may reflect the environmental individuality and particularities of each island.
Full Text Available Genomic DNA from 23 patients with isolated growth hormone (GH deficiency (12 males and 11 females: heights -4.9 ± 1.4 SDS was screened for GH gene deletions by restriction endonuclease analysis of polymerase chain reaction amplification products. Three unrelated patients had typical features of severe GH deficiency and deletions (6.7 kb in two and 7.6 kb in one of the GH gene. The two patients with 6.7-kb deletions developed growth-attenuating anti-GH antibodies whereas the patient with the 7.6-kb deletion continued to grow with GH replacement therapy. Our finding that 3/23 (~13% Brazilian subjects had GH gene deletions agrees with previous studies of severe isolated GH deficiency subjects in other populations. Two of three subjects (67% with deletions developed blocking antibodies despite administration of exogenous GH at low doses. Interestingly, only 1/10 of cases with affected relatives or parental consanguinity had GH-1 gene deletions
Chadi, Gerson; Maximino, Jessica Ruivo; Jorge, Frederico Mennucci de Haidar; Borba, Fabrício Castro de; Gilio, Joyce Meire; Callegaro, Dagoberto; Lopes, Camila Galvão; Santos, Samantha Nakamura Dos; Rebelo, Gabriela Natania Sales
To investigate gene mutations in familial form (FALS) and sporadic form (SALS) of amyotrophic lateral sclerosis (ALS) in a highly miscegenated population. Frequencies of mutations in the C9orfF72, TARDBP, SOD1, FUS and VAPB genes were investigated in a cohort of FALS (n = 39) and SALS (n = 189) subjects from the Research Centre of the University of São Paulo School of Medicine. All patients were subjected to C9orf72 and TARDBP analyses. SOD1, FUS and VAPB were also evaluated in FALS subjects. Mutations were identified in FALS (61.3%) and SALS (5.3%) patients. Mutations in C9orf72 (12.8%, >45 GGGGCC hexanucleotide repeats), VAPB (43.6%, P56S) and SOD1 (7.7%, L145S) were identified in FALS subjects. Pathogenic C9orf72 expansions (2.64%) were identified in some SALS patients. Similar changes of TARDBP were found in SALS (2.64%) but not in FALS subjects. No FUS mutations were seen in any FALS subjects. TARDBP and C9orf72 mutations in this cohort were similar to those found in other centres worldwide. VAPB mutation (P56S) was highly prevalent in Brazilian FALS patients.
Full Text Available Alexandre Faisal-Cury,1 Karen M Tabb,2 Guilherme Niciunovas,3 Carrie Cunningham,4 Paulo R Menezes,1 Hsiang Huang4,5 1Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil; 2School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL, USA; 3School of Medicine, Federal University of São Paulo, São Paulo, Brazil; 4Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA; 5Department of Psychiatry, Laboratory of Psychopathology and Psychiatric Therapeutics (LIM-23, Faculty of Medicine, University of São Paulo, São Paulo, Brazil Abstract: Adolescent pregnancy has social, economic, and educational consequences and is also linked to adverse perinatal outcomes. However, studies show a positive relationship between pregnancy and increased social status among low-income adolescents. This study aims to assess the association between planned pregnancy and years of schooling among low-income Brazilian adolescents. This is a secondary analysis of a cohort study conducted from May 2005 to March 2007 in public primary care clinics in São Paulo, Brazil. Participants (n=168 completed a detailed structured questionnaire. Logistic regression was used to examine the association between years of schooling and planned pregnancy. After adjusting for the covariates income, wealth score, crowding, age, marital status, and race, planned pregnancy was independently associated with lower years of education (odds ratio: 1.82; 95% confidence interval: 1.02–3.23. Although this finding may be related to these adolescents having less access to information and health services, another possible explanation is that they have a greater desire to have children during adolescence. Keywords: adolescent pregnancy, planned pregnancy, Brazil, low-income population, women
Moura, Cristiano; Cavalcanti, Alessandro Leite; Gusmão, Estela Santos; Soares, Renata de Souza Coelho; Moura, Fabiana Torres Cavalcante; Santillo, Patrícia Morgana Hordonho
This study estimated the prevalence of negative self-perception of smile because of occlusion abnormalities and investigated their association according to standard clinical criteria. The sample consisted of 1290 randomly selected Brazilian adolescent boys and girls aged 12-16 years. The outcome of interest was dissatisfaction with smile, and data were collected using a standardized questionnaire. Occlusion characteristics were assessed using the dental aesthetic index (DAI). The other study variables were gender, age, and use of dental services. A chi-square test and Poisson multiple regression were used for statistical analysis. Of the 1290 students interviewed and examined, 539 (41.8 per cent) were dissatisfied with their smile; of these, 373 (69.2 per cent) assigned their dissatisfaction to the presence of an occlusal abnormality, and 166 (30.8 per cent) reported reasons other than occlusal abnormalities for their negative self-perception of their smile. In multivariate analysis, the following variables were associated with the outcome of interest: maxillary anterior irregularity [prevalence ratio (PR) = 1.40; 95 per cent confidence interval (CI) = 1.29-1.80], incisal spacing (PR = 1.37; 95 per cent CI = 1.19-1.57), vertical open bite (PR = 1.34; 95 per cent CI = 1.15-1.55), mandibular anterior irregularity (PR = 1.29; 95 per cent CI = 1.14-1.46), permanent anterior teeth missing (PR = 1.21; 95 per cent CI = 1.05-1.39), and incisal diastema (PR = 1.14; 95 per cent CI = 1.01-1.31). The negative self-perception of smile was statistically associated with severity of occlusal disorders according to the DAI scores, which suggests that self-perception should be used together with standard clinical criteria when decisions about orthodontic treatments are made in public health care systems.
Full Text Available Gaucher disease (GD, the most prevalent lysosome storage disorder, presents an autosomal recessive mode of inheritance. It is a paradigm for therapeutic intervention in medical genetics due to the existence of effective enzyme replacement therapy. We report here the analysis of GD in 262 unrelated Brazilian patients, carried out in order to establish the frequency of the most common mutations and to provide prognostic information based on genotype-phenotype correlations. Among 247 type 1 GD patients, mutation N370S was detected in 47% of all the alleles, but N370S/N370S homozygosity was found in only 10% of the patients, a much lower frequency than expected, suggesting that most individuals presenting this genotype may not receive medical attention. Recombinant alleles were detected at a high frequency: 44% of the chromosomes bearing mutation L444P had other mutations derived from the pseudogene sequence, present in 25% of patients. Three neuronopathic type 2 patients were homozygous for L444P, all presenting additional mutations (E326K or recombinant alleles that probably lead to the more severe phenotypes. Six children, classified as type 1 GD patients, had a L444P/L444P genotype, showing that neuronopathic symptoms may only manifest later in life. This would indicate the need for a higher treatment dose during enzyme replacement therapy. Finally, mutation G377S was present in 4 homozygous type 1 patients and also in compound heterozygosity in 5 (42% type 3 patients. These findings indicate that G377S cannot be unambiguously classified as mild and suggest an allele-dose effect for this mutation.
Rodolfo Delfini Cançado
Full Text Available CONTEXT AND OBJECTIVE: Hemochromatosis is a common inherited disorder of iron metabolism and one of the most important causes of iron overload. The objective was to analyze the presence of C282Y, H63D and S65C mutations in the HFE gene and HLA-A alleles for a group of Brazilian patients with iron overload, and to correlate genotype with clinical and laboratory variables. DESIGN AND SETTING: Prospective study, in Discipline of Hematology and Oncology, Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo. METHODS: We studied 35 patients with iron overload seen at our outpatient unit between January 2001 and December 2003. Fasting levels of serum iron and ferritin, and total iron-binding capacity, were assayed using standard techniques. Determinations of C282Y, H63D and S65C mutations in the HFE gene and of HLA-A alleles were performed by polymerase chain reaction (PCR. RESULTS: Twenty-six out of 35 patients (74% presented at least one of the HFE gene mutations analyzed. Among these, five (14% were C282Y/C282Y, four (11% C282Y/H63D, one (3% H63D/H63D, six (17% C282Y/WT and ten (29% H63D/WT. No patients had the S65C mutation and nine (25% did not present any of the three HFE mutations. Four out of five patients with C282Y/C282Y genotype (80% and three out of four patients with C282Y/H63D genotype (75% were HLA A*03. CONCLUSION: Analysis of HFE gene mutations constitutes an important procedure in identifying patients with hereditary hemochromatosis, particularly for patients with iron overload.
De Jesus, Maria; Earl, Tara R
Mental health providers are increasingly coming into contact with large and growing multi-racial/ethnic and immigrant patient populations in the United States. Knowledge of patient perspectives on what constitutes quality mental health care is necessary for these providers. The aim of this study was to identify indicators of quality of mental health care that matter most to two underrepresented immigrant patient groups of Portuguese background: Brazilians and Cape Verdeans. A qualitative design was adopted using focus group discussions. Six focus groups of patients (n=24 Brazilians; n=24 Cape Verdeans) who received outpatient mental health treatment through public safety net clinics in the northeast region of the United States were conducted. The Consensual Qualitative Research analytic method allowed us to identify three quality of care domains: provider performance, aspects of mental health care environment, and effectiveness of mental health care treatment. Provider performance was associated with five categories: relational, communication, linguistic, cultural, and technical competencies. Aspects of mental health care environment were linked to two categories: psychosocial and physical environment. Effectiveness of mental health care treatment was related to two categories: therapeutic relationship and treatment outcomes. Study findings provide useful data for the development of more culturally appropriate and effective patient-centered models and policies in mental health care.
Felipe Carneiro da Silva
Full Text Available Lynch syndrome (LS accounts for 3-5% of all colorectal cancers (CRC and is inherited in an autosomal dominant fashion. This syndrome is characterized by early CRC onset, high incidence of tumors in the ascending colon, excess of synchronous/metachronous tumors and extra-colonic tumors. Nowadays, LS is regarded of patients who carry deleterious germline mutations in one of the five mismatch repair genes (MMR, mostly in MLH1 and MSH2, but also in MSH6, PMS1 and PMS2. To comprehensively characterize 116 Brazilian patients suspected for LS, we assessed the frequency of germline mutations in the three minor genes MSH6, PMS1 and PMS2 in 82 patients negative for point mutations in MLH1 and MSH2. We also assessed large genomic rearrangements by MLPA for detecting copy number variations (CNVs in MLH1, MSH2 and MSH6 generating a broad characterization of MMR genes. The complete analysis of the five MMR genes revealed 45 carriers of pathogenic mutations, including 25 in MSH2, 15 in MLH1, four in MSH6 and one in PMS2. Eleven novel pathogenic mutations (6 in MSH2, 4 in MSH6 and one in PMS2, and 11 variants of unknown significance (VUS were found. Mutations in the MLH1 and MSH2 genes represented 89% of all mutations (40/45, whereas the three MMR genes (MSH6, PMS1 and PMS2 accounted for 11% (5/45. We also investigated the MLH1 p.Leu676Pro VUS located in the PMS2 interaction domain and our results revealed that this variant displayed no defective function in terms of cellular location and heterodimer interaction. Additionally, we assessed the tumor phenotype of a subset of patients and also the frequency of CRC and extra-colonic tumors in 2,365 individuals of the 116 families, generating the first comprehensive portrait of the genetic and clinical aspects of patients suspected of LS in a Brazilian cohort.
Rodriguez, David Enrique Aguilar; Lima, Carmen Silvia Passos; Lourenço, Gustavo Jacob; Figueiredo, Maria Estela; Carneiro, Jorge David Aivazoglu; Tone, Luiz Gonzaga; Llerena Jr., Juan Clinton; Toscano, Raquel Alves; Brandalise, Silvia; Pinto Júnior, Walter; Costa, Fernando Ferreira; Bertuzzo, Carmen Sílvia
Fanconi anaemia (FA) is a recessive autosomal disease determined by mutations in genes of at least eleven complementation groups, with distinct distributions in different populations. As far as we know, there are no reports regarding the molecular characterisation of the disease in unselected FA patients in Brazil. OBECTIVE: This study aimed to investigate the most prevalent mutations of FANCA and FANCC genes in Brazilian patients with FA. METHODS: Genomic DNA obtained from 22 racially and et...
Denilson C. Albuquerque
Full Text Available OBJECTIVE: To evaluate the efficacy, safety and tolerability of sildenafil among Brazilian patients with hypertension treated with combinations of anti-hypertensive drugs. MATERIALS AND METHODS: One hundred twenty hypertensive men aged 30 to 81 years old under treatment with 2 or more anti-hypertensive drugs and with erectile dysfunction (ED lasting for at least 6 months were enrolled at 7 research centers in Brazil. Patients were randomized to receive treatment with either sildenafil or placebo taken 1 hour before sexual intercourse (initial dose of 50 mg, adjusted to 25 mg or 100 mg according to efficacy and toxicity. During the following 8 weeks, patients were evaluated regarding vital signs, adverse events, therapeutic efficacy, satisfaction with treatment and use of concurrent medications. RESULTS: The primary evaluation of efficacy, which was based on responses to questions 3 and 4 of the International Index of Erectile Function, showed significant differences regarding treatment with sildenafil (p = 0.0002 and p < 0.0001, respectively. In the assessment of global efficacy, 87% of the patients treated with sildenafil reported improved erections, as compared with 37% of patients given placebos (p < 0.0001. The other secondary evaluations supported the results favoring sildenafil. The most frequent adverse events among patients treated with sildenafil were headaches (11.4%, vasodilation (11.4% and dyspepsia (6.5%. There were no significant changes in blood pressure measurements in both groups. CONCLUSION: Sildenafil is efficacious and safe for the treatment of hypertensive patients with ED who receive concurrent combinations of anti-hypertensive drugs.
Jasper Guimarães Santos
Full Text Available Objective (1 To evaluate whether the Nine Items Questionnaire (WOQ-9 for the detection of wearing-off (WO in Parkinson Disease (PD, by means of its screening ability, is a helpful tool to assist neurologists in diagnosing WO; (2 To determine the sensitivity and the specificity of a free Brazilian Portuguese translation of WOQ-9. Method A sample obtained by convenience included 60 patients. The WOQ-9 was answered by the patients themselves before their routine consultations. The detection of the WO by the WOQ-9 was compared with the neurologist assessment. Statistical significance was 5%. Results The WOQ-9 showed sensitivity of 100%, specificity of 10.3%, positive and negative predictive values of 54.4% and 100% respectively. The identification of WO by the WOQ-9 was congruent in 54.5% of cases with neurological evaluation. Conclusion The WOQ-9 is a convenient screening tool to aid physicians to detect WO in PD patients, and it is a quick and easy self-administered questionnaire.
Full Text Available Cognitive impairment is a symptom of multiple sclerosis (MS. Different clinical forms of multiple sclerosis have different cognitive profiles, according to findings of previous studies which used extensive batteries of neuropsychological tests. OBJECTIVE: To investigate cognitive profiles of Brazilian patients with relapsing-remitting multiple sclerosis (RRMS and primary progressive multiple sclerosis (PPMS by using a brief battery of neuropsychological tests. METHOD: Sixty-six patients, within 18-65 of age and 3-18 years of education, were paired with healthy control subjects, regarding gender, age, and education level. RESULTS: On Symbol Digit Modalities Test and Hooper Visual Organization Test, cognition was affected in 50% in RRMS and 69% in PPMS. Fluency of "F" was impaired in 24% of RRMS and 81% of PPMS. Immediate recall was affected in 32% of RRMS and in 63% of PPMS; whereas late recall, in 46% of relapsing-remitting and in 69% of primary progressive. CONCLUSION: Cognitive profiles of relapsing-remitting and primary progressive patients are different
Pereira, Carlos Alberto Pires; Marra, Alexandre R.; Camargo, Luis Fernando Aranha; Pignatari, Antônio Carlos Campos; Sukiennik, Teresa; Behar, Paulo Renato Petersen; Medeiros, Eduardo Alexandrino Servolo; Ribeiro, Julival; Girão, Evelyne; Correa, Luci; Guerra, Carla; Carneiro, Irna; Brites, Carlos; Reis, Marise; de Souza, Marta Antunes; Tranchesi, Regina; Barata, Cristina U.; Edmond, Michael B.
Background Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality and are the most frequent type of nosocomial infection in pediatric patients. Methods We identified the predominant pathogens and antimicrobial susceptibilities of nosocomial bloodstream isolates in pediatric patients (≤16 years of age) in the Brazilian Prospective Surveillance for nBSIs at 16 hospitals from 12 June 2007 to 31 March 2010 (Br SCOPE project). Results In our study a total of 2,563 cases of nBSI were reported by hospitals participating in the Br SCOPE project. Among these, 342 clinically significant episodes of BSI were identified in pediatric patients (≤16 years of age). Ninety-six percent of BSIs were monomicrobial. Gram-negative organisms caused 49.0% of these BSIs, Gram-positive organisms caused 42.6%, and fungi caused 8.4%. The most common pathogens were Coagulase-negative staphylococci (CoNS) (21.3%), Klebsiella spp. (15.7%), Staphylococcus aureus (10.6%), and Acinetobacter spp. (9.2%). The crude mortality was 21.6% (74 of 342). Forty-five percent of nBSIs occurred in a pediatric or neonatal intensive-care unit (ICU). The most frequent underlying conditions were malignancy, in 95 patients (27.8%). Among the potential factors predisposing patients to BSI, central venous catheters were the most frequent (66.4%). Methicillin resistance was detected in 37 S. aureus isolates (27.1%). Of the Klebsiella spp. isolates, 43.2% were resistant to ceftriaxone. Of the Acinetobacter spp. and Pseudomonas aeruginosa isolates, 42.9% and 21.4%, respectively, were resistant to imipenem. Conclusions In our multicenter study, we found a high mortality and a large proportion of gram-negative bacilli with elevated levels of resistance in pediatric patients. PMID:23861860
Larissa Rodrigues Gomes
Full Text Available Anti-glycosylphosphatidylinositol (GPI antibodies (Abs may reflect and mediate, at least partially, anti-disease immunity in malaria by neutralising the toxic effect of parasitic GPI. Thus, we assessed the anti-GPI Ab response in asymptomatic individuals living in an area of the Brazilian Amazon that has a high level of malaria transmission. For comparative purposes, we also investigated the Ab response to a crude extract prepared from Plasmodium falciparum, the merozoite surface protein (MSP3 antigen of P. falciparum and the MSP 1 antigen of Plasmodium vivax (PvMSP1-19 in these individuals and in Angolan patients with acute malaria. Our data suggest that the Ab response against P. falciparum GPI is not associated with P. falciparum asymptomatic infection in individuals who have been chronically exposed to malaria in the Brazilian Amazon. However, this Ab response could be related to ongoing parasitaemia (as was previously shown in the Angolan patients. In addition, our data show that PvMSP1-19may be a good marker antigen to reflect previous exposure to Plasmodium in areas that have a high transmission rate of P. vivax.
Full Text Available The human beta defensin 1 (hBD-1 antimicrobial peptide is a member of the innate immune system known to act in the first line of defence against microorganisms, including viruses such as human papillomavirus (HPV. In this study, five functional polymorphisms (namely g-52G>A, g-44C>G and g-20G>A in the 5’UTR and c.*5G>A and c.*87A>G in the 3’UTR in the DEFB1 gene encoding for hBD-1 were analysed to investigate the possible involvement of these genetic variants in susceptibility to HPV infection and in the development of HPV-associated lesions in a population of Brazilian women. The DEFB1 g-52G>A and c.*5G>A single-nucleotide polymorphisms (SNPs and the GCAAA haplotype showed associations with HPV-negative status; in particular, the c.*5G>A SNP was significantly associated after multiple test corrections. These findings suggest a possible role for the constitutively expressed beta defensin-1 peptide as a natural defence against HPV in the genital tract mucosa.
Renata Rigacci Abdalla
Full Text Available Objective: To investigate the association of alcohol and cocaine use with urban violence (both as victim and as perpetrator in a representative sample of the Brazilian population. Method: The Second Brazilian Alcohol and Drugs Survey (II BNADS interviewed 4607 individuals aged 14years and older from the Brazilian household population including an oversample of 1157 adolescents (14 to 18years old. The survey gathered information on alcohol, tobacco and illegal substances use as well as on risk factors for abuse and dependence, behaviors associated with the use of substances and the possible consequences, as urban violence indicators. Results: Approximately 9.3% of the Brazilian population has been victim of at least one form of urban violence. This proportion increases to 19.7% among cocaine users and to 18.1% among individuals with alcohol use disorders (AUD. Perpetration of violence was reported by 6.2% of the sample. Cocaine use and AUD increased in almost four times the chances of being an aggressor. Being religious and married decreased the chances of being a victim and/or perpetrador of urban violence. Higher education also decreased the chances of involvement in both victimization or perpetration of violence. Both Parallel Mediation Models considering cocaine use as a predictor of urban violence (victimization or perpetration were valid and alcohol consumption and depressive symptoms were mediators of this relationship. Conclusions: This study presents relevant data of interest to Brazil as this country is one of the major consumer market of cocaine and also is among the most violent countries worldwide. Keywords: Urban violence, Cocaine, Alcohol use disorder, Household survey, Epidemiology
Machado Arruda, Soraia Pinheiro; da Silva, Antônio Augusto Moura; Kac, Gilberto; Vilela, Ana Amélia Freitas; Goldani, Marcelo; Bettiol, Heloisa; Barbieri, Marco Antônio
The objective of the present study was to investigate whether dietary patterns are associated with excess weight and abdominal obesity among young adults (23-25 years). A cross-sectional study was conducted on 2061 participants of a birth cohort from Ribeirão Preto, Brazil, started in 1978-1979. Twenty-seven subjects with caloric intake outside ±3 standard deviation range were excluded, leaving 2034 individuals. Excess weight was defined as body mass index (BMI ≥ 25 kg/m(2)), abdominal obesity as waist circumference (WC > 80 cm for women; >90 cm for men) and waist/hip ratio (WHR > 0.85 for women; >0.90 for men). Poisson regression with robust variance adjustment was used to estimate the prevalence ratio (PR) adjusted for socio-demographic and lifestyle variables. Four dietary patterns were identified by principal component analysis: healthy, traditional Brazilian, bar and energy dense. In the adjusted analysis, the bar pattern was associated with a higher prevalence of excess weight (PR 1.46; 95 % CI 1.23-1.73) and abdominal obesity based on WHR (PR 2.19; 95 % CI 1.59-3.01). The energy-dense pattern was associated with a lower prevalence of excess weight (PR 0.73; 95 % CI 0.61-0.88). Men with greater adherence to the traditional Brazilian pattern showed a lower prevalence of excess weight (PR 0.65; 95 % CI 0.51-0.82), but no association was found for women. There was no association between the healthy pattern and excess weight/abdominal obesity. In this sample, the bar pattern was associated with higher prevalences of excess weight and abdominal obesity, while the energy-dense (for both genders) and traditional Brazilian (only for men) patterns were associated with lower prevalences of excess weight.
Malta, Deborah Carvalho; Bernal, Regina Tomie Ivata; Andrade, Silvânia Suely Caribé de Araújo; Silva, Marta Maria Alves da; Velasquez-Melendez, Gustavo
To analyze factors associated with self-reported high blood pressure among adults in Brazilian state capitals. The study uses data from Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel - Surveillance System of Risk and Protection Factors of Noncommunicable Diseases by Telephone Survey) collected in 2013. Prevalence rates and their respective 95% confidence intervals by gender were estimated according to sociodemographic variables, lifestyle, reported noncommunicable diseases and self-rated health status. Multivariate logistic regression modeling was used to identify variables associated with self-reported high blood pressure with α high blood pressure among adults living in Brazilian state capitals and the Federal District was 24.1%. The following variables were associated with self-reported high blood pressure: age group, taking 18-24 as reference (all age groups presented increased risk - from 25-34 years [OR = 2.6; 95%CI 2.0-3.4] up to 65 years or more [OR = 28.1; 95%CI 21.7-36.4]); low education level (9 to 11 years of study [OR = 0.8; 95%CI 0.7-0.9] and 12 years or more [OR = 0.6; 95%CI 0.6-0.7]); Black race or skin color (OR = 1.3; 95%CI 1.1-1.5); being a former smoker (OR = 1.2; 95%CI 1.1-1.3); obesity (OR = 2.7; 95%CI 2.4-3.0); diabetes (OR = 2.9; 95%CI 2.5-3.5%), and high cholesterol (OR = 1.9; 95%CI 1.8-2.2). Approximately one quarter of the adult population living in Brazilian state capitals reported having high blood pressure. Information from Vigitel is useful to monitor high blood pressure and identity its associated factors, supporting public policies for health promotion, surveillance and care. Analisar os fatores associados à hipertensão arterial autorreferida entre adultos nas capitais brasileiras. Estudo com os dados do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel) coletados no ano de 2013. Foram estimadas
Assunção, Ada Ávila; Abreu, Mery Natali Silva
To describe the prevalence of work-related musculoskeletal disorder (WMSD) and analyze the factors associated with this outcome in the Brazilian population. In this cross-sectional, population-based study, we use data from the National Survey on Health (PNS) of 2013. The sample was composed of 60,202 Brazilians aged 18 years or older. The outcome variable was the occurrence of self-reported WMSD. Sociodemographic and occupational characteristics, personal resources, and health conditions were investigated as explanatory variables. Analyses were performed with the software Stata 12.0 and considered the weighting imposed by the sampling design of the study. Then, univariate and multivariate binary logistic models were carried out, considering a significance level of 5%. The results obtained indicated that the prevalence of WMSD in the Brazilian population was of 2.5%, ranging from 0.2% (Acre) to 4.2% (Santa Catarina). The factors associated with a greater chance of occurrence of WMSD were: female sex (OR = 2.33; 95%CI 1.72-3.15); be temporarily away from work (OR = 2.44; 95%CI 1.41-4.23); be exposed to noise at the workplace (OR = 2.16; 95%CI 1.68-2.77); seniority equal to or greater than 4.5 years at the current job (OR = 1.37; 95%CI 1.09-1.72); participate in volunteer work (OR = 1.65; 95%CI 1.25-2.17); report medical diagnosis of arthritis or rheumatism (OR = 2.40; 95%CI 1.68-3.44); and depression (OR = 2.48; 95%CI 1.86-3.31). On the other hand, factors associated with less chance of WMSD were: not having a partner (OR = 0.73; 95%CI 0.37-0.71) and working in an open environment (OR = 0.51; 95%CI 0.37-0.71). The associated factors and the prevalence found indicate regional and gender differences. Special attention to comorbidities and environmental noise monitoring would benefit the health of workers in the Country. Descrever a prevalência de distúrbio osteomuscular relacionado ao trabalho (Dort) e analisar os fatores associados com esse desfecho na popula
Vieira, E; Maia, H S; Monteiro, C B; Carvalho, L M; Tonon, T; Vanz, A P; Schwartz, I V D; Ribeiro, M G
Early dietary treatment of phenylketonuria (PKU), an inborn error of phenylalanine (Phe) metabolism, results in normal cognitive development. Although health-related quality of life (HRQoL) of PKU patients has been reported as unaffected in high-income countries, there are scarce data concerning HRQoL and adherence to treatment of PKU children and adolescents from Brazil. The present study compared HRQoL scores in core dimensions of Brazilian early-treated PKU pediatric patients with those of a reference population, and explored possible relationships between adherence to treatment and HRQoL. Early-treated PKU pediatric patient HRQoL was evaluated by self- and parent-proxy reports of the Pediatric Quality of Life Inventory (PedsQL) core scales. Adherence to treatment was evaluated by median Phe levels and percentage of results within the therapeutic target range in two periods. Means for total and core scales scores of PedsQL self- and parent proxy-reports of PKU patients were significantly lower than their respective means for controls. Adequacy of median Phe concentrations and the mean percentage of values in the target range fell substantially from the first year of life to the last year of this study. There was no significant difference in mean total and core scale scores for self- and parent proxy-reports between patients with adequate and those with inadequate median Phe concentrations. The harmful consequences for intellectual capacity caused by poor adherence to dietary treatment could explain the observed decrease in all HRQoL scales, especially in school functioning. Healthcare system and financial difficulties may also have influenced negatively all HRQoL dimensions.
Palhares, Daniel M F; Marcolino, Milena S; Santos, Thales M M; da Silva, José L P; Gomes, Paulo R; Ribeiro, Leonardo B; Macfarlane, Peter W; Ribeiro, Antonio L P
Knowledge of the normal limits of the electrocardiogram (ECG) is mandatory for establishing which patients have abnormal ECGs. No studies have assessed the reference standards for a Latin American population. Our aim was to establish the normal ranges of the ECG for pediatric and adult Brazilian primary care patients. This retrospective observational study assessed all the consecutive 12-lead digital electrocardiograms of primary care patients at least 1 year old in Minas Gerais state, Brazil, recorded between 2010 and 2015. ECGs were excluded if there were technical problems, selected abnormalities were present or patients with selected self-declared comorbidities or on drug therapy. Only the first ECG from patients with multiple ECGs was accepted. The University of Glasgow ECG analysis program was used to automatically interpret the ECGs. For each variable, the 1st, 2nd, 50th, 98th and 99th percentiles were determined and results were compared to selected studies. A total of 1,493,905 ECGs were recorded. 1,007,891 were excluded and 486.014 were analyzed. This large study provided normal values for heart rate, P, QRS and T frontal axis, P and QRS overall duration, PR and QT overall intervals and QTc corrected by Hodges, Bazett, Fridericia and Framingham formulae. Overall, the results were similar to those from other studies performed in different populations but there were differences in extreme ages and specific measurements. This study has provided reference values for Latinos of both sexes older than 1 year. Our results are comparable to studies performed in different populations.
Maria Helena Vaisbich
Full Text Available INTRODUCTION: Nephrogenic diabetes insipidus is characterized by a lack of response in the distal nephron to the antidiuretic hormone arginine vasopressin. Manifestations include polyuria, polydipsia, hyposthenuria, recurrent episodes of dehydration and fever and growth failure. Most cases are caused by mutations in the AVPR2 gene. The mutant receptors are trapped intracellularly. METHOD: We studied five boys using clinical, laboratory and molecular data. The mean age at diagnosis was 14.6 months (range 6 to 24 and 12.2 years (7.8 to 19 after the follow-up period. The mean period of follow-up was 132.2 ± 50.9 months. RESULTS: The geometric means of the z-scores of weight and stature were -4.5 and -3.6, respectively, at diagnosis. At the last medical appointment, the z-scores of weight and stature were -0.3 and -0.9, respectively. Three patients were diagnosed with ureterohydronephrosis and exhibited increased post-void urine volume. Mutations in the AVPR2 gene were found in all patients, and the carrier status was confirmed in four of five cases. Two unrelated children presented identical mutations (S167L in arginine vasopressin R2. Two of the patients had a mutation that has already been described in other Brazilian families (R337X, and one patient showed a de novo mutation (Y128D in arginine vasopressin R2, since his mother's molecular analysis was normal. The recurrence risk for this family was significantly reduced. CONCLUSION: This study reports the clinical and laboratory characterization of Nephrogenic diabetes insipidus and reiterates the importance of the genetic basis that underlies the disease diagnosis and genetic counseling.
Eshriqui, Ilana; Vilela, Ana Amélia Freitas; Rebelo, Fernanda; Farias, Dayana Rodrigues; Castro, Maria Beatriz Trindade; Kac, Gilberto
To identify gestational dietary patterns and evaluate the association between these patterns and the blood pressure (BP) rate of change during pregnancy and the postpartum. Prospective cohort study composed of 191 healthy pregnant women. Systolic BP (SBP) and diastolic BP (DBP) were obtained at the 5th-13th, 20th-26th, 30th-36th gestational weeks, and with 30-45 days postpartum. A food frequency questionnaire administered at the 30th-36th gestational week was used to measure dietary intake during pregnancy. Principal component analysis was performed to identify the dietary patterns. A longitudinal linear mixed-effects regression model was used to evaluate the association between the dietary patterns and BP (adjusted for time elapsed after conception and the women's age, education, parity, body mass index and total energy intake). Three gestational dietary patterns were identified: healthy, common-Brazilian and processed. SBP/DBP mean values (SD) were 110.1 (9.0)/66.9 (7.5), 108.7 (9.0)/64.9 (6.7), 111.3 (9.2)/67.0 (6.9) and 115.0 (10.7)/73.7 (8.6) mmHg at the first, second and third gestational trimesters and postpartum, respectively. Women with higher/lower adherence to the processed pattern presented SBP of 117.9 and 113.0 mmHg (P = 0.037), respectively, during postpartum. No association was found between any of the three dietary patterns and SBP in the multiple longitudinal linear regression models, whereas 1 SD increase in the common-Brazilian pattern was associated with a small change of DBP (β = 0.0006; 95% CI 4.66e-06, 0.001; P = 0.048). The three dietary patterns identified revealed no association with changes of SBP and DBP levels during pregnancy and at early postpartum in this sample of healthy Brazilian women.
Breder, Raphael; Leite, Marco Antonio Araujo; Pinto, Jony Arrais; Cavalcante, Igor Pinto; Pessoa, Bruno Lima; Neves, Marco Antônio Orsini
Recent publications have highlighted the low sensitivity of the Mini-Mental State Examination (MMSE) for the cognitive assessment of patients with Parkinson disease (PD). The Montreal Cognitive Assessment (MoCA), otherwise, has shown greater sensitivity when compared to the MMSE. Based on this, we have searched for the cognitive impairment measurable by the MoCA and the functional performance on activities of daily living in a sample of Brazilian patients with PD and normal MMSE. We hypothesized that the low sensitivity of the MMSE, already shown by other authors, could be replicated in a low-income country. To describe the performance on the MoCA and the dependence on third parties for activities of daily living in a sample of Brazilian patients with PD and normal MMSE. We evaluated 43 volunteers with PD and normal MMSE considering the Brazilian cutoffs. Cognitive performance was assessed through the MoCA and functional performance through a modified version of the Disability Assessment for Dementia Scale. Despite normal score on the MMSE, considering the Brazilian cutoffs, 62.7% of the volunteers performed below the literature cutoff for the MoCA (26 points). Furthermore, 30.2% had dependence on third party for activities of daily living. By using a strict cutoff for the MMSE (26 points), 56.7% performed below the MoCA cutoff and 24.3% had dependence for activities of daily living. Our findings confirm the limitations of the MMSE for the cognitive screening of patients with PD in a low-income country.
Full Text Available INTRODUCTION: The objective of this study was to identify the patterns of dental variables of adolescent Japanese-Brazilian descents with normal occlusion, and also to compare them with a similar Caucasian and Mongoloid sample. METHODS: Lateral cephalometric radiographs were used to compare the groups: Caucasian (n = 40, Japanese-Brazilian (n = 32 and Mongoloid (n = 33. The statistical tests used were one-way ANOVA and ANCOVA. The cephalometric measurements used followed the analyses of Steiner, Tweed and McNamara Jr. RESULTS: Statistical differences (P < 0.05 indicated a smaller interincisal angle and overbite for the Japanese-Brazilian sample, when compared to the Caucasian sample, although with similar values to the Mongoloid group. CONCLUSION: The dental patterns found for the Japanese-Brazilian descents were, in general, more similar to those of the Mongoloid sample.
Goudouris, Ekaterini Simões; Rego Silva, Almerinda Maria do; Ouricuri, Aluce Loureiro; Grumach, Anete Sevciovic; Condino-Neto, Antonio; Costa-Carvalho, Beatriz Tavares; Prando, Carolina Cardoso; Kokron, Cristina Maria; Vasconcelos, Dewton de Moraes; Tavares, Fabíola Scancetti; Silva Segundo, Gesmar Rodrigues; Barreto, Irma Cecília; Dorna, Mayra de Barros; Barros, Myrthes Anna; Forte, Wilma Carvalho Neves
In the last few years, new primary immunodeficiencies and genetic defects have been described. Recently, immunoglobulin products with improved compositions and for subcutaneous use have become available in Brazil. In order to guide physicians on the use of human immunoglobulin to treat primary immunodeficiencies, based on a narrative literature review and their professional experience, the members of the Primary Immunodeficiency Group of the Brazilian Society of Allergy and Immunology prepared an updated document of the 1st Brazilian Consensus, published in 2010. The document presents new knowledge about the indications and efficacy of immunoglobulin therapy in primary immunodeficiencies, relevant production-related aspects, mode of use (routes of administration, pharmacokinetics, doses and intervals), adverse events (major, prevention, treatment and reporting), patient monitoring, presentations available and how to have access to this therapeutic resource in Brazil. RESUMO Nos últimos anos, novas imunodeficiências primárias e defeitos genéticos têm sido descritos. Recentemente, produtos de imunoglobulina, com aprimoramento em sua composição e para uso por via subcutânea, tornaram-se disponíveis em nosso meio. Com o objetivo de orientar o médico no uso da imunoglobulina humana para o tratamento das imunodeficiências primárias, os membros do Grupo de Assessoria em Imunodeficiências da Associação Brasileira de Alergia e Imunologia produziram um documento que teve por base uma revisão narrativa da literatura e sua experiência profissional, atualizando o I Consenso Brasileiro publicado em 2010. Apresentam-se novos conhecimentos sobre indicações e eficácia do tratamento com imunoglobulina nas imunodeficiências primárias, aspectos relevantes sobre a produção, forma de utilização (vias de administração, farmacocinética, doses e intervalos), efeitos adversos (principais efeitos, prevenção, tratamento e notificação), monitorização do
Full Text Available Neurological disorders associated with glutamic acid decarboxylase (GAD antibodies are rare pleomorphic diseases of uncertain cause, of which stiff-person syndrome (SPS is the best-known. Here, we described nine consecutive cases of neurological disorders associated with anti-GAD, including nine patients with SPS and three cases with cerebellar ataxia. Additionally, four had hypothyroidism, three epilepsy, two diabetes mellitus and two axial myoclonus.
Enes, Sandra Maria Sampaio; Opitz, Simone Perufo; Faro, André Ricardo Maia da Costa de; Pedreira, Mavilde de Luz Gonçalves
To identify the presence of phlebitis and the factors that influence the development of this complication in adult patients admitted to hospital in the western Brazilian Amazon. Exploratory study with a sample of 122 peripheral intravenous catheters inserted in 122 patients in a medical unit. Variables related to the patient and intravenous therapy were analyzed. For the analysis, we used chi-square tests of Pearson and Fisher exact test, with 5% significance level. Complication was the main reason for catheter removal (67.2%), phlebitis was the most frequent complication (31.1%). The mean duration of intravenous therapy use was 8.81 days in continuous and intermittent infusion (61.5%), in 20G catheter (39.3%), inserted in the dorsal hand vein arc (36.9 %), with mean time of usage of 68.4 hours. The type of infusion (p=0.044) and the presence of chronic disease (p=0.005) and infection (p=0.007) affected the development of phlebitis. There was a high frequency of phlebitis in the sample, being influenced by concomitant use of continuous and intermittent infusion of drugs and solutions, and more frequent in patients with chronic diseases and infection. Identificar a presença de flebite e os fatores que influenciam o desenvolvimento desta complicação em pacientes adultos internados em hospital da Amazônia Ocidental Brasileira. Estudo exploratório, com amostra de 122 cateteres intravenosos periféricos instalados em 122 pacientes de uma unidade de clínica médica. Foram analisadas variáveis relacionadas ao paciente e à terapia intravenosa. Para a análise utilizaram-se os testes de Qui-quadrado de Pearson e Exato de Fisher, com nível de significância de 5%. A complicação foi o principal motivo da retirada do cateter (67,2%), e a flebite a complicação mais frequente (31,1%). O tempo médio de uso de terapia intravenosa foi de 8,81 dias, em infusão contínua e intermitente (61,5%), em cateter calibre 20G (39,3%), inseridos nas veias do arco dorsal da m
Leite, Paula Mendonça; de Freitas, Aline A; Mourão, Aline de O Magalhães; Martins, Maria A P; Castilho, Rachel O
The aim of this study was to analyze factors associated with the consumption of medicinal plants by patients being treated with warfarin in a Brazilian anticoagulation clinic and to study the safety of medicinal plant use in patients on warfarin therapy. The study was performed as an observational cross-sectional analysis. Study participants were outpatients on long-term warfarin therapy for at least 2 months for atrial fibrillation or prosthetic cardiac valves. Interviews were carried out concerning information about the habits of medicinal herb consumption, and logistic regression analysis was performed to identify factors associated with the consumption of herbs. The scientific names of the medicinal plants were identified to search for information on the effects on the hemostasis of the interactions between the medicinal herbs reported and warfarin. The mean age of the 273 patients included was 60.8 years; 58.7% were women. Medicinal plants were used by 67% of the participants. No association between demographic and clinical data and the use of medicinal plants was identified. Patients reported a total of 64 different plants, primarily consumed in the form of tea. The plants were mainly used to treat respiratory tract and central nervous system disorders. About 40% of the plants cited have been reported to potentially interfere with the anticoagulation therapy, principally by potentiating the effects of warfarin, which could, increase the risk of bleeding. The use of medicinal plants was highly common and widespread in patients receiving warfarin as an anticoagulation therapy. Univariate analysis of variables associated with the consumption of herbs showed no statistically significant difference in the consumption of medicinal plants for any of the sociodemographic and clinical data. The medicinal plants that were reportedly consumed by the patients could affect hemostasis. This study reinforces the need for further studies evaluating the habits of patients
Cristofoletti, Maria F; Gimeno, Suely G A; Ferreira, Sandra R G; Cardoso, Marly A
The aim of this study was to investigate the association between the consumption of processed meat with overall, abdominal, and overall with abdominal obesity in a Japanese-Brazilian population, which is known to be at cardiometabolic risk. A total of 329 men and 443 women aged ≥ 30 years were evaluated in a cross-sectional population-based survey. Diagnosis of overall obesity and abdominal obesity were based on the World Health Organization (WHO) criteria for Asians. Food intake was assessed by a validated food frequency questionaire. In men, processed meat intake was positively associated with overall with abdominal obesity (OR 2.97; 95%CI 1.13-7.78) after adjustment. In women, only the red meat group was associated with overall with abdominal obesity after adjustment (OR 0.47, 95%CI 0.23-0.96). Our results showed that high intakes of processed meats were associated with overall with abdominal obesity in male Japanese-Brazilians, but not in females.
had an influence on the RVR rate (odds ratio [OR] =0.011; 95% confidence interval [CI]: 0.001–0.119; P<0.001/OR =13.004; 95% CI: 1.522–111.115; P=0.019, respectively.Conclusion: In this longitudinal multicenter cohort study conducted from the Brazilian perspective, differences were found in the RVR rates, favoring telaprevir over boceprevir for genotype 1 HCV-infected patients. In addition, the baseline viral load was associated with RVR achievement in both evaluated groups. As RVR is also reported in the literature as a predictor of the sustained virological response (SVR, further analyses of RVR as predictor of SVR outcomes should be further evaluated in Brazil. Keywords: hepatitis C, rapid virological response, protease inhibitors, telaprevir, boceprevir, multicenter
Aguiar, Helder de Souza; Nascimento, Paulo Tromboni de Souza; YU, Abraham Sin Oih
The study examines the fuzzy front end of the largest Brazilian socks manufacturer when its managers decided to diversify their business. At the time, further growth possibilities were stagnant and the option to increase earnings was to develop a new product platform to support a new business. This paper aims to analyze and understand the content of the decision making that led to the development of new sporting goods platform, brand and franchise. The company’s existing capabilities were tak...
Maria José Couto Oliveira
Full Text Available After the World Health Organization officially declared the end of the first pandemic of the XXI century in August 2010, the influenza A(H1N1pdm09 virus has been disseminated in the human population. In spite of its sustained circulation, very little on phylogenetic data or oseltamivir (OST resistance is available for the virus in equatorial regions of South America. In order to shed more light on this topic, we analysed the haemagglutinin (HA and neuraminidase (NA genes of influenza A(H1N1pdm09 positive samples collected during the pandemic period in the Pernambuco (PE, a northeastern Brazilian state. Complete HA sequences were compared and amino acid changes were related to clinical outcome. In addition, the H275Y substitution in NA, associated with OST resistance, was investigated by pyrosequencing. Samples from PE were grouped in phylogenetic clades 6 and 7, being clustered together with sequences from South and Southeast Brazil. The D222N/G HA gene mutation, associated with severity, was found in one deceased patient that was pregnant. Additionally, the HA mutation K308E, which appeared in Brazil in 2010 and was only detected worldwide the following year, was identified in samples from hospitalised cases. The resistance marker H275Y was not identified in samples tested. However, broader studies are needed to establish the real frequency of resistance in this Brazilian region.
Santos, I S; Griep, R H; Alves, M G M; Goulart, A C; Lotufo, P A; Barreto, S M; Chor, D; Benseñor, I M
Migraine is an important source of social burden and work-related costs. Studies addressing the association of migraine with job stress are rare. The aim of this paper was to study the association of job stress components and migraine using structured, validated questionnaires that were part of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The ELSA-Brasil is a multicentre cohort of 15,105 civil servants (12,096 current workers) in Brazil. Job strain was assessed using the 17-item Brazilian version of the Swedish Demand-Control-Support Questionnaire. Headache episodes in the preceding 12 months were assessed using a questionnaire based on the International Headache Society criteria. We analysed the association between job stress domains and migraine in men and women using adjusted logistic regression and interaction models. We included 3113 individuals without headache and 3259 migraineurs. Low job control [odds ratio (OR) 1.30; 95% confidence interval (95% CI) 1.10-1.53], high job demands (OR 1.37; 95% CI 1.18-1.59) and low social support (OR 1.49; 95% CI 1.29-1.71) were associated with migraine. Job control was more strongly associated with migraine in women (p for interaction = 0.02). High-strain (high demand and low control) jobs were associated with migraine in both men (OR 1.48; 95% CI 1.11-1.97) and women (OR 1.51; 95% CI 1.17-1.95). We observed a strong association between high-strain jobs and migraine. Job control was a stronger migraine-related factor for women. Low social support was associated with migraine in both sexes. © 2014 European Pain Federation - EFIC®
Bárbara B. Santana
Full Text Available Objective. This study investigated the association of the single nucleotide polymorphisms (SNPs in the FAS and FASL genes with the outcome of hepatitis B virus (HBV infection. Methods. Blood samples were collected from 116 HBV-infected patients at the Hospital of the Santa Casa de Misericordia Foundation (Belém, PA, Brazil. Seronegative individuals were used as controls. DNA samples were extracted from the leukocytes and assayed using the polymerase chain reaction (PCR followed by RFLP analysis with restriction endonucleases. Results. The frequencies of the mutant genotypes for -670FAS (GG, Ivs2nt-124FASL (GG, Ivs3nt-169FASL (ΔT/ΔT, and -844FASL (TT were higher in the HBV patients, and the FAS-1377AA genotype was more frequent in the control group; however, the differences between the allele and genotype frequencies were not statistically significant. When the HBV patient population was divided into two groups (inactive carriers and active chronic hepatitis patients, the mutant genotypes were found to be more prevalent in the active chronic hepatitis group with respect to the FAS gene polymorphisms; however, this difference was not statistically significant. Conclusions. The results suggest that the polymorphisms in FAS and FASL genes are not associated with HBV infection or even with the natural history of the infection in the Brazilian Amazon region.
Souza, D.R.S.; Nakazone, M.A.; Pinhel, M.A.S.; Alvares, R.M.; Monaco, A.C.; Pinheiro, A.; Barros, C.F.D.C.; Cury, P.M.; Cunrath, G.S.; Netinho, J.G.
We evaluated genetic variants of apolipoprotein E (APOE HhaI) and their association with serum lipids in colorectal cancer (CRC), together with eating habits and personal history. Eight-seven adults with CRC and 73 controls were studied. APOE*2 (rs7412) and APOE*4 (rs429358) were identified by polymerase chain reaction-restriction fragment length polymorphism. APOE gene polymorphisms were similar in both groups, but the ε4/ε4 genotype (6%) was present only in controls. The patients ...
de Castro, Alinne Pereira; Araújo, Samuel Dias; Reis, Alessandra M. M.; Pompeu, Maira; Hatay, Mark; de Moura, Rodrigo Leão; Francini-Filho, Ronaldo B.; Thompson, Fabiano L.; Krüger, Ricardo H.
The diversity of bacterial communities associated with three Brazilian endemic reef corals from genus Mussismilia (M. hispida, M. braziliensis, and M. harttii) at a single site was assessed using 16S rRNA clone libraries. The study site, Pedra do Leste, is a coastal reef within the largest and richest South Atlantic coralline reef complex (Abrolhos Bank) and is subject to high fishing pressure, high sedimentation loads, and other land-based stressors. The three coral species are Neogene relicts with unique biological and morphological traits that enable them to survive relatively high sedimentation levels. Our results show that sequences affiliated with γ-Proteobacteria predominated, accounting for more than 60% of the examined sequences. Indeed, the most frequent species were related to Alteromonas, Marinomonas, Neptuniibacter, and Vibrio, which are copiotrophic microorganisms common in environments highly affected by anthropogenic stress. Principal component analysis revealed that bacterial communities of M. braziliensis and M. hispida were more similar to each other than to M. harttii-associated bacteria. Such pattern is likely related to distinct morphological properties of M. harttii, such as the existence of phaceloid colonies, in which polyps are not connected by soft tissue. This is the first investigation assessing the bacterial communities of the three Brazilian endemic Mussismilia species at the same location.
de Oliveira Francisco, Daniela; de Paula Andres, Marina; Gueuvoghlanian-Silva, Bárbara Yasmim; Podgaec, Sergio; Fridman, Cintia
Based on the assumption that genetic factors are involved in the etiology of endometriosis, this study aimed to investigate the possibility of rs498679 (TLR4 gene), rs1799964 (TNF-α gene), rs3024496 (IL-10 gene), and rs2294021 (CCDC22 gene) polymorphisms being associated with the occurrence of this disease in a sample of Brazilian women. We conducted a case-control study with 100 women with histological confirmation of endometriosis (endometriosis group) and 100 women submitted to laparoscopy for benign disorders, in which the absence of endometriosis was confirmed (control group). All samples were genotyped by real-time PCR technique for rs498679, rs1799964, rs3024496, and rs2294021 polymorphisms. No significant difference was observed in genotypic or allelic frequencies between control and endometriosis groups for rs498679 (TLR4 gene), rs1799964 (TNF-α gene), rs3024496 (IL-10 gene), neither when comparing endometriosis subgroups (I-II versus III-IV). On the other hand, significant difference between stages I-II and III-IV of the disease was found in genotypic and allelic frequencies for the rs2294021 (CCDC22 gene) SNP (p = 0.048 and p = 0.017, respectively). Our results suggest that the rs2294021 (CCDC22 gene) polymorphism could be associated with increased susceptibility to endometriosis in Brazilian women when the allele C is present. In order to clarify this result, further studies should be conducted on a larger population.
Silveira, Cíntia Botelho; Pantoja, Ivaneida Kzarina Olaia Ribeiro; Silva, Allan Roberto Marques; Azevedo, Rômulo Nina de; Sá, Nayara Bandeira de; Turiel, Marck Gregório Pereira; Nunes, Mário Barbosa Guedes
End-stage chronic kidney disease (CKD) requiring dialysis affects the quality of life sometimes more severely than other chronic diseases, such as rheumatoid arthritis, heart failure, coronary artery disease, and chronic obstructive pulmonary disease, exerting a negative effect on the energy and vitality levels, limiting social interactions, and hindering psychic health. To evaluate the quality of life of patients with CKD on hemodialysis in a public Brazilian Amazonian hospital. Data were collected through interview based on the Brazilian version of the SF-36 questionnaire. The study was conducted on 50 patients (mean age, 48 ± 16 years; mean hemodialysis time, 3 ± 2.9 years). The most affected domain was role limitations due to physical health, with a mean score of 36 ± 36, and 58% of the patients in the lowest quartile, while mental health and social functioning were relatively preserved, with most patients in the highest quartile. Men obtained poorer scores than women did for role limitations due to physical health and vitality. Age correlated negatively with physical functioning. Patients on hemodialysis for more than one year had better scores in the social functioning domain, with a positive correlation between dialysis time and physical functioning. The domains assessed were globally impaired in the population studied, especially regarding role limitations due to physical health, suggesting that chronic disease with prolonged treatment has a negative influence on those domains.
Martins, Andréa Maria Eleutério de Barros Lima; Jardim, Lorena Amaral; Souza, João Gabriel Silva; Rodrigues, Carlos Alberto Quintão; Ferreira, Raquel Conceição; Pordeus, Isabela Almeida
This study aimed at identifying the prevalence of the negative evaluation of dental services among elderly Brazilians and at investigating whether the prevalence was higher among those using public or philanthropic provider services than among those paying privately or using private health plans. Additionally, factors associated with this negative assessment were identified. Interview and survey data were collected in the residences of participants by trained and calibrated examiners as part of a national epidemiological survey of oral health conditions of the Brazilian population in 2002/2003. The dependent variable was obtained in response to questions regarding whether the participant had ever used dental services, the frequency of use, and the quality of this service. Potential responses to the questions regarding the quality of service were very poor or poor, fair, and good or very good. The main independent variable was the system of health care used with potential responses being health plan or private, public, and philanthropic services. We conducted univariate (linear tendency χ2 test) and multiple descriptive analyses, and the partial proportional Odds model for ordinal logistic regression. Among the elderly, 196 (3.7%) evaluated the provided services negatively (very poor or poor). Participants with the following responses were more likely to evaluate the services negatively: those who had used public or philanthropic services, men, those with higher education, the ones who had not received information about preventing dental problems, those who perceived pain in their teeth and gums in the last six months, and those who self-reported their oral health and speech was poor. In conclusion, elderly Brazilian users of public and philanthropic services were more likely than users of private or insurance-based plans to evaluate their dental services negatively, regardless of the other investigated variables.
Reis Rodrigo S
Full Text Available Abstract Background The aim of this study was analyze associations between the practice of walking and environmental perception among elderly Brazilians in a region of low socioeconomic level. Methods A cross-sectional study was conducted among 385 elderly people aged 60 years and over. To evaluate walking, the International Physical Activity Questionnaire (IPAQ, long version (leisure and transport modules was used. The environment was evaluated by means of the Neighborhood Environmental Walkability Scale (NEWS (adapted Brazilian version. For the statistical analysis, multiple logistic regression models were created separately for men and women. The practice of at least 150 minutes a week of walking was the dependent variable, and the variables of environmental perception were the independent variables. All the models were controlled for schooling level and age. Results The proportion of elderly people active in walking was 56.9% for the men and 26.4% for the women. The perception of the presence of soccer fields (OR = 4.12 and their proximity, within ten minutes' walk from home (OR = 3.43, were associated with the practice of walking among the men. The perception of the presence of public squares (OR = 4.70 and the proximity of primary healthcare units, within ten minutes' walk from home (OR = 3.71, were associated with the practice of walking among the women. An association with adequate perception of vehicle traffic remained at the threshold of significance for the women. Conclusion Accessibility of leisure structures such as football fields and public squares and of health services such as primary healthcare units were important environmental variables associated with the practice of walking among elderly people living in a region of low socioeconomic level in Brazil. These variables need to be taken into consideration when aiming to promote the practice of walking among elderly people living in similar regions.
Jaime Natan Eisig
Full Text Available CONTEXT: The curative treatment of peptic ulcer is made available nowadays through the eradication of the bacterium Helicobacter pylori, which is associated with it, but the best therapeutic regimen is yet to be determined. OBJECTIVE: To assess the efficacy of a therapeutic regimen with 400 mg ranitidine bismuth citrate associated with 500 mg clarithromycin given twice a day for seven days in a cohort of Brazilian patients with peptic ulcer. TYPE OF STUDY: Cross-sectional study. SETTING: Tertiary-care hospital. PATIENTS: One hundred and twenty nine outpatients, with active or healed peptic ulcers infected by Helicobacter pylori, diagnosed via endoscopy with confirmation via the urease test and histological examination, who had never undergone a regimen for the eradication of the bacterium. PROCEDURE: Administration of 400 mg ranitidine-bismuth and 500 mg clarithromycin twice a day, for seven days. MAIN MEASUREMENTS: Efficacy of the treatment, with a check on the cure done via another endoscopy eight weeks after drug administration. The eradication of the bacterium was determined via the urease test and histological examination. Patients who were negative for both were considered to be cured. RESULTS: Eight patients failed to complete the study. The eradication rate according to intention to treat was 81% (104/129 and per protocol was 86% (104/121. CONCLUSION: The bismuth ranitidine compound associated with clarithromycin used for one week was shown to be a simple, effective and well-tolerated therapeutic regimen for the eradication of Helicobacter pylori.
Frazão, Paulo; Costa, Carla Maria; de Almeida, Márcia Furquim
Self-reported tendinitis/tenosynovitis was evaluated by gender, age group, skin color, family income, and educational and psychological status. !The study was carried out in a representative sample of formally contracted Brazilian workers from a household survey. A total of 54,660 participants were included. Occupations were stratified according to estimated prevalences of self-reported injuries. Non-conditional logistic regression was performed, and all variables were analyzed in two occupational groups. The overall prevalence rate of tendinitis/tenosynovitis was 3.1%: 5.5% in high-prevalence occupations (n = 10,726); and 2.5% in low-prevalence occupations (n = 43,934). White female workers between the ages of 45 and 64 years and at a higher socioeconomic level were more likely to report tendinitis/tenosynovitis regardless of their occupational category. An adjusted OR = 3.59 [95% CI: 3.15--4.09] was found between tendinitis/tenosynovitis and psychological status. Among formally contracted Brazilian workers, higher income can imply greater physical and psychological demands that, regardless of occupational stratum, increase the risk of tendinitis/tenosynovitis. (c) 2009 Wiley-Liss, Inc.
Souza, D R S; Nakazone, M A; Pinhel, M A S; Alvares, R M; Monaco, A C; Pinheiro, A; Barros, C F D C; Cury, P M; Cunrath, G S; Netinho, J G
We evaluated genetic variants of apolipoprotein E (APOE HhaI) and their association with serum lipids in colorectal cancer (CRC), together with eating habits and personal history. Eight-seven adults with CRC and 73 controls were studied. APOE*2 (rs7412) and APOE*4 (rs429358) were identified by polymerase chain reaction-restriction fragment length polymorphism. APOE gene polymorphisms were similar in both groups, but the epsilon4/epsilon4 genotype (6%) was present only in controls. The patients had reduced levels (mean +/- SD) of total cholesterol and low-density lipoprotein cholesterol fraction (180.4 +/- 49.5 and 116.1 +/- 43.1 mg/dL, respectively) compared to controls (204.2 +/- 55.6, P = 0.135 and 134.7 +/- 50.8 mg/dL; P = 0.330, respectively) indicating that they were not statistically significant after the Bonferroni correction. The APOE*4 allele was associated with lower levels of total cholesterol, low- and high-density lipoprotein cholesterol fraction and increased levels of very low-density lipoprotein cholesterol fraction and triglycerides only among patients (P = 0.014). There was a positive correlation between the altered lipid profile and increased body mass indexes in both groups (P hypertension and overweight was observed in controls (P < 0.002). In conclusion, the presence of the epsilon4/epsilon4 genotype only in controls may be due to a protective effect against CRC. Lower lipid profile values among patients, even those on lipid-rich diets associated with the APOE*4 allele, suggest alterations in the lipid synthesis and metabolism pathways in CRC.
Full Text Available We evaluated genetic variants of apolipoprotein E (APOE HhaI and their association with serum lipids in colorectal cancer (CRC, together with eating habits and personal history. Eight-seven adults with CRC and 73 controls were studied. APOE*2 (rs7412 and APOE*4 (rs429358 were identified by polymerase chain reaction-restriction fragment length polymorphism. APOE gene polymorphisms were similar in both groups, but the ε4/ε4 genotype (6% was present only in controls. The patients had reduced levels (mean ± SD of total cholesterol and low-density lipoprotein cholesterol fraction (180.4 ± 49.5 and 116.1 ± 43.1 mg/dL, respectively compared to controls (204.2 ± 55.6, P = 0.135 and 134.7 ± 50.8 mg/dL; P = 0.330, respectively indicating that they were not statistically significant after the Bonferroni correction. The APOE*4 allele was associated with lower levels of total cholesterol, low- and high-density lipoprotein cholesterol fraction and increased levels of very low-density lipoprotein cholesterol fraction and triglycerides only among patients (P = 0.014. There was a positive correlation between the altered lipid profile and increased body mass indexes in both groups (P < 0.010. Moreover, a higher rate of hypertension and overweight was observed in controls (P < 0.002. In conclusion, the presence of the ε4/ε4 genotype only in controls may be due to a protective effect against CRC. Lower lipid profile values among patients, even those on lipid-rich diets associated with the APOE*4 allele, suggest alterations in the lipid synthesis and metabolism pathways in CRC.
Werneck, André O; Cyrino, Edilson S; Collings, Paul J; Ronque, Enio R V; Szwarcwald, Célia L; Sardinha, Luís B; Silva, Danilo R
This study describes the levels and patterns of television (TV) viewing in Brazilian adults and investigates associations of TV viewing with hypertension, type 2 diabetes, and heart disease. Data from the Brazilian Health Survey, a nationally representative survey that was conducted in 2013 (N = 60,202 men and women aged ≥18 y), were used. Information regarding TV viewing, physician diagnoses of type 2 diabetes, hypertension, and heart disease was collected via interview-administered questionnaire. Data on covariables (including chronological age, educational status, skin color, sodium consumption, sugar consumption, tobacco smoking, alcohol consumption, and leisure-time physical activity) were also self-reported. Logistic regression models and population attributable fractions were used for the etiological analyses. The prevalence (95% confidence interval) of >4 hours per day of TV viewing was 12.7% (12.0-13.4) in men and 17.5% (16.8-18.3) in women. Men and women being younger or older, moderately educated, living alone, smoking tobacco, and drinking alcohol were associated with higher reported TV viewing time. Odds ratios (95% confidence interval) revealed that >4 hours per day of TV viewing was associated with type 2 diabetes [male: 1.64 (1.23-2.17) and female: 1.33 (1.09-1.63)], hypertension [male: 1.36 (1.14-1.63) and female: 1.20 (1.05-1.37)], and heart disease [male: 1.96 (1.43-2.69) and female: 1.30 (1.00-1.68)]. Exceeding 4 hours per day of TV viewing was responsible for 6.8% of type 2 diabetes, 3.7% of hypertension, and 7.5% of heart disease cases. Independent of covariates, >4 hours per day of TV viewing was associated with type 2 diabetes, hypertension, and heart disease. High volumes of TV viewing are prevalent and appear to contribute to chronic disease burden.
Turi, B C; Monteiro, H L; Lemes, Í R; Codogno, J S; Lynch, K R; Asahi Mesquita, C A; Fernandes, R A
The purpose of this study was to investigate the association between television (TV) viewing and all-cause mortality among Brazilian adults after 6 years of follow-up. This longitudinal study started in 2010 in the city of Bauru, SP, Brazil, and involved 970 adults aged ≥50 years. Mortality was reported by relatives and confirmed in medical records of the Brazilian National Health System. Physical activity (PA) and TV viewing were assessed by the Baecke questionnaire. Health status, sociodemographic and behavioral covariates were considered as potential confounders. After 6 years of follow-up, 89 deaths were registered (9.2% [95% CI=7.4%-11%]). Type 2 diabetes mellitus was associated with higher risk of mortality (P-value=.012). Deaths correlated significantly with age (ρ=.188; P-value=.001), overall PA score (ρ=-.128; P-value=.001) and TV viewing (ρ=.086; P-value=.007). Lower percentage of participants reported TV viewing time as often (16%) and very often (5.7%), but there was an association between higher TV viewing time ("often" and "very often" grouped together) and increased mortality after 6 years of follow-up (P-value=.006). The higher TV viewing time was associated with a 44.7% increase in all-cause mortality (HR=1.447 [1.019-2.055]), independently of other potential confounders. In conclusion, the findings from this cohort study identified increased risk of mortality among adults with higher TV viewing time, independently of PA and other variables. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Campos, Juliana Alvares Duarte Bonini; Spexoto, Maria Cláudia Bernardes; da Silva, Wanderson Roberto; Serrano, Sergio Vicente; Marôco, João
ABSTRACT Objective To evaluate the psychometric properties of the seven theoretical models proposed in the literature for European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), when applied to a sample of Brazilian cancer patients. Methods Content and construct validity (factorial, convergent, discriminant) were estimated. Confirmatory factor analysis was performed. Convergent validity was analyzed using the average variance extracted. Discriminant validity was analyzed using correlational analysis. Internal consistency and composite reliability were used to assess the reliability of instrument. Results A total of 1,020 cancer patients participated. The mean age was 53.3±13.0 years, and 62% were female. All models showed adequate factorial validity for the study sample. Convergent and discriminant validities and the reliability were compromised in all of the models for all of the single items referring to symptoms, as well as for the “physical function” and “cognitive function” factors. Conclusion All theoretical models assessed in this study presented adequate factorial validity when applied to Brazilian cancer patients. The choice of the best model for use in research and/or clinical protocols should be centered on the purpose and underlying theory of each model. PMID:29694609
Carmen R. Vargas
Full Text Available Adrenoleukodystrophy (X-ALD is an X-linked recessively inherited peroxisomal disorder, phenotypically heterogeneous, characterized by progressive white-matter demyelination of the central nervous system and adrenocortical insufficiency. We investigated 15 male X-ALD patients varying in age from 7 to 39, diagnosed among 108 suspected patients referred for investigation. Plasma levels of very long chain fatty acids (VLCFA were measured at our laboratory using gas chromatography (GC. Eleven cases of childhood X-ALD and four cases of adrenomyeloneuropathy (AMN were diagnosed. Adrenal leukodystrophy insufficiency and limb weakness were the most frequent symptoms, appearing in 12, 8 and 6 of the patients, respectively. Physician awareness of X-ALD seems inadequate to judge by age at diagnosis and lengthy interval between the start of symptoms and diagnosis. This is the first published series of Brazilian patients with X-ALD. We determined signs and symptoms relevant for diagnosis, as early identification seems important for treatment outcome. In addition, diagnosis identifies carriers, who could benefit from genetic counselling and prenatal diagnosis.Adrenoleucodistrofia (X-ALD é uma desordem peroxissomal com padrão de herança ligada ao X, fenotipicamente heterogênea, caracterizada por uma progressiva desmielinização da substância branca do sistema nervoso central e por insuficiência adrenal. Foram investigados por nós 15 pacientes do sexo masculino com sinais clínicos sugestivos de X-ALD, com idade entre 7 e 39 anos, diagnosticados entre 108 pacientes encaminhados para investigação por suspeita clínica. Os níveis plasmáticos dos ácidos graxos de cadeia muito longa (VLCFA foram dosados em nosso laboratório através de cromatografia gasosa (GC. Onze (73% casos da forma infantil de X-ALD (ALD e 4 (27% casos de adrenomieloneuropatia (AMN foram diagnosticados. Insuficiência leucodistrofia adrenal e fraqueza muscular foram os sinais mais
Villar, Livia M; de Melo, Maria M M; Calado, Izabelle A; de Almeida, Adilson J; Lampe, Elisabeth; Gaspar, Ana M C
Hepatitis A virus (HAV) superinfection is associated with a high risk of liver failure and death in patients with hepatitis C virus (HCV) infection. The aim of this study was to investigate the presence of serological and molecular HAV markers in a population of HCV-infected patients in order to determine a cost-effective strategy to vaccinate against HAV. The presence of total and immunoglobulin (Ig)M anti-HAV antibodies was investigated in 399 patients (median age, 50 years; range, 4-81) referred to the Public Health Central Laboratory of Pernambuco State who tested positive for anti-HCV antibodies and HCV RNA. HAV RNA was investigated by reverse transcription-nested polymerase chain reaction in these patients. Three hundred and eighty-four (96%) patients were positive for anti-HAV total and negative for IgM anti-HAV antibodies (immune patients). Three patients had IgM (and total) anti-HAV antibodies, showing an acute infection, and two of them had HAV RNA detected in serum samples. HAV RNA was also found in another patient in the absence of detectable anti-HAV antibodies. By nucleotide sequencing, it was demonstrated that the HAV isolates infecting these patients belonged to subgenotype 1B. This study provides valuable new data on anti-HAV prevalence among HCV carriers in Brazil. In the present study, we found a high proportion of patients with anti-HAV positivity, indicating that anti-HAV testing of HCV-infected patients is a cost-effective strategy and should be carried out before vaccination against HAV in these patients, particularly in regions such as our geographical area with high total anti-HAV prevalence.
Sousa, Carlos Augusto Moreira de; Bahia, Camila Alves; Constantino, Patrícia
Brazil has the sixth largest bicycles fleet in the world and bicycle is the most used individual transport vehicle in the country. Few studies address the issue of cyclists' accidents and factors that contribute to or prevent this event. VIVA is a cross-sectional survey and is part of the Violence and Accidents Surveillance System, Brazilian Ministry of Health. We used complex sampling and subsequent data review through multivariate logistic regression and calculation of the respective odds ratios. Odds ratios showed greater likelihood of cyclists' accidents in males, people with less schooling and living in urban and periurban areas. People who were not using the bike to go to work were more likely to suffer an accident. The profile found in this study corroborates findings of other studies. They claim that the coexistence of cyclists and other means of transportation in the same urban space increases the likelihood of accidents. The construction of bicycle-exclusive spaces and educational campaigns are required.
Schwingel, Paulo Adriano; Cotrim, Helma Pinchemel; Santos, Crimério Ribeiro dos; Santos, Adriano Oliveira dos; Andrade, Antônio Ricardo Cardia Ferraz de; Carruego, Marcos Vinicius Vilas Boas; Zoppi, Cláudio Cesar
The recreational use of anabolic-androgenic steroids (AAS) has reached alarming levels among healthy people. However, several complications have been related to consumption of these drugs, including liver disorders. To evaluate the prevalence of liver injuries in young Brazilian recreational AAS users. Between February/2007 and May/2012 asymptomatic bodybuilders who were ≥18 years old and reported AAS use for ≥6 months were enrolled. All had clinical evaluations, abdominal ultrasound (AUS), and blood tests. 182 individuals were included in the study. The median age (interquartile range) was 26.0 years (22.0-30.0) and all were male. Elevated liver enzyme levels were observed in 38.5% (n = 70) of AAS users, and creatine phosphokinase was normal in 27.1% (n = 19) of them. Hepatic steatosis was observed by AUS in 12.1% of the sample. One individual had focal nodular hyperplasia and another had hepatocellular adenoma. One case each of hepatitis B and C virus infection was found. A diagnosis of toxic liver injury was suggested in 23 (12.6%) AAS users without a history of alcohol or other medications/drugs consumption, or evidence of other liver diseases. Young Brazilian recreational AAS users presented a wide spectrum of liver injuries that included hepatotoxicity, fatty liver, and liver neoplasm. They also presented risk factors for liver diseases such as alcohol consumption and hepatitis B and C virus infection. The results suggest that the risk of AAS use for the liver may be greater than the esthetic benefits, and demonstrate the importance of screening AAS users for liver injuries.
Mónica Viviana Alvarado-Mora
Full Text Available The hepatitis B virus (HBV is among the leading causes of chronic hepatitis, cirrhosis and hepatocellular carcinoma. In Brazil, genotype A is the most frequent, followed by genotypes D and F. Genotypes B and C are found in Brazil exclusively among Asian patients and their descendants. The aim of this study was to sequence the entire HBV genome of a Caucasian patient infected with HBV/C2 and to infer the origin of the virus based on sequencing analysis. The sequence of this Brazilian isolate was grouped with four other sequences described in China. The sequence of this patient is the first complete genome of HBV/C2 reported in Brazil.
Renata Fragelli Fonseca
Full Text Available Members of the Herpesviridae family have been implicated in a number of tumours in humans. At least 75% of the human population has had contact with cytomegalovirus (HCMV. In this work, we screened 75 Brazilian glioma biopsies for the presence of HCMV DNA sequences. HCMV DNA was detected in 36% (27/75 of the biopsies. It is possible that HCMV could be a co-factor in the evolution of brain tumours.
Maria Letícia Santos Cruz
Full Text Available Challenges to the adherence to combination antiretroviral therapy among the pediatric population should be understood in the context of the trajectories of families, their interaction with healthcare services, and their access to material and symbolic goods. The present study analyzed individual, institutional and social factors that might be associated with the caregivers’ role in the treatment adherence of children and adolescents living with HIV (CALHIV. Based on semi-structured interviews and questionnaires applied to 69 caregivers seen at pediatric AIDS services of five Brazilian macro-regions, we observed that adherent caregivers had better acceptance of diagnosis and treatment, were less likely to face discrimination and social isolation secondary to AIDS-related stigma and tended to believe in the efficacy of treatment, and to be more optimistic about life perspectives of CALHIV. Interventions aiming to improve adherence and to promote the health of CALHIV should take in consideration the interplay of such different factors.
Cruz, Maria Letícia Santos; Cardoso, Claudete A. Araújo; Darmont, Mariana Q.; Dickstein, Paulo; Bastos, Francisco I.; Souza, Edvaldo; Andrade, Solange D.; Fabbro, Marcia D’All; Fonseca, Rosana; Monteiro, Simone
Challenges to the adherence to combination antiretroviral therapy among the pediatric population should be understood in the context of the trajectories of families, their interaction with healthcare services, and their access to material and symbolic goods. The present study analyzed individual, institutional and social factors that might be associated with the caregivers’ role in the treatment adherence of children and adolescents living with HIV (CALHIV). Based on semi-structured interviews and questionnaires applied to 69 caregivers seen at pediatric AIDS services of five Brazilian macro-regions, we observed that adherent caregivers had better acceptance of diagnosis and treatment, were less likely to face discrimination and social isolation secondary to AIDS-related stigma and tended to believe in the efficacy of treatment, and to be more optimistic about life perspectives of CALHIV. Interventions aiming to improve adherence and to promote the health of CALHIV should take in consideration the interplay of such different factors. PMID:27338431
Cruz, Maria Letícia Santos; Cardoso, Claudete A Araújo; Darmont, Mariana Q; Dickstein, Paulo; Bastos, Francisco I; Souza, Edvaldo; Andrade, Solange D; Fabbro, Marcia D'All; Fonseca, Rosana; Monteiro, Simone
Challenges to the adherence to combination antiretroviral therapy among the pediatric population should be understood in the context of the trajectories of families, their interaction with healthcare services, and their access to material and symbolic goods. The present study analyzed individual, institutional and social factors that might be associated with the caregivers' role in the treatment adherence of children and adolescents living with HIV (CALHIV). Based on semi-structured interviews and questionnaires applied to 69 caregivers seen at pediatric AIDS services of five Brazilian macro-regions, we observed that adherent caregivers had better acceptance of diagnosis and treatment, were less likely to face discrimination and social isolation secondary to AIDS-related stigma and tended to believe in the efficacy of treatment, and to be more optimistic about life perspectives of CALHIV. Interventions aiming to improve adherence and to promote the health of CALHIV should take in consideration the interplay of such different factors.
Jamile Sanches Codogno
Full Text Available DOI: http://dx.doi.org/10.5007/1980-0037.2013v15n1p82 The relationship between physical activity and the use of medicines is not clear. The purpose of this study was to investigate this relationship between the level of physical activity and the use of medications by type 2 diabetic patients who were attended in the Brazilian public healthcare system. The sample was composed of 121 Brazilian diabetic patients, of both genders, attended by the public healthcare system. Body fat (estimated by anthropometry and bioelectrical impedance, physical activity (measured by Baecke’s questionnaire, and the participant’s use of medicines (during the 15 days before evaluation were assessed. There was a relationship between the use of medicines and: gender (r = 0.18; p = 0.045, body mass index (BMI (r = 0.22; p = 0.012, waist circumference (r = 0.19; p = 0.029, body fat percentage (r = 0.21; p = 0.016, age (r = 0.23; p = 0.009, and level of physical activity (r = -0.22; p = 0.012. Linear regression included in the multivariate model only age (β = 0.718; p = 0.057, BMI (β= 0.057; p = 0.022, and level of physical activity (β = -0.176; p = 0.044. In conclusion, physical activity decreases medicinal use independent of age or obesity.
Karla Cristina Vasconcelos Moura
Full Text Available Parkinson's disease is the second most frequent neurodegenerative disorder in the world, affecting 1-2% of individuals over the age of 65. The etiology of Parkinson's disease is complex, with the involvement of gene-environment interactions. Although it is considered a disease of late manifestation, early-onset forms of parkinsonism contribute to 5–10% of all cases. In the present study, we screened mutations in coding regions of PARK2 and PINK1 genes in 136 unrelated Brazilian patients with early-onset Parkinson's disease through automatic sequencing. We identified six missense variants in PARK2 gene: one known pathogenic mutation, two variants of uncertain role, and three nonpathogenic changes. No pathogenic mutation was identified in PINK1 gene, only benign polymorphisms. All putative pathogenic variants found in this study were in heterozygous state. Our data show that PARK2 point mutations are more common in Brazilian early-onset Parkinson's disease patients (2.9% than PINK1 missense variants (0%, corroborating other studies worldwide.
Alex Magno Coelho Horimoto
Full Text Available ABSTRACT Introduction: Systemic sclerosis (SSc is a connective tissue disease of unknown etiology, characterized by a triad of vascular injury, autoimmunity and tissue fibrosis. It is known that a positive family history is the greatest risk factor already identified for the development of SSc in a given individual. Preliminary observation of a high prevalence of polyautoimmunity and of familial autoimmunity in SSc patients support the idea that different autoimmune phenotypes may share common susceptibility variants. Objectives: To describe the frequency of familial autoimmunity and polyautoimmunity in 60 SSc patients in the Midwest region of Brazil, as well as to report the main autoimmune diseases observed in this association of comorbidities. Methods: A cross-sectional study with recruitment of 60 consecutive patients selected at the Rheumatology Department, University Hospital, Medicine School, Federal University of Mato Grosso do Sul (FMUFMS, as well as interviews of their relatives during the period from February 2013 to March 2014. Results: A frequency of 43.3% of polyautoimmunity and of 51.7% of familial autoimmunity in SSc patients was found. Patients with the presence of polyautoimmunity and familial autoimmunity presented primarily the diffuse form of SSc, but this indicator did not reach statistical significance. The autoimmune diseases most frequently observed in polyautoimmunity patients were: Hashimoto's thyroiditis (53.8%, Sjögren's syndrome (38.5%, and inflammatory myopathy (11.5%. The main autoimmune diseases observed in SSc patients' relatives were: Hashimoto's thyroiditis (32.3%, rheumatoid arthritis (22.6%, and SLE (22.6%. The presence of more than one autoimmune disease in SSc patients did not correlate with disease severity or activity. Conclusions: From the high prevalence of coexisting autoimmune diseases found in SSc patients, we stress the importance of the concept of shared autoimmunity, in order to promote a
Ilana de França Azevedo
Full Text Available Objective: This study investigated the occurrence of the p190 and p210 break point clusterregion-Abelson (BCR-ABL rearrangements in adults with acute lymphoblastic leukemia and possible associations with clinical and laboratory characteristics and survival. Methods: Forty-one over 18-year-old patients with acute lymphoblastic leukemia of both genders followed-up between January 2008 and May 2012 were included in this study. Clinical and laboratory data were obtained from the medical charts of the patients. Reverse transcription polymerase chain reaction (RT-PCR using specific primers was employed to identify molecular rearrangements. Results: At diagnosis, the median age was 33 years, and there was a predominance of males (61%. The most common immunophenotype was B lineage (76%. BCR-ABL rearrangements was detected in 14 (34% patients with the following distribution: p190 (28%, p210 (50% and double positive (22%. Overall survival of patients with a mean/median of 331/246 days of follow up was 39%, respectively, negative BCR-ABL (44% and positive BCR-ABL (28%. Conclusion: These results confirm the high frequency of BCR-ABL rearrangements and the low survival rate of adult Brazilian patients with acute lymphoblastic leukemia.
Pedro Giovâni da Silva
Full Text Available The Brazilian Atlantic Forest is one of the world's biodiversity hotspots, and is currently highly fragmented and disturbed due to human activities. Variation in environmental conditions in the Atlantic Forest can influence the distribution of species, which may show associations with some environmental features. Dung beetles (Coleoptera: Scarabaeinae are insects that act in nutrient cycling via organic matter decomposition and have been used for monitoring environmental changes. The aim of this study is to identify associations between the spatial distribution of dung beetle species and Atlantic Forest structure. The spatial distribution of some dung beetle species was associated with structural forest features. The number of species among the sampling sites ranged widely, and few species were found in all remnant areas. Principal coordinates analysis indicated that species composition, abundance and biomass showed a spatially structured distribution, and these results were corroborated by permutational multivariate analysis of variance. The indicator value index and redundancy analysis showed an association of several dung beetle species with some explanatory environmental variables related to Atlantic Forest structure. This work demonstrated the existence of a spatially structured distribution of dung beetles, with significant associations between several species and forest structure in Atlantic Forest remnants from Southern Brazil. Keywords: Beta diversity, Species composition, Species diversity, Spatial distribution, Tropical forest
Full Text Available Puba or carimã is a Brazilian staple food obtained by spontaneous submerged fermentation of cassava roots. A total of 116 lactobacilli and three cocci isolates from 20 commercial puba samples were recovered on de Man, Rogosa and Sharpe agar (MRS; they were characterized for their antagonistic activity against foodborne pathogens and identified taxonomically by classical and molecular methods. In all samples, lactic acid bacteria were recovered as the dominant microbiota (7.86 ± 0.41 log10 CFU/g. 16S-23S rRNA ARDRA pattern assigned 116 isolates to the Lactobacillus genus, represented by the species Lactobacillus fermentum (59 isolates, Lactobacillus delbrueckii (18 isolates, Lactobacillus casei (9 isolates, Lactobacillus reuteri (6 isolates, Lactobacillus brevis (3 isolates, Lactobacillus gasseri (2 isolates, Lactobacillus nagelii (1 isolate, and Lactobacillus plantarum group (18 isolates. recA gene-multiplex PCR analysis revealed that L. plantarum group isolates belonged to Lactobacillus plantarum (15 isolates and Lactobacillus paraplantarum (3 isolates. Genomic diversity was investigated by molecular typing with rep (repetitive sequence-based PCR using the primer ERIC2 (enterobacterial repetitive intergenic consensus. The Lactobacillus isolates exhibited genetic heterogeneity and species-specific fingerprint patterns. All the isolates showed antagonistic activity against the foodborne pathogenic bacteria tested. This antibacterial effect was attributed to acid production, except in the cases of three isolates that apparently produced bacteriocin-like inhibitory substances. This study provides the first insight into the genetic diversity of Lactobacillus spp. of puba.
Full Text Available Abstract Objectives: to summarize Brazilian studies that analyzed the risk factors for Exclusive Breastfeeding (EBF interruption before the child's six months of life. Methods: systematic review and meta-analysis indexed articles from Bireme, Scielo and Pubmed databases published in the period of January 2000 to December 2015. Results: 22 articles were included in the meta-analysis. The factors related to newborns were observed, such as birth weight (OR= 1.17; CI 95%: 1.05-1.29, female gender (OR= 1,09; CI 95%: 1.04-1.13 and the use of pacifier (OR= 2.29; CI 95%: 1.68-2.91 were the main factors responsible for the increase in the occurrence of EBF interruption. The factors were related to the mother, maternal age below twenty years old (OR= 1.22; CI 95%: 1.12-1.33 low schooling level (OR=1.28; CI 95%: 1.11-1.45, primiparity (OR= 1.17; CI 95%: 1.02-1.32 maternal employment during the postpartum period (OR= 1.26; CI 95%: 1.11-1.41, and low family income (OR= 1.22; CI 95%: 1.08-1.37 contributed significantly to the EBF interruption . Conclusions: the meta-analysis of Brazilian epidemiological studies demonstrated evidences to conclude that below the age of twenty, low schooling, primiparity, maternal employment in the postpartum period and low family income are associated to the interruption of exclusive breastfeeding until 6 months of age. Children with low birth weight, female gender and used a pacifier had greater vulnerability to not be exclusively breastfed. In conclusion, most of these factors can be modified through appropriate public policies throughout the adequate prenatal period to promote exclusive breastfeeding.
da Silva, Jaqueline Aragoni; da Silva, Kelly Samara; Del Duca, Giovani Firpo; Dos Santos, Priscila Cristina; Wolker, Sofia; de Oliveira, Elusa Santina Antunes; de Barros, Mauro Virgílio Gomes; Nahas, Markus Vinicius
To investigate the moderating effect of gross family income on the association between demographic indicators and active commuting to work in Brazilian adults. Secondary analysis of the survey "Lifestyle and leisure habits of industry workers" (n=46,981), conducted in 24 Brazilian states (2006-2008). Self-reported information was collected with a previously tested questionnaire. Crude and adjusted logistic regression models were applied to analyze the association between sociodemographic variables (sex, age, marital status, number of children, education, country area and company size) and active commuting to work in different strata of gross family income. To test the moderating effect, an interaction analysis was applied. The proportion of active commuters among low-, medium- and high-income workers was 40.7% (95%CI:40.0%;41.5%), 27.0% (95%CI:26.3;27.6%) and 11.1%, (95%CI:10.5%;11.7%), respectively. The moderating effect of gross family income was confirmed. Men were more likely (OR:1.22 95%CI:1.12;1.32) to commute actively than women among low-income individuals. Active commuting was less likely among older workers in low-(OR30-39:0.90 95%CI: 0.83;0.98; OR≥40: 0.76 95%CI: 0.68;0.85) and medium-income strata (OR30-39:0.87 95%CI:0.80;0.95; OR≥40:0.84 95%CI:0.76;0.93) and among married individuals in high-income strata (OR:0.72 95%IC:0.61;0.84). Adults with lower education (ORhigh:10.80 95%CI:8.47;13.77), working in the south (ORhigh:1.93 95%CI:1.53;2.44) and in small companies (ORlow:2.50 95%CI:2.28;2.74) were more likely to commute actively; however, the magnitude of these associations differed at each income strata. There was an inverse association between gross family income and active commuting. Gross family income acts as a moderator of the association between demographic indicators and active commuting. Copyright © 2016 Elsevier Inc. All rights reserved.
de Carvalho, Thiago Bittencourt Ottoni; Suman, Marcela; Molina, Fernando Drimel; Piatto, Vânia Belintani; Maniglia, José Victor
Serotonin (5-HT) regulates a variety of visceral and physiological functions, including sleep. Polymorphisms in the 5-HT2A receptor gene can alter its transcription, affecting the number of receptors in the serotoninergic system, contributing to obstructive sleep apnea syndrome (OSAS). The aim of this study was to determine the prevalence of the 102T-C and -1438G-A polymorphisms in the 5-HTR2A gene in Brazilian patients with and without OSAS. A cross-sectional study performed at the Otorhinolaryngology and Sleep Disorder Out Clinics, São José do Rio Preto Medical School, FAMERP. One hundred patients were examined as index cases and 100 persons as controls, of both genders to both groups. DNA was extracted from peripheral blood leukocytes, and the sites that encompassed both polymorphisms were amplified by PCR-RFLP. There was a significant prevalence of the male gender in index cases compared with the control group gender (p < 0.0001). There was no significant genotypic difference in the 102T-C polymorphism between the case and control groups (p = 1.000). The AA genotype of the -1438G-A polymorphism was more prevalent in the patients with OSAS compared with the controls (OR, 2.3; CI 95% 1.20-4.38; p = 0.01). There was no difference in the prevalence of the 102T-C polymorphism between patients with OSAS and the control group. Serotoninergic system dysfunction appeared to be related to OSAS. The -1438G-A polymorphism and OSAS are related in this studied Brazilian population.
Carlos Henrique F. Camargo
Full Text Available Several genes have been mapped in families or in sporadic cases of dystonia. TOR1-A (DYT1 gene was linked to isolated dystonia. Objective To associate clinical information of patients with dystonia with the TOR1-A gene mutations. Method Eighty-eight patients with dystonia in cervical area (focal, segmental, multifocal and generalized were recruited at Movement Disorders Clinic of Hospital de Clínicas of the Federal University of Paraná between June of 2008 and June of 2009. They were submitted to the clinical evaluation. DNA was extract from blood and submitted at analysis to TOR1-A mutations by PCR according standard protocols. Results Two patients had c.907GAGdel mutation on TOR1-A gene. These patients, with familial history of dystonia, started his symptoms by legs and had secondary generalization. Conclusion We can suggest that analysis for TOR1-A mutations should be performed only in patients with early onset, generalized and familial dystonia.
Câmara, Rachel de A; Köhler, Cristiano A; Frey, Benicio N; Hyphantis, Thomas N; Carvalho, André F
To develop and validate a Brazilian Portuguese version of the Premenstrual Symptoms Screening Tool (PSST), a questionnaire used for the screening of premenstrual syndrome (PMS) and of the most severe form of PMS, premenstrual dysphoric disorder (PMDD). The PSST also rates the impact of premenstrual symptoms on daily activities. A consecutive sample of 801 women aged ≥ 18 years completed the study protocol. The internal consistency, test-retest reliability, and content validity of the Brazilian PSST were determined. The independent association of a positive screen for PMS or PMDD and quality of life determined by the World Health Organization Quality of Life instrument-Abbreviated version (WHOQOL-Bref) was also assessed. Of 801 participants, 132 (16.5%) had a positive screening for PMDD. The Brazilian PSST had adequate internal consistency (Cronbach's alpha = 0.91) and test-retest reliability. The PSST also had adequate convergent/discriminant validity, without redundancy. Content validity ratio and content validity index were 0.61 and 0.94 respectively. Finally, a positive screen for PMS/PMDD was associated with worse WHOQOL-Bref scores. These findings suggest that PSST is a reliable and valid instrument to screen for PMS/PMDD in Brazilian women.
Egan, Kieren J; Campos Santos, Hadassa; Beijamini, Felipe; Duarte, Núbia E; Horimoto, Andréa R V R; Taporoski, Tâmara P; Vallada, Homero; Negrão, André B; Krieger, José E; Pedrazzoli, Mário; Knutson, Kristen L; Pereira, Alexandre C; von Schantz, Malcolm
Significant questions remain unanswered regarding the genetic versus environmental contributions to racial/ethnic differences in sleep and circadian rhythms. We addressed this question by investigating the association between diurnal preference, using the morningness-eveningness questionnaire (MEQ), and genetic ancestry within the Baependi Heart Study cohort, a highly admixed Brazilian population based in a rural town. Analysis was performed using measures of ancestry, using the Admixture program, and MEQ from 1,453 individuals. We found an association between the degree of Amerindian (but not European of African) ancestry and morningness, equating to 0.16 units for each additional percent of Amerindian ancestry, after adjustment for age, sex, education, and residential zone. To our knowledge, this is the first published report identifying an association between genetic ancestry and MEQ, and above all, the first one based on ancestral contributions within individuals living in the same community. This previously unknown ancestral dimension of diurnal preference suggests a stratification between racial/ethnic groups in an as yet unknown number of genetic polymorphisms.
Souza, João Gabriel Silva; Jones, Kimberly Marie; Fonseca, Adelia Dayane Guimarães; de Barros Lima Martins, Andréa Maria Eleutério
To estimate the prevalence of the consumption of beer and distilled beverages and associated factors among Brazilian older adults residing in a highly populated city in Brazil, highlighting the factors associated with frequent consumption and differences in consumption between men and women. It was a cross-sectional, analytic study carried out by means of probability samples of conglomerates of older adults (aged 65-74 years). Descriptive analysis, univariate analysis and estimates of multivariate models through logistic regression (OR, 95% CI) were realized. 500 of the 736 evaluated seniors were included in the present analysis. 128 (27.3%), 103 (21.3%) and 167 (34.9%) of the seniors indicate past or current use of beer, distilled beverages and frequent use of alcohol, respectively. The consumption of beer was associated with use of tobacco between women; and with marital status and schooling between men. The consumption of distilled beverages was associated with schooling and use of tobacco between women; and age and use of tobacco in men. Daily or weekly use was associated with schooling and use of tobacco between women; age and the use of tobacco between men. In the elderly population studied, a noteworthy prevalence of the consumption of beer and distilled beverages was identified, and this use was associated with personal and behavioral determinants. Similar associations related to frequent (daily or weekly) consumption were also identified. Significant differences in the profile of consumption were identified between men and women, with more abusive use among men. Geriatr Gerontol Int 2016; 16: 810-820. © 2015 Japan Geriatrics Society.
Jonas Augusto C. Silveira
Full Text Available OBJECTIVE: To examine the associations between socioeconomic and biological factors and infant weight gain. METHODS: All infants (0-23 months of age with available birth and postnatal weight data (n = 1763 were selected from the last nationally representative survey with complex probability sampling conducted in Brazil (2006/07. The outcome variable was conditional weight gain (CWG, which represents how much an individual has deviated from his/her expected weight gain, given the birth weight. Associations were estimated using simple and hierarchical multiple linear regression, considering the survey sampling design, and presented in standard deviations of CWG with their respective 95% of confidence intervals. Hierarchical models were designed considering the UNICEF Conceptual Framework for Malnutrition (basic, underlying and immediate causes. RESULTS: The poorest Brazilian regions (-0.14 [-0.25; -0.04] and rural areas (-0.14 [-0.26;-0.02] were inversely associated with CWG in the basic causes model. However, this association disappeared after adjusting for maternal and household characteristics. In the final hierarchical model, lower economic status (-0.09 [-0.15; -0.03], human capital outcomes (maternal education < 4th grade (-0.14[-0.29; 0.01], higher maternal height (0.02[0.01; 0.03], and fever in the past 2 weeks (-0.13[-0.26; -0.01] were associated with postnatal weight gain. CONCLUSION: The results showed that poverty and lower human capital are still key factors associated with poor postnatal weight gain. The approach used in these analyses was sensitive to characterize inequalities among different socioeconomic contexts and to identify factors associated with CWG in different levels of determination.
Full Text Available The aim of this study was to determine risk factors for adverse events (AE-related treatment discontinuation and severe anemia among patients with chronic hepatitis C virus (HCV genotype 1 infection, treated with first-generation protease inhibitor (PI-based therapy. We included all patients who initiated treatment with PI-based therapy at a Brazilian university hospital between November 2013 and December 2014. We prospectively collected data from medical records using standardized questionnaires and used Epi Info 6.0 for analysis. Severe anemia was defined as hemoglobin ≤8.5 mg/dL. We included 203 patients: 132 treated with telaprevir (TVR and 71 treated with boceprevir (BOC. AE-related treatment discontinuation rate was 19.2% and anemia was the main reason (38.5%. Risk factors for treatment discontinuation were higher comorbidity index (OR=1.85, CI=1.05-3.25 for BOC, and higher bilirubin count (OR=1.02, CI=1.01-1.04 and lower BMI (OR=0.98, CI=0.96-0.99 for TVR. Severe anemia occurred in 35 (17.2% patients. Risk factors for this outcome were lower estimated glomerular filtration rate (eGFR; OR=0.95, CI=0.91-0.98 for patients treated with TVR, and higher comorbidity index (OR=2.21, CI=1.04-4.67 and ribavirin dosage (OR=0.84, CI=0.72-0.99 for those treated with BOC. Fifty-five (57.3% patients treated with TVR and 15 (27.3% patients treated with BOC achieved sustained virological response (SVR. Among patients who received TVR and interrupted treatment due to AE (n=19, only 26.3% (n=5 achieved SVR (P=0.003. Higher number of comorbidities, lower eGFR and advanced liver disease are associated with severe anemia and early treatment cessation, which may compromise SVR achievement.
Sampaio-Barros, Percival D; Bortoluzzo, Adriana B; Marangoni, Roberta G; Rocha, Luiza F; Del Rio, Ana Paula T; Samara, Adil M; Yoshinari, Natalino H; Marques-Neto, João Francisco
To analyze survival, prognostic factors, and causes of death in a large cohort of patients with systemic sclerosis (SSc). From 1991 to 2010, 947 patients with SSc were treated at 2 referral university centers in Brazil. Causes of death were considered SSc-related and non-SSc-related. Multiple logistic regression analysis was used to identify prognostic factors. Survival at 5 and 10 years was estimated using the Kaplan-Meier method. One hundred sixty-eight patients died during the followup. Among the 110 deaths considered related to SSc, there was predominance of lung (48.1%) and heart (24.5%) involvement. Most of the 58 deaths not related to SSc were caused by infection, cardiovascular or cerebrovascular disease, and cancer. Male sex, modified Rodnan skin score (mRSS) > 20, osteoarticular involvement, lung involvement, and renal crisis were the main prognostic factors associated to death. Overall survival rate was 90% for 5 years and 84% for 10 years. Patients presented worse prognosis if they had diffuse SSc (85% vs 92% at 5 yrs, respectively, and 77% vs 87% at 10 yrs, compared to limited SSc), male sex (77% vs 90% at 5 yrs and 64% vs 86% at 10 yrs, compared to female sex), and mRSS > 20 (83% vs 90% at 5 yrs and 66% vs 86% at 10 yrs, compared to mRSS < 20). Survival was worse in male patients with diffuse SSc, and lung and heart involvement represented the main causes of death in this South American series of patients with SSc.
Pacheco, Felipe Torres; Littig, Ingrid Aguiar; Gagliardi, Rubens Jose; Rocha, Antônio Jose da
Objective The potential of computed tomography angiography (CTA) was assessed for early determination of stroke subtypes in a Brazilian cohort of patients with stroke. Method From July 2011 to July 2013, we selected patients with suspected hyperacute stroke (< 6 hours). Intracranial and cervical arteries were scrutinized on CTA and their imaging features were correlated with concurrent subtype of stroke. Results Stroke was documented in 50/106 selected patients (47.2%) based on both clinical ...
Screening of cognitive impairment in patients with Parkinson's disease: diagnostic validity of the Brazilian versions of the Montreal Cognitive Assessment and the Addenbrooke's Cognitive Examination-Revised
Emmanuelle Sobreira; Márcio A. Pena-Pereira; Alan L. Eckeli; Manoel A. Sobreira-Neto; Marcos H. N. Chagas; Maria P. Foss; Brenna Cholerton; Cyrus P. Zabetian; Ignacio F. Mata; Vitor Tumas
ABSTRACTObjective The aim of the present study is to examine the accuracy of the Brazilian versions of the Montreal Cognitive Assessment (MoCA) and the Addenbrooke's Cognitive Examination-Revised (ACE-R) to screen for mild cognitive impairment (PDMCI) and dementia (PDD) in patients with Parkinson's disease (PD).Method Both scales were administered to a final convenience sample of 79 patients with PD. Patients were evaluated by a neurologist, a psychiatrist and a neuropsychologist using UPDRS,...
Pordeus Isabela A
Full Text Available Abstract Background Traumatic dental injury (TDI could have physical and psychosocial consequences for children. Thus, it is important to measure the impact of TDI on the quality of life of children (QoL. The aim of the present study was to investigate the association between treated/untreated TDI and the impact on the quality of life of 11-to-14-year-old Brazilian schoolchildren. Methods A cross-sectional study was carried out involving 1612 male and female schoolchildren aged 11 to 14 years attending public and private elementary schools in the city of Belo Horizonte, Brazil. A multi-stage sampling technique was adopted to select the children. Three calibrated examiners used the Andreasen classification for the diagnosis of TDI. Oral health-related quality of life was assessed using the Brazilian version of the Child Perceptions Questionnaire (CPQ11-14 - Impact Short Form (ISF:16, composed of 16 items and self-administered by all children. Other oral conditions (dental caries and malocclusion and the Social Vulnerability Index were determined and used as controlling variables. Results Two hundred nineteen children were diagnosed with untreated TDI and 64 were diagnosed with treated TDI. There were no statistically significant associations between untreated or treated TDI and overall CPQ11-14 (Fisher = 0.368 and Fisher = 0.610, respectively. Children with an untreated TDI were 1.4-fold (95% CI = 1.1-2.1 more likely to report impact on the item "avoided smiling/laughing" than those without TDI, whereas children with a treated TDI were twofold (95% CI = 1.1-3.5 more likely to report impact on the item "other children asked questions" than those without TDI. Conclusions Neither treated nor untreated TDI was associated with oral symptoms, functional limitations or emotional wellbeing. However, children with a TDI in the anterior teeth experienced a negative impact on social wellbeing, mainly with regard to avoiding smiling or laughing and being
José Fernando Vila Nova de Moraes
Full Text Available DOI: http://dx.doi.org/10.5007/1980-0037.2016v18n3p259 Obesity is considered a disease with multiple etiologies. Recent advances in technology have pointed candidate genes that are related to weight gain in several populations. However, in countries with ethnic miscegenation, such as Brazil, studies of this nature with students are still scarce. The aim of the present study was to compare anthropometric variables of Brazilian male students according to the genotypes of the rs9939609 of the FTO gene. In order to do so, 205 participants underwent body mass, height, waist circumference and skinfold thickness measurements. Body mass index (BMI, waist-to-height ratio and body fat percentage were calculated. Volunteers were characterized as overweight according to the BMI-for-age z-score. Participants were genotyped according to the single nucleotide polymorphism rs9939609 of the FTO gene (AA, AT and TT. ANOVA one-way with Bonferroni’s post hoc was performed to compare genotypes and anthropometric variables. Odds Ratio was calculated to reveal increased chances of presenting higher body mass index z-score, waist-to-height ratio and body fat percentage. Participants homozygous for the A allele presented significantly higher values of BMI-for-age z-score (0.38±1.01 vs. -0.29±1.15, waist circumference (77.15±6.51 vs. 72.85±7.36 cm and waist-to-height ratio (0.44±0.04 vs. 0.42±0.04 when compared to individuals with the TT genotype. The A allele of the rs9939609 of the FTO gene seems to influence in the adiposity of male students.
Gabriela S. Longo
Full Text Available Introduction The pathogenesis of Parkinson’s disease (PD involves both genetic susceptibility and environmental factors, with focus on the mutation in the alpha-synuclein gene (SNCA.Objective To analyse the polymorphism SNCA-A53T in patients with familial PD (FPD and sporadic PD (SPD.Method A total of 294 individuals were studied, regardless of sex and with mixed ethnicity. The study group with 154 patients with PD, and the control group included 140 individuals without PD. The genotyping of SNCA-A53T was performed by PCR/RFLP. Significance level was p < 0.05.Results Among all patients, 37 (24% had FPD and 117 (75.9% had SPD. The absence of SNCA-A53T mutation was observed in all individuals.Conclusion SPD is notably observed in patients. However, the SNCA-A53T mutation was absent in all individuals, which does not differ controls from patients. This fact should be confirmed in a Brazilian study case with a more numerous and older population.
Rachel Sayuri Honjo
Full Text Available Williams-Beuren syndrome (WBS is a genetic disease caused by a microdeletion in the 7q11.23 region. It is characterized by congenital heart disease, mainly supravalvular aortic stenosis, mental retardation, mild short stature, facial dysmorphisms, and variable abnormalities in different systems. Objectives. To report the clinical findings of 55 Brazilian patients confirmed by multiplex ligation-dependent probe amplification (MLPA. Methods. Patients were followed up for 4 years at the Genetics Unit of the Instituto da Criança of the Hospital das Clínicas, FMUSP, Brazil. A kit specific for WBS was used to detect the 7q11.23 microdeletion. Results. Two patients with negative FISH results had positive MLPA results for WBS. The characteristics of the patients with the deletion were as follows: typical WBS facies (98.2%, neuropsychomotor delay (98.2%, hypersocial behavior (94.5%, hyperacusis (94.5%, and congenital heart disease (81.8%. Conclusions. MLPA was effective in detecting the microdeletion in the 7q11.23 region to confirm the diagnosis of WBS. MLPA was also able to confirm the diagnosis of WBS in two patients with typical clinical characteristics but negative FISH results. Thus, MLPA is a promising method in the diagnostic investigation of WBS. WBS is a multisystemic disorder and therefore requires multidisciplinary care and specific follow-up to prevent complications.
Araujo, Amanda Costa; Filho, Rúben Negrão; Oliveira, Crystian B; Ferreira, Paulo H; Pinto, Rafael Z
In the low back pain (LBP) field, therapeutic alliance is considered a non-specific factor of interventions associated with improvements in clinical outcomes. However, there is a paucity of studies aimed to evaluate measurement properties of tools used to objectively quantify the alliance between therapist and patients, such as the Working Alliance Inventory (WAI) and Session Rating Scale (SRS). To translate and cross-culturally adapt the short-form version of WAI - therapist and SRS into Brazilian Portuguese; to investigate the measurement properties, of the WAI-Patient, WAI-Therapist and SRS in patients with LBP and their physical therapists, respectively. One hundred patients with LBP and 18 physical therapists were recruited from physical therapy clinics in Brazil. Therapeutic alliance measures were collected at the initial assessment, prior to the second session, and at 2-month follow-up. The measurement properties investigated were reproducibility, internal consistency, ceiling/floor effects and responsiveness. Although WAI-Patient, WAI-Therapist and SRS were considered to have acceptable test-retest reliability (ICC2,1 > 0.70), these questionnaires showed problems with other measurement properties. WAI-Patient showed problems with internal consistency (i.e. Cronbach's alpha 15% of participants with the maximum score) and poor internal responsiveness were found for the WAI-Patient (Effect size = 0.15; 84% CI: 0.04 to 0.29) and for the SRS (Effect size = 0.05; 84% CI: -0.22 to 0.11). The WAI-Therapist revealed slightly better measurement properties. We identified psychometric limitations with most measurement properties of the WAI questionnaires and SRS. Future studies are needed to refine these tools.
Isac da S. F. Lima
Full Text Available ABSTRACT Objective To identify factors associated with timely treatment of malaria in the Brazilian Amazon. Malaria, despite being treatable, has proven difficult to control and continues to be an important public health problem globally. Brazil accounted for almost half of the 427 000 new malaria cases notified in the Americas in 2013. Methods This was a cross-sectional study using secondary data on all notified malaria cases for the period from 2004 – 2013. Timely treatment was considered to be all treatment started within 24 hours of symptoms onset. Multivariate logistic regression was used to identify independent factors associated with timely treatment. Results The proportion of cases starting treatment on a timely basis was 41.1%, tending to increase in more recent years (OR = 1.40; 95%CI: 1.37 – 1.42 in 2013. Furthermore, people starting within < 24 hours were more likely to: reside in the states of Rondônia (OR = 1.50; 95%CI: 1.49 – 1.51 or Acre (OR = 1.53; 95%CI: 1.55 – 1.57; be 0 – 5 years of age (OR = 1.39; 95%CI: 1.34 – 1.44 or 6 – 14 years of age (OR = 1.34; 95%CI: 1.32 – 1.36; be indigenous (OR = 1.41; 95%CI: 1.37 – 1.45; have a low level of schooling (OR = 1.20; 95%CI: 1.19 – 1.22; and be diagnosed by active detection (OR = 1.39; 95%CI: 1.38 – 1.39. Conclusion In the Brazilian Amazon area, individuals were more likely to have timely treatment of malaria if they were young, residing in Acre or Rondônia states, have little schooling, and be identified through active detection. Identifying groups vulnerable to late treatment is important for preventing severe cases and malaria deaths.
Erick Nelo Pedreira
Full Text Available The purposes of this study were to investigate radiographically the dental and maxillomandibular in patients with neuropsychomotor disorders and determine the role of panoramic radiographs for quantitative and qualitative analyses of dental alterations. A total of 322 panoramic radiographs from 190 males and 132 females aged 4 to 57 years were obtained from the files of the Center for Care to Patients with Special Needs (CAPE; Dental School, University of São Paulo and subdivided into syndromes, special needs, neurological, neuromuscular or cerebral disorders, and sequels of diseases. 32% of dental alterations were in tooth position, with 69% of this group associated with tooth rotation. The mandible accounted for 54.62% of alterations. The male gender (55.85% and the permanent dentition (78.7% were most affected. Panoramic radiographs were proved to be well suited for quantitative evaluation of dental anomalies of epidemiological nature. Panoramic radiographs are important diagnostic resources when applied to patients with special needs because of the difficulty to place intraoral films and held them correctly positioned during the radiographic technique.
Renan Cardoso Soares
Full Text Available Malassezia yeasts are part of the resident cutaneous microbiota, and are also associated with skin diseases such as seborrheic dermatitis (SD. The role these fungi play in skin diseases and why they are pathogenic for only some individuals remain unclear. This study aimed to characterize Malassezia microbiota from different body sites in healthy and SD subjects from Brazil. Scalp and forehead samples from healthy, mild SD and severe SD subjects were collected. Non-scalp lesions from severe SD patients were also sampled. 5.8S rDNA/ITS2 amplicons from Malassezia sp. were analyzed by RFLP and sequencing. Results indicate that Malassezia microbiota did not group according to health condition or body area. Phylogenetic analysis revealed that three groups of sequences did not cluster together with any formally described species, suggesting that they might belong to potential new species. One of them was found in high proportions in scalp samples. A large variety of Malassezia subtypes were detected, indicating intra-specific diversity. Higher M. globosa proportions were found in non-scalp lesions from severe SD subjects compared with other areas, suggesting closer association of this species with SD lesions from areas other than scalp. Our results show the first panorama of Malassezia microbiota in Brazilian subjects using molecular techniques and provide new perspectives for further studies to elucidate the association between Malassezia microbiota and skin diseases.
VALLE Antonio Carlos Francesconi do
Full Text Available We present the case of a 15-year-old patient infected with HTLV-1 who developed a cutaneous T-cell lymphoma, confirmed by histopathological and immunohistochemical examination, as well as clinically and hematologically confirmed leukemia. The patient died 3 months after initial presentation of the disease. The rarity of the disease in this age group justifies the present report.
Baggio, Jussara A O; Santos-Pontelli, Taiza E G; Cougo-Pinto, Pedro T; Camilo, Millene; Silva, Nathalia F; Antunes, Paula; Machado, Laura; Leite, João P; Pontes-Neto, Octavio M
The modified Rankin Scale (mRS) is a commonly used scale to assess the functional outcome after stroke. Several studies on mRS showed good reliability, feasibility, and interrater agreement of this scale using a face-to-face assessment. However, telephone assessment is a more time-efficient way to obtain an mRS grade than a face-to-face interview. The aim of this study was to validate the telephone assessment of mRS among the Portuguese using a structured interview in a sample of Brazilian stroke patients. We evaluated 50 stroke outpatients twice. The first interview was face-to-face and the second was made by telephone and the time between the two assessments ranged between 7 and 14 days. Four certified raters evaluated the patients using a structured interview based on a questionnaire previously published in the literature. Raters were blinded for the Rankin score given by the other rater. For both assessments, the rater could also interview a caregiver if necessary. The patients' mean age was 62.8 ± 14.7, mean number of years of study 5.2 ± 3.4, 52% were males, 55.2% of patients needed a caregiver's help to answer the questions. The majority of caregivers were female (85%), mean age 49.1 ± 15, and mean number of years of study 8.3 ± 3.4. Perfect agreement between the telephone and face-to-face assessments was obtained for 27 (54%) patients, corresponding to an unweighted Kappa of 0.44 (95% CI 0.27-0.61) and a weighted Kappa of 0.89. The median of telephone assessment mRS was 3.5 (interquartile range = 2-4) and of face-to-face assessment was 4 (interquartile range = 2-5). There was no difference between the two assessments (Wilcoxon test, p = 0.35). Despite the low education level of our sample, the telephone assessment of functional impairment of stroke patients using a translated and culturally adapted Brazilian Portuguese version of the mRS showed good validity and reliability. Therefore, the telephone assessment of mRS can be used in clinical practice and
Kianoush, Sina; Yakoob, Mohammad Yawar; Al-Rifai, Mahmoud; DeFilippis, Andrew P; Bittencourt, Marcio S; Duncan, Bruce B; Bensenor, Isabela M; Bhatnagar, Aruni; Lotufo, Paulo A; Blaha, Michael J
There is a need to identify sensitive biomarkers of early tobacco-related cardiovascular disease. We examined the association of smoking status, burden, time since quitting, and intensity, with markers of inflammation and subclinical atherosclerosis. We studied 14 103 participants without clinical cardiovascular disease in ELSA-Brasil (Brazilian Longitudinal Study of Adult Health). We evaluated baseline cross-sectional associations between smoking parameters and inflammation (high-sensitivity C-reactive protein [hsCRP]) and measures of subclinical atherosclerosis (carotid intima-media thickness, ankle-brachial index, and coronary artery calcium [CAC]). The cohort included 1844 current smokers, 4121 former smokers, and 8138 never smokers. Mean age was 51.7±8.9 years; 44.8% were male. After multivariable adjustment, compared with never smokers, current smokers had significantly higher levels of hsCRP (β=0.24, 0.19-0.29 mg/L; P media thickness (β=0.03, 0.02-0.04 mm; P 0 (odds ratio: 1.83; 95% confidence interval, 1.46-2.30; P media thickness levels and odds of ankle-brachial index ≤1.0 and CAC >0 were lower with increasing time since quitting ( P 0 ( P =0.03) after adjusting for duration of smoking. Strong associations were observed between smoking status, burden, and intensity with inflammation (hsCRP) and subclinical atherosclerosis (carotid intima-media thickness, ankle-brachial index, CAC). These markers of early cardiovascular disease injury may be used for the further study and regulation of traditional and novel tobacco products. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
Full Text Available In June 2008, the Brazilian Interdisciplinary AIDS Association (ABIA and the Indian NGO SAHARA submitted a joint pre-grant opposition to the patent application of Tenofovir Disoproxil Fumarate in India. This joint action provides a pertinent case model of the potential effects of South-South cooperation between civil society groups. In this study, the aim sought to determine the practicality of the methodology and propositions developed in Resources, Knowledge and Influence: the Organizational Effects of Interorganizational Collaboration (Hardy et al., 2003 in predicting the types of collaboration effects that would result from the degree of “involvement” and “embeddedness” of a collaboration. Data collection came from archival research, participant observation research and interviews. Research tasks included an investigation on South-South Cooperation in the area of IP rights and AIDS, compiling an SLR on knowledge management and collaboration theories, creating a chronology of the collaboration and application of aforementioned methodology. Application included (1 implementation of codification methodology based on “involvement” and “embeddedness” and (2 identification of types of effects in collaboration - strategic, knowledge creation or political. During data analysis, these effects were compared with the aims of collaboration. Results were then tested against propositions (Hardy et al., 2003 of the relationship between involvement and embeddedness and the collaborative effects. Findings support three propositions: (1 Collaborations with high levels of involvement will be positively associated with the acquisition of distinctive resources, (2 Collaborations with high levels of involvement and high levels of embeddedness will be positively associated with the creation of knowledge, (3 Collaborations that are highly embedded will be positively associated with an increase of influence.
A. C. G. César
Full Text Available Exposure to nitrogen oxides (NOx emitted by burning fossil fuels has been associated with respiratory diseases. We aimed to estimate the effects of NOx exposure on mortality owing to respiratory diseases in residents of Taubaté, São Paulo, Brazil, of all ages and both sexes. This time-series ecological study from August 1, 2011 to July 31, 2012 used information on deaths caused by respiratory diseases obtained from the Health Department of Taubaté. Estimated daily levels of pollutants (NOx, particulate matter, ozone, carbon monoxide were obtained from the Centro de Previsão de Tempo e Estudos Climáticos Coupled Aerosol and Tracer Transport model to the Brazilian developments on the Regional Atmospheric Modeling System. These environmental variables were used to adjust the multipollutant model for apparent temperature. To estimate association between hospitalizations owing to asthma and air pollutants, generalized additive Poisson regression models were developed, with lags as much as 5 days. There were 385 deaths with a daily mean (±SD of 1.05±1.03 (range: 0-5. Exposure to NOx was significantly associated with mortality owing to respiratory diseases: relative risk (RR=1.035 (95% confidence interval [CI]: 1.008-1.063 for lag 2, RR=1.064 (95%CI: 1.017-1.112 lag 3, RR=1.055 (95%CI: 1.025-1.085 lag 4, and RR=1.042 (95%CI: 1.010-1.076 lag 5. A 3 µg/m3 reduction in NOx concentration resulted in a decrease of 10-18 percentage points in risk of death caused by respiratory diseases. Even at NOx concentrations below the acceptable standard, there is association with deaths caused by respiratory diseases.
Sánchez-Ribas, Jordi; Oliveira-Ferreira, Joseli; Gimnig, John E; Pereira-Ribeiro, Cleomar; Santos-Neves, Maycon Sebastião Alberto; Silva-do-Nascimento, Teresa Fernandes
Many indigenous villages in the Amazon basin still suffer from a high malaria burden. Despite this health situation, there are few studies on the bionomics of anopheline larvae in such areas. This publication aims to identify the main larval habitats of the most abundant anopheline species and to assess their associations with some environmental factors. We conducted a 19-month longitudinal study from January 2013 to July 2014, sampling anopheline larvae in two indigenous Yanomami communities, comprised of four villages each. All natural larval habitats were surveyed every two months with a 350 ml manual dipper, following a standardized larval sampling methodology. In a third study area, we conducted two field expeditions in 2013 followed by four systematic collections during the long dry season of 2014-2015. We identified 177 larval habitats in the three study areas, from which 9122 larvae belonging to 13 species were collected. Although species abundance differed between villages, An. oswaldoi (s.l.) was overall the most abundant species. Anopheles darlingi, An. oswaldoi (s.l.), An. triannulatus (s.s.) and An. mattogrossensis were primarily found in larval habitats that were partially or mostly sun-exposed. In contrast, An. costai-like and An. guarao-like mosquitoes were found in more shaded aquatic habitats. Anopheles darlingi was significantly associated with proximity to human habitations and larval habitats associated with river flood pulses and clear water. This study of anopheline larvae in the Brazilian Yanomami area detected high heterogeneities at micro-scale levels regarding species occurrence and densities. Sun exposure was a major modulator of anopheline occurrence, particularly for An. darlingi. Lakes associated with the rivers, and particularly oxbow lakes, were the main larval habitats for An. darlingi and other secondary malaria vectors. The results of this study will serve as a basis to plan larval source management activities in remote
Regis Goulart Rosa
Full Text Available We compared the discriminatory capacity of the sequential organ failure assessment (SOFA versus the systemic inflammatory response syndrome (SIRS score for predicting ICU mortality, need for and length of mechanical ventilation, ICU stay, and hospitalization in patients with suspected infection admitted to a mixed Brazilian ICU. We performed a retrospective analysis of a longitudinal ICU database from a tertiary hospital in Southern Brazil. Patients were categorized according to whether they met the criteria for sepsis according to SOFA (variation ≥2 points over the baseline clinical condition and SIRS (SIRS score ≥2 points. From January 2008 to December 2014, 1487 patients were admitted to the ICU due to suspected infection. SOFA ≥2 identified more septic patients than SIRS ≥2 (79.0% [n = 1175] vs. 68.5% [n = 1020], p 7 days (AUROC = 0.65 vs. 0.63, p = 0.004, and length of hospitalization >10 days (AUROC = 0.61 vs. 0.59, p 7 days.
Full Text Available In most mammals, male development is triggered by the transient expression of the SRY gene, which initiates a cascade of gene interactions ultimately leading to the formation of a testis from the indifferent fetal gonad. Mutation studies have identified several genes essential for early gonadal development. We report here a molecular study of the SRY, DAX1, SF1 and WNT4 genes, mainly involved in sexual determination, in Brazilian 46,XX and 46,XY sex-reversed patients. The group of 46,XX sex-reversed patients consisted of thirteen 46,XX true hermaphrodites and four 46,XX males, and was examined for the presence of the SRY gene and for the loss of function (inactivating mutations and deletions of DAX1 and WNT4 genes. In the second group consisting of thirty-three 46,XY sex-reversed patients we investigated the presence of inactivating mutations in the SRY and SF1 genes as well as the overexpression (duplication of the DAX1 and WNT4 genes. The SRY gene was present in two 46,XX male patients and in none of the true hermaphrodites. Only one mutation, located outside homeobox domain of the 5' region of the HMG box of SRY (S18N, was identified in a patient with 46,XY sex reversal. A novel 8-bp microdeletion of the SF1 gene was identified in a 46,XY sex-reversed patient without adrenal insufficiency. The dosage of DAX1 and WNT4 was normal in the sex-reversed patients studied. We conclude that these genes are rarely involved in the etiology of male gonadal development in sex-reversed patients, a fact suggesting the presence of other genes in the sex determination cascade.
Yêska Paola Costa Aguiar
Full Text Available Dental erosion is a pathological condition resulting from the irreversible dissolution of the mineralized portion of the teeth, being recognized in modern society as an important cause of loss of tooth structure. The aim of this study was to assess the prevalence and its association with diet in Brazilian adolescents of Campina Grande, PB, Brazil. A population-based study was conducted on a stratified sample of 675 adolescents aged from 15 to 19 of both sexes using the index proposed by O'Sullivan. Dental examinations were performed by two calibrated dentists (kappa = 0.82. The significance level adopted was 5%. The prevalence of dental erosion was 21%, and the upper central incisors and lateral incisors were the most affected elements, with 50.5% and 40.2%, respectively. The buccal surface showed greater impairment (51.4% and 67.8% of teeth with dental erosion had more than half of the surface of affected area. Most damage was on the enamel (93.5%. There were no statistically significant differences between the occurrence of dental erosion and gender, age, socioeconomic status, self-reported ethnicity, and diet. There was high prevalence of dental erosion in its early stages among adolescents and there were no significant differences in the frequency of the consumption of foods and beverages and the presence of dental erosion.
Aguiar, Yêska Paola Costa; dos Santos, Fábio Gomes; Moura, Eline Freitas de Farias; da Costa, Fernanda Clotilde Mariz; Auad, Sheyla Marcia; de Paiva, Saul Martins; Cavalcanti, Alessandro Leite
Dental erosion is a pathological condition resulting from the irreversible dissolution of the mineralized portion of the teeth, being recognized in modern society as an important cause of loss of tooth structure. The aim of this study was to assess the prevalence and its association with diet in Brazilian adolescents of Campina Grande, PB, Brazil. A population-based study was conducted on a stratified sample of 675 adolescents aged from 15 to 19 of both sexes using the index proposed by O'Sullivan. Dental examinations were performed by two calibrated dentists (kappa = 0.82). The significance level adopted was 5%. The prevalence of dental erosion was 21%, and the upper central incisors and lateral incisors were the most affected elements, with 50.5% and 40.2%, respectively. The buccal surface showed greater impairment (51.4%) and 67.8% of teeth with dental erosion had more than half of the surface of affected area. Most damage was on the enamel (93.5%). There were no statistically significant differences between the occurrence of dental erosion and gender, age, socioeconomic status, self-reported ethnicity, and diet. There was high prevalence of dental erosion in its early stages among adolescents and there were no significant differences in the frequency of the consumption of foods and beverages and the presence of dental erosion.
Gazolla, Fernanda Mussi; Neves Bordallo, Maria Alice; Madeira, Isabel Rey; de Miranda Carvalho, Cecilia Noronha; Vieira Monteiro, Alexandra Maria; Pinheiro Rodrigues, Nádia Cristina; Borges, Marcos Antonio; Collett-Solberg, Paulo Ferrez; Muniz, Bruna Moreira; de Oliveira, Cecilia Lacroix; Pinheiro, Suellen Martins; de Queiroz Ribeiro, Rebeca Mathias
Early exposure to cardiovascular risk factors creates a chronic inflammatory state that could damage the endothelium followed by thickening of the carotid intima-media. To investigate the association of cardiovascular risk factors and thickening of the carotid intima. Media in prepubertal children. In this cross-sectional study, carotid intima-media thickness (cIMT) and cardiovascular risk factors were assessed in 129 prepubertal children aged from 5 to 10 year. Association was assessed by simple and multivariate logistic regression analyses. In simple logistic regression analyses, body mass index (BMI) z-score, waist circumference, and systolic blood pressure (SBP) were positively associated with increased left, right, and average cIMT, whereas diastolic blood pressure was positively associated only with increased left and average cIMT (p<0.05). In multivariate logistic regression analyses increased left cIMT was positively associated to BMI z-score and SBP, and increased average cIMT was only positively associated to SBP (p<0.05). BMI z-score and SBP were the strongest risk factors for increased cIMT.
Nassar Junior, Antonio Paulo; Azevedo, Luciano César Pontes de
To evaluate job and personal satisfaction rates in physicians who work in adult intensive care units and to identify the factors associated with satisfaction. A cross-sectional study performed with physicians who participated in two intensive medicine online discussion groups. A questionnaire designed to assess the physician's sociodemographic profile and job was available for both groups for 3 months. At the end of the questionnaire, the participants addressed their degrees of job and personal satisfaction using a Likert scale in which 1 represented "very dissatisfied" and 5 represented "very satisfied". The association between sociodemographic and job characteristics with job and personal satisfaction was evaluated. Variables independently associated with satisfaction were identified using a logistic regression model. The questionnaire was answered by 250 physicians, of which 137 (54.8%) declared they were satisfied with their jobs and 34 (13.5%) were very satisfied. None of the evaluated characteristics were independently associated with job satisfaction. Regarding personal satisfaction, 136 (54.4%) physicians reported being satisfied, and 48 (19.9%) reported being very satisfied. Job satisfaction (OR = 7.21; 95%CI 3.21 - 16.20) and working in a university hospital (OR = 3.24; 95%CI 1.29 - 8.15) were factors independently associated with the personal satisfaction of the participants. The participant physicians reported job and personal satisfaction with their work in intensive care. Job satisfaction and working in a university hospital were independently associated with greater personal satisfaction.
David Enrique Aguilar Rodriguez
Full Text Available Fanconi anaemia (FA is a recessive autosomal disease determined by mutations in genes of at least eleven complementation groups, with distinct distributions in different populations. As far as we know, there are no reports regarding the molecular characterisation of the disease in unselected FA patients in Brazil. OBECTIVE: This study aimed to investigate the most prevalent mutations of FANCA and FANCC genes in Brazilian patients with FA. METHODS: Genomic DNA obtained from 22 racially and ethnically diverse unrelated FA patients (mean age ± SD: 14.0 ± 7.8 years; 10 male, 12 female; 14 white, 8 black was analysed by polymerase chain reaction and restriction site assays for identification of FANCA (delta3788-3790 and FANCC (delta322G, IVS4+4A -> T, W22X, L496R, R548X, Q13X, R185X, and L554P gene mutations. RESULTS: Mutations in FANCA and FANCC genes were identified in 6 (27.3% and 14 (63.6% out of 22 patients, respectively. The disease could not be attributed to the tested mutations in the two remaining patients enrolled in the study (9.1%. The registry of the two most prevalent gene abnormalities (delta3788-3790 and IVS4 + 4 -> T revealed that they were present in 18.2% and 15.9% of the FA alleles, respectively. Additional FANCC gene mutations were found in the study, with the following prevalence: delta322G (11.4%, W22X (9.1%, Q13X (2.3%, L554P (2.3%, and R548X (2.3% of total FA alleles. CONCLUSION: These results suggest that mutations of FANCA and FANCC genes are the most prevalent mutations among FA patients in Brazil.
Full Text Available Merozoites of Plasmodium falciparum invade through several pathways using different RBC receptors. Field isolates appear to use a greater variability of these receptors than laboratory isolates. Brazilian field isolates were shown to mostly utilize glycophorin A-independent invasion pathways via glycophorin B (GPB and/or other receptors. The Brazilian population exhibits extensive polymorphism in blood group antigens, however, no studies have been done to relate the prevalence of the antigens that function as receptors for P. falciparum and the ability of the parasite to invade. Our study aimed to establish whether variation in the GYPB*S/s alleles influences susceptibility to infection with P. falciparum in the admixed population of Brazil.Two groups of Brazilian Amazonians from Porto Velho were studied: P. falciparum infected individuals (cases; and uninfected individuals who were born and/or have lived in the same endemic region for over ten years, were exposed to infection but have not had malaria over the study period (controls. The GPB Ss phenotype and GYPB*S/s alleles were determined by standard methods. Sixty two Ancestry Informative Markers were genotyped on each individual to estimate admixture and control its potential effect on the association between frequency of GYPB*S and malaria infection.GYPB*S is associated with host susceptibility to infection with P. falciparum; GYPB*S/GYPB*S and GYPB*S/GYPB*s were significantly more prevalent in the in the P. falciparum infected individuals than in the controls (69.87% vs. 49.75%; P<0.02. Moreover, population genetics tests applied on the GYPB exon sequencing data suggest that natural selection shaped the observed pattern of nucleotide diversity.Epidemiological and evolutionary approaches suggest an important role for the GPB receptor in RBC invasion by P. falciparum in Brazilian Amazons. Moreover, an increased susceptibility to infection by this parasite is associated with the GPB S
Karina Miranda Santiago
Full Text Available Xeroderma pigmentosum (XP is a rare autosomal recessive disorder characterized by DNA repair defects that cause photophobia, sunlight-induced cancers, and neurodegeneration. Prevalence of germline mutations in the nucleotide excision repair gene XPA vary significantly in different populations. No Brazilian patients have been reported to carry a germline mutation in this gene. In this study, the germline mutational status of XPA was determined in Brazilian patients exhibiting major clinical features of XP syndrome. The study was conducted on 27 unrelated patients from select Brazilian families. A biallelic inactivating transition mutation c.619C>T (p.Arg207Ter was identified in only one patient with a history of neurological impairment and mild skin abnormalities. These findings suggest that XP syndrome is rarely associated with inherited disease-causing XPA mutations in the Brazilian population. Additionally, this report demonstrates the effectiveness of genotype-phenotype correlation as a valuable tool to guide direct genetic screening.
Santiago, Karina Miranda; França de Nóbrega, Amanda; Rocha, Rafael Malagoli; Rogatto, Silvia Regina; Achatz, Maria Isabel
Xeroderma pigmentosum (XP) is a rare autosomal recessive disorder characterized by DNA repair defects that cause photophobia, sunlight-induced cancers, and neurodegeneration. Prevalence of germline mutations in the nucleotide excision repair gene XPA vary significantly in different populations. No Brazilian patients have been reported to carry a germline mutation in this gene. In this study, the germline mutational status of XPA was determined in Brazilian patients exhibiting major clinical features of XP syndrome. The study was conducted on 27 unrelated patients from select Brazilian families. A biallelic inactivating transition mutation c.619C>T (p.Arg207Ter) was identified in only one patient with a history of neurological impairment and mild skin abnormalities. These findings suggest that XP syndrome is rarely associated with inherited disease-causing XPA mutations in the Brazilian population. Additionally, this report demonstrates the effectiveness of genotype-phenotype correlation as a valuable tool to guide direct genetic screening.
Carvalho, Chrissie Ferreira de; Oulhote, Youssef; Martorelli, Marina; Carvalho, Carla Oliveira de; Menezes-Filho, José Antônio; Argollo, Nayara; Abreu, Neander
Manganese (Mn) is an essential element, however high levels of Mn have been associated with lower neuropsychological performance and behavioral problems in children. We investigated the associations between hair Mn concentrations and neuropsychological and behavioral performances among children with long-term exposure to airborne Mn aged between 7 and 12 years. Neuropsychological performance included tests of: verbal memory, inhibitory control, cognitive flexibility, verbal fluency, and motor function. We used the Conners Abbreviated Rating Scale for teachers to assess students' behaviors of hyperactivity. Hair manganese (MnH) concentrations in children and exposure to airborne manganese from a ferro-manganese alloy plant were analyzed and correlated with tests scores. Multivariable linear models adjusting for potential confounders showed that elevated levels of MnH were associated with lower performance in verbal memory, as measured by the free recall after interference (β = - 1.8; 95% CI: - 3.4, - 0.2), which indicates susceptibility to interference, and Delayed Effect (β = -2.0; 95% CI: -3.7, - 0.2), representing a loss of information over time. Additionally, we found patterns of effect modification by sex in three subtests measuring verbal memory: the free recall after interference score, Interference Effect, and Delayed Effect (all at p < 0.10). Overall, the results suggest that long-term airborne Mn exposure may be associated with lower performance in verbal memory, and hyperactivity behaviors. Copyright © 2018 Elsevier B.V. All rights reserved.
da Costa Lima Caniatti, Marcela Caleffi; Borelli, Sueli Donizete; Guilherme, Ana Lúcia Falavigna; Tsuneto, Luiza Tamie
Type I hypersensitivity, also known as IgE-mediated allergy, is a complex, multifactorial condition whose onset and severity are influenced by both genetic and environmental factors. Mite allergens stimulate the production of humoral response (IgE), especially in children, which is closely involved in atopic asthma and rhinitis. This study aimed to investigate the association between HLA class I (-A, -B, and -C), and HLA class II (-DRB1) genes in individuals sensitive to dust mites (Dermatophagoides farinae, Dermatophagoides pteronyssinus, or Blomia tropicalis) and mite-insensitive controls. 396 participants were grouped as mite-sensitive and mite-insensitive according to immediate hypersensitivity as determined by skin-prick tests, and to HLA genotyping by polymerase chain reaction-sequence specific oligonucleotide (PCR-SSO). After chi-square heterogeneity testing no significant differences were observed in HLA-A, B, and C genes, except for the HLA-DRB1 locus, which, showed a negative association for DRB1∗04, between mite-sensitive and mite-insensitive individuals. In high resolution, DRB1∗04:11 allele was significantly different from all other results (P=0.0042, OR=0.26, and 95%CI=0.09-0.70). The analysis stratified by etiologic agent confirmed these associations. Our results suggest a possible association between HLA-DRB1 genes and hypersensitivity to dust mites. Copyright © 2016 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.
Paulino, Gustavo Vasconcelos Bastos; Félix, Ciro Ramon; Broetto, Leonardo; Landell, Melissa Fontes
Some of the main threats to coral reefs come from human actions on marine environment, such as tourism, overfishing and pollution from urban development. While several studies have demonstrated an association between bacteria and corals, demonstrating how these communities react to different anthropogenic stressors, yeast communities associated with corals have received far less attention from researchers. The aim of this work was therefore to describe cultivable yeasts associated with three coral species and to evaluate the influence of sewage discharge on yeasts community. We obtained 130 isolates, mostly belonging to phylum Ascomycota and many of them had previously been isolated from human samples or are considered pathogens. The mycobiota was more similar among corals collected from the same reef, indicating that the composition of reef yeast community is more influenced by environmental conditions than host species. We suggest further studies to elucidate which factors are most influential on the composition of the coral-associated yeast community. Copyright © 2017 Elsevier Ltd. All rights reserved.
Teixeira, Helena M P; Alcantara-Neves, Neuza M; Barreto, Maurício; Figueiredo, Camila A; Costa, Ryan S
Asthma is a chronic inflammatory disease of the respiratory tract. This heterogeneous disease is caused by the interaction of interindividual genetic variability and environmental factors. The gene adenylyl cyclase type 9 (ADCY9) encodes a protein called adenylyl cyclase (AC), responsible for producing the second messenger cyclic AMP (cAMP). cAMP is produced by T regulatory cells and is involved in the down-regulation of T effector cells. Failures in cAMP production may be related to an imbalance in the regulatory immune response, leading to immune-mediated diseases, such as allergic disorders. The aim of this study was to investigate how polymorphisms in the ADCY9 are associated with asthma and allergic markers. The study comprised 1309 subjects from the SCAALA (Social Changes Asthma and Allergy in Latin America) program. Genotyping was accomplished using the Illumina 2.5 Human Omni bead chip. Logistic regression was used to assess the association between allergy markers and ADCY9 variation in PLINK 1.07 software with adjustments for sex, age, helminth infection and ancestry markers. The ADCY9 candidate gene was associated with different phenotypes, such as asthma, specific IgE, skin prick test, and cytokine production. Among 133 markers analyzed, 29 SNPs where associated with asthma and allergic markers in silico analysis revealed the functional impact of the 6 SNPs on ADCY9 expression. It can be concluded that polymorphisms in the ADCY9 gene are significantly associated with asthma and/or allergy markers. We believe that such polymorphisms may lead to increased expression of adenylyl cyclase with a consequent increase in immunoregulatory activity. Therefore, these SNPs may offer an impact on the occurrence of these conditions in admixture population from countries such as Brazil. Copyright © 2017 Elsevier Ltd. All rights reserved.
Williams, M. Lee; Clampitt, Phillip G.
Using data drawn from ten initial physician/patient interviews, an original category system was employed to analyze patterns of physician/patient communication. Static analysis, interaction analysis, and Markov chain analysis were used to discover the underlying communication patterns associated with patient satisfaction. Results revealed that…
Iva Carneiro Leão Barros
Full Text Available This study aims to investigate fern flora similarity and fern species relationships in the study areas, in terms of their substrates, habitat types, and life forms. The study was conducted in the Água Azul forest fragment, municipality of Timbaúba, Pernambuco, and the Maria Maior forest fragment, municipality of São José da Laje, Alagoas. The Jaccard similarity index was used for cluster analysis. The 112 species that occur in the two areas were used for numerical analysis. The floristic similarity was great (J=43.75%, principally due to similarities in the two areas vegetational types, as was expected due to their geographic proximity to one another and their similar climatic conditions. Five groups of associated species were determined for the Água Azul fragment and six groups for the Maria Maior fragment. In general, the ecological factors that determined fern species associations were habitat and type of substrate.
Full Text Available Almost all individuals (182 belonging to an Amazonian riverine population (Portuchuelo, RO, Brazil were investigated for ascertaining data on epidemiological aspects of malaria. Thirteen genetic blood polymorphisms were investigated (ABO, MNSs, Rh, Kell, and Duffy systems, haptoglobins, hemoglobins, and the enzymes glucose-6-phosphate dehydrogenase, glyoxalase, phosphoglucomutase, carbonic anhydrase, red cell acid phosphatase, and esterase D. The results indicated that the Duffy system is associated with susceptibility to malaria, as observed in other endemic areas. Moreover, suggestions also arose indicating that the EsD and Rh loci may be significantly associated with resistance to malaria. If statistical type II errors and sample stratification could be ruled out, hypotheses on the existence of a causal mechanism or an unknown closely linked locus involved in susceptibility to malaria infection may explain the present findings.
Kochem, Frederico B; Silva, Julio G
To investigate the prevalence of playing-related musculoskeletal disorders (PRMD) and associated factors among violinists from the state of Rio de Janeiro, Brazil. This cross-sectional study included 106 violinists from eight cities in the state of Rio de Janeiro. Sociodemographic and musical characteristic data, pain symptoms, and upper-limb functionality were collected using the DASH and the Standardized Nordic Questionnaires. The associations between musculoskeletal complaints and possible predictors were analyzed by binary logistic regression. Of the 106 surveyed violin players, 86.8% reported at least one painful area in the last 12 months and 77.4% in the last week. These symptoms were responsible for the temporary interruption of musical activity in 8.1% of musicians. More than 50% of violinists showed dysfunctional upper limbs according to the DASH optional module. Women were more likely to develop musculoskeletal disorders (OR 4.4, CI 1.9-10.0, p<0.001). In addition, older musicians were more likely to report pain in the last 7 days (OR 3.3, CI 5.1-10.97; p=0.04) and also had higher scores on the DASH (OR 1.8, CI 1.1-3.1; p=0.01). Other factors associated with the development of PRMD were body mass index, practice hours per week, and final DASH score. Violinists living and working in the state of Rio de Janeiro have a high prevalence of PRMD, especially women and older musicians.
Gustavo C. Medeiros
Full Text Available Objective: Bipolar disorder (BD is often left untreated for long periods, and this delay in treatment correlates with unfavorable prognosis. The present study sought to assess the magnitude of duration of untreated bipolar disorder (DUB in Brazil. We hypothesized that DUB would be longer in Brazil than in developed countries, and would be associated with poor clinical outcomes. Methods: One hundred and fifty-two psychiatric outpatients were evaluated for BD diagnosis, demographics, DUB, and clinical outcomes. Results: The mean age and mean DUB were, respectively, 38.9±10.8 and 10.4±9.8 years. An extended DUB was associated with early onset of BD (p < 0.001, depression as first mood episode (p = 0.04, and presence of BD in a first-degree relative (p = 0.012. Additionally, a longer DUB was associated with poorer clinical outcomes, such as elevated rates of rapid cycling (p = 0.004 and anxiety disorders (p = 0.016, as well as lower levels of current full remission (p = 0.021. Conclusion: As DUB may be a modifiable variable, better medical education regarding mental health, more structured medical services, and population-wide psychoeducation might reduce the time between onset and proper management of BD, thus improving outcome.
Fronza Fernanda Cerveira Abuana Osório
Full Text Available Purpose. Sedentary behavior has been identified as a risk factor for chronic non-communicable diseases. This study identified the prevalence of excessive TV viewing time during the week and weekend and associated factors in adolescents living in a small urban and rural area. Methods. A cross-sectional study involving 283 students (aged 10-19 years from Brazil was conducted in 2010. Data on TV viewing time and sociodemographic information were collected by questionnaires, cardiorespiratory fitness was evaluated by the 20-m shuttle run test, and anthropometric characteristics were obtained by measuring waist circumference and skinfold thickness. Statistical analysis involved binary logistic regression. Results. The prevalence of excessive TV viewing time ( 2 h was 76.7% during on weekdays and 78.4% on the weekend. Adolescents aged 10-12 years (OR = 6.20; 95% CI = 2.91, 13.19; p < 0.001 and 13-15 years (OR = 2.57; 95% CI = 1.28, 5.18; p = 0.008 were more exposed to excessive TV viewing time during the week. No associations were found for excessive TV viewing time on the weekend. Conclusions. Approximately 8 in 10 adolescents presented excessive TV viewing time; excessive TV viewing time during the week was associated with age.
Marcos Adegas de Azambuja
Full Text Available This paper problematizes the Brazilian Social Psychology and its knowledge production on the registers of the Work Group (WG of symposiums of the National Association of Research and Post-Graduation in Psychology (ANPEPP, during 1988 to 2010. Using Michel Foucault's archeo-genealogical perspective and the contributions by Ian Hacking about the historical ontology of subjects, we analyzed technologies of power and knowledge in the disciplines of Social Psychology. We selected the WG abstracts in which circulate the utterances that make up the discursive field of Brazilian Social Psychology. Using the narrative of WGs we outlined a discursive formation of identities/technologies of the subject. The knowledges of Social Psychology in the history of the ANPEPP's WGs contribute to the constitution of categories and psychological classifications which objectivize subjects. We think Social Psychology, in its criticisms related to psychological and social concepts comprises practices and regimes of truth about the subject of Social Psychology.
Audi, Celene Aparecida Ferrari; Segall-Corrêa, Ana M; Santiago, Silvia M; Pérez-Escamilla, Rafael
domestic violence during pregnancy remains an unsolved and neglected social problem despite the recognised adverse physical and mental health consequences. to examine the association between domestic violence (psychological violence and physical or sexual violence) and health problems self-reported by pregnant women. a cross-sectional analysis from a cohort study of 1,379 pregnant women attending prenatal care in public primary care units in Campinas, São Paulo, Brazil. Data were collected by interviewing women when they enroled for prenatal care. Domestic violence and alcohol abuse were ascertained by validated questionnaires. Referred morbidities, undesirable behaviours and sociodemographic characteristics were also recorded. Univariate analyses were used to estimate prevalence and unadjusted odd ratios. Multivariate logistic regression was used to identify the independent association between psychological violence and physical or sexual violence during pregnancy and women's health outcomes. psychological violence and physical or sexual violence were reported by 19.1% (n=263) and 6.5% (n=89) of the pregnant women, respectively. Psychological violence was significantly associated with obstetric problems [odds ratio (OR) 1.95; 95% confidence interval (CI) 1.39-2.73], premature rupture of membranes (OR 1.64, 95% CI 1.01-2.68), urinary tract infection (OR 1.71, 95% CI 1.19-2.42), headache (OR 1.75, 95% CI 1.25-2.40) and sexual risk behaviours (OR 2.28, 95% CI 1.18-4.41). Physical or sexual violence was significantly associated with: obstetric problems (OR 1.72, 95% CI 1.08-2.75), premature rupture of membranes (OR 2.11, 95% CI 1.14-3.88), urinary tract infection (OR 2.05, 95% CI 1.26-3.34), vaginal bleeding (OR 1.95, 95% CI 1.10-3.43) and lack of sexual desire (OR 3.67, 95% CI 2.23-6.09). domestic violence during pregnancy was associated with adverse clinical and psychological outcomes for women. These results suggest that a well-organised health-care system and
Niedzielska, Iwona; Puszczewicz, Zbigniew; Mertas, Anna; Niedzielski, Damian; Różanowski, Bartosz; Baron, Stefan; Konopka, Tomasz; Machorowska-Pieniążek, Agnieszka; Skucha-Nowak, Małgorzata; Tanasiewicz, Marta; Paluch, Jarosław; Markowski, Jarosław; Orzechowska-Wylęgała, Bogusława; Król, Wojciech; Morawiec, Tadeusz
Maintenance of proper oral hygiene by dental plaque elimination is one of the most important factors affecting the healing process in postoperative oral wounds. Propolis is a substance produced by bees. Ethanolic extract of propolis has bactericidal, fungicidal, anti-inflammatory, and antioxidative properties. Moreover, it can scavenge free radicals. The purpose of this paper is to demonstrate the efficacy of a gel containing 3% of ethanolic extract of Brazilian green propolis (EEP-B) when used for maintaining oral hygiene in patients with postoperative oral mucosal wounds. The hygiene was assessed using API, OHI, and SBI followed by microbiological examinations. The patients were divided into two groups. Group 1 consisted of those who used a gel containing EEP-B for oral hygiene, and group 2 consisted of those who used a gel without EEP-B. Although improved oral hygiene was noted in both groups, the improvement was markedly greater in the group using gel containing EEP-B. Summing up the results of microbiological examinations, EEP-B has beneficial effect on mouth microflora in postoperative period. Propolis preparations used for oral hygiene allow eliminating microorganisms of pathogenic character and physiological flora microorganisms considered as being opportunistic, with no harmful influence on physiological microflora in oral ecosystem.
Full Text Available Maintenance of proper oral hygiene by dental plaque elimination is one of the most important factors affecting the healing process in postoperative oral wounds. Propolis is a substance produced by bees. Ethanolic extract of propolis has bactericidal, fungicidal, anti-inflammatory, and antioxidative properties. Moreover, it can scavenge free radicals. The purpose of this paper is to demonstrate the efficacy of a gel containing 3% of ethanolic extract of Brazilian green propolis (EEP-B when used for maintaining oral hygiene in patients with postoperative oral mucosal wounds. The hygiene was assessed using API, OHI, and SBI followed by microbiological examinations. The patients were divided into two groups. Group 1 consisted of those who used a gel containing EEP-B for oral hygiene, and group 2 consisted of those who used a gel without EEP-B. Although improved oral hygiene was noted in both groups, the improvement was markedly greater in the group using gel containing EEP-B. Summing up the results of microbiological examinations, EEP-B has beneficial effect on mouth microflora in postoperative period. Propolis preparations used for oral hygiene allow eliminating microorganisms of pathogenic character and physiological flora microorganisms considered as being opportunistic, with no harmful influence on physiological microflora in oral ecosystem.
Full Text Available INTRODUCTION: Prospective studies have shown that the course of bipolar disorder (BD is characterized by the persistence of symptoms, predominantly depression, along most of the time. However, to our knowledge, no studies in Latin America have investigated it. OBJECTIVES: To replicate international studies using a Brazilian sample to prospectively analyze treatment outcomes in the first year and to determine potential chronicity factors. METHODS: We followed up 102 patients with BD for 12 months and evaluated the number of months with affective episodes and the intensity of manic and depressive symptoms using the Young Mania Rating Scale (YMRS and the Hamilton Depression Scale (HAM-D17. Sociodemographic and retrospective clinical data were examined to determine possible predictors of outcome. RESULTS: Almost 50% of the patients had symptoms about half of the time, and there was a predominance of depressive episodes. Disease duration and number of depressive episodes were predictors of chronicity. Depressive polarity of the first episode and a higher number of depressive episodes predicted the occurrence of new depressive episodes. CONCLUSION: In general, BD outcome seems to be poor in the first year of monitoring, despite adequate treatment. There is a predominance of depressive symptoms, and previous depressive episodes are a predictor of new depressive episodes and worse outcome.
Gonçalves, Priscila Dib; Cunha, Paulo Jannuzzi; Malbergier, André; do Amaral, Ricardo Abrantes; de Oliveira, Lúcio Garcia; Yang, Jasmine J; de Andrade, Arthur Guerra
Although there are a large number of studies focused on binge drinking and traffic risk behaviors (TRB), little is known regarding low levels of alcohol consumption and its association to TRB. The aim of this cross-sectional study is to examine the association of low to moderate alcohol intake pattern and TRB in college students in Brazil. 7037 students from a National representative sample were selected under rigorous inclusion criteria. All study participants voluntarily fulfilled a structured, anonymous, and self-questionnaire regarding alcohol and drug use, social-demographic data, and TRB. Alcohol was assessed according to the average number of alcoholic units consumed on standard occasions over the past 12 months. The associations between alcohol intake and TRB were summarized with odds ratio and their confidence interval obtained from logistic regression. Compared with abstainers students who consumed only one alcohol unit had the risk of being a passenger in a car driven by a drunk driver increased by almost four times, students who reported using five or more units were increased by almost five times the risk of being involved in a car crash. Compared with students who consumed one alcohol unit, the risk of driving under the influence of alcohol increased four times in students using three alcohol units. Age group, use of illicit drugs, employment status, gender, and marital status significantly influenced occurrence of TRB among college students. Our study highlights the potential detrimental effects of low and moderate pattern of alcohol consumption and its relation to riding with an intoxicated driver and other TRB. These data suggest that targeted interventions should be implemented in order to prevent negative consequences due to alcohol use in this population. Copyright © 2012 Elsevier Inc. All rights reserved.
Suzuki, Cibele; Lopes da Silva, Nilceia; Kumar, Praveen; Pathak, Purnima; Ong, Siew Hwa
Omalizumab add-on to standard-of-care therapy has proven to be efficacious in severe asthma patients for whom exacerbations cannot be controlled otherwise. Moreover, evidence from different healthcare settings suggests reduced healthcare resource utilization with omalizumab. Based on these findings, this study aimed to assess the cost-effectiveness of the addition of omalizumab to standard-of-care therapy in patients with uncontrolled severe allergic asthma in a Brazilian healthcare setting. A previously published Markov model was adapted using Brazil-specific unit costs to compare the costs and outcomes of the addition of omalizumab to standard-of-care therapy vs standard-of-care therapy alone. Model inputs were largely based on the eXpeRience study. Costs and health outcomes were calculated for lifetime-years and were annually discounted at 5%. Both one-way and probabilistic sensitivity analyses were performed. An additional cost of R$280,400 for 5.20 additional quality-adjusted life-years was estimated with the addition of omalizumab to standard-of-care therapy, resulting in an incremental cost-effectiveness ratio of R$53,890. One-way sensitivity analysis indicated that discount rates, standard-of-care therapy exacerbation rates, and exacerbation-related mortality rates had the largest impact on incremental cost-effectiveness ratios. Assumptions of lifetime treatment adherence and rate of future exacerbations, independent of previous events, might affect the findings. The lack of Brazilian patients in the eXpeRience study may affect the findings, although sample size and baseline characteristics suggest that the modeled population closely resembles Brazilian severe allergic asthma patients. Results indicate that omalizumab as an add-on therapy is more cost-effective than standard-of-care therapy alone for Brazilian patients with uncontrolled severe allergic asthma, based on the World Health Organization's cost-effectiveness threshold of up to 3-times the gross
Deborah B. Maia
Full Text Available Objective: Peritraumatic reactions feature prominently among the main predictors for development of posttraumatic stress disorder (PTSD. Peritraumatic tonic immobility (PTI, a less investigated but equally important type of peritraumatic response, has been recently attracting the attention of researchers and clinicians for its close association with traumatic reactions and PTSD. Our objective was to investigate the role of PTI, peritraumatic panic, and dissociation as predictors of PTSD symptoms in a cohort of police recruits (n=132. Methods: Participants were asked to complete the following questionnaires during academy training and after the first year of work: Posttraumatic Stress Disorder Checklist - Civilian Version (PCL-C, Physical Reactions Subscale (PRS, Peritraumatic Dissociative Experiences Questionnaire (PDEQ, Tonic Immobility Scale (TIS, and Critical Incident History Questionnaire. Results: Employing a zero-inflated negative binomial regression model, we found that each additional point in the TIS was associated with a 9% increment in PCL-C mean scores (RM = 1.09, whereas for PRS, the increment was 7% (RM = 1.07. As the severity of peritraumatic dissociation increased one point in the PDEQ, the chance of having at least one symptom in the PCL-C increased 22% (OR = 1.22. Conclusions: Our findings highlight the need to expand investigation on the incidence and impact of PTI on the mental health of police officers.
De Souza, A R; Lopes-Mielezrski, G N; Lopes, E N; Querino, R B; Corsato, C D A; Giustolin, T A; Zucchi, R A
The purpose of this study was to investigate native species of parasitoids of frugivorous larvae and their associations with host plants in commercial guava orchards and in typical native dry forests of a caatinga-cerrado ecotone in the State of Minas Gerais, Brazil. Nine species of parasitoids were associated with larvae of Anastrepha (Tephritidae) and Neosilba (Lonchaeidae) in fruit of Psidium guajava L. (Myrtaceae), Ziziphus joazeiro Mart. (Rhamnaceae), Spondias tuberosa Arruda (Anacardiaceae), Spondias dulcis Forst. (Anacardiaceae), Syzygium cumini (L.) Skeels (Myrtaceae), and Randia armata (Sw.) DC. (Rubiaceae). Doryctobracon areolatus was the most abundant species, obtained from puparia of Anastrepha zenildae, An. sororcula, An. fraterculus, An. obliqua, and An. turpiniae. This is the first report of Asobara obliqua in Brazil and of As. anastrephae and Tropideucoila weldi in dry forests of Minas Gerais State. The number of species of parasitoids was higher in areas with greater diversity of cultivated species and lower pesticide use. The forest fragments adjacent to the orchards served as shelter for parasitoids of frugivorous larvae.
Full Text Available The aim of this paper was to assess the epidemiology of traumatic dental injury (TDI in preschool children and its relation to socioeconomic and clinical factors. This study was carried out in Santa Maria, Brazil, during National Children's Vaccination Day, and 441 children aged 12 to 59 months were included. Data about socioeconomic status were collected through a semi-structured questionnaire administered to parents. Calibrated examiners evaluated the prevalence of TDI, overjet, and lip coverage. Data were analyzed with a Poisson regression model (PR; 95% confidence intervals. The TDI prevalence was 31.7%. The maxillary central incisors were the most frequently traumatized teeth. The most common TDI was enamel fracture. No association was found between TDI prevalence and the socioeconomic status of children. After adjustments were performed, the eldest children with an overjet > 3 mm were more likely to have TDI than their counterparts. The data indicated a high prevalence of TDI. Only overjet was a strong predictor for TDI, whereas socioeconomic factors were not associated with TDI in this age group.
Cavalcanti, Alessandro L; Ramos, Ianny A; Cardoso, Andreia M R; Fernandes, Liege Helena F; Aragão, Amanda S; Santos, Fábio G; Aguiar, Yêska P C; Carvalho, Danielle F; Medeiros, Carla C M; De S C Soares, Renata; Castro, Ricardo D
Obesity is a serious problem of public health and affects all socio-economic groups, irrespective of age, sex or ethnicity. The aim of this study was to evaluate the association between periodontal condition and nutritional status of adolescents. This was a cross-sectional study using a probability cluster sampling, and the sample was defined by statistical criterion, consisting of 559 students aged 15-19 yr enrolled in public schools of adolescents of Campina Grande, PB, Brazil in 2012. Socioeconomic characteristics were analyzed, as well as self-reported general and oral health, anthropometric data and periodontal condition (CPI and OHI-S). Descriptive and analytical analysis from bivariate and multivariate Poisson regression analysis with 5% significance level was performed. Of the 559 adolescents, 18.6% were overweight and 98.4% had some form of periodontal changes such as: bleeding (34.3%), calculus (38.8%), shallow pocket (22.9%) and deep pocket (2.3%). There was association between presence of periodontal changes with obesity ( P periodontal changes and obesity status in adolescents was indicated.
Caniatti, Marcela Caleffi da Costa Lima; Borelli, Sueli Donizete; Guilherme, Ana Lúcia Falavigna; Franzener, Soraya Barrionuevo; Tsuneto, Luiza Tamie
Killer cell immunoglobulin-like receptors (KIRs), found on the surface of natural killer (NK) cells, play a key role in controlling the innate response. Such response depends on a series of cellular interactions between these receptors and HLA activating/inhibiting ligands. Atopic diseases have been associated with genes that regulate cytokine production and HLA genes, which may either protect or predispose to hypersensitivity. To verify an association study of KIR genes with sensitization to the following mites: Dermatophagoides farinae, Dermatophagoides pteronyssinus, and Blomia tropicalis. A total of 341 children aged up to 14 years, were classified as mite-sensitive or mite-insensitive after undergoing a skin prick test for immediate allergic reactions. The presence/absence of KIR genes and their human leukocyte antigen (HLA) ligands was determined by polymerase chain reaction-sequence specific oligonucleotide (PCR-SSO) with the commercial kit LabType™ using Luminex™. The frequencies of KIR genes and their respective class I HLA ligands and the frequency of haplotypes were performed in sensitive and insensitive individuals, and no significant differences were found. Our results suggest no influence of KIR genes on resistance/susceptibility to sensitization to dust mites. Copyright © 2017 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.
Maia, Deborah B; Nóbrega, Augusta; Marques-Portella, Carla; Mendlowicz, Mauro V; Volchan, Eliane; Coutinho, Evandro S; Figueira, Ivan
Peritraumatic reactions feature prominently among the main predictors for development of posttraumatic stress disorder (PTSD). Peritraumatic tonic immobility (PTI), a less investigated but equally important type of peritraumatic response, has been recently attracting the attention of researchers and clinicians for its close association with traumatic reactions and PTSD. Our objective was to investigate the role of PTI, peritraumatic panic, and dissociation as predictors of PTSD symptoms in a cohort of police recruits (n=132). Participants were asked to complete the following questionnaires during academy training and after the first year of work: Posttraumatic Stress Disorder Checklist - Civilian Version (PCL-C), Physical Reactions Subscale (PRS), Peritraumatic Dissociative Experiences Questionnaire (PDEQ), Tonic Immobility Scale (TIS), and Critical Incident History Questionnaire. Employing a zero-inflated negative binomial regression model, we found that each additional point in the TIS was associated with a 9% increment in PCL-C mean scores (RM = 1.09), whereas for PRS, the increment was 7% (RM = 1.07). As the severity of peritraumatic dissociation increased one point in the PDEQ, the chance of having at least one symptom in the PCL-C increased 22% (OR = 1.22). Our findings highlight the need to expand investigation on the incidence and impact of PTI on the mental health of police officers.
Santos, O C S; Soares, A R; Machado, F L S; Romanos, M T V; Muricy, G; Giambiagi-deMarval, M; Laport, M S
Marine bacteria are a rich source of structurally unique natural compounds, several of which have shown a wide variety of biological activities. In this study, the metabolites present in the culture supernatants of the eight sponge-associated bacteria were extracted using ethyl acetate, and all extracts showed activity against Staphylococcus aureus. Subsequently, the extracts of the Pseudomonas fluorescens H40 and H41, and Pseudomonas aeruginosa H51 were subjected to solvent partitioning, and the active fractions were submitted to chromatographic separation. Three different active fractions were obtained, one of which was identified as diketopiperazine cyclo-(L-Leu-L-Pro). This substance was bactericidal for Staph. aureus and Ps. aeruginosa and showed cytotoxic activity against HEp-2 tumour cells. Putative gene fragments coding for the type I polyketide synthase (PKS-I) and nonribosomal peptide synthetase (NRPS) domains were PCR-amplified from five and three strains, respectively. The results suggest that sponge-associated bacteria analysed in this study may represent a potential source for production of antimicrobial substances against bacterial pathogens of medical importance. © 2014 The Society for Applied Microbiology.
Malta, Deborah Carvalho; Bernal, Regina Tomie Ivata; Teixeira, Barbara de Sá Menezes; Silva, Marta Maria Alves da; Freitas, Maria Imaculada de Fátima
This study explored the association between demographic characteristics (age and sex) and other variables related to violence committed against children (form of violence perpetrator, place of occurrence, and nature of injury) using a sample of 404 children taken from the 2014 Violence and Accident Surveillance System (Sistema de Vigilância de Violências e Acidentes, VIVA) survey. Correspondence analysis was used to identify variables associated with the outcome violence against children. Victims were predominantly male. The most common form of violence was neglect/abandonment, followed by physical violence and sexual violence. The most common perpetrators were parents (ages zero to one and two to five years), followed by friends (ages six to nine years). The most common place of occurrence was the home. Notable levels of violence were observed at school, particularly among children aged between six and nine years. Neglect was most common in the age group zero to one year and two to five years, while physical violence was most common between children aged between six and nine years.
Mello, Flávia Carvalho Malta; Silva, Jorge Luiz da; Oliveira, Wanderlei Abadio de; Prado, Rogério Ruscitto do; Malta, Deborah Carvalho; Silva, Marta Angélica Iossi
This study explored associations between bullying and sociodemographic, mental health and risk behavior variables in school age children. This cross-sectional survey analyzed data from the National School Health Survey (PeNSE 2015). A multiple logistic regression analysis checked for factors associated with bullying. Nineteen point eight percent (95%CI 10.5 - 20.0) of the students claimed they practiced bullying. The practice of bullying was more common among students enrolled in private schools, those living with their parents, and those whose mothers have more years of schooling and are gainfully employed (28.1% CI 27.3-28.8). In terms of mental health characteristics, bullying was more common among those feeling alone, suffering from insomnia and with no friends. Looking at family characteristics, those reporting they are physically punished by family members (33.09% CI 33.1-34.6) and miss school without telling their family (28.4% 95% CI 27.9-29.0) are more likely to practice bullying. Bullying was more frequent among those reporting tobacco, alcohol and drug use, and among students claiming to have had sexual relations. The data shows that bullying is significant and interferes in school children's health and the teaching-learning process. This must be addressed looking at youth as protagonists and in an inter-sectoral context.
Fiorelli, A I; Stolf, N A G; Pego-Fernandes, P M; Oliveira Junior, J L; Santos, R H B; Contreras, C A M; Filho, D D L; Dinkhuysen, J J; Moreira, M C V; Mejia, J A C; Castro, M C R
The high prevalence of heart failure has increased the candidate list for heart transplantation; however, there is a shortage of viable donated organs, which is responsible for the high mortality of patients awaiting a transplantation. Because the marginal donor presents additional risk factors, it is not considered to be an ideal donor. The use of a marginal donor is only justified in situations when the risk of patient death due to heart disease is greater than that offered by the donor. These recommendations sought to expand the supply of donors, consequently increasing the transplant rate. We selected articles based on robust evidence to provide a substratum to develop recommendations for donors who exceed the traditional acceptance criteria. Recipient survival in the immediate postoperative period is intimately linked to allograft quality. Primary allograft failure is responsible for 38% to 40% of immediate deaths after heart transplantation: therefore; marginal donor selection must be more rigorous to not increase the surgical risk. The main donor risk factors with the respective evidence levels are: cancer in the donor (B), female donor (B), donor death due to hemorrhagic stroke (B), donor age above 50 years (relative risk [RR] = 1.5) (B), weight mismatch between donor and recipient 240 minutes (RR = 1.2) (B), left ventricular dysfunction with ejection fraction below 45% (B), and use of high doses of vasoactive drugs (dopamine > 15 mg/kg·min) (B). Factors that impact recipient mortality are: age over 50 years (RR = 1.5); allograft harvest at a distance; adult recipient weighing more than 20% of the donor; high doses of vasoactive drugs (dopamine greater than 15 mg/kg·min) and ischemic time >4 hours. The use of a marginal donor is only justified when it is able to increase life expectancy compared with clinical treatment, albeit the outcomes are interior to those using an ideal donor. Copyright © 2011 Elsevier Inc. All rights reserved.
Doença celíaca: avaliação da obediência à dieta isenta de glúten e do conhecimento da doença pelos pacientes cadastrados na Associação dos Celíacos do Brasil (ACELBRA Celiac disease: evaluation of compliance to a gluten-free diet and knowledge of the disease in celiac patients registered at the Brazilian Celiac Association (BCA
Vera Lucia SDEPANIAN
. Conclusões - Quanto maior o grau de conhecimento da doença e seu tratamento, maior a obediência à dieta isenta de glúten.Background The compliance to a gluten-free diet may prevent the development of both non-malignant and malignant complications. Aim - To evaluate compliance to a gluten-free diet and knowledge of the disease in celiac patients registered at the Brazilian Celiac Association (BCA. Methods - A structured questionnaire was designed to assess compliance to a gluten-free diet as well as knowledge of the celiac disease. It was mailed to 584 members of BCA. Results - Five hundred and twenty nine (90.6% of a total of 534 (91.4% answered questionnaires were analyzed; 69.4% were classified as compliant patients whereas 29.5% were classified as noncompliant. The proportion of patients age 21 or older who consume gluten frequently or without any restriction is larger (17.7% than those who were younger than 21 years (9.9%. Frequency of dietary compliance was higher when the diagnosis had taken less than 5 years to be established; 82% of the patients replied that the small intestine was the part of the body affected by the disease. The most common symptoms of the disease according to the answers were diarrhea (96.6%, weight loss (93.4%, protuberant abdomen (90.4%, anemia (68.1% and vomiting (59.6%. Only 59.0% agreed with the existence of genetic predisposition; 90.4% answered that the disease is permanent and 96.2% stated that the diet should exclude gluten absolutely; 67.1% answered that the gluten is a protein and according to 92.1% questionnaires this protein is present in wheat, rye, barley and oat. Greater compliance was observed when there was an understanding of the disease and diet. The small intestine biopsy was considered necessary for just 67.5% of the patients, and greater compliance was observed in patients who had undergone at least one small intestine biopsy. Conclusion - Our findings indicate that the more the patients know and understand about
Vinholes, Daniele B; Bassanesi, Sérgio L; Chaves Junior, Hilton de Castro; Machado, Carlos Alberto; Melo, Ione M F; Fuchs, Flavio Danni; Fuchs, Sandra Costa
Exposure to risk factors for hypertension may be influenced by the characteristics of the workplace, where workers spend most of their daily time. To evaluate the association between features of the companies, particularly the presence of facilities to provide meals, and of population characteristics and the prevalence of hypertension, taking into account individual risk factors for hypertension. This multilevel analysis was based on a cross-sectional study with individual and company data from the SESI (Serviço Social da Indústria-Social Service of Industries) study and population-based data from the national census statistics. Workers aged ≥15 years were randomly selected from small (20-99), medium (100-499) and large (≥500 employees) companies per state using multistage sampling. Logistic regression was used to analyse the association between hypertension and individual, workplace and population variables, with odds ratios (ORs; 95% CI) adjusted for three-level variables. 4818 Workers from 157 companies were interviewed and their blood pressure, weight and height were measured. Overall, 77% were men, aged 35.4 ±10.7 years, with 8.7 ±4.1 years of schooling and mostly worked in companies with a staff canteen (66%). Besides individual characteristics-being male, ageing, low schooling, alcohol abuse and higher BMI-a workplace with no staff canteen (OR=1.28; 95% CI 1.08 to 1.52), small companies (OR=1.31; 95% CI 1.07 to 1.60) and living in cities with higher economic inequality (OR=1.47; 95% CI 1.23 to 1.76) were associated with a higher risk for hypertension. Among Brazilian workers, the prevalence of hypertension is associated with individual risk factors, lack of a canteen at the workplace, small companies and higher economic inequalities of cities. These three-level characteristics help to interpret differences in the prevalence of hypertension between regions or countries. © Article author(s) (or their employer(s) unless otherwise stated in the
Dawkins, Karim; Esiobu, Nwadiuto
The potential role of soil fungi in the invasion of the Brazilian pepper tree (Schinus terebinthifolius—BP) in Florida is not known; although the low biotic resistance of Florida soils is often invoked to explain the prevalence of many invasive species. To gain an initial insight into BP's mycorrhizal associations, this study examined the rhizobiome of BP and two native plants (Hamelia patens and Bidens alba) across six locations. Arbuscular mycorrhizal fungi (AMF) associated with the roots of the target plants and bulk soil was characterized by spore morphotyping. Sequence analysis of metagenomic DNA from lateral roots/rhizosphere of BP (n = 52) and a native shrub H. patens (n = 37) on the same parcel yielded other fungal associates. Overall, the total population of AMF associated with BP was about two folds greater than that of the two native plants (p = 0.0001) growing on the same site. The dominant AMF under Schinus were members of the common Glomus and Rhizophagus spp. By contrast, the most prevalent AMF in the bulk soil and rhizosphere of the two Florida native plants, Acaulospora spp (29%) was sharply diminished (9%) under BP rhizosphere. Analysis of the ITS2 sequences also showed that Schinus rhizosphere had a high relative abundance of ectomycorrhizal fungi (76.5%) compared to the native H. patens (2.6%), with the species Lactifluus hygrophoroides (Basidiomycota) being the most prevalent at 61.5% (p < 0.05). Unlike the native plants where pathogenic fungi like Phyllosticta sp., Phoma sp., and Neofusicoccum andium were present (8.1% for H. patens), only one potentially pathogenic fungal taxon was detected (3.9%) under BP. The striking disparity in the relative abundance of AMF and other fungal types between BP and the native species is quite significant. Fungal symbionts could aide plant invasion via resource-use efficiency and other poorly defined mechanisms of protection from pathogens in their invaded range. This report exposes a potentially
Full Text Available Abstract Background Many indigenous villages in the Amazon basin still suffer from a high malaria burden. Despite this health situation, there are few studies on the bionomics of anopheline larvae in such areas. This publication aims to identify the main larval habitats of the most abundant anopheline species and to assess their associations with some environmental factors. Methods We conducted a 19-month longitudinal study from January 2013 to July 2014, sampling anopheline larvae in two indigenous Yanomami communities, comprised of four villages each. All natural larval habitats were surveyed every two months with a 350 ml manual dipper, following a standardized larval sampling methodology. In a third study area, we conducted two field expeditions in 2013 followed by four systematic collections during the long dry season of 2014–2015. Results We identified 177 larval habitats in the three study areas, from which 9122 larvae belonging to 13 species were collected. Although species abundance differed between villages, An. oswaldoi (s.l. was overall the most abundant species. Anopheles darlingi, An. oswaldoi (s.l., An. triannulatus (s.s. and An. mattogrossensis were primarily found in larval habitats that were partially or mostly sun-exposed. In contrast, An. costai-like and An. guarao-like mosquitoes were found in more shaded aquatic habitats. Anopheles darlingi was significantly associated with proximity to human habitations and larval habitats associated with river flood pulses and clear water. Conclusions This study of anopheline larvae in the Brazilian Yanomami area detected high heterogeneities at micro-scale levels regarding species occurrence and densities. Sun exposure was a major modulator of anopheline occurrence, particularly for An. darlingi. Lakes associated with the rivers, and particularly oxbow lakes, were the main larval habitats for An. darlingi and other secondary malaria vectors. The results of this study will serve as a
Nascente, Flávia Miquetichuc Nogueira; Jardim, Thiago Veiga; Peixoto, Maria do Rosário Gondim; Carneiro, Carolina de Souza; Mendonça, Karla Lorena; Póvoa, Thaís Inácio Rolim; Sousa, Ana Luiza Lima; Barroso, Weimar Kunz Sebba; Jardim, Paulo César Brandão Veiga
Adolescence is a transition stage between childhood and adulthood and is an important phase for the acquisition of future lifestyles, including the practice of physical activity (PA). The prevalence of sedentary lifestyle in adolescents is often high, creating the need for studies addressing the practice of PA and its associated factors for a better understanding of the phenomenon and possible interventions that would encourage positive changes. Cross-sectional study of a representative sample of students aged 14-18 years enrolled in both public and private schools of a large Brazilian city to determine the level of physical activity (PA) and its associated factors. Sedentary lifestyle was measured by applying the International Physical Activity Questionnaire. The independent variables were gender, age, race, tobacco use and alcohol consumption in the past 30 days, socioeconomic status, body mass index, waist circumference and blood pressure. The crude prevalence ratio was used as a measure of association and was estimated from a Poisson regression. The sample consisted of 862 adolescents with a mean age of 15.4 ± 1.1 years. Females were predominant (52.8%), and the age between 14 and 15 years was the most frequent (52.2%). The majority of the group reported themselves as Caucasians (51.2%), belonging to socioeconomic class C (52.5%) and were attending to public schools (69.1%). The prevalence of sedentary lifestyle was 66.8% (95% confidence interval [CI]: 63.5-69.9), where values of 65.4% and 69.9% were observed among students from public and private schools, respectively (p = 0.196). Sedentary lifestyle was more frequent in females (78.0% vs 54.3%; p sedentary lifestyle was female gender both in public and private schools and the only independent variable related to sedentarism was also female gender. The prevalence of sedentary lifestyle was extremely high in the population of adolescents studied both in public and private schools. Female sex was
Godinho, Marluce Rodrigues; Greco, Rosangela Maria; Teixeira, Maria Teresa Bustamante; Teixeira, Liliane Reis; Guerra, Maximiliano Ribeiro; Chaoubah, Alfredo
Studies about work ability have grown in importance owing to the worldwide aging of active populations. Research has shown that measuring work ability has a predictive value in cases of long-term sickness absence and early retirement. Our goal was to analyze the work ability and associated factors of civil servants from a higher education institution in Brazil. The participants in this cross-sectional study were 600 technical-administrative workers at a public university. Work ability was measured using the work ability index. The participants were as follows: 51.8% male; mean age of 45 years (SD = ±11); married or in a stable union (61.5%); holding a graduate degree (56.7%); having only one job (83.3%), working 40 h a week or less (78.6%); not working evenings (79.8%); and having direct contact with the public (58.3%). The prevalence of reduced work ability was 13.9%. The following factors were found to be associated with reduced work ability: age 50 years old or above (PR = 2.58; 95% CI 1.25-5.09); female (PR = 2.77; 95% CI 1.25-3.60); education up to secondary school (PR = 2.37; 95% CI 1.13-3.59); overall poor self-assessed health (PR = 2.96; 95% CI 1.32-3.93); signs and symptoms of depression (PR = 4.86; 95% CI 2.23-6.55); sedentariness (PR = 3.00; 95% CI 1.38-4.68) and poor social support at work (PR = 4.01; 95% CI 1.66-4.37). Most of the participants showed good work ability, but some subjects had reduced work ability. This study makes a contribution to expanding the discussion about the factors associated with work ability toward proposing actions for maintaining that ability or helping recovery in the case of diminished ability. Such actions can help reduce work absenteeism and early retirement, both of which have a social and economic impact in Brazil. Studying the determinants of work ability and recommendations to address those determinants will help efforts to improve the quality of life of individuals, both at work and personally, and promote healthy
Full Text Available ABSTRACT Objective The aim of this study was to evaluate the association of Porphyromonas endodontalis, Filifactor alocis and Dialister pneumosintes with the occurrence of periodontitis. Material and Methods Thirty subjects with chronic periodontitis (ChP and 10 with periodontal health (PH were included in the study. Nine subgingival biofilm samples were collected as follows: i PH group - from the mesial/buccal aspect of each tooth in two randomly chosen contralateral quadrants; ii ChP group - from three sites in each of the following probing depth (PD categories: shallow (≤3 mm, moderate (4-6 mm and deep (≥7 mm. Checkerboard DNA-DNA hybridization was used to analyze the samples. Results We found the three species evaluated in a higher percentage of sites and at higher levels in the group with ChP than in the PH group (p<0.05, Mann-Whitney test. We also observed these differences when the samples from sites with PD≤4 mm or ≥5 mm of subjects with ChP were compared with those from subjects with PH (p<0.05, Mann-Whitney test. In addition, the prevalence and levels of D. pneumosintes, and especially of F. alocis were very low in healthy subjects (0.12x105 and 0.01x105, respectively. Conclusion F. alocis and D. pneumosintes might be associated with the etiology of ChP, and their role in the onset and progression of this infection should be further investigated. The role of P. endodontalis was less evident, since this species was found in relatively high levels and prevalence in the PH group.
Full Text Available The prevalence of obesity, pre-diabetes, and type 2 diabetes (T2D is increasing worldwide, especially in the developing nations of South America. Brazil has experienced an exponential increase in the prevalence of these chronic non-communicable diseases. The rising prevalence is probably due to changing eating patterns, sedentary living, and a progressive aging of the population. These trends and their underlying causes carry untoward consequences for all Brazilians and the future of Brazilian public health and the healthcare system. Lifestyle changes that include healthy eating (nutrition therapy and regular physical activity (structured exercise represent efficient inexpensive measures to prevent and/or treat the aforementioned disorders and are recommended for all afflicted patients. Regrettably, the implementation of lifestyle changes is fraught with clinical and personal challenges in real life. The transcultural Diabetes Nutrition Algorithm (tDNA is a therapeutic tool intended to foster implementation of lifestyle recommendations and to improve disease-related outcomes in common clinical settings. It is evidence-based and amenable to cultural adaptation. The Brazilian Diabetes Association, Society of Cardiology and Ministry of Health guidelines for nutrition therapy and physical exercise were considered for the Brazilian adaptation. The resultant tDNA-Brazil and its underlying recommendations are presented and explained.
Castro, Renata A; Quecine, Maria Carolina; Lacava, Paulo T; Batista, Bruna D; Luvizotto, Danice M; Marcon, Joelma; Ferreira, Anderson; Melo, Itamar S; Azevedo, João L
The mangrove ecosystem is a coastal tropical biome located in the transition zone between land and sea that is characterized by periodic flooding, which confers unique and specific environmental conditions on this biome. In these ecosystems, the vegetation is dominated by a particular group of plant species that provide a unique environment harboring diverse groups of microorganisms, including the endophytic microorganisms that are the focus of this study. Because of their intimate association with plants, endophytic microorganisms could be explored for biotechnologically significant products, such as enzymes, proteins, antibiotics and others. Here, we isolated endophytic microorganisms from two mangrove species, Rhizophora mangle and Avicennia nitida, that are found in streams in two mangrove systems in Bertioga and Cananéia, Brazil. Bacillus was the most frequently isolated genus, comprising 42% of the species isolated from Cananéia and 28% of the species from Bertioga. However, other common endophytic genera such as Pantoea, Curtobacterium and Enterobacter were also found. After identifying the isolates, the bacterial communities were evaluated for enzyme production. Protease activity was observed in 75% of the isolates, while endoglucanase activity occurred in 62% of the isolates. Bacillus showed the highest activity rates for amylase and esterase and endoglucanase. To our knowledge, this is the first reported diversity analysis performed on endophytic bacteria obtained from the branches of mangrove trees and the first overview of the specific enzymes produced by different bacterial genera. This work contributes to our knowledge of the microorganisms and enzymes present in mangrove ecosystems.
Rodrigo Costa da Silva
Full Text Available Leptospirosis is a worldwide anthropozoonosis that infects livestock, including sheep as the carriers to other animals and humans. The present study aimed to determine the prevalence of Leptospira spp. in sheep from two slaughterhouses in the state of São Paulo, Brazil and its association with epidemiological variables. Serum samples from 182 sheep were evaluated for Leptospira spp. antibodies by microscopic agglutination test (MAT. Results indicated 34/182 (18.68%; CI95% 13.70-24.98% positive serum samples, mainly to the serovar Copenhageni (17/34; 50%; CI95% 33.99-66.01%. Bacterial growth in the Fletcher medium was detected for 13/34 (38.24%; CI95% 23.87-55.08% animals, and confirmed by Polymerase Chain Reaction (PCR and sequencing for only two kidney samples from two animals. Thus, treatment and vaccination of sheep, besides rodent control, can be useful to prevent the infection in the studied region since sheep are important Leptospira spp. carriers, and its transmission to slaughterhouse workers is mainly through the manipulation of visceral tissues.
Sanchez, Zila M; Martins, Silvia S; Opaleye, Emerita S; Moura, Yone G; Locatelli, Danilo P; Noto, Ana R
Binge drinking (BD) seems to be related to health and social complications among adolescents. Considering that knowledge about BD in developing countries is limited and that in Brazil high socioeconomic status is a risk factor for alcohol abuse, this study sheds light about this phenomenon among adolescents from a different cultural background than prior North-American and European studies. Brazilian students (n = 2691) selected through a representative, stratified and clustered sampling method were asked to answer a self-report questionnaire. The questionnaire contained questions about patterns of alcohol consumption, religious beliefs, leisure activities, family structure and relationships. Data were analyzed with basic contingency tables with Chi-square tests followed by a decision tree analysis and weighted logistic regression. Almost thirty-five percent of the students reported recent binge drinking. BD in the past month was positively associated with older age (aOR = 1.5[1.2-1.7]), male gender (aOR = 1.5[1.2-2.0]) going out with friends almost every night (aOR = 33.9[14.2-80.7]), not living with mother (aOR = 2.4[1.3-4.7]), believing in God with little conviction (aOR = 1.6[1.2-2.0]) and rarely talking to parents about anything (aOR = 1.7[1.3-2.2]) or always about drugs (aOR = 1.8[1.3-2.5]). Factors inversely associated with BD were: paying lower monthly tuition fees (aOR = 0.5[0.4-0.9]), living with people who do not get drunk (aOR = 0.6[0.4-0.7]) and frequent engagement in worships (aOR = 0.7[0.5-0.9]). The habit of BD in adolescents enrolled in private high schools in Brazil is strongly linked to the frequency with which they go out with friends at night. Factors such as religiosity, expressed by trust in God and participation in worship, and being enrolled in a school with cheaper tuition fees were associated with avoidance of BD in this population.
Locatelli Danilo P
Full Text Available Abstract Background Binge drinking (BD seems to be related to health and social complications among adolescents. Considering that knowledge about BD in developing countries is limited and that in Brazil high socioeconomic status is a risk factor for alcohol abuse, this study sheds light about this phenomenon among adolescents from a different cultural background than prior North-American and European studies. Methods Brazilian students (n = 2691 selected through a representative, stratified and clustered sampling method were asked to answer a self-report questionnaire. The questionnaire contained questions about patterns of alcohol consumption, religious beliefs, leisure activities, family structure and relationships. Data were analyzed with basic contingency tables with Chi-square tests followed by a decision tree analysis and weighted logistic regression. Results Almost thirty-five percent of the students reported recent binge drinking. BD in the past month was positively associated with older age (aOR = 1.5[1.2-1.7], male gender (aOR = 1.5[1.2-2.0] going out with friends almost every night (aOR = 33.9[14.2-80.7], not living with mother (aOR = 2.4[1.3-4.7], believing in God with little conviction (aOR = 1.6[1.2-2.0] and rarely talking to parents about anything (aOR = 1.7[1.3-2.2] or always about drugs (aOR = 1.8[1.3-2.5]. Factors inversely associated with BD were: paying lower monthly tuition fees (aOR = 0.5[0.4-0.9], living with people who do not get drunk (aOR = 0.6[0.4-0.7] and frequent engagement in worships (aOR = 0.7[0.5-0.9]. Conclusion The habit of BD in adolescents enrolled in private high schools in Brazil is strongly linked to the frequency with which they go out with friends at night. Factors such as religiosity, expressed by trust in God and participation in worship, and being enrolled in a school with cheaper tuition fees were associated with avoidance of BD in this population.
Soares, Marcia Fatima; Ferreira, Rachel Conceição; Pazzini, Camila Alessandra; Travassos, Denise Vieira; Paiva, Saul Martins; e Ferreira, Efigênia Ferreira
The empowerment embedded in the health area is defined as a process that can facilitate control over the determinants of health of individuals and population as a way to improve health. The aim of this study was to verify the association between individual and collective empowerment with sociodemographic conditions, lifestyle, health conditions and quality of life. A cross-sectional analytical study was conducted with 1150 individuals (aged 35 to 44 years). The empowerment was determined by questions from the Integrated Questionnaire for the Measurement of Social Capital (IQ-MSC). The quality of life was measured using the WHOQOL (World Health Organization Quality of Life-Bref). Lifestyle and health conditions were obtained by adapted questions from the Fantastic Lifestyle Questionnaire The DMFT Index was incorporated in the health conditions questions. Logistic regression or multinomial regression was performed. The practice of physical activity was related to individual (OR: 2.70) and collective (OR: 1.57) empowerment. Regarding individual empowerment, people with higher education level (5-11 years - OR: 3.46 and ≥12 years - OR: 4.41), who felt more able to deal with stress (OR:3.76), who presented a high score on quality of life (psychological domain) (OR:1.23) and that smoked (OR:1.49) were more likely to feel able to make decisions and participate in community activities. The increase in the DMFT Index represented less chance of individuals to feel more able to make decisions (OR: 0.96). Regarding the collective empowerment, being religious (catholic) (OR: 1.82), do not drink or drink just a little (OR: 1.66 and 2.28, respectively), and increased score of overall quality of life (OR: 1.08) were more likely to report that people cooperate to solve a problem in their community. The two approaches to empowerment, the individual and collective are connected, and the physical activity showed to be a good strategy for the empowerment construction.
Bandeira, Sabrina Sampaio; Pires, Carla Avelar; Quaresma, Juarez Antonio Simões
To describe nerve damage and its association with clinical and epidemiologic characteristics in young patients with leprosy diagnosed in an endemic area of the Brazilian Amazon. All 45 patients with leprosy younger than 15 years of age and diagnosed at a health referral unit in northern Brazil were invited to participate in a cross-sectional, descriptive, analytical study. Subjects were submitted to a templated simple neurologic examination of the peripheral nerves and answered a structured questionnaire. Of 41 cases, referral was the mode of detection in 33 participants (80.5%); 19 (46.3%) had been seen by 3 or more physicians to obtain a diagnosis, and 26 (63.4%) had received other diagnoses. The interval between the onset of symptoms and diagnosis was more than 1 year in 30 cases (73.2%). Borderline leprosy was the predominant clinical form (48.8%); 63.4% of the participants had multibacillary leprosy, 31.7% had nerve damage, and 17.1% exhibited disabilities. The following variables showed a statistically significant association (P???.05) with nerve damage at diagnosis: home visit by the community health worker, number of doctors seen, number of skin lesions (>5), and lesions along the path of nerve trunks. Centralized healthcare, a low frequency of home visits by community health workers, and the difficulty in diagnosing leprosy in children are factors that contribute to late treatment initiation and an increased risk of peripheral nerve damage. In addition, multiple skin lesions and lesions along the path of nerve trunks require rigorous monitoring. Copyright © 2017 Elsevier Inc. All rights reserved.
Bhakta, Hemangini C; Marco, Catherine A
Patient satisfaction with emergency care is associated with timeliness of care, empathy, technical competence, and information delivery. Previous studies have demonstrated inconsistent findings regarding the association between pain management and patient satisfaction. This study was undertaken to determine the association between pain management and patient satisfaction among Emergency Department (ED) patients presenting with acute painful conditions. In this survey study, a standardized interview was conducted at the Emergency Department at the University of Toledo Medical Center in May-July 2011. Participants were asked to answer 18 questions pertaining to patient satisfaction. Additional data collected included demographic information, pain scores, and clinical management. Among 328 eligible participants, 289 (88%) participated. The mean triage pain score on the verbal numeric rating scale was 8.2 and the mean discharge score was 6.0. The majority of patients (52%) experienced a reduction in pain of 2 or more points. Participants received one pain medication dose (44%), two medication doses (14%), three medication doses (5%), or four medication doses (2%). Reduction in pain scores of 2 or more points was associated with a higher number of medications administered. Reduction in pain scores was associated with higher satisfaction as scored on questions of patient perceptions of adequate assessment and response to pain, and treatment of pain. There was a significant association between patient satisfaction and a reduction in pain of 2 or more points and number of medications administered. Effective pain management is associated with improved patient satisfaction among ED patients with painful conditions. Copyright © 2014 Elsevier Inc. All rights reserved.
Pasquini, T.A.S. [Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG (Brazil); Neder, H.D. [Instituto de Economia, Universidade Federal de Uberlândia, Uberlândia, MG (Brazil); Araújo-Junqueira, L. [Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG (Brazil); De-Souza, D.A. [Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG (Brazil); Departamento de Clínica Médica e Curso de Nutrição, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG (Brazil)
Protein-energy malnutrition (PEM) is a treatable disease with high prevalence among hospitalized patients. It can cause significant increases in the duration of hospitalization and costs. PEM is especially important for health systems since malnourished patients present higher morbidity and mortality. The objective of the present study was to assess the evolution of nutritional status (NS) and the effect of malnutrition on clinical outcome of patients at a public university hospital of high complexity in Brazil. Patients hospitalized in internal medicine (n = 54), oncology (n = 43), and infectious diseases (n = 12) wards were included. NS was evaluated using subjective global assessment up to 48 h after admission, and thereafter at intervals of 4-6 days. On admission, patients (n = 109) were classified as well-nourished (n = 73), moderately malnourished or at risk of malnutrition (n = 28), and severely malnourished (n = 8). During hospitalization, malnutrition developed or worsened in 11 patients. Malnutrition was included in the clinical diagnosis of only 5/36 records (13.9% of the cases, P = 0.000). Nutritional therapy was administered to only 22/36 of the malnourished patients; however, unexpectedly, 6/73 well-nourished patients also received commercial enteral diets. Complications were diagnosed in 28/36 malnourished and 9/73 well-nourished patients (P = 0.000). Death occurred in 12/36 malnourished and 3/73 well-nourished patients (P = 0.001). A total of 24/36 malnourished patients were discharged regardless of NS. In summary, malnutrition remains a real problem, often unrecognized, unappreciated, and only sporadically treated, even though its effects can be detrimental to the clinical course and prognosis of patients. The amount of public and private funds unnecessarily dispersed because of hospital malnutrition is significant.
Pasquini, T.A.S.; Neder, H.D.; Araújo-Junqueira, L.; De-Souza, D.A.
Protein-energy malnutrition (PEM) is a treatable disease with high prevalence among hospitalized patients. It can cause significant increases in the duration of hospitalization and costs. PEM is especially important for health systems since malnourished patients present higher morbidity and mortality. The objective of the present study was to assess the evolution of nutritional status (NS) and the effect of malnutrition on clinical outcome of patients at a public university hospital of high complexity in Brazil. Patients hospitalized in internal medicine (n = 54), oncology (n = 43), and infectious diseases (n = 12) wards were included. NS was evaluated using subjective global assessment up to 48 h after admission, and thereafter at intervals of 4-6 days. On admission, patients (n = 109) were classified as well-nourished (n = 73), moderately malnourished or at risk of malnutrition (n = 28), and severely malnourished (n = 8). During hospitalization, malnutrition developed or worsened in 11 patients. Malnutrition was included in the clinical diagnosis of only 5/36 records (13.9% of the cases, P = 0.000). Nutritional therapy was administered to only 22/36 of the malnourished patients; however, unexpectedly, 6/73 well-nourished patients also received commercial enteral diets. Complications were diagnosed in 28/36 malnourished and 9/73 well-nourished patients (P = 0.000). Death occurred in 12/36 malnourished and 3/73 well-nourished patients (P = 0.001). A total of 24/36 malnourished patients were discharged regardless of NS. In summary, malnutrition remains a real problem, often unrecognized, unappreciated, and only sporadically treated, even though its effects can be detrimental to the clinical course and prognosis of patients. The amount of public and private funds unnecessarily dispersed because of hospital malnutrition is significant
Bevilacqua Roberta A.U.; Corvello Cassandra M.; Duarte Ana Paula; Simpson Andrew J.G.
A crucial role for the adenomatous polyposis colonic (APC) gene in colorectal carcinogenesis has been conclusively established, but, the role of APC in gastric tumors remains controversial. APC mutations have been detected at a relatively high frequency in gastric tumors of Japanese patients, yet such mutations have been reported to be extremely rare in British patients and patients from north-central-Italy. We here report the analysis of 40 primary sporadic gastric adenocarcinomas and 35 pri...
Loch, Mathias Roberto; de Souza, Regina Kazue Tanno; Mesas, Arthur Eumann; González, Alberto Durán; Rodriguez-Artalejo, Fernando
OBJECTIVE To investigate the association between social capital and social capital and self-perception of health based on examining the influence of health-related behaviors as possible mediators of this relationship. METHODS A cross-sectional study was used with 1,081 subjects, which is representative of the population of individuals aged 40 years or more in a medium-sized city in Southern Brazil. The subjects who perceived their health as fine, bad or very bad were considered to have a negative self-perception of their health. The social capital indicators were: number of friends, people from whom they could borrow money from when needed; the extent of trust in community members; whether or not members of the community helped each other; community safety; and extent of participation in community activities. The behaviors were: physical activity during leisure time, fruits and vegetable consumption, tobacco use and alcohol abuse. The odds ratios (OR) and confidence intervals (CI) 95% were calculated by binary logistic regression. The significance of mediation was verified using the Sobel test. RESULTS Following adjustment for demographic and clinical variables, subjects with fewer friends (OR = 1.39, 95%CI 1.08;1.80), those who perceived less frequently help from people in the neighborhood (OR = 1.30, 95%CI 1.01;1.68), who saw the violent neighborhood (OR = 1.33, 95%CI 1.01;1.74) and who had not participated in any community activity (OR = 1.39, 95%CI 1.07;1.80) had more negative self-perception of their health. Physical activity during leisure time was a significant mediator in the relationship between all social capital indicators (except for the borrowed money variable) and self-perceived health. Fruit and vegetable consumption was a significant mediator of the relationship between the extent of participation in community activities and self-perceived health. Tobacco use and alcohol abuse did not seem to have a mediating role in any relationship. CONCLUSIONS
Full Text Available Children from developed and developing countries differ in their body size and shape due to marked differences across their life history caused by social, economic and cultural differences which are also linked to their motor performance (MP. We used allometric models to identify size/shape characteristics associated with MP tests between Brazilian and Peruvian schoolchildren. A total of 4,560 subjects, 2,385 girls and 2,175 boys aged 9-15 years were studied. Height and weight were measured; biological maturation was estimated with the maturity offset technique; MP measures included the 12 minute run (12MR, handgrip strength (HG, standing long jump (SLJ and the shuttle run speed (SR tests; physical activity (PA was assessed using the Baecke questionnaire. A multiplicative allometric model was adopted to adjust for body size differences across countries. Reciprocal ponderal index (RPI was found to be the most suitable body shape indicator associated with the 12MR, SLJ, HG and SR performance. A positive maturation offset parameter was also associated with a better performance in SLJ, HG and SR tests. Sex differences were found in all motor tests. Brazilian youth showed better scores in MP than their Peruvian peers, even when controlling for their body size differences The current study identified the key body size associated with four body mass-dependent MP tests. Biological maturation and PA were associated with strength and motor performance. Sex differences were found in all motor tests, as well as across countries favoring Brazilian children even when accounting for their body size/shape differences.
Silva, Simonete; Bustamante, Alcibíades; Nevill, Alan; Katzmarzyk, Peter T.; Freitas, Duarte; Prista, António; Maia, José
Children from developed and developing countries differ in their body size and shape due to marked differences across their life history caused by social, economic and cultural differences which are also linked to their motor performance (MP). We used allometric models to identify size/shape characteristics associated with MP tests between Brazilian and Peruvian schoolchildren. A total of 4,560 subjects, 2,385 girls and 2,175 boys aged 9–15 years were studied. Height and weight were measured; biological maturation was estimated with the maturity offset technique; MP measures included the 12 minute run (12MR), handgrip strength (HG), standing long jump (SLJ) and the shuttle run speed (SR) tests; physical activity (PA) was assessed using the Baecke questionnaire. A multiplicative allometric model was adopted to adjust for body size differences across countries. Reciprocal ponderal index (RPI) was found to be the most suitable body shape indicator associated with the 12MR, SLJ, HG and SR performance. A positive maturation offset parameter was also associated with a better performance in SLJ, HG and SR tests. Sex differences were found in all motor tests. Brazilian youth showed better scores in MP than their Peruvian peers, even when controlling for their body size differences The current study identified the key body size associated with four body mass-dependent MP tests. Biological maturation and PA were associated with strength and motor performance. Sex differences were found in all motor tests, as well as across countries favoring Brazilian children even when accounting for their body size/shape differences. PMID:26939118
Silva, Simonete; Bustamante, Alcibíades; Nevill, Alan; Katzmarzyk, Peter T; Freitas, Duarte; Prista, António; Maia, José
Children from developed and developing countries differ in their body size and shape due to marked differences across their life history caused by social, economic and cultural differences which are also linked to their motor performance (MP). We used allometric models to identify size/shape characteristics associated with MP tests between Brazilian and Peruvian schoolchildren. A total of 4,560 subjects, 2,385 girls and 2,175 boys aged 9-15 years were studied. Height and weight were measured; biological maturation was estimated with the maturity offset technique; MP measures included the 12 minute run (12MR), handgrip strength (HG), standing long jump (SLJ) and the shuttle run speed (SR) tests; physical activity (PA) was assessed using the Baecke questionnaire. A multiplicative allometric model was adopted to adjust for body size differences across countries. Reciprocal ponderal index (RPI) was found to be the most suitable body shape indicator associated with the 12MR, SLJ, HG and SR performance. A positive maturation offset parameter was also associated with a better performance in SLJ, HG and SR tests. Sex differences were found in all motor tests. Brazilian youth showed better scores in MP than their Peruvian peers, even when controlling for their body size differences The current study identified the key body size associated with four body mass-dependent MP tests. Biological maturation and PA were associated with strength and motor performance. Sex differences were found in all motor tests, as well as across countries favoring Brazilian children even when accounting for their body size/shape differences.
Machado, Luzia Neri C; Marcondes, Nadir R; Leite, Clarice Q Fijimura; Santos, Adolfo C Barreto; Pavan, Fernando Rogério; Baldin, Vanessa Pietrowski; Castilho, Aline Lemes; Siqueira, Vera Lúcia D; Baeza, Lilian Cristiane; Berghs, Henri; Cardoso, Rosilene Fressatti
At the triple border Brazil/Paraguay/Argentina there is easy mobility from one city to another for economic and tourism activities. This constant and fast population mobility is mainly to visit Iguazu Falls, in the Iguazu River, on the border of the Brazilian state of Paraná and the Argentina. As the incidence of tuberculosis is high in this setting, our study aimed to establish a first baseline of circulating genotypic lineages of Mycobacterium tuberculosis. This study included 120 patients from 10 cities in southwestern Paraná, Brazil with pulmonary symptoms, from July 2009 to July 2011. Information about sex, age, clinical features and address was collected by reviewing the national tuberculosis notification database. Of these, 96 (80%) isolates were identified as M. tuberculosis and 22 (22.9%) were drug resistant (20, 20.8% INH mono-resistant and 2, 2.1% multidrug-resistant). All isolates were subjected to genotyping by Spoligotyping and MIRU-VNTR typing. The distribution of the isolates analyzed by spoligotyping revealed 30 distinct patterns. The four mainly detected clades were Latin American and Mediterranean (LAM), ill-defined T, Haarlem (H) and S. The MIRU-VNTR showed 85 distinct patterns. Spoligotyping combined to MIRU-VNTR allowed 90 distinct patterns. Our study demonstrated that there is significant molecular diversity in circulating M. tuberculosis, with predominance of the LAM and T clades in cities of southwestern Paraná, Brazil, bordering Argentina and Paraguay.
Portugal, Maria da Glória; Coutinho, Evandro Silva Freire; Almeida, Cloyra; Barca, Maria Lage; Knapskog, Anne-Brita; Engedal, Knut; Laks, Jerson
There are few studies on validation of depression scales in the elderly in Latin America. This study aimed to assess the validity of Montgomery-Åsberg. Depression Rating Scale (MADRS) and Cornell Scale for Depression in Dementia (CSDD) in Brazilian elderly outpatients. A convenience sample of 95 outpatients was diagnosed for dementia and depression according to DSM-IV-TR, ICD-10, and PDC-dAD criteria. Receiver Operating Curves (ROC) were used to calculate the area under the curve (AUC) and to assess MADRS and CSDD cut-offs for each diagnostic criterion. Dementia was diagnosed in 71 of 95 patients. Depression was diagnosed in 35, 30, and 51 patients by ICD-10, DSM-IV, and PDC-dAD, respectively. MADRS cut-off score of 10 correctly diagnosed 67.4% and 66.3% patients as depressed according to DSM-IV and ICD-10. A cut-off of 9 correctly identified 74.7% by PDC-dAD criteria; a CSDD cut-off score of 13 best recognized depression according to DSM-IV and ICD-10. A score of 11 diagnosed depression according to PDC-dAD, while MADRS = 9 recognized depression in dementia. CSDD was more efficient in showing depression in mild than in moderate/severe dementia according to DSM-IV/ICD-10. PDC-dAD behaved nicely for any severity stage. MADRS and CSDD cut-offs of 10 and 13 were the optimal ones to diagnose depression in elderly, respectively. CSDD cut-offs are higher than those found in other countries. Other Latin American studies are needed to compare results with our study.
The Program of Health Section / Brazilian Cnen, which was elaborated to promote the use of ionizing radiations (nuclear and x-ray techniques) in benefit of Brazilian health, with safety assurance of patients, personnels, population and environment, is presented. The Ministry of Health, industries, Medical and Physicist Associations, Universities and Research Centers are participants of this program. The activities involved in the program are: production of isotopes and radiopharmaceuticals; radiation detectors and nuclear instrumentation; radiation protection and dosimetry; education and training of human resources; applied research and new technologies. The guiding and actions that the section will adopt to attend the growing necessities of Brazilian society, considering technological powers, management, available substructure and associated difficulties are defined. (M.C.K.) [pt
Rosales, Ana Carolina de Mesquita Netto; Esteves, Sérgio Carlos Barros; Jorge, Jacks; Almeida, Oslei Paes de; Lopes, Márcio Ajudarte
In spite of its recognized benefits in the treatment of malignant tumors, radiation therapy have several side effects in the head and neck region. The evaluation of oral conditions by a dentist is important to prevent or minimize these problems. The aim of this retrospective review was to analyze the dental needs in 357 patients who received radiotherapy in the head and neck region and were treated at Orocentro/FOP/UNICAMP, between January 1990 and December 2004. Review of patient files showed that dental examination before radiotherapy was not performed in 148 patients (41.5%) and was done in 209 patients (58.5%). From the total of examined patients, 94 (45%) did not require dental procedures at the moment of examination, while 115 (55%) presented some sort of dental need. Following the patients after the radiotherapy, it was observed that the group of patients that was evaluated before radiation presented less need of restorations, root canal filling and dental extractions than those who were not evaluated. The results of this study confirm that the evaluation of oral conditions prior to radiotherapy is essential to minimize the dental needs, emphasizing the importance of the dentist in the multidisciplinary team that treats cancer patients.
Rosales, Ana Carolina de Mesquita Netto; Jorge, Jacks; Almeida, Oslei Paes de; Lopes, Marcio Ajudarte
In spite of its recognized benefits in the treatment of malignant tumors, radiation therapy have several side effects in the head and neck region. The evaluation of oral conditions by a dentist is important to prevent or minimize these problems. The aim of this retrospective review was to analyze the dental needs in 357 patients who received radiotherapy in the head and neck region and were treated at Orocentro/FOP/UNICAMP, between January 1990 and December 2004. Review of patient files showed that dental examination before radiotherapy was not performed in 148 patients (41.5%) and was done in 209 patients (58.5%). From the total of examined patients, 94 (45%) did not require dental procedures at the moment of examination, while 115 (55%) presented some sort of dental need. Following the patients after the radiotherapy, it was observed that the group of patients that was evaluated before radiation presented less need of restorations, root canal filling and dental extractions than those who were not evaluated. The results of this study confirm that the evaluation of oral conditions prior to radiotherapy is essential to minimize the dental needs, emphasizing the importance of the dentist in the multidisciplinary team that treats cancer patients. (author)
Da Silva, Rozana C.; Lyon, Sandra; Lyon, Ana C.; Grossi, Maria A. F.; Lyon, Silvia H.; Bührer-Sékula, Samira; Antunes, Carlos M. F.
Serological tests can be helpful in classifying leprosy patients as having either the paucibacillary or the multibacillary form. The aim of this study was to evaluate the concordance between two serological assays, i.e. ML Flow and ELISA, in a population of leprosy patients in Brazil. The
Luis Jesuino de Oliveira Andrade
Full Text Available Cryoglobulinemia and non-organ-specific-autoantibody are biomarkers of autoimmunity of the chronic infection caused by hepatitis C virus (HCV. In this work, we report the association between the presence of smooth muscle antibodies (SMA and cryoglobulinemia and chronic liver disease in HCV carriers. Sixty-five untreated HCV patients, 38 women and 27 men were included in this study. Cryoglobulinemia was tested by cryoprecipitation, SMA by indirect fluorescent antibody test, and liver fibrosis and hepatocellular inflammation activity was investigated by histology of liver biopsy using the METAVIR score. The prevalence of SMA in the patients was 33.8% and cryoglobulinemia was demonstrated in 36.9% patients. Cryoglobulinemia and SMA seropositivity was associated with advanced fibrosis (p < 0.05. The presence of SMA and cryoglobulinemia was not associated with hepatocellular inflammation activity, age, carrier gender or HCV genotype. We concluded that liver biopsy should be recommended for HCV carriers that are seropositive for SMA or cryoglobulinemia.
Lobo, Clarisse Lopes de Castro; do Nascimento, Emilia Matos; Abelha, Renato; Queiroz, Ana Maria Mach; Connes, Philippe; Cardoso, Gilberto Perez; Ballas, Samir K
This study was a prospective cross-sectional cohort study of 125 patients with sickle cell anemia (SS) between the ages of 16 to 60 years. Enrolled patients were followed-up prospectively for 15 months. Demographic, clinical, hematological and routine biochemical data were obtained on all patients. Six-minute walk test and Doppler Echocardiography were performed on all patients. A tricuspid regurgitant jet velocity (TRJV) 3.0 m/sec, severe. Patients with abnormal TRJV were significantly older and more anemic, had significantly higher lactate dehydrogenase (LDH) levels, reticulocyte count and incidence of death. The logistic multimodal model implemented for the 125 patients indicated that age was the covariate that influenced the outcome of normal or abnormal TRJV with a cutoff age of thirty-two years. The survival rate for the group of patients with creatinine (Cr) > 1.0 mg/dL was lower than the group with Cr ≤ 1 and normal TRJV. A coefficient matrix showed that the LDH values were weakly correlated with the reticulocyte count but strongly correlated with hemoglobin suggesting that the TRJV values were not correlated with the hemolytic rate but with anemia. Ten patients died during the follow-up of whom 7 had TRJV > 2.5 m/sec. Acute chest syndrome was the most common cause of death followed by sepsis. In conclusion, this study shows that patients with SS older than thirty-two years with high LDH, elevated TRJV, severe anemia and Cr > 1 have poor prognosis and may be at risk of having pulmonary hypertension and should undergo RHC.
Clarisse Lopes de Castro Lobo
Full Text Available This study was a prospective cross-sectional cohort study of 125 patients with sickle cell anemia (SS between the ages of 16 to 60 years. Enrolled patients were followed-up prospectively for 15 months. Demographic, clinical, hematological and routine biochemical data were obtained on all patients. Six-minute walk test and Doppler Echocardiography were performed on all patients. A tricuspid regurgitant jet velocity (TRJV 3.0 m/sec, severe. Patients with abnormal TRJV were significantly older and more anemic, had significantly higher lactate dehydrogenase (LDH levels, reticulocyte count and incidence of death. The logistic multimodal model implemented for the 125 patients indicated that age was the covariate that influenced the outcome of normal or abnormal TRJV with a cutoff age of thirty-two years. The survival rate for the group of patients with creatinine (Cr > 1.0 mg/dL was lower than the group with Cr ≤ 1 and normal TRJV. A coefficient matrix showed that the LDH values were weakly correlated with the reticulocyte count but strongly correlated with hemoglobin suggesting that the TRJV values were not correlated with the hemolytic rate but with anemia. Ten patients died during the follow-up of whom 7 had TRJV > 2.5 m/sec. Acute chest syndrome was the most common cause of death followed by sepsis. In conclusion, this study shows that patients with SS older than thirty-two years with high LDH, elevated TRJV, severe anemia and Cr > 1 have poor prognosis and may be at risk of having pulmonary hypertension and should undergo RHC.
Passos Gregorio, Sheila; Gattaz, Wagner F; Tavares, Hildeberto
Abnormality in neurodevelopment is one of the most robust hypotheses on the etiology of schizophrenia and has found substantial support from brain imaging and genetic studies. Neurodevelopmental processes involve several signaling pathways, including the Notch, but little is known at present...... regarding their possible involvement in schizophrenia. In the present study we investigated the link of non-synonymous variants of five genes of the Notch pathway (NOTCH2, NOTCH3, JAGGED2, ASCL1 and NUMBL) to schizophrenia in a group of 200 Brazilian patients and 200-paired controls. Also, we replicated...
Rocha, Luiz Roberto Martins; Veiga, Daniela Francescato; e Oliveira, Paulo Rocha; Song, Elaine Horibe; Ferreira, Lydia Masako
The Health Service Quality Scale is a multidimensional hierarchical scale that is based on interdisciplinary approach. This instrument was specifically created for measuring health service quality based on marketing and health care concepts. The aim of this study was to translate and culturally adapt the Health Service Quality Scale into Brazilian Portuguese and to assess the validity and reliability of the Brazilian Portuguese version of the instrument. We conducted a cross-sectional, observational study, with public health system patients in a Brazilian university hospital. Validity was assessed using Pearson's correlation coefficient to measure the strength of the association between the Brazilian Portuguese version of the instrument and the SERVQUAL scale. Internal consistency was evaluated using Cronbach's alpha coefficient; the intraclass (ICC) and Pearson's correlation coefficients were used for test-retest reliability. One hundred and sixteen consecutive postoperative patients completed the questionnaire. Pearson's correlation coefficient for validity was 0.20. Cronbach's alpha for the first and second administrations of the final version of the instrument were 0.982 and 0.986, respectively. For test-retest reliability, Pearson's correlation coefficient was 0.89 and ICC was 0.90. The culturally adapted, Brazilian Portuguese version of the Health Service Quality Scale is a valid and reliable instrument to measure health service quality.
Background The Health Service Quality Scale is a multidimensional hierarchical scale that is based on interdisciplinary approach. This instrument was specifically created for measuring health service quality based on marketing and health care concepts. The aim of this study was to translate and culturally adapt the Health Service Quality Scale into Brazilian Portuguese and to assess the validity and reliability of the Brazilian Portuguese version of the instrument. Methods We conducted a cross-sectional, observational study, with public health system patients in a Brazilian university hospital. Validity was assessed using Pearson’s correlation coefficient to measure the strength of the association between the Brazilian Portuguese version of the instrument and the SERVQUAL scale. Internal consistency was evaluated using Cronbach’s alpha coefficient; the intraclass (ICC) and Pearson’s correlation coefficients were used for test-retest reliability. Results One hundred and sixteen consecutive postoperative patients completed the questionnaire. Pearson’s correlation coefficient for validity was 0.20. Cronbach's alpha for the first and second administrations of the final version of the instrument were 0.982 and 0.986, respectively. For test-retest reliability, Pearson’s correlation coefficient was 0.89 and ICC was 0.90. Conclusions The culturally adapted, Brazilian Portuguese version of the Health Service Quality Scale is a valid and reliable instrument to measure health service quality. PMID:23327598
Screening of cognitive impairment in patients with Parkinson's disease: diagnostic validity of the Brazilian versions of the Montreal Cognitive Assessment and the Addenbrooke's Cognitive Examination-Revised.
Sobreira, Emmanuelle; Pena-Pereira, Márcio A; Eckeli, Alan L; Sobreira-Neto, Manoel A; Chagas, Marcos H N; Foss, Maria P; Cholerton, Brenna; Zabetian, Cyrus P; Mata, Ignacio F; Tumas, Vitor
The aim of the present study is to examine the accuracy of the Brazilian versions of the Montreal Cognitive Assessment (MoCA) and the Addenbrooke's Cognitive Examination-Revised (ACE-R) to screen for mild cognitive impairment (PDMCI) and dementia (PDD) in patients with Parkinson's disease (PD). Both scales were administered to a final convenience sample of 79 patients with PD. Patients were evaluated by a neurologist, a psychiatrist and a neuropsychologist using UPDRS, Hoehn and Yahr and Schwab and England scales, global deterioration scale, a psychiatric structured interview, Mattis Dementia Rating Scale and other cognitive tests. There were 32 patients with PDMCI and 17 patients with PDD. The MoCA and the ACE-R were able to discriminate patients with PDD from the others. Both scales showed to be useful to screen for dementia but not for mild cognitive impairment in patients with PD.
Screening of cognitive impairment in patients with Parkinson's disease: diagnostic validity of the Brazilian versions of the Montreal Cognitive Assessment and the Addenbrooke's Cognitive Examination-Revised
Full Text Available ABSTRACTObjective The aim of the present study is to examine the accuracy of the Brazilian versions of the Montreal Cognitive Assessment (MoCA and the Addenbrooke's Cognitive Examination-Revised (ACE-R to screen for mild cognitive impairment (PDMCI and dementia (PDD in patients with Parkinson's disease (PD.Method Both scales were administered to a final convenience sample of 79 patients with PD. Patients were evaluated by a neurologist, a psychiatrist and a neuropsychologist using UPDRS, Hoehn and Yahr and Schwab and England scales, global deterioration scale, a psychiatric structured interview, Mattis Dementia Rating Scale and other cognitive tests.Results There were 32 patients with PDMCI and 17 patients with PDD. The MoCA and the ACE-R were able to discriminate patients with PDD from the others.Conclusion Both scales showed to be useful to screen for dementia but not for mild cognitive impairment in patients with PD.
Rogério Lessa Horta; Bernardo Lessa Horta; Andre Wallace Nery da Costa; Rogério Ruscitto do Prado; Maryane Oliveira-Campos; Deborah Carvalho Malta
OBJECTIVE: This study aimed at describing the prevalence of illicit drug use among 9th grade students in the morning period of public and private schools in Brazil, and assessing associated factors. METHOD: The Brazilian survey PeNSE (National Adolescent School-based Health Survey) 2012 evaluated a representative sample of 9th grade students in the morning period, in Brazil and its five regions. The use of illicit drugs at least once in life was assessed for the most commonly used drugs,...
Graziella Hanna PEREIRA
Full Text Available Paracoccidioidomycosis and histoplasmosis are systemic fungal infections endemic in Brazil. Disseminated clinical forms are uncommon in immunocompetent individuals. We describe two HIV-negative patients with disseminated fungal infections, paracoccidioidomycosis and histoplasmosis, who were diagnosed by biopsies of suprarenal lesions. Both were treated for a prolonged period with oral antifungal agents, and both showed favorable outcomes.
Botelho, Ricardo Vieira; Jardim Miranda, Bárbara Cristina; Nishikuni, Koshiro; Waisberg, Jaques
Life expectancy (LE) refers to the number of years that an individual is expected to survive. Emphasis is frequently placed on the relationship between LE and the conditions under which a population lives, but fewer studies have investigated the relationship between stress factors associated with specific professions and their effects on LE. The aim of this study is to evaluate Brazilian neurosurgeons' life expectancies (BNLEs) and compare them with those of physicians (both Brazilian and foreign) from other fields, as well as with Brazilian nondoctors. The Brazilian Society of Neurosurgery death registry was used to obtain data that compared LEs from non-neurosurgeon physicians, as described in the national and international literature. BNLEs were also compared with the LEs of Brazilian citizens. Fifty-one neurosurgeons died between 2009 and 2016. All were males. The mean age at death was 68.31 ± 17.71 years. Among all-cause mortality, the breakdown was 20% cardiovascular diseases, 39% malignancies, 10% external factors, 6% gastrointestinal disorders, 12% neurologic illnesses, and 14% unknown causes. BNLE was shorter than LE of male Brazilian citizens. LE was similar among neurosurgeons and other doctors but shorter compared with Brazilian citizens. Further research is needed to provide data that can add to and confirm these results. Copyright © 2018 Elsevier Inc. All rights reserved.
Attar-Lévy, D; Gay, C
Providing information to the patients and their families represents one of today's new conditions in the management of the depressed. It will help their adaptation to the illness and its effects. It will maintain a good therapeutic alliance among patients and practitioners, and will enhance their treatment adherence thus improving their quality of life. Several aspects are essential in the transmission of this information: it must be available to every patient, easily accessible, concise, repeated and revised as necessary, discouraging self-diagnosis and self-prescription. This education must be given personally by the physicians and the pharmacists. Depressed patients may also have an access to complementary sources: books, magazines and more rarely scientific journals. Patients' associations provide another potential source of information, offering a comprehensive approach to the patient and the illness. France-Déxpression is a depressive and manic-depressive patients association. Its goals are to provide information and support to the patients and their families, promoting a better understanding and recognition of depressive and manic-depressive illness.
Cardoso, Isabel Habeyche; Zajdenweber, Moysés Eduardo; Muccioli, Cristina; Fimamor, Luciana Peixoto; Belfort, Rubens
To determine the applicability of the international revised diagnostic criteria for Vogt-Koyanagi-Harada disease. Retrospective study. Medical charts of 140 patients with the diagnosis of Vogt-Koyanagi-Harada disease, from the Uveitis Sector of the Federal University of Sao Paulo (UNIFESP), were revised and classified following the revised diagnostic criteria. Of the 140 patients, 12.85% fulfilled the criteria for complete disease, 29.28% incomplete disease, 28.57% "probable" Vogt-Koyanagi-Harada disease and 28.27% were considered not Vogt-Koyanagi-Harada disease. The authors consider that the international revised diagnostic criteria have good applicability and are very useful to help in the diagnosis of Vogt-Koyanagi-Harada disease.
Castilhos, Zuleica; Rodrigues-Filho, Saulo; Cesar, Ricardo; Rodrigues, Ana Paula; Villas-Bôas, Roberto; de Jesus, Iracina; Lima, Marcelo; Faial, Kleber; Miranda, Antônio; Brabo, Edilson; Beinhoff, Christian; Santos, Elisabeth
Mercury (Hg) contamination is an issue of concern in the Amazon region due to potential health effects associated with Hg exposure in artisanal gold mining areas. The study presents a human health risk assessment associated with Hg vapor inhalation and MeHg-contaminated fish ingestion, as well as Hg determination in urine, blood, and hair, of human populations (about 325 miners and 321 non-miners) from two gold mining areas in the Brazilian Amazon (São Chico and Creporizinho, Pará State). In São Chico and Creporizinho, 73 fish specimens of 13 freshwater species, and 161 specimens of 11 species, were collected for total Hg determination, respectively. The hazard quotient (HQ) is a risk indicator which defines the ratio of the exposure level and the toxicological reference dose and was applied to determine the threat of MeHg exposure. The mean Hg concentrations in fish from São Chico and Creporizinho were 0.83 ± 0.43 and 0.36 ± 0.33 μg/g, respectively. More than 60 and 22 % of fish collected in São Chico and Creporizinho, respectively, were above the Hg limit (0.5 μg/g) recommended by WHO for human consumption. For all sampling sites, HQ resulted from 1.5 to 28.5, except for the reference area. In Creporizinho, the values of HQ are close to 2 for most sites, whereas in São Chico, there is a hot spot of MeHg contamination in fish (A2-São Chico Reservoir) with the highest risk level (HQ = 28) associated with its human consumption. Mean Hg concentrations in urine, blood, and hair samples indicated that the miners group (in São Chico: urine = 17.37 μg/L; blood = 27.74 μg/L; hair = 4.50 μg/g and in Creporizinho: urine = 13.75 μg/L; blood = 25.23 μg/L; hair: 4.58 μg/g) was more exposed to mercury compared to non-miners (in São Chico: urine = 5.73 μg/L; blood = 16.50 μg/L; hair = 3.16 μg/g and in Creporizinho: urine = 3.91 μg/L; blood = 21.04 μg/L, hair = 1.88 μg/g). These high Hg levels (found
Luzia Neri C Machado
Full Text Available BACKGROUND: At the triple border Brazil/Paraguay/Argentina there is easy mobility from one city to another for economic and tourism activities. This constant and fast population mobility is mainly to visit Iguazu Falls, in the Iguazu River, on the border of the Brazilian state of Paraná and the Argentina. As the incidence of tuberculosis is high in this setting, our study aimed to establish a first baseline of circulating genotypic lineages of Mycobacterium tuberculosis. METHODOLOGY/PRINCIPAL FINDINGS: This study included 120 patients from 10 cities in southwestern Paraná, Brazil with pulmonary symptoms, from July 2009 to July 2011. Information about sex, age, clinical features and address was collected by reviewing the national tuberculosis notification database. Of these, 96 (80% isolates were identified as M. tuberculosis and 22 (22.9% were drug resistant (20, 20.8% INH mono-resistant and 2, 2.1% multidrug-resistant. All isolates were subjected to genotyping by Spoligotyping and MIRU-VNTR typing. The distribution of the isolates analyzed by spoligotyping revealed 30 distinct patterns. The four mainly detected clades were Latin American and Mediterranean (LAM, ill-defined T, Haarlem (H and S. The MIRU-VNTR showed 85 distinct patterns. Spoligotyping combined to MIRU-VNTR allowed 90 distinct patterns. CONCLUSIONS/SIGNIFICANCE: Our study demonstrated that there is significant molecular diversity in circulating M. tuberculosis, with predominance of the LAM and T clades in cities of southwestern Paraná, Brazil, bordering Argentina and Paraguay.
Full Text Available Abstract: Abortion is a very sensitive issue with relevance to public health; however few clinical or population-based studies have examined induced abortion among drug users. The study aims to evaluate the prevalence of induced abortion and sex-related conditions in an inpatient drug user sample. A cross-sectional design study was conducted in an inpatient addiction treatment unit in São Paulo, Brazil, with a sample of 616 patients, aged 18-75. Sociodemographic data, sexual behavior, and dependence severity were evaluated in relation to induced abortion. Approximately 27% of patients reported having a history of abortion (themselves in the case of women or partners in the case of men. The mean age was 34.6±10.9 years old, 34.9% diagnosed with severe alcohol dependence, 33% were diagnosed with severe levels of dependence on other drugs, 69.6% were diagnosed cocaine users (inhaled and smoked, and alcohol was the drug of choice for 30.4%. Chances of having a history of abortion is greater for women than for men with a odds ratio (OR = 2.9; 95%CI: 1.75-4.76, (OR = 1.7; 95%CI: 1.09-2.75 of no condom use; (OR = 2.0; 95%CI: 1.35-3.23 of history of STI and (OR = 3.2; 95%CI: 1.29-5.73 use of morning-after pill. Drug- and alcohol-dependent patients have high-risk behaviours of sporadic use or no-condom use which contribute to unplanned pregnancy and induced abortion, making this vulnerable population a group which deserves special attention in sexual health prevention programmes and health promotion efforts for the reduction of induced abortion.
Full Text Available Enterocytozoon bieneusi is the most prevalent microsporidian parasite that causes gastrointestinal infection in persons with AIDS. Microsporidia are increasingly recognized as important opportunistic pathogens all over the world but in Brazil only few cases have been reported due either to the non awareness of the clinical presentation of the disease or to difficulties in the laboratory diagnosis. We report a 3-year follow-up of a Brazilian HIV-positive patient in whom microsporidial spores were detected in stools and were identified as E. bieneusi using electron microscopy and PCR. The patient presented with chronic diarrhea, CD4 T-lymphocytes count below 100/mm3 and microsporidial spores were consistently detected in stools. Albendazole was given to the patient in several occasions with transient relief of the diarrhea, which reappeared as soon as the drug was discontinued. Nevertheless, a diarrhea-free period with weight gain up to 18 Kg occurred when a combination of nucleoside and protease inhibitors was initiated as part of the antiviral treatment.Enterocytozoon bieneusi é o mais comum microsporídio agente de infecções gastrointestinais que ocorre predominantemente em pessoas com AIDS. Em todo o mundo os microsporídios são reconhecidos como importantes patógenos oportunistas, entretanto poucos casos já foram diagnosticados no Brasil, provavelmente devido ao pouco conhecimento do quadro clínico que os agentes produzem ou a dificuldades no diagnóstico laboratorial. No presente trabalho relatamos o caso de um paciente brasileiro HIV-positivo acompanhado durante 3 anos, em que foram detectados esporos de microsporídios nas fezes, identificados como Enterocytozoon bieneusi por microscopia eletrônica e PCR. O paciente apresentava diarréia crônica, contagem de linfócitos CD4 abaixo de 100/mm3 e fez uso de albendazol em diferentes ocasiões com melhora transitória da diarréia, que reaparecia logo que a droga era suspensa
Brazilian Energy provides all the information necessary for energy companies to invest and operate in Brazil, including: a review of Brazil's natural resources; an assessment of privatisation strategies at the federal, state and regional level; an analysis of the electricity industry and the future for Electrobras; an analysis of the oil industry and, in particular, Petrobras; a discussion of the fuel alcohol industry; the discovery of local natural gas, its prospects and the involvement of the auto industry; an assessment of the problems facing the coal industry and its future; a discussion of the regulatory framework for the newly privatised companies; the importance of intra-regional energy links and the booming membership of Mercosur; the difficulties experienced by foreign investors doing business in Brazil; brief profiles of the key energy companies; profiles of key people influencing the privatisation process in Brazil. Brazilian energy is essential reading for those wishing to advise and assist Brazil in this period of change and development, as well as those who wish to invest or become key players in the Brazilian energy sector. (author)
Sanders, T G
Women are gradually gaining influence in Brazilian politics, especially since recent advances in the women's movement, but they still play a limited role. There have been journals devoted to feminism and some notable feminists since 1850. In 1932 suffragettes in Brazil gained women the right to vote. Women's associations burgeoned in the 1940s and 1950s, culminating in a peak in number of women in national elected positions in 1965. A repressive military regime reversed the process, which resumed in 1975. 1975 was also significant for the Brazilian women's movement because of the U.N. Women's Year. Several large, influential feminist political action groups were formed, typically by upper class women with leftist views, although some church and union groups from lower classes also appeared. In 1979-1981, the coherence of these groups fell into schism and fragmentation, because of disagreements over the feminist political doctrines and roles, views on legality of abortion, and special interest groups such as lesbians. Another bitter dispute is opposition by leftist women to BEMFAM, the Brazilian Society of Family Welfare, which provides family planning for the poor: leftists oppose BEMFAM because it is supported by funds from "imperialist" countries such as the U.S. There are several types of feminists groups: those that emphasize health, sexuality and violence; those composed of lesbians; those originating from lower classes and unions; publicly instituted organizations. Brazilian law forbids discrimination against women holding public office, but in reality very few women actually do hold office, except for mayors of small towns and a few administrators of the Education and Social Security ministries. Political office in Brazil is gained by clientism, and since women rarely hold powerful positions in business, they are outsiders of the system. Brazilian women have achieved much, considering the low female literacy rate and traditional power system, but their
Background: Tuberculosis (TB) causes significant morbidity/mortality among human immunodeficiency virus‑infected individuals in Africa. Reducing TB burden in the era of highly active antiretroviral therapy (HAART) is a public health priority. Aim: We determined the factors associated with prevalent TB among patients ...
Lucas Trevizani Rasmussen
Full Text Available Helicobacter pylori is an important human pathogen that causes chronic gastritis and is associated with the development of peptic ulcer disease and gastric malignancies. The oral cavity has been implicated as a potential H. pylori reservoir and may therefore be involved in the reinfection of the stomach, which can sometimes occur following treatment of an H. pylori infection. The objectives of this paper were (i to determine the presence of H. pylori in the oral cavity and (ii to examine the relationship between oral H. pylori and subsequent gastritis. Gastric biopsies, saliva samples and dental plaques were obtained from 78 dyspeptic adults. DNA was extracted and evaluated for the presence of H. pylori using polymerase chain reaction and Southern blotting methods. Persons with gastritis were frequently positive for H. pylori in their stomachs (p < 0.0001 and there was a statistically significant correlation between the presence of H. pylori in gastric biopsies and the oral cavity (p < 0.0001. Our results suggest a relationship between gastric infection and the presence of this bacterium in the oral cavity. Despite this, H. pylori were present in the oral cavity with variable distribution between saliva and dental plaques, suggesting the existence of a reservoir for the species and a potential association with gastric reinfection.
Full Text Available The objective of the present study was to evaluate the factor structure of Bech's version of the Brief Psychiatric Rating Scale (BPRS, translated into Portuguese. The BPRS was administered to a heterogeneous group of psychiatric inpatients (N = 98 and outpatients (N = 62 in a University Hospital. Each patient was evaluated from one to eight times. The interval between consecutive interviews was one week for the inpatients and one month for the outpatients. The results were submitted to factorial analysis. The internal consistency of the total scale and of each factor was also estimated. Factorial analysis followed by normalized orthogonal rotation (Varimax yielded four factors: Withdrawal-Retardation, Thinking Disorder, Anxious-Depression and Activation. Internal consistency measured by Cronbach's alpha coefficient ranged from 0.766 to 0.879. The data show that the factor structure of the present instrument is similar to that of the American version of the BPRS which contains 18 items, except for the absence of the fifth factor of the latter scale, Hostile-Suspiciousness.
Sawada, Namie Okino; Nicolussi, Adriana Cristina; de Paula, Juliana Maria; Garcia-Caro, Maria Paz; Marti-Garcia, Celia; Cruz-Quintana, Francisco
characterize the scientific production of Brazil and Spain in regard to methodological aspects and aspects of health-related quality of life experienced by cancer patients receiving chemotherapy in both countries. integrative literature review was conducted using the following databases: CINAHL, MEDLINE, SCOPUS and CUIDEN and the electronic libraries PubMed and SciELO, conducted in September 2013. a total of 28 papers met the inclusion criteria. The synthesis of knowledge was presented in three categories of analysis: assessment of quality of life in different types of cancer; sociodemographic factors that influenced quality of life; and type of cancer and interventions that improve quality of life. Chemotherapy affects health-related quality of life and the most important factors were: age, sex, chemotherapy protocol, type of surgery, stage of the disease, educational level, and emotional intelligence. Complementary therapies such as acupuncture, guided visualization, prayers and exercise were positive and reduced side effects. the results showed a poor level of evidence, since 86% of the studies were cross-sectional descriptive studies; the instrument most frequently used to measure health-related quality of life was EORTC QLQ C-30 and more studies were conducted in Brazil than in Spain.
Sawada, Namie Okino; Nicolussi, Adriana Cristina; de Paula, Juliana Maria; Garcia-Caro, Maria Paz; Marti-Garcia, Celia; Cruz-Quintana, Francisco
Objective: characterize the scientific production of Brazil and Spain in regard to methodological aspects and aspects of health-related quality of life experienced by cancer patients receiving chemotherapy in both countries. Method: integrative literature review was conducted using the following databases: CINAHL, MEDLINE, SCOPUS and CUIDEN and the electronic libraries PubMed and SciELO, conducted in September 2013. Results: a total of 28 papers met the inclusion criteria. The synthesis of knowledge was presented in three categories of analysis: assessment of quality of life in different types of cancer; sociodemographic factors that influenced quality of life; and type of cancer and interventions that improve quality of life. Chemotherapy affects health-related quality of life and the most important factors were: age, sex, chemotherapy protocol, type of surgery, stage of the disease, educational level, and emotional intelligence. Complementary therapies such as acupuncture, guided visualization, prayers and exercise were positive and reduced side effects. Conclusion: the results showed a poor level of evidence, since 86% of the studies were cross-sectional descriptive studies; the instrument most frequently used to measure health-related quality of life was EORTC QLQ C-30 and more studies were conducted in Brazil than in Spain. PMID:27192414
Santos, Itamar S; Goulart, Alessandra C; Pereira, Alexandre C; Lotufo, Paulo A; Benseñor, Isabela M
The American Heart Association aims to reduce the burden of cardiovascular disease in this decade by improving seven ideal cardiovascular health (CVH) characteristics in the population. The aim of this study was to quantify the association between the American Heart Association's CVH score and values for carotid intima-media thickness (CIMT) in the Brazilian Longitudinal Study of Adult Health baseline assessment. The Brazilian Longitudinal Study of Adult Health is a multicenter cohort study of civil servants aged 35 to 74 years in Brazil. In this study, the investigators analyzed 9,662 individuals with no previous cardiovascular disease. The distribution of CIMT values (categorized into age-, sex-, and race-specific quartiles) was analyzed according to CVH scores using χ 2 trend tests. Linear and multinomial regression models were built to evaluate the association between CIMT and CVH score. A significant increase was observed in the proportion of individuals within the first and second CIMT quartiles, as well as a decrease within the fourth quartile with higher CVH score strata (P for trend < .001). A 1-point increase in CVH score was associated in adjusted models with a decrease of 0.011 mm in CIMT and an odds ratio of 0.79 (95% CI, 0.77-0.81) of having CIMT in the fourth quartile. However, nearly 16% of individuals with optimal CVH scores had CIMT values in the highest quartile. In this study, significant associations were found between CIMT and CVH score in a large sample of middle-aged adults. However, a high CVH score did not warrant the absence of a significant subclinical atherosclerotic burden. Copyright Â© 2016 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.
Menezes, Josiane Roberta de; Luvisaro, Bianca Maria Oliveira; Rodrigues, Claudia Fernandes; Muzi, Camila Drumond; Guimarães, Raphael Mendonça
To assess the test-retest reliability of the Memorial Symptom Assessment Scale translated and culturally adapted into Brazilian Portuguese. The scale was applied in an interview format for 190 patients with various cancers type hospitalized in clinical and surgical sectors of the Instituto Nacional de Câncer José de Alencar Gomes da Silva and reapplied in 58 patients. Data from the test-retest were double typed into a Microsoft Excel spreadsheet and analyzed by the weighted Kappa. The reliability of the scale was satisfactory in test-retest. The weighted Kappa values obtained for each scale item had to be adequate, the largest item was 0.96 and the lowest was 0.69. The Kappa subscale was also evaluated and values were 0.84 for high frequency physic symptoms, 0.81 for low frequency physical symptoms, 0.81 for psychological symptoms, and 0.78 for Global Distress Index. High level of reliability estimated suggests that the process of measurement of Memorial Symptom Assessment Scale aspects was adequate. Avaliar a confiabilidade teste-reteste da versão traduzida e adaptada culturalmente para o português do Brasil do Memorial Symptom Assessment Scale. A escala foi aplicada em forma de entrevista em 190 pacientes com diversos tipos de câncer internados nos setores clínicos e cirúrgicos do Instituto Nacional de Câncer José de Alencar Gomes da Silva e reaplicada em 58 pacientes. Os dados dos testes-retestes foram inseridos num banco de dados por dupla digitação independente em Excel e analisados pelo Kappa ponderado. A confiabilidade da escala mostrou-se satisfatória nos testes-retestes. Os valores do Kappa ponderado obtidos para cada item da escala apresentaram-se adequados, sendo o maior item de 0,96 e o menor de 0,69. Também se avaliou o Kappa das subescalas, sendo de 0,84 para sintomas físicos de alta frequência, de 0,81 para sintomas físicos de baixa frequência, de 0,81 também para sintomas psicológicos, e de 0,78 para Índice Geral de Sofrimento
Full Text Available The hemochromatosis gene, HFE, is located on chromosome 6 in close proximity to the HLA-A locus. Most Caucasian patients with hereditary hemochromatosis (HH are homozygous for HLA-A3 and for the C282Y mutation of the HFE gene, while a minority are compound heterozygotes for C282Y and H63D. The prevalence of these mutations in non-Caucasian patients with HH is lower than expected. The objective of the present study was to evaluate the frequencies of HLA-A antigens and the C282Y and H63D mutations of the HFE gene in Brazilian patients with HH and to compare clinical and laboratory profiles of C282Y-positive and -negative patients with HH. The frequencies of HLA-A and C282Y and H63D mutations were determined by PCR-based methods in 15 male patients (median age 44 (20-72 years with HH. Eight patients (53% were homozygous and one (7% was heterozygous for the C282Y mutation. None had compound heterozygosity for C282Y and H63D mutations. All but three C282Y homozygotes were positive for HLA-A3 and three other patients without C282Y were shown to be either heterozygous (N = 2 or homozygous (N = 1 for HLA-A3. Patients homozygous for the C282Y mutation had higher ferritin levels and lower age at onset, but the difference was not significant. The presence of C282Y homozygosity in roughly half of the Brazilian patients with HH, together with the findings of HLA-A homozygosity in C282Y-negative subjects, suggest that other mutations in the HFE gene or in other genes involved in iron homeostasis might also be linked to HH in Brazil.
Cristilene Akiko Kimura
Full Text Available Introduction: Integrality is considered an essential constitutional doctrinal principle of SUS, being considered as a major challenge in health in Brazil. This involves practicing focusing on the quality of life of oncological stomized people. Objective: To analyze quality of life of oncological stomized people from the Health Department, the Federal District, Brazil, from the perspective of integrality of the Unified Health System in Brazil. Methods: Cross-sectional, exploratory and descriptive study with a quantitative and qualitative approach in the light of a content analysis. This was a convenience sample, including 120 patients registered in the Stomized People Program of the Health Department, the Federal District, Brazil. In this study, sociodemographic, clinical, and WHOQOL-bref questionnaires and an individual interview were used. Data were analyzed by Microsoft® Office Excel 2010 program and SPSS 20.0 software. Statistical significance was accepted at 5%. Results: Physical, Social Affairs, and Environment domains are correlated with the mean score, with statistically significant results (p < 0.0001, the content analysis resulted in three categories: complications with the stoma, self-care, and Comprehensive health care. Conclusion: Our results highlight the need to realize the integrality as a principle at various levels of discussion and of the practice of health care for stomized oncological people. Resumo: Introdução: A integralidade é considerada um princípio doutrinário constitucional e essencial do SUS, e é apreciada como um grande desafio no âmbito da saúde no Brasil. Isto implica práticas voltadas para a qualidade de vida das pessoas oncológicas estomizadas. Objetivo: Analisar a qualidade de vida de pessoas oncológicas estomizadas da Secretária de Saúde do Distrito Federal, Brasil, sob a perspectiva da integralidade do Sistema Único de Saúde do Brasil. Métodos: Estudo transversal, explorat
Luana Magalhães Navarro
Full Text Available Summary Introduction: In patients with essential thrombocythemia (ET, the vascular complications contribute to morbidity and mortality. To better predict the occurrence of thrombotic events, an International Prognostic Score for Thrombosis in Essential Thrombocythemia (IPSET-thrombosis has recently been proposed. We present the application of this score and compare its results with the usual classification system. Method: We retrospectively evaluated the characteristics and risk factors for thrombosis of 46 patients with a diagnosis of ET seen in the last 6 years at Faculdade de Medicina do ABC (FMABC. Results: Thrombosis in the arterial territory was more prevalent than in venous sites. We observed that cardiovascular risk factors (hypertension, hypercholesterolemia, diabetes mellitus, and smoking were also risk factors for thrombosis (p<0.001. Age over 60 years and presence of JAK2 V617F mutation were not associated with the occurrence of thrombotic events. No patient classified by IPSET-thrombosis as low risk had a thrombotic event. Furthermore, using the IPSET-thrombosis scale, we identified two patients who had thrombotic events during follow-up and were otherwise classified in the low-risk group of the traditional classification. Leukocytosis at diagnosis was significantly associated with arterial thrombosis (p=0.02, while splenomegaly was associated with venous thrombotic events (p=0.01. Conclusion: Cardiovascular risk factors and leukocytosis were directly associated with arterial thrombosis. IPSET-thrombosis appears to be better than the traditional classification at identifying lower risk patients who do not need specific therapy.
Felipe Torres Pacheco
Full Text Available Objective The potential of computed tomography angiography (CTA was assessed for early determination of stroke subtypes in a Brazilian cohort of patients with stroke. Method From July 2011 to July 2013, we selected patients with suspected hyperacute stroke (< 6 hours. Intracranial and cervical arteries were scrutinized on CTA and their imaging features were correlated with concurrent subtype of stroke. Results Stroke was documented in 50/106 selected patients (47.2% based on both clinical grounds and imaging follow-up (stroke group, with statistically significant arterial stenosis and vulnerable plaques on CTA. Intracranial large artery disease was demonstrated in 34% of patients in the stroke group. Partial territorial infarct prevailed (86% while artery-to-artery embolization was the most common stroke mechanism (52%. Conclusion Multidetector CTA was useful for the etiologic work-up of hyperacute ischemic stroke and facilitated the knowledge about the topographic pattern of brain infarct in accordance with its causative mechanism.
Soares, Eveline K B; Esmerino, Erick A; Ferreira, Marcus Vinícius S; da Silva, Maria Aparecida A P; Freitas, Mônica Q; Cruz, Adriano G
The aim of this study was to investigate the effects of regional diversity aspects related to consumers' perceptions of coalho cheese, with Brazilian Northeast and Southeast consumers (n=400, divided equally in each area) using Word Association (WA) task. Different perceptions were detected for both Northeast and Southeast consumers, and among 17 categories elicited for describing coalho cheese, only 7 categories (positive feeling, social aspects, sensory characteristic, dairy product technology, negative feeling, and lack of quality standard) presented significant differences in the frequency of mention according to chi-square per cell approach. The application of the discriminant technique Partial Least Square Discriminant Analysis (PLS-DA) indicated that the categories "Social", "Accompaniment", "Manufacturing method" were the main responsible for differentiating consumers' perceptions of both areas. Overall, the main dimensions involved in the consumers' perceptions of coalho cheese from different Brazilian regions were identified, thus obtaining comprehensive insights that can be used as a guideline for coalho cheese producers to develop marketing strategies considering the intra-cultural differences. Copyright © 2017. Published by Elsevier Ltd.
Hess, Dean R
Rotational beds, prone position, and semi-recumbent position have been proposed as procedures to prevent ventilator-associated pneumonia (VAP). Rotational therapy uses a special bed designed to turn continuously, or nearly continuously, the patient from side to side; specific designs include kinetic therapy and continuous lateral rotation therapy. A meta-analysis of studies evaluating the effect of rotational bed therapy shows a decrease in the risk of pneumonia but no effect on mortality. Two studies reported a lower risk of VAP in patients placed in a prone position, with no effect on mortality. Studies using radiolabeled enteral feeding solutions in mechanically ventilated patients have reported that aspiration of gastric contents occurs to a greater degree when patients are in the supine position, compared with the semirecumbent position. One study reported a lower rate of VAP in patients randomized to semi-recumbent compared to supine position. Although each of the techniques discussed in this paper has been shown to reduce the risk of VAP, none has been shown to affect mortality. The available evidence suggests that semi-recumbent position should be used routinely, rotational therapy should be considered in selected patients, and prone position should not be used as a technique to reduce the risk of VAP.
Full Text Available Background: Tuberculosis (TB is one of the main causes of morbidity and mortality in different societies. Understanding factors leading to death following diagnosis of TB is important to predict prognosis in TB patients. The aim of this study was to identify common risk factors associated with death in patients with an in-hospital diagnosis of TB, in a city in Iran with the highest prevalence and incidence of TB in the country. Materials and Methods: A retrospective study was conducted at a university-affiliated hospital, Zahedan, in the south-east of Iran, which is a referral center for TB. To identify factors leading to death, medical records of 715 patients ≥15 years old with pulmonary TB from February 2002 to February 2011 have been evaluated. Registered factors included smoking, human immune deficiency virus (HIV infection, using drugs, lung cancer, drug hepatitis following anti-TB medications, diabetes mellitus, previous TB treatment, anemia; and results of sputum smears. Univariate comparison and multiple logistic regression were performed to identify factors associated with mortality in TB patients. Results: Among 715 registered TB patients, 375 (52.5% patients were male; among those, 334 (53% were in the alive group and 41 (54% in the death group. Seventy-five (10.5% of the total number of TB patients died during TB treatment. The multivariate model showed that anemia (AOR: 19.8, 95% CI: 5.6-35.5, positive sputum smear (AOR: 13.4, 95% CI: 6.8-33.6, smoking (AOR: 12.9, 95% CI: 3.9-27.3, drug hepatitis (AOR: 12.3, 95% CI: 6.7-24.7, diabetes mellitus (AOR: 9.7, 95% CI: 2.9-32.0, drug use (AOR: 7.8, 95% CI: 2.4-25.5, and history of previous TB (AOR: 6.8, 95% CI: 2.2-21.3 were major risk factors for death in TB patients. Conclusion: Monitoring co-morbid conditions like diabetes mellitus and anemia are important to reduce death rate in TB patients. Preventive measures for smoking and drug addiction also play an important role to decrease
Full Text Available Loss to follow-up (LF, which refers to patients who started care but voluntary stopped it, is a problem for patients with chronic disease. We aimed to estimate the rate of LF among patients seropositive for hepatitis C virus (HCV and identify possible demographic and lifestyle risk factors associated with LF. From January 2009 through December 2012, 1010 anti-HCV-positive patients were included in the study. Among participants, 223 (22.1% met the case definition for LF (more than 1-year elapsed since the last clinical appointment. Among 787 patients who remained in follow-up, 372 (47.2% were discharged after undetectable HCV RNA, 88 (11.1% were transferred (and remained on regular follow-up at the destination, and 25 (3.1% died. According to univariate analysis, male gender, absence of a life partner, black race, psychiatric illness, previous alcohol abuse, previous or current recreational drug use, and previous or current smoking were significantly associated with LF. In multivariate analysis, absence of a life partner (adjusted odds ratio (AOR=1.44; 95% confidence interval (95%CI=1.03–2.02, black race (AOR=1.81, 95%CI=1.12–2.89, psychiatric illness (AOR=1.77, 95%CI=1.14–2.73, and the presence of at least one lifestyle risk factor (pertaining to substance abuse (AOR=1.95, 95%CI=1.29–2.94 were independently associated with LF. Our study provides an estimate of the incidence of LF among anti-HCV-positive patients and identifies risk factors associated with this outcome. In addition, these results can help clinicians recognize patients at risk for LF, who require additional support for the continuity of care.
Patrão, Ana Luísa; Almeida, Maria da Conceição; Matos, Sheila Maria Alvim; Chor, Dora; Aquino, Estela M L
It has been estimated that over 50% of the premature deaths occurring in Western countries can be attributed to causes rooted in lifestyle. In turn, leading a healthy lifestyle has also been associated with a wide range of psychosocial factors. Today, it is known that these differ among men and women. The present article aimed to identify, from a gender-based perspective, the psychosocial factors associated with healthy lifestyles in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort, the largest study concerning adult health conducted in Latin America to date. This cross-sectional study was conducted using ELSA-Brasil baseline data, collected between 2008 and 2010. Six Brazilian public higher education and research institutions. The ELSA-Brasil cohort consists of approximately 15 000 employees (8218 women and 6887 men), both currently working and retired. The lifestyle indicator was constructed by summing the scores attributed to four different behaviours. The women of the ELSA-Brasil cohort have healthier lifestyles than men. In women, strong associations were found between a healthy lifestyle and age 60 years or older, Asian race and university level of education or higher. In men, being 60 years or older, of Asian or Caucasian race, having a high-school equivalent level of education or higher, being retired, having a housekeeper, having a good or very good self-perception of health and being satisfied with body image were the psychosocial factors associated with leading a healthy lifestyle. The factors that influenced healthy lifestyles were found to differ among men and women, a fact that must be addressed when developing programmes designed to promote health. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Alwadi, Maram Ali M; Vettore, Mario Vianna
The aim of this study was to test the association of contextual school and home environmental characteristics and individual factors with oral health-related quality of life (OHRQoL) in a representative sample of Brazilian adolescents and young adults. Individual-level data from 3854 fifteen- to nineteen-year-olds who participated in the Brazilian Oral Health Survey were pooled with contextual city-level data. The dependent variable was the frequency of impacts of oral disorders on daily performances (OIDP extent), as a measure of OHRQoL. Contextual school and home environmental characteristics were categorized into three equal groups according to tertiles of the contextual variable's scores (low, moderate and high). Individual demographic, socioeconomic and oral clinical measures were the covariates. The association between contextual and individual characteristics and OIDP extent was estimated using multilevel Poisson regression models. The mean of OIDP extent was 0.9 (standard error 0.1). Adolescents and young adults living in the cities with high levels of lack of security at school (RR 1.33; 95% CI=1.02-1.74), moderate levels of bullying at school (RR 1.56; 95% CI=1.20-2.03) and moderate levels of low maternal schooling (RR 1.43; 95% CI=1.06-1.92) had a higher mean OIDP extent. Male sex, higher age, skin colour, poor individual socioeconomic status and worse oral clinical measures were also associated with higher mean of OIDP extent. Poor school and home environmental characteristics were independently associated with poor OHRQoL in individuals aged between 15 and 19 years. Our findings suggest the place where they study and the maternal level of education are meaningful aspects for their oral health. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Maria José Franco Brochado
Full Text Available Natural resistance-associated macrophage protein 1/solute carrier family 11 member 1 gene (Nramp1/Slc11a1 is a gene that controls the susceptibility of inbred mice to intracellular pathogens. Polymorphisms in the human Slc11a1/Nramp1 gene have been associated with host susceptibility to leprosy. This study has evaluated nine polymorphisms of the Slc11a1/Nramp1 gene [(GTn, 274C/T, 469+14G/C, 577-18G/A, 823C/T, 1029 C/T, 1465-85G/A, 1703G/A, and 1729+55del4] in 86 leprosy patients (67 and 19 patients had the multibacillary and the paucibacillary clinical forms of the disease, respectively, and 239 healthy controls matched by age, gender, and ethnicity. The frequency of allele 2 of the (GTn polymorphism was higher in leprosy patients [p = 0.04, odds ratio (OR = 1.49], whereas the frequency of allele 3 was higher in the control group (p = 0.03; OR = 0.66. Patients carrying the 274T allele (p = 0.04; OR = 1.49 and TT homozygosis (p = 0.02; OR = 2.46, such as the 469+14C allele (p = 0.03; OR = 1.53 of the 274C/T and 469+14G/C polymorphisms, respectively, were more frequent in the leprosy group. The leprosy and control groups had similar frequency of the 577-18G/A, 823C/T, 1029C/T, 1465-85G/A, 1703G/A, and 1729+55del4 polymorphisms. The 274C/T polymorphism in exon 3 and the 469+14G/C polymorphism in intron 4 were associated with susceptibility to leprosy, while the allele 2 and 3 of the (GTn polymorphism in the promoter region were associated with susceptibility and protection to leprosy, respectively.
Liciana Xavier Eurico de Alencar
Full Text Available Human leukocyte antigen (HLA alleles have been correlated with susceptibility or resistance to severe dengue; however, few immunogenetic studies have been performed in Latin American (LA populations. We have conducted immunogenetic studies of HLA class I and II alleles in a cohort of 187 patients with DENV-3 infection and confirmed clinical diagnosis of either severe dengue, known as dengue hemorrhagic fever (DHF, or the less severe form, dengue fever (DF, in Recife, Pernambuco, Brazil. An association analysis was performed using Fisher’s association test, with odds ratios (ORs calculated using conditional maximum likelihood estimates. HLA-B*44 (P=0.047, OR = 2.025, 95% CI = 0.97–4.24 was found to be associated with increased susceptibility to DHF in response to DENV-3 infection. In addition, HLA-B*07 (P=0.048, OR = 0.501, one-sided 95% CI = 0–0.99 and HLA-DR*13 (P=0.028, OR = 0.511, one-sided 95% CI = 0–0.91 were found to be associated with resistance to secondary dengue infection by DENV-3. These results suggest that HLA-B*44 supertype alleles and their respective T-cell responses might be involved in susceptibility to severe dengue infections, whereas the HLA-B*07 supertype alleles and DR*13 might be involved in cross-dengue serotype immunity.
Full Text Available OBJECTIVE: To develop a Brazilian version of the gesture behavior test (GBT for patients with chronic low back pain. METHODS: Translation of GBT into Portuguese was performed by a rheumatologist fluent in the language of origin (French and skilled in the validation of questionnaires. This translated version was back-translated into French by a native-speaking teacher of the language. The two translators then created a final consensual version in Portuguese. Cultural adaptation was carried out by two rheumatologists, one educated patient and the native-speaking French teacher. Thirty patients with chronic low back pain and fifteen healthcare professionals involved in the education of patients with low back pain through back schools (gold-standard were evaluated. Reproducibility was initially tested by two observers (inter-observer; the procedures were also videotaped for later evaluation by one of the observers (intra-observer. For construct validation, we compared patients' scores against the scores of the healthcare professionals. RESULTS: Modifications were made to the GBT for cultural reasons. The Spearman's correlation coefficient and the intra-class coefficient, which was employed to measure reproducibility, ranged between 0.87 and 0.99 and 0.94 to 0.99, respectively (p < 0.01. With regard to validation, the Mann-Whitney test revealed a significant difference (p < 0.01 between the averages for healthcare professionals (26.60; SD 2.79 and patients (16.30; SD 6.39. There was a positive correlation between the GBT score and the score on the Roland Morris Disability Questionnaire (r= 0.47. CONCLUSIONS: The Brazilian version of the GBT proved to be a reproducible and valid instrument. In addition, according to the questionnaire results, more disabled patients exhibited more protective gesture behavior related to low-back.
Full Text Available OBJECTIVE: To describe the clinical impact of the first year treatment with dornase alfa, according to age groups, in a cohort of Brazilian Cystic Fibrosis (CF patients. METHODS: The data on 152 eligible patients, from 16 CF reference centers, that answered the medical questionnaires and performed laboratory tests at baseline (T0, and at six (T2 and 12 (T4 months after dornase alfa initiation, were analyzed. Three age groups were assessed: six to 11, 12 to 13, and >14 years. Pulmonary tests, airway microbiology, emergency room visits, hospitalizations, emergency and routine treatments were evaluated. Student's t-test, chi-square test and analysis of variance were used when appropriated. RESULTS: Routine treatments were based on respiratory physical therapy, regular exercises, pancreatic enzymes, vitamins, bronchodilators, corticosteroids, and antibiotics. In the six months prior the study (T0 phase, hospitalizations for pulmonary exacerbations occurred in 38.0, 10.0 and 61.4% in the three age groups, respectively. After one year of intervention, there was a significant reduction in the number of emergency room visits in the six to 11 years group. There were no significant changes in forced expiratory volume in one second (VEF1, in forced vital capacity (FVC, in oxygen saturation (SpO2, and in Tiffenau index for all age groups. A significant improvement in Shwachman-Kulczychi score was observed in the older group. In the last six months of therapy, chronic or intermittent colonization by P. aeruginosa was detected in 75.0, 71.4 and 62.5% of the studied groups, respectively, while S. aureus colonization was identified in 68.6, 66.6 and 41.9% of the cases. CONCLUSIONS: The treatment with dornase alfa promoted the maintenance of pulmonary function parameters and was associated with a significant reduction of emergency room visits due to pulmonary exacerbations in the six to 11 years age group, with better clinical scores in the >14 age group, one
Samelli, Alessandra G; Santos, Itamar S; Moreira, Renata R; Rabelo, Camila M; Rolim, Laurie P; Bensenõr, Isabela J; Lotufo, Paulo A
Although several studies have investigated the effects of diabetes on hearing loss, the relationship between these two conditions remains unclear. Some studies have suggested that diabetes may cause sensorineural hearing loss, whereas others have failed to find an association. The biggest challenge in investigating the association between diabetes and hearing loss is the presence of confounding variables and the complexity of the auditory system. Our study investigated the association between diabetes and sensorineural hearing loss. We evaluated the influence of time from diabetes diagnosis on this association after controlling for age, gender, and hypertension diagnosis and excluding those subjects with exposure to noise. This cross-sectional study evaluated 901 adult and elderly Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) participants from São Paulo, Brazil who underwent audiometry testing as part of ELSA-Brasil's baseline assessment. Hearing thresholds and speech test results were significantly worse in the group with diabetes than in the group without diabetes. However, no significant differences were found between participants with and without diabetes after adjusting for age, gender, and the presence of hypertension. Hearing thresholds were not affected by occupational noise exposure in the groups with and without diabetes. In addition, no association between the duration of diabetes and hearing thresholds was observed after adjusting for age, gender, and hypertension. We found no association between the duration of diabetes and worse hearing thresholds after models were adjusted for age, gender, and the presence of hypertension.
Esther G. BIRMAN
Full Text Available One hundred and forty-four Brazilian AIDS patients presenting with Kaposi’s sarcoma (KS were evaluated with respect to the frequency of oral neoplasms and their clinical features. The majority of the patients were young male adults (age range: 21-40 years old, from which 11.1 % presented with oral KS (OKS exclusively. Oral and skin lesions were associated in 25% of the cases, while only four patients showed association between oral and visceral KS; 49.3% of the cases were exclusively dermatological. The hard palate was the main site affected, followed by the oropharynx. The localization of KS was found to be similarly frequent in the tongue, gingiva and other sites of the oral mucosa. Candidosis was the prevailing fungal disease; in 20% of the cases it was restricted to the oral mucosa and in 80% it was systemic. No high frequency of paracoccidioidomicosis and cryptococcosis was detected. The prevailing bacterial disease was Tuberculosis and there was only one case of syphilis. Among the viral diseases, the most frequently detected was herpes simplex, followed by molusco contagiosum, condiloma acuminatum and cytomegaloviroses at lower frequencies. Pneumonia caused by Pneumocystes carinii and toxoplasmosis were also identified. The authors emphasise the importance of oral examination in HIV-infected patients bearing in mind several aspects related especially to KS, and stress the need for an interdisciplinary team in the management of these patients, in order to provide better quality of life as well as rapid diagnosis and treatment.Foram estudados pacientes brasileiros portadores de SIDA apresentando sarcoma de Kaposi (SK. O perfil de idade mostrou um grupo com média de idade entre 21 e 40 anos, sendo que 11,1% da amostra apresentava SK exclusivamente na cavidade bucal, observando-se em 25% da amostra uma associação de lesões bucais e na pele. Somente quatro pacientes apresentaram associação de lesões bucais e viscerais, enquanto 49
Full Text Available The objective of the present study was to determine whether the duration of disease has any influence on the prevalence of glutamic acid decarboxylase autoantibodies (GADA in Brazilian patients with type 1 diabetes (T1D and variable disease duration. We evaluated 83 patients with T1D. All participants were interviewed and blood was obtained for GADA measurement by a commercial radioimmunoassay (RSR Limited, Cardiff, UK. Four groups of patients were established according to disease duration: A 1-5 years of disease (N = 24, B 6-10 years of disease (N = 19, C 11-15 years of disease (N = 25, and D >15 years of disease (N = 15. GADA prevalence and its titers were determined in each group. GADA was positive in 38 patients (45.8% and its frequency did not differ between the groups. The prevalence was 11/24 (45.8%, 8/19 (42.1%, 13/25 (52%, and 6/15 (40% in groups A, B, C, and D, respectively (P = 0.874. Mean GADA titer was 12.54 ± 11.33 U/ml for the sample as a whole and 11.95 ± 11.8, 12.85 ± 12.07, 10.57 ± 8.35, and 17.45 ± 16.1 U/ml for groups A, B, C, and D, respectively (P = 0.686. Sex, age at diagnosis or ethnic background had no significant effect on GADA (+ frequency. In conclusion, in this transversal study, duration of disease did not affect significantly the prevalence of GADA or its titers in patients with T1D after one year of diagnosis. This was the first study to report this finding in the Brazilian population.
Vieira Neto, Leonardo; Gadelha, Monica R.; Boguszewski, Cesar L.; Bronstein, Marcello D.; Musolino, Nina R. de C.; Miranda, Paulo Augusto C.; Nave, Luciana A.; Vilar, Lucio; Oliveira Junior, Antonio Ribeiro
Clinically nonfunctioning pituitary adenomas (NFPA) are the most common pituitary tumors after prolactinomas. The absence of clinical symptoms of hormonal hypersecretion can contribute to the late diagnosis of the disease. Thus, the majority of patients seek medical attention for signs and symptoms resulting from mass effect, such as neuro-ophthalmologic symptoms and hypopituitarism. Other presentations include pituitary apoplexy or an incidental finding on imaging studies. Mass effect and hypopituitarism impose high morbidity and mortality. However, early diagnosis and effective treatment minimizes morbidity and mortality. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism is to provide a review of the diagnosis and treatment of patients with NFPA, emphasizing that the treatment should be performed in reference centers. This review is based on data published in the literature and the authors' experience. (author)
Vieira Neto, Leonardo; Gadelha, Monica R., E-mail: firstname.lastname@example.org [Hospital Universitario Clementino Fraga Filho (HUCFF/UFRJ), Rio de Janeiro, RJ (Brazil); Boguszewski, Cesar L. [Universidade Federal do Parana (SEMPR/UFPN), Curitiba, PR (Brazil). Hospital de Clinicas; Araujo, Luiz Antonio de [Centro de Endocrinologia e Diabetes de Joinville (Endoville), Joinville, SC (Brazil); Bronstein, Marcello D.; Musolino, Nina R. de C. [Universidade de Sao Paulo (FM/USP), Sao Paulo, SP (Brazil). Servico de Endocrinologia; Miranda, Paulo Augusto C. [Santa Casa de Belo Horizonte, Belo Horizonte, MG (Brazil). Servico de Endocrinologia e Metabologia; Nave, Luciana A. [Universidade de Brasilia (UnB), Brasilia, DF (Brazil). Hospital Universitario. Servico de Endocrinologia; Vilar, Lucio [Universidade Federal de Pernambuco (UFPE), Recife, PE (Brazil). Servico de Endocrinologia; Oliveira Junior, Antonio Ribeiro [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Hospital das Clinicas. Servico de Endocrinologia
Clinically nonfunctioning pituitary adenomas (NFPA) are the most common pituitary tumors after prolactinomas. The absence of clinical symptoms of hormonal hypersecretion can contribute to the late diagnosis of the disease. Thus, the majority of patients seek medical attention for signs and symptoms resulting from mass effect, such as neuro-ophthalmologic symptoms and hypopituitarism. Other presentations include pituitary apoplexy or an incidental finding on imaging studies. Mass effect and hypopituitarism impose high morbidity and mortality. However, early diagnosis and effective treatment minimizes morbidity and mortality. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism is to provide a review of the diagnosis and treatment of patients with NFPA, emphasizing that the treatment should be performed in reference centers. This review is based on data published in the literature and the authors' experience. (author)
Full Text Available Orthodontic appliances modify the local environment of the oral cavity, increase the accumulation of dental plaque, and affect the condition of the gingiva. The aim of this study is assessment of Brazilian propolis toothpaste’s effect on plaque index (PLI and gingival index (GI in patients with CL/CLP treated using orthodontic appliances in the 35-day study period. The study population included 96 patients of an Orthodontic Outpatient Clinic, ACSiMS in Bytom. All the patients participated in the active phase of orthodontic treatment using buccal multibracket appliances or removable appliances. During the first examination, each patient was randomly qualified to the propolis group or control group. A statistically significant decrease in GI and PLI in the entire propolis group (P<0.01 was shown during repeated examination. Insignificant change in GI was in the entire control group during the repeated examination compared to the baseline. Similar result was obtained in patients treated with multibracket and removable appliances. The orthodontic appliance type did not affect the final dental plaque amount and gingival condition in patients using the propolis toothpaste. These results may be clinically useful to improve prevention and control oral infectious diseases during orthodontic treatment patients with oral cleft.
da Silva Fernandes, Natália Maria; Bastos, Marcus Gomes; Franco, Márcia Regina Gianotti; Chaoubah, Alfredo; da Glória Lima, Maria; Divino-Filho, José Carolino; Qureshi, Abdul Rashid
OBJECTIVES: To determine the roles of body size and longitudinal body weight changes in the survival of incident peritoneal dialysis patients. PATIENTS AND METHODS: Patients (n = 1911) older than 18 years of age recruited from 114 dialysis centers (Dec/2004-Oct/2007) and participating in the Brazilian Peritoneal Dialysis Multicenter Cohort Study were included. Clinical and laboratory data were collected monthly (except if the patient received a transplant, recovered renal function, was transferred to hemodialysis, or died). RESULTS: Survival analyses were performed using Kaplan-Meier survival curves and Cox proportional hazards. Total follow-up was 34 months. The mean age was 59 years (54% female). The weight category percentages were as follows: underweight: 8%; normal: 51%; overweight: 29%; and obese 12%. The multivariate model showed a higher risk of death for a body mass index 30 kg/m2. Patients were divided into five categories according to quintiles of body weight changes during the first year of dialysis: +7.1%. Patients in the lowest quintile had significantly higher mortality, whereas no negative impact was observed in the other quintiles. CONCLUSION: These findings suggest that overweight/obesity and a positive body weight variation during the first year of peritoneal dialysis therapy do not increase mortality in incident dialysis patients in Brazil. PMID:23420157
Horta, Rogério Lessa; Horta, Bernardo Lessa; da Costa, Andre Wallace Nery; do Prado, Rogério Ruscitto; Oliveira-Campos, Maryane; Malta, Deborah Carvalho
This study aimed at describing the prevalence of illicit drug use among 9th grade students in the morning period of public and private schools in Brazil, and assessing associated factors. The Brazilian survey PeNSE (National Adolescent School-based Health Survey) 2012 evaluated a representative sample of 9th grade students in the morning period, in Brazil and its five regions. The use of illicit drugs at least once in life was assessed for the most commonly used drugs, such as marijuana, cocaine, crack, solvent-based glue, general ether-based inhalants, ecstasy and oxy. Data were subjected to descriptive analysis, and Pearson's χ² test and logistic regression was used in the multivariate analysis. The use of illicit drugs at least once in life was reported by 7.3% (95%CI 5.3 - 9.4) of the respondents. Logistic regression was used for multivariate analysis and the evidences suggest that illicit drug use is associated to social conditions of greater consumption power, the use of alcohol and tobacco, behaviors related to socialization, such as having friends or sexual activity, and also the perception of loneliness, loose contact between school and parents and experiences of abuse in the family environment. The outcome was inversely associated with close contact with parents and parental supervision. In addition to the association with the processes of socialization and consumption, the influence of family and school is expressed in a particularly protective manner in different records of direct supervision and care.
Chimetto, L A; Brocchi, M; Gondo, M; Thompson, C C; Gomez-Gil, B; Thompson, F L
A taxonomic survey of the vibrios associated with the Brazilian endemic coral Mussismilia hispida and the sympatric zoanthids (i.e. Palythoa caribaeorum, Palythoa variabilis and Zoanthus solanderi). Mucus of 54 cnidarian specimens collected in three different places at São Sebastião in two consecutive years (i.e. 2005 and 2006) was used for taxonomic characterization of the cnidarian microbiota. Ninety-eight of the 151 vibrio isolates fell within the vibrio core group according to partial 16S rDNA sequences. We performed the sequencing of recA and pyrH genes of all vibrio isolates. The most abundant taxa belonged to the vibrio core group (Vibrio harveyi, Vibrio rotiferianus, Vibrio campbellii and Vibrio alginolyticus), Vibrio mediterranei (=Vibrio shillonii) and Vibrio chagasii. With the exception of V. chagasii which was found only in the mucus of M. hispida, the other species appeared in different hosts with no evidence for the presence of host-specific clones or species. Using rep-PCR analysis, we observed a high genomic heterogeneity within the vibrios. Each vibrio isolate generated a different rep-PCR fingerprint pattern. There was a complete agreement between the grouping based on rep-PCR and concatenated sequences of pyrH, recA and 16S rDNA, but the pyrH gene has the highest discriminatory power for vibrio species identification. The vibrio core group is dominant in the mucus of these cnidarians. There is a tremendous diversity of vibrio lineages within the coral mucus. pyrH gene sequences permit a clear-cut identification of vibrios. The taxonomic resolution provided by pyrH (but not recA) appears to be enough for identifying species of vibrios and for disclosing putative new taxa. The vibrio core group appears to be dominant in the mucus of the Brazilian cnidarians. The overrepresentation of these vibrios may reflect as yet unknown ecological functions in the coral holobiont.
Full Text Available Abstract Background Differences in sex hormone levels among populations might contribute to the variation in breast cancer incidence across countries. Previous studies have shown higher breast cancer incidence and mortality among Japanese Brazilians than among Japanese. To clarify the difference in hormone levels among populations, we compared postmenopausal endogenous sex hormone levels among Japanese living in Japan, Japanese Brazilians living in the state of São Paulo, and non-Japanese Brazilians living in the state of São Paulo. Methods A cross-sectional study was conducted using a control group of case-control studies in Nagano, Japan, and São Paulo, Brazil. Participants were postmenopausal women older than 55 years of age who provided blood samples. We measured estradiol, estrone, androstenedione, dehydroepiandrosterone sulfate (DHEAS, testosterone and free testosterone by radioimmunoassay; bioavailable estradiol by the ammonium sulfate precipitation method; and sex hormone-binding globulin (SHBG by immunoradiometric assay. A total of 363 women were included for the present analyses, comprising 185 Japanese, 44 Japanese Brazilians and 134 non-Japanese Brazilians. Results Japanese Brazilians had significantly higher levels of estradiol, bioavailable estradiol, estrone, testosterone and free testosterone levels, and lower SHBG levels, than Japanese. Japanese Brazilians also had significantly higher levels of bioavailable estradiol, estrone and DHEAS and lower levels of SHBG and androstenedione than non-Japanese Brazilians. Levels of estradiol, testosterone and free testosterone, however, did not differ between Japanese Brazilians and non-Japanese Brazilians. These differences were observed even after adjustment for known breast cancer risk factors. We also found an increase in estrogen and androgen levels with increasing body mass index, but no association for most of the other known risk factors. Conclusions We found higher levels of
Chor, Dóra; Cardoso, Letícia Oliveira; Nobre, Aline Araújo; Griep, Rosane Härter; Fonseca, Maria de Jesus Mendes; Giatti, Luana; Bensenor, Isabela; Del Carmen Bisi Molina, Maria; Aquino, Estela M L; Diez-Roux, Ana; de Pina Castiglione, Débora; Santos, Simone M
The study explores associations between perceived neighbourhood characteristics, physical activity and diet quality, which in Latin America and Brazil have been scarcely studied and with inconsistent results. We conducted a cross-sectional analysis of 14,749 individuals who participated in the Brazilian Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto, ELSA-Brasil) baseline. The study included current and retired civil servants, aged between 35 and 74 years, from universities and research institutes in six Brazilian states. The International Physical Activity Questionnaire (IPAQ) long form was used to characterize physical activity during leisure time and commuting; additional questions assessed how often fruit and vegetables were consumed, as a proxy for diet quality. Neighbourhood characteristics were evaluated by the "Walking Environment" and "Availability of Healthy Foods" scales originally used in the Multi-Ethnic Study of Atherosclerosis (MESA). Associations were examined using multinomial logistic regression. Perceiving a more walkable neighbourhood was positively associated with engaging in leisure time physical activity and doing so for longer weekly. Compared with those who saw their neighbourhood as less walkable, those who perceived it as more walkable had 1.69 (95 % CI 1.57-1.83) and 1.39 (1.28-1.52) greater odds of engaging in leisure time physical activity for more than 150 min/week or up to 150 min/week (vs. none), respectively. Perceiving a more walkable neighbourhood was also positively associated with transport-related physical activity. The same pattern was observed for diet: compared with participants who perceived healthy foods as less available in their neighbourhood, those who saw them as more available had odds 1.48 greater (1.31-1.66) of eating fruits, and 1.47 greater (1.30-1.66) of eating vegetables, more than once per day. Perceived walkability and neighbourhood availability of healthy food were
Pacheco, Antonio G; Grinsztejn, Beatriz; da Fonseca, Maria de Jesus M; Moreira, Ronaldo I; Veloso, Valdiléa G; Friedman, Ruth K; Santini-Oliveira, Marilia; Cardoso, Sandra W; Falcão, Melissa; Mill, José G; Bensenor, Isabela; Lotufo, Paulo; Chor, Dóra
Combination antiretroviral therapy (cART) had a dramatic impact on the mortality profile in human immunodeficiency virus (HIV) infected individuals and increased their life-expectancy. Conditions associated with the aging process have been diagnosed more frequently among HIV-infected patients, particularly, cardiovascular diseases. Patients followed in the Instituto de Pesquisa Clínica Evandro Chagas (IPEC) prospective cohort in Rio de Janeiro were submitted to the general procedures from the Brazilian Longitudinal Study of Adult Health, comprising several anthropometric, laboratory and imaging data. Carotid intima-media thickness (cIMT) was measured by ultrasonography, following the Mannheim protocol. Linear regression and proportional odds models were used to compare groups and covariables in respect to cIMT. The best model was chosen with the adaptive lasso procedure. A valid cIMT exam was available for 591 patients. Median cIMT was significantly larger for men than women (0.56mm vs. 0.53mm; p = 0.002; overall = 0.54mm). In univariable linear regression analysis, both traditional risk factors for cardiovascular diseases (CVD) and HIV-specific characteristics were significantly associated with cIMT values, but the best multivariable model chosen included only traditional characteristics. Hypertension presented the strongest association with higher cIMT terciles (OR = 2.51; 95%CI = 1.69-3.73), followed by current smoking (OR = 1,82; 95%CI = 1.19-2.79), family history of acute myocardial infarction or stroke (OR = 1.60; 95%CI = 1.10-2.32) and age (OR per year = 1.12; 95%CI = 1.10-1.14). Our results show that traditional cardiovascular disease (CVD) risk factors are the major players in determining increased cIMT among HIV infected patients in Brazil. This finding reinforces the need for thorough assessment of those risk factors in these patients to guarantee the incidence of CVD events remain under control.
Luciano, Luanda Cristina O; Ferreira, Meire Coelho; Paschoal, Marco Aurelio
Dental erosion in young individuals has increased significantly in recent years, due to changes in lifestyle. Thus, the present study investigated the prevalence and factors associated with dental erosion in individuals aged 12-30 years in the city of Imperatriz of Maranhão, Brazil. A cross-sectional study was conducted on 335 individuals who answered a questionnaire consisting of variables related to dental erosion. Afterwards, the individuals were subjected to clinical examinations and the basic erosive wear examination index was used to classify their teeth according to the presence and severity of dental erosion. Descriptive statistics, the chi-square test, Poisson univariate and multivariate regression were performed at 5% level of significance. The sample was characterized by 204 females (60.9%), the majority of whom were from 12 to 19 years of age (78.5%), among whom 28.7% presented dental erosion. Their monthly family income was from 1 to 3 minimum wages (56.4%). The variables that were significantly associated with the outcome were family income, chewing gum, and consumption of soft-drinks/juices before going to sleep ( p =0.03, p =0.001, and p =0.04, respectively). Individuals who chewed chewing gum were 2.27 times (95% CI =1.43-3.60) more likely to present dental erosion than those who did not chew gum. Individuals who ingested soft drinks or juices were 2.30 times (95% CI =1.30-4.10) more likely to present dental erosion. The prevalence of erosion reflected the need for programs of prevention and guidance for patients about the etiological factors of the disease.
Efficacy of doxorubicin after progression on carboplatin and paclitaxel in advanced or recurrent endometrial cancer: a retrospective analysis of patients treated at the Brazilian National Cancer Institute (INCA).
Moreira, Emeline; Paulino, Eduardo; Ingles Garces, Álvaro Henrique; Fontes Dias, Mariane S; Saramago, Marcos; de Moraes Lino da Silva, Flora; Thuler, Luiz Claudio Santos; de Melo, Andréia Cristina
The treatment of endometrial cancer (EC) is challenging. There is no standard of care for patients who progressed after carboplatin and paclitaxel (CT) and all available drugs show a small response and poor long-term survival in this scenario. The objective of this study was to evaluate the efficacy and toxicity profile of palliative doxorubicin after progression to CT therapy in advanced or recurrent EC. A retrospective review of the Brazilian National Cancer Institute database between 2009 and 2013 was performed, and all patients with recurrent and advanced EC treated with palliative doxorubicin after progression on CT were included. Progression-free survival (PFS), overall survival (OS), objective response rates as well as toxicity were evaluated. A total of 33 patients were enrolled, with a median age of 65.7 years. Objective responses were documented in 12.1% (3.0% of complete responses and 9.1% of partial responses). The median PFS was 4.4 months, and the median OS was 8.1 months for patients exposed to doxorubicin. The most common adverse event was anemia observed in 60.6% of patients. This retrospective study suggests that doxorubicin has a modest activity in patients with advanced or recurrent EC after treatment with CT.
Machorowska-Pieniążek, Agnieszka; Skucha-Nowak, Małgorzata; Mertas, Anna; Tanasiewicz, Marta; Niedzielska, Iwona; Morawiec, Tadeusz; Baron, Stefan
Orthodontic appliances modify the local environment of the oral cavity, increase the accumulation of dental plaque, and affect the condition of the gingiva. The aim of this study is assessment of Brazilian propolis toothpaste's effect on plaque index (PLI) and gingival index (GI) in patients with CL/CLP treated using orthodontic appliances in the 35-day study period. The study population included 96 patients of an Orthodontic Outpatient Clinic, ACSiMS in Bytom. All the patients participated in the active phase of orthodontic treatment using buccal multibracket appliances or removable appliances. During the first examination, each patient was randomly qualified to the propolis group or control group. A statistically significant decrease in GI and PLI in the entire propolis group (P appliances. The orthodontic appliance type did not affect the final dental plaque amount and gingival condition in patients using the propolis toothpaste. These results may be clinically useful to improve prevention and control oral infectious diseases during orthodontic treatment patients with oral cleft.
Renato T Souza
Full Text Available About 15 million children are born under 37 weeks of gestation worldwide. Prematurity is the leading cause of neonatal deaths and short/long term morbidities, entailing consequences not only for the individual, but also their family, health agencies, facilities and all community. The provider-initiated preterm birth is currently one of the most important obstetric conditions related to preterm births, particularly in middle and high income countries, thus decreasing the need for therapeutic preterm birth is essential to reduce global prematurity. Therefore detailed knowledge on the factors associated with provider-initiated preterm birth is essential for the efforts to reduce preterm birth rates and its consequences. In this current analysis we aimed to assess the proportion of provider-initiated (pi-PTB among preterm births in Brazil and identify associated factors.This is an analysis of a multicenter cross-sectional study with a nested case-control component called Brazilian Multicenter Study on Preterm Birth (EMIP. EMIP was conducted in 20 referral obstetric hospitals located in the three most populated of the five Brazilian regions. We analysed data of women with pi-PTB, defined as childbirth occurring at less than 37 weeks, medically indicated for maternal/fetal compromise or both; and women with term birth, childbirth at or after 37 weeks. Maternal, sociodemographic, obstetric, prenatal care, delivery, and postnatal characteristics were assessed as possible factors associated with pi-PTB, compared to term births. The overall prevalence of preterm births was 12.3%. Of these, approximately one-third of cases were initiated by the provider. Hypertensive disorders, placental abruption, and diabetes were the main maternal conditions leading to pi-PTB. Caesarean section was the most common mode of delivery. Chronic hypertension (OR 7.47; 95%CI 4.02-13.88, preeclampsia/eclampsia/HELLP syndrome (OR 15.35; 6.57-35.88, multiple pregnancy (OR 12
Boekhout van Solinge, T.|info:eu-repo/dai/nl/156696207
This essay takes a (green) criminological and multidisciplinary perspective on deforestation in the Brazilian Amazon, by focusing on the crimes and damages that are associated with Amazonian deforestation. The analysis and results are partly based on longer ethnographic stays in North Brazil (Amazon
Daniel Zanetti Scherrer
Full Text Available Background:Evidences suggest that paraoxonase 1 (PON1 confers important antioxidant and anti-inflammatory properties when associated with high-density lipoprotein (HDL.Objective:To investigate the relationships between p.Q192R SNP of PON1, biochemical parameters and carotid atherosclerosis in an asymptomatic, normolipidemic Brazilian population sample.Methods:We studied 584 volunteers (females n = 326, males n = 258; 19-75 years of age. Total genomic DNA was extracted and SNP was detected in the TaqMan® SNP OpenArray® genotyping platform (Applied Biosystems, Foster City, CA. Plasma lipoproteins and apolipoproteins were determined and PON1 activity was measured using paraoxon as a substrate. High-resolution β-mode ultrasonography was used to measure cIMT and the presence of carotid atherosclerotic plaques in a subgroup of individuals (n = 317.Results:The presence of p.192Q was associated with a significant increase in PON1 activity (RR = 12.30 (11.38; RQ = 46.96 (22.35; QQ = 85.35 (24.83 μmol/min; p Conclusion:In low-risk individuals, the presence of the p.192Q variant of PON1 is associated with a beneficial plasma lipid profile but not with carotid atherosclerosis.
Lima, Amanda B; Köhler, Cristiano A; Stubbs, Brendon; Quevedo, João; Hyphantis, Thomas N; Koyanagi, Ai; Marazziti, Donatella; Soares, Jair C; Vieta, Eduard; Carvalho, André F
Jealousy is a heterogenous emotion on a spectrum from normality to psychopathology. The relationship between different jealousy subtypes/dimensions and affective temperaments remain unknown. In addition, few large surveys have investigated the associations between jealousy subtypes and psychopathological dimensions. A Brazilian Portuguese version of the "Questionario della Gelosia" (QUEGE) was developed. We obtained data from an anonymous web-based research platform. Socio-demographic data was obtained and participants answered the QUEGE, the TEMPS-Rio de Janeiro, and the Symptom Checklist-90-Revised (SCL-90-R). 2042 participants (29% men, 71% female, mean age+SD: 28.9±8.8 years), took part in this survey. Confirmatory factor analysis provided a five-factor model for the QUEGE with self-esteem, paranoia, interpersonal sensitivity, fear of being abandoned, and obsessive dimensions. The anxious, irritable, cyclothymic, and depressive temperaments were independently associated with jealousy dimensions, whereas the hyperthymic temperament was associated with lower scores on the self-esteem jealousy dimension (N=2042, PJealousy subtypes were dissimilarly associated with SCL-90R psychopathological dimensions, whereas the 'obsessive' jealousy dimension was not significantly associated with SCL-90R dimension scores. We found no independent influence of gender across any jealousy dimension. A convenience web-based sample was employed. Cross-sectional design precludes the establishment of causal inferences. Our data indicate that a five-factor solution may provide the best-fit model for the QUEGE. Different jealousy subtypes were independently associated with affective temperaments and psychopathological dimensions. These associations reported herein should be confirmed in prospective studies. Copyright © 2017 Elsevier B.V. All rights reserved.
Zago, V H S; Scherrer, D Z; Parra, E S; Panzoldo, N B; Alexandre, F; Nakandakare, E R; Quintão, E C R; de Faria, E C
ATP binding cassette transporter G1 (ABCG1) promotes lipidation of nascent high-density lipoprotein (HDL) particles, acting as an intracellular transporter. SNP rs1893590 (c.-204A > C) of ABCG1 gene has been previously studied and reported as functional over plasma HDL-C and lipoprotein lipase activity. This study aimed to investigate the relationships of SNP rs1893590 with plasma lipids and lipoproteins in a large Brazilian population. Were selected 654 asymptomatic and normolipidemic volunteers from both genders. Clinical and anthropometrical data were taken and blood samples were drawn after 12 h fasting. Plasma lipids and lipoproteins, as well as HDL particle size and volume were determined. Genomic DNA was isolated for SNP rs1893590 detection by TaqMan(®) OpenArray(®) Real-Time PCR Plataform (Applied Biosystems). Mann-Whitney U, Chi square and two-way ANOVA were the used statistical tests. No significant differences were found in the comparison analyses between the allele groups for all studied parameters. Conversely, significant interactions were observed between SNP and age over plasma HDL-C, were volunteers under 60 years with AA genotype had increased HDL-C (p = 0.048). Similar results were observed in the group with body mass index (BMI) m(2), where volunteers with AA genotype had higher HDL-C levels (p = 0.0034), plus an increased HDL particle size (p = 0.01). These findings indicate that SNP rs1893590 of ABCG1 has a significant impact over HDL-C under asymptomatic clinical conditions in an age and BMI dependent way.
Pedro Gabriel Melo de Barros e Silva
Full Text Available ABSTRACT OBJECTIVE: To report the initial changes after quality-improvement programs based on STS-database in a Brazilian hospital. METHODS: Since 2011 a Brazilian hospital has joined STS-Database and in 2012 multifaceted actions based on STS reports were implemented aiming reductions in the time of mechanical ventilation and in the intensive care stay and also improvements in evidence-based perioperative therapies among patients who underwent coronary artery bypass graft surgeries. RESULTS: All the 947 patients submitted to coronary artery bypass graft surgeries from July 2011 to June 2014 were analyzed and there was an improvement in all the three target endpoints after the implementation of the quality-improvement program but the reduction in time on mechanical ventilation was not statistically significant after adjusting for prognostic characteristics. CONCLUSION: The initial experience with STS registry in a Brazilian hospital was associated with improvement in most of targeted quality-indicators.
Luiz Herman Soares Gil
Full Text Available Longitudinal entomological surveys were performed in Vila Candelária and adjacent rural locality of Bate Estaca concomitantly with a clinical epidemiologic malaria survey. Vila Candelária is a riverside periurban neighborhood of Porto Velho, capital of the state of Rondônia in the Brazilian Amazon. High anopheline densities were found accompanying the peak of rainfall, as reported in rural areas of the region. Moreover, several minor peaks of anophelines were recorded between the end of the dry season and the beginning of the next rainy season. These secondary peaks were related to permanent anopheline breeding sites resulting from human activities. Malaria transmission is, therefore, observed all over the year. In Vila Candelária, the risk of malaria infection both indoors and outdoors was calculated as being 2 and 10/infecting bites per year per inhabitant respectively. Urban malaria in riverside areas was associated with two factors: (1 high prevalence of asymptomatic carriers in a stable human population and (2 high anopheline densities related to human environmental changes. This association is probably found in other Amazonian urban and suburban communities. The implementation of control measures should include environmental sanitation and better characterization of the role of asymptomatic carriers in malaria transmission.
Full Text Available Marcio Machado,1 Thomas R Einarson21GlaxoSmithKline Brasil Ltd, Rio de Janeiro, Brazil; 2Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, CanadaObjective: To evaluate, from the perspective of the Brazilian public health care system, the cost-effectiveness of lapatinib plus capecitabine (LAP/CAP versus capecitabine alone (CAP or trastuzumab plus capecitabine (TRAST/CAP in the treatment of women with human epidermal growth factor receptor-2-positive metastatic breast cancer previously treated with trastuzumab.Methods: An economic model was developed to compare costs and clinical outcomes over a 5-year time horizon. Both costs and outcomes were discounted at a 5% rate, in accordance with Brazilian pharmacoeconomic guidelines. Clinical inputs were determined using indirect treatment comparisons. Costs were derived from public reimbursement databases and reported in 2010 Brazilian real (R$1 = USD$0.52. Clinical outcomes included progression-free survival years (PFYs, life-years (LYs and quality-adjusted life-years (QALYs. The economic outcome was the incremental cost per LY, PFY, or QALY gained. The impact of variations in individual inputs (eg, drug cost, drug effectiveness was examined using one-way sensitivity analyses. Overall model robustness was tested using probabilistic sensitivity analyses, varying the ranges of all input parameters within their standard distributions.Results: Expected cost per patient was R$41,195 for CAP, R$95,256 for LAP/CAP, and R$113,686 for TRAST/CAP. Respective LYs were 1.406, 1.695, and 1.465; PFYs were 0.473, 0.711, and 0.612; and QALYS were 0.769, 0.958, and 0.827. LAP/CAP dominated TRAST/CAP for all outcomes. Incremental cost-effectiveness ratios of LAP/CAP over CAP were R$186,563 for LYs, R$226,403 for PFYs, and R$284,864 for QALYs. Results remained unchanged in one-way sensitivity analyses. In probabilistic analyses, LAP/CAP was dominant over TRAST/CAP in 93.5% of simulations.Conclusion: LAP
Camila Fernanda da Silveira Alves
Full Text Available Abstract Approximately one-third of the individuals infected with human immunodeficiency virus type 1 (HIV-1 are co-infected with hepatitis C virus (HCV. Co-infected patients have an increased risk for developing end-stage liver diseases. Variants upstream of the IFNL3 gene have been associated with spontaneous and treatment-induced clearance of HCV infection. Recently, a novel polymorphism was discovered, denoted IFNL4 ΔG > TT (rs368234815, which seems to be a better predictor of spontaneous clearance than the IFNL4 rs12979860 polymorphism. We aimed to determine the prevalence of the IFNL4 ΔG > TT variants and to evaluate the association with spontaneous clearance of HCV infection in Brazilian HIV-1 patients. The IFNL4 ΔG > TT genotypes were analyzed by polymerase chain reaction followed by restriction digestion in 138 HIV-1 positive patients who had an anti-HCV positive result. Spontaneous clearance of HCV was observed in 34 individuals (24.6%. IFNL4 genotype distribution was significantly different between individuals who had spontaneous clearance and chronic HCV patients (p=0.002. The probability of spontaneous clearance of HCV infection for patients with the IFNL4 TT/TT genotype was 3.6 times higher than for patients carrying the IFNL4 ΔG allele (OR=3.63, 95% CI:1.51-8.89, p=0.001. The IFNL4 ΔG > TT polymorphism seems to be better than IFNL4 rs12979860 to predict spontaneous clearance of the HCV in Brazilian HIV-1 positive patients.
Ana Paula Gasparini Braga
Full Text Available Propôs-se estimar a prevalência da autopercepção da mastigação e investigar os fatores relacionados à autopercepção regular e ruim. Foram entrevistados e examinados 13.431 adultos, participantes do projeto SBBrasil. Foram realizadas análises descritiva, bivariada (χ2; p This study estimated the prevalence of bad/very bad self-rated mastication and investigated associated factors among Brazilian adults. The sample included 13,431 adults examined and interviewed in the SBBrazil project. Self-rated mastication was combined in three categories: good/ very good (the reference, fair, and bad/very bad. Multinomial logistic regression was performed to measure the association between fair and bad/very bad self-rated mastication and all independent variables included in the analysis, with significance set at p < 0.05. 55.6% of participants rated their mastication as good/very good, 24.9% as fair, and 19.5% as bad/very bad. In the final multivariate analysis, factors associated with bad or fair self-rated mastication were: receiving no information on how to avoid oral problems; presenting fewer than 23 remaining teeth; requiring total or partial prosthesis; bad/very bad self-rated oral health; gingival pain and/or toothache in the previous year; and need of dental treatment. In conclusion, various factors were associated with self-rated mastication, especially subjective conditions, thus emphasizing its importance as an oral health indicator.
Patente, Thiago A; Monteiro, Maria B; Vieira, Suzana M; Rossi da Silva, Maria E; Nery, Márcia; Queiroz, Márcia; Azevedo, Mirela J; Canani, Luis H; Parisi, Maria C; Pavin, Elizabeth J; Mainardi, Débora; Javor, Juraj; Velho, Gilberto; Coimbra, Cássio N; Corrêa-Giannella, Maria Lúcia
A functional variant in the promoter region of the gene encoding tumor necrosis factor (TNF; rs1800629, -308G>A) showed to confer susceptibility to T1D. However, TNF rs1800629 was found, in several populations, to be in linkage disequilibrium with HLA susceptibility haplotypes to T1D. We evaluated the association of TNF rs1800629 with T1D in a cohort of Brazilian subjects, and assessed the impact of HLA susceptibility haplotypes in this association. 659 subjects with T1D and 539 control subjects were genotyped for TNF-308G>A variant. HLA-DRB1 and HLA-DQB1 genes were genotyped in a subset of 313 subjects with T1D and 139 control subjects. Associations with T1D were observed for the A-allele of rs1800629 (OR 1.69, 95% CI 1.33-2.15, p<0.0001, in a codominant model) and for 3 HLA haplotypes: DRB1*03:01-DQB1*02:01 (OR 5.37, 95% CI 3.23-8.59, p<0.0001), DRB1*04:01-DQB1*03:02 (OR 2.95, 95% CI 1.21-7.21, p=0.01) and DRB1*04:02-DQB1*03:02 (OR 2.14, 95% CI 1.02-4.50, p=0.04). Linkage disequilibrium was observed between TNF rs1800629 and HLA-DRB1 and HLA-DQB1 alleles. In a stepwise regression analysis HLA haplotypes, but not TNF rs1800629, remained independently associated with T1D. Our results do not support an independent effect of allelic variations of TNF in the genetic susceptibility to T1D. Copyright © 2015 Elsevier B.V. All rights reserved.
Celso Eduardo de Souza
Full Text Available INTRODUCTION : Brazilian spotted fever (BSF is a disease transmitted by ticks for which the etiological agent is Rickettsia rickettsii. The present essay evaluates the risk factors associated with the transmission of cases of BSF in the time period between 2003 and 2013 in the Piracicaba river basin, state of São Paulo. METHODS : This essay presents a retrospective study to identify the factors associated with the transmission of cases of BSF among all suspected cases identified by the System for Epidemiological Surveillance of São Paulo (CVE. After the description of temporal distribution (onset of symptoms and the environmental and demographic variations of the confirmed and discarded cases, a multiple logistic regression model was applied. RESULTS : We searched 569 probable locations of infection (PLI with 210 (37% confirmed cases of BSF and 359 (63% discarded cases. The associated variables for the confirmation of BSF in the multiple logistic model using a confidence interval (CI of 95% were age (OR = 1.025 CI: 1.015-1.035, the presence of Amblyomma sculptum in the environment (OR = 1.629 CI: 1.097-2.439, the collection of ticks from horses (OR = 1.939 CI: 0.999-3.764, the presence of capybaras (OR = 1.467 CI: 1.009-2.138, an urban environment (OR = 1.515 CI: 1.036-2.231, and the existence of a dirty pasture (OR = 1.759 CI: 1.028-3.003. CONCLUSIONS : The factors associated with the confirmation of BSF cases included an urban environment, age, presence of the A. sculptum vector, the collection of ticks from horses, the presence of a capybara population, and a dirty pasture environment.
Malta, Deborah Carvalho; do Prado, Rogério Ruscitto; Dias, Antônio José Ribeiro; Mello, Flavia Carvalho M; Silva, Marta Angelica Iossi; da Costa, Michelle Ralil; Caiaffa, Waleska Teixeira
To estimate the prevalence of bullying from the victim's perspective in Brazilian school children and to analyze its association with individual and family context variables. An analysis of the data on 109,104 adolescents, obtained by the National Adolescent School-based Health Survey, held in schools in 2012, was carried out. An association model between bullying and explanatory variables was tested in different contexts: sociodemographic, risk behaviors, mental health and family context. Univariate and multivariate analyzes were performed, calculating the Odds Ratio and confidence intervals. The prevalence of bullying found in this study was of 7.2% (95%CI 6.6 - 7.8). A higher chance of bullying was found among male students (OR = 1.58; 95%CI 1.51 - 1.66), with an inverse relation between age and bullying, with the magnitude of risk among adolescents younger than 13 years of age being higher when compared to those with 16 years of age or more. Of individual risk behaviors, only being a smoker remained in the final model (OR = 1.11; 95%CI 1.01 - 1.23). Mental health variables associated with bullying were: feeling lonely (OR = 2.66; 95%CI 2.52 - 2.81), insomnia (OR = 1.92; 95%CI 1.80 - 2.05), not having friends (OR = 1.71; 95%CI 1.54 - 1.89), and, in the family context, those who skip class without telling their parents (OR = 1.13; 95%CI 1,07 - 1,19) and those who suffer physical abuse by family members (OR = 2.03; 95%CI 1.91 - 2.146). Bullying was associated to male students, younger, of black color, smokers, with mental health vulnerabilities and victims of domestic violence. This suggests the need for a holistic approach from education and health professionals, parents and the community in seeking measures for the prevention of bullying.
Schneider, Nayê Balzan; Pastor, Tatiane; Paula, André Escremim de; Achatz, Maria Isabel; Santos, Ândrea Ribeiro Dos; Vianna, Fernanda Sales Luiz; Rosset, Clévia; Pinheiro, Manuela; Ashton-Prolla, Patricia; Moreira, Miguel Ângelo Martins; Palmero, Edenir Inêz
Lynch syndrome (LS) is the most common hereditary colorectal cancer syndrome, caused by germline mutations in one of the major genes involved in mismatch repair (MMR): MLH1, MSH2, MSH6 and more rarely, PMS2. Recently, germline deletions in EPCAM have been also associated to the syndrome. Most of the pathogenic MMR mutations found in LS families occur in MLH1 or MSH2. Gene variants include missense, nonsense, frameshift mutations, large genomic rearrangements and splice-site variants and most of the studies reporting the molecular characterization of LS families have been conducted outside South America. In this study, we analyzed 60 unrelated probands diagnosed with colorectal cancer and LS criteria. Testing for germline mutations and/or rearrangements in the most commonly affected MMR genes (MLH1, MSH2, EPCAM and MSH6) was done by Sanger sequencing and MLPA. Pathogenic or likely pathogenic variants were identified in MLH1 or MSH2 in 21 probands (35.0%). Of these, approximately one-third were gene rearrangements. In addition, nine variants of uncertain significance (VUS) were identified in 10 (16.6%) of the sixty probands analyzed. Other four novel variants were identified, only in MLH1. Our results suggest that MSH6 pathogenic variants are not common among Brazilian LS probands diagnosed with CRC and that MMR gene rearrangements account for a significant proportion of the germline variants in this population underscoring the need to include rearrangement analysis in the molecular testing of Brazilian individuals with suspected Lynch syndrome. © 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
Full Text Available Abstract The study aimed to identify urban environmental characteristics, which may be associated with the physical activity (PA level of women from Brazilian cities of Santa Catarina. The sample was composed of 2047 women aged 20 to 59 from six Santa Catarina cities: Blumenau, Chapecó, Criciúma, Florianópolis, Itajaí, and São José. The PA was evaluated through the IPAQ (short version, and the NEWS to environmental variables. An inferential and descriptive statistic was used: Chi-squared test, ANOVA with post hoc, and raw and adjusted multinomial regression analysis (p < .05. The participants from São José presented greater chances to PA practice when they reside close to appropriated areas, sidewalks, fitness centers, well-lit streets, and when invited by relatives to the practice. The PA Program for the community enables greater chances of practice for women in Florianópolis, São José, Criciúma and Blumenau. As a conclusion, some environmental factors appeared to influence PA practice positively in Catarinense women. Besides that, the fact of belonging to the high economic status could increasingly enable practice, since they seem broader access to gyms and PA private professionals.
Teche, Stefania Pigatto; Barros, Alcina Juliana Soares; Rosa, Regis Goulart; Guimarães, Luciano Pinto; Cordini, Kariny Larissa; Goi, Julia Domingues; Hauck, Simone; Freitas, Lucia Helena
This study investigated the association between resilience and posttraumatic stress disorder (PTSD) among Brazilian victims of urban violence. It also compared defense mechanisms, parental bonding, and childhood trauma between those who developed PTSD and those who did not. This cross-sectional case-control study included 66 adult subjects exposed to recent urban violence in southern Brazil - 33 with PTSD and 33 healthy controls matched by sex and age - who were administered the Resilience Scale, Defense Style Questionnaire, Parental Bonding Instrument, and Childhood Trauma Questionnaire. The statistical tests used were the McNemar test for categorical variables, the Wilcoxon signed-rank test for continuous asymmetric variables, and the paired Student t-test for continuous symmetric variables. The PTSD group showed lower total Resilience Scale scores compared with controls (128.4±20.7 vs. 145.8±13.1, respectively; p = 0.01), along with a lower ability to solve situations and lower personal values that give meaning to life (p = 0.019). They also had lower rates of mature defense mechanisms (p violence.
Oliveira, Harley Francisco de; Trevisan, Felipe Amstalden; Bighetti, Viviane Marques; Guimaraes, Flavio da Silva; Amaral, Leonardo Lira; Barbi, Gustavo Lazaro; Borges, Leandro Federiche; Peria, Fernanda Maris, E-mail: email@example.com [Universidade de Sao Paulo (FMRP/USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina
Objective: the offering of high-technology radiotherapy to the population assisted by the Brazilian unified health system (SUS) is limited since it is not included in the system’s list of procedures and, many times, because of the insufficient installed capacity and lack of specialized human resources. Thus the access to intensity-modulated radiotherapy (IMRT) is restricted to few centers in Brazil. The present study is aimed at presenting the characteristics of the first 508 cases treated with IMRT during the first years after the technique implementation in a university hospital. Materials and methods: the first consecutive 508 cases of IMRT treatment completed in the period from May/2011 to September/2013 were reviewed. Static multi leaf was the technique employed. Results: amongst 4,233 treated patients, 12.5% were submitted to IMRT. Main indications for the treatment included cancers located in the skull, head and neck and prostate. Intensity modulated radiotherapy was utilized in about 30% of cranial and 50% of prostate treatments. Treatment toxicity was observed in 4% of the patients. Conclusion: because of restricted access to radiotherapy in addition to lack of coverage for the procedure, IMRT indications for SUS patients should be based on institutional clinical protocols, with special attention to the reduction of toxicity. (author)
Cocco, Luiz Fernando; Ejnisman, Benno; Belangero, Paulo Santoro; Cohen, Moises; Dos Reis, Fernando Baldy
The treatment of humeral fractures remains controversial. Systematic reviews demonstrate similar results between dynamic compression plating and locked intramedullary nailing in the surgical treatment of these fractures. However, it appears that antegrade intramedullary nailing causes higher residual pain in the shoulder. The proposal of this work is to evaluate through the WORC protocol (Western Ontario Rotator Cuff Index) the consequences in the quality of life of patients submitted to osteosynthesis of the humerus with antegrade locked intramedullary nailing. This work is a cohort retrospective study in addition to the application of a questionnaire for self-rated quality of life with its 05 domains (WORC - Western Ontario Rotator Cuff Index) for patients ( N = 26) classified in the Trauma Sector of the Department of Orthopedics and Traumatology of the Federal University of São Paulo (DOT/UNIFESP) submitted to Humerus Osteosynthesis with Antegrade Locked Intramedullary Nailing. There was also the inclusion of data related to the time since surgery, age, sex, surgical laterality, dominance among members and work leave, which were not considered in the original protocol. After, the data were statistically assessed to evaluate the association between numerical and categorical variables. The overall WORC score was 82.75 ± 17.00 (Mean ± SD) and was not different considering sex, age and postoperative period. Among the WORC domains, both Work and Sport / Recreation Protocols were the most unfavorable factors in the evaluation of patients. Although not statistically significant, those who had the procedure on the dominant side presented a lower quality of life score than those who had the surgery on the non-dominant side. Although non-significant again, those who were away from work had an overall lower quality of life score than those who were not. The WORC Quality of Life Protocol shows good results for evaluating patients submitted to humerus
Peixoto de Miranda, Érique José F; Bittencourt, Márcio Sommer; Goulart, Alessandra C; Santos, Itamar S; de Oliveira Titan, Silvia Maria; Ladeira, Roberto Marini; Barreto, Sandhi Maria; Lotufo, Paulo A; Benseñor, Isabela Judith Martins
Few studies have evaluated a possible relationship between thyrotropin levels and glomerular filtration rate (GFR) and albumin/creatinine ratio in euthyroid subjects. We aimed to analyze this association using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Cross-sectionally, we included subjects with normal thyroid function and with subclinical hypothyroidism (SCH). We excluded individuals using medications that affect thyroid function. Linear and logistic regression models evaluated GFR estimated by Chronic Kidney Disease Epidemiology Collaboration (CKD-Epi) and albuminuria/creatinine ratio as dependent variables and thyrotropin quartiles in individuals with euthyroidism and SCH as independent variables, adjusted for demographical characteristics and diseases related to CKD. We included 13,193 subjects with a median age of 51 years [interquartile range, (IQR): 45-58], 6840 (51.8%) women, 12,416 (94.1%) euthyroid, and 777 (5.9%) with SCH. SCH subjects were characterized by higher age, triglycerides, frequency of white race, cardiovascular disease, CKD, and former smokers. In adjusted models, log-transformed TSH in euthyroid subjects was inversely and strongly associated with CKD (β = -2.181, 95% CI -2.714 to -1.648), P < 0.0001 for glomerular filtration rate and 4.528 (1.190-7.865) for albuminuria/creatinine ratio. Multivariate logistic models for euthyroid subjects showed an OR of 1.45 (95% CI 1.15-1.83) for GFR and of 1.95 (95% CI 1.08-3.54) for albuminuria/creatinine ratio in the fourth quartile of TSH using the first as the reference. Thyrotropin levels are independently associated with CKD in euthyroid subjects.
Dias, Marcos Augusto Bastos; Domingues, Rosa Maria Soares Madeira; Schilithz, Arthur Orlando Corrêa; Nakamura-Pereira, Marcos; do Carmo Leal, Maria
The rate of cesarean delivery (CD) in Brazil has increased over the past 40 years. The CD rate in public services is three times above the World Health Organization recommended values. Among strategies to reduce CD, the most important is reduction of primary cesarean. This study aimed to describe factors associated with CD during labor in primiparous women with a single cephalic pregnancy assisted in the Brazilian Public Health System (SUS). This study is part of the Birth in Brazil survey, a national hospital-based study of 23,894 postpartum women and their newborns. The rate of CD in primiparous women was estimated. Univariate and multivariable logistic regression was performed to analyze factors associated with CD during labor in primiparous women with a single cephalic pregnancy, including estimation of crude and adjusted odds ratios and their respective 95 % confidence intervals. The analyzed data are related to the 2814 eligible primiparous women who had vaginal birth or CD during labor in SUS hospitals. In adjusted analyses, residing in the Southeast region was associated with lower CD during labor. Occurrence of clinical and obstetric conditions potentially related to obstetric emergencies before delivery, early admission with women cared for by at least one nurse midwife. The CD rate in primiparous women in SUS in Brazil is extremely high and can compromise the health of these women and their newborns. Information and support for vaginal birth during antenatal care, avoiding early admission, and promoting the use of good practices during labor assistance can reduce unnecessary CD. Considering the experience of other countries, incorporation of nurse midwives in childbirth care may increase the use of good practices during labor.
Background. Delivery of integrated care for patients with HIV-associated TB is challenging. We assessed the uptake and timing of antiretroviral treatment (ART) among eligible patients attending a primary care service with co-located ART and TB clinics. Methods. In a retrospective cohort study, all HIV-associated TB patients ...
Roger Haruki Yamakawa
Full Text Available The profile of patients undergoing haemodialysis in the dialysis unit of Hospital Santa Casa de Maringá, Maringá PR Brazil, is provided. A questionnaire on social and economic data and underlying diseases prior to the Chronic Kidney Disease (CKD identified the patients’ profile. The project was approved by the Ethics Committee of the institution. Eighty-three patients, with 54.21% males, were interviewed. Age bracket ranged between 20 and 59 years in 65.06% of patients. Only 27.71% maintained jobs after the diagnosis and the start of treatment; 63.86% had an average personal income between 1 and 3 minimum wages; 63.85% did not practice any physical activity. Moreover, 53.01% belonged to the European-Brazilian white group; 20.48% to the Afro-Brazilian brown group; 19.28% to the Afro-Brazilian Negro group; 6.02% to other ethnic groups. Further, 85.54% patients reported having an underlying disease prior to the CKD, namely, 61.45% were hypertensive; 31.33% were diabetics and 20.48% had other diseases. Results show the need of a greater attention to these patients’ health care to reduce the negative impacts related to the chronic disease focused.Este estudo teve como objetivo identificar o perfil dos pacientes em tratamento hemodialítico do setor de diálise do Hospital Santa Casa de Maringá - Paraná, Brasil. Para a identificação do perfil destes pacientes foi utilizado um questionário contendo questões que abrangem dados socioeconômicos e doenças de base anteriores à Insuficiência Renal Crônica (IRC. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da instituição. Entre os 83 pacientes entrevistados, 54,21% eram do sexo masculino. A faixa etária variou de 20 a 59 anos para 65,06% dos pacientes. Somente 27,71% continuaram trabalhando após o diagnóstico e início do tratamento. A renda pessoal média ficou entre um e três salários mínimos para 63,86% dos indivíduos. A atividade física está ausente em 63
M. R. Lopes
Full Text Available Vitamin D deficiency is frequent among patients with heart failure (HF and diabetes, disorders associated with exercise intolerance and muscle weakness. This study aims to search for associations between vitamin D sufficiency and physical function indexes in patients with HF and diabetes. A cross-sectional study of 146 HF patients, 39.7% with diabetes, at a Brazilian tertiary outpatient clinic was performed. Patients underwent clinical evaluation, 6-minute walk test (6 MWT, handgrip strength, physical activity level (IPAQ, and biochemical evaluations including serum 25-hydroxyvitamin D. Classification was done according to vitamin D status (≥30 ng/dL, sufficient and presence/absence of diabetes in vitamin sufficient, no diabetes (DS-C, n=25, vitamin sufficient, diabetes (DS-DM, n=18, vitamin deficient, no diabetes (DD-C, n= 63, and vitamin deficient, diabetes (DD-DM, n=40. Patients age was 55.4 ± 8 yrs; 70.5% had vitamin D deficiency. Clinical characteristics were similar among groups. Total time expended in physical activity was similar among groups (P=0.26. DS-C covered higher distances in the 6 MWT (392 ± 60 m versus DD-DM (309 ± 116 m; P=0.024. Handgrip strength was similar among groups but tended to lower levels in DD-DM (P=0.074 even after being adjusted to physical activity (P=0.069. Vitamin D deficiency can influence physical function in HF diabetic patients.
Mônica Barcellos Arruda
Full Text Available Adverse reactions are the main cause of treatment discontinuation among HIV+ individuals. Genes related to drug absorption, distribution, metabolism and excretion (ADME influence drug bioavailability and treatment response. We have investigated the association between single nucleotide polymorphisms (SNPs in 29 ADME genes and intolerance to therapy in a case-control study including 764 individuals. Results showed that 15 SNPs were associated with intolerance to nucleoside and 11 to non-nucleoside reverse transcriptase inhibitors (NRTIs and NNRTIs, and 8 to protease inhibitors (PIs containing regimens under alpha = 0.05. After Bonferroni adjustment, two associations remained statistically significant. SNP rs2712816, at SLCO2B1 was associated to intolerance to NRTIs (ORGA/AA = 2.37; p = 0.0001, while rs4148396, at ABCC2, conferred risk of intolerance to PIs containing regimens (ORCT/TT = 2.64; p = 0.00009. Accordingly, haplotypes carrying rs2712816A and rs4148396T alleles were also associated to risk of intolerance to NRTIs and PIs, respectively. Our data reinforce the role of drug transporters in response to HIV therapy and may contribute to a future development of personalized therapies.
Locatelli, Nathália Tarossi; Canella, Daniela Silva; Bandoni, Daniel Henrique
The aim was to study the association between socio-demographic and routine dietary variables and consumption of school meals by adolescents enrolled in public schools in Brazil. The study used data used from the National School Health Survey (PeNSE) 2012. To assess differences between schoolchildren based on whether or not they ate school meals, the study used Pearson's chi-square test, and associations were analyzed with univariate and multivariate Poisson regression models. Of the 86,660 students included in the study, 22.8% eat school meals. Higher consumption of school meals is associated with male gender, brown skin color, residence outside state capitals, working, and low maternal schooling, for those that ate breakfast and lunch with their parents. The findings are relevant for planning strategies to encourage consumption of school meals.
Forty-seven percent of the cervical cancer patients were referred to Ocean Road Cancer Institute for radiotherapy and or chemotherapy. Patients discharged home for palliative care were 30% and 17% patients died at the hospital. Known HIV positive patients were significantly associated with death and terminal care seen ...
Lamarca Gabriela A
Full Text Available Abstract Background Social conditions, social relationships and neighbourhood environment, the components of social capital, are important determinants of health. The objective of this study was to investigate the association of neighbourhood and individual social capital with consistent self-rated health in women between the first trimester of pregnancy and six months postpartum. Methods A multilevel cohort study in 34 neighbourhoods was performed on 685 Brazilian women recruited at antenatal units in two cities in the State of Rio de Janeiro, Brazil. Self-rated health (SRH was assessed in the 1st trimester of pregnancy (baseline and six months after childbirth (follow-up. The participants were divided into two groups: 1. Good SRH – good SRH at baseline and follow-up, and, 2. Poor SRH – poor SRH at baseline and follow-up. Exploratory variables collected at baseline included neighbourhood social capital (neighbourhood-level variable, individual social capital (social support and social networks, demographic and socioeconomic characteristics, health-related behaviours and self-reported diseases. A hierarchical binomial multilevel analysis was performed to test the association between neighbourhood and individual social capital and SRH, adjusted for covariates. Results The Good SRH group reported higher scores of social support and social networks than the Poor SRH group. Although low neighbourhood social capital was associated with poor SRH in crude analysis, the association was not significant when individual socio-demographic variables were included in the model. In the final model, women reporting poor SRH both at baseline and follow-up had lower levels of social support (positive social interaction [OR 0.82 (95% CI: 0.73-0.90] and a lower likelihood of friendship social networks [OR 0.61 (95% CI: 0.37-0.99] than the Good SRH group. The characteristics that remained associated with poor SRH were low level of schooling, Black and Brown
Khan, M.A.; Khan, M.I.; Andleeb, U.
Objectives: To stratify patients into various stages, calculate average patient delay and study various causes of delay to presentation. Methodology: This was a one year hospital based cross sectional study at Khyber Teaching Hospital, using non probability consecutive sampling. A simplified staging was used for this study; Early (Stage I), Intermediate (Stage II, III), and Late (Stage IV). A patient was labelled delay when >3 months had elapsed between first symptom perception and first doctor consultation. Results: 80 patients were included with age 21-80 years (mean 45.28+-13.15). 80% of the patients were married, 76.3% (n=61/80) were poor with annual income of <500 US $, 85% of patients were illiterate. The participants from Rural and Urban areas were similar (37 % vs 31%); 15% were from Afghanistan. 80% patients presented with a delay of >3 months. Most common cause of delay was false symptom interpretation in 25.3% (n=17) patients. Conclusion: Late clinical presentation is because of lack of health education, unawareness, misconceptions about treatment and strong belief in traditional medicine resulting in advanced disease. This is worsened by poverty and unavailability of health care services especially in rural areas. (author)
Paulo R.G. Zen
psychiatric disorders. However, not all manifestations are present at diagnosis, indicating the necessity of long-term follow-up of these patients. This long-term follow-up should be extended to the patients' closest relatives, having in mind the increased risk of occurrence of psychiatric disorders and diabetes mellitus among the heterozygous carriers of Wolfram Syndrome. Description: male, white patients, only child of non-consanguineous parents, was healthy until four years of age, when he presented with polydipsia and polyuria, being diagnosed with diabetes mellitus type I. Since then, he has needed regular insulin use, but has followed an inadequate diet due to socioeconomic problems. He was evaluated by the genetic service when he was 11 years old. Brachydactyly was observed on physical examination. In the course of the complementary investigation, bilateral atrophy of the optic nerve was observed; the visual evoked potential and the electroretinogram were compatible with extensive optic nerve injury. Both retinas were normal. The presence of insulin-dependent diabetes mellitus together with atrophy of the optic nerve is a sufficient criterion for the diagnosis of Wolfram Syndrome. The molecular investigation confirmed the diagnosis of Wolfram Syndrome. Comments: the aim of the present report is to alert physicians about the association between diabetes mellitus and monogenic syndromes, such as Wolfram Syndrome.
Márcia B. Silva
Full Text Available In the present article, we provide shortly, data on risk factors for acquiring Toxocara spp. infection and investigate possible associations between this infection with atopy and asthma in school children of a small town and its semi-rural areas of Northeast Brazil. The data set are composed by demographic, social and home environment variables. The detection of anti-Toxocara spp. IgG and specific IgE to aeroallergens was determined by ELISA and ImmunocAP/Phadiatrope systems, respectively. The data presented in this article are related to the article entitled “Risk factors for Toxocara spp. seroprevalence and its association with atopy and asthma phenotypes in school-age children in a small town and semi-rural areas of Northeast Brazil” (M.B. Silva, A.L. Amor, L.N. Santos, A.A. Galvão, A.V. Oviedo Vera, E.S. Silva et al., 2016 .
Nascente, Fl?via Miquetichuc Nogueira; Jardim, Thiago Veiga; Peixoto, Maria do Ros?rio Gondim; Carneiro, Carolina de Souza; Mendon?a, Karla Lorena; P?voa, Tha?s In?cio Rolim; Sousa, Ana Luiza Lima; Barroso, Weimar Kunz Sebba; Jardim, Paulo C?sar Brand?o Veiga
Abstract Background Adolescence is a transition stage between childhood and adulthood and is an important phase for the acquisition of future lifestyles, including the practice of physical activity (PA). The prevalence of sedentary lifestyle in adolescents is often high, creating the need for studies addressing the practice of PA and its associated factors for a better understanding of the phenomenon and possible interventions that would encourage positive changes. Methods Cross-sectional stu...
Silveira, Erika Aparecida; Martins, Bruna Bittar; de Abreu, Laísa Ribeiro Silva; Cardoso, Camila Kellen de Souza
The scope of the study was to evaluate the prevalence of daily consumption of fruit, vegetables and greens by the elderly and its association with sociodemographic, lifestyle, morbidity and hospitalization variables. The study was part of the multiple-stage sampling cross-sectional research entitled the Goiânia Elderly Project (Projeto Idosos Goiânia). 416 elderly people were interviewed in their homes. Multivariate analysis was conducted using Poisson regression to analyze statistical associations. P values of fruit, vegetables and greens was 16.6%: fruit accounted for 44%, vegetables 39.7% and greens 32.5%. Factors statistically associated with daily consumption of fruits and vegetables were female sex, age between 70 and 79, higher education level, social class A/B and C, alcohol consumption, use of sweeteners, regular physical activity during leisure time, abdominal obesity and hospitalization. Public policies to promote health should develop strategies that encourage adequate intake of fruit, vegetables and greens among the elderly, since regular consumption of same can improve quality of life and prevent/control diseases.
Valéria Maria de Azeredo Passos
Full Text Available CONTEXT AND OBJECTIVE: Diabetes is an increasing cause of death in developing countries. Our objective was to describe the prevalence and clinical factors associated with diabetes and impaired fasting glycemia among adults (18-59 years and elderly adults (60+ years. DESIGN AND SETTING: Population based, cross-sectional study in Bambuí, Brazil. METHODS: 816 adult and 1,494 elderly participants were interviewed; weight, height and blood pressure measured; and blood samples collected. Diabetes was defined as plasma fasting glucose > 126 mg/dl and/or use of hypoglycemic agents; impaired fasting glycemia as glycemia of 110-125 mg/dl. Associations were investigated using multinomial logistical regression (reference: fasting glycemia 240 mg/dl; for elderly adults, with family history of diabetes, body-mass index of 25-29 kg/m², body-mass index > 30 kg/m², increased waist-to-hip ratio, low HDL-cholesterol triglyceridemia of 200-499 mg/dl and triglyceridemia > 500 mg/dl. Among adults, impaired fasting glycemia remained associated negatively with male sex and positively with ages of 40-59 years, physical inactivity and increased waist-to-hip ratio; among the elderly, with alcohol consumption, overweight, obesity and triglycerides > 200 mg/dl. CONCLUSIONS: The results reinforce the importance of interventions to reduce physical inactivity, alcohol consumption, obesity and dyslipidemia, so as to prevent increasing incidence of diabetes.
Swart, Marte; Liemburg, Edith Jantine; Kortekaas, Rudie; Wiersma, Durk; Bruggeman, Richard; Aleman, Andre
Emotional deficits are among the core features of schizophrenia and both associative emotional learning and the related ability to verbalize emotions can be reduced. We investigated whether schizophrenia patients demonstrated impaired function of limbic and prefrontal areas during associative
Peixoto de Miranda, É J F; Bittencourt, M S; Pereira, A C; Goulart, A C; Santos, I S; Lotufo, P A; Bensenor, I M
Although subclinical hypothyroidism (SCH) is associated with cardiovascular risk, there is scarce data about subclinical atherosclerosis in subjects with SCH. We aimed to analyze the association between SCH and carotid intima-media thickness (IMT) using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We included subjects with normal thyroid function (TSH: 0.4-4.0 mIU/l, and normal free thyroxine (FT4): 0.8-1.9 ng/dl) and SCH (TSH ≥ 4.0 mIU/l and normal FT4) evaluated for IMT in a cross-sectional analysis. We excluded individuals using medications that affect thyroid function and those with a history of cardiovascular disease. We performed logistic and linear regression models to evaluate the association with IMT (mean values and categorized at the 75th percentile) as a dependent variable and SCH as an independent variable, adjusted for other cardiovascular risk factors. From 8623 subjects (median age of 50 years; interquartile range: 44-57), 4624 (53.6%) were women, 8095 (93.9%) were euthyroid, and 528 (6.1%) had SCH. Groups varied in age, body mass index, Framingham risk score, Homeostasis Model Assessment for Insulin Resistance (HOMA-IR), C-reactive protein, as well as, IMT, that were all higher in SCH compared to euthyroid participants. SCH is associated with IMT as a continuous variable (β = 0.010, P = 0.036) and IMT >75th percentile: OR = 1.30 (95% CI = 1.06-1.59) in logistic models. Individuals with SCH presented higher IMT compared with euthyroid subjects, even after adjustment for potential confounders. IMT was independently associated with SCH in the baseline of the ELSA-Brasil study. Copyright © 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
Scherrer, Daniel Zanetti; Zago, Vanessa Helena de Souza; Vieira, Isabela Calanca; Parra, Eliane Soler; Panzoldo, Natália Baratella; Alexandre, Fernanda; Secolin, Rodrigo; Baracat, Jamal; Quintão, Eder Carlos Rocha; de Faria, Eliana Cotta
Background Evidences suggest that paraoxonase 1 (PON1) confers important antioxidant and anti-inflammatory properties when associated with high-density lipoprotein (HDL). Objective To investigate the relationships between p.Q192R SNP of PON1, biochemical parameters and carotid atherosclerosis in an asymptomatic, normolipidemic Brazilian population sample. Methods We studied 584 volunteers (females n = 326, males n = 258; 19-75 years of age). Total genomic DNA was extracted and SNP was detected in the TaqMan® SNP OpenArray® genotyping platform (Applied Biosystems, Foster City, CA). Plasma lipoproteins and apolipoproteins were determined and PON1 activity was measured using paraoxon as a substrate. High-resolution β-mode ultrasonography was used to measure cIMT and the presence of carotid atherosclerotic plaques in a subgroup of individuals (n = 317). Results The presence of p.192Q was associated with a significant increase in PON1 activity (RR = 12.30 (11.38); RQ = 46.96 (22.35); QQ = 85.35 (24.83) μmol/min; p < 0.0001), HDL-C (RR= 45 (37); RQ = 62 (39); QQ = 69 (29) mg/dL; p < 0.001) and apo A-I (RR = 140.76 ± 36.39; RQ = 147.62 ± 36.92; QQ = 147.49 ± 36.65 mg/dL; p = 0.019). Stepwise regression analysis revealed that heterozygous and p.192Q carriers influenced by 58% PON1 activity towards paraoxon. The univariate linear regression analysis demonstrated that p.Q192R SNP was not associated with mean cIMT; as a result, in the multiple regression analysis, no variables were selected with 5% significance. In logistic regression analysis, the studied parameters were not associated with the presence of carotid plaques. Conclusion In low-risk individuals, the presence of the p.192Q variant of PON1 is associated with a beneficial plasma lipid profile but not with carotid atherosclerosis. PMID:26039660
Flossmann, Oliver; Berden, Annelies; de Groot, Kirsten
Wegener's granulomatosis and microscopic polyangiitis are antineutrophil cytoplasm antibodies (ANCA)-associated vasculitides with significant morbidity and mortality. The long-term survival of patients with ANCA associated vasculitis treated with current regimens is uncertain.......Wegener's granulomatosis and microscopic polyangiitis are antineutrophil cytoplasm antibodies (ANCA)-associated vasculitides with significant morbidity and mortality. The long-term survival of patients with ANCA associated vasculitis treated with current regimens is uncertain....
Paiva, Carlos Eduardo; Carneseca, Estela Cristina; Barroso, Eliane Marçon; de Camargos, Mayara Goulart; Alfano, Ana Camila Callado; Rugno, Fernanda Capella; Paiva, Bianca Sakamoto Ribeiro
The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) is considered a valid instrument for use in Brazil. However, the previous Brazilian validation study included only 30 lung cancer patients and only measured test-retest reliability. The aim of this study was to evaluate the psychometric properties of the EORTC QLQ-C30 in a sample of cancer patients at different educational levels who completed the instrument administered by an interviewer. Data from six prospective studies conducted by the same group of researchers were combined in this study (N = 986). Reliability was assessed using Cronbach's alpha coefficient, all values of which were >0.7, with the exception of cognitive functioning, social functioning, and nausea and vomiting (α = 0.57, α = 0.69, and α = 0.68, respectively). In multi-trait scaling analysis, convergent and divergent validity were considered adequate (validity indices were 91.6 and 97.4%). In general, moderate to strong correlations were found between the subscales of the EORTC QLQ-C30 and its respective dimensions from the WHOQOL-bref, the hospital anxiety and depression scale, and the Edmonton Symptom Assessment System (ESAS) instruments. In addition, the EORTC QLQ-C30 was able to differentiate groups of patients with distinct performance statuses and types of treatment (known-group validation). Statistical analyses were also performed on educational status, yielding similar results. Detailed psychometric property data using the EORTC QLQ-C30 in Brazil are added by this study. In addition, we demonstrated that this instrument is in general reliable and valid regardless of the patient educational level.
Research on Candida dubliniensis in a Brazilian yeast collection obtained from cardiac transplant, tuberculosis, and HIV-positive patients, and evaluation of phenotypic tests using agar screening methods.
Ribeiro, Patrícia Monteiro; Querido, Silvia Maria Rodrigues; Back-Brito, Graziela Nueremberg; Mota, Adolfo José; Koga-Ito, Cristiane Yumi; Jorge, Antonio Olavo Cardoso
The aim of this study was to research Candida dubliniensis among isolates present in a Brazilian yeast collection and to evaluate the main phenotypic methods for discrimination between C. albicans and C. dubliniensis from oral cavity. A total of 200 isolates, presumptively identified as C. albicans or C. dubliniensis obtained from heart transplant patients under immunosuppressive therapy, tuberculosis patients under antibiotic therapy, HIV-positive patients under antiretroviral therapy, and healthy subjects, were analyzed using the following phenotypic tests: formation and structural arrangement of chlamydospores on corn meal agar, casein agar, tobacco agar, and sunflower seed agar; growth at 45 °C; and germ tube formation. All strains were analyzed by polymerase chain reaction (PCR). In a preliminary screen for C. dubliniensis, 48 of the 200 isolates on corn meal agar, 30 of the 200 on casein agar, 16 of the 200 on tobacco agar, and 15 of the 200 on sunflower seed agar produced chlamydoconidia; 27 of the 200 isolates showed no or poor growth at 45 °C. All isolates were positive for germ tube formation. These isolates were considered suggestive of C. dubliniensis. All of them were subjected to PCR analysis using C. dubliniensis-specific primers. C. dubliniensis isolates were not found. C. dubliniensis isolates were not recovered in this study done with immunocompromised patients. Sunflower seed agar was the medium with the smallest number of isolates of C. albicans suggestive of C. dubliniensis. None of the phenotypic methods was 100% effective for discrimination between C. albicans and C. dubliniensis. Copyright © 2011 Elsevier Inc. All rights reserved.
Statistics of Brazilian mineral resources and production in 1977 are presented. Data included refer also to economic aspects, market, taxes, government incentives, manpower, exportation, importation, etc [pt
Silveira, Jonas Augusto C; Colugnati, Fernando Antônio B; Cocetti, Monize; Taddei, José Augusto A C
to describe the secular trends in overweight among preschool children in the years 1989, 1996, and 2006, and to identify risk factors associated with this condition in 2006. anthropometric data from three surveys (1989, 1996, and 2006) with a representative sample of the population were analyzed. Overweight was defined as the weight-for-height Z-score. The multivariable models of overweight association with risk factors were generated by Poisson regression, and the estimates were shown as prevalence ratios with their respective 95% confidence intervals (PR [95% CI]). throughout the 17-year period studied, the relative prevalence of overweight in preschoolers increased by 160% in Brazil, representing an increase of 9.4% per year. Based on data from the National Survey on Demography and Health of Women and Children - 2006/07, four multivariable models were created (macro-environmental, maternal, individual, and final model) assuming hierarchy among the risk factors. In the final model, only the following remained associated with overweight: regions South/Southeast (1.55 [1.17 to 2.06]), middle-class (1.35 [1.02 to 1.77]), maternal obesity (1.66 [1.22 to 2.27]), birth weight ≥ 3.9kg (1.87 [1.31 to 2.67]), and being an only child or having only one sibling (1.81 [1.31 to 2.49]). the prevalence of overweight among preschool children in Brazil has increased dramatically over the past 17 years, and it was higher in the 1996-2006 period. Future strategies for prevention and