Afonso Dinis Costa Passos

Evolução da ocorrência (1980-1999) da doença de Crohn e da retocolite ulcerativa idiopática e análise das suas características clínicas em um hospital universitário do sudeste do Brasil

Background - Crohns disease and ulcerative colitis are regarded as uncommon in developing countries, but studies on their occurrence in Brazil are scarce. Aims - To determine the occurrence of Crohns disease and ulcerative colitis in a Brazilian university hospital throughout a 20-year period, and analyze the demographical, clinical and evolutive features of these cases. Methods - The frequencies of new cases of Crohns disease and ulcerative colitis admitted from January 1980 up to December 1999 were calculated and a descriptive analysis of the features of all cases seen from January 1990 up to December 1999 was performed. Results - A total of 257 new cases (126 with Crohns disease and 131 with ulcerative colitis) was recorded. The frequencies of admissions for both Crohns disease and ulcerative colitis have increased progressively from 40 up to 61 cases/10.000 new admissions and Crohns disease gradually became more common than ulcerative colitis. For both diseases, there was predominance of women, age at admission in the range of 30-40 years, Caucasian origin, married state and non-smokers. Digestive symptoms presented were similar to those already described for both diseases and there were no differences between Crohns disease and ulcerative colitis regarding the frequencies of general complaints and extra-intestinal manifestations (29.5% vs 23.3%), including thromboembolism (5.9% vs 5.4%). Obstruction and/or perforation were seen in up to 59.2% of Crohns disease cases, whereas 53.7% of all ulcerative colitis cases presented as severe forms. In Crohns disease cases with obstruction, smoking was significantly more common than in non-complicated cases. In ulcerative colitis cases of increased severity, general complaints, extra-intestinal manifestations and pancolitis were significantly more frequent than in less severe forms. Conclusions - For the last 20 years, there have been an increased frequency of admission of inflammatory bowel diseases, and Crohns disease have become more prevalent than ulcerative colitis. Demographical, clinical and evolutive features of these diseases seems to be similar to those already described, but there seems to be a predominance of more severe forms of both diseases.

Effectiveness of Oral Rinse with Chlorhexidine in Preventing Nosocomial Respiratory Tract Infections among Intensive Care Unit Patients

OBJECTIVE To evaluate the effectiveness of the oral application of a 0.12% solution of chlorhexidine for prevention of respiratory tract infections among intensive care unit (ICU) patients. DESIGN The study design was a double-blind, randomized, placebo-controlled trial. SETTING The study was performed in an ICU in a tertiary care hospital at a public university. PATIENTS. Study participants comprised 194 patients admitted to the ICU with a prospective length of stay greater than 48 hours, randomized into 2 groups: those who received chlorhexidine (n = 98) and those who received a placebo (n = 96). INTERVENTION Oral rinses with chlorhexidine or a placebo were performed 3 times a day throughout the duration of the patients stay in the ICU. Clinical data were collected prospectively. RESULTS Both groups displayed similar baseline clinical features. The overall incidence of respiratory tract infections (RR, 1.0 [95% confidence interval [CI], 0.63-1.60]) and the rates of ventilator-associated pneumonia per 1,000 ventilator-days were similar in both experimental and control groups (22.6 vs 22.3; P = .95). Respiratory tract infection-free survival time (7.8 vs 6.9 days; P = .61), duration of mechanical ventilation (11.1 vs 11.0 days; P = .61), and length of stay (9.7 vs 10.4 days; P = .67) did not differ between the chlorhexidine and placebo groups. However, patients in the chlorhexidine group exhibited a larger interval between ICU admission and onset of the first respiratory tract infection (11.3 vs 7.6 days; P = .05). The chances of surviving the ICU stay were similar (RR, 1.08 [95% CI, 0.72-1.63]). CONCLUSION Oral application of a 0.12% solution of chlorhexidine does not prevent respiratory tract infections among ICU patients, although it may retard their onset.

Co-infecção HIV e vírus da hepatite B: prevalência e fatores de risco

The objective of this study was to assess the prevalence of hepatitis B virus and possible risk factors for this disease in 401 patients infected with the human immunodeficiency virus, followed at the University Hospital of the Ribeirao Preto Medical School, Sao Paulo State University. Each participant was submitted to a specific questionnaire and had a blood sample tested for the serologic markers HBsAg, total anti-HBcAg, anti-HBsAg and anti-HCV, using ELISA technique. The overall prevalence of hepatitis B markers was 40.9%, with 8.5% for HBsAg, 39.7% for total anti-HBcAg and 5.5% for anti-HBsAg. The variables that showed association with HBV were: age, higher education level, history of jaundice, time spent in prison, having a homosexual partner and positive markers for anti-HCV. Co-infection HBV/HCV was present in 20.4% of the participants.

Marcadores sorológicos das hepatites B e C em doadores de sangue do Hemocentro de Ribeirão Preto, SP

The investigation involved 25,891 blood donors who attended for the first time the Blood Center of Ribeirao Preto, Brazil, between Jun 23, 1996 and Jun 22, 2001. The objective was to study the proportion of positive serological markers for hepatitis B and C at the initial screening tests and to estimate the prevalence of such infections through the analysis of confirmatory tests, carried out at the University Hospital as a part of the patients evaluation. Data from the donors and laboratory results were obtained from the records of both the Blood Bank and the Hospital. The population of donors was mainly composed by males (83.6%) and by individuals between 26 and 45 (64%) years of age. The proportions of positive results in screening tests were 0.6% (CI95%: 0.54-0.72) for HBsAg and 1.2% (CI95%: 1.02-1.28) for anti-HCV. Confirmatory testes showed values of prevalence of 0.2% (CI95%: 0.16-0.28) for hepatitis B and 0.3% (IC95%: 0.24-0.38) for hepatitis C.

Fatores de risco para doenças sexualmente transmissíveis entre prostitutas e travestis de Ribeirão Preto (SP), Brasil

OBJETIVO: Caracterizar a populacao de profissionais do sexo em atividade em Ribeirao Preto, Brasil, segundo variaveis demograficas e socioeconomicas, e estudar os fatores de risco para doencas sexualmente transmissiveis nessa populacao. METODOS: Foram visitados todos os locais de pratica de prostituicao identificados na cidade. Os participantes responderam um questionario que levantava informacoes socio-demograficas e fatores de risco para doencas sexualmente transmissiveis. Foi responsavel pelas entrevistas uma assistente social que ha mais de 5 anos desenvolvia atividades educativas junto aos profissionais do sexo de Ribeirao Preto. RESULTADOS: As 449 prostitutas, 53 travestis e 13 miches estudados representam uma populacao jovem, de baixa escolaridade, reduzido nivel socioeconomico e grande mobilidade espacial. Em relacao as prostitutas, os travestis apresentaram risco significativamente mais elevado para doencas sexualmente transmissiveis, o qual se traduz por diferencas em termos do tempo de trabalho, numero medio de parceiros por dia, antecedente de doencas sexualmente transmissiveis ulcerativas, pratica de sexo anal, uso de drogas ilicitas nao-injetaveis, especialmente o crack, e antecedente de prisao. A exposicao a bebidas alcoolicas foi o unico fator de risco mais frequente entre as prostitutas. O uso de preservativo com parceiros fixos foi menos comum do que nas relacoes sexuais comerciais, tanto em prostitutas como em travestis. CONCLUSOES: Os profissionais do sexo de Ribeirao Preto, especialmente os travestis, representam uma populacao socialmente marginalizada e de alto risco para doencas sexualmente transmissiveis. E necessario que os servicos de saude publica dediquem mais atencao aos profissionais do sexo, tanto em termos de programas preventivos como de realizacao de novas investigacoes que permitam um melhor conhecimento acerca dos fatores de risco especificos desse grupo para as doencas sexualmente transmissiveis.

Frequency of serum anti-cysticercus antibodies in the population of a rural Brazilian community (Cássia dos Coqueiros, SP) determined by ELISA and immunoblotting using Taenia crassiceps antigens

Considering the impact of cysticercosis on public health, especially the neurologic form of the disease, neurocysticercosis (NC), we studied the frequency of positivity of anti-Taenia solium cysticercus antibodies in serum samples from 1,863 inhabitants of Cássia dos Coqueiros, SP, a municipal district located 80 km from Ribeirão Preto, an area considered endemic for cysticercosis. The 1,863 samples were tested by enzyme linked immunosorbent assay (ELISA) using an antigenic extract from Taenia crassiceps vesicular fluid (Tcra). The reactive and inconclusive ELISA samples were tested by immunoblotting. Of the 459 samples submitted to immunoblotting, 40 were strongly immunoreactive to the immunodominant 18 and 14 kD peptides. Considering the use of immunoblotting as confirmatory due to its high specificity, the anti-cysticercus serum prevalence in this population was 2.1%.

Prevalence of restless legs syndrome in the rural town of Cassia dos Coqueiros in Brazil

OBJECTIVE To estimate the prevalence and evaluate the characteristics and severity of restless legs syndrome (RLS) in an urban Brazilian community. METHODS A transversal study was conducted over an 18-month period. A neurologist conducted 1155 interviews using the diagnostic criteria of the International Restless Legs Syndrome Study Group (IRLSSG). RESULTS The lifetime prevalence of RLS was found to be 6.40%. Prevalence during the last year, the last month, and the last week were found to be 5.71%, 5.36%, and 4.15%, respectively. A greater proportion of women met diagnostic criteria for RLS compared to men (OR: 2.63, CI 95%: 1.54-4.51). Furthermore, participants with low monthly family income (<

HIV prevalence and risk factors in a Brazilian penitentiary

1575 USD) had a lower prevalence of disease compared to those with a high monthly family income (>

Hepatite C: prevalência e fatores de risco entre portadores do VIH/SIDA em Belém, Pará, na Amazônia brasileira

1575 USD) (OR: 2.91, CI 95%: 1.41-5.98). CONCLUSIONS This is the first epidemiologic study of RLS conducted in a Brazilian population. The overall prevalence of disease and the greater proportion of RLS in women found in this study are similar to the findings of other studies conducted in western countries. The association of RLS with high family income is unpublished and should be confirmed in subsequent studies.

Serological markers of hepatitis B in people submitted to blood testing in health care clinics

HIV infection among prison inmates shows one of the highest prevalence rates for specific population subgroups, reaching as high as 17% in Brazil and elsewhere in the world. The present study aimed to estimate HIV antibody prevalence and risk factors for infection in male inmates at the Ribeirão Preto Penitentiary, São Paulo State, Brazil, from May to August 2003. Using simple random sampling, 333 participants were selected, answered a standardized questionnaire, and had blood samples collected. Enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence were used for HIV serological diagnosis. Overall HIV prevalence among inmates was 5.7% (95%CI: 3.2-8.2). All variables associated with HIV antibodies in the univariate analysis were submitted to unconditional multivariate logistic regression. Independent predictors of HIV infection were: total prison sentence less than five years and sharing needles and syringes.