Dilermando Fazito de Rezende

O Projeto Queixadinha: a morbidade e o controle da esquistossomose em área endêmica no nordeste de Minas Gerais, Brasil

In an endemic area for schistosomiasis in the northeast of the slate of Minas Gerais in Brazil 516 individuals have been submitted to clinical and laboratory examination, ultrasonography of the abdomen and dopplerecocardiography in order to define the morbidity of schistosomiasis before and after treatment. A high prevalence of schistosomiasis (66.3%) and of severe disease (9.5% with palpable spleens) were recorded. Ultrasonography classified liver periportal fibrosis as light (19.4%), moderate (27.6%) and intense (6.8%), and 46.0% presented no periportal fibrosis. Twenty one out of the 53 individuals (39.6%) with palpable spleens did not present liver fibrosis on ultrasound. Periportal lymph nodes were described in 33.8% of the population and anti-KLH antibodies were found in the serum of 40.7%. Urinary alterations compatible with the glomerulopathy of schistosomiasis were observed in 4.5% of the population, and 11.7% of the individuals examined by dopplerecocardiography had pulmonary hypertension. Twelve months after treatment for schistosomiasis the prevalence of the disease dropped from 66.3% to 25.0%. In Queixadinha, a profile of the morbidity of schistosomiasis has just been established.

Prevalence of systemic hypertension in students aged 7 to 14 years in the municipality of Barbacena, in the State of Minas Gerais, in 1999

OBJECTIVE To detect the prevalence of systemic hypertension in children and to establish the relation between blood pressure levels and sex, age, ethnicity, weight, and height. METHODS The prevalence of systemic hypertension and its relation to sex, age, ethnicity, weight, and height were studied in 611 students aged 7 to 14 years out of 19.928 students classified according to age, ethnicity, and sex, who underwent anthropometric evaluation and blood pressure measurement. Hypertensive individuals were considered those whose blood pressure level was > the 95th percentile for age and sex, confirmed on 3 examinations. RESULTS The prevalence of hypertension was 16.6% in the first evaluation, and 4.6% and 2.5% in the subsequent evaluations. The mean blood pressure levels increased with age. Weight was important, not only to determine blood pressure in healthy children, but also to determine systemic hypertension in children, which was not observed with height despite the different studies. The prevalence of systemic hypertension in the different ethnic groups and the mean blood pressure levels according to sex were similar. CONCLUSION In addition to routine physical examinations, age, weight, and appropriate cuff size should be considered when assessing blood pressure in children to prevent hypertension, morbidity and mortality, and to avoid placing a financial burden on health care providers.

Pathogenetic factors of acute schistosomiasis mansoni: correlation of worm burden, IgE, blood eosinophilia and intensity of clinical manifestations

A clinical study of 34 previously healthy young patients simultaneously infected in an endemic area of schistosomiasis mansoni is presented, emphasizing the initial phase of the infection. Its intensity was established according to the occurrence, intensity, and duration of the signs and symptoms in order to investigate the possible correlations between the worm burden (estimated by the number of eggs in faeces), the blood eosinophilia and specific levels of IgE (estimated by the area of immediate intradermal reaction), with the clinical manifestations. A significant but low‐level association was found between the worm burden and morbidity, suggesting that multiple factors, besides worm burden itself, may contribute to the pathogenesis of the disease.

Pulmonary manifestations in the initial phase of schistosomiasis mansoni

The clinical and radiological pulmonary manifestations in the initial phase of schistosomiasis mansoni were studied in thirty previously healthy individuals who were simultaneously infected. The findings were compared with those concerning a control group and related to possible pathogenetic factors. The respiratory manifestations were of light or of moderate intensity, the dry cough being the most common symptom. The significant radiological alterations were: thickening of bronchial walls and beaded micronodulation, predominantly localized in the lower pulmonary fields. It was observed significant association between wheezing and IgE levels, estimated by the area of immediate intradermal reaction, as well as between the number of blood eosinophils and the occurrence of radiological changes. Moreover, there was correlation between the worm burden and the presence of wheezing, thoracic pain and beaded micronodulation. Thus, the clinical and radiological pulmonary manifestations described are significant part of the initial phase of schistosomiasis mansoni and present the worm burden, eosinophilia and levels of IgE as probable pathogenetic factors.

Determinantes ambientais e sociais da esquistossomose mansoni em Ravena, Minas Gerais, Brasil

This study identified the role of biological and social determinants in the transmission of schistosomiasis mansoni in Ravena, Minas Gerais, Brazil, in 1980. This data was used to characterize the clinical and epidemiological profiles of the endemic desease in the population, allowing for the determination of the efficacy of the potable water supply and the specific treatment of those infected with S. mansoni. The district contains three locations, Ravenopolis, Ravena and Lavapes, where the prevalence of the endemic disease was, 20.1%, 42.6% and 63.9%, respectively. The prevalence in the district was statistically higher in men. The age brackets that displayed differences by gender were 10-14 and 15-19 years. Severity of infection was statistically different among individuals within the 10-14 year bracket in ali three locations, and in the 15-19 year bracket among individuals from Ravenopolis and Ravena. The hepatointestinal form was associated with age, and individuals under 15 years of age presented risk of infection 8.85 times higher than adults. Multivariable analysis of the factors involved in transmission of the disease showed that Lavapes was independently associated with infection. In that area, poor sanitary conditions and the proximity of houses to streams infested with S. marsoni cercariae facilitated infection of neighborhood women while performing domestic activities, as well as men digging sand from the streams for construction. These results show the focal nature of transmission of the endemic requiring specific intervention for effective control of disease.

Trends in non-AIDS-related causes of death among adults with HIV/AIDS, Brazil, 1999 to 2010.

The aim of this study was to analyze trends in the listing of non-AIDS-related causes of death on the death certificates of adults with HIV/AIDS in Brazil. The study analyzed mortality data for persons 15 to 69 years of age from 1999 to 2010. Standardized mortality odds ratios were used to compare mortality from non-AIDS-related causes in the group with HIV/AIDS listed on the death certificate and in the group without HIV/ AIDS. From 1999 to 2010, there were 6,120,670 deaths among adults in Brazil. Deaths in the HIV group represented 2.2% of the total. Non- AIDS-related causes, and more specifically cardiovascular diseases, diseases of the genitourinary system, and non-AIDS-related malignant neoplasms increased at higher rates in the group with HIV/AIDS listed on the death certificate. The results point to a greater increase in mortality from non-AIDS-related diseases among persons with HIV/AIDS. This finding suggests that long contact with HIV and antiretroviral therapy play an important role in the occurrence of these diseases.

Subaortic stenosis associated with perimembranous ventricular septal defect: clinical follow-up of 36 patients

OBJECTIVE To study the clinical pattern of subaortic stenosis associated with perimembranous ventricular septal defect. METHODS From January 1979 to June 2000, 36 children with perimembranous ventricular septal defect and fixed subaortic stenosis were followed-up regarding anatomic characteristics, evolvement, and clinical events. RESULTS Age at diagnosis of subaortic stenosis ranged from 6 months to 170 months, and it was less than 1 year in only 2 children. Regarding sex, the distribution was 2:1 with a greater predominance of males. Ventricular septal defect was small in 61.0% of cases, medium in 30.56%, and large in 8.40%; the size of the septal defect decreased during follow-up in 30.56% (11 cases). In all patients, subaortic stenosis was membranous and fixed. During follow-up, 23 patients experienced evolvement of the stenosis. Surgical treatment was performed in 21 cases, and one patient underwent surgery for restenosis. Infectious endocarditis occurred in 2 patients; one of the patients died. CONCLUSION Subaortic stenosis occurs in the natural history of ventricular septal defect usually after the first year of life, and it is progressive and requires surgery in most cases.

Tendência de causas não associadas ao HIV/AIDS como causas de óbito entre adultos que viviam com HIV/AIDS no Brasil, 1999 a 2010

The aim of this study was to analyze trends in the listing of non-AIDS-related causes of death on the death certificates of adults with HIV/AIDS in Brazil. The study analyzed mortality data for persons 15 to 69 years of age from 1999 to 2010. Standardized mortality odds ratios were used to compare mortality from non-AIDS-related causes in the group with HIV/AIDS listed on the death certificate and in the group without HIV/ AIDS. From 1999 to 2010, there were 6,120,670 deaths among adults in Brazil. Deaths in the HIV group represented 2.2% of the total. Non- AIDS-related causes, and more specifically cardiovascular diseases, diseases of the genitourinary system, and non-AIDS-related malignant neoplasms increased at higher rates in the group with HIV/AIDS listed on the death certificate. The results point to a greater increase in mortality from non-AIDS-related diseases among persons with HIV/AIDS. This finding suggests that long contact with HIV and antiretroviral therapy play an important role in the occurrence of these diseases.

Tendencia de las causas no asociadas al VIH/SIDA, como causa de muerte entre adultos que vivían con el VIH/SIDA en Brasil, de 1999 a 2010

The aim of this study was to analyze trends in the listing of non-AIDS-related causes of death on the death certificates of adults with HIV/AIDS in Brazil. The study analyzed mortality data for persons 15 to 69 years of age from 1999 to 2010. Standardized mortality odds ratios were used to compare mortality from non-AIDS-related causes in the group with HIV/AIDS listed on the death certificate and in the group without HIV/ AIDS. From 1999 to 2010, there were 6,120,670 deaths among adults in Brazil. Deaths in the HIV group represented 2.2% of the total. Non- AIDS-related causes, and more specifically cardiovascular diseases, diseases of the genitourinary system, and non-AIDS-related malignant neoplasms increased at higher rates in the group with HIV/AIDS listed on the death certificate. The results point to a greater increase in mortality from non-AIDS-related diseases among persons with HIV/AIDS. This finding suggests that long contact with HIV and antiretroviral therapy play an important role in the occurrence of these diseases.