Dirceu Bartolomeu Greco

Dinâmica da institucionalização de idosos em Belo Horizonte, Brasil

OBJETIVO: O processo de envelhecimento populacional brasileiro tem sido acompanhado por transformacoes epidemiologicas e sociais que, em outros paises, aumentaram a demanda por instituicoes de longa permanencia. Nesse sentido, desenvolveu-se estudo sobre dinâmica da institucionalizacao de idosos atraves da analise da oferta de leitos e caracteristicas demograficas dos residentes em asilos. METODOS: Foi realizado levantamento dos asilos de idosos do Municipio de Belo Horizonte, MG. Foram registradas datas de nascimento e admissao de 1.128 residentes de 33 dos 40 asilos em funcionamento no municipio. A lotacao foi calculada atraves da capacidade informada e da taxa de institucionalizacao, segundo dados da Pesquisa Nacional por Amostra de Domicilios (PNAD). RESULTADOS: As taxas de institucionalizacao de idosos (65+) do municipio foram 0,9% (mulheres) e 0,3% (homens). A lotacao mediana dos asilos era de 92%. Dentre os 1.128 residentes arrolados (92,5% do total), as mulheres (81%) apresentavam maiores medias de idade (76,4 x 70,4 anos; p=0,00) e estada (5,6 x 4,5 anos; p=0,01). DISCUSSAO/CONCLUSOES: Elevada lotacao, listas de espera nos asilos filantropicos (85% do total) e rigidos criterios para admissao (metade recusava idosos demenciados ou dependentes) sugerem que a baixa taxa de institucionalizacao se deve a escassez de vagas. A predominância de idosas reflete a prevalencia de viuvas ou separadas na comunidade (66% contra 76% de homens casados). A proporcao de homens adultos (31% < 65 anos) sugere dificuldade de se auto-sustentarem apos a viuvez. Elevada taxa de mortalidade (24% durante 20 meses de acompanhamento de amostra aleatoria de 263 residentes), incompativel com o rigor dos criterios de admissao, determina a baixa mediana de estada (3 anos). Os dados refletem o anacronismo de um sistema nao direcionado a manutencao dos idosos em seus proprios domicilios.

Antibodies to Rickettsia rickettsii, Rickettsia typhi, Coxiella burnetii, Bartonella henselae, Bartonella quintana, and Ehrlichia chaffeensis among healthy population in Minas Gerais, Brazil

Rickettsial diseases except those belonging to spotted fever group rickettsioses are poorly studied in South America particularly in Brazil where few epidemiological reports have been published. We describe a serosurvey for Rickettsia rickettsii, R. typhi, Coxiella burnetii, Bartonella henselae, B. quintana, and Ehrlichia chaffeensis in 437 healthy people from a Brazilian rural community. The serum samples were tested by indirected micro-immunoflourescence technique and a cutoff titer of 1:64 was used. The seroprevalence rates for R. rickettsii, R. typhi, C. burnetii, B. henselae, B. quintana, and E. chaffeensis were respectively 1.6% (7 samples); 1.1% (5 samples); 3.9% (17 samples); 13.7% (60 samples); 12.8% (56 samples), and 10.5% (46 samples). Frequent multiple/cross-reactivity was observed in this study. Age over 40 years old, urban profession, and rural residence were significantly associated with some but not all infections rate. Low seropositivity rates for R. rickettsii, R. typhi, and C. burnetii contrasted with higher rates of seropositivity for B. quintana, B. henselae, and E. chaffeensis. These results show that all tested rickettsial species or antigenically closely related possible exist in this particular region.

Avaliação da aderência aos anti-retrovirais em pacientes com infecção pelo HIV/Aids

OBJECTIVES: To assess the compliance to antiretroviral drugs, and identify the main predictive factors and causes for treatment failure and poor compliance. METHODS: Twenty HIV/AIDS were randomly selected for the study. The assessment was carried out using self-reporting and complemented with diary and pharmacy checks. Univariate analysis was performed using Student test and Qui-square. Odds ratio was calculated as an inclusion measure. RESULTS: One hundred and twenty patients were assessed, of which 87 (72.5%) were males and 33 (27.5%) were females, with a mean age of 35.5 years old. . Most of them were light dark skin, had completed only elementary school, and were employed, with an income of up to two minimum wages. The mean time of the antiretroviral use was 12 months. The main reason to initiate treatment was a decrease in CD4 lymphocyte counts to less than 350 cells/mm3. Most were taking three or more antiretrovirals. Eighty-nine patients (74%) were considered compliant. The main cause of treatment failure was the medication side effects. The educational level, age and time of antiretroviral use were the most important predictors of compliance to antiretrovirals. CONCLUSIONS: To improve treatment compliance there is a need to have treatment regimens with less side effects and treatment all the aspects should be constantly reviewed.

Sexual Practices and Attitudes of Street Youth in Belo Horizonte, Brazil

Street youth are at risk of HIV infection worldwide. To develop effective prevention strategies, information about the meanings and functions of sexual activity for street youth is needed. In this paper, data from structured questionnaires, focus group discussions, in-depth interviews and field observations are used to build up a picture of the sexual culture of 9-to-18-year-olds living and/or working on the streets of a large Brazilian city. The findings reveal that these children and adolescents engage in sexual behavior that puts them at risk of sexually transmitted diseases, including HIV/AIDS, and reinforce that sex is a multi-determined and entrenched behavior in this population. Interventions must take into account the fact that for street youth, sex is used as a means of ensuring survival, seeking comfort, finding pleasure, and dealing with psychological issues that arise during adolescence.

Neurological disease in HIV-infected patients in the era of highly active antiretroviral treatment: a Brazilian experience

To study characteristics of neurological disorders in HIV/AIDS patients and their relationship to highly active antiretroviral treatment, a cross-sectional study was conducted in an infectious disease public hospital in Belo Horizonte, Brazil, between February 1999 and March 2000. Of the 417 patients enrolled, neurological disease was observed in 194 (46.5%) and a new AIDS-defining neurological event developed in 23.7% of individuals. Toxoplasmosis (42.3%), cryptococcosis meningitis (12.9%) and tuberculosis (10.8%) were the most common causes of neurological complications. The majority (79.3%) of patients were on highly active antiretroviral treatment and these individuals using HAART showed higher CD4 cell counts (p = 0.014) and presented stable neurological disease (p = 0.0001), although no difference was found with respect to the profile of neurological complications. The neurological diseases continue to be a frequent complication of HIV/AIDS and infections are still its main causes in Brazil, even in the highly active antiretroviral treatment era.

HIV risk behavior and medical status of underprivileged youths in Belo Horizonte, Brazil☆☆☆

METHODS From June 1989 to April 1991, 394 adolescents aged 10-18 years randomly selected upon admission at a state shelter in Belo Horizonte, Brazil underwent health history interview, physical examination, serology for HIV, hepatitis B, and syphilis, and stool examination. Participants were classified as street-based youths (n = 195) or home-based youths (n = 199). The age distribution was similar in both groups, although males were overrepresented among street-based youths (79.5% versus 62.3%). RESULTS Compared with home-based youths, street-based youths reported earlier onset (p = 0.009) and higher rates of sexual activity (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.4-3.3), sexual abuse (OR, 3.7; 95% CI, 1.2-10.1), and sexually transmitted diseases (OR, 2.9; 95% CI, 1.3-6.6). Overall condom use was low in both groups. Street-based youths were 7.8 times more likely to use drugs than home-based youths (95% CI, 4.9-12.7). Inhalants and marijuana were the more commonly used drugs. Intravenous drug use was low. CONCLUSIONS Although chronic malnutrition and multiple parasitosis were common findings in both groups, street-based youths were more likely to present disorders related to trauma and poor hygienic conditions. Antibodies to HIV were detected in four (2%) street-based youths and in none of the home-based youths. This study confirms that street youths are at higher risk for HIV infection than their home-based peers and indicates a need for HIV prevention programs targeting this population.

High-sensitivity C-reactive protein levels in HIV-infected patients treated or not with antiretroviral drugs and their correlation with factors related to cardiovascular risk and HIV infection

AIMS To compare high-sensitivity C-reactive protein (hsCRP) in HIV-infected patients treated or not with antiretroviral (ARV) drugs and to correlate hsCRP levels with traditional cardiovascular risk factors and parameters of HIV infection. METHODS One hundred and seventy-one HIV-infected patients were included (129 ARV-treated and 42 ARV-naïve). Evaluations included anthropometric measurements, blood pressure, laboratory tests, ultrasonographic measurement of fat thickness and impedance analysis. RESULTS hsCRP levels were higher in ARV-treated compared to ARV-naïve patients (p<0.001). Seventy-two (56%) ARV-treated patients and 11 (26%) ARV-naïve patients had hsCRP concentrations >3 mg/dl (high risk for cardiovascular complications) (OR 3.56; 95%CI: 1.55-8.29; p=0.001, chi(2) test). hsCRP levels correlated positively with waist measurement (p=0.004), waist-to-hip ratio (p<0.001), systolic (p=0.05) and diastolic (p=0.03) blood pressure, intra-abdominal fat thickness (p=0.02), triglycerides (p=0.001), total cholesterol (p=0.01), fasting glucose (p=0.01), and glucose (p<0.001) and insulin levels (p=0.02) measured 2 h after load. No correlation was found between hsCRP levels and CD4 cell counts and HIV-viral load. Independent factors associated with hsCRP levels were therapy with current non-nucleoside reverse transcriptase inhibitors (NNRTI) (p=0.003), waist-to-hip ratio (p=0.006), fasting glucose (p=0.049) and glucose levels 2 h after load (p=0.003) in multivariate analysis model 1 and current NNRTI therapy (p<0.001), protease inhibitor therapy (p=0.016) and cardiometabolic syndrome (p=0.022) in multivariate analysis model 2. CONCLUSION hsCRP in HIV-infected patients is associated with traditional cardiovascular risk factors, principally in ARV-treated patients. hsCRP levels are not associated with CD4 cell counts and HIV-viral load and may constitute a marker for cardiovascular risk related to HIV infection and ARV therapy.

More about human monocytotropic ehrlichiosis in Brazil: serological evidence of nine new cases

Human Ehrlichia chaffeensis infections have been reported in North America, Asia and Europe, but only recently have human cases been reported in Brazil. Nine new human cases of E. chaffeensis infection diagnosed on a clinical and serological basis are reported. Serological tests were performed with indoor slides prepared with CDC stock DH-82 cells infected with E. chaffeensis (Arkansas strain). All but two patients were adults. Seven patients were male and two female. The fever duration varied from 4 to 120 days with a median of 6 days. All patients recalled previous tick attack. IgM was detected in four cases. Influenza like syndrome was the most frequent clinical form affecting five patients. Two patients had fever of unknown origin (FUO), one patient had blood culture-negative endocarditis and one had encephalitis. All patients except one recovered. Two patients were correctly treated. One patient with FUO had AIDS and unexplained pancytopenia. The occurrence of human ehrlichiosis by E. chaffeensis remains to be proved in Brazil; the cases reported here highlight the possibility of such disease occurrence in Brazil.

Distribuição da gordura corporal e perfis lipídico e glicêmico de pacientes infectados pelo HIV

The aims of this study were to describe anthropometric data and glycemic and lipidic profiles of HIV-infected patients treated or not with antiretrovirals (ARV) drugs, and to assess association between these drugs and body composition changes, lipid and glucose homeostasis disturbances. There were 176 patients included (133 ARV-treated patients and 43 ARV-naïve). The patients were submitted to clinical evaluation, laboratorial analysis, ultrasonographic measurements, bioelectrical impedance analysis and skin folds thickness measurements. The ARV-treated group showed higher waist-to-hip ratio (p= 0.0002), higher intra-abdominal fat thickness measured by ultrasonography (p= 0.003) and lower bicipital (p= 0.01) and tricipital (p= 0.0002) skin folds. This group also showed higher triglyceride (p= 0.0002), total cholesterol (p= 0.00007), HDL cholesterol (p= 0.009), glucose measurements one hour (p= 0.01) and two hours (p= 0.001) after dextrose load, higher levels of fasting insulin (p= 0.03) and higher HOMAR index (p= 0.02). The antiretroviral drugs are associated with increased visceral fat and decreased peripheral fat pads. Beside that, these drugs are associated with atherogenic lipid profile and insulin resistance, two independent risk predictors of cardiovascular disease.

Pulmonary involvement in Schistosomiasis mansoni

The post-treatment pulmonary alterations were evaluated in patients (Study 1) and in mice (Study 2) infected with Schistosoma mansoni. Study 1: the patients were examined pre and post-treatment (with ora oxamniquine) and the following exams were performed: sputum for eosinophils and chest x-ray. Study 2: four groups of mice (total = 64) were studied; Group I (infected and treated with oxamniquine); II (infected and not treated); III (not infected and treated) and IV (not infected and not treated). All were x-rayed to check for pulmonary abnormalities pre and post-treatment and lung specimens were studied by optical microscopy and immunofluorescence. We have found abnormalities in the parameters checked in both studies and the results suggest an immunological reaction, probably due to deposition of immune complexes in the lungs, with subsequent activation of the complement system. The experimental study showed that the alterations are not dependent of the presence of eggs and/or worms of S. mansoni in the lungs, thus corroborating the hypothesis of deposition of circulating material.