Eugênio Marcos Andrade Goulart

Influence of Saccharomyces boulardii on the intestinal permeability of patients with Crohn's disease in remission.

Objective. Crohns disease (CD) is characterized by a reduction in mucosal integrity that permits antigen penetration into the intestinal tissue. The administration of probiotics has been suggested to improve the barrier function of the mucosa. The objective of this study was to evaluate the influence of Saccharomyces boulardii on the intestinal permeability in CD. Material and methods. Thirty-four patients were randomized according to the Vienna classification for treatment with either placebo or Saccharomyces boulardii. Baseline medications (mesalamine, azathioprine, prednisone, metronidazole and/or thalidomide) were maintained. Intestinal permeability (lactulose/mannitol ratio) was evaluated immediately before the beginning of treatment and at the end of the first and third treatment month. Fifteen healthy volunteers were also submitted for the intestinal permeability test. Results. In volunteers, the lactulose/mannitol ratio was 0.005±0.0037, whereas this value was 0.021±0.01 in patients with CD (p=0.001). In the placebo group, there was an increase in lactulose/mannitol ratio by 0.004±0.010 (p=0.12) at the end of the third month. In the S. boulardii group, there was an improvement in intestinal permeability, with a decrease in the lactulose/mannitol ratio by 0.008±0.006 (p=0.0005) in the same period. Conclusions. Patients with CD in remission present alterations in the integrity of the intestinal mucosal barrier according to lactulose/mannitol ratio. S. boulardii added to baseline therapy improved intestinal permeability in these patients, even though complete normalization was not achieved.Objective. Crohns disease (CD) is characterized by a reduction in mucosal integrity that permits antigen penetration into the intestinal tissue. The administration of probiotics has been suggested to improve the barrier function of the mucosa. The objective of this study was to evaluate the influence of Saccharomyces boulardii on the intestinal permeability in CD. Material and methods. Thirty-four patients were randomized according to the Vienna classification for treatment with either placebo or Saccharomyces boulardii. Baseline medications (mesalamine, azathioprine, prednisone, metronidazole and/or thalidomide) were maintained. Intestinal permeability (lactulose/mannitol ratio) was evaluated immediately before the beginning of treatment and at the end of the first and third treatment month. Fifteen healthy volunteers were also submitted for the intestinal permeability test. Results. In volunteers, the lactulose/mannitol ratio was 0.005±0.0037, whereas this value was 0.021±0.01 in patients with CD (p=0....

Association between socioeconomic factors and infant deaths due to diarrhea, pneumonia, and malnutrition in a metropolitan area of Southeast Brazil: a case-control study

A population-based case-control study was carried out to identify determinant factors for post-neonatal infant deaths due to diarrhea, pneumonia, and malnutrition in Greater Metropolitan Belo Horizonte, Southeast Brazil. From May 1, 1991, to April 30, 1992, 511 post-neonatal deaths due to diarrhea, pneumonia, and malnutrition were selected after investigation of medical records to validate cause of death. Of this total, 396 deaths were compared to a neighborhood control group, matched for age. The study was carried out in a low-income area with a high proportion of families living in shantytowns. The article discusses the methodology and selected socioeconomic factors. Logistic regression analysis indicated that number of household appliances, mothers and fathers education, and mothers marital and work status were significantly associated with risk of infant death, i.e., they were determinants of infant deaths due to avoidable causes.

Breastfeeding in Montes Claros, Minas Gerais: a representative sample study

OBJECTIVE: To evaluate the situation of breast-feeding in Montes Claros, among under-two-year-old children, and to determine variables associated to major risk for early weaning. METHODS: In this cross-sectional study interviews were carried out by trained personnel with 602 mothers selected randomly in the urban area of Montes Claros, from September to November, 1996. The survival analysis was the method used to calculate the prevalence and the median duration of breast-feeding. The chi-square test was conducted to compare the proportions, and the level of significance was set at 5%. The prevalence ratio (PR) was used to measure the strength of the associations, with a 95% confidence interval. The logistic regression analysis was used to identify the risk factors for early weaning. RESULTS: The median duration of breast-feeding in general was 8.7 months; however the median duration of exclusive breastfeeding was only 27 days. The risk factors for early weaning were low birth weight (OR=2.65; CI95%=1.10-6.40), mothers with difficulties to breast-feed in the first days (OR=1.86; CI95%=1.21-2.85) and lack of posnatal medical incentive to breast-feed (OR=1.75; CI95%=1.15-2.66). CONCLUSIONS: For breast-feeding in general there is a better situation than that showed by other national reports, but it is still below recommended by WHO. There is a critical exclusive breastfeeding pattern. The factors related with early weaning denote a weak support of the maternal-infant health services to breast-feeding.

Impact of highly active antiretroviral therapy (HAART) on the incidence of opportunistic infections, hospitalizations and mortality among children and adolescents living with HIV/AIDS in Belo Horizonte, Minas Gerais State, Brazil

The impact of highly active antiretroviral therapy (HAART) can be evaluated using indicators, such as rates of opportunistic infections, hospitalizations by cause of infection, and associated death. This study aimed to estimate the impact of HAART on the incidence of these indicators, in children and adolescents with HIV/AIDS. It was a hybrid cohort study; 371 patients were followed from 1989 to 2003. In December 2003, 76% of the patients were still being followed, while 12.1% had died, 9.5% had dropped out, and 2.4% had been transferred. The overall rate of opportunistic infections was 18.32 infections/100 persons-year and 2.63 in the pre- and post-HAART periods, respectively. In the multivariate analysis, the risk of developing an opportunistic infection was 5.4 times greater and 3.3 times greater for hospitalization risk before HAART. Respiratory causes represented 65% of the hospitalizations and they were reduced by 44.6% with therapeutic intervention. The average hospital stay of 15 days was reduced to 9. There was a post-HAART decline in deaths of 38%. This study demonstrates the effectiveness of HAART in significantly reducing opportunistic infections, hospitalizations, and deaths in this Brazilian cohort.

Pressure pain threshold in children with recurrent abdominal pain.

Background Experimental studies on humans have shown that recurrent pain is associated with altered pain perception. We measured the pressure pain threshold in regions of the body surface in a group of children who had recurrent abdominal pain and in a group of children with chronic or recurrent disease but with no pain. Methods Each group consisted of 45 boys and 55 girls ranging in age from 5 to 15.8 years. The regions of the body were the trapezius, deltoid, and supraspinous muscles, nine areas on the abdominal wall, and the median part of the tibias. Using an algometer, pressure was applied through a rubber disc with a surface area of 1 cm2 at a rate of 0.5 kg/cm2/s. The pressure values recorded with the algometer when the children communicated that they started to feel pain were considered as pressure pain thresholds. Results The pain thresholds were reduced in all regions investigated in children with recurrent pain. The median thresholds for all regions of the patients with and without pain were 1.60 and 2.2 kg/cm2, respectively. The diseases of children with pain did not influence the pain thresholds. Conclusion There was an association between recurrent abdominal pain and a lower pressure pain threshold, with no influence of the type of disease, and there was a central nervous system alteration in the perception of pain in these patients.

Confiabilidade da declaração de causa básica de mortes infantis em região metropolitana do sudeste do Brasil

The objective was to investigate the agreement between basic causes of death registered in the death certificates and those obtained by detailed review of hospital records of children to ascertain the reliability of death certificates in the definition of major causes of infant mortality in Brazil. Belo Horizonte (capital city of Minas Gerais) and 13 towns comprised the metropolitan area. A total of 195 infant deaths that occurred in 1989 were analyzed by studying hospital forms. The 195 deaths were grouped into neonatal (0-27 days) and postneonatal (28 days-1 year of age). The agreement between age groups and 5 large disease groups was studied: perinatal congenital anomalies pneumonias diarrhea and malnutrition plus the 6th group of other causes. 5 groups of causes were responsible for 91% of deaths. Perinatal causes accounted for 55%. 92 of deaths for perinatal causes were confirmed of 107 originally classified as perinatal causes. 15 deaths of 19 originally classified as congenital were confirmed. Only 8 of 21 originally classified as diarrhea were confirmed. Only 11 of 20 deaths due to pneumonia were confirmed. 6 of 10 deaths ascribed to malnutrition were confirmed. 13 of 18 other causes were confirmed. 11.7% of neonatal deaths did not have the underlying cause of death confirmed (kappa = 0.61) nor did 44.0% of postneonatal deaths (kappa = 0.47). Associated malnutrition was observed in 76.9% of cases where diarrhea was coded as an underlying cause of death. Malnutrition was associated with pneumonia in 18.7% and other causes in 21.6%. Of 43 deaths due to other causes in original certificates only 5 (11.6%) were confirmed. This high level of disagreement necessitates reviewing the role of the physician as the recorder of mortality causes while also considering the major causes in the region (diarrhea pneumonia and malnutrition) as relevant in establishing accurate encoding.A partir de dados coletados para um estudo sobre a mortalidade infantil na regiao metropolitana de Belo Horizonte, MG, Brasil, foi selecionada uma amostra aleatoria de obitos infantis ocorridos em 1989, para avaliar a concordância da causa basica de morte registrada na declaracao de obito e a obtida apos revisao detalhada do prontuario hospitalar da crianca. Verificou-se que 11,7% dos obitos neonatais nao tiveram a causa basica registrada no atestado, confirmada pela investigacao nos prontuarios medicos (kappa = 0,61), o mesmo ocorrendo em 44,0% dos pos-neonatais (kappa = 0,47). Esta maior discordância no grupo pos-neonatal provavelmente se deveu a maior dificuldade de definicao das causas contribuintes e da causa basica dos obitos por diarreias, pneumonias e desnutricao, principais causas de mortalidade nesse grupo. Em relacao aos obitos por desnutricao e diarreia, observou-se associacao entre ambas em 76,9% das vezes em que a diarreia foi selecionada como causa basica, mostrando que essas patologias podem ser destacadas como um mesmo grupamento em saude publica. As discordâcias encontradas demonstram que os medicos ainda dao pouca importância ao seu papel como agentes geradores de informacao de saude. Os dados da declaracao de obito fornecem indicacao razoavel das principais causas de mortes infantis, principalmente quando se considera o grupamento diarreia-pneumonia-desnutricao, composto de patologias evitaveis e ainda de grande relevância como causa de mortalidade infantil na regiao.

Clinical and Laboratory Predictors of Esophageal Varices in Children and Adolescents With Portal Hypertension Syndrome

Objectives: To determine the clinical and laboratory parameters that may predict the presence of esophageal varices in children and adolescents with portal hypertension. Patients and Methods: Overall, 111 patients with portal hypertension and no previous history of digestive bleeding underwent esophagogastroduodenoscopy for detection of esophageal varices. A univariate analysis initially was carried out, followed by a logistic regression analysis to identify the independent variables associated with the presence of esophageal varices. Sensitivity and specificity rates, positive predictive value, negative predictive value, and the accuracy of the predictive variables identified among cirrhotic patients were calculated with the esophagogastroduodenoscopy as the reference test. Results: Sixty percent of patients had esophageal varices on the first esophagogastroduodenoscopy. Patients with portal vein thrombosis and congenital hepatic fibrosis were 6.15-fold more likely to have esophageal varices than cirrhotic patients. When we analyzed 85 cirrhotic patients alone, splenomegaly and hypoalbuminemia remained significant indicators of esophageal varices. Only spleen enlargement showed appropriate sensitivity and negative predictive value (97.7% and 91.7%, respectively) to be used as a screening test for esophageal varices among cirrhotic patients. Conclusions: In reference services and research protocols, endoscopic screening should be performed in all patients with portal vein thrombosis and congenital hepatic fibrosis. Among cirrhotic patients, the indication should be conditioned to clinical evidence of splenomegaly or hypoalbuminemia. For clinicians, the recommendation is to emphasize the orientations given to guardians of patients with portal vein thrombosis and congenital hepatic fibrosis as to the risk of digestive bleeding. Cirrhotic patients with hypoalbuminemia and splenomegaly should receive the same orientations.

Evolução da mortalidade infantil por causas evitáveis, Belo Horizonte, 1984-1998

OBJETIVO: Analisar a evolucao da mortalidade infantil em regiao urbana com enfoque para o grupamento de causas evitaveis no periodo neonatal e pos-neonatal. METODOS: O numero de obitos ocorridos na regiao metropolitana de Belo Horizonte, MG, foi obtido do Sistema de Informacoes em Mortalidade do Ministerio da Saude (SIM-MS) e o numero de nascidos vivos foi estimado a partir das estatisticas do registro civil da Fundacao Instituto Brasileiro de Geografia e Estatistica (IBGE), com correcao dos registros atrasados de nascimentos. Utilizou-se modelo de regressao linear simples para estimar a tendencia temporal das taxas de mortalidade infantil e seus componentes. A significância estatistica da inclinacao das curvas de regressao foi considerada para o nivel p<0,05. RESULTADOS: Foi observado decrescimo da taxa de mortalidade infantil de 48,5 para 22,1 por mil nascidos vivos em toda a regiao. Entretanto, a queda mais acentuada foi observada nos ultimos quatro anos da serie. O componente pos-neonatal foi o principal responsavel pelo declinio tanto na capital como nos demais municipios que compoem a regiao metropolitana de Belo Horizonte. CONCLUSOES: Embora tenha sido observada para a regiao uma queda significativa da mortalidade infantil e particularmente da mortalidade pos-neonatal, esta ultima ainda se apresenta elevada em relacao aos paises desenvolvidos. As afeccoes perinatais e o grupamento diarreia-pneumonia-desnutricao representam importante potencial de reducao. Discute-se o papel dos servicos de saude na evitabilidade de tais obitos.

Fatores de risco para o desmame entre usuárias de uma unidade básica de saúde de Belo Horizonte, Minas Gerais, Brasil, entre 1980 e 2004

This study was a comparative analysis of factors affecting duration of breastfeeding among users of the Sao Marcos primary care clinic in Belo Horizonte, Minas Gerais State, Brazil, in 1980, 1986, 1992, 1998, and 2004. Five retrospective longitudinal studies (historical cohorts) were performed with the same questionnaire, and 790 mothers of children less than 24 months of age were interviewed. The statistical analysis was conducted year-by-year using the Kaplan-Meier method and Cox model. From 1980 to 2004, conditions significantly associated with risk of weaning were: primiparity; difficulty in postpartum breastfeeding; belief in ideal breastfeeding duration of less than six months; start of breastfeeding after discharge from the maternity hospital, non-recognition of the advantages of breastfeeding for the child; and unfavorable, unknown, or indifferent paternal opinion concerning breastfeeding. In four of the five studies, difficulty in breastfeeding (RR: 1.70-3.97) and belief in ideal breastfeeding duration of less than six months (RR: 1.67-3.27) were risk factors for weaning. Median duration of breastfeeding was five months in 1980 and 11 months in 2004.

Fatores de risco para hospitalização de crianças e adolescentes asmáticos

OBJECTIVE To assess the prevalence rate and risk factors for hospital admissions among asthma children and to evaluate care delivered to these patients. METHODS Three-hundred and twenty-five asthmatic children attending a public outpatient reference clinic were studied. Of them, 202 were hospitalized. Care was evaluated using a questionnaire covering general aspects of hospital stay and biological, demographics, socioeconomic and asthma-related factors. Univariate and multivariate analyses were performed to measure the association between hospital admissions and selected independent variables. RESULTS Of the total, 62.2% had already been hospitalized due to asthma, 64.9% developed asthma episodes, and 60.9% were hospitalized in their first year of life. Most (76.0%) had moderate to severe asthma. Despite that, 94.2% were not on anti-inflammatory drugs and were treated only during isolated acute episodes. None of these were regularly seen in primary health care centers for a periodic control of their steroid inhalants. Most parents (97.8%) referred not to know how to take care of asthma children. Symptoms onset is normally seen before the age of 12 months (OR=3.20; 95%CI 1.55-6,61) or between 12 and 24 months (OR=3.89; 95%CI 1.62-9.36). Mothers have attended school for less than 7 years (OR=3.06; 95%CI 1.62-5.76). Disease severity (OR=2.32; 95%CI 1.24-3.88), 2 or more monthly visits to emergency wards (OR=2.19; 95%CI 1.24-3.88), and referred recurrent pneumonia (OR=2.00; 95%IC 1.06-3.80) were the main risk factors for hospital admissions. CONCLUSIONS Organizing health care services is crucial to reduce hospital admissions and provide adequate care for asthma children and adolescents, especially those less than 2 years old.