bluuebunny/crossref_metadata_2025 huggingface dataset:
Breastfeeding training for health professionals and resultant changes in breastfeeding duration
Authors: Taddei José Augusto de Aguiar Carrazedo , Westphal Marcia Faria , Venancio Sonia , Bogus Cláudia , Souza Sonia
Published: April 2005

CONTEXT: Promotion of breastfeeding in Brazilian maternity hospitals. OBJECTIVE: To quantify changes in the breastfeeding duration among mothers served by hospitals exposed to the Wellstart-SLC course, comparing them with changes among mothers attended by institutions not exposed to this course. DESIGN: Randomized Institutional Trial. SETTING: The effects of training on breastfeeding duration was assessed in eight Brazilian hospitals assigned at random to either an exposed group (staff attending the Wellstart-SLC course) or a control group. SAMPLE: For each of the eight study hospitals, two cohorts of about 50 children were visited at home at one and six months after birth. The first cohort (n = 494) was composed of babies born in the month prior to exposure to the Wellstart-SLC course, and the second cohort (n = 476) was composed of babies born six months subsequent to this exposure. MAIN MEASUREMENTS: Kaplan-Meier curves were plotted to describe the weaning process and log-rank tests were used to assess statistical differences among survival curves. Hazard ratio (HR) estimates were calculated by fitting Cox proportional hazard regression models to the data. RESULTS: The increases in estimated, adjusted rates for children born in hospitals with trained personnel were 29% (HR = 0.71) and 20% (HR = 0.80) for exclusive and full breastfeeding, respectively. No changes were identified for total breastfeeding. CONCLUSION: This randomized trial supports a growing body of evidence that training hospital health professionals in breastfeeding promotion and protection results in an increase in breastfeeding duration.
Infant mortality due to perinatal causes in Brazil: trends, regional patterns and possible interventions
Authors: Victora Cesar Gomes , Barros Fernando Celso
Published: April 2005

CONTEXT: Brazilian infant and child mortality levels are not compatible with the country's economic potential. In this paper, we provide a description of levels and trends in infant mortality due to perinatal causes and malformations and assess the likely impact of changing intermediate-level determinants, many of which are amenable to direct interventions through the health or related sectors. TYPE OF STUDY: Review paper. METHODS: Two main sources of mortality data were used: indirect mortality estimates based on censuses and surveys, and rates based on registered deaths. The latter were corrected for under-registration. Combination of the two sources of data allowed the estimation of cause-specific mortality rates. Data on current coverage of preventive and curative interventions were mostly obtained from the 1996 Demographic and Health Survey. Other national household surveys and Ministry of Health Statistics were also used. A thorough review of the Brazilian literature on levels, trends and determinants of infant mortality led to the identification of a large number of papers and books. These provided the background for the analyses of risk factors and potential interventions. RESULTS: The indirect infant mortality rate estimate for 1995-97 is of 37.5 deaths per thousand live births, about six times higher than in the lowest mortality countries in the world. Perinatal causes account for 57% of all infant deaths, and congenital malformations are responsible for 11.2% of these deaths. Mortality levels are highest in the Northeast and North, and lowest in the South and Southeast; the Center-West falls in between. Since surveys of the North region do not cover rural areas, mortality for this region may be underestimated. CONCLUSIONS: A first priority for the further reduction in infant mortality in Brazil is to improve equality among regions, since the North and Northeast, and particularly rural areas, still show very high death rates. Further reductions in infant mortality will largely depend on decreasing deaths due to perinatal causes. Improvements in the coverage and particularly in the quality of antenatal and delivery care are urgently needed. Another intervention with a potential important impact on infant mortality is the promotion of family planning. Improving birth weight might lead to an 8% reduction in infant mortality but the efficacy of available interventions is low.
Evaluation of invasive and non-invasive methods for the diagnosis of Helicobacter pylori infection in symptomatic children and adolescents
Authors: Ogata Silvio Kazuo , Kawakami Elisabete , Patrício Francy Reis Silva , Pedroso Margareth Zabeu , Santos Antonio Mario
Published: April 2005

CONTEXT: Multiple diagnostic methods are available for the detection of Helicobacter pylori infection, but at present no single one can be used as the gold standard. OBJECTIVE: The aim of this study was to evaluate the diagnostic accuracy of 3 invasive and 2 non-invasive methods for detection of Helicobacter pylori infection in symptomatic children and adolescents. DESIGN: Prospective cohort study SETTING: Peptic Disease outpatients service, Discipline of Pediatric Gastroenterology, Universidade Federal de São Paulo / Escola Paulista de Medicina. PATIENTS: Forty-seven patients who underwent endoscopy because of dyspeptic symptoms. DIAGNOSTIC METHODS: Endoscopy with gastric biopsies for 3 invasive (rapid urease test, histology and culture) and 2 non-invasive methods (a commercial ELISA serology and 13carbon urea breath test - isotope ratio mass spectrometry) for detection of Helicobacter pylori infection. MAIN MEASUREMENTS: Sensitivity, specificity, positive and negative predictive values of each method and agreement and disagreement rates between the methods. RESULTS: Forty-seven patients [mean age, 11y9mo (SD 2y10mo), 27 female and 20 male]; 62% of them were Helicobacter pylori-positive. All methods agreed in 61%, and were negative in 21% and positive in 40%. The greatest concordance between 2 methods occurred between the invasive methods: histology and rapid urease test (89.6%) and histology and culture (87.5%). The greatest sensitivity, considering Helicobacter pylori-positive cases, for any combination of 3 or more tests, was achieved by the rapid urease test (S=100%), followed by histology, serology and 13carbon-urea breath test (S=93.1%) and lastly by culture (S=79.3%). The highest specificity was obtained by histology (100%) and culture (100%), followed by the rapid urease test (84.2%), serology (78.9%) and 13carbon-urea breath test (78.9%). CONCLUSIONS: Our results suggest that among invasive methods, an association between the rapid urease test and histology constituted the best choice for the detection of Helicobacter pylori infection. If results of histology and the rapid urease test are different, serology may be recommended.
The perimenopause, depressive disorders, and hormonal variability
Authors: Soares Cláudio de Novaes , Cohen Lee Stuart
Published: April 2005

CONTEXT: Several investigations have postulated that the perimenopause may represent a period of increased psychiatric vulnerability, particularly for mood disorders. This review characterizes the perimenopause, including biological changes, the influence of psychosocial factors and the most common clinical manifestations. Clinic-based studies and community-based surveys addressing the prevalence of depressive symptoms in perimenopausal women are critically reviewed. We also discuss the potential greater vulnerability to mood disturbance during the perimenopause in response to hormonal variability. A therapeutic algorithm for management of depressive symptoms in middle-aged perimenopausal women is also presented. The role of estrogen in the treatment of perimenopausal depressive symptoms is particularly discussed. In addition, we review the existing data regarding the potential efficacy of estrogen as an antidepressant agent (monotherapy, augmentation strategy or prophylaxis). DESIGN: Narrative review.
Latent Autoimmune Diabetes of the Adult (LADA) in a Brazilian Indian
Authors: Vieira Filho João Paulo Botelho , Moisés Regina Célia Santiago , Sá João Roberto de , Chacra Antonio Roberto , Dib Sergio Atala
Published: April 2005

CONTEXT: Latent autoimmune diabetes of the adult (LADA) as originally described represents perhaps as many as 10 -- 20% of adult-onset patients with diabetes. DESIGN: case report. CASE REPORT: A 38-year-old Brazilian Xavante-Jê Indian with Latent Autoimmune Diabetes of the Adult (LADA) is described, coming from the Sangradouro community in Poxoréu, Mato Grosso. The onset of diabetes after reaching 25 years of age, the evolution to insulin deficiency after a period of insulin-independence and the presence of auto-antibodies to glutamic acid decarboxylase (GAD) characteristic of LADA were present. This patient may represent the first case of LADA in a Brazilian with full Indian heritage. Further studies are necessary to verify the prevalence of this new type of diabetes in this population that does not have Caucasoid admixture and has a particular environmental background.
Comparison of knowledge on asthma: doctors completing internal medicine residency and doctors completing medical school
Authors: Vieira Joaquim Edson , Cukier Alberto , Stelmach Rafael , Kasahara David Itiro , Gannam Silmar , Warth Maria do Patrocínio Tenório Nunes
Published: April 2005

CONTEXT: Asthma has been reported as a disease of increasing prevalence. OBJECTIVE: To assess the level of information and knowledge about asthma by means of a questionnaire among recent graduate physicians applying for medical residency at the Clinical Hospital of the University of São Paulo Medical School, Brazil. DESIGN: 14 multiple-choice questions for asthma diagnosis and management. SETTING: University of São Paulo Medical School (FMUSP). PARTICIPANTS: Recent graduate physicians applying for the medical residency program at FMUSP in 1999 (n = 448) and physicians that had completed 2 year of internal medicine residency (n = 92). MAIN MEASUREMENTS: We applied a questionnaire with 14 multiple-choice questions about the management of asthma based upon the Expert Panel Report 2 - Guidelines for the Diagnosis and Management of Asthma, NIH/NHLBI, 1997 (EPR-2). RESULTS: The medical residency program in Internal Medicine improved treatment skills (the ability to propose adequate therapy) when compared to medical education (a score of 57.2% versus 46.9%, P < 0.001) but not diagnosis knowledge (understanding of asthma symptoms related to medicine intake) (33.5% versus 33.3%, P = 0.94). Treatment skills were higher among physicians who received their Medical Degree (MD) from public-sponsored medical schools in comparison with those from private schools [49.7 (SE 1.17)] versus [41.8 (SE 1.63)], P < 0.001. CONCLUSION: Medical schools might consider reevaluating their programs regarding asthma in order to improve medical assistance, especially when considering the general results for residents, as they were supposed to have achieved performance after completing this in-service training.
Chronic activation of the innate immune system may underlie the metabolic syndrome
Authors: Duncan Bruce Bartholow , Schmidt Maria Inês
Published: April 2005

CONTEXTO: The metabolic syndrome is characterized by a clustering, in free-living populations, of cardiovascular and diabetes risk factors generally linked to insulin resistance, obesity and central obesity. Consonant with the well-established inflammatory pathogenesis of atherosclerotic disease, the metabolic syndrome is now being investigated in relation to its inflammatory nature. OBJETIVO: We present cross-sectional findings demonstrating that markers of inflammation correlate with components of the metabolic syndrome, and prospective findings of the ARIC Study indicating that markers of inflammation and endothelial dysfunction predict the development of diabetes mellitus and weight gain in adults. We present biological evidence to suggest that chronic activation of the innate immune system may underlie the metabolic syndrome, characterizing the common soil for the causality of type 2 diabetes mellitus and cardiovascular disease. CONCLUSIONS: Better understanding of the role of the innate immune system in these diseases may lead to important advances in the prediction and management of diabetes and cardiovascular disease.
Prognostic significance of bi/oligoclonality in childhood acute lymphoblastic leukemia as determined by polymerase chain reaction
Authors: Scrideli Carlos Alberto , Defavery Ricardo , Bernardes José Eduardo , Tone Luíz Gonzaga
Published: April 2005

CONTEXT: The CDR-3 region of heavy-chain immunoglobulin has been used as a clonal marker in the study of minimal residual disease in children with acute lymphoblastic leukemia. Southern blot and polymerase chain reaction studies have demonstrated the occurrence of bi/oligoclonality in a variable number of cases of B-lineage acute lymphoblastic leukemia, a fact that may strongly interfere with the detection of minimal residual disease. Oligoclonality has also been associated with a poorer prognosis and a higher chance of relapse. OBJECTIVES: To correlate bi/oligoclonality, detected by polymerase chain reaction in Brazilian children with B-lineage acute lymphoblastic leukemia with a chance of relapse, with immunophenotype, risk group, and disease-free survival. DESIGN: Prospective study of patients’ outcome. SETTING: Pediatric Oncology Unit of the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo. PARTICIPANTS: 47 children with acute lymphoblastic leukemia DIAGNOSTIC TEST: Polymerase chain reaction using consensus primers for the CDR-3 region of heavy chain immunoglobulin (FR3A, LJH and VLJH) for the detection of clonality. RESULTS: Bi/oligoclonality was detected in 15 patients (31.9%). There was no significant difference between the groups with monoclonality and biclonality in terms of the occurrence of a relapse (28.1% versus 26.1%), presence of CALLA+ (81.2% versus 80%) or risk group (62.5% versus 60%). Disease-free survival was similar in both groups, with no significant difference (p: 0.7695). CONCLUSIONS: We conclude that bi/oligoclonality was not associated with the factors investigated in the present study and that its detection in 31.9% of the patients may be important for the study and monitoring of minimal residual disease.
Pharmacological management of acute myocardial infarction in the municipal district of Rio de Janeiro
Authors: Escosteguy Claudia Caminha , Portela Margareth Crisóstomo , Vasconcellos Maurício Teixeira Leite de , Medronho Roberto de Andrade
Published: April 2005

CONTEXT: International studies have shown a large variation in the utilization patterns of interventions, in acute myocardial infarction. OBJECTIVE: To analyze utilization patterns of pharmacological interventions in acute myocardial infarction and their corresponding effects on hospital mortality. DESIGN: Cross-sectional study. LOCAL: Hospitals of the Brazilian National Health System (SUS) in the municipal district of Rio de Janeiro. SAMPLE: A stratified hospital sample of 391 medical records selected from the 1,936 admissions registered in the SUS Hospital Information System (SIH/SUS) with a main diagnosis of acute myocardial infarction, in the studied district in 1997. MAIN MEASUREMENTS: Sex, age, time to treatment, risk factors, severity factors, diagnosis confirmation, use of pharmacological interventions, hospital death, contraindication of the use of thrombolytic therapy, contraindication of aspirin use. RESULTS: We reviewed 98.2% of the sampled medical records. Acute myocardial infarction diagnosis was confirmed in 91.7% (95% CI 88.3 to 94.2). 61.5% were men and 38.5% women, with an average age of 60.2 years (SD 2.4). The median time interval between symptom onset and hospital admission was 11 hours. Hospital mortality was 20.6% (95% CI 16.7 to 25.0). Intravenous thrombolytic therapy was used in 19.5% (95% CI 15.8 to 23.9) of the cases; aspirin in 86.5% (95% CI 82.5 to 89.6); beta-blockers in 49.0% (95% CI 43.8 to 54.1); angiotensin-converting enzyme (ACE) inhibitors in 63.3% (95% CI 58.2 to 68.1); nitrates in 82.0% (95% CI 82.4 to 89.6); heparin in 81.3% (95% CI 76.9 to 85.0); calcium antagonists in 30.5% (95% CI 26.0 to 35.4). There was a significant variation in the use of thrombolytic therapy, beta-blockers, ACE inhibitors, calcium antagonists and heparin among hospitals of different juridical nature. CONCLUSIONS: There was underutilization of some interventions with well-established efficacy (thrombolytic therapy, aspirin, beta-blockers and intravenous nitrates). The use of calcium antagonists, not supported by scientific evidence in acute myocardial infarction, was quite frequent. A logistic model documented the benefit of aspirin, beta-blockers and ACE inhibitor use in reducing the chance of hospital death.
Twinning rate in a sample from a Brazilian hospital with a high standard of reproductive care
Authors: Colletto Gloria Maria Duccini Dal , Segre Conceição Aparecida de Mattos , Beiguelman Bernardo
Published: April 2005

CONTEXT: Epidemiological studies on twin births have been motivated mostly by the positive correlation between twinning rate and human fertility, prematurity, low birth weight, increased risk of infant death and long term risk for morbidity. OBJECTIVE: This paper intends to estimate the incidence of multiple births in a private hospital in Brazil with a high standard of reproductive care, and to evaluate the effects of maternal age, gestation order and assisted fertilization on twinning rate. DESIGN: Retrospective analysis. SETTING: First-class tertiary private hospital, São Paulo, Brazil. PARTICIPANTS: The multiple birth rate was investigated among 7,997 deliveries from 1995 to 1998, including 7,786 singletons, 193 twins, 17 triplets and one quadruplet. RESULTS: The rates per 1,000 dizygotic and monozygotic pairs and for triplets were estimated as 19.51, 4.50 and 2.13, respectively. The dizygotic and triplet rates were the highest observed in Brazil up to the present day. The twinning rate among primigravidae older than 30 years was very high (45.02 per 1,000) and was due to a disproportionately high frequency of dizygotic pairs. The triplet rate was also very high among the mothers of this age group (5.71 per 1,000). These facts are strong indicators that these women were the ones most frequently submitted to assisted reproductive techniques. The mean maternal age of the studied population was about six years higher than that estimated for mothers in the general population of southeastern Brazil. Primigravidae aged under 30 years as well as multigravidae showed similar twinning rates, which were almost 20 per 1,000. Among the deliveries of multigravidae older than 30 years, an unusually high frequency of monozygotic twins was observed (7.04 per 1,000), probably as a consequence of the residual effect of long-term use of oral contraceptives. CONCLUSIONS: The dizygotic twinning rate increased from 13.51 to 28.98 per 1,000 over the four years studied, with the twinning rate for primigravidae over 30 years old in 1998 being twice that observed in 1995. The mean maternal age was also high during this period, but the extremely high increase in twinning rate observed cannot be attributed solely to this variable. Assisted fertilization seems to be the most probable cause of this unusually high twinning rate.
The effect of an HIV-1 viral protease inhibitor on staurosporine-induced apoptosis in immortalized mesangial cells
Authors: Serone Adrian Pierce , Camargo Simone Mafalda Rodrigues , Schor Nestor
Published: April 2005

CONTEXT: Progressive glomerular sclerosis is a condition characterized by the accumulation of glomerular extracellular matrix and a decrease in the number of glomerular cells. The mechanisms involved in the progressive loss of glomerular cells are not well understood but may involve the process of apoptosis. The principal mediators for the apoptotic pathway are a class of protease enzymes called caspases. It is not known how other therapeutic protease inhibitors affect the caspase cascade and therefore whether they would be effective in preventing excessive apoptosis in the late stages of progressive glomerular sclerosis. OBJECTIVE: To evaluate whether an inhibitor of the HIV-1 viral protease Ac-Leu-Val-phenylalanine (PI) could inhibit apoptosis in immortalized mesangial cells. DESIGN: Experimental. SETTING: Nephrology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina. PARTICIPANTS: Immortalized mesangial cells. PROCEDURES: Cell culture. MAIN MEASUREMENTS: Viability and rate of apoptosis. RESULTS: Immortalized mesangial cells were treated with staurosporine (at concentrations of 10-100 nM for 8-28 hours) to induce apoptosis. Staurosporine at 10 nM for 8 hours had no effect on viability, but did cause a significant increase in the rate of apoptosis (p = 0.0411, n = 6). Increasing the incubation time elicited a greater increase in the rate of apoptosis (p = 0.0001, n = 6), although there was also a significant decrease in viability (p=0.0002). Increasing the concentration of staurosporine to 100 nM resulted in a marked increase in apoptosis (p <0.0001) but resulted in unacceptable viability (<40%, p <0.0001, n = 6). CONCLUSIONS: Incubation of immortalized mesangial cells with PI (900 nM) alone for 2-24 hours had no effect on cell viability or the rate of apoptosis when compared with vehicle (methanol) controls. Co-incubation of the cells with staurosporine (10 nM) and PI for 24 hours had no significant effect on the rate of apoptosis. Therefore, in immortalized mesangial cells, staurosporine-induced apoptosis was not significantly affected by the HIV-1 viral protease inhibitor Ac-Leu-Val-phenylalanine.
Hand-assisted bilateral nephrectomy in a patient with adult polycystic kidney disease
Authors: Pinto Marcello Alves , Juliano Roberto Vaz , Tobias-Machado Marcos , Borrelli Milton , Wroclawski Eric Roger
Published: April 2005

CONTEXT: Dominantly autosomal polycystic disease is characterized by multiple bilateral and non-functional cysts, which lead to progressive kidney failure. OBJECTIVE: Our objective was to report on a case of hand-assisted bilateral nephrectomy in a 28-year-old female patient with adult polycystic disease and recurring pyelonephritis in a kidney transplant program. CASE REPORT: A hand-assisted bilateral nephrectomy was performed through a supra-umbilical median incision of approximately 6 cm, and with 3 ports of 10 mm. The length of the surgery was 3 hours and 15 minutes. The kidneys were removed after the aspiration of some cysts through the supra-umbilical incision. Pain control was achieved via the use of analgesics. The blood loss during surgery was 160 ml. During the postoperative period, the patient developed right-side pneumothorax, which was drained with no further occurrence. This drain was kept in place for 48 hours. The length of hospitalization was 4 days.
Antenatal treatment with corticosteroids for preterm neonates: impact on the incidence of respiratory distress syndrome and intra-hospital mortality
Authors: Meneguel Joice Fabíola , Guinsburg Ruth , Miyoshi Milton Harumi , Peres Clovis de Araujo , Russo Regina Helena , Kopelman Benjamin Israel , Camano Luiz
Published: April 2005

CONTEXT: Although the benefits of antenatal corticosteroids have been widely demonstrated in other countries, there are few studies among Brazilian newborn infants. OBJECTIVE: To evaluate the effectiveness of antenatal corticosteroids on the incidence of respiratory distress syndrome and intra-hospital mortality among neonates with a gestational age of less than 34 weeks. TYPE OF STUDY: Cross-sectional. SETTING: A tertiary-care hospital. PARTICIPANTS: Neonates exposed to any dose of antenatal corticosteroids for fetal maturation up to 7 days before delivery, and newborns paired by sex, birth weight, gestational age and time of birth that were not exposed to antenatal corticosteroids. The sample obtained consisted of 205 exposed newborns, 205 non-exposed and 39 newborns exposed to antenatal corticosteroids for whom it was not possible to find an unexposed pair. PROCEDURES: Analysis of maternal and newborn records. MAIN MEASUREMENTS: The primary clinical outcomes for the two groups were compared: the incidence of respiratory distress syndrome and intra-hospital mortality; as well as secondary outcomes related to neonatal morbidity. RESULTS: Antenatal corticosteroids reduced the occurrence of respiratory distress syndrome (OR: 0.33; 95% CI: 0.21-0.51) and the protective effect persisted when adjusted for weight, gestational age and the presence of asphyxia (adjusted OR: 0.27; 95% CI: 0.17-0.43). The protective effect could also be detected through the reduction in the need for and number of doses of exogenous surfactant utilized and the number of days of mechanical ventilation needed for the newborns exposed to antenatal corticosteroids. Their use also reduced the occurrence of intra-hospital deaths (OR: 0.51: 95% CI: 0.38-0.82). However, when adjusted for weight, gestational age, presence of prenatal asphyxia, respiratory distress syndrome, necrotizing enterocolitis and use of mechanical ventilation, the antenatal corticosteroids did not maintain the protective effect in relation to death. With regard to other outcomes, antenatal corticosteroids reduced the incidence of intraventricular hemorrhage grades III and IV (OR: 0.28; 95% CI: 0.10-0.77). CONCLUSIONS: Antenatal corticosteroids were effective in the reduction of morbidity and mortality among premature newborns in the population studied, and therefore their use should be stimulated within our environment.
HPV 16 detection in cervical lesions, physical state of viral DNA and changes in p53 gene
Authors: Oliveira Ledy do Horto dos Santos , Rodrigues Eliane de Vasconcelos Machado , Lopes Ana Paula Terra Alvim de Salles , Fernandez André de Paula , Cavalcanti Silvia Maria Baeta
Published: April 2005

CONTEXT: Persistent infection with high risk human papillomavirus (HPV) has been linked to cervical carcinoma. Integration of viral DNA into host cell DNA is essential for this cancer development, promoting disruption of the HPV E2 gene, thus leading to unregulated increases in E6 and E7 proteins and inactivating the products of p53 and Rb tumor suppressor genes. OBJECTIVE: To investigate HPV 16 infection in cervical lesions, physical state of viral DNA and p53 gene alterations in a group of women attending a public health service. DESIGN: Prospective, non-controlled, transversal study. SETTING: Gynecological clinic of the School od Medicine, Universidade Federal Fluminense. SAMPLE: 43 consective patients with cervical lesions referred to our service. MAIN MEASUREMENTS: Cases were classified via cytology/histology as normal, HPV infection, condyloma, low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL) and carcinoma. HPV infection was studied via polymerase chain reaction (PCR) using two PCR primer sets, to determine DNA integration. p53 gene changes were investigated by single-strand conformation polymorphism (SSCP) analysis. RESULTS: One normal case, 7 HPV infections, 6 condylomas, 7 LSIL, 14 HSIL and 8 cancers were found, with 95% positive for HPV genome when tested using both L1 and E6 primers. HPV 16 was most prevalent (73.1%). HPV 16 DNA was integrated within the host genome in 3 LSIL. One LSIL progressed to HSIL by 13 months after first diagnosis. Among HPV 16-positive HSIL cases, 50% contained integrated viral DNA. HPV 16 E2 gene disruption was seen in 7 cancers (87.5%). Only smal-cell carcinoma showed intact HPV 16 E2 gene. Abnormal p53 bands detected by PCR/SSCP were observed in 4 cases: 2 squamous carcinoma with parametrium (exon 8) and two cervical intraepithelial neoplasia (CIN) III (exons 5 and 7). All cases presented HPV 16 E2 gene loss. CONCLUSIONS: The sample had a high rate of high-risk HPV detected in benign and malignant lesions; high cervical cancer burden; HPV 16 DNA integration in all except one case of cancer; p53 gene changes in CIN III and in invasive cancer cases associated with DNA integration.
Therapeutic response to benzodiazepine in panic disorder subtypes
Authors: Valença Alexandre Martins , Nardi Antonio Egidio , Mezzasalma Marco André , Nascimento Isabella , Zin Walter Araújo , Lopes Fabiana Leão , Versiani Marcio
Published: April 2005

CONTEXT: This study makes a comparison between two subtypes of panic disorder regarding the clinical efficacy of clonazepam, a benzodiazepine. OBJECTIVES: To evaluate the clinical efficacy of clonazepam in a fixed dosage (2 mg/day), compared to placebo, in the treatment of panic disorder patients and to verify whether there are any differences in the responses to clonazepam between panic disorder patients with the respiratory and non-respiratory subtypes. TYPE OF STUDY: Randomized study with clonazepam and placebo. SETTING: Outpatient Anxiety and Depression Unit of the Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. PARTICIPANTS: 34 patients with a diagnosis of panic disorder with agoraphobia, between 18 and 55 years old. PROCEDURES: Administration of clonazepam or placebo for 6 weeks, in panic disorder patients, after they were classified within two subtypes of panic disorder: respiratory and non-respiratory. MAIN MEASUREMENTS: Changes in the number of panic attacks in comparison with the period before the beginning of the study; Hamilton Anxiety Scale; Global Clinical Impression Scale; and Patient's Global Impression scale. RESULTS: In the group that received clonazepam, by the end of the 6th week there was a statistically significant clinical improvement, shown by the remission of panic attacks (p < 0.001) and decrease in anxiety (p = 0.024). In the group that received clonazepam there was no significant difference between the respiratory and non-respiratory subtypes of panic disorder, regarding the therapeutic response to clonazepam. CONCLUSION: Clonazepam was equally effective in the treatment of the respiratory and non-respiratory subtypes of panic disorder, suggesting there is no difference in the therapeutic response between the two subtypes.
Soluble transferrin receptor and immature reticulocytes are not useful for distinguishing iron-deficiency anemia from heterozygous beta-thalassemia
Authors: Lima Gisélia Aparecida Freire Maia de , Grotto Helena Zerlotti Wolf
Published: April 2005

Iron deficiency and heterozygous beta-thalassemia are important causes of hypochromic-microcytic anemia. Two laboratory parameters are suggested for the differentiation of such anemia. High-fluorescence reticulocyte counts and soluble transferrin receptor levels were determined in iron-deficiency anemia patients (n = 49) and heterozygous beta-thalassemia patients (n = 43). There was no significant difference in high-fluorescence reticulocyte and soluble transferrin receptor values between the two groups, but a correlation was observed between high-fluorescence reticulocytes and soluble transferrin receptors in iron-deficiency anemia, probably due to increased receptor synthesis as a response to decreased iron content in erythrocytes.
Accuracy of the serological ELISA test compared with the polymerase chain reaction for the diagnosis of cytomegalovirus infection in pregnancy
Authors: Parmigiani Silvana Varella , Barini Ricardo , Costa Sandra Cecília Botelho , Amaral Eliana , Silva José Carlos Gama da , Pinto e Silva João Luiz de Carvalho
Published: April 2005

CONTEXT: The most frequently used methods for detecting antibodies are the indirect immunofluorescence test and the enzymatic immunoassay (ELISA). The polymerase chain reaction is a molecular biology technique in which the production of large amounts of specific DNA fragments is induced from very low concentrations of complex substrates aloowing the detection of very low amounts of viral particles. OBJECTIVE: To assess the accuracy of serological/ELISA tests in comparison with the polymerase chain reaction in maternal blood to diagnose cytomegalovirus infection. DESIGN: A descriptive study was performed. SETTING: High-risk outpatient clinic of Campinas University (Unicamp). PARTICIPANTS: We selected 243 pregnant women. All of them had been indicated for blood sampling because of suspicions of cytomegalovirus infection and also because of other infections. MAIN MEASUREMENTS: The group was tested for cytomegalovirus. Serological tests were run and compared to the polymerase chain reaction, which was considered to be the gold standard. Status analyses were done using Fisher's exact test, via the SAS software. RESULTS: The previous cytomegalovirus infection rate was 94.6%. The main reasons for inclusion in the study were fetal nervous system malformation (25.5%), maternal toxoplasmosis (25.5%) and Rh isoimmunization (14.8%). Only two women were included because of positive serological immunoglobulin M test for cytomegalovirus. The sensitivity and specificity of the serological tests were 94% and 6% for immunoglobulin G. CONCLUSION: Serological tests had lower sensitivity in comparison with the polymerase chain reaction test when diagnosing cytomegalovirus infection. The consequences of positive polymerase chain reaction and negative immunoglobulin M in women remain unknown.
Miliary tuberculosis with positive acid-fast bacilli in a pediatric patient
Authors: Fernandes Sara Regina Castanheira , Homa Marcia Noriko de Oliveira , Igarashi Aghata , Salles Andréa Luiza Mendes , Jaloretto Ana Paula , Freitas Maria Silvia , Nogueira Paulo Cesar Koch
Published: April 2005

CONTEXT: Tuberculosis is an important public health issue. The Brazilian government reported 78,460 new cases in 1999. Miliary tuberculosis is a severe form of this disease. OBJECTIVE: To report on an uncommon clinical presentation of miliary tuberculosis in a child. CASE REPORT: A 5-year old boy presented in the emergency room with fatigue and weight loss. He had had Staphylococcus aureus pneumonia 7 months before. Chest radiography revealed lobar consolidation and miliary pattern associated with small cavities in both upper lobes. Antibiotic therapy was started. The sputum was positive for acid-fast bacilli and hence the treatment recommended for tuberculosis (rifampicin, isoniazid [INH], pyrazinamide) was started. The patient was treated for 9 months and at the end of the follow-up period he had made a complete clinical recovery. CONCLUSION: Although in some particular cases sputum can be positive for acid-fast bacilli in children, limitations to the sputum test have forced pediatricians to base tuberculosis diagnosis on epidemiological data, clinical findings and radiographic pattern. In this particular case, we hypothesize that the sputum bacillus test was positive because bacilli grew inside residual pneumatoceles that were produced during previous pneumonia.
Weight-for-length relationship at birth to predict neonatal diseases
Authors: Bertagnon José Ricardo Dias , Segre Conceição Aparecida de Mattos , Dall Colletto Gloria Maria
Published: April 2005

CONTEXT: Intrauterine growth curves are extremely useful for classifying newborn children and predicting neonatal diseases. However, such curves rely on knowledge of the gestational age, which is not always easily obtained. Therefore, the study of other anthropometric measurements and their interrelationship is always desirable, in order to attain such objectives. OBJECTIVE: To evaluate whether newborns' birth weight and length can identify neonatal diseases, independent of knowledge of the gestational age. TYPE OF STUDY: Retrospective study. SETTING: Institute of Teaching and Research of Hospital Israelita Albert Einstein, São Paulo, Brazil. PARTICIPANTS: During the period from February 1995 to January 1998, 8,397 live newborns were studied in the hospital's maternity ward. PROCEDURES: The weight and length of live newborns were obtained at birth, thus allowing the analysis of weight-for-length adequacy, i.e. the distribution of birth weight for each class of birth lenght. These measurements were determined for the first 4,634 live newborns and the 10th and 90th percentiles were established. These parameters were applied to the next 3,763 consecutive newborns of the same population. The relationships between these variables and some neonatal diseases were investigated. The significance level adopted was p < 0.05. MAIN MEASUREMENTS: Birth weight and length, weight-for-length adequacy (10th and 90th percentiles for weight distribution in each 1-cm length class), weight/length index (10th and 90th percentiles of newborn's weight divided by the length) and frequent neonatal diseases in this population. RESULTS: There was a significant association of adequacy and index with the following affections: asphyxia, jaundice, hypoglycemia, hypomagnesemia, congenital pneumonia, pulmonary hypertension and sepsis. Additionally, there was a relationship between the index and respiratory distress syndrome, transient tachypnea and persistent ductus arteriosus. CONCLUSIONS: Weight-for-length adequacy and weight/length index alone, without the knowledge of gestational age, were able to identify newborns at risk for some selected neonatal diseases.
Tumoral form of aspergillosis in central nervous system (cerebral aspergilloma): case report
Authors: Figueiredo Eberval Gadelha , Fonoff Erich , Gomes Marcos , Macedo Emílio , Marino Júnior Raul
Published: April 2005

Aspergillosis of the central nervous system is an uncommon infection, mainly occurring in immunocompromised patients. It may be presented in several forms: meningitis, mycotic aneurysms, infarcts and the tumoral form (aspergilloma). The authors report a case of a diabetic patient with cerebral aspergilloma.
Influence of sedation on morbidity and mortality in the intensive care unit
Authors: Rodrigues Junior Geraldo Rolim , Amaral José Luiz Gomes do
Published: April 2005

CONTEXT: Although 30 to 50% of hospitalized patients in a critical care unit are under sedation, there is sparse data on the impact of sedation on morbidity and case-fatality rates in Brazil. Sedation is associated with higher risks of infection and death rate among patients. However, it is difficult to assess the clinical impact of sedation. OBJECTIVE: To evaluate the impact of sedation on the incidence of nosocomial infection and all-cause deaths at a critical care unit. TYPE OF STUDY: Prospective study. SETTING: Tertiary-care teaching hospital. PARTICIPANTS: After the exclusion of patients hospitalized for less than 24 hours, 307 patients were assigned to two groups, considering their states of sedation. After confirmation of heterogeneity in relation to the Acute Physiology and Chronic Health Evaluation (APACHE II) prognostic system, 97 sedated and 97 non-sedated patients were matched in relation to this severity index. MAIN MEASUREMENTS: Impact of sedation on deep venous thrombosis, incidence of decubital eschars, presence of infection, mortality and length of hospital stay. RESULTS: There was no difference in the incidence of deep venous thrombosis between the sedated and non-sedated groups, while the frequency of decubital eschars was significantly higher among sedated patients (p = 0.03). Infection was detected in 45.4% of patients under sedation and 21.6% of patients not under sedation (p = 0.006). Mortality for patients that did not receive any kind of sedative was 20.6% and, for those that were sedated during hospitalization, the rate was 52.6% (p < 0.0001). The sedated patients had longer hospitalization (11 vs. 4 days) (p < 0.0001). CONCLUSION: We concluded that sedation is associated with higher infection risk and case-fatality rate, and longer hospital stay.
Evaluation of the rupture of silicone breast implants by mammography, ultrasonography and magnetic resonance imaging in asymptomatic patients: correlation with surgical findings
Authors: Scaranelo Anabel Medeiros , Marques Américo Ferreira , Smialowski Elizabeth Brenda , Lederman Henriquel Manoel
Published: April 2005

CONTEXT: Different imaging methods can identify the integrity of breast implants and also the extent of possible silicone leakage. Mammography, ultrasonography and magnetic resonance imaging are often used to evaluate the integrity of breast implants, usually in patients that are symptomatic for rupture. A group of clinically asymptomatic patients was taken as a sample. These patients wanted to remove or change their breast implants for psychological or cosmetic reasons. OBJECTIVE: The purpose of this study was to compare the efficacy of mammography, sonography and magnetic resonance imaging in the detection of breast implant rupture in an asymptomatic population. TYPE OF STUDY: Prospective study. SETTING: Department of Diagnostic Imaging, Universidade de São Paulo, São Paulo, Brazil. METHODS: The participants were 44 asymptomatic patients who subsequently had implants surgically removed. Eighty-three implants were evaluated by both film-screen mammography and high-resolution sonography and 77 implants were evaluated by magnetic resonance imaging. The sensitivity and specificity of mammography, ultrasonography and magnetic resonance imaging were assessed using predetermined diagnostic criteria for implant rupture. All radiological signs were discussed and false positives and false negatives were retrospectively evaluated to identify the pitfalls in the investigations. RESULTS: The respective sensitivity and specificity of mammography were 20% and 89%; sonography, 30% and 81%; and magnetic resonance imaging, 64% and 77%. The differences between patients with breast implants for cosmetic and oncological reasons were discussed. CONCLUSIONS: Our experience suggests that magnetic resonance imaging seems to be the best imaging method on its own for the evaluation of rupturing among asymptomatic patients.
Mid-arm circumference and mid-arm/head circumference ratio in term newborns
Authors: Figueira Bettina Barbosa Duque , Segre Conceição Aparecida de Mattos
Published: April 2005

CONTEXT: Mid-arm circumference of the newborn is strongly associated with birth weight and is a very good indicator of low and insufficient birth weight. However, there are few Brazilian studies on the relationship between mid-arm and head circumferences and, thus, this does not form part of the routine evaluation for newborns. OBJECTIVES: To establish the mid-arm circumference and mid-arm/head circumference ratio in a population of term newborns. TYPE OF STUDY: Cross-sectional study carried out between June 1997 and August 1999. SETTING: Hospital Maternidade Leonor Mendes de Barros, São Paulo. PARTICIPANTS: Term newborns (66 males and 65 females) of appropriate growth for gestational age, whose mothers were healthy, were included in the study. MAIN MEASUREMENTS: Arm circumference, arm circumference/head circumference ratio, birth weight and gestational age were measured within 48 hours of birth. Data were considered significant when p < 0.01. RESULTS: The mean values for the mid-arm circumference were 10.76 cm (standard deviation, SD = 0.68) for females and 10.76 (SD = 0.81) for males. The mean value for the mid-arm/head circumference ratio was 0.31 (SD = 0.02) for both sexes. Mid-arm circumference values were significantly related to birth weight and gestational age, whereas mid-arm/head circumference ratio was related only to birth weight. CONCLUSIONS: Mid-arm circumference and mid-arm/head circumference ratio values were established for the studied population. It was possible to obtain curves for both mid-arm circumference and mid-arm/head circumference ratio in relation to birth weight. However, for mid-arm circumference, it was only possible to obtain curves in relation to gestational age. The use of the regression curves did not seem powerful enough to predict the mid-arm circumference and mid-arm/head circumference ratio in this population of term newborns. There were no gender differences for either of the measurements studied.
Obstetric and perinatal effects of active and/or passive smoking during pregnancy
Authors: Nakamura Mary Uchiyama , Alexandre Sandra Maria , Santos Jorge Francisco Kuhn dos , Souza Eduardo de , Sass Nelson , Beck Anna Paula Auritscher , Trayna Evelyn , Andrade Carla Maria de Araújo , Barroso Teresa , Kulay Júnior Luiz
Published: April 2005

CONTEXT: Cigarette smoke, whether inhaled voluntarily or not, causes damage to the mother-infant pair. The antenatal period may present the best opportunity for performing effective anti-smoking campaigns. OBJECTIVE: To study the obstetric and perinatal effects of smoking on pregnancy and the infant. TYPE OF STUDY: Prospective study, interviewing pregnant women who were randomly selected at the maternity hospital as they were being discharged after giving birth. SETTING: Hospital Municipal Vereador José Storópolli, São Paulo, Brazil. METHODS: 758 patients were interviewed regarding smoke inhalation before being discharged from the maternity hospital. The groups were formed by 42 active smokers, 272 passive smokers, 108 who inhaled smoke both actively and passively, and 336 non-smokers. The groups were compared regarding age, parity, school education, incidence of spontaneous abortion, rate of caesarian births, average gestational age at birth, rate of low birth weight and adequacy of weight in relation to the gestational age of newborn infants. For all variables we considered p < 0.05 as statistically significant. RESULTS: There was a high rate (55.7%) of pregnant smokers, including 5.5% active, 35.9% passive and 14.3% active-passive smokers. Active and active-passive smokers were older and had higher parity. Active smokers had lower education levels and higher rates of previous spontaneous abortion. The weights of newborn babies were lower for smoking mothers. DISCUSSION: The study was performed among patients that were mostly of low economic, social and cultural levels, thus possibly explaining the high incidence of smokers. Worse still was that 35.9% of the non-smokers were actually passive smokers. These rates we report were similar to those from the literature. The typical receptiveness of teenage girls to unrestricted advertising in the media contributes towards an early start to acquiring the habit of smoking, including during pregnancy in our country. We emphasize the difficulties in quantifying exposure to cigarettes even among active smokers. CONCLUSIONS: Cigarette smoke, whether inhaled voluntarily or not, has an unfavorable effect on the mother-infant pair.
Pan-cytokeratin immunoexpression in Wilms' tumors: a simple approach for understanding tumor epithelial differentiation
Authors: Sredni Simone Treiger , Neves José Ivanildo , Camargo Beatriz de , Caballero Otávia Luiza Damas de , Soares Fernando Augusto
Published: April 2005

Wilms' tumor is one of the most common solid tumors in children and is an interesting model for understanding the pathogenesis of embryonal tumors. Cytokeratins are intracellular fibrous proteins present in tissue of epithelial origin. The immunoexpression of the pan-cytokeratin AE1AE3 was studied in paraffin-embedded tissue sections from 24 Wilms' tumors (12 with nephrogenic rests) and also tissue samples from 15 corresponding normal kidneys, to evaluate epithelial differentiation in the genesis of Wilms' tumor. We observed that the intensity of the expression of AE1AE3 in the epithelial component of Wilms' tumors directly correlated with the degree of maturity of the epithelial structures correspondent to the collecting ducts.