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OBJECTIVES: This study sought to analyze the clinical and epidemiologic characteristics of critically ill patients who were denied intensive care unit admission due to the unavailability of beds and to estimate the direct costs of treatment. METHODS: A prospective cohort study was performed with critically ill patients treated in a university hospital. All consecutive patients denied intensive care unit beds due to a full unit from February 2012 to February 2013 were included. The data collected included clinical data, calculation of costs, prognostic scores, and outcomes. The patients were followed for data collection until intensive care unit admission or cancellation of the request for the intensive care unit bed. Vital status at hospital discharge was noted, and patients were classified as survivors or non-survivors considering this endpoint. RESULTS: Four hundred and fifty-four patients were analyzed. Patients were predominantly male (54.6%), and the median age was 62 (interquartile range (ITQ): 47 - 73) years. The median APACHE II score was 22.5 (ITQ: 16 - 29). Invasive mechanical ventilation was used in 298 patients (65.6%), and vasoactive drugs were used in 44.9% of patients. The median time of follow-up was 3 days (ITQ: 2 - 6); after this time, 204 patients were admitted to the intensive care unit and 250 had the intensive care unit bed request canceled. The median total cost per patient was US$ 5,945.98. CONCLUSIONS: Patients presented a high severity in terms of disease scores, had multiple organ dysfunction and needed multiple invasive therapeutic interventions. The study patients received intensive care with specialized consultation during their stay in the hospital wards and presented high costs of treatment.

Objectives To analyze the direct costs of treating critically ill patients in the intensive care unit of a center specializing in treating burns. Methods This is a prospective cohort study of 180 patients from May 2011 to May 2013. Clinical and demographic data were collected in addition to data for the calculation of severity scores. The costs related to daily clinical and surgical treatment were evaluated until hospital outcome. The costs were grouped into five blocks: Clinical support, Drugs and blood products, Medical procedures, Specific burn procedures and Hospital fees. The level of significance was set at 5%. Results There was a predominance of males, 131 (72.8%). The mean age of the patients was 42.0 ± 15.3 years and the mean burned body surface area was 27.9 ± 17%. The median length of stay in intensive care beds was 15.0 (interquartile range IQR: 7.0–24.8) days and the median hospital stay was 23.0 (IQR: 14.0–34.0) days. The mean daily cost was US$ 1330.48 (standard error of the mean SE = 38.36) and the mean total cost of hospitalization was US$ 39,594.90 (SE: 2813.11). The drugs and blood products block accounted for the largest fraction of the total costs (US$ 18,086.09; SE 1444.55). There was a difference in the daily costs of survivors and non survivors (US$ 1012.89; SE: 29.38 and US$ 1866.11, SE: 36.43, respectively, P Conclusion The direct costs of the treatment of burn patients at the study center were high. The drugs and blood products block presented the highest mean total and daily costs. Non surviving patients presented higher costs.

The aim of the present study was to verify the effects of fish oil and a soya-based product on inflammatory markers and endothelial function measured by NO in women with the metabolic syndrome (MetS). A total of sixty-five women (mean age: 47·9 (sd9·98) years) were studied in a 90-d parallel, randomised design. A control group maintained their usual diet; the second group received 29 g/d of soyabean (kinako); the third group received 3 g/d of fish oiln-3 fatty acids; and the fourth group received fish oil (3 g/d) and kinako (29 g/d). Anthropometric, blood pressure (BP), inflammatory markers, anti-inflammatory marker (adiponectin) and NO concentrations were evaluated. In relation to the baseline values, the group that received fish oil and kinako concomitantly presented a statistically significant decrease in systolic BP (SBP;P P P P P P P

Metabolic syndrome (MS) is a multifactorial disease involving inflammatory activity and endothelial dysfunction. The aim of the present study was to evaluate the relationship between the changes in lipoperoxidation, in immunological and biochemi-cal parameters and in nitric oxide metabolite (NOx) levels in MS patients. Fifty patients with MS (4 males/46 females) and 50 controls (3 males/47 females) were studied. Compared to control (Mann-Whitney test), MS patients presented higher serum levels (P < 0.05) of fibrinogen: 314 (185-489) vs 262 (188-314) mg/dL, C-reactive protein (CRP): 7.80 (1.10-46.50) vs 0.70 (0.16-5.20) mg/dL, interleukin-6: 3.96 (3.04-28.18) vs 3.33 (2.55-9.63) pg/mL, uric acid: 5.45 (3.15-9.65) vs 3.81 (2.70-5.90) mg/dL, and hydroperoxides: 20,689 (19,076-67,182) vs 18,636 (15,926-19,731) cpm. In contrast, they presented lower (P < 0.05) adiponectin: 7.11 (3.19-18.22) vs 12.31 (9.11-27.27) µg/mL, and NOx levels: 5.69 (2.36-8.18) vs 6.72 (5.14-12.43) µM. NOx was inversely associated (Spearman’s rank correlation) with body mass index (r = -0.2858, P = 0.0191), insulin resistance determined by the homeostasis model assessment (r = -0.2530, P = 0.0315), CRP (r = -0.2843, P = 0.0171) and fibrinogen (r = -0.2464, P = 0.0413), and positively correlated with hydroperoxides (r = 0.2506, P = 0.0408). In conclusion, NOx levels are associated with obesity, insulin resistance, oxidative stress, and inflammatory markers. The high uric acid levels together with reactive oxygen species generation may be responsible for the reduced NO levels, which in turn lead to endothelial dysfunc-tion. The elevated plasma chemiluminescence reflecting both increased plasma oxidation and reduced antioxidant capacity may play a role in the MS mechanism.Key words: Metabolic syndrome; Uric acid; Inflammation; Adiponectin; Nitric oxide; Lipoperoxidation

OBJECTIVE: To verify the effects of fish oil and soy on nitric oxide (NO) and blood pressure in patients with metabolic syndrome (MS). SUBJECTS AND METHODS: Sixty women with MS were investigated in a parallel randomized design study. The first group maintained their usual diet; the second group received 25 g/day of soy; the third group received 3 g/day of n-3 fatty acids, and the fourth group the same amount previously cited of n-3 fatty acids and soy. RESULTS: Serum nitric oxide metabolites showed significant increase after 90 days in the fish oil and soy groups. Systolic pressure reduced after 45 days of treatment with fish oil, whereas diastolic pressure decreased significantly throughout the study in the soy group. CONCLUSIONS: NO increase and blood pressure reduction with fish oil or soy protein reinforce the importance of the influence of NO on blood pressure in patients with MS. OBJETIVO: Verificar o efeito do óleo de peixe e soja sobre o óxido nítrico (NO) e a pressão arterial em pacientes com síndrome metabólica (SM). SUJEITOS E MÉTODOS: Sessenta mulheres com SM foram avaliadas em estudo paralelo randomizado. O primeiro grupo manteve sua dieta habitual, o segundo grupo recebeu 25 g/dia de soja, o terceiro grupo recebeu 3 g/dia de ácidos graxos n-3 e o quarto grupo, a mesma quantidade citada anteriormente de ácidos graxos n-3 e soja. RESULTADOS: Os níveis séricos de metabólitos de NO foram significativamente superiores após 90 dias de intervenção com soja ou óleo de peixe. Somente o grupo que recebeu o óleo de peixe apresentou redução na pressão sistólica após 45 dias. Já a soja reduziu a pressão diastólica em 45 e 90 dias. CONCLUSÕES: O aumento de NO e a redução da pressão arterial com óleo de peixe ou proteína de soja reforçam a influência do óxido nítrico sobre a pressão arterial em pacientes com SM.

Brazilian scientific literature on the adverse effects of lead on the general population is still very limited. Lead, a potentially toxic substance, has become a public health problem due to its effects, mainly those affecting the central nervous system and on the synthesis of heme. The aim of this study is to evaluate the level of lead exposure of donors to the Breast Milk Bank in the city of Londrina, Parana, by estimating the levels of that metal in milk and blood samples. This is a cross-sectional study conducted during the period between January and July 2007. All mothers enrolled as donors in the Breast Milk Bank were included in this study. A total of 92 volunteers presenting the following inclusion criteria were evaluated in the project: volunteers who were healthy, without any chronic disease, full-term pregnancy, breastfeeding between the 15th and 210 th day after giving birth, and living in the city of the study. Lead in milk and blood was quantified using the inductive coupled plasma mass spectroscopy (ICP-MS) technique. All mothers signed a consent form approved by the Research Ethics Committee from Londrina State University. The median lead concentration in milk samples was 3.0 microg/L, varying from 1.0 to 8.0 microg/L. The median of lead in blood was of 2.7 microg/dl, varying from 1.0 to 5.5 microg/dl. In Spearman correlation analysis, significant but modest correlations could be observed between the concentration of lead in blood and in milk (r(s)=0.207, p=0.048), hemoglobin and ALAD activity (r(s)=-0.264, p=0.011), level of lead in blood and mother's age (r(s)=0.227, p=0.029). However, for hematocrit and hemoglobin, the correlation was higher (r(s)=0.837, p0.001). No statistically significant associations were found between concentrations of lead in milk and blood and demographic variables studied, obtained through interviews and validated questionnaire. The mean of milk/blood lead ratio was equal to 0.11. In general, the values found in the present study are similar to those obtained in populations in other countries, and are within background levels.

Eur J Clin Invest 2010; 40 (4): 330–338 Abstract Background The magnitude of lipoprotein level reduction during the acute-phase response may be associated with the severity and mortality of sepsis. However, it remains to be determined whether low lipoprotein levels can be considered a risk factor for developing sepsis. We aimed to investigate lipoprotein levels as risk factors for sepsis in hospitalized patients, and also describe sequential changes in lipoprotein and cholesterol ester transfer protein (CETP) levels during sepsis. Design This is a prospective cohort study and case–control analysis from selected hospitalized patients. Blood samples were collected at admission, and participants were monitored for severe sepsis. Total cholesterol, high density lipoprotein (HDL), low density lipoprotein, and triglyceride levels were compared between sepsis cases and controls. Cholesterol, apolipoprotein, phospholipid and CETP concentrations were monitored in the case group. Results Of 1719 enrolled patients, 51 developed severe sepsis and were paired with 71 controls by age, gender, presence of infection at admission and chronic disease. HDL cholesterol level at admission was a risk factor for severe sepsis (OR = 0·969; 95% CI: 0·944–0·995). Mean CETP levels diminished between hospital admission and day 3 of sepsis. The magnitude of this variation (ΔCETP) was more pronounced in non-survivors (0·78 ± 1·08 μg mL−1) than that in survivors (0·02 ± 0·58 μg mL−1, P = 0·01). Conclusions HDL cholesterol may have a protective effect against sepsis. Each 1 mg dL−1 increase in HDL decreased the odds of severe sepsis by 3% during hospitalization. The reduction of plasma CETP was associated with mortality.

The aim of this study was to evaluate associations between seropositivity for IgG and IgM anti-Toxoplasma gondii antibodies and socio-economic and environmental variables in pregnant women of Londrina, state of Parana, Brazil. We interviewed 492 pregnant women, each of whom answered an epidemiological questionnaire, and collected blood samples for measurement of IgG and IgM anti-T. gondii antibodies by chemiluminescence. A confirmatory diagnosis of acute infection was made by an IgG avidity test. Titres of specific IgG anti-T. gondii were obtained by IFAT. Seropositivity for IgG anti-T. gondii antibodies was observed in 242 women (49.2%) and, of these, six pregnant women (1.2%) showed seropositivity for IgM. Age group, level of education, per capita income, presence of a cat in the house and a habit of eating green vegetables were all factors associated with a greater chance of infection with T. gondii. This study showed that 250 (50.8%) pregnant women were susceptible to T. gondii and considered to be at high risk for toxoplasmosis during pregnancy. Based on the results obtained, is critical to establish a program of health surveillance for toxoplasmosis, in order to contribute to diagnosis and early treatment during the prenatal period. It is also necessary to introduce measures to prevent the Toxoplasma infection in seronegative pregnant women.

ObjectiveTo find the ideal combination of Fe fortifier and its food vehicle is an essential measure in developing countries. However, its cost also plays an important role. In the present study, the effect on blood parameter values of corn flour-derived products fortified with powdered elemental Fe in the form of H2-reduced Fe was investigated in children and adolescents.MethodsOne hundred and sixty-two individuals (eighty-six boys and seventy-six girls) from public educational centres in Londrina, Paraná (southern Brazil) participated in the study. Fe-deficiency anaemia (IDA) was defined when Hb and serum ferritin values fell below 12 g/dl and 20 μg/l, respectively; Fe deficiency (ID) was considered when serum ferritin was below 20 μg/l.ResultsThe prevalence of ID and IDA decreased from 18·0 % and 14·9 %, values found at the beginning of the study, to respectively 5·6 % and 1·2 % after 6 months. Changes from altered to normal values occurred more often than normal to altered values with transferrin saturation (14·2 %v. 6·8 %;P< 0·04) and ferritin (12·4 %v. 0 %;P< 0·001). Hb, transferrin saturation and ferritin showed differences between normal and altered parameters after 6 months (P< 0·001).ConclusionA pronounced reduction in the prevalence of ID and IDA was observed in children and adolescents following 6 months’ ingestion of corn flour-derived products enriched with elemental Fe.

Chemokines and their receptors regulate the trafficking of immune cells during their development, inflammation, and tissue repair. The single‐nucleotide polymorphism (SNP) rs1801157 (previously known as CXCL12‐A/ stromal cell‐derived factor‐1 (SDF1)‐3′A) in CXCL12/SDF1 gene was assessed in breast cancer, Hodgkin's lymphoma (HL), and non‐Hodgkin's lymphoma (NHL), since the chemokine CXCL12, previously known as SDF1, and its receptor CXCR4 regulate leukocyte trafficking and many essential biological processes, including tumor growth, angiogenesis, and metastasis of different types of tumors. Genotyping was performed by PCR‐RFLP (polymerase chain reaction followed by restriction fragment length polymorphism) using a restriction enzyme HpaII cleavage. No significant difference was observed in genotype distribution between breast cancer patients (GG: 57.3%; GA: 39.8%; AA: 2.9%) and healthy female controls (GG: 62.9%; GA: 33%; AA: 4.1%) nor between HL patients (GG: 61.1%; GA:27.8%; AA: 11.1%) and healthy controls (GG: 65.6%; GA: 28.9%; AA: 5.5%), whereas a significant difference was observed in genotype distribution between NHL patients (GG: 51.4%; GA: 47.1%; AA: 1.5%) and healthy controls (GG: 65.6%; GA: 28.9%; AA: 5.5%). Further studies will be necessary to elucidate the cancer chemokine network. However, this study suggests that CXCL12 rs1801157 polymorphism may have important implications in the pathogenesis of NHL. J. Clin. Lab. Anal. 23:387–393, 2009. © 2009 Wiley‐Liss, Inc.

Numerous interactions of the immune system with the central nervous system have been described recently. Mood and psychotic disorders, such as severe depression and schizophrenia, are both heterogeneous disorders regarding clinical symptomatology, the acuity of symptoms, the clinical course, the treatment response, and probably also the etiology. Detection of p24 RNA from Borna disease virus (BDV) by the reverse transcriptase polymerase chain reaction in patients with schizophrenia, schizoaffective disorder, and in their biological relatives was evaluated. The subjects were 27 schizophrenic and schizoaffective patients, 27 healthy controls, 20 relatives without psychiatric disease, and 24 relatives with mood disorder, who attended the Psychiatric Ambulatory of Londrina State University, Paraná, Brazil. The subjects were interviewed by structured diagnostic criteria categorized according to the Diagnostic and Statistical Manual of Mental Disorders‐IV, axis I, (SCID‐IV). The mean duration of illness in schizophrenic and schizoaffective patients was 15.341±1.494 years and the median age at onset was 22.4±7.371 years. There were no significant differences in gender (P=0.297), age (P=0.99), albumin (P=0.26), and body mass index (kg/m(2)) (p=0.28), among patients, controls, and relatives. Patients and biological relatives had significantly higher positive p24 RNA BDV detection than controls (P=0.04); however, the clinical significance of BDV remains to be clarified. J. Clin. Lab. Anal. 22:314–320, 2008. © 2008 Wiley‐Liss, Inc.

Pneumonia is the most frequent hospital infection in patients admitted to intensive care units (ICU) and is also responsible for the highest lethality rates, as well as an increase in both the duration and costs of hospitalization. The objective of this study was to identify predisposing factors for pneumonia. A prospective cohort study was carried out between June 1996 and June 1997, and included 540 patients admitted consecutively for periods greater than 24 hours to the adult ICU of the Londrina State University's Teaching Hospital. Of these, 83 (15.4%) developed pneumonia. All patients were analyzed with respect to various risk factors for hospital-acquired pneumonia. Univariate analysis identified the following factors: decreased level of consciousness, craniotomy, prior use of antibiotics, mechanical ventilation, nasogastric tube feeding, enteral feeding, aspiration of gastric contents, central venous catheter and the time spent in the ICU. Multivariate analysis identified four risk factors for pneumonia in the ICU: tracheotomy (RR = 1.09; 95%CI = 1.04-1.17), nasogastric tube feeding (RR = 1.11; 95%CI = 1.05-1.18), H2-blocker use (RR = 1.09; 95%CI = 1.05-1.14) and decreased level of consciousness (RR = 2.67; 95%CI = 1.43-5.04). In 56.6% of patients, pneumonia occurred within the first four days following ICU admission. The risk factors identified were all necessary for the treatment of the patient except for decreased level of consciousness, either present at admission or occurring during hospitalization due to deterioration in the clinical condition of the patient or to the use of sedatives.

To determine the association of the HLA in 50 patients with schizophrenia, schizoaffective disorder, 48 healthy controls, 41 biological relatives without psychiatric disease, and 48 biological relatives with mood disorder, the HLA genotype at the class I and class II were determined. The subjects were interviewed by structured diagnostic criteria categorized according to DSM-IV, axis I, (SCID-IV). Significant positive association was found with HLA-B*15 in patients, family with humor disorder and without mental disorder ( p = 0.003) and negative association of the HLA-B*35 in relatives without psychiatric disease ( p = 0.03). The HLA-B*15 frequency was significantly increased in a subgroup of patients with age at onset in the early 20s, lower educational achievement, occupational disability, chronically ill, more paranoid type. These findings suggest the existence of some involvement of an immunogenetic mechanism in a subgroup of schizophrenic, schizoaffective patients, and biological relatives.

The municipality of Londrina ranks second in the number of AIDS cases in the state of Paraná, Brazil, with the Ministry of Health notified of 1070 cases from 1984 to 2002. The aim of this study was to determine the seroprevalence and risk factors for HTLV-1/2 infection in HIV-infected patients attending the AIDS Reference Center serving Londrina (and surrounding region), Paraná, Brazil. Data concerning sociodemographic conditions and risk factors were collected from 784 HIV-infected patients, using a questionnaire. Blood samples were obtained from 758 of the patients and subjected to serologic screening tests for the determination of HTLV-1/2, as well as hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis. Most patients were white (mean age, 35.9 years); 55.9% were males and 44.1% were females. The most frequent sexually transmitted disease was gonorrhea (28.5%), followed by syphilis (14.3%) and condyloma (12.2%). The major risk factors associated with the acquisition of retroviruses were sexual contact (84.8%) and intravenous drug use (IDU, 11.9%). The overall infection seroprevalence was 6.4% for HTLV-1/2, 37.2% for HBV, 21.0% for HCV, and 24.4% for syphilis. HTLV-1 and HTLV-2 infections were confirmed in 0.8 and 4.9% of patients, respectively. HIV/HTLV-1/2 coinfection was more frequent in IDUs (59.2% of cases) and was strongly associated with HCV (22.60 [95% CI, 10.35-49.35]). A weak association with HBV (2.09 [95% CI, 1.13-3.90]) and no association with syphilis were observed. The results showed that human retroviruses are circulating in southern Brazil, mainly among white people of both genders of low socioeconomic conditions and educational level. Although the sexual route was considered to be the major risk factor for HIV infection, HTLV-1/2 infection was strongly associated with IDU.

This study evaluated whether supplementation with olive oil could improve clinical and laboratory parameters of disease activity in patients who had rheumatoid arthritis and were using fish oil supplements.Forty-three patients (34 female, 9 male; mean age = 49 +/- 19y) were investigated in a parallel randomized design. Patients were assigned to one of three groups. In addition to their usual medication, the first group (G1) received placebo (soy oil), the second group (G2) received fish oil omega-3 fatty acids (3 g/d), and the third group (G3) received fish oil omega-3 fatty acids (3 g/d) and 9.6 mL of olive oil. Disease activity was measured by clinical and laboratory indicators at the beginning of the study and after 12 and 24 wk. Patients' satisfaction in activities of daily living was also measured.There was a statistically significant improvement (P0.05) in G2 and G3 in relation to G1 with respect to joint pain intensity, right and left handgrip strength after 12 and 24 wk, duration of morning stiffness, onset of fatigue, Ritchie's articular index for pain joints after 24 wk, ability to bend down to pick up clothing from the floor, and getting in and out of a car after 24 wk. G3, but not G2, in relation to G1 showed additional improvements with respect to duration of morning stiffness after 12 wk, patient global assessment after 12 and 24 wk, ability to turn faucets on and off after 24 wk, and rheumatoid factor after 24 wk. In addition, G3 showed a significant improvement in patient global assessment in relation to G2 after 12 wk.Ingestion of fish oil omega-3 fatty acids relieved several clinical parameters used in the present study. However, patients showed a more precocious and accentuated improvement when fish oil supplements were used in combination with olive oil.

Serological, epidemiological and molecular aspects of hepatitis C virus (HCV) infection were evaluated in 183 subjects from Londrina, Paraná, Brazil, and adjacent areas. Serum samples which tested anti-HCV positive by microparticle enzyme immunoassay (MEIA) obtained from eight patients with chronic hepatitis C, 48 blood donors, and 127 patients infected with the human immunodeficiency virus (HIV) were submitted to another enzyme immunoassay (ELISA) and to the polymerase chain reaction (PCR). About 78.7% of samples were also reactive by ELISA, with the greater proportion (70.8%) of discordant results verified among blood donors. A similar finding was observed for HCV-RNA detection by PCR, with 111/165 (67.3%) positive samples, with higher rates among HIV-positive subjects and patients with chronic hepatitis than among blood donors. Sixty-one PCR-positive samples were submitted to HCV genotyping, with 77.1, 21.3 and 1.6% of the samples identified as types 1, 3 and 2, respectively. Finally, analysis of some risk factors associated with HCV infection showed that intravenous drug use was the most common risk factor among HIV/HCV co-infected patients, while blood transfusion was the most important risk factor in the group without HIV infection. The present study contributed to the knowledge regarding risk factors associated with HCV infection and the distribution of HCV genotypes in the population evaluated.

This study evaluated the usefulness of the anti-HBc, hepatitis C virus antibodies (anti-HCV), human T cell lymphotropic virus I and II antibodies (anti-HTLV I/II), serologic tests for syphilis, and surface antigen of hepatitis B virus (HBsAg) as surrogate markers for the risk for HIV infection in 80,284 serum samples from blood donors from the Blood Bank of "Hospital Universitário Regional Norte do Paraná", Londrina, Paraná State, Brazil, analyzed from July 1994 to April 2001. Among 39 blood donors with positive serology for HIV, 12 (30.8%) were anti-HBc positive, 10 (25.6%) for anti-HCV, 1 (2.6%) for anti-HTLV I/I, 1 (2.6%) was positive for syphilis, and 1 (2.6%) for HBsAg. Among the donors with negative serology for HIV, these markers were detected in 8,407 (10.5%), 441 (0.5%), 189 (0.2%), 464 (0.6%), and 473 (0.6%) samples, respectively. The difference was statistically significant (p < 0.001) for anti-HBc and anti-HCV. Although the predictive positive value for these surrogate markers were low for HIV infection, the results confirmed the anti-HBc and anti-HCV as useful surrogate markers for HIV infection thus reinforcing the maintenance of them in the screening for blood donors contributing to the prevention of the small number of cases in which HIV is still transmitted by transfusion. Este estudo avaliou a utilidade dos testes sorológicos para pesquisa de anticorpos anti-antígeno "core" do vírus da hepatite B (anti-HBc), anti-vírus da hepatite C (anti-HCV), anti-vírus linfotrópico de células T humanas tipos I e II (anti-HTLV I/II), testes sorológicos para sífilis e pesquisa do antígeno de superfície do vírus da hepatite B (HBsAg) como marcadores sorológicos indiretos do risco de infecção pelo vírus da imunodeficiência humana (HIV) em 80.284 amostras de soro de doadores de sangue do Hemocentro do Hospital Universitário Regional Norte do Paraná, Londrina, do período de julho de 1994 a abril de 2001. Entre 39 doadores de sangue com sorologia positiva para HIV, 12 (30,8%) apresentaram anti-HBc, 10 (25,6%) anti-HCV, 1 (2,6%) anti-HTLV I/II, 1 (2,6%) sorologia reagente para sífilis, e 1 (2,6%) a presença de HBsAg. Entre os doadores com sorologia negativa para HIV, estes marcadores foram detectados em 8.407 (10,5%), 441 (0,5%), 189 (0,2%), 464 (0,6%), e 473 (0,6%) amostras, respectivamente. A diferença foi estatisticamente significativa (p < 0,001) para anti-HBc e anti-HCV. Embora o valor preditivo positivo para estes marcadores para a infecção pelo HIV foi baixo, os resultados confirmam a importância do anti-HBc e o anti-HCV como marcadores indiretos úteis da infecção por HIV em doadores de sangue e reforçam a sua manutenção na triagem sorológica dos doadores de sangue contribuindo para a prevenção do pequeno número de casos em que o HIV é ainda transmitido por transfusão.

Introdução e Objetivos: Comparar características clínicas e evolução dos pacientes com e sem injúria renal aguda (IRA), avaliar a incidência, mortalidade da IRA e fatores de risco de IRA e de óbito em pacientes em uma Unidade de Terapia Intensiva (UTI). Métodos: Estudo retrospectivo que analisou 152 pacientes em uma única UTI. Avaliamos a idade, o sexo, o motivo do internamento, fatores de risco para IRA, dados laboratoriais, a necessidade de terapia renal substitutiva e a mortalidade. Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA) e RIFLE foram registrados no dia de admissão na UTI. Determinamos a incidência da IRA, mortalidade e os preditores independentes de IRA e de óbito utilizando o modelo de regressão logística. Resultados: A idade média foi de 57,1 ± 20 anos e 60,1% eram masculinos. IRA não dialítica ocorreu em 81 pacientes (53,2%) e a IRA dialítica ocorreu em 19 pacientes (12,4%). A mortalidade global foi de 35,9%, enquanto que a taxa de mortalidade nos pacientes com IRA não dialítica foi de 43,2% e a dos com IRA dialítica de 84,2%. Na análise multivariada, a ventilação mecânica invasiva, a creatinina e a ureia elevadas na admissão foram fatores de risco independentes para IRA, enquanto que diagnóstico clínico, uso de ventilação mecânica invasiva, ureia e lactato aumentados e hipernatremia foram fatores de risco independentes para mortalidade na UTI. Conclusão: A incidência e a mortalidade de IRA na UTI foram elevadas neste estudo, apesar dos avanços que vêm surgindo no seu manejo. Introduction and Objectives: To compare clinical characteristics and outcomes of patients with and without acute kidney injury (AKI), to evaluate the incidence and mortality of AKI and predictors of AKI and death in patients hospitalized in an Intensive Care Unit (ICU). Methods: A retrospective study analyzed 152 patients admitted to a single ICU. We assessed age, gender, reason for hospitalization, risk factors for ARF, laboratory data, the need for renal therapy substitutive and mortality. Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA) and RIFLE were recorded on the day of ICU admission. We determined the incidence of AKI, mortality and the independent predictors of AKI and death using logistic regression model. Results: Mean age was 57.1 ± 20 years, ranging between 19 to 88 years, and 60.1% were male. Non-dialysis dependent AKI occurred in 81 patients (53.2%) while the ARF requiring dialysis occurred in 19 patients (12.4%). The overall mortality rate in the ICU was 35.9%, whereas the mortality rate in patients with non-dialysis dependent AKI was 43.2% and the IRA with dialysis of 84.2%. In multivariate analysis, invasive mechanical ventilation, elevated creatinine and urea at admission were independent risk factors for AKI, whereas clinical diagnosis, invasive mechanical ventilation, increased lactate and urea and hypernatremia were independent risk factors for ICU mortality. Conclusion: The incidence and mortality of AKI in ICU were high in this study, despite the advances that have been emerging in their management.

Objective The nursing workload consists of the time spent by the nursing staff to perform the activities for which they are responsible, whether directly or indirectly related to patient care. The aim of this study was to evaluate the nursing workload in an adult intensive care unit at a university hospital using the Nursing Activities Score (NAS) instrument. Methods A longitudinal, prospective study that involved the patients admitted to the intensive care unit of a university hospital between March and December 2008. The data were collected daily to calculate the NAS, the Acute Physiology and Chronic Health Evaluation (APACHE II), the Sequential Organ Failure Assessment (SOFA) and the Therapeutic Intervention Scoring System (TISS-28) of patients until they left the adult intensive care unit or after 90 days of hospitalization. The level of significance was set at 5%. Results In total, 437 patients were evaluated, which resulted in an NAS of 74.4%. The type of admission, length of stay in the intensive care unit and the patients’ condition when leaving the intensive care unit and hospital were variables associated with differences in the nursing workload. There was a moderate correlation between the mean NAS and APACHE II severity score (r=0.329), the mean organic dysfunction SOFA score (r=0.506) and the mean TISS-28 score (r=0.600). Conclusion We observed a high nursing workload in this study. These results can assist in planning the size of the staff required. The workload was influenced by clinical characteristics, including an increased workload required for emergency surgical patients and patients who died.

Lactobacillus plantarum has been used in human clinical trials to promote beneficial effects in the immune system, to alleviate intestinal disorders, and to reduce the risk of cardiovascular disease. It is also involved in many fermentation processes in the food industry. However, information on the fate of ingested L. plantarum is limited. In this study, 61 subjects received daily doses of fermented milk containing 2 × 10 11 cells of L. plantarum Lp115 for different periods of time. The target microorganism was monitored in the fecal microbiota via quantitative PCR (qPCR). L. plantarum was detected and quantified in all of the subjects during the ingestion periods. The differences between the L. plantarum levels at time zero and during all the different ingestion periods were statistically significant ( P = 0.001). However, at 15 and 45 days after discontinuing supplementation, the number of lactobacilli was reduced to the baseline level (those at time zero). A longer period with L. plantarum in the diet did not result in increased levels of this bacterium in the stool, based on postconsumption evaluations ( P = 0.001). The qPCR method was specific and sensitive for L. plantarum quantification in such a complex microbial environment as the gastrointestinal tract.

Fortification of food with iron is considered the best sustainable way of preventing iron deficiency when an appropriate diet is not available. The most difficult challenge is to find the ideal combination of iron fortification compound and food vehicle. We investigated the effect of cheese whey drink with 15% of frozen strawberry fortified with ferrous bisglycinate on hemoglobin values in children and adolescents.The assessed population participates in Public Educational Centers in Londrina, Paraná (southern Brazil), which assist families living in precarious socioeconomic conditions (annual income500.00 US dollars per capita). Hemoglobin was measured for 1 y with a Hemocue portable photometer. Anemia was defined as hemoglobin values below 12 g/dL. Thus, hemoglobin was verified in 467 (7 to 14 y) individuals (249 boys and 218 girls).Although anemia prevalence did not decrease after 3 mo, there was a statistically significant decrease from 41.9% at the beginning of the study to 26.4% after 6 mo (P0.001) and to 9.6% after 1 y (P0.001). Statistically significant changes (mean +/- standard deviation) were observed between children and adolescents with hemoglobin values below 11 g/dL (increase of 2.2 +/- 1.03) and above 12 g/dL (increase of 0.35 +/- 1.07; P0.0001).There was a marked reduction in the prevalence of anemia in children and adolescents after long-term fortification of whey drink with ferrous bisglycinate.

Aims To identify the prevalence of higher risk of foot ulceration and associated factors among patients with diabetes mellitus (DM) at primary health care services. Methods Individuals with DM, registered at primary health care services in a municipality in southern Brazil, were interviewed and underwent foot examinations. Their risk of ulceration was classified in accordance with the recommendations of the International Working Group on the Diabetic Foot. Poisson bivariate and multivariate analyses were performed and adjusted prevalence ratios (PR) and 95% confidence intervals (CI) were calculated. Results The prevalence of higher risk of foot ulceration among the 337 interviewees was 27.9% (95% CI 23.1–32.9). The following factors were associated with this risk: having been diagnosed with DM for more than 10 years (Adjusted-PR 1.669; 95% CI 1.175–2.373; p =0.004); having had previous diagnoses of acute myocardial infarction (Adjusted-PR 1.873; 95% CI 1.330–2.638; p p =0.019); presenting interdigital mycosis (Adjusted-PR 1.539; 95% CI 1.030–2.300; p =0.035) and calluses (Adjusted-PR 1.654; 95% CI 1.117–2.451; p =0.012). Conclusions The prevalence of higher risk of ulceration was high, which reinforces the importance of continued education for health care professionals in order to prevent complications in the feet of these patients.

The objective of the study was to identify factors associated with reports of road accidents, among motorcycle couriers in two medium-sized municipalities in southern Brazil. A self-administered questionnaire was answered by motorcycle couriers that had worked for at least 12 months in this profession. The outcomes analyzed were reports on accidents and serious accidents over the 12 months prior to the survey. Bivariate and multivariate analyses by means of logistic regression were carried out to investigate factors that were independently associated with the outcomes. Seven hundred and fifty motorcycle couriers, of mean age 29.5 years (standard deviation=8.1), were included in the study. Young age (18 to 24 years compared to ≥25 years, odds ratio[OR]=1.77) speeding (OR=1.48), and use of cell phones while driving (OR=1.43) were factors independently associated with reports of accidents. For serious accidents, there was an association with alternation of work shifts (OR=1.91) and speeding (OR=1.67). The characteristics associated with accidents—personal (young age), behavioral (use of cell phones while driving and speeding), and professional (speeding and alternation of work shifts)—reveal the need to adopt wide-ranging strategies to reduce these accidents, including better work conditions for these motorcyclists.

To describe trends in the incidence of Aids cases according to age and gender from 1986 to 2008.Analyses of Aids trends according to age group and to gender was carried out Londrina, Southern Brazil. The timeframe was divided into two periods (1986-1995 and 1996-2008). Of the polynomial models, it was the first-degree polynomial model which best explained the Aids epidemic within the two periods. The incidence rate of Aids among men who have sex with other men (MSM), injecting drug users (IDU), heterosexual men and women was calculated.During the first period, from 1986 to 1995, there was an increase in the incidence of Aids in almost all age groups and the epidemic spread across both sexes (p0.001), although this was more marked in men aged 14-39. The second period (1996-2008) did not show a positive or negative statistical increase, indicating that the epidemic had stabilized. A significant fall in the rate for the male 14 to 29 age group was found, with increases of 0.88 and 0.87 for the first and second period respectively. Cases in women aged 50 and over showed a marked increase (p = 0.019). The IDU and MSM groups predominated as the categories with the most exposure, with MSM taking over from IDU in the last three years of the study. From 2000 onwards, incidences in females aged 15 to 49 overtook that of heterosexual men.The study showed a decrease in incidence in the younger age groups and stabilization in the other age groups. There is a need for different approaches in order to reach groups with several characteristics due to the increase in the proportion of women and MSM within the exposure categories.

A cross-sectional study was conducted with 385 hypertensive patients between 20 and 79 years of age in a family health unit in Londrina, State of Parana, Brazil, to determine the adherence to pharmacological and non pharmacological treatment for arterial hypertension in primary healthcare and identify associated factors. The adherence to pharmacological treatment was 59%. Regular physical activity was reported by 68 (17.7%) hypertensive patients and 266 (69.1%) mentioned dietary changes. In the multiple regression analysis, adherence to drug treatment was associated with: increased age (50 to 79), consulting with a physician at least once a year, no regular alcohol consumption and previous myocardial infarction. Hypertensive males, with education up to 4th grade and above, who had at least one consultation per year, with diabetes or no history of high cholesterol, were more adherent to physical activity. Dietary changes were associated with education below the 4th grade and consulting with a physician at least once a year. These results show variable levels of adherence to treatment and demonstrate the importance of comprehensive actions in the care for hypertensive patients.

The present study aimed to assess mortality rates and related demographic factors among indigenous peoples in the State of Mato Grosso do Sul, Central-West Brazil, compared to the State's general population. Mortality rates were estimated based on data obtained from the Health Care Database for Indigenous Peoples and monthly patient care records as well as demographic data from the Brazilian Unified National Health System (SUS) and mortality data from the SUS Mortality Database. Compared to the overall population, among indigenous peoples there were proportionally more individuals under 15 years of age and fewer elderly, besides higher mortality rates at early ages and from infectious and parasitic diseases. Indigenous men showed significantly higher mortality rates from external causes and respiratory and infectious diseases, while among women the mortality rates from external causes and infectious diseases were higher. Suicide rates among young indigenous individuals were also particularly alarming. Indigenous people's health conditions are worse than those of the general population in Mato Grosso do Sul.

Purpose The aim of the study was to evaluate risk factors for infection and sepsis in surgical patients admitted to the intensive care unit (ICU). Materials and Methods Data were prospectively collected from a cohort of surgical patients from January 2005 to December 2007. We analyzed the incidence of infection and sepsis and certain other variables from the pre-, intra-, and postoperative periods as risk factors for infection and sepsis. Results We studied 625 surgical patients. The mortality rate was 18.2%, and the mean age of the subjects was 53.1 ± 18.8 years. The incidences of severe sepsis and septic shock were 5% and 11.5%, respectively. A multivariate analysis showed that the following variables were associated with sepsis in the postoperative period: urgent surgery (odds ratio, 2.63; 95% confidence interval [CI], 1.50-4.63), fluid resuscitation (odds ratio, 1.90; 95% CI, 1.18-3.05), vasoactive drugs (odds ratio, 2.58; 95% CI, 1.61-4.14), and mechanical ventilation (odds ratio, 5.51; 95% CI, 3.07-9.89). A Sequential Organ Failure Assessment was associated with infection or sepsis upon ICU admission (area under the curve, 0.737 ± 0.019; 95% CI, 0.748-0.825). Conclusions This study showed that sepsis has high incidence and mortality in surgical patients admitted to the ICU. Urgent surgeries, mechanical ventilation, fluid resuscitation, and vasoactive drugs in the postoperative period and Sequential Organ Failure Assessment at ICU admission were risk factors for sepsis.

Metabolic disorders are frequently observed in pediatric patients with renal lithiasis.Study the metabolic and anatomical alterations and perform the chemical analysis of stones found in children with nephrolithiasis in our region.A retrospective study on 158 children with evidence of recent renal stone formation was performed. One hundred and nine children concluded the metabolic study. Laboratory investigation consisted in two samples of 24-hour urine for calcium, uric acid, citrate, oxalate, sodium and creatinine; qualitative cystinuria, urinary pH following 12-hour fasting and water restriction, urine culture and chemical analysis when the stones were available. Renal imaging techniques included, at least, renal ultrasound and excretory urogram.A cause for nephrolithiasis was identified in 96.3% of children. The main metabolic alteration was hypercalciuria (73.4%). Chemical analysis of stones showed calcium oxalate in 90.9% of the cases. Anatomical alterations were found in 18.0% of the investigated cases and the most frequently found alteration was pyelo-ureteral duplication (28.6%).Hypercalciuria was the most frequently found disorder and pyelo-ureteral duplication was the most common anatomical alteration; moreover, calcium oxalate was the most frequent chemical constituent. The present study showed the characteristics of pediatric patients with nephrolithiasis in our region.

The human immunodeficiency virus type 1 (HIV-1) epidemic in Brazil is spreading to small municipalities as well as the innermost parts of the country and scarce information has been reported on the frequency of HIV-1 resistance-associated mutations in these areas. To determine the frequency and diversity of the HIV-1 antiretroviral resistance-associated mutations among patients failing highly active antiretroviral therapy from Londrina in Southern Brazil, 127 HIV-1 genotyping tests that were assayed during January 2000 to July 2008 from 108 patients were evaluated. Sixty-nine patients (63.9%) were male and 39 (36.1%) were female and the age ranged from 10 to 68 years (mean, 40.8+/-9.2). All of them showed at least one HIV-1 antiretroviral resistance-associated mutation and in 72 (56.7%) genotyping tests, mutations for the three antiretroviral classes were detected simultaneously. Mutations associated with resistance to protease inhibitor (PI) were detected in 124 tests (97.6%), the main ones were L90M in 28 (22.0%), V82A in 27 (21.2%), M46I in 26 (20.5%), and I54V in 23 (18.1%). The main mutations associated with nucleoside reverse transcriptase inhibitor (NRTI) resistance were M184V in 82 (64.6%), and the thymidine analog mutations were D67N in 51 (40.1%) tests, K70R in 45 (35.4%), T215Y in 40 (31.5%), and M41L in 38 (30.0%). The most frequent major mutations associated with resistance to non-nucleoside RT inhibitors (NNRTI) were K103N in 47 (37.0%), G190A in 11 (8.7%), and G190S in 2 (2.6%) tests. Mutations associated with reduced susceptibility to NRTI and IP simultaneously were observed in 46 (36.2%) tests. The results obtained may contribute to the improvement of the treatment strategies and the management of the antiretroviral drug therapy of HIV-1-infected patients from this Brazilian region, reducing public costs for antiretroviral drugs which have not been efficient in therapy.

Some sort of restriction of the pouch emptying is supported by many surgeons to allow a sustained weight loss through the use of a ring placed circumferentially around the gastric pouch. Most previous studies focused on the length of the ring, not the actual diameter of the gastric pouch outlet. This study aims to evaluate the association between the actual diameter of the gastric pouch outlet and the weight loss in obese patients submitted to silicon ring Roux-en-Y gastric bypass. We studied prospectively 257 patients that underwent silicon ring (65 mm) Roux-en-Y gastric bypass between July 2005 and August 2007. Upper digestive endoscopy was performed to measure the diameter of the gastric pouch outlet at 1 and 2 years with the aid of calibrated balloons. The diameter of the gastric pouch outlet ranged from 9 to 14 mm (mean = 11 mm). Excess weight loss ranged from 37% to 127% (mean = 69%) during the first year and 29% to 110% (mean = 69%) during the second year. A negative correlation between the diameter of the gastric pouch outlet and excess weight loss at first year (r = −0.792, p < 0.001) and at the second year of follow-up (r = −0.921, p < 0.001) was found. The actual diameter of the gastric pouch outlet was associated with weight loss after silicon ring Roux-en-Y gastric bypass during the 2-year follow-up.

The incidence and prevalence of treated end-stage chronic kidney disease (CKD) patients continue to grow throughout the world. Renal transplantation remains the preferred form of renal substitutive therapy, but given the limited number of donors, dialytic therapies are the most common modalities.To assess a registry of patients admitted for renal substitutive therapy at a single centre from 1984 to 2009.This is a retrospective epidemiological study. The following were analyzed: demographic and clinical characteristics; incidence of CKD; underlying kidney disease; dialysis modalities; mortality; and causes of death. The variables were compared by using the chi-square test, Student t test, ANOVA, and Tukey test. Kaplan-Meier curves were used to estimate patient's survival. A p value0.05 was considered statistically significant.In the period studied, 878 patients were admitted to dialysis. Their mean age was 47.0 ± 16.2 years, 549 (62.5%) were males, and 712 (81.1%) were white. The major cause of CKD was hypertension in 351 (40.0%) patients, diabetic nephropathy in 174 (19.8%), and chronic glomerulonephritis in 180 (20.5%) patients. The main dialytic modality was hemodialysis. The one-year mortality rate was 10.4%. The most common cause of death was cardiovascular, affecting 126 (34.6%) patients.The cohort of patients studied had a low mortality rate. Cardiovascular disease remains the most common cause of death in end-stage chronic kidney disease. Screening for cardiovascular disease is highly recommended for those patients.

To evaluate the application of the Sequential Organ Failure Assessment (SOFA) in describing the severity of organ dysfunctions and the associated mortality rates in critically ill patients at a teaching hospital.Prospective longitudinal study performed in 1164 adult, critically ill patients who were admitted consecutively into intensive care units between January 2004 and December 2005. We analysed static evaluation of SOFA and dynamic changes in the SOFA scores. The discriminative power of SOFA was evaluated using ROC curves.There was an increase in the mortality rate when the SOFA scores increased (chi2(trend)=272.08, p0.001, increase rate=0.13). The SOFA score on the third day in the ICU had the highest area under the curve for hospital mortality (AUC: 0.817+/-0.0133, CI 95%: 0.792-0.840). We analysed SOFA score changes with time and observed that patients with low scores (0-5) upon admission and who increased to the medium or high SOFA groups had a significantly higher mortality rate (51.7 and 100%, respectively, p0.001).Applying SOFA to critically ill patients effectively described the severity of organ dysfunctions, and higher SOFA scores had a positive association with mortality.

Objetivo: Avaliar a reprodutibilidade do teste de sobrecarga hidrica (TSH) em diferentes horarios em que e realizado, em pacientes com glaucoma primario de ângulo aberto (GPAA) e em individuos normais. Metodos: Quinze pacientes com GPAA e 30 individuos normais foram submetidos a tres TSHs, realizados em diferentes horarios do dia (as 7:00, 12:00 e 17:00), em tres dias diferentes. Foram comparados os resultados dos testes em pacientes com GPAA e individuos normais. Foram analisadas a concordância e a correlacao entre os valores de medida basal, pico e variacao de pressao intra-ocular (PIO) (pico de PIO - PIO basal) nos testes realizados nos diferentes horarios. Apenas as medidas do olho direito foram analisadas. Resultados: Os valores medios de medida basal, pico e variacao de PIO foram significativamente maiores nos pacientes glaucomatosos que nos individuos normais, em todos os horarios (p 3 mmHg), apesar de o teste de Pearson demonstrar boa correlacao entre os resultados. Conclusoes: O TSH apresenta valores de pico e variacao de Pio significativamente maiores em pacientes glaucomatosos que em individuos normais. Os baixos niveis de concordância entre os TSHs realizados em diferentes horarios do dia sugerem uma baixa reprodutibilidade do TSH, que pode limitar sua aplicabilidade para diagnostico e acompanhamento do glaucoma Ab

This study evaluated the use of the POSSUM (Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity) score for predicting mortality in surgical practice. In this study, 416 surgical patients admitted into ICUs for post-surgical care were analyzed. Both predicted and actual mortality rates were compared, according to four risk groups: 0-4%, 5-14%, 15-49%, 50% and over, and the area under the ROC curve of the POSSUM and APACHE II for mortality. The POSSUM and APACHE II scores overestimated the risk of death. The area under the ROC curve of the POSSUM was 0.762, and under APACHE II was 0.737, suggesting the use of POSSUM as an auxiliary tool to predict the risk of death in surgical patients.

To compare smokers and never smokers in terms of the following: quality of life; BMI; hospitalizations; functionality; family history of mental disorder; tobacco-related diseases; depression; and psychoactive substance use.We evaluated 167 smokers enrolled in a smoking cessation program at the Londrina State University Referral Center for Understanding and Treating Smoking, together with 272 never-smoking blood donors. We employed the following instruments, all validated for use in Brazil: a structured questionnaire for the collection of sociodemographic data; the Alcohol, Smoking and Substance Involvement Screening Test; the World Health Organization Quality of Life Instrument, brief version (WHOQoL-BREF); and the Fagerström Test for Nicotine Dependence. We also applied diagnostic criteria for the investigation of depressive disorders.The mean age of the smokers and never smokers was, respectively, 45 and 44 years. Females predominated in both groups. Smokers more often presented with impaired work/domestic functionality, hospitalizations, depressive disorders, smoking in the household, sedative use and a family history of mental disorders, as well as scoring lower in all domains of the WHOQoL-BREF. The mean age at smoking onset was lower for smokers with depression or using psychoactive substances than for smokers without such comorbidities. Diabetes, arterial hypertension, heart disease, respiratory disease and peptic ulcer were more common in smokers than in never smokers. The mean BMI was lower in the smokers than in the never smokers.This study suggests that, for smoking cessation programs, subgroups of smokers with specific characteristics (early age at smoking onset, tobacco-related diseases, depressive disorders and use of psychoactive substances) should be identified.

The objective of this study was to identify risk factors associated with pre-term birth among live births in a hospital in Londrina, Paraná State, Brazil. Cases consisted of 328 pre-term births, and controls were 369 births with gestational age greater than 37 weeks. A multiple hierarchical logistic regression analysis was carried out. There was a significant correlation (p0.05) between pre-term birth and the following variables: socioeconomic status (slum residence); low age of head-of-family; maternal BMI19 or30 kg/m2; history of prematurity; history of assisted reproduction; mothers in a relationship for less than two years; maternal stress; weekly maternal alcohol consumption; insufficient prenatal care; gestational complications such as bleeding, genital tract infection, altered amniotic fluid volume, high blood pressure, and hospital admission; and twin pregnancy. Regular walks during pregnancy were a protective factor. Improved quality of prenatal care and the identification of the above factors during pregnancy may help reduce premature birth.

To assess nutritional and metabolic evolution and inflammatory activity in severe obese patients submitted to bariatric surgery.This prospective study evaluated 56 patients (50 female and 6 male), mean age 40 + or - 9,9 years, submitted to RYGB. Nutritional, metabolic, and inflammatory parameters were assessed prior to and 12 months postsurgery.It was verified significant decreases in weight loss in relation to baseline values from 138 + or - 28,8 to 90 + or - 19,5 kg (p0,0001), glucose levels from 116 + or - 47,3 to 84 + or - 9,8 mg/dL (p0,0001), triacylglycerol levels from 137 + or - 61,4 to 84 + or - 38,6 mg/dL (p0,0001), and also in total cholesterol from 189 + or - 41,6 to 166 + or - 36,4 mg/dL (p0,0001) and LDL-cholesterol from 119 + or - 36,1 to 104 + or - 30,7 mg/dL (p0,0005). C-reactive protein levels reduced from 11,33 + or - 10,82 to 3,62 + or - 4,49 mg/dL (p0,0001). Although maintenance of iron levels was verified after one year, there was a significant decrease in hemoglobin from 13 + or - 1,3 to 12 + or - 1,4 g/dL (p0,01), and reduction in ferritin levels, especially in women who showed a decrease from 101,2 + or - 123,3 to 85,0 + or - 101,9 (p0,03).Therefore, weigh loss in patients with severe obese after RYGB showed improvement in both metabolic and inflammatory status and may reduce substantially co-morbidities associated with increased cardiovascular risk.

The frequency of CCR5-Delta32 allele in human immunodeficiency virus type 1 (HIV-1) infection in the southern Brazilian population was determined in a cross-sectional study carried out from October 2001 to June 2004. Genomic DNA was extracted from peripheral blood cells of 134 healthy blood donors, 145 HIV-1-exposed seronegative individuals, 152 HIV-1-seropositive asymptomatic individuals, and 478 HIV-1-seropositive individuals with AIDS. A fragment with 225 base-pairs of the CCR5 gene was amplified by polymerase chain reaction. The CCR5-Delta32 homozygous deletion was observed in 2 (1.5%) blood donors and in 1 (0.7%) individual HIV-1-exposed seronegative, and was absent among all the HIV-1-seropositive individuals (Fisher's exact test, p=0.0242). The frequency of the homozygous CCR5-Delta32 deletion in the HIV-1-exposed did not differ when compared with that observed in the HIV-1 seronegative blood donors (Fisher's exact test, p=0.6093; OR: 2.18, 95% CI: 0.11-129.6). The wild-type genotype CCR5/CCR5 frequency was higher among the HIV-1-seropositive with AIDS compared to HIV-1 seropositive asymptomatic individuals (Chi-square test, p=0.0263; OR: 2.02, 95% CI: 1.03-3.97). The absence of the homozygous deletion of CCR5-Delta32 among HIV-1-seropositive individuals underscored that this genotype is an important genetic factor associated with the decreased susceptibility to HIV-1 infection. The higher frequency of heterozygosity for the CCR5-Delta32 and the CCR5-Delta32 allele in HIV-1 seropositive asymptomatic compared to HIV-seropositive with AIDS individuals also underscored that this deletion could be associated with the delay of the HIV-1 disease progression in this population. However, the low frequency of CCR5-Delta32 homozygosity observed among HIV-1-exposed seronegative individuals shows that the allele could not explain, by itself, the natural resistance to HIV-1 infection and different mechanisms of protection against HIV-1 infection that must be involved in this population.

Some measures have been put into practice in Brazil over the last few years, to reduce the mortality due to road traffic-related injuries. The present study had the aim of evaluating the trends and characteristics of mortality due to this cause among the inhabitants of a medium-sized Brazilian city that has good-quality mortality data.This was a time series study carried out using consolidated data from the Ministry of Health, covering 1994 to 2005.The results indicate that the obligatory use of seat belts in urban areas (starting in September 1995), implementation of speed control radar at some strategic points (end of 1995 and 1996), and introduction of prehospital attention for victims of road traffic events (starting in June 1996) had a small impact on mortality among victims of road traffic injuries, which continued at a high rate (more than 35 per 100,000 population). In 1999, the year after a new national road traffic code had been implemented, a larger reduction in mortality levels was observed (to 27.2 per 100,000). However, this downward trend was not maintained over subsequent years, with mortality levels continuing to be around 23 to 29 per 100,000 population. Pedestrians, motorcyclists, elderly people, and men were the victims at highest risk of death.This study shows that, despite the general reduction in mortality rate after the new road traffic code was introduced, this trend was not maintained over subsequent years. This shows the need for new strategies aimed at reducing road traffic deaths in towns, particularly among pedestrians and motorcyclists.

There are few studies about the consumption of medication by adults in Brazil. Therefore, the purpose of this research was to identify the profile of medication consumption and associated factors among adults aged 29 to 59 years old. This is a cross-sectional study. The sample included 374 individuals from the area of a family health unit in the city of Ponta Grossa, State of Paraná. The interviews were conducted from December 2006 to January 2007, with a 7-day recall. The medications were classified according to the Anatomical Therapeutic Chemical Classification. Qui-square test and logistic regression were used for statistical analysis. The prevalence of medication consumption was 67.1%. The use varied from 1 to 17 drugs. Analgesics were the therapeutic class most consumed. After multivariate analysis, the variables which remained significantly associated to use were: gender, self-perception of health, presence of chronic diseases, and access to a health plan. Commercial pharmacy was the main place for obtaining medicines (63.6%). The prevalence of medication consumption was similar to that found in national and international studies. The findings in this research may be a guide for the actions of family health teams.

ObjectiveTo determine the prevalence of metabolic syndrome (MetS) in schoolchildren from 6 to 16 years old, while considering their socio-economic status and other potential risk factors.DesignA cross-sectional study was conducted between April and November of 2005 in a semi-rural city with a total population of 13 000 inhabitants.SettingThe study was conducted in Maracai city, located in the Brazilian state of Sao Paulo.SubjectsSchoolchildren (n 2170) of both genders, corresponding to approximately 82 % of all Maracai schoolchildren, were evaluated for components of MetS, as defined by the National Cholesterol Education Program; reference values for children and adolescents were adjusted for age and sex.ResultsOverall, MetS prevalence was 3·6 % (95 % CI 2·9, 4·5) and did not differ statistically between genders, skin colour, between children and adolescents. However, when we analysed groups of subjects by weight, MetS prevalence progressively increased from 0·3 % (95 % CI 0·1, 0·8) in normal-weight subjects to 10·7 % (95 % CI 7·4, 14·8) and 34·5 % (95 % CI 25·9, 43·9) in overweight and obese subjects, respectively (both P < 0·001 compared to normal-weight controls). When socio-economic classes were considered, 4·7 % high-income students (95 % CI 3·5, 6·2) had MetS, which was significantly greater than low-income students (2·7 %; 95 % CI 1·9, 3·9; P = 0·023).ConclusionsMetS prevalence was high in overweight and obese schoolchildren and these risk factors were present during childhood and adolescence. Changes in lifestyle and alimentary safety should be encouraged to avoid future cardiovascular morbidity and type 2 diabetes mellitus.

PURPOSE: To determine the prevalence of early and late-stage age-related macular degeneration (ARMD) and its association with risk factors such as age, gender, smoking, body mass index, hypertension and diabetes history, cataracts and pseudophakia. Design: Population-based cross-sectional study in an elderly Japanese-Brazilian population from Londrina (Parana, Brazil). METHODS: The study included 483 (80.5%) of the 600 registered members of a local association for Japanese immigrants and their descendants, aged 60 years and up. The presence of early and late-stage age-related macular degeneration was determined using the standard protocol and the international classification system. RESULTS: The mean age of the study subjects was 71 years. The overall prevalence of age-related macular degeneration was 15.1% (CI 95%; 12-18.7). The prevalence of early-stage age-related macular degeneration was 13.8% (CI 95%; 10.9-17.3), geographic atrophy was present in 0.4% and neovascular age-related macular degeneration in 0.8%. Age-related macular degeneration was significantly (p=0.004) and linearly (p=0.001) associated with age. CONCLUSION: Our study population displays a prevalence of early and late-stage age-related macular degeneration and component lesions similar to those of other Western countries, and data suggest a higher prevalence than that reported for populations in Japan. Since the age-related macular degeneration prevalence tends to rise as the population ages, studies identifying risk factors and exploring prevention methods are becoming increasingly important.

Homicides are the main cause of non-natural death in Brazil and studies about them may contribute to their control. The objective of this study was to verify mortality rates due to homicides and legal interventions among young men in the State of Paraná, Brazil, and to identify correlated municipal characteristics. An ecological study was conducted, having the municipalities of the State as units of analysis. Mortality rates of homicides and legal interventions among men from 15 to 29 years of age were calculated for the years 2002-2004 and demographic and social municipal indicators were obtained. Mortality rate in the State was 94.8 per one hundred thousand. The size of the population, the proportion of young people aged 15 to 24 years, the proportion of enrollments in universities and the Gini index were the main indicators correlated to homicide mortality (p0.0001). Mortality rates were highest in municipalities of metropolitan regions, in those located at the border with Paraguay and in those located in the way between them and the Southeast Region of Brazil. Mortality rates and the proportion of deaths due to firearms increased with the size of the municipality. The greater number of youth and easier access to firearms and illicit drugs in such places may be influencing on these rates.

A cross-sectional study was carried out in order to describe the epidemiological, immunological and virological characteristics, and the disease progression of hepatitis C virus (HCV)/human immunodeficiency virus type 1 (HIV-1)- co-infected patients from a southern Brazilian population. Of 778 HIV-1-infected individuals enrolled in the study from September 2001 to December 2003, and followed up until June 2004, 757 were tested for anti-HCV antibodies. Of these, 159 (21.0%) showed positive results for anti-HCV. Males, individuals in the 25 to 34 year age range, and individuals of lower economic levels were more likely to be seropositive for both viruses [prevalence rate (PR), 2.04; 95% confidence interval (95% CI), 1.43-2.92; p

To describe the levels of non-HDL cholesterol and correlated factors in a group of Brazilian male and female children and adolescents.From March to October 2002 we evaluated 2,029 schoolchildren from 7 to 17 years old in the town of Maracaí, São Paulo, Brazil. The biochemical determinations of triglycerides, total cholesterol, and high-density lipoprotein (HDL) cholesterol were carried out using enzymatic reactions and the Vitros 750 analyzer. Low-density lipoprotein (LDL) cholesterol levels were calculated using the Friedewald formula: LDL cholesterol = total cholesterol-HDL cholesterol-(triglycerides/5). Non-HDL cholesterol was calculated by subtracting HDL cholesterol from total cholesterol.The correlation between non-HDL cholesterol levels and LDL cholesterol levels was 0.971 (P0.001). Non-HDL cholesterol had a stronger correlation than did LDL cholesterol with all the variables under study: total cholesterol, triglycerides, HDL cholesterol, very low-density lipoproteins, body mass index, and waist circumference. The non-HDL cutpoints identified as corresponding to the four cutpoints of LDL cholesterol (110, 130, 160, and 190 mg/dL) indicating the need to treat dyslipidemia in children and adolescents were, respectively: 127.8, 149.2, 181.2, and 213.2 mg/dL.Our findings contribute toward estimating non-HDL levels in Brazilian children and adolescents. The results also indicate that non-HDL cholesterol is a reliable and less costly method for researching the presence of dyslipidemias in this age group.

The CCR5 chemokine receptor has been implicated in the pathogenesis of multiple sclerosis (MS). This research was carried out to investigate the association between the CCR5-Delta32 deletion in 124 patients with MS from Southern Brazil. Ninety-eight (79.0%) patients presented with relapsing-remitting MS (RR-MS), 17 (13.7%) secondary progressive MS (SP-MS), 8 (6.5%) primary progressive MS (PP-MS) and one (0.8%) clinically isolated syndrome (CIS). The control group consisted of 127 healthy blood donors from the same geographic region. The disease severity was assessed clinically using the Expanded Disability Status Scale (EDSS). Genomic DNA was extracted from peripheral blood cells and the genetic polymorphism was evaluated by polymerase chain reaction. Of the MS patients, 85 (68.5%) were females (p=0.0093). The CCR5-Delta32 frequency among the controls was 5.5%, and did not differ from that observed among the MS patients (4.8%) (p=0.7337). The mean (+/-SD) age at disease onset among the carriers and non-carriers of the CCR5-Delta32 allele was 31.7 (+/-11.1) and 36.6 (+/-12.0) years, respectively (p=0.1312). The duration (+/-SD) of the disease was 11.2 (+/-12.9) and 7.7 (+/- 5.6) years among the CCR5-Delta32 heterozygous, and CCR5 wild type, respectively (p=0.396). The mean (+/-SD) EDSS among the MS patients carriers and non-carriers of the CCR5-Delta32 allele was 2.4+/-1.2 and 2.67+/-2.2, respectively (p=0.9796). The MRI findings in MS patients with the CCR5-Delta32 genotype exhibited lower positive gadolinium enhancing-imaging (p=0.0013) and lower brain atrophy (p=0.1333) than MS patients with the CCR5 wild-type genotype. Despite that the differences were not significant, the results suggested that the disease onset and progression to disability may be prolonged in MS carriers of CCR5-Delta32, and CCR5-Delta32 could be considered a favorable prognostic biomarker of MS. Further studies comprising larger numbers of individuals carrying non-wild-type haplotypes are needed to determine CCR5-Delta32 involvement in the specific process of MS pathology and pathogenesis.

The present study evaluated the breastfeeding practice of 278 preterm infants born at the University Hospital of Londrina, Paraná, Brazil, during hospitalization and in the first 6 months of life. Data were obtained from the hospital records, and the mothers were interviewed by home visit (75.5%) or by telephone (24.5%) when the children were 6 months old. Data were analyzed statistically using the Kaplan-Meier survival method and Cox's multivariate regression model. During hospitalization, 100% of the preterm infants received human milk and 31% received exclusive breastfeeding. The median duration of exclusive breastfeeding and breastfeeding was 63.5 and > 180 days, respectively. The prevalence of breastfeeding in the sixth month was 54.7%, and 6.8% of the infants were still exclusively breastfed. Pacifiers were used (currently using or ever used) by 127 (45.7%) preterm infants and were associated with a 1.67 times higher risk of interruption of exclusive breastfeeding. J Hum Lact. 23(3):269-274.

Homocysteine is a risk factor for atherosclerosis in the general population, and serum homocysteine levels are almost universally elevated in chronic renal failure patients. When such patients are treated with dialysis, cardiovascular disease accounts for more than 50% of their mortality, which, in some proportion, may be pathophysiologically related to the elevated serum homocysteine levels. From April 2003 to March 2005, we conducted a 2-year, double-blind, randomized, placebo-controlled trial of 186 patients with end-stage kidney disease due to any cause, who were older than 18 years and stable on hemodialysis. Patients were assigned to receive either oral folic acid 10 mg 3 times a week immediately after every dialysis session under nurse supervision or an identical-appearing placebo for the entire study. On admission, plasma total homocysteine (tHcy) levels were above 13.9 micromol/L in 96.7% of patients (median 25.0 micromol/L, range 9.3-104.0 micromol/L). In the placebo group, tHcy levels remained elevated at 6, 12, and 24 months, while oral folate significantly decreased tHcy to a median value of 10.5 (2.8-20.3) micromol/L, (p

The human immunodeficiency virus type 1 (HIV-1) epidemic is increasing in Brazil, and little information has been reported about the genetic host factors related to HIV-1 infection in the Brazilian population. A polymorphism in the conserved 3' untranslated region of the stromal cell-derived factor 1 (SDF1/CXCL12) gene has been related either to resistance to HIV-1 infection and delayed progression to AIDS or to rapid disease progression and death. A longitudinal study was conducted to evaluate the association of the SDF1 polymorphism and the progression of HIV-1 infection in 161 asymptomatic patients infected with HIV-1 (ASYMPT) and 617 patients with AIDS (SYMPT) from Londrina and the surrounding region, southern Brazil. The endpoints used were the development of AIDS, death, and the slopes of the CD4+ T cell counts and HIV-1 RNA plasma levels. Among the 161 ASYMPT patients, all of the 7 patients (4.3%) homozygous for the mutation remained asymptomatic (p=0.1906); 6 of them had not initiated antiretroviral therapy. Among the 617 patients with AIDS, 40 (6.5%) progressed to death. Of these, 33/388 (8.5%) did not have the SDF1-3'A allele, 6/196 (3.1%) were heterozygous and 1/33 (3.0%) was homozygous for the SDF1-3'A allele (p=0.029). The SDF1 genotypes were not associated with the surrogate markers of HIV-1 disease progression such as the CD4+ T cell decline and plasma HIV-1 RNA levels. The results observed in this study support the hypothesis that the mutation of SDF1-3'A could have a possible late-stage protective effect on HIV-1 disease progression in the Brazilian population.

The current diagnosis of human T-lymphotropic virus type-2 (HTLV-2) infection is based on the search of specific antibodies; nevertheless, several studies conducted in Brazil pointed deficiencies of the commercially available kits in detecting HTLV-2, mostly in HIV/AIDS patients. This study searched for the presence of HTLV-1 and -2 in 758 HIV/AIDS patients from Londrina, Paraná, Brazil. Serum samples were screened for HTLV-1/2 antibodies using two EIA kits (Vironostika and Murex), and confirmed by WB (HTLV Blot 2.4, Genelabs). The results obtained by EIA disclosed 49 (6.5%) reactive sera: 43 positive by both EIA kits, and six with discordant results. WB confirmed HTLV-1 infection in seven samples (0.9%) and HTLV-2 in 21 sera (2.8%). Negative and indeterminate results were detected in four (0.5%) and 16 (2.1%) sera, respectively. Blood from 47 out of 49 HTLV seroreactive patients were collected and analyzed for the presence of env, LTR and tax genomic segments of HTLVs by PCR. PCR confirmed six cases of HTLV-1 and 37 cases of HTLV-2 infection (14 out of 16 that were found to be WB indeterminate). Restriction analysis of the env PCR products of HTLV-2 disclosed 36 isolates of HTLV-2a/c subtype, and one of HTLV-2b subtype. These results emphasize the need of improving serologic tests for detecting truly HTLV-2 infected patients from Brazil, and confirm the presence of HTLV-2b subtype in the South of this country.