Search

O objetivo deste trabalho foi avaliar linhas quase isogênicas de trigo com o caráter permanência verde e de maturação sincronizada quanto à tolerância ao alumínio e à sensibilidade ao ácido giberélico (AG3). O experimento foi conduzido no Laboratório de Duplo-haplóides e Hidroponia da FAEM/UFPel, em delineamento de blocos ao acaso, com parcelas subdivididas com três repetições, através do teste simultâneo utilizando solução nutritiva com concentrações de 10mg L-1 de Al3+ e 100mg L-1 de AG3. Foram determinados: a inserção da 1feminine folha, o comprimento da 1feminine folha, a inserção da 2feminine folha, comprimento da 2feminine folha, diferença da inserção entre a 1feminine e 2feminine folha, estatura de plântula, estatura de planta, área foliar, área radicular e o crescimento de raiz. Os caracteres estatura da plântula, inserção da 1feminine folha e comprimento da 2feminine folha foram os mais expressivos para a seleção de indivíduos com estatura reduzida através da reação do AG3. O grupo do caráter permanência verde apresentou maior insensibilidade à ação do AG3, enquanto o grupo de plantas sincronizadas proporcionou maior tolerância ao Al3+. Contudo, existe possibilidade de selecionar linhas quase isogênicas dentro do grupo permanência verde com tolerância ao Al3+ e insensibilidade ao AG3 através da técnica de cultivo hidropônico com solução nutritiva em ambiente controlado.

Objective: To estimate the prevalence of restless legs syndrome/Willis-Ekbom disease (RLS/WED) and its impact on sleep and quality of life in children and adolescents., Methods: This was a cross-sectional study conducted in the Municipality of Cássia dos Coqueiros, Brazil. Participants included 383 children and adolescents 5-17 years of age. A comparison group was randomly matched by gender and age with the RLS/WED-affected individuals, pairing one by one., Results: Interviews were conducted for 383 individuals by a neurologist experienced in sleep medicine. RLS/WED was diagnosed using the essential clinical criteria for definitive RLS/WED in children recommended by the International Restless Legs Syndrome Study Group. Sleep and quality of life were evaluated using the Sleep Behavior Questionnaire (SBQ) and the Health-related Quality of Life Questionnaire─Pediatric Quality of Life Inventory (PedsQL). Comparisons were established with a group of randomly selected individuals without RLS/WED, matched by age and gender (control group). The prevalence of RLS/WED symptoms that manifested at least twice a week was 1.9%. The average age of children with RLS/WED was higher compared to the general population (11.5 ± 2.3 vs 9.9 ± 2.5, p < 0.005). A family history of RLS/WED was detected in 90.9% of the patients. The scores obtained by SBQ were higher (53.9 ± 9.4 vs 47.6 ± 10.9, p < 0.047), whereas the scores achieved by PedsQL were lower (69.8 ± 14.8 vs 81.9 ± 10.4, p < 0.003) in children with RLS/WED compared to controls., Conclusion: The prevalence of RLS/WED symptoms manifested at least twice in the preceding week was 1.9% in children and adolescents. Worsened sleep and quality of life were observed in the study., (Copyright © 2016 Elsevier B.V. All rights reserved.)

In this work the mass transfer characteristics in a µ-tube that simulates a simplified dentinal tubule geometry are numerically investigated. The aim is to assess the key features that affect transdentinal diffusion of substances and consequently to define the necessary quantitative and qualitative issues related to a specific bioactive agent before its potential application in clinical practice. CFD simulations were performed in an S-shaped tapered micro-tube, while the code was validated using the non-intrusive optical measuring technique Laser Induced Fluorescence (LIF). As the phenomenon is one-dimensional, diffusion dominated and strongly dependent on the molecular size, the time needed for the concentration of released molecules to attain a required value can be controlled by their initial concentration. Thus, we propose a model, which is successfully verified by experimental data using a dentinal disc and which given the type of applied molecules and their critical pulpal concentration is able to estimate the initial concentration to be imposed., (Copyright © 2016 IPEM. Published by Elsevier Ltd. All rights reserved.)

Objective: to describe the cases of violence against children reported in Ribeirão Preto-SP, Brazil., Methods: this was a descriptive study using data provided by the Violence and Accidents Surveillance System (VIVA), of the Municipal Health Department of Ribeirão Preto-SP, Brazil, from 2006 to 2008., Results: a total of 498 cases of violence against children (0-9 years old) were reported in the period, with an increase in the number of notifications, from 112 in 2006 to 197 in 2008; 79.3% of the notifications came from the Health area; and most children were female (56.4%), aged between two and five years old (over 60%); most aggressors were male (53.6%) and the father figure stood out (22.7%); physical aggressions were the most frequent (59.2%) and the most frequent place of the occurrence was the family household (75.5%)., Conclusion: most victims were female, abused by men, mostly fathers and other family members, at the family household.

Objective: It was to identify trends of traumatic and non-traumatic causes of lower limb amputations, as well as the role played by population aging, traffic violence increase, public health policy of diabetes control program and drivers anti-alcohol laws on these amputations., Method: Hospitalization data recorded in the discharge forms of 32 hospitals located in the region of Ribeirão Preto, Brazil, from 1985 to 2008 were analyzed., Result: A total of 3,274 lower-limb amputations were analyzed, of which 95.2% were related to non-traumatic causes, mainly infectious and ischemic complications of diabetes mellitus. Cancer (2.8%) and congenital (1.3%) causes were included in this group. Only 4.8% were related to traumatic causes. Traumatic amputation average rate was 1.5 amputations in 100,000 habitants with a slight tendency of increase in the last 5 years. Non-traumatic causes showed an average rate of 30.0 amputations for 100,000 habitants and remained relatively constant during the whole period. Non-traumatic were much more predominant in patients older than 60 years and traumatic amputations occurred more frequently in patients younger than 39 years., Conclusion: The overall rates of amputation and the rates of traumatic and non-traumatic amputations remained nearly constant during the study period. The impact of diabetes control policies and the introduction of traffic safety laws could not be identified on the amputation rates.

Introduction: This study investigated the knowledge of users of primary healthcare services living in Ribeirão Preto, Brazil, about dengue and its vector., Methods: A cross-sectional survey of 605 people was conducted following a major dengue outbreak in 2013., Results: Participants with higher levels of education were more likely to identify correctly the vector of the disease., Conclusions: The results emphasize the relevance of health education programs, the continuous promotion of educational campaigns in the media, the role of the television as a source of information, and the importance of motivating the population to control the vector.

Objective: To generate a global reference for caesarean section (CS) rates at health facilities., Design: Cross-sectional study., Setting: Health facilities from 43 countries., Population/sample: Thirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10,045,875 women giving birth from 43 countries for model testing., Methods: We hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three-step approach to generate the global benchmark of CS rates at health facilities: creation of a multi-country reference population, building mathematical models, and testing these models., Main Outcome Measures: Area under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate., Results: According to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C-Model, with summary estimates ranging from 0.832 to 0.844. The C-Model was able to generate expected CS rates adjusted for the case-mix of the obstetric population. We have also prepared an e-calculator to facilitate use of C-Model (www.who.int/reproductivehealth/publications/maternal&#95;perinatal&#95;health/c-model/en/)., Conclusions: This article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C-Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS., Tweetable Abstract: The C-Model provides a customized benchmark for caesarean section rates in health facilities and systems., (© 2015 World Health Organization; licensed by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.)

The objective of this study was to characterize admissions to an emergency hospital due to suicide attempts and verify outcomes in 2 years. Data were collected from medical records and were analyzed using descriptive statistics and logistic regression. The sample consisted of 412 patients (58.7% women; mean age = 32.6 years old, SD = 14.3). Self-poisoning was the most frequent method (84.0%), and they were diagnosed mainly as depressive (40.3%) and borderline personality disorders (19.1%). Previous suicide attempts and current psychiatric treatment were reported by, respectively, 32.0% and 28.4%. Fifteen patients (3.6%, 9 males) died during hospitalization. At discharge, 79.3% were referred to community-based psychiatric services. Being male (OR = 2.11; 95% CI = 1.25-3.55), using violent methods (i.e., hanging, firearms, and knives) (OR = 1.96; 95% CI = 1.02-3.75) and psychiatric treatment history (OR = 2.58; 95% CI = 1.53-4.36) were predictors for psychiatric hospitalization. Of 258 patients followed for 2 years, 10 (3.9%) died (3 suicide), and 24 (9.3%) undertook new suicide attempts. Patients with a history of psychiatric treatment had higher risks of new suicide attempts (OR = 2.46, 95% CI = 1.07-5.65). Suicide attempters admitted to emergency hospitals exhibit severe psychiatric disorders, and despite interventions, they continue to present high risks for suicide attempts and death.

Introduction: Hepatitis B and C viral infections remain an important cause of global morbidity and mortality. Studies have been conducted in population groups of large cities, leaving gaps in the knowledge regarding the situation in small municipalities. We aimed to measure the prevalence of hepatitis B and C markers and presence of infection-associated factors., Methods: All inhabitants of Cássia dos Coqueiros aged ≥18 years who agreed to participate in the research were included. We collected blood as well as information via a questionnaire between March 2011 and December 2013. Univariate and multivariate analyses were conducted., Results: Among the 1,001 participants, 41 (4.1%) participants had a serological profile of hepatitis B viral exposure, and only one (0.1%) participant was considered a virus carrier. The frequency of isolated antibody to hepatitis B virus surface antigen (anti-HBs) markers was 17.8% for the overall population. In the multivariate analysis, hepatitis B virus (HBV) infection was associated with age, birth outside the State of São Paulo, history of hepatitis, ≥2 sexual partners in the last 6 months, and tattoos. Four (0.4%) participants had a serological profile of hepatitis C viral exposure. However, after confirmation using viral ribonucleic acid (RNA) evaluation, only one (0.1%) individual remained positive., Conclusions: The positivity rates for hepatitis B and C were low, despite greater sexual freedom and the recent emergence of illicit drugs, as observed by the health personnel working in Cássia dos Coqueiros.

The need for simulation models to thoroughly test the inflammatory effects of dental materials and dentinogenic effects of specific signaling molecules has been well recognized in current dental research. The development of a model that simulates the transdentinal flow and the mass transfer mechanisms is of prime importance in terms of achieving the objectives of developing more effective treatment modalities in restorative dentistry. The present protocol study is part of an ongoing investigation on the development of a methodology that can calculate the transport rate of selected molecules inside a typical dentinal tubule. The transport rate of biological molecules has been investigated using a validated CFD code. In that framework we propose a simple algorithm that, given the type of molecules of the therapeutic agent and the maximum acceptable time for the drug concentration to attain a required value at the pulpal side of the tubules, can estimate the initial concentration to be imposed.

Introduction: Although deaf people are exposed to hepatitis B and C risk factors, epidemiological studies regarding these diseases in deaf people are lacking., Methods: After watching an explanatory digital versatile disc (DVD) in Brazilian Sign Language, 88 deaf people were interviewed and tested for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), hepatitis B core antibody (anti-HBc), and hepatitis C virus antibody (anti-HCV)., Results: The prevalence of hepatitis B markers was 8%; they were associated with incarceration and being born outside the State of São Paulo. No cases of hepatitis C were identified., Conclusions: Participants showed a substantial lack of knowledge regarding viral hepatitis, indicating a need for public policies that consider linguistic and cultural profiles.

Introduction: Few studies have evaluated the factors involved in the spontaneous HBsAg seroclearance in patients with chronic hepatitis B (HBV) followed up on a long-term basis from areas with a low prevalence of HBV infection. We aimed to determine the rate of spontaneous HBsAg seroclearance and the factors related to it in patients with chronic HBV infection followed up at the Hepatitis Outpatient Clinic of HCFMRP from 1992-2008., Materials and Methods: A total of 548 patients with chronic HBV infection (366 with chronic hepatitis B and 182 inactive carriers) were followed for 15 years and 9 months with an annual measurement of HBV-DNA, ALT, AST and GGT (average of 4 annual determinations) and serology (HBsAg, HBeAg, Anti-HBeAg and Anti-HBsAg)., Results: Spontaneous HBsAg seroclearance occurred in 40 patients (7.3%) with a mean age of 46.0 ± 14.4 years, corresponding to an annual rate of 0.7%.The factors related to spontaneous HBsAg seroclearance were inactive carrier status (67.5 vs. 32.5%, p = 0.000191) and age of more than 40 years (p = 0.0007). There was no difference in the rate of spontaneous HBsAg seroclearance when comparing males and females (p = 0.383). Patients with spontaneous HBsAg seroclearance did not progress to more severe forms of the disease during follow-up., Conclusion: Spontaneous HBsAg seroclearance has a favorable long-term prognosis in patients with chronic HBV infection. HBsAg seroclearance occurred at rates compatible with low prevalence areas and was associated with low serum HBV-DNA levels and an age older than 40 years.

Introduction: Hepatitis C virus (HCV) is primarily transmitted via contact with the blood of infected patients, although the form of contact has not been identified for a significant percentage of carriers. The present study evaluated possible risk factors for HCV transmission in a medium-sized town located in the northwest region of the State of São Paulo., Methods: This was a case-control study, with the case group consisting of 190 chronic HCV carriers older than 18 years residing in the municipality of Catanduva. The control group also consisted of 190 individuals with HCV-negative serology. The groups were paired (1:1) for gender, age range (± five years), and place of residence. The same structured questionnaire was applied to all subjects, who gave written informed consent to participate in the study. The data were statistically analyzed using crude and adjusted logistic regression, and the results were expressed as odds ratios with a 95% confidence interval., Results: The demographic profiles of the groups indicated a predominance of males (68.9%) and mean ages of 47.1 years (case group) and 47.3 years (control group). After adjusting for conditional regression, the following factors were found to represent risks for HCV: history of sexually transmitted disease (STD) and blood transfusion; accidents with syringes and/or needles; tattoos; and the use of non-injectable drugs and injectable medications., Conclusions: The transmission of HCV via the blood route has been well characterized. Other forms of contact with human blood and/or secretions are likely to transmit the virus, although with a lower frequency of occurrence.

Introduction: In recent years, hantavirus infections producing severe diseases have obtained an increased attention from public health authorities from the countries of Eurasia to the Americas. Brazil has reported 1,300 cases of hantavirus cardiopulmonary syndrome (HCPS) from 1993 to 2010, with about 80 of them occurring in the northeast of the State of São Paulo, with 48% fatality rate. Araraquara virus was the causative agent of HCPS in the region. Considering that hantaviruses causing human disease in the Americas were unknown until 1993, we have looked for hantavirus infections in the population of Cássia dos Coqueiros county, northeast of the State of São Paulo, Brazil, before this time. This county has about 2,800 inhabitants and an economy based on agriculture, including cultivation of Brachiaria decumbens grass. The grass seeds are an important rodent attraction, facilitating transmission of hantavirus to man. Four HCPS cases were reported so far in the county., Methods: In this study, 1,876 sera collected from 1987 to 1990 were tested for IgG to hantavirus by IgG-ELISA, using the N recombinant protein of Araraquara virus as antigen., Results: Positive results were observed in 89 (4.7%) samples, which were all collected in 1987. The positivity among urban inhabitants was 5.3%, compared with 4.3% among those living in rural areas., Conclusions: Our results showed that hantavirus infections occurred in Cássia dos Coqueiros, completely unrecognized, even before hantaviruses were described in the Americas.

In order to assess the contribution of different parenteral routes as risk exposure to the hepatitis C virus (HCV), samples from nine surveys or cross-sectional studies conducted in two Brazilian inland regions were pooled, including a total of 3,910 subjects. Heterogeneity among the study results for different risk factors was tested and the results were shown to be homogeneous. Anti-HCV antibodies were observed in 241 individuals, of which 146 (3.7%, 95% CI = 3.2-4.4) had HCV exposure confirmed by immunoblot analysis or PCR test. After adjustment for relevant variables, a correlation between confirmed HCV exposure and injection drug use, tattooing, and advance age was observed. In a second logistic model that included exposures not searched in all nine studies, a smaller sample was analyzed, revealing an independent HCV association with past history of surgery and males who have sex with other males, in addition to repeated injection drug use. Overall, these analyses corroborate the finding that injection drug use is the main risk factor for HCV exposure and spread, in addition to other parenteral routes., (Copyright © 2012 Wiley Periodicals, Inc.)

Objective: This study aimed to investigate the frequency of positive results for hepatitis B and C, HIV and syphilis in blood donations at the Centro Regional de Hemoterapia de Ribeirão Preto, to describe donors with positive results according to some demographic and socioeconomic variables, to identify risk factors associated to these donors and the reasons that they were not detected during clinical screening., Methods: A descriptive study was performed between July 1(st) 2005 and July 31(st) 2006 by interviewing 106 donorsafter medical consultations where they were informed of positive results for hepatitis B, hepatitis C, HIV or syphilis., Results: There was a predominance of first-time donors, males, under 50-year olds, married individuals, from Ribeirão Preto, with elementary education, low economic status and of people who donated at the request of friends or relatives. Hepatitis C was the most frequently detected infection (56.6%), followed by hepatitis B (20.7%), HIV (12.3%) and syphilis(10.4%). About 40% of donors had omitted risk factors for different reasons: because they trusted the results of serological tests, did not feel comfortable about talking of risk factors or did not consider them relevant. Other justifications were the duration of the interview, the interviewer was unskilled, embarrassment and doubts about confidentiality., Conclusion: The results indicate the need for changes in the approach to clinical screening and a review of methods to attract and guide potential donors.

Surgical-site infection (SSI) is the most prevalent type of hospital infection in surgical patients and is associated with an increase in hospital stay, costs and morbidity/lethality. The knowledge of the main risk factors for this type of infection is important for the establishment of prevention measures regarding modifiable risks factors. The objective of the preset study was to assess the occurrence of SSI and study the risk factors in oncologic surgeries of the digestive system at Hospital de Câncer in Barretos, São Paulo, Brazil. Individuals undergoing oncologic surgeries of the digestive system in the period of 08/01/2007 to 08/10/2008 were prospectively followed for 30 days after surgery. Possible risk factors related to the patient and to the surgical procedure were also studied. A total of 210 surgeries were analyzed, with a global SSI incidence of 23.8%. The following variables were independently associated with SSI: time and type of surgery, radiotherapy before surgery and surgeon's years of experience. The risk factors found in this study have been described by other authors and are not amenable to intervention for SSI prevention. Further studies are recommended with the objective of investigating interventions that could reduce the risk for SSI in this type of surgery.

A survey for seroprevalence of Chagas disease was held in a representative sample of Brazilian individuals up to 5 years of age in all the rural areas of Brazil, with the single exception of Rio de Janeiro State. Blood on filter paper was collected from 104,954 children and screened in a single laboratory with two serological tests: indirect immunofluorescence and enzyme linked immunoassay. All samples with positive or indetermined results, as well as 10% of all the negative samples were submitted to a quality control reference laboratory, which performed both tests a second time, as well as the western blot assay of TESA (Trypomastigote Excreted Secreted Antigen). All children with confirmed final positive result (n = 104, prevalence = 0.1%) had a follow-up visit and were submitted to a second blood collection, this time a whole blood sample. In addition, blood samples from the respective mothers and familiar members were collected. The infection was confirmed in only 32 (0.03%) of those children. From them, 20 (0.025%) had maternal positive results, suggesting congenital transmission; 11 (0.01%) had non-infected mothers, indicating a possible vectorial transmission; and in one whose mother had died the transmission mechanism could not be elucidated. In further 41 visited children the infection was confirmed only in their mothers, suggesting passive transference of maternal antibodies; in other 18, both child and mother were negative; and in 13 cases both were not localized. The 11 children that acquired the infection presumably through the vector were distributed mainly in the Northeast region of Brazil (States of Piauí, Ceará, Rio Grande do Norte, Paraíba and Alagoas), in addition to one case in Amazonas (North region) and another in Parana (South region). Remarkably, 60% of the 20 cases of probably congenital transmission were from a single State, Rio Grande do Sul, with the remaining cases distributed in other states. This is the first report demonstrating regional geographical differences in the vertical transmission of Chagas disease in Brazil, which probably reflects the predominant Trypanosoma cruzi group IId and IIe (now TcV and TcVI) found in this state. Overall, these results show that the regular and systematic control programs against the transmission of Chagas disease, together with socioeconomic changes observed in Brazil in the last decades, interrupted the vectorial transmission in Brazil, resumed in the few cases found in this national survey. Furthermore they reinforce the need for maintenance of control programs for the consolidation of this major advance in public health.

Introduction: Hepatitis B is common in Brazil, although there are regional differences regarding the degree of endemicity, the most frequent forms of transmission and the presence of different evolutive stages of chronic disease. The present study aimed to determine the clinical, demographic and epidemiological characteristics of patients chronically infected with hepatitis B virus (HBV) residing in the Ribeirão Preto region, southeastern Brazil., Methods: A total of 529 medical records of individuals with HBV monoinfection were reviewed., Results: More than 60% of the subjects were males, with a mean age of 38 years-old. The HBeAg-negative serological pattern was verified in 84.4% of the patients, among whom the risk of vertical/intrafamily transmission was 43.2% (p = 0.02). The consumption of alcohol in amounts exceeding 20 g a day was observed in 21.3% of the subjects and was more frequent among men (33%) (p < 0.001). Among patients with cirrhosis, 54.1% were alcohol abusers (p = 0.04), all of them males. The presence of cirrhosis was more frequent in the HBeAg-positive group (24.4%) than in the HBeAg-negative group (10.2%) (p < 0.001)., Conclusions: High proportions of HBV-infected subjects with an HBeAg-negative pattern were observed, with a higher risk of vertical/intrafamily transmission. Alcohol abuse was associated with male subjects and with cirrhosis of the liver in this group. A tendency toward an increase in the number of HBeAg-negative cases was observed over time.

This article aims to correlate the main results of three large national surveys on Chagas disease (entomologic, seroprevalence and electrocardiographic) carried out in Brazil from late 1970's to early 1980's, which served as baseline for definition of the control measures adopted in the country. The proportion of infected people was much higher in areas where Triatoma infestans, the most efficient vector of Chagas disease among the five principal species involved in transmission at that time, was predominant. Similar result was observed in places where Triatoma sordida was dispersed, mainly in the country's central region, which corresponds to its native area. This finding is due to the coincidence observed in the geographic distribution of both vectors, since T. sordida is not considered to play an important role in transmission. In the Northeastern semi-arid, endemic area for Triatoma brasiliensis and Triatoma pseudomaculata, rates of human infection were much lower, although both vectors may have some relevance in the maintenance of the disease. As for areas with Panstrongylus megistus, human infection varied according to the levels of domiciliation. Whenever domiciled, like in the humid northeastern coastal area, its involvement in transmission can be clearly demonstrated. In some parts of Bahia State it represented the exclusive vector of the disease. Based upon the results of the seroprevalence survey an electrocardiographic study was carried out in 11 Brazilian states, which showed marked differences in the presence of cardiac alterations when comparing different areas of the country.

Background: Conflicting results have been reported in studies evaluating the relationship between serum markers of iron overload, liver iron deposits, and HFE mutations (C282Y and H63D) in chronic hepatitis C patients, and also their impact on the response to therapy in these patients., Aim: To evaluate the role of HFE mutations in the severity of liver disease and in the response to therapy in chronic hepatitis C., Methods: Two hundred and sixty-four hepatitis C patients treated with standard interferon and ribavirin were divided into two groups according to type of antiviral response: sustained virological response (SVR) and nonresponse or relapse. We evaluated the relationship between HFE mutation and the type of antiviral response, clinical data, biochemical tests, liver histopathology, virological data, and HFE mutations., Results: Of the 264 patients, 88 (32.1%) had SVR whereas 67.9% had nonresponse or relapse. Liver iron deposits were observed in 49.2% of the patients. The factors associated with SVR were hepatitis C virus genotype 2 or 3, transferrin saturation value of 45% or less, and detection of the H63D mutation. HFE mutation was more frequent in patients with iron deposits, but without association with serum iron biochemistry or severity of liver disease. Steatosis was more frequent in patients with liver iron deposits. CONCLUSION THE: H63D mutation was an independent factor associated with SVR in chronic hepatitis C patients, as also were hepatitis C virus genotype 2 or 3 and transferrin saturation value of 45% or less. Moreover, the H63D mutation was associated with liver iron deposits.

Objective: To study the driving behavior of medical students, comparing current patterns with those found in a study previously conducted at the same school of medicine., Methods: We administered standardized questionnaires to a sample of students enrolled at the medicine major of the Ribeirão Preto School of Medicine, Universidade de São Paulo (USP), in order to collect demographic and socioeconomic data, as well as information on their driving behavior and involvement in traffic accidents. Our findings were compared with those found in a similar study conducted in 1997., Results: We included 354 students in the present study conducted in 2008. The sample of the study conducted in 1997 included 377 students. Of the total number of participants, 431 (59%) had driven after drinking alcohol, and of these, 21.5% had consumed large amounts of alcohol. Participation in illegal street racing was reported by 10.5% of the participants, with significant difference between sexes (12.5% of men and 3.4% of women). Involvement in accidents with fatal or non-fatal casualties was reported by 19.2% of the participants. These percentages reached 31.1% among those who have already driven while being heavily intoxicated and 42.9% among those who participated in illegal street racing. The 2008 study showed higher use of helmets and seat belts in urban areas and reduced use of alcohol before driving. On the other hand, the same study showed an increased disrespect for traffic lights., Conclusion: Driving risk behaviors were always highly frequent among the participants, being directly related to involvement in accidents with casualties. Since this sample includes a privileged portion of the population, which is aware of and has direct contact with the consequences of such accidents, we expected lower rates of high-risk behaviors. Our findings may lead the academic community to consider the implementation of educational programs that can effectively change students' behavior.

Background and Aim: The durability of the sustained virologic response (SVR) in patients with chronic hepatitis C after treatment and the ideal follow-up time for these patients remains undefined. The objective of the study was to evaluate the durability of the virologic response in patients with chronic hepatitis C followed up for at least 12 months after SVR at HCFMRP-USP., Methods: The study was conducted on 174 patients with chronic hepatitis C treated with different antiviral regimens who had achieved SVR. Qualitative serum HCV-RNA was determined by the commercial kit (COBAS AMPLICOR HCV, v2.0)., Results: There was predominance of male (73%) with a mean age of 45.6 ± 10 years. Liver cirrhosis was present in 16.1% of the study subjects. Mean follow-up time after SVR was 47 months (12-156 months). Twenty-two patients received monotherapy with interferon; 94 received interferon plus ribavirin, and 58 received pegylated interferon plus ribavirin. A total of 134 patients (77.0%) received one treatment course, 29 (16.7%) received two courses, and 11 (6.3%) received three courses. The distribution of HCV genotypes was: genotype 1 (40.2%), genotype 3 (40.8%) and genotype 2 (10.3%). Genotype was undetermined in 8.7% of cases. None of the 174 patients had recurrence of HCV infection. Two cirrhotic patients developed hepatocellular carcinoma (HCC) during follow-up., Conclusions: Among patients with SVR there was no recurrence of HCV infection or evidence of liver disease progression in any patient followed up for a mean of 47 months after SVR, except for patients with advanced hepatic disease before treatment, who may develop HCC despite SVR. Therefore, one can assume that SVR is associated with long term good prognosis.

Patients with chronic pancreatitis may have abnormal gastrointestinal transit, but the factors underlying these abnormalities are poorly understood. Gastrointestinal transit was assessed, in 40 male outpatients with alcohol-related chronic pancreatitis and 18 controls, by scintigraphy after a liquid meal labeled with (99m)technetium-phytate. Blood and urinary glucose, fecal fat excretion, nutritional status, and cardiovascular autonomic function were determined in all patients. The influence of diabetes mellitus, malabsorption, malnutrition, and autonomic neuropathy on abnormal gastrointestinal transit was assessed by univariate analysis and Bayesian multiple regression analysis. Accelerated gastrointestinal transit was found in 11 patients who showed abnormally rapid arrival of the meal marker to the cecum. Univariate and Bayesian analysis showed that diabetes mellitus and autonomic neuropathy had significant influences on rapid transit, which was not associated with either malabsorption or malnutrition. In conclusion, rapid gastrointestinal transit in patients with alcohol-related chronic pancreatitis is related to diabetes mellitus and autonomic neuropathy.

Objective: To evaluate the effectiveness of the oral application of a 0.12% solution of chlorhexidine for prevention of respiratory tract infections among intensive care unit (ICU) patients., Design: The study design was a double-blind, randomized, placebo-controlled trial., Setting: The study was performed in an ICU in a tertiary care hospital at a public university. PATIENTS. Study participants comprised 194 patients admitted to the ICU with a prospective length of stay greater than 48 hours, randomized into 2 groups: those who received chlorhexidine (n = 98) and those who received a placebo (n = 96)., Intervention: Oral rinses with chlorhexidine or a placebo were performed 3 times a day throughout the duration of the patient's stay in the ICU. Clinical data were collected prospectively., Results: Both groups displayed similar baseline clinical features. The overall incidence of respiratory tract infections (RR, 1.0 [95% confidence interval [CI], 0.63-1.60]) and the rates of ventilator-associated pneumonia per 1,000 ventilator-days were similar in both experimental and control groups (22.6 vs 22.3; P = .95). Respiratory tract infection-free survival time (7.8 vs 6.9 days; P = .61), duration of mechanical ventilation (11.1 vs 11.0 days; P = .61), and length of stay (9.7 vs 10.4 days; P = .67) did not differ between the chlorhexidine and placebo groups. However, patients in the chlorhexidine group exhibited a larger interval between ICU admission and onset of the first respiratory tract infection (11.3 vs 7.6 days; P = .05). The chances of surviving the ICU stay were similar (RR, 1.08 [95% CI, 0.72-1.63])., Conclusion: Oral application of a 0.12% solution of chlorhexidine does not prevent respiratory tract infections among ICU patients, although it may retard their onset.

Hepatitis C virus (HCV) infection has quite high prevalence in the prison system, reaching rates of up to 40%. This survey aimed to estimate the prevalence of HCV infection and evaluate risk factors for this exposure among male inmates at the Ribeirão Preto Prison, State of São Paulo, Brazil, between May and August 2003. A total of 333 participants were interviewed using a standardized questionnaire and underwent immunoenzymatic assaying to investigate anti-HCV. The prevalence of HCV infection among the inmates was 8.7% (95% CI: 5.7-11.7). The participants'mean age was 30.1 years, and the prevalence was predominantly among individuals over 30 years of age. Multivariate analysis showed that the variables that were independently associated with HCV infection were age > 30 years, tattooing, history of previous hepatitis, previous injection drug use and previous needle-sharing.

Objective: Trauma is the third most important cause of death in Brazil. However, its impact on survivors' quality of life has been scarcely studied in this country. This study aimed to assess trauma victims' quality of life, cared for in an emergency hospital unit, six months after discharge., Methods: A total of 35 patients from the emergency unit of a university hospital in the city of Ribeirão Preto, Southeastern Brazil, were included in this study, between 2005 and 2006. Patients were interviewed in their homes, six months after hospital discharge. The short version of the World Health Organization Quality of Life (WHOQOL-BREF) instrument was applied to assess the physical, psychological, social relationships, and environmental domains. Associations between domain scores and hospital stay, age, sex and Injury Severity Score variables were analyzed with linear regression models., Results: Significant reduction in quality of life was found in the group studied, when compared to samples of normal people in national and international studies, especially as regards the physical, psychological, and environmental domains. The social relationships domain revealed the highest mean scores, with 69.7 points, whereas the environmental domain received the lowest score (52.4 points), both on the percentage scale. Variables associated with the physical domain were hospital stay (p=0.02), age (p<0.01) and sex (p=0.03). The analysis did not show association with the variables studied for the remaining domains., Conclusions: Trauma victims showed a reduction in quality of life scores. Even though the physical aspect was the most affected, there is evidence that the psychological and environmental domains remained far from the ideal conditions expected for the general population.

This article aimed to estimate the prevalence of hepatitis C in Botafogo, a district of Bebedouro, São Paulo State, Brazil, and investigate possible risk factors. One individual over 18 years of age was selected from each household to answer a questionnaire on socio-demographic variables and factors associated with hepatitis C. Blood samples were also drawn for immunoenzymatic tests. Positive HCV-antibody samples were submitted to viral RNA detection. HCV prevalence was 8.8% (95%CI: 5.8-11.7), and independent variables associated with risk of infection were: male gender, time of local residence > 30 years, and history of injected medication using non-disposable material, sterilized by boiling. The high prevalence of hepatitis C infection in this relatively isolated rural population appears to result from previous exposure to injections with inadequately sterilized material, with some evidence suggesting a specific elderly pharmacy employee who customarily applied such injections and may have been a chronic HCV carrier.

This study was performed with the purpose of testing the hypothesis that the high prevalence of hepatitis C among former athletes is associated with their past use of injectable stimulants. The study involved the participation of 208 former professional and amateur soccer and basketball players from the region of Ribeirão Preto, Brazil, who answered a questionnaire regarding their exposure to risk factors, including the use of injectable stimulants in the time they were engaged in sporting activities. ELISA tests were used to detect infection by the hepatitis C virus, and confirmed with PCR and genotyping for the positive cases. It was observed that the former use of injectable stimulants was a practice disseminated among the participants (24.5%), reaching 50.8% in the professionals. The overall prevalence for hepatitis C was 7.2%, with values of 11% among professionals and 5.5% among amateurs. In both categories, the presence of infection was markedly higher among those who admitted past use of injectable stimulants when compared to those who denied such practice (36% and 0.8% among amateurs; 21.9% and 0% among professionals, respectively). Multivariate analysis showed that the use of those substances was the only variable associated with the risk of hepatitis C. This confirms previous observations, performed with reduced sample sizes and without comparison groups, which indicated that the use of injectable vitamins was a risk factor of hepatitis C among former athletes.

The Brazilian emergency system is being reorganized as a hierarchy in the region of Ribeirão Preto, state of São Paulo. We found increased occupational risk for tuberculosis in this region tertiary reference center--a nurse technician (Incidence rate [IR] 526.3/100,000 inhabitants) had a risk of tuberculosis 12.6 (95% confidence interval [CI], 2.57-37.23) greater than the city population (41.8/100,000 inhabitants). The system reorganization will have to make the centers adequate to deal with this problem.

Background: Examination of the epidemiology and timing of trauma deaths has been deemed a useful method to evaluate the quality of trauma care., Objective: The purpose of this study was to evaluate the quality of trauma care in a regional trauma system and in a university hospital in Brazil by comparing the timing of deaths in the studied prehospital and in-hospital settings to those published for trauma systems in other areas., Methods: We analyzed the National Health Minister's System of Deaths Information for the prehospital mortality and we retrospectively collected the demographics, timelines, and trauma severity scores of all in-hospital patients who died after admission through the Emergency Unit of Hospital das Clinicas de Ribeirao Preto between 2000 and 2001., Results: During the study period, there were 787 trauma fatalities in the city: 448 (56.9%) died in the prehospital setting and 339 (43.1%) died after being admitted to a medical facility. In 2 years, 238 trauma deaths occurred in the studied hospital, and we found a complete clinical set of data for 224 of these patients. The majority of deaths in the prehospital setting were caused by penetrating injuries (66.7%), whereas in-hospital mortality was mainly because of blunt traumas (59.1%). The largest number of in-hospital deaths occurred beyond 72 hours of stay (107 patients-47%)., Conclusion: The region studied showed some deficiencies in prehospital and in-hospitals settings, in particular in the critical care and short-term follow-up of trauma patients when compared with the literature. Particularly, the late mortality may be related to training and human resources deficiency. Based on the timeline of trauma deaths, we can suggest that the studied region needs improvements in the prehospital trauma system and in hospital critical care.

Chagas disease (American trypanosomiasis) is caused by the protozoan parasite Trypanosoma cruzi. Chagas disease following solid-organ transplantation has occurred in Latin America. This report presents the occurrence of Chagas disease despite negative serological tests in both the donor and the recipient, as well as the effectiveness of treatment. A 21-year-old woman from the state of Sao Paulo (Brazil) underwent cadaveric donor liver transplantation in November 2005, due to cirrhosis of autoimmune etiology. Ten months after liver transplantation, she developed signs and symptoms of congestive heart failure (New York Heart Association functional class IV). The echocardiogram, which was normal preoperatively, showed dilated cardiac chambers, depressed left ventricular systolic function (ejection fraction = 35%) and moderate pulmonary hypertension. Clinical investigation discarded ischemic heart disease and autoimmune and other causes for heart failure. Immuno fluorescence (immunoglobulin M and immunoglobulin G) and hemagglutination tests for T cruzi were positive, and abundant T cruzi amastigotes were readily identified in myocardial biopsy specimens. Treatment with benznidazole for 2 months yielded an excellent clinical response. At the moment of submission, the patient remains in functional class I. This case highlighted that more appropriate screening for T cruzi infection is mandatory in potential donors and recipients of solid-organ transplants in regions where Chagas disease is prevalent. Moreover, it stressed that this diagnosis should always be considered in recipients who develop cardiac complications, since negative serological tests do not completely discard the possibility of disease transmission and since good results can be achieved with prompt trypanocidal therapy.

Background: Compliance to drug therapy is important for a successful treatment. Although many studies have assessed compliance to treatment in patients with chronic diseases, few investigations have been carried out in inflammatory bowel diseases., Aim: To assess compliance to drug therapy in patients with inflammatory bowel diseases, Crohn's disease and ulcerative colitis, followed at a university hospital, who had prescribed medication supplied by the Brazilian National Health System., Methods: In a cross sectional study, a structured interview was applied to assess the compliance of 26 Crohn's disease patients, 26 ulcerative colitis patients and 4 cases with undetermined colitis. Patients were characterized as presenting higher or lower degree of compliance, based on the comparison of the information provided by the patient in the interview and data in the medical records. The Morisky test was also used to assess the behavioral pattern of the patient regarding the daily use of the medication., Results: The interview showed that 15.4% of patients with Crohn's disease and 13.3% of those with ulcerative colitis could be regarded as less compliant. However, the Morisky test revealed lower compliance in 50% of patients with Crohn's disease and 63.3% of those with ulcerative colitis. Univariate analysis showed an association between low compliance and long disease duration, married status and colon involvement in Crohn's disease, and between low compliance and increased disease activity and greater number of medications in ulcerative colitis. However, multivariate analysis did not confirm any association between low compliance and any demographic or clinical factor., Conclusions: A high degree of noncompliance to treatment, linked to habitual behavior and hard to predict from demographic or clinical factor, was detected in inflammatory bowel disease patients, which suggests the need for investment in patient education regarding medication use.

HIV infection among prison inmates shows one of the highest prevalence rates for specific population subgroups, reaching as high as 17% in Brazil and elsewhere in the world. The present study aimed to estimate HIV antibody prevalence and risk factors for infection in male inmates at the Ribeirão Preto Penitentiary, São Paulo State, Brazil, from May to August 2003. Using simple random sampling, 333 participants were selected, answered a standardized questionnaire, and had blood samples collected. Enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence were used for HIV serological diagnosis. Overall HIV prevalence among inmates was 5.7% (95%CI: 3.2-8.2). All variables associated with HIV antibodies in the univariate analysis were submitted to unconditional multivariate logistic regression. Independent predictors of HIV infection were: total prison sentence less than five years and sharing needles and syringes.

Background: Patients with alcohol-related chronic pancreatitis (ARCP) may present with abnormal gastric emptying (GE), which has been ascribed mainly to nutrient maldigestion. Nevertheless, many patients also have diabetes with autonomic dysfunction and malnutrition and the role of these factors on abnormal GE has not been investigated., Goals: To determine the influences of malabsorption, diabetes, malnutrition, and autonomic dysfunction on GE abnormalities in patients with ARCP., Study: Forty ARCP outpatients and 18 healthy controls were studied. GE was measured by scintigraphy after a standard, liquid, nutrient meal labeled with Technetium-phytate. Autonomic function was evaluated by cardiovascular tests. The influence of each factor on abnormal GE was assessed by Bayesian multiple regression analysis., Results: In the ARCP group, GE was abnormal in 19 patients (47.5%), who showed either accelerated (N=12) or delayed emptying (N=7). Diabetes was highly prevalent (P<0.01) in ARCP patients with either rapid or delayed GE (18/19). Multiple regression analysis showed that not only diabetes, but also autonomic dysfunction has significant effects on abnormal GE, whereas malabsorption and malnutrition seemed not to be associated to abnormal emptying., Conclusions: A substantial proportion of patients with ARCP may have abnormal GE. Either delayed or accelerated GE seem to be related to underlying diabetes mellitus and autonomic neuropathy rather than to nutrient malabsorption and malnutrition.

Objective: To verify the prevalence of periodontal disease (PD) in patients with ischemic heart disease. PD is a serious public dental health care problem with a differentiated distribution in regards to severity, age group, type of infection, co-morbidities and risk factors., Methods: Four hundred and eighty patients were examined at the Ischemic Cardiopathy Outpatient Clinic of the Hospital das Clínicas of the Ribeirão Preto Medical School, São Paulo University, as well as 154 patients without heart disease from the same institution. Fifty-eight patients with heart disease and 62 patients without heart disease between the ages of 30 and 79 met the criteria to be included in the investigation. In accordance with recommendations of WHO (1999) the Community Periodontal Index (CPI) and the Periodontal Attachment Loss Index (PALI) were used., Results: Patients with heart disease had a prevalence of sextants with moderate to advanced PD (76.3% versus 20.2%; p < 0.00001). In these patients, 1.1% of the sextants were found to be healthy versus 32.0% of those without heart disease (p < 0.00001). In regards to the progression of PD, 6.0% of the sextants of the patients with heart disease did not exhibit attachment loss versus 68.0% of those without heart disease (p < 0.00001). Dental biofilm was observed in 100.0% of the patients with heart disease and in 82.3% of those without heart disease (p < 0.001). Treatment of periodontal pockets > 6 mm was required in 79.3% of the patients with heart disease versus 9.7% of those without heart disease (p < 0.0001)., Conclusion: PD was very prevalent in the groups studied with a higher degree of severity in those with ischemic heart diseases. The elevated prevalence of risk factors found, indicates that intervention strategies are required.

Over the past two decades, nosocomial infections caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella spp. have become a major problem all around the world. This situation is of concern because there are limited antimicrobial options to treat patients infected with these pathogens, and also because this kind of resistance can spread to a wide variety of Gram-negative bacilli. Our objectives were to evaluate among in-patients at a public university tertiary-care hospital with documented infection due to Klebsiella spp., which were the risk factors (cross-sectional analysis) and the clinical impact (prospective cohort) associated with an ESBL-producing strain. Study subjects were all patients admitted at the study hospital between April 2002 and October 2003, with a clinically and microbiologically confirmed infection caused by Klebsiella spp. at any body site, except infections restricted to the urinary tract. Of the 104 patients studied, 47 were infected with an ESBL-producing strain and 57 with a non-ESBL-producing strain. Independent risk factors associated with infection with an ESBL-producing strain were young age, exposure to mechanical ventilation, central venous catheter, use of any antimicrobial agent, and particularly use of a 4th generation cephalosporin or a quinolone. Length of stay was significant longer for patients infected with ESBL-producing strains than for those infected with non-ESBL-producing strains, although fatality rate was not significantly affected by ESBL-production in this cohort. In fact, mechanical ventilation and bacteremia were the only variables within dependent association with death detected in this investigation.

Chronic liver disease is a considerable burden on society, being one of the three main causes of death in certain regions of Africa and Asia. Liver transplant is the only treatment option for cirrhosis, which is the end stage of many chronic liver diseases. This article reviews the preventable causes of cirrhosis and the preventive strategies which could be implemented in order to avoid the catastrophic consequences of cirrhosis. With small variations around the world, 70 to 80% of the end stage liver diseases are caused by excessive alcohol consumption and by viral hepatitis, both of which are potentially preventable. Excessive alcohol consumption has important public health consequences because of its involvement not only with cirrhosis, but also with motor vehicle accidents, unemployment, domestic violence etc. Among the viral causes, Hepatitis Virus B and C have the greatest impact on public health. Effective vaccine is available for Hepatitis Virus B and must be put in use. While a vaccine for Hepatitis Virus C is awaited, effective preventive strategies should be undertaken to avoid the preventable cases of end stage liver disease.

The investigation involved 25,891 blood donors who attended for the first time the Blood Center of Ribeirão Preto, Brazil, between Jun 23, 1996 and Jun 22, 2001. The objective was to study the proportion of positive serological markers for hepatitis B and C at the initial screening tests and to estimate the prevalence of such infections through the analysis of confirmatory tests, carried out at the University Hospital as a part of the patients evaluation. Data from the donors and laboratory results were obtained from the records of both the Blood Bank and the Hospital. The population of donors was mainly composed by males (83.6%) and by individuals between 26 and 45 (64%) years of age. The proportions of positive results in screening tests were 0.6% (CI95%: 0.54-0.72) for HBsAg and 1.2% (CI95%: 1.02-1.28) for anti-HCV. Confirmatory testes showed values of prevalence of 0.2% (CI95%: 0.16-0.28) for hepatitis B and 0.3% (IC95%: 0.24-0.38) for hepatitis C.

The objective of this study was to assess the prevalence of hepatitis B virus and possible risk factors for this disease in 401 patients infected with the human immunodeficiency virus, followed at the University Hospital of the Ribeirão Preto Medical School, São Paulo State University. Each participant was submitted to a specific questionnaire and had a blood sample tested for the serologic markers HBsAg, total anti-HBcAg, anti-HBsAg and anti-HCV, using ELISA technique. The overall prevalence of hepatitis B markers was 40.9%, with 8.5% for HBsAg, 39.7% for total anti-HBcAg and 5.5% for anti-HBsAg. The variables that showed association with HBV were: age, higher education level, history of jaundice, time spent in prison, having a homosexual partner and positive markers for anti-HCV. Co-infection HBV/HCV was present in 20.4% of the participants.

Objective: To describe the demographic and socioeconomic characteristics of sex workers in the city of Ribeirão Preto, which is in the state of São Paulo, Brazil, and to investigate the risk factors for sexually transmitted diseases (STDs) in this population., Methods: All the areas in the city where female or male prostitutes or transvestites work or live were visited. The participants answered a questionnaire that collected sociodemographic data and information concerning risk factors for STDs. A social worker who for more than five years had carried out educational activities with sex workers in Ribeirão Preto was responsible for the interviews., Results: The 449 female prostitutes, 13 male prostitutes, and 53 male transvestite sex workers who were included in the study make up a young population, with little schooling and a low socioeconomic level. A majority of them were born in states other than São Paulo, and a third of them still maintain a residence in some other state. In comparison to the prostitutes (the female and male prostitutes considered together), the transvestites had a significantly higher risk for STDs, which was reflected in their number of years as sex workers, average number of sexual partners per day, history of ulcerative STDs, practice of anal sex, use of illegal noninjectable drugs (especially crack), and history of incarceration. Exposure to alcohol was the only risk factor found more frequently in the prostitutes. Using a condom with a steady partner was less frequent than was condom use in commercial sex, for both the prostitutes and the transvestites., Conclusions: Sex workers in Ribeirão Preto, especially transvestites, are socially marginalized and at high risk for STDs. Public health services should focus more attention on this population by developing prevention programs and by supporting additional research that could provide more detailed knowledge concerning the specific risk factors that put this population at risk for STDs.