Biomedical subjects
Publications and source records attributed to J C Pereira.
The authors report a unique case of cervical chordoma in a 37-year-old woman without radiological evidence of bone involvement that was found to be totally intradural at surgery. Chordomas that are entirely extrasseous and intradural are extremely rare and in most of the cases described are located near the clivus. This is the first reported case of an intraspinal intradural chordoma.
This work presents the results of a time series study relating air pollution and respiratory mortality in children under 5 years of age in the metropolitan area of São Paulo, Brazil. Daily records of mortality (excluding neonatal mortality) for the period May 1990 to April 1991 were collected along with daily records of relative humidity, temperature, SO2, CO, particulates (PM10), O3, and NOx concentrations. Using multiple regression methods we demonstrated a significant association between mortality due to respiratory diseases and the NOx levels. After controlling for weather and season effects, the odds of dying due to respiratory diseases, considering the mean levels of NOx in São Paulo, was estimated at 1.3 (+/- 0.13). This result is in accord with previous animal studies conducted by our group and indicates that air pollution in São Paulo has reached levels high enough to have adverse health effects on the exposed population.
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The results of a cross-sectional (prevalence) study of high blood pressure, carried out in 1987 in Araraquara County in the north of S. Paulo State, Brazil are presented. The group studies numbered 1,199 people, including 533 men and 666 women, of from 15 to 74 years of age. The results show a high prevalence of the disease (32.0% for men and 25.3% for women), with a tendency to increase with age, up to the 40's (men) and the 50's (women). There was also a greater percentage of hypertensives in the mulatto and black groups, in the obese, and among those of lower family income, with a lower level of schooling and with less well remunerated jobs. However, the logistic regression showed very small odds ratios associated with these risk factors, which could be attributed to the way these factors were considered.
A programme for the control of respiratory diseases in children was conceived for the State of S. Paulo, Brazil, in 1986. Its progress thereafter and the epidemiology of the diseases concerned are examined. Apart from an inquiry into the 64 existing State local health authorities, a sample of 18,255 cases of children assisted by the programme at different levels, including both in-patient and outpatient care, is analysed. Each case record included information about identification (child, doctor and health facility), reasons for calling, diagnoses made and outcome of treatment. Further data were also sought from hospitals and from State mortality records. The programme was found to be poorly implemented in the State but, where implemented, it showed itself capable of resolving problems (only 0.5% of the cases could not be handled) as also of changing ongoing trends (more than 50% reduction in hospital admission rates). Individual assessment of each item of the programme indicated its bottlenecks. Regarding the epidemiology of respiratory diseases, it is observed that the major burden to health services comes from children aged less than five, and that the most important diseases are wheezing illnesses and pneumonia. Moreover, they were found to be significantly associated (p = 0.000) so that a child in the community presenting wheezing diseases is 5 times more likely to develop pneumonia than a child with any other respiratory diagnosis. Similarly, among the under five deaths it was found that the risk for pneumonia is 3 times greater for children who died presenting wheezing diseases than it is for children with any other sort of diagnosis. In conclusion, the programme is deemed to be efficient and effective but its efficacy is marred by administrative flaws. The successful control of respiratory problems in childhood is related to a proper appreciation of the importance of wheezing diseases.
In September 1987, a powder radioactive source was removed from a teletherapy machine in Goiânia, Brazil. Subsequently, it was ruptured in a residential garden causing the dissemination of 137Cs throughout the city. Soil resuspension processes and burial of contaminated house waste in unused gardens were the major contributors to the Cs dissemination in soils at the secondary contaminated sites. Only locations within a radius of 50 m from the primary contaminated sites presented the need for remedial action. The radiation dose-rate measurements and the soil profiles were good indicators of the extent of the secondary contamination and were fundamental for the decisions taken regarding decontamination procedures. In cases of surface contamination, 60% on average of the total activity remained in the upper 1.5-cm layer over the first 5 mo after the accident, and topsoil removal proved to be an effective procedure for decontamination.
The main contamination areas in Goiânia were exposed soil surfaces, and with the first rainfalls, 137Cs quickly reached the Meia-Ponte River, the main local waterway. Regular measurements of bottom sediment, surface water, and fish were begun 3 wk after the accident. In the first survey, 137Cs was detectable in sediments up to 12 km downstream from the accident area. Maximum 137Cs concentrations found in sediments of the Meia-Ponte River were 1.3 kBq kg-1 dry weight and 200 Bq kg-1 fresh weight for fish. Cesium-137 was always less than 10 Bq L-1 in surface waters plus suspended particulates, even in the most contaminated creeks. Because it was the beginning of the rainy season, downstream sediment transport was enhanced. This resulted in a decrease of 137Cs concentrations in sediments of the urban area by a factor of approximately 20, 5 wk after the accident. The main sedimentation area for suspended sediments in this portion of the river is the Rochedo Reservoir, which is 80 km downstream from the accident area. In a survey performed 10 mo after the accident, 137Cs concentrations in the reservoir were up to 14 Bq kg-1 for fish, 1 Bq kg-1 for aquatic plants, and 100 Bq kg-1 dry weight for bottom sediments.
Seventy four asthmatic children aged 7 to 11 years were examined along with controls matched by age and sex. Clinical and laboratory investigations preceded a 28-day follow-up where data about morning and evening peak expiratory flow rate (PEF), symptoms and treatment were recorded. The coefficient of variation of PEF was found to be an objective measurement of asthma severity that has statistically significant correlation with both symptoms (rs = .36) and treatment (rs = .60). Moreover, it separates mild and severe asthmatics, as confirmed by statistically significant differences (p = .008 or less) in symptoms, treatment, skin allergy and airways response to exercise. Skin allergy and airways responsiveness to exercise were found to be predictors of both disease and severity. By means of logistic regression analysis it was possible to establish the probabilities for both asthma and severe asthma when children presenting and not presenting these characteristics are compared. One single positive skin test represent a probability of 88% for the development of asthma and a probability of 70% for severe disease. A PEF reduction of 10% after an exercise test implies a probability of 73% for disease and a probability of 64% for severe disease. Increases in these variables imply geometrically increased risks and their presence together have a multiplicative effect in the final risk.
A discussion of health policy in developing countries is presented. It argues that developing countries must adopt a progressive approach to health policy which rejects the two-tiered system of public and private health care. However, it also points out that ideology is not sufficient to maintain support. A progressive health system must utilize administrative and social and behavioral sciences to achieve effectiveness and efficiency in health care delivery. It cannot ignore these goals any more than a private health care system can.
Sixty-eight clinical amalgam restorations were removed to examine the consistency of the calcium hydroxide bases. The variation of the base consistency was influenced by the age and/or clinical profile of teeth and the status of the restorations. The clinical conditions affected the calcium hydroxide base consistency.
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The pulpo-dentinal complex responds to external injuries with dentin sclerosis (DS), dead tracts (DT), or reparative dentin (RD). This investigation correlates the prevalence of these responses with age, sex, type and surface location of tooth lesions (caries, restorations, attrition, abrasion and erosion) utilizing ground sections, microradiographs and decalcified paraffin-embedded tooth sections treated with the Pollak trichrome stains (270 teeth from 113 patients). The main response to caries, restorations and erosion was DS, followed by RD and DT. DS, RD and DT occurred equally in any tooth, on any tooth surface and even beneath the same lesion. DS did not necessarily prevent RD. Root and furcation DS and RD in the floor of the pulp chamber and root canals were unrelated to particular lesions but did relate to increasing age. Root DS extended from apical to cervical area with increasing age. Beneath caries and restorations DS and RD were more prevalent in males, but DT was more prevalent in females. Pollak staining of decalcified paraffin sections for DS was approximately 80% as accurate as ground sections and microradiography. In pulp studies, where the result is contrary to previous experience, the Pollak stains reveal whether DS has decreased dentin permeability.
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The pulps of seventy dog teeth were evaluated histopathologically and radiographically following intentional exposure and treatment with either a calcium hydroxide powder or a calcium hydroxide paste prepared with distilled water. The results were recorded after periods of 2, 30, 70, and 120 days. No differences were detected in the pulpal responses to direct pulp capping achieved with a calcium hydroxide paste and with a calcium hydroxide powder.
The evolution of medicine from an applied science to the extension of specialized medical care delivery, has had a bearing on the student's early decision, influenced by a specialist teacher, to chose specialization in a given field. The author gives current explanations of the specialization process in order to conclude that, in Brazil, one of its leading determinants is a policy of the social welfare system that favors the specialist. Other factors cited are the (not always justified) preference of patients--at least of those who can afford it--for physicians who work with sophisticated equipment, the vested interests of the industry that produces or owns that equipment, and the desire of the young physician to escape the stiff competition he would encounter in general practice, while at the same time separating himself from the somewhat negative image of the general clinician who does not keep abreast of developments in medicine. The author examines the question in light of sociological theories of social and technical division of labor, and asserts that the process has led to the atomization of responsibilities among physicians who have become incapable, because of overspecialization, of viewing the patient as a biological, psychological, social and cultural whole.
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