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R Sesso

Publications and source records attributed to R Sesso.

At least 19 recordsLinked to original sources
PubMed2007

Crack cocaine: a five-year follow-up study of treated patients.

OBJECTIVES: To follow-up a group of 131 crack cocaine users and examine drug use, treatment experience, employment status, involvement in crime and mortality at 2 and 5 years. METHODS: Consecutive crack-dependent patients who were admitted to a detoxification unit in São Paulo between 1992 and 1994 were re-interviewed on two occasions: 1995-1996 and 1998-1999. RESULTS: 5 years after treatment information was obtained on 124 (95%) of the original cohort. 39.7% (n = 52) of the patients reported having been abstinent from cocaine for at least the last year, and 21.4% (n = 28) had used the drug. Of those subjects not using cocaine at 2 years, 19 (62%) were still abstinent at 5 years. Twenty-three (17.6%) patients had died by the 5-year follow-up with homicide, due to firearms or other weapons, being the commonest cause (n = 13). The annual adjusted mortality rate for the sample was 24.92 deaths/1,000 individuals, the excess mortality rate was of 21.64 deaths/1,000 individuals, and the standardized mortality ratio was 7.60. A history of injecting drug use, unemployment at the time of the index admission and administrative discharge at the index admission were factors that contributed to the risk of dying over the next 5 years. CONCLUSIONS: There was a progressive movement towards abstinence over the follow-up period, and there was evidence that once abstinence had been achieved it was maintained. On the other hand, the mortality rate was extremely high and was higher among those who were still using crack at 2 years.

Adolescent↗
PubMed2005

Cultural adaptation and validation of the "Kidney Disease and Quality of Life--Short Form (KDQOL-SF 1.3)" in Brazil.

The objective of the present study was to translate the Kidney Disease Quality of Life -- Short Form (KDQOL-SF 1.3) questionnaire into Portuguese to adapt it culturally and validate it for the Brazilian population. The KDQOL-SF was translated into Portuguese and back-translated twice into English. Patient difficulties in understanding the questionnaire were evaluated by a panel of experts and solved. Measurement properties such as reliability and validity were determined by applying the questionnaire to 94 end-stage renal disease patients on chronic dialysis. The Nottingham Health Profile Questionnaire, the Karnofsky Performance Scale and the Kidney Disease Questionnaire were administered to test validity. Some activities included in the original instrument were considered to be incompatible with the activities usually performed by the Brazilian population and were replaced. The mean scores for the 19 components of the KDQOL-SF questionnaire in Portuguese ranged from 22 to 91. The components "Social support" and "Dialysis staff encouragement" had the highest scores (86.7 and 90.8, respectively). The test-retest reliability and the inter-observer reliability of the instrument were evaluated by the intraclass correlation coefficient. The coefficients for both reliability tests were statistically significant for all scales of the KDQOL-SF (P < 0.001), ranging from 0.492 to 0.936 for test-retest reliability and from 0.337 to 0.994 for inter-observer reliability. The Cronbach's alpha coefficient was higher than 0.80 for most of components. The Portuguese version of the KDQOL-SF questionnaire proved to be valid and reliable for the evaluation of quality of life of Brazilian patients with end-stage renal disease on chronic dialysis.

Adult↗
PubMed2004

Stunted children gain less lean body mass and more fat mass than their non-stunted counterparts: a prospective study.

The aim of the present study was to analyse the changes in body composition of stunted children during a follow-up period and to test the hypothesis of a tendency to accumulate body fat as a consequence of undernutrition early in life. We selected fifty boys and girls aged 11 to 15, who were residents of slums in Sao Paulo, Brazil. Twenty were stunted (S) and thirty had normal stature (NS). The children's nutritional status and body composition were assessed through anthropometry and dual-energy X-ray absorptiometry, at the beginning of the present study and after 3 years, and changes in lean mass (LM and LM%) and fat mass (FM and FM%) were calculated. Stunted boys accumulated more body fat (FM%: S=1.62%, NS=-3.40%; P=0.003) and gained less lean mass (LM%: S=-1.46, NS=3.21%; P=0.004). Stunted girls gained less lean mass (S=7.87 kg, NS=11.96 kg; P=0.032) and had significantly higher values of FM% at follow-up when compared with their baseline values (P=0.008), whereas non-stunted girls had a non-significant difference in FM% over time (P=0.386). These findings are important to understand the factors involved in the increased prevalence of overweight and obesity among poor populations, which appear to be associated with hunger during infancy and/or childhood.

Adipose Tissue↗
PubMed2003

Influence of renal function on spontaneous dietary intake and on nutritional status of chronic renal insufficiency patients.

OBJECTIVE: To analyze the spontaneous food intake and the nutritional parameters of patients with different degrees of chronic renal insufficiency (CRI) at the onset of predialysis treatment. DESIGN: Cross-sectional. SETTING: Outpatient Clinic of the Nephrology Division of Federal University of São Paulo, Brazil. SUBJECTS: The analysis involved 487 (187 women and 300 men) patients with moderate to advanced CRI who were evaluated in the first visit to the clinic. RESULTS: Patients were divided according to creatinine clearance (CrCl) quartiles. CrCl in the first quartile was lower than 19.9 ml/min/1.73 m(2) and in the fourth one was higher than 43 ml/min/1.73 m(2). Energy intake was significantly (P<0.05) lower in the first quartile when compared with the fourth one while protein intake estimated by protein equivalent of nitrogen appearance (PNA) was significantly lower in the first, second and third quartiles in comparison with the fourth (P<0.05). Body mass index (BMI) and percentage of ideal body weight were significantly decreased in the three lowest levels of renal function. Standard per cent of triceps skinfold thickness was lower in the first quartile when compared with the fourth one. Compared with the fourth quartile, standard per cent of midarm muscle circumference (MAMC) was lower in the second and in the third quartile. CrCl correlated directly and significantly with PNA (r=0.30; P<0.01), energy intake (r=0.17; P<0.01), and MAMC (r=0.20; P<0.01). In a multiple linear regression analysis, controlling for energy and protein intake, CrCl correlated significantly and positively with BMI and MAMC. CONCLUSION: This study suggests that a spontaneous decrease in energy and protein intake as well as in anthropometric indices follows a decline in renal function in patients with no previous dietary intervention.

Creatinine↗
PubMed2001

Follow-up of patients with epidemic poststreptococcal glomerulonephritis.

In 1998 there was a large outbreak of acute glomerulonephritis (GN) in Nova Serrana, Brazil, caused by group C Streptococcus zooepidemicus and linked to the consumption of contaminated cheese produced with unpasteurized milk. This study describes the follow-up of these patients after a mean of 2 years following the acute episode. Of 134 patients identified in 1998, 69 patients were reexamined and underwent measurements of blood pressure, 24-hour creatinine clearance, microalbuminuria (radioimmunoassay), and urine sediment analysis. Of the original group of 134 patients, 3 patients died in the acute phase and 5 patients (3.7%) required chronic dialysis. Of 69 patients reevaluated, 65 patients (94%) were adults (mean age, 39 +/- 2 [SE] years) and 47 patients (68%) were women. At the follow-up examination, we found arterial hypertension in 42% of subjects (27 of 64 subjects), serum creatinine levels greater than 1.2 mg/dL in 12% (10 of 68 subjects), reduced creatinine clearance (<80 mL/min/1.73 m(2)) in 30% (20 of 67 subjects, 2 of them on chronic dialysis therapy), and increased microalbuminuria (>20 microg/min) in 34% (22 of 65 subjects). Increased microalbuminuria and/or reduced creatinine clearance were detected in 48% of the subjects (31 of 65 subjects). Patients with microalbuminuria had greater diastolic blood pressure than those without microalbuminuria (mean, 98 +/- 4 versus 88 +/- 2 mm Hg; P = 0.02). In conclusion, after a mean of 2 years, patients with epidemic poststreptococcal GN caused by S zooepidemicus present a high rate of hypertension and frequent abnormalities of renal function, with some having reached end-stage renal disease. Longer follow-up will be important to define the prognosis of these patients.

Adolescent↗
PubMed2001

Resting energy expenditure in pre-dialysis diabetic patients.

BACKGROUND: The metabolic derangements of diabetes mellitus (DM) associated with those of chronic renal failure (CRF) may interfere with the energy and protein balance of patients with both diseases. The aim of this study was to verify whether the resting energy expenditure (REE) of non-dialysis chronic renal failure diabetic patients differs from that of chronic renal failure patients without DM. METHODS: REE was measured by indirect calorimetry in 24 CRF diabetic patients (CRF diabetes group), matched for age, gender, and degree of renal impairment to 24 CRF patients without DM (CRF control group). RESULTS: The CRF diabetes group had a significantly higher REE (1538+/-230 kcal/day) than the CRF control group (1339+/-315 kcal/day, P = 0.009). This difference was maintained even when the REE was adjusted for lean body mass (LBM; 30.3+/-4.3 vs 26.3+/-5.4 kcal/kg LBM/day, P = 0.004). Mean protein intake was significantly higher in the CRF diabetes than in the CRF control group (0.89+/-0.20 vs 0.76+/-0.25 g/kg/day, P = 0.02). Mean protein equivalent of nitrogen appearance (PNA) was also significantly higher in the CRF diabetes patients (1.21+/-0.31 vs 1.03+/-0.22 g/kg/day, P = 0.02), reflecting a higher protein intake and/or elevated protein breakdown. Accordingly, REE was directly correlated with PNA mainly in the CRF diabetes group (r = 0.57, P < 0.003). CONCLUSION: Metabolic disturbances of poorly controlled DM may account for the higher REE observed in the CRF diabetes group. The role of the apparently higher protein breakdown in this increased REE remains to be clarified.

Aged↗
PubMed2001

Factors associated with acceptance of patients for chronic dialysis.

BACKGROUND/AIMS: There is evidence suggesting that a number of patients with chronic renal failure (CRF) are not accepted for maintenance dialysis treatment, however, the factors that influence this process are not well known. METHODS: Data from patients who died of CRF in the city of São Paulo in 1998 were recorded from death certificates. The International Classification of Diseases, tenth revision, was used to select patients with an underlying cause of death associated with CRF. Patients who received dialysis were identified through the files of the São Paulo State Health Secretariat. Subjects accepted for dialysis or not were compared regarding demographic, socioeconomic factors and primary renal disease. RESULTS: Of 1225 subjects, 414 (33.8%) received dialysis and 811 (66.2%) did not. The adjusted odds ratio (OR) (95% CI) of not being accepted for dialysis was greater in older (> 65 years; OR: 2.94 (2.28 3.79)) and in younger subjects (<18 years; OR: 3.20 (1.16-8.28)) compared to those aged 18-64 years. Single subjects had a greater chance of not being accepted for dialysis than married individuals (OR: 1.28 (1.01-1.65)). Patients with diabetes were less likely to receive dialysis than those with an unknown cause of renal failure (OR: 1.37 (1.01-1.86)). CONCLUSION: Age, underlying cause of renal failure and social support are associated with the acceptance of CRF patients for dialysis. Further studies are necessary to examine interventions to improve the access to treatment for potentially eligible patients.

Adolescent↗
PubMed2000

Quality of life at the initiation of maintenance dialysis treatment--a comparison between the SF-36 and the KDQ questionnaires.

OBJECTIVE: To evaluate the construct validity of the Medical Outcomes Study Questionnaire 36-Item Short Form Health Survey (SF-36) and to assess the quality of life of patients with end-stage renal disease (ESRD) at the initiation of maintenance dialysis treatment. METHODS: Cross-sectional study. SETTING: Eight ambulatory dialysis units in São Paulo city, Brazil. STUDY PARTICIPANTS: Eighty ESRD patients at the initiation of chronic dialysis program and consecutively accepted for treatment in selected units in 1998. MAIN OUTCOME MEASURES: Quality of life as measured by the dimensions of the SF-36 questionnaire. The 'Kidney Disease Questionnaire' was used in a subgroup of patients to evaluate the validity of the SF-36. RESULTS: Median (range) scores of the SF-36 dimensions (ranging from 0 to 100, higher scores representing better quality of life) were: Physical Function 70 (0-100), Role Limitations due to Physical Problems 25 (0-100), Bodily Pain 62 (0-100), General Health 57 (5-100), Vitality 55 (10-100), Social Function 63 (0-100), Role Limitations due to Emotional Problems 34 (0-100) and Mental Health 68 (0-100). SF-36 dimensions correlated significantly with those of the 'Kidney Disease Questionnaire' (correlation coefficients ranging from 0.23 to 0.68). CONCLUSIONS: The SF-36 was shown to have construct validity when used in patients with ESRD in Brazil. The quality of life of ESRD patients is impaired at the initiation of dialysis treatment and this was clearly evidenced in the Role Limitations due to Physical Function and Emotional Function items. Greater attention should be given to interventions that could improve the quality of life parameters at the initiation of dialysis treatment.

Adult↗
PubMed1999

Abnormalities of renal function in the elderly.

OBJECTIVE: To investigate the glomerular and proximal tubular renal function and the prevalence of urinary abnormalities in the elderly. DESIGN: Cross-sectional study. SETTING: General community in the city of São Paulo. PARTICIPANTS: A population-based sample of 200 elderly subjects was randomly selected. Of these, 81 subjects (45 females and 36 males; mean +/- SD age: 73.7 +/- 6 years) accepted to undergo laboratory examination and were included in the study. MAIN OUTCOME MEASURES: 24-h creatinine clearance (CCr), microalbuminuria, urinary retinol-binding protein (urRBP), leukocyturia, hematuria and total proteinuria. RESULTS: CCr was lower than 80 ml/min/1.73 m2 in 68% of the subjects. The median (range) CCr was 65 ml/min/1.73 m2 (21-112) in males and 77 ml/min/1.73 m2 (27-107) in females (p = 0.14). No individual had serum creatinine greater than 1.5 mg/dl. urRBP determination was normal in 79 of 81 subjects. The prevalence of microalbuminuria (> 20 micrograms/ml) was 31% (n = 25, 19 men and 6 women). These individuals presented higher mean systolic blood pressure (147 +/- 20 vs. 135 +/- 22 mmHg, p = 0.02) and mean serum creatinine (1.13 +/- 0.20 vs. 0.96 +/- 0.20 mg/dl, p < 0.01) than those without microalbuminuria. The prevalence of leukocyturia (> 10,000/mm3), hematuria (> 10,000/mm3) and total proteinuria (> or = 0.3 mg/dl) was 19%, 28% and 5% in males and 33%, 27% and 4% in females. CONCLUSIONS: Glomerular dysfunction and urinary abnormalities are frequent features in the elderly, however, proximal tubular dysfunction is uncommon in this population.

Aged↗
PubMed1998

Idiopathic focal segmental glomerulosclerosis and HLA antigens.

The objective of the present study was to investigate a possible association between HLA class II antigens and idiopathic focal segmental glomerulosclerosis (FSGS). HLA-A, -B, -DR and -DQ antigens were determined in 19 Brazilian patients (16 white subjects and three subjects of Japanese origin) with biopsy-proven FSGS. Comparison of the HLA antigen frequencies between white patients and white local controls showed a significant increase in HLA-DR4 frequency among FSGS patients (37.7 vs 17.2%, P < 0.05). In addition, the three patients of Japanese extraction, not included in the statistical analysis, also presented HLA-DR4. In conclusion, our data confirm the association of FSGS with HLA-DR4 previously reported by others, thus providing further evidence for a role of genes of the HLA complex in the susceptibility to this disease.

Brazil↗
PubMed1998

Renal dysfunction in patients with sickle cell anemia or sickle cell trait.

Patients with sickle cell anemia (Hb SS) or sickle cell trait (Hb AS) may present several types of renal dysfunction; however, comparison of the prevalence of these abnormalities between these two groups and correlation with the duration of disease in a large number of patients have not been thoroughly investigated. In a cross-sectional study using immunoenzymometric assays to measure tubular proteinuria, microalbuminuria, measurement of creatinine clearance, urinary osmolality and analysis of urine sediment, we evaluated glomerular and tubular renal function in 106 adults and children with Hb SS (N = 66) or Hb AS (N = 40) with no renal failure (glomerular filtration rate (GFR) > 85 ml/min). The percentage of individuals with microalbuminuria was higher among Hb SS than among Hb AS patients (30 vs 8%, P < 0.0001). The prevalence of microhematuria was similar in both groups (26 vs 30%, respectively). Increased urinary levels of retinol-binding protein or beta 2-microglobulin were detected in only 3 Hb SS and 2 Hb AS patients. Urinary osmolality was reduced in patients with Hb SS or with Hb AS; however, it was particularly evident in Hb SS patients older than 15 years (median = 393 mOsm/kg, range = 366-469) compared with Hb AS patients (median = 541 mOsm/kg, range = 406-722). Thus, in addition to the frequently reported early reduction of urinary osmolality and increased GFR, nondysmorphic hematuria was found in 26 and 30% of patients with Hb SS or Hb AS, respectively. Microalbuminuria is an important marker of glomerular injury in patients with Hb SS and may also be demonstrated in some Hb AS individuals. Significant proximal tubular dysfunction is not a common feature in Hb SS and Hb AS population at this stage of the disease (i.e., GFR > 85 ml/min).

Adolescent↗
PubMed1998

A retrospective study of kidney transplant recipients from living unrelated donors.

Due to the shortage of cadaveric organs, kidneys from living unrelated donors (LUD) are increasingly being used for transplantation. The long-term outcome for LUD recipients is not completely known. This study was undertaken to evaluate the long-term graft survival in LUD recipients and compare it with that of cadaver donor allograft recipients. Three hundred and sixty-four LUD and 3881 cadaveric kidney recipients were evaluated using data obtained through the Brazilian Renal Transplant Registry. Transplants performed between January 1, 1987, and June 30, 1996, were eligible for analysis. Graft and patient survival were estimated by the Kaplan-Meier method. Sixty percent of the LUD were from spouses. The median duration of follow-up was 23.8 mo (0 to 117.2 mo). Patient survival rates were not significantly different for LUD and cadaveric kidney recipients (69% [95% confidence interval (CI), 61.9 to 76.1%] versus 73.2% [71 to 75.4%] at 5 yr; 69% [61.9 to 76.1%] versus 60.6% [55.1 to 66.1%] at 9.6 yr). Graft survival rates for recipients of LUD allografts were similar to those for cadaveric kidneys at 5 yr (50.1% [43.2 to 57%] versus 50.4% [48.1 to 52.8%]) and higher, although not significantly, at 9.6 yr (45.7% [37.7 to 53.7%] versus 32.7% [26.4 to 39%], respectively, P = 0.14). In a multivariate analysis using the Cox proportional hazards regression model, after adjusting for recipient age, race, history of previous transplantation, and year of transplantation, the risk of graft failure was 16% (95% CI, -3% to 31%) lower for LUD than cadaveric recipients. We conclude that LUD are an excellent alternative to cadaveric kidney donors. The long-term patient and graft survival rates for recipients of LUD allografts are at least as good as those for recipients of cadaveric kidneys.

Adult↗
PubMed1998

Staphylococcus aureus prophylaxis in hemodialysis patients using central venous catheter: effect of mupirocin ointment.

Central venous catheterization is a common technique to establish rapid and temporary access for hemodialysis. However, it is a known risk factor for Staphylococcus aureus infection and bacteremia. Mupirocin is a topical antibiotic with high in vitro anti-staphylococcal activity. A randomized prospective trial was conducted to assess the effectiveness of mupirocin ointment in the prevention of Staphylococcus aureus skin and catheter colonization, and episodes of bacteremia in 136 end-stage renal disease patients. Of these, 67 received skin disinfection at the venous catheter insertion site with povidone iodine (control group), and 69 received the same treatment followed by application of 2% mupirocin ointment at the cannula site after catheter placement and at the end of each dialysis session. Patients were followed until catheter removal and were monitored for the development of Staphylococcus aureus skin/catheter colonization and episodes of bacteremia. Median duration of catheter use was greater in the mupirocin than in the control group (37 versus 20 d, P < 0.01). Patients in the mupirocin group had a significantly lower rate of Staphylococcus aureus isolation from the pericatheter skin (1.76 per 1000 versus 14.27 per 1000 patient-days, P < 0.001) and from the catheter surface (3.17 per 1000 versus 14.27 per 1000 patient-days, P < 0.001). The proportion of patients with Staphylococcus aureus skin infection at the insertion site was lower in the mupirocin group (4.3% versus 23.9%, P = 0.001). Staphylococcus aureus-associated bacteremia was observed in 17 patients (two in the mupirocin group [0.71 episodes per 1000 patient-days] and 15 in the control group [8.92 per 1000 patient-days], P < 0.001). The hazard ratio of developing Staphylococcus aureus bacteremia was 7.2 (95% confidence interval, 1.6 to 31.6) times greater in patients not receiving mupirocin. Mupirocin applied to the insertion site significantly reduces the risk of Staphylococcus aureus skin and catheter colonization, exit-site infection, and Staphylococcus aureus bacteremia in hemodialysis patients.

Adolescent↗
PubMed1998

[Breastfeeding in shantytowns: an educational program through home visits].

This is a study of breastfeeding length, with and without a community educational program. It was done through home visits to 125 women residing in Vila Marianaís shantytowns in the city of São Paulo. It was found that breastfeeding lasts an average of more than 6 months after the educational intervention. When comparing the group that received education with the one that didnít, it was observed that in the former the percentage of children breastfed for 6 months or longer was 64%, while in the control group it was 17% (p < 0.001). This shows a significant increase in the number of mothers who nursed their children after an educational program promoting breastfeeding.

Adult↗
PubMed1997

Time of diagnosis of chronic renal failure and assessment of quality of life in haemodialysis patients.

BACKGROUND: Time of diagnosis of chronic renal failure ani predialysis care may be important factors related to the quality of life of patients on dialysis treatment. METHODS: We evaluated the quality of life of 113 haemodialysis patients who had a late (< or = 1 month before starting dialysis, n = 53) or early (> or = 6 months, n = 60) diagnosis of chronic renal failure. At the time of the survey patients had been on dialysis for a median duration of 55 days (range 1-109). Quality of life was measured by the Kidney Disease Questionnaire (KDQ), including five dimensions with scales ranging from 1.0 to 7.0 (1.0 = more impairment): the health and life satisfaction indices (higher score = more dissatisfied), functional status (Karnofsky scale), and the time trade-off technique. RESULTS: Mean scores of quality of life measures were worse in the late- than in the early-diagnosis group. A significant difference (P < 0.05) was observed in the depression (4.46 +/- 1.45 vs 5.23 +/- 1.36), relationships with others (3.95 +/- 1.31 vs 4.53 +/- 1.31) and frustration (4.08 +/- 1.51 vs 5.21 +/- 1.34) dimensions of the KDQ. and in life satisfaction (4.11 +/- 1.92 vs 3.32 +/- 1.57). Functional status declined compared to 1 year before dialysis, particularly in the late-diagnosis group. Among the elderly patients, the magnitude of the difference was more pronounced, (including in the physical symptoms item of the KDQ). CONCLUSIONS: Our findings demonstrate that late diagnosis of chronic renal failure and the consequent lack of predialysis care adversely affect the quality of life of haemodialysis patients. Early diagnosis and regular predialysis care should be encouraged to improve the quality of life during dialysis treatment.

Adult↗
PubMed1997

Renal abnormalities in ankylosing spondylitis.

Renal abnormalities have been reported in Ankylosing Spondylitis (AS) patients. Possible mechanisms include the effects of nonsteroidal anti-inflammatory drugs (NSAIDs), an increased incidence of glomerulonephritis, particularly the ones associated with deposition of IgA-containing immune complexes and the renal deposition of amyloid. These observations prompted us to evaluate in detail the frequency and severity of renal dysfunction in 40 AS patients, consecutively selected attending the rheumatology disease unit outpatient clinic at Escola Paulista de Medicina, using sensitive tests of glomerular and tubular function. Fourteen of the 40 patients presented one or more signs of renal involvement: microscopic hematuria (9 patients), microalbuminuria (4 patients), decreased renal function assessed by serum creatinine (2 patients), and creatinine clearance (4 patients). None of the patients presented increased urinary excretion of retinol binding protein (RBP). The finding of renal abnormalities in 35% of our patients suggests that in this illness evidence of renal involvement should be actively investigated.

Adolescent↗