Biomedical subjects

R Sesso

Publications and source records attributed to R Sesso.

47 records · Page 3Linked to original sources

PubMed1990

Exposure to hydrocarbons and rapidly progressive glomerulonephritis.

1. A case-control study of the relationship between the regular exposure to hydrocarbons and rapidly progressive glomerulonephritis (GN) was carried out in São Paulo, Brazil. Regular exposure was defined as 1 h or more weekly for 3 consecutive months or longer. We studied 17 patients with rapidly progressive renal failure and biopsy-proven crescentic GN and 34 matched hospital controls. 2. We found an increased risk of rapidly progressive GN associated with exposure to organic solvents (relative risk = 5.00; 95% confidence interval = 1.14 to 22.00). The frequency of exposure to solvents was 52.9% among the patients and 17.7% among the control subjects (P less than 0.05). However, no statistically significant increased risk was detected in those patients who had been exposed to fuels (relative risk = 3.25; 95% confidence interval = 0.76 to 13.89); the proportion of exposure to fuels was 47.1% among the patients and 20.6% among the control subjects. 3. Renal histologic findings suggest that immune complex mediated injury as well as a direct glomerular toxic effect may participate in the pathogenesis of rapidly progressive GN associated with hydrocarbon exposure.

Adolescent↗

PubMed1989

Level of fetal hemoglobin as an indicator of clinical complications in sickle cell anemia.

1. The fetal hemoglobin (HbF) level was used as an indicator of the development of severe clinical complications in 89 patients with sickle cell anemia (SCA). 2. HbF was determined by the alkali denaturation technique. The mean HbF level was 6.7 +/- 4.2% (range, 0.7 to 19.2%) of total hemoglobin. 3. Major organ failures were considered to be terminal events of morbidity and included 8 cerebrovascular accidents, 13 aseptic necroses of the femoral head and 17 leg ulcer episodes. 4. The characteristics of the test, including sensitivity, specificity and positive predictive value were analyzed for different levels of HbF. 5. The overall specificities were 76, 76, and 85% for HbF levels greater than or equal to 8, 10 and 12%, respectively. The sensitivity of the test was low. The positive predictive value reached 71% for children with HbF greater than or equal to 8%. The data suggest that HbF level may be a useful indicator of the possibility of a patient developing serious clinical complications.

Adolescent↗

PubMed1989

Staphylococcus aureus skin carriage and development of peritonitis in patients on continuous ambulatory peritoneal dialysis.

We conducted a 15-month prospective study to investigate the skin carriage of Staphylococcus aureus and the development of peritonitis in 43 patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Sixteen of 43 patients (37%) were chronic carriers of S. aureus in the anterior nares and/or in the exit-site of the catheter; 12 patients (28%) were intermittent carriers, and 15 (35%) were noncarriers. Fifty episodes of peritonitis occurred during a total of 422 patient-months of observation. S. aureus was responsible for 16 episodes of peritonitis diagnosed in 15 patients. All episodes of S. aureus peritonitis occurred in chronic and intermittent carriers. Phage typing was performed on isolates from 8 patients with S. aureus peritonitis, and they were found to have the same phage type as that previously carried in the skin. We conclude that CAPD patients who are chronic or intermittent carriers of S. aureus are at higher risk of development of peritonitis than noncarriers.

Adolescent↗

PubMedDate not supplied

Application of restriction endonuclease analysis of chromosomal DNA in the study of Staphylococcus aureus colonization in continuous ambulatory peritoneal dialysis patients.

The relationship between nasal and skin colonization with Staphylococcus aureus and subsequent infection in continuous ambulatory peritoneal dialysis (CAPD) patients in Brazil has been documented by restriction endonuclease analysis of plasmid DNA. However, S. aureus strains without detectable plasmids have been identified. Using restriction endonuclease analysis of chromosomal DNA hybridized with an rRNA gene probe, we document the diversity of S. aureus strains without detectable plasmids colonizing CAPD patients. Ten paired strains without detectable plasmids from five patients were studied by restriction endonuclease analysis of chromosomal DNA and by phage typing. Five different profiles were obtained by restriction endonuclease analysis of chromosomal DNA. Although four of the ten paired isolates were nontypeable by phage typing, all were discriminated by restriction endonuclease analysis of chromosomal DNA. These results demonstrate that restriction endonuclease analysis of chromosomal DNA is a useful epidemiologic tool and complements the restriction endonuclease analysis of plasmid DNA of S. aureus by providing a means of typing strains without detectable plasmids.

Bacteriophage Typing↗

PubMedDate not supplied

The use of cyclosporine modifies the clinical and histopathological presentation of tuberculosis after renal transplantation.

Tuberculosis is one of the most frequent opportunistic infections after renal transplantation and occurred in 30 of 1264 patients transplanted between 1976 and 1996 at Hospital São Paulo - UNIFESP and Hospital Dom Silvério, Brazil. The incidence of 2.4% is five times higher than the Brazilian general population. The disease occurred between 50 days to 18 years after the transplant, and had an earlier and worse development in patients receiving azathioprine, prednisone and cyclosporine, with 35% presenting as a disseminated disease, while all patients receiving azathioprine and prednisone had exclusively pulmonary disease. Ninety percent of those patients had fever as the major initial clinical manifestation. Diagnosis was made by biopsy of the lesion (50%), positivity to M. tuberculosis in the sputum (30%) and spinal cerebral fluid analysis (7%). Duration of treatment ranged from 6 to 13 months and hepatotoxicity occurred in 3 patients. The patients who died had a significant greater number of rejection episodes and received higher doses of corticosteroid. In conclusion, the administration of cyclosporine changed the clinical and histopathological pattern of tuberculosis occurring after renal transplantation.

Adolescent↗

PubMedDate not supplied

Osteomalacia secondary to renal tubular acidosis in a patient with primary Sjögren's syndrome.

We report a case of a 41-year-old woman whose disease manifested as osteomalacia and whose etiological investigation revealed renal tubular acidosis secondary to primary Sjögren's syndrome. Proximal tubular dysfunction was also present and was documented by increased urinary excretion of beta-2-microglobulin and retinol-binding protein. The patient showed clinical and laboratory improvement after treatment with oral potassium citrate, calcium supplements and steroids.

Acidosis, Renal Tubular↗

PubMedDate not supplied

[Usefulness of HLA-B27 in the diagnosis of ankylosing spondylitis: positive and negative predictive value and the probability ratio of diseases].

The authors discuss the usefulness of the HLA-B27 test in the diagnosis of ankylosing spondylitis (AS). Sensitivity, Specificity, Predictive Value of a Negative Test, Predictive Value of a Positive Test, and Likelihood Ratio are defined and illustrated through the example involving HLA-B27 and AS. The HLA-B27 cannot be used as a screening test for the diagnosis of AS when evaluating an asymptomatic population, however the test is most useful in assisting the diagnosis of AS when used by physicians who understand the principles of probability.

HLA-B27 Antigen↗

PubMedDate not supplied

[Epidemiologic aspects of the dialysis treatment in Grande São Paulo. Comissão Regional de Nefrologia da Secretaria da Saúde de São Paulo and Centro de Informática da Escola Paulista de Medicina].

OBJECTIVE: Epidemiological data about the treatment of patients with end-stage renal disease in the Great Sao Paulo, Brazil, are presented. MATERIAL AND METHODS: Patients on dialysis in the city of Sao Paulo and surroundings, distributed in 15 Regional Offices of Health (ERSAs), during 1991, were studied. Data were collected by the Secretary of Health of the State of Sao Paulo. RESULTS: There was an increase of 18.6% in the number of alive patients on dialysis from January 1 to December 31 (n = 2,425 to 2,875). Patients were treated in 40 dialysis centers, of which 24 were located in the ERSAs 1, 2 and 3. Depending on the ERSA, a percentage of patients varying from 37% to 88% did not live in the same region where they received treatment. At the end of the year, 79% of the patients were on hemodialysis, 15% on continuous ambulatory peritoneal dialysis and 6% on intermittent peritoneal dialysis. The diagnoses more frequently reported of primary disease were non-determined, glomerulonephritis, hypertension and diabetes (36%, 27%, 17% and 8%, respectively). New cases (1,483) initiated dialysis during the year, corresponding to an incidence rate of 83 patients per million population (pmp). The prevalence of patients on dialysis was 148 pmp. The annual fatality rate was 17.2% (range in the ERSAs: 12.0-3.5). The actuarial one year survival for the patients who started treatment in 1991 was 80.2%. 246 patients received transplantation, corresponding to 14 patients pmp. CONCLUSIONS: Dialysis treatment provided in the Great Sao Paulo is satisfactory.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

[Survival of dialyzed diabetic patients].

OBJECTIVE: Diabetes is a cause of end-stage renal failure of increasing importance. Our aim was to evaluate the survival of diabetic and non-diabetic patients on dialysis treatment. MATERIAL AND METHODS: Two hundred and ninety-five patients on dialysis program in a tertiary referral center of the São Paulo city, from 1992-94, were studied. Seventy-one patients were diabetics (17 type I and 54 type II) and 224 had other diagnoses of renal disease. Data were prospectively collected using standard questionnaires and also retrospectively for patients who started treatment between 1992 and June 1993. Survival analysis was done using the product-limit method. RESULTS: Diabetic patients had a greater mean age and a higher proportion on peritoneal dialysis than non-diabetics. After one year, survival rates were 67% and 86% for diabetics and non-diabetics (p < 0.0001). The difference in survival rates increased with the duration of treatment. This difference was observed both in young (< or = 50 years) and in elderly patients, although it has been noted earlier in the former. Survival of diabetics remained significantly reduced adjusting for the age of the patients. CONCLUSIONS: Diabetic patients on dialysis have lower survival rates than non-diabetics, independently of their greater mean age. Special attention should be given to these patients, both in relation to pre-dialysis comorbidity and during dialysis treatment, to improve their survival experience.

Adult↗

PubMedDate not supplied

A microcomputer-based transplantation registry.

We describe a microcomputer-based program developed for the Brazilian Kidney Transplant Registry. The system can construct life tables and survival curves online, without the need to export the database. From 1987 through 1993, 6069 kidney transplants were reported; 3485 (57.4%) were from living donors and 2584 from cadavers. The proportion of cadaveric transplants increased from 28.5% in 1987 to 58.1% in 1993. Overall kidney transplantation activity was 8.1 patients per million population per year. Sixty-four percent of the patients were male, and 71% were white. The mean age was 33.4 years. The primary renal diseases most frequently reported were glomerulonephritis (43.6%) and hypertensive renal disease (13.6%). Only 3.6% of the recipients were diabetic. Patient and graft survival rates have improved in recent years. We expect that cadaveric organ procurement programs will continue to develop in our country, increasing the number of organ transplantations and creating a more equal distribution of cadaveric organs.

Adolescent↗

PubMedDate not supplied

[Access to chronic dialysis treatment: deficient and unequal].

OBJECTIVE: To determine the fraction of patients with end-stage renal disease (ESRD) who received dialysis treatment in the city of São Paulo in 1991 and to investigate the influence of age in the access to dialysis. MATERIAL AND METHODS: All patients who received dialysis for ESRD in the city of São Paulo during 1991, and were registered in the Secretary of Health of São Paulo files were included in the study. In the same year, information was also collected on individuals who died having as basic cause of death a disease related to chronic renal failure. These data were obtained from death certificates files. Using simultaneously information from both data bases it was possible to ascertain the patients who died without receiving dialysis and to calculate the treated fraction in several age groups. RESULTS: Overall 25.6% of ESRD patients did not receive treatment. There was a progressive reduction in the fraction of patients treated for those older than 40 years. In children less or equal to 9 years of age the percentage of treatment was also reduced (29%). Individuals in the age groups 60-69 and 70-79 years had a chance about 5 and 11 times greater, respectively, of dying without receiving dialysis than those in the 20-29 years group. CONCLUSIONS: We estimate that at least one fourth of the ESRD patients died in São Paulo in 1991 without receiving dialysis treatment. Age is a major factor of discrimination for acceptance in chronic dialysis programs.

Adolescent↗