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PubMed1996

Thoracoscopic surgery in Brazil. An overview.

The Video Assisted Thoracic Surgery (VATS) was introduced in Brazil in 1992 by Losso, Ghefter and Imaeda. Since its advent up to November 1994, 488 patients have been submitted to 497 VATS procedures in four Medical Centers of São Paulo city. The indications for the procedures were: lung diseases in 244 patients (50%), pleural disease in 155 patients (31.7%), thoracic traumas in 42 patients (8.6%), mediastinal diseases in 35 patients (7.1%), cardiovascular diseases in 7 patients (1.4%), chest wall diseases in 3 patients (0.6%) and esophageal diseases in 2 patients (0.4%). In the group of lung disease the most commonly used procedures were the lung biopsy in order to diagnose diffuse pulmonary disease and the indeterminate solitary nodule resection. Among the occurrences of pleural diseases, the most commonly used procedures were the pleurodesis with talc (talc poudrage) for the treatment of recurrent pleural effusion, the driven pleura biopsy and debridment or decortication of trapped lung in cases of pleural empyema. Concerning the mediastinal diseases, the pathology which was most frequently treated by VATS was the recurrent pericardic effusion through partial pericardiectomy. Among the patients presenting chest traumatic diseases, the VATS was used to explore thoracoabdominal penetrating injuries, to control bleeding, to remove clotted hemothorax, to suture diaphragm lesions and to remove intrapleural foreign bodies. Out of 497 procedures, there were 28 convertions to thoracotomy (5.7%) and two deaths occurred all over the cases. The complications, limitations and growth related to this method as well as a future overview of the VATS in Brazil will be presented.

Brazil↗
PubMed1999

Coronary angioplasty in Brazil.

In 1979, the first transluminal coronary angioplasty (PTCA) was performed in Brazil, two years after the original contribution of Andreas Gruentzig, in Zurich. In the years which followed, the development of PTCA in the country grew and in the mid eighties several centres had already had the experience of more than 600 cases. In the beginning of the nineties, PTCA underwent an additional promotion with a large number of procedures, now subventioned by the bodies of public health. In addition to this, the introduction of new technologies such as directional atherectomy, rotablator, laser and stents. In 1991, the Brazilian Society of Interventional Cardiology created a national registry (CENIC) to gather data on the coronary procedures performed in the country. The CENIC data for the 1992/1993 and 1996/1997 bienniums were compared and it was observed that there had been a significant increase in the number of cases treated (from 16,429 in 92/93 to 22,025 in 96/97), complex lesions of the B/C type (from 71.4% to 92.3%), patients with previous revascularisation (from 22% to 28.3%), acute myocardial infarction (from 16% to 17.4%) and multiarterial lesions (from 34.4% to 38.8%). However, despite a greater clinical and angiographic complexity, the success of the procedure grew (from 89.7% to 92.8%) and complications reduced: acute occlusion (from 3.2% to 1.5%); acute myocardial infarction (from 2.5% to 1.2%) and death (from 1.8% to 1.4%). Interventional cardiology in Brazil has consequently progressed at the same rate as that of other countries. The incorporation of new technologies, particularly coronary endoprostheses has increased, guaranteeing better success rates, better results and a decrease in complications arising from acute occlusion of the target vessel.

Angioplasty, Balloon, Coronary↗
PubMed1998

[Risk factors for acute myocardial infarction in Brazil. FRICAS Study].

PURPOSE: To determine risk factors related to acute myocardial infarction (AMI) in Brazil. METHODS: Five hundred ninety one patients were selected in 20 medical centers in Brazil, between January/94 and March/95. Two-hundred-ninety-nine patients were cases, and 292 controls with a variety of acute diseases not related to the suspected or known risk factors for acute myocardial infarction. All data were collected through a structured questionnaire filled by the patients. The evaluation of the variables was done through univariate analysis with a significance level of 5%. RESULTS: The factors related to acute myocardial infarction were respectively to cases and controls: Hypercholesterolemia--210.93 +/- 46.74 mg/dl and 185.71 +/- 45.45 mg/dl, (p = 0.000); smoking--41.69% and 27.20% (p = 0.000); hypertension--52.35% and 20.88% (p = 0.000); diabetes--19.70% and 9.93% (p = 0.001); family history--related to the patient's father in 42.14% and 33.22% (p = 0.025) and to the mother in 42.14% and 30.82% (p = 0.007); socioeconomic level--88.99% and 60.20% owned house (p = 0.002); 44.45% and 33.21% owned car (p = 0.010); physical activity--56.83% and 48.28% had the habit of walking in the year prior to study entry (p = 0.029); diet--38.79% and 28.42% consumed canned food (p = 0.013). The mean weight was 72.50 +/- 26.89 kg and 69 +/- 12.26 kg (p = 0.0271). The mean height was 166.56 +/- 8.81 cm and 166.66 +/- 8.47 cm. CONCLUSION: This study confirmed the importance of hypercholesterolemia, hypertension, diabetes mellitus, overweight and family history as risk factors for acute myocardial infarction. There was a significant relation between socioeconomic level and the prevalence of acute myocardial infarction.

Adult↗
PubMed1999

Serologic prevalence of Sarcocystis neurona, Toxoplasma gondii, and Neospora caninum in horses in Brazil.

OBJECTIVE: To determine serologic prevalence of Sarcocystis neurona, Toxoplasma gondii, and Neospora caninum in horses in Brazil. DESIGN: Prevalence survey. ANIMALS: 101 Thoroughbreds in Brazil. PROCEDURE: Blood samples were obtained from horses and tested for serum antibodies against S neurona by use of an immunoblot procedure with culture-derived S neurona merozoites as antigen, and for serum antibodies against T gondii and N caninum by use of a modified agglutination test with formalin-preserved tachyzoites and mercaptoethanol. RESULTS: Antibodies against S neurona and T gondii were detected in 36 and 16 of 101 horses, respectively. Cross-reactivity between antibodies against T gondii and S neurona was not detected. Antibodies against N caninum were not detected in any samples. CONCLUSIONS AND CLINICAL RELEVANCE: The high prevalence of antibodies against S neurona detected in clinically normal horses emphasizes the importance of examining CSF for antibodies when establishing a diagnosis of equine protozoal myeloencephalitis.

Animals↗
PubMedDate not supplied

[Clinical and epidemiological study of calcifying chronic pancreatitis in Goiânia, GO, Brazil].

The authors studied, prospectively, 102 cases of calcifying chronic pancreatitis in Goiânia, GO, Brazil, from 1985 to 1996. Alcohol was the major cause of calcifying chronic pancreatitis, responsible for 94.1% of the cases. In others 5.9% of the cases, not associated with alcohol, the etiologic diagnosis could not be confirmed. The average age of the patients was 39.8 +/- 9.8 years, and the first symptoms appeared with the average age of male sex in the proportion of 9.2/1. The average of alcoholic beverage ingested was 258 +/- 187.1 g/day of ethanol through an average period of 17.5 +/- years. The major complications found were: chronic diarrhea (malabsorption), pleural effusion, cysts, diabetes mellitus, jaundice and digestive hemorrhage. This study, when compared to others from other Brazilian cities, suggests that there are differences in the natural history of calcifying chronic pancreatitis among several regions of Brazil.

Adult↗
PubMedDate not supplied

[Prevalence of adenocarcinoma of the esophagus and esophagogastric junction in a 10 year period at a cancer referral center in southern Brazil].

UNLABELLED: There is increasing incidence of adenocarcinoma of the esophagus and esophagogastric junction in the USA and Europe, however, data in Brazil are scanty. OBJECTIVE AND METHODS: We reviewed all histology confirmed esophageal and esophagogastric junction cancer reports during a 10-year period (1987-1996) obtained by upper digestive endoscopy biopsies at a cancer referral center in Southern Brazil. Cancer cases were classified in three categories: adenocarcinoma, squamous cell carcinoma, and others. RESULTS: Among 349 cases, adenocarcinoma was found in 53 (15.2%), squamous cell carcinoma in 283 (81.1%) and others in 13 (3.7%). CONCLUSIONS: In this study, the prevalence of adenocarcinoma was 15%.

Adenocarcinoma↗
PubMed1999

[Health promotion and health education at the school of governance in health, National School of Public Health, Brazil].

Schools of public health should define their teaching, research, and technical cooperative programs on the basis of epidemiological, epistemological, and health care parameters, which are heavily affected by the socioeconomic context of their countries. Brazil's demographic and epidemiological transition has been characterized by an increasing prevalence of diseases and risk factors associated with life styles, thus requiring an extensive and in-depth change in the country's health care model, with a greater supply of evidence-based services and preventive and health promotion measures, including new initiatives in information, education, and communications. This article approaches the recent experience at the Brazilian National School of Public Health, which has added to its long-standing academic tradition with a strategic reorientation known as the School of Governance in Health, including distance education as one of its main teaching options. Given Brazil's prevailing social and health situation, we conclude by highlighting the importance of training health professionals and promoting research and technological development in the fields of health promotion and education within the context of the School of Governance in Health at the National School of Public Health.

Brazil↗
PubMed2000

Transmission of tuberculosis in an endemic urban setting in Brazil.

SETTING: Two out-patient facilities in São Paulo, Brazil. OBJECTIVE: To study the transmission pattern of tuberculosis (TB) among human immunodeficiency virus (HIV) infected and uninfected persons in a setting endemic for TB. DESIGN: A prospective study comparing HIV-seropositive and -seronegative TB patients identified consecutively between 1 March 1995 and 1 April 1997. The patients were stratified according to their Mycobacterium tuberculosis isolate IS6110 RFLP patterns. Risk factors were sought for infection with an RFLP cluster pattern strain, inferred to represent recent transmission. RESULTS: Fifty-eight (38%) of 151 HIV-seropositive patients and 36 (25%) of 142 HIV-seronegative patients were infected with M. tuberculosis isolates that belonged to cluster patterns (OR 1.84, 95% CI 1.08-3.13). Multidrug-resistant (MDR) strains were isolated from 19 patients, all of whom were HIV seropositive; 12 (63%) of these, and 46 (35%) of 132 drug-susceptible isolates had cluster patterns (OR 3.20, 95% CI 1.08-9.77). CONCLUSION: In a TB-endemic urban setting in Brazil, the proportion of cases resulting from recent transmission appears to be greater among HIV-seropositive than among HIV-seronegative patients. A large proportion of MDR-TB (63%) cases was caused by strains that had cluster RFLP patterns, suggesting recent transmission of already resistant organisms. This type of knowledge regarding TB transmission may help to improve locally appropriate TB control programs.

AIDS-Related Opportunistic Infections↗
PubMed1999

Antioxidant concentration effect on stability of Brazil nut (Bertholletia excelsa) crude oil.

Shelled and broken Brazil nuts easily lose quality, if not properly stored. Pressing is an alternative use of these nuts and the crude oil stability was studied. Our previous studies demonstrated that TBHQ (200 mg kg-1) was very efficient to prevent rancidity development in oils bottled in brown and clear glass. As TBHQ has higher price than other phenolic antioxidants like BHT and BHA, an oven test (at 63 degrees C) was conducted to determine the economical and best concentration of TBHQ for Brazil nut crude oil. An assay at ambient temperature was conducted in brown and clear glass flasks with and without the economical concentration of TBHQ calculated (83 mg kg-1) for 90 days. Acid, peroxide, and iodine indices and the absorptivity at 232 nm were determined. TBHQ, even at this low dosage, was very efficient in both brown and clear glass flasks. Peroxide value increased from 11.5 meq O2 kg-1 to average 15 and 35, in TBHQ and control samples after 90 days. The absorptivity at 232 nm remained at 1.3 in samples with TBHQ while the control increased to 1.6.

Brazil↗
PubMed2000

Subtypes of intimin among non-toxigenic Escherichia coli from diarrheic calves in Brazil.

One hundred and five strains of Escherichia coli that were isolated from calves with diarrhea in the state of São Paulo, Brazil, and were negative for enterotoxins and cytotoxins, were examined for the eae gene. Four (3.8%) strains were positive by polymerase chain reaction (PCR) and were shown to produce intimin by using Western blot with specific antiserum against the conserved N-terminal region of intimin. Subtyping of the intimins was done by PCR with specific primers and by Western blot with specific antisera against the C-terminal variable region of the protein. Three of these isolates (O?:H11, O26:H-, O123:H1) produced the beta subtype of intimin, and the 4th (0103:H2) produced intimin that was not typable. The 0103:H2 and the O26:H-isolates adhered to HEp-2 cells with diffuse adherence and localized-like adherence patterns, respectively. The other strains did not adhere to HEp-2 cells. To our knowledge, this is the first report of the occurrence of a subtype of intimin described for human enteropathogenic E. coli among bovine diarrheogenic E. coli. It is also the first report from Brazil demonstrating the presence of bovine E. coli harboring the eae gene.

Adhesins, Bacterial↗
PubMed2000

Genetic characterization of adenovirus strains isolated from patients with acute conjunctivitis in the city of São Paulo, Brazil.

Genome analysis was carried out on adenovirus strains isolated from patients with acute follicular conjunctivitis in the city of São Paulo, Brazil. Eighteen conjunctival scrapings, collected between December 1993 and March 1994, were analyzed by two methods: a combination of polymerase chain reaction with restriction fragment length polymorphism and viral DNA restriction analysis, carried out using 10 restriction endonucleases: BamHI, BglI, BglII, HindIII, KpnI, SacI, SalI, SmaI, XbaI, and XhoI. Among 11 adenovirus detected by cell culture isolation, nine were Ad8, and two were Ad7. By restriction analysis the Ad8 isolates were typed as two new variants-Ad8/D11 (seven of nine samples) and Ad8/D12 (two of nine samples). Ad7 isolates were identified as a subtype of the widespread genome type Ad7b and the virulent type Ad7h, a predominant genome type circulating in Argentina, Chile, and Uruguay but absent in Brazil until 1991.

Acute Disease↗
PubMed1976

Misuse of organomercury fungicides in Brazil.

A methoxyethyl mercuric compound, licensed in Brazil as a fungicide for seed dressing, was widely used for spraying tomato and other vegetable crops in 1966 and 1967.Mercury residues ranging from 0.05 to 0.30 mg/kg were detected in 14% of the tomatoes, 13% of other vegetable samples, and 57% of the tomato paste batches.A wide campaign through newspapers, radio, and television was quickly established to educate farmers and the population in general on the hazards of ingestion of mercury-contaminated food.All samples of tomatoes and other vegetables positive for mercury (residues above 0.05 mg/kg) were destroyed. Inspection posts on the main roads and highways prevented the delivery of contaminated food to cities and food processing plants.The sale of organomercury fungicides is now controlled in Brazil; however, treated seeds which are not planted may be diverted to human or animal consumption. There is no official record of accidents, but occasional cases of poisoning are known.The mercury residue level in Brazilian fish is low, indicating that environmental pollution by mercury is not a big problem in the country. However, some fresh-water and estuarine fish may contain mercury residues ranging from 0.01 to 0.66 mg/kg.

Animals↗
PubMed2000

Trance surgery in Brazil.

This report presents the results of fieldwork in Brazil on healer-mediums who perform crude forms of surgery, often employing sharp instruments. We found that these healer-mediums were in a hyperaroused brain state while they were engaged in behaviors commonly described in the anthropology literature as "possession trance"; therefore, this practice is termed "trance surgery" in this report. The research was conducted at widely scattered sites throughout Brazil. We observed several thousand patients being treated by 9 trance surgeons and videotaped several hundred of these cases. In addition to background information and our own observational material, this paper includes 2 medical case reports, physiological data gathered from healers and patients, and results of a pathologist's examination of a surgically excised tumor. Topographic brain mapping revealed increased brain activity (36-44 Hz) when healer-mediums were engaged in trance behaviors, compared to resting baseline conditions at midline scalp locations (Cz, P < .009 and Pz, P < .004; both matched t tests). These results suggest the presence of a hyperaroused brain state associated with the trance behaviors of the healers. We believe that such a state is required for this unusual practice, but other factors may also be involved. In contrast, a small sample of patients monitored during possession trance surgical procedures revealed no high-frequency brain activity; instead, there were indications of cortical quieting, suggesting relaxation, despite the absence of anesthesia. Pathohistological examination of a tumor excised from a patient in our presence revealed a human fibroadenoma. We conclude that these practices are usually benign and that pain is often absent, despite the lack of sterile procedures and anesthesia. Although during the period of our investigation we were informed anecdotally of 3 cases involving serious complications or death, we personally observed no cases of shock, hemorrhage, or death. The cases presented in this paper, as well as others we have followed, suggest that serious illnesses, not likely to improve without treatment, may do so after trance surgery procedures are performed. If the major benefit of trance surgery is to initiate self-healing processes, it would have to do so in powerful ways, which possibly can be elucidated with positron emission tomography and functional magnetic resonance imaging scans. Positive findings would be helpful in understanding large-scale healing effects and may lead to new treatment protocols.

Aged↗
PubMed1999

An outbreak of group C rotavirus gastroenteritis among children attending a day-care centre in Belém, Brazil.

In August 1993, an outbreak of group C rotavirus-associated gastroenteritis occurred among children attending a day-care centre in Belém, Brazil. Of the 64 children, 21 (33%) became ill. Group C rotavirus was identified in faecal specimens from 8 (38%) children with diarrhoea by electron microscopy (EM) and an enzyme immunoassay (EIA), using antibodies specific to the Cowden strain of porcine group C rotavirus. By polyacrylamide gel electrophoresis (PAGE), a pattern similar to that of group C rotavirus was observed in 5 (62.5%) of the 8 EM- and EIA-positive samples. These 5 faecal samples were confirmed to be positive for group C rotavirus by reverse transcriptase-polymerase chain reaction, using specific VP6 and VP7 primers. This is the first report of an outbreak of diarrhoea in North Brazil associated with group C rotavirus. These findings suggest that group C rotavirus may be an important aetiological agent of diarrhoea in this region, which requires further study.

Brazil↗
PubMedDate not supplied

[Overview of the geography of intestinal schistosomiasis in Brazil].

The distribution of schistosomiasis in Brazil is highly contrasted, with most cases concentrated in a large area in the North East, where the disease is endemic and considered a major threat to public health, and small isolated foci of disease scattered throughout the country seen as being of little epidemiological importance. The common interpretation of the history of this endemic disease (that it began in the endemic zone and has spread to the isolated foci) has added to the stigmatization of the North East. However, this interpretation is challenged by many examples of the recent establishment of the disease in the North-East and its more long-standing nature in the isolated foci. Besides, overstressing the role of recent migration simply obscures both social issues and the biogeography of vectors. Areas are not homogeneous in terms of schistosomiasis and we must therefore consider these factors if we are to understand the spread of the disease and its current distribution. Thus, in Amazonia, low human population pressure and the rarity of snails (mainly due to the acidity of the water) together account for the low level of transmission despite the high proportion of infected individuals among immigrants to this area. The converse is true for the city of Belém. Very similar reasons can be given for the limited impact of schistosomiasis in the central plateau and its high frequency around the federal capital, Brasilia. In contrast, the rate of infection is not very high around São Paolo due to the specific characteristics of urbanization of this city and its highly efficient control program. However, the enormous size of this city results in the number of cases reported being similar to that for Belém or Brasilia. These three cities are linked by a highway, which serves as a major axis for migration, particularly for those heading north from southern Brazil or São Paolo. This migration axis has increased in importance because there are now far fewer opportunities to settle in the West (Amazonia and the central plateau). The older "endemic territory" of the North East is experiencing a process of concentration of its cases of schistosomiasis in its larger cities, Recife and Salvador in particular. Thus, this endemic disease is becoming more urban and a network of five major cities, widely dispersed geographically, with high levels of infection, is emerging.

Brazil↗
PubMedDate not supplied

[Hospital function and the urban system in Brazil].

Do hospital services, like other services and commerce, contribute to the structuring of geographical regions, as proposed by central place theory? This question raises the issue of the rating of hospital facilities in land use planning policies. According to the theory, a polarized region forms around a central place due to the minimization of transport costs by consumers seeking to satisfy their needs. If a center offers more central functions (rare trades, services for individuals and businesses), its level in the urban hierarchy is raised and its area of influence expands. This theory was validated using a model, the variant of the gravitation model proposed by Huff. Brazil is an excellent testing ground for these hypotheses due to the great variety of geographic situations, economic and social development levels and the availability of sufficient data. Geographic research has resulted in the construction of an urban center hierarchy based on central functions, and the Unified Health System (or SUS) systematically records authorizations for hospital admission (or AIH) throughout the country. Processing of the 12 million AIH for 1996 showed that in a quarter of cases, the individual was admitted to hospital in a town other than their town of residence (exogenous AIH). Mapping the percentage of exogenous AIH makes it possible to delimit the area of influence of health services (observed influence) for the whole of Brazil. In Minas Gerais State, these areas of influence were compared with the estimates made according to the Huff model (calculated influence), with adjustment for distance and the number of hospital beds. Differences between the observed and calculated areas of influence are due to factors not taken into account by the model, such as the heterogeneity of many regions in the country. However, the accuracy of the estimation is satisfying, as is the simplicity of the equations. All the results tend towards a single conclusion: hospital services play a major role in the structuring of geographic space, by increasing the attraction potential of urban centers.

Brazil↗
PubMed2001

Field observations of Ateleia glazioviana poisoning in cattle in Southern Brazil.

Ateleia glazioviana is an important poisonous plant from southern Brazil. Heavy losses in cattle from this region occur each year due to ingestion of the plant. The epidemiological, clinical, gross and histopathological features of A. glazioviana poisoning in cattle are described here from a 5-year field survey in southern Brazil. A. glazioviana poisoning in cattle induces 3 clinical presentations: abortions, disease characterized by lethargy, and cardiac failure. The latter is associated with marked necrosis and fibrosis of the myocardium and can cause sudden death or congestive heart failure.

Abortion, Veterinary↗
PubMed2001

Seasonality of insect succession and pig carcass decomposition in a natural forest area in southeastern Brazil.

In this study, successional patterns, relative abundance of larvae and adults of sarcosaprophagous insects, carcass decay, diversity and seasonality of species, and their potential as forensic indicators were studied. Four experiments were carried out in each season in a natural area of southeastern Brazil. Two pigs (Sus scrofa L.) were used in each experiment and were exposed to sunlight and shade, respectively. The Calliphoridae outnumbered the Sarcophagidae in specimens collected and reared from the carcasses. More insects were collected from carcasses exposed to the sun, while a larger number of specimens were reared from those in the shade. Temperature and rainfall influenced the stages of carcass decay and insect activity and abundance. Chrysomya albiceps was the most abundant species in all four experiments. The carcasses were used as a protein source and substratum for oviposition. The dark putrefaction and fermentation stages yielded more flies than the other stages. These results show that flies are important in carcass decay and are, therefore, also of forensic importance. Seven species can be considered valuable forensic indicators in Southeastern Brazil. However, only three species were useful as forensic indicators in wooded areas: P. intermutans, H. segmentaria, and H. semidiaphana.

Animals↗