DECPA - Departamento de Clínicas Pediátrica e do Adulto

URI permanente desta comunidadehttp://www.hml.repositorio.ufop.br/handle/123456789/8505

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Projeto corações do Brasil.
(2005) Nascimento Neto, Raimundo Marques do; Krieger, José Eduardo; Coelho, George Luiz Lins Machado; Pereira, Alexandre da Costa
A comparative study of methods for diagnosis of obesity in an urban mixed-race population in Minas Gerais, Brazil.
(2007) Freitas, Silvia Nascimento de; Caiaffa, Waleska Teixeira; César, Cibele Comini; Cândido, Ana Paula Carlos; Faria, Valéria Andrade; Nascimento Neto, Raimundo Marques do; Coelho, George Luiz Lins Machado
Obesity is defined as an excess of total body fat and may be assessed by different methods. The objective of the present study was to establish the discriminatory power of anthropometric data in determining obesity.
Risco nutricional na população urbana de Ouro Preto, Sudeste do Brasil : estudo de corações de Ouro Preto.
(2007) Freitas, Silvia Nascimento de; Caiaffa, Waleska Teixeira; César, Cibele Comini; Faria, Valéria Andrade; Nascimento Neto, Raimundo Marques do; Coelho, George Luiz Lins Machado
Comparação da adequação das indicações de cinecoronariografias diagnósticas eletivas entre os sistemas de saúde público e privado no Estado de Minas Gerais.
(2008) Gontijo, Roberto Veloso; Rezende, Nilton Alves de
Vulnerability and non-adherence to antiretroviral therapy among HIV patients, Minas Gerais State, Brazil.
(2008) Bonolo, Palmira de Fátima; Machado, Carla Jorge; César, Cibele Comini; Ceccato, Maria das Graças Braga; Guimarães, Mark Drew Crosland
The aim of the present study was to describe vulnerability profiles and to verify their association with non-adherence to antiretroviral therapy (ART) among 295 HIV-patients receiving their first prescription in two public-referral centers in Minas Gerais States, Brazil. The cumulative incidence of non-adherence was 36.9%. Three pure vulnerability profiles (lower, medium and higher) were identified based on the Grade of Membership method (GoM). Pure type patients of the “higher vulnerability” profile had, when compared to the overall sample, an increased probability of being younger, not understanding the need of ART, having a personal reason to be HIV-tested, not disclosing their HIV status, having more than one (non-regular) sexual partner, reporting use of alcohol, tobacco and illicit drugs, and having sex among men. Non-adherence to ART was statistically associated (p < 0.001) with this profile. Also, the heterogeneity of the sample was found to be high, since over 40% were mixed type. The implications are that health staff should be trained to develop strategies for incorporating risk-reduction interventions, bearing in mind the three dimensions of vulnerability and the diversity of those patients initiating antiretroviral therapy.
Prevalência e fatores de risco associados à doença arterial periférica no Projeto Corações do Brasil.
(2008) Makdisse, Marcia; Pereira, Alexandre da Costa; Brasil, David Pádua; Borges, Jairo Lins; Coelho, George Luiz Lins Machado; Krieger, José Eduardo; Nascimento Neto, Raimundo Marques do; Chagas, Antonio Carlos Palandri
Compreensão da terapia anti-retroviral : uma aplicação de modelo de traço latente.
(2008) Ceccato, Maria das Graças Braga; Acúrcio, Francisco de Assis; César, Cibele Comini; Bonolo, Palmira de Fátima; Guimarães, Mark Drew Crosland
The aim of this study was to develop a score to determine the level of understanding regarding information on antiretroviral therapy (ART) among patients initiating treatment. This was a cross-sectional analysis based on interviews with HIV patients in outpatient public referral centers (Belo Horizonte, Minas Gerais State, Brazil). The score for patients’ understanding of their medicines was obtained using a latent trait model, estimated by the Item Response Theory, based on the concordance between each patient answer and the written prescription. Hierarchical linear regression was used to assess patients’ global understanding of ART, considering each class of drugs (level 1) and the individual (level 2). Among 406 patients, 37.9% failed to reach a minimum level of understanding of their treatment. The item with the highest level of difficulty was “precaution in use”. The item “dosage” showed the most varied understanding of ART. A high proportion of patients displayed minimal understanding of ART, indicating a high potential risk for non-adherence to therapy. It is thus necessary to identify factors associated with insufficient understanding of ART.
Avaliação da qualidade de vida de aposentados com a utilização do questionário SF-36.
(2008) Pimenta, Fausto Aloísio Pedrosa; Simil, Fabrícia Fonseca; Tôrres, Henrique Oswaldo da Gama; Amaral, Carlos Faria Santos; Rezende, Camila Farnese; Coelho, Thaissa Oliveira; Rezende, Nilton Alves de
OBJETIVO. O aumento da população idosa no Brasil justifica a necessidade de avaliar os aspectos que podem interferir na qualidade de vida de aposentados. MÉTODOS. A versão brasileira do questionário SF-36 foi aplicada em 87 aposentados para avaliação da qualidade de vida. Os resultados obtidos foram associados às características demográficas, socioeconômicas, condições de saúde e estilo de vida e foram estudados por meio de análise uni e multivariada. RESULTADOS. A idade média foi de 57,3 anos (desvio-padrão de 8,9 anos) e tempo médio de aposentadoria foi de 7,1 anos. A aposentadoria foi por invalidez em 55,2% da amostra e 23,4% dos aposentados trabalhavam no momento da pesquisa. Os fumantes somaram 11,5% e 5,7% eram dependentes de álcool. A depressão e hipertensão arterial sistêmica foram as doenças mais prevalentes, e 56,3% dos aposentados praticavam algum tipo de atividade física regularmente. Após a análise multivariada, evidenciou-se melhor qualidade de vida apenas nos aposentados que praticavam atividade física regular ou que tinham alguma atividade de trabalho no momento da pesquisa. CONCLUSÃO. O questionário SF-36 foi um instrumento adequado, de aplicação relativamente rápida e de fácil uso para avaliação da qualidade de vida em aposentados. A qualidade de vida na amostra estudada foi associada ao estilo de vida dos pacientes e aponta para a necessidade de ações que contribuam de forma positiva para melhorar o estilo de vida nesta nova fase da vida.
Internações por condições sensíveis à atenção primária : a construção da lista brasileira como ferramenta para medir o desempenho do sistema de saúde (Projeto ICSAP – Brasil).
(2009) Alfradique, Maria Elmira; Bonolo, Palmira de Fátima; Dourado, Inês; Costa, Maria Fernanda Lima; James, Macinko; Mendonça, Claunara Schilling; Oliveira, Berenice Veneza; Sampaio, Luís Fernando Rolim; Simoni, Carmen De; Turci, Maria Aparecida
Ambulatory care sensitive hospitalizations are a set of conditions for which access to effective primary care can reduce the likelihood of hospitalization. These hospitalizations have been used as an indicator of primary care performance in several countries and in three Brazilian states, but there is little consensus on which conditions should be included in this indicator. This paper presents a description of the steps undertaken to construct and validate a list for Brazil. The final list includes 20 groups of diagnostic conditions that represented 28.3% of a total of 2.8 million hospitalizations in the National Unified Health System in 2006. Gastroenteritis and complications, congestive heart failure, and asthma represented 44.1% of all ambulatory care sensitive hospitalizations. From 2000 to 2006, ambulatory care sensitive hospitalizations decreased by 15.8%, and this reduction was more significant than that observed in all other hospitalizations. The article concludes with potential applications and limitations of the proposed Brazilian list.
Major expansion of primary care in brazil linked to decline In unnecessary hospitalization.
(2010) Macinko, James; Dourado, Inês; Aquino, Rosana; Bonolo, Palmira de Fátima; Costa, Maria Fernanda Lima; Medina, Maria Guadalupe; Mota, Eduardo; Oliveira, Veneza Berenice de; Turci, Maria Aparecida
In 1994 Brazil launched what has since become the world’s largest community-based primary health care program. Under the Family Health Program, teams consisting of at least one physician, one nurse, a medical assistant, and four to six trained community health agents deliver most of their services at community-based clinics. They also make regular home visits and conduct neighborhood health promotion activities. This study finds that during 1999–2007, hospitalizations in Brazil for ambulatory care–sensitive chronic diseases, including cardiovascular disease, stroke, and asthma, fell at a rate that was statistically significant and almost twice the rate of decline in hospitalizations for all other causes. In municipalities with high Family Health Program enrollment, chronic disease hospitalization rates were 13 percent lower than in municipalities with low enrollment, when other factors were held constant. These results suggest that the Family Health Program has improved health system performance in Brazil by reducing the number of potentially avoidable hospitalizations.
The angiotensin-(1-7)/Mas receptor axis is expressed in sinoatrial node cells of rats.
(2011) Ferreira, Anderson José; Moraes, Patrícia Lanza de; Foureaux, Giselle; Andrade, Alexandre Barbosa; Santos, Robson Augusto Souza dos; Almeida, Alvair Pinto de
Density of ghrelin-producing cells is higher in the gastric mucosa of morbidly obese patients.
(2011) Maksud, Fabiana Alves Nunes; Alves, Jairo Silva; Diniz, Marco Túlio Costa; Barbosa, Alfredo José Afonso
Ghrelin is a peptide mainly secreted by gastric mucosa and has been implicated in the regulation of eating behavior and weight balance. Obesity and Helicobacter pylori infection are associated with changes in plasma ghrelin levels.
Dystonia induced by peripheral trauma Organic or psychogenic?
(2011) Nicaretta, Denise H.; Rosso, Ana Lucia Zuma de; Mattos, James P. de; Barreto, Leonardo Brandão; Pimentel, Maria Lucia V.; Novis, Sergio A. P.
CYP2C19 and ABCB1 gene polymorphisms are differently distributed according to ethnicity in the Brazilian general population.
(2011) Santos, Paulo Caleb Júnior de Lima; Soares, Renata A. G.; Santos, Diogo B. G.; Nascimento Neto, Raimundo Marques do; Coelho, George Luiz Lins Machado; Nicolau, José Carlos; Mill, José Geraldo; Krieger, José Eduardo; Pereira, Alexandre da Costa
Background: Recent studies have reported the clinical importance of CYP2C19 and ABCB1 polymorphisms in an individualized approach to clopidogrel treatment. The aims of this study were to evaluate the frequencies of CYP2C19 and ABCB1 polymorphisms and to identify the clopidogrel-predicted metabolic phenotypes according to ethnic groups in a sample of individuals representative of a highly admixtured population. Methods: One hundred and eighty three Amerindians and 1,029 subjects of the general population of 4 regions of the country were included. Genotypes for the ABCB1c.C3435T (rs1045642), CYP2C19*2 (rs4244285), CYP2C19*3 (rs4986893), CYP2C19*4 (rs28399504), CYP2C19*5 (rs56337013), and CYP2C19*17 (rs12248560) polymorphisms were detected by polymerase chain reaction followed by high resolution melting analysis. The CYP2C19*3, CYP2C19*4 and CYP2C19*5 variants were genotyped in a subsample of subjects (300 samples randomly selected). Results: The CYP2C19*3 and CYP2C19*5 variant alleles were not detected and the CYP2C19*4 variant allele presented a frequency of 0.3%. The allelic frequencies for the ABCB1c.C3435T, CYP2C19*2 and CYP2C19*17 polymorphisms were differently distributed according to ethnicity: Amerindian (51.4%, 10.4%, 15.8%); Caucasian descent (43.2%, 16.9%, 18.0%); Mulatto (35.9%, 16.5%, 21.3%); and African descent (32.8%, 20.2%, 26.3%) individuals, respectively. As a result, self-referred ethnicity was able to predict significantly different clopidogrel-predicted metabolic phenotypes prevalence even for a highly admixtured population. Conclusion: Our findings indicate the existence of inter-ethnic differences in the ABCB1 and CYP2C19 variant allele frequencies in the Brazilian general population plus Amerindians. This information could help in stratifying individuals from this population regarding clopidogrel-predicted metabolic phenotypes and design more costeffective programs towards individualization of clopidogrel therapy.
Antiretroviral therapy-associated dyslipidemia in patients from a reference center in Brazil.
(2011) Ceccato, Maria das Graças Braga; Bonolo, Palmira de Fátima; Souza Neto, Aureliano Inácio de; Araújo, Francisca Soares de; Freitas, Maria Imaculada de Fátima
The aim of this study was to determine the impact of antiretroviral therapy on the lipid profile of human immunodeficiency virus (HIV) patients before and after the initiation of highly active antiretroviral therapy (HAART). This was a cross-sectional analysis of patients receiving HAART at a reference center in Belo Horizonte, Brazil, on the basis of medical records from 2002 to 2006. Patients were included if they had at least one lipid test or a clinical or laboratory diagnosis of dyslipidemia/lipodystrophy. Among the 692 patients, 620 met the eligibility criteria. The majority were males (66.5%), middle age (average 39 years), had a low educational level (60.4%), and low income (51.0%). HAART duration ranged from 11 days to 4.6 years, with a mean of 28.6 months (SD = ± 470.19 days). The prevalence of dyslipidemia/lipodystrophy nearly tripled (11.3% pre- and 32.4% post-HAART). Dyslipidemia was associated with older age (P = 0.007), nucleoside reverse transcriptase inhibitor (NRTI) + protease inhibitor (PI) regimens (P = 0.04), NRTI + non-NRTI (NNRTI) regimens (P = 0.026), the use of stavudine (d4T) in any regimen (P = 0.002) or in NRTI-based regimens (P = 0.006), and longer exposure to HAART (P < 0.000). In addition, there was no correlation between dyslipidemia and gender (P = 0.084). Only 2.0% of the patients received treatment for dyslipidemia during the trial. These results= show a need for continuous monitoring of patients under antiretroviral therapy, particularly those using NRTI-based regimens, especially when combined with d4T and PIs. Secondly, interventions should be developed to correct metabolic changes.
The influence of primary care and hospital supply on ambulatory care–sensitive hospitalizations among adults in Brazil, 1999–2007.
(2011) Macinko, James; Oliveira, Veneza Berenice de; Turci, Maria Aparecida; Aguiar, Frederico Campos Guanais de; Bonolo, Palmira de Fátima; Costa, Maria Fernanda Lima
Classificação internacional de funcionalidade, de doenças e prognóstico médico em pacientes idosos.
(2011) Hansen, Érika de Oliveira; Tavares, Silas Tadeu Oliveira; Cândido, Simone Abrantes; Pimenta, Fausto Aloísio Pedrosa; Moraes, Edgar Nunes de; Rezende, Nilton Alves de
O envelhecimento populacional e o aumento das doenças crônico-degenerativas sinalizam para a necessidade de discutir como proceder a abordagem clínica atual, em que a conduta é definida pelos achados orgânicos em doenças associadas. A avaliação da Medicina moderna deve considerar como modelo a Classificação Internacional de Funcionalidade, Incapacidades e Saúde associada à Classificação Internacional de Doenças proposta pela Organização Mundial de Saúde. A abordagem médica baseada apenas na doença não representa, verdadeiramente, o real estado do paciente. É necessário, portanto, avaliar os aspectos relacionados à prática clínica atual, pautada no “paradigma da cura”, baseada principalmente em aspectos etiológicos e dados estatísticos que não se aplicam às doenças associadas e não respeitam a singularidade dos pacientes. Dados etiológicos, epidemiológicos e capacidade funcional devem compor a abordagem que respeite a individualidade. Deve ser questionado o paradigma tradicional do diagnóstico e da cura como objetivos fundamentais. Desta forma, é importante avaliar os potenciais ganhos funcionais e psicológicos não apenas para o paciente, mas também para seus familiares. Este trabalho procura contribuir para melhor abordagem médica, em que se considera a avaliação dos conceitos de funcionalidade associados aos diagnósticos anatômicos no prognóstico de idosos com doenças associadas.
SLCO1B1 RS4149056 polymorphism associated with statin-induced myopathy is differently distributed according to ethnicity in the Brazilian general population : amerindians as a high risk ethnic group.
(2011) Santos, Paulo Caleb Júnior de Lima; Soares, Renata A. G.; Nascimento Neto, Raimundo Marques do; Coelho, George Luiz Lins Machado; Mill, José Geraldo; Krieger, José Eduardo; Pereira, Alexandre da Costa
Background: Recent studies reported the association between SLCO1B1 polymorphisms and the development of statin-induced myopathy. In the scenario of the Brazilian population, being one of the most heterogeneous in the world, the main aim here was to evaluate SLCO1B1 polymorphisms according to ethnic groups as an initial step for future pharmacogenetic studies. Methods: One hundred and eighty-two Amerindians plus 1,032 subjects from the general urban population were included. Genotypes for the SLCO1B1 rs4149056 (c.T521C, p.V174A, exon 5) and SLCO1B1 rs4363657 (g.T89595C, intron 11) polymorphisms were detected by polymerase chain reaction followed by high resolution melting analysis with the Rotor Gene 6000® instrument. Results: The frequencies of the SLCO1B1 rs4149056 and rs4363657 C variant allele were higher in Amerindians (28.3% and 26.1%) and were lower in African descent subjects (5.7% and 10.8%) compared with Mulatto (14.9% and 18.2%) and Caucasian descent (14.8% and 15.4%) ethnic groups (p < 0.001 and p < 0.001, respectively). Linkage disequilibrium analysis show that these variant alleles are in different linkage disequilibrium patterns depending on the ethnic origin. Conclusion: Our findings indicate interethnic differences for the SLCO1B1 rs4149056 C risk allele frequency among Brazilians. These data will be useful in the development of effective programs for stratifying individuals regarding adherence, efficacy and choice of statin-type.
Combined use of Paracoccidioides brasiliensis recombinant rPb27 and rPb40 antigens in an enzyme-linked immunosorbent assay for immunodiagnosis of paracoccidioidomycosis.
(2011) Santos, Viviane Cristina Fernandes dos; Gonçalves, Juliana Barbosa Coitinho; Veloso, Juliana Márcia Ribeiro; Araújo, Stanley de Almeida; Pedroso, Enio Roberto Pietra; Goes, Alfredo Miranda de
Paracoccidioidomycosis (PCM) is one of themost important endemicmycoses in LatinAmerica; it's usually diagnosed by observation and/or isolation of the etiologic agent, Paracoccidioides brasiliensis, as well as by a variety of immunological methods, such as complement fixation and immunodiffusion. Although these approaches are useful, historically their sensitivity and specificity have often been compromised by the use of complex mixtures of undefined antigens. The use of combinations of purified,well-characterized antigens appears preferable andmay yield good results. In the present study combinations of the previously described 27-kDa recombinant antigen(rPb27) and a recombinant 40-kDa-molecular-mass antigen(rPb40) fromthis fungus, that was identified by Goes et al. (2005) through the AST strategy as a homolog of Neurospora crassa calcineurin B, were used in an indirect enzyme linked immunosorbent assay (ELISA) for diagnosis and follow-up of patients with PCM. The complete coding cDNA of rPb40 and rPb27 were cloned into a pET-21a and a pET-DEST 42 plasmid, respectively, expressed in E. coli with a his-tag and purified by affinity chromatography. Among 109 PCM serum samples analyzed, a homogeneous IgG response to these proteinswas observed. 62 serumsamples frompatientswith other diseases, 18 frompatientswith othermycosis and 23 fromhealthy individualswere also studied. Detection of anti-rPb27 and anti-rPb40 antibodies in sera of patientswith PCMby ELISA using a combination of the two purified proteins showed a sensitivity of 96% with a specificity of 100% in relation to control normal human sera andto sera frompatientswith other systemicmycosis and 93.5%to sera from patients with diverse infections. The use of this two proteins combination provided an excellent immunodiagnosis assaywith great values of sensitivity and specificity, even in relation to sera frompatients with othermycosis,making possible the standadization of a new methodology to diagnose this important mycosis, with a good confiability and reprodutibility.
Trends in primary health care-sensitive conditions in Brazil.
(2011) Dourado, Inês; Oliveira, Veneza Berenice de; Aquino, Rosana; Bonolo, Palmira de Fátima; Costa, Maria Fernanda Lima; Medina, Maria Guadalupe; Mota, Eduardo; Turci, Maria Aparecida; Macinko, James
This study describes trends in hospital admission rates for primary healthcare-sensitive conditions (PHCSC) in Brazil.