Registro da memória audiovisual do combate à doença de Chagas no município de Cássia dos Coqueiros, São Paulo

Some of the major advances in Chagas’s disease control in Brazil should be credited to Professor José Lima Pedreira de Freitas (1917-1966). From 1947 to 1966, his contributions included development of serological techniques, investigations on the biological aspects of the triatomines, as well as clinical and epidemiological studies. His most relevant achievement, however, was a technique for controlling triatomines based upon selective spraying of insecticide only within infested houses, which was thought and developed in Cassia dos Coqueiros, a small village in the state of São Paulo, Brazil. Named selective purge, this revolutionary technique combined high efficacy, low cost and less environmental risks, which caused it to be largely adopted in the American continent. Unfortunately, its authorship has been missed within the brazilian public health memory, being its association with Cássia dos Coqueiros and Pedreira de Freitas rarely mentioned. The present project aimed at recovering the memory of professor Freitas’s struggle against Chagas’s disease, by developing a documentary involving participation of old local inhabitants and former professors of the Medical School which worked closely to him.Algumas das mais relevantes contribuições ao combate à doença de Chagas no Brasil foram feitas pelo professor José Lima Pedreira de Freitas (1917-1966), entre 1947 e 1966. Incluem-se aí o desenvolvimento de técnicas sorológicas, investigações sobre biologia dos triatomíneos e estudos clínicos e epidemiologicos. Todavia, a sua mais importante contribuição reside no desenvolvimento do chamado expurgo seletivo, técnica de controle de triatomíneos a partir de aplicações de inseticidas feitas seletivamente nos domicílios, idealizada e desenvolvida em Cássia dos Coqueiros, Estado de São Paulo. Este procedimento representou uma revolução conceitual, por combinar elevada eficácia com redução de custo e de agressão ao meio ambiente, razões que levaram a sua incorporação em todo o continente americano. A sua autoria, contudo, foi perdida na memória da Saúde Pública brasileira, sendo muito raramente lembrada a sua associação com Cássia dos Coqueiros e com o seu idealizador. Este projeto visou resgatar a memória da participação do professor Pedreira de Freitas no combate à doença de Chagas, mediante a elaboração de um documentário envolvendo o depoimento de antigos moradores e de ex-professores da Faculdade de Medicina de Ribeirão Preto, que com ele tiveram contato próximo ao longo da sua trajetória profissional

Aspectos epidemiológicos das hepatites virais

Apresentam-os, neste trabalho, algumas das principais características epidemiológicas dos cinco tipos reconhecidos de hepatites virais, com ênfase nas causadas pelos vírus B e C. Por sua larga distribuição geográfica e capacidade de causar infecções crônicas – as quais se associam a risco elevado de cirrose hepática e hepatocarcinoma – essas duas formas representam grave problema sanitário em praticamente todos os países do mundo. Discutimos sua relevância epidemiológica e os principais mecanismos de transmissão, identificados para ambas as formas.Some of the main epidemiological characteristics of the five identified types of viral hepatitis are presented, emphasizing those caused by virus B and C. These two forms show a large geographical distribution and ability to cause chronic infections, which are associated with cirrhosis and liver cancer. Thus, these forms of hepatitis are an important public health problem worldwide. Their epidemiological relevance and main transmission routes are discussed

Associação entre achados abreugráficos de cardiomegalia e manifestações clínicas

A possible association between megalocardia and clinical signs and/or symptoms registered in the records of a university hospital (Clinical Hospital of the Ribeirão Preto Medical School, Brazil) was studied. In order to carry out the research a case control study was developed. Those patients who showed enlargement of the cardiac area diagnosed by roentigenphotography when moment they were seen in the Hospital for the first time (700 cases) were included. For each case a control corresponding to a patient who had also had his first consultation at the same Hospital, and whose roentgenphotography showed no cardiac enlargement, was selected. Cases and controls were seen during the period from September 25th, 1967 to September 25th, 1969. They were matched according to sex and age. The presence or absence of the following complaints was sought in the cases' and controls' records: precordial ache, cough and/or expectoration, edema, pain in the right upper part of the abdomen, hemoptysis, palpitation and dyspneia. An association between megalorcardia and the following signs and/or symptoms was established; precordial ache, cough and/or expectoration, edema and hemoptysis, as well as the patient's age. Due to these findings it is suggested that the use of roentgenphotography as a diagnostic method for cardiac abnormalities should be restricted to population groups that are previously selected according to age and the presence of at least one of the five above mentioned complaints.Com o objetivo de estudar possível associação entre achados abreugráficos de cardiomegalia e sinais e/ou sintomas clínicos registrados na primeira consulta, foram analisados os prontuários de 700 pacientes atendidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, SP - Brasil, durante o período de 25/9/1967 a 25/9/1969. Foram tomados 700 controles pareados com os casos segundo sexo e grupo etário. Encontrou-se associação entre achados de cardiomegalia e o registro de queixas referentes a dor precordial, tosse e/ou expectoração, edema e hemoptise, bem como entre cardiomegalia e idade. Sugere-se, quando o objetivo específico for diagnosticar alterações cardíacas, limitação do uso da abreugrafia apenas a grupos pré-selecionados segundo idade e presença de pelo menos uma das queixas assinaladas

The association between anomalous X-ray findings of the respiratory organs and their clinical manifestation

Foram analisados os registros dos principais sintomas de anamnese do aparelho respiratório e de diagnóstico de pneumopatia, nas histórias clínicas de primeira consulta de pacientes com achados anormais do aparelho respiratório na abreugrafia de rotina realizada no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, a partir de 1967. Foram tomados 997 controles (pacientes sem alteração na abreugrafia) pareados com os casos segundo idade e sexo. Em cerca de 1/3 do total de observações clínicas não foi registrada anamnese do aparelho respiratório. Verificou-se maior proporção de registro de sintomas respiratórios e de diagnóstico de pneumopatia entre os casos que entre os controles. O mesmo achado foi verificado para os casos quando os mesmos foram separados em dois grupos de acordo com a maior ou menor gravidade das lesões apresentadas. Hemoptise e dor torácica foram os sintomas que melhor discriminaram doentes de sadios. Recomenda-se que o uso da abreugrafia para diagnóstico de alterações respiratórias seja seletivo, aplicando-se apenas a pacientes com queixas de hemoptise, dor torácica e tosse e/ou expectoração, isoladamente ou combinadas.A retrospective study of hospital charts was conducted for the purpose of analysing the association of roent-genphotographs obtained routinely at the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Brazil, since 1967, with the records of respiratory symptoms and pneumopathic diagnosis found in the medical case histories as from the patients' first clinical out-patient consultation at that hospital. For this purpose, 997 patients with abnormal pulmonary roentgenphotography findings were matched according to sex and age with the same number of controls (normal roentgenphotography). It was observed that in one third of the medical histories there was no record of any anamnesis of the respiratory system. A greater proportion of respiratory symptoms and pneumopathic diagnoses was registered in the case group. The same finding separated the patients into two groups according to the severity of the lesions. Hemoptysis and thoracic pain were the symptoms that better differentiated sick from normal patients. A selective utilization of roentgenphotography is recommended, with the method being applied only to patients presenting hemoptysis, thoracic pain and cough/expectoration, either alone or in combination

The national survey of seroprevalence for evaluation of the control of Chagas disease in Brazil (2001-2008)

Um inquérito de soroprevalência de doença de Chagas foi realizado em amostra representativa da população com idade até cinco anos de toda a área rural brasileira, exceto o Estado do Rio de Janeiro. Foram estudadas 104.954 crianças, que tiveram amostras de sangue coletadas em papel de filtro e submetidas a testes de screening pelas técnicas de imunofluorescência indireta (IFI) e ELISA em um único laboratório. Todas as amostras com resultados positivos ou indeterminados, juntamente com 10% daquelas com resultados negativos, foram enviadas para um laboratório de referência e aí submetidas a novos testes por IFI e ELISA, além de western blot TESA (Trypomastigote Excreted Secreted Antigen). Para as crianças com resultado final positivo foi agendada uma re-visita para coleta de sangue venoso do próprio participante e das suas mães e familiares. Da avaliação do conjunto de testes resultaram 104 (0,1%) resultados positivos, dos quais apenas 32 (0,03%) foram confirmadas como infectadas. Destas, 20 (0,02%) com positividade materna concomitante (sugerindo transmissão congênita), 11 (0,01%) com positividade apenas na criança (indicativo de provável transmissão vetorial), e uma criança positiva cuja mãe havia falecido. Em 41 situações ocorreu confirmação apenas nas mães, sugerindo transferência passiva de anticorpos maternos; em 18 a positividade não se confirmou nem nas crianças nem nas suas mães; e em 13 não foi possível a localização de ambas. As 11 crianças que adquiriram a infecção por provável via vetorial distribuíram-se predominantemente na região nordeste (Piauí, Ceará, Rio Grande do Norte, Paraíba e Alagoas), acrescidas de um caso no Amazonas e um no Paraná. Dos 20 casos com provável transmissão congênita sobressaiu-se o Rio Grande do Sul, com 60% deles, representando este o primeiro relato de diferenças regionais na transmissão congênita da doença de Chagas no Brasil, possivelmente relacionada à existência de Trypanosoma cruzi grupo IId e IIe, atualmente classificados como TcV e TcVI. Os resultados deste inquérito apontam para a virtual inexistência de transmissão de doença de Chagas por via vetorial no Brasil em anos recentes, resultante da combinação dos programas regulares e sistemáticos de combate á moléstia e de mudanças de natureza socioeconômica observadas no país ao longo das últimas décadas. Por outro lado, reforçam a necessidade de manutenção de um programa de controle que garanta a consolidação deste grande avanço.A survey for seroprevalence of Chagas disease was held in a representative sample of Brazilian individuals up to 5 years of age in all the rural areas of Brazil, with the single exception of Rio de Janeiro State. Blood on filter paper was collected from 104,954 children and screened in a single laboratory with two serological tests: indirect immunofluorescence and enzyme linked immunoassay. All samples with positive or indetermined results, as well as 10% of all the negative samples were submitted to a quality control reference laboratory, which performed both tests a second time, as well as the western blot assay of TESA (Trypomastigote Excreted Secreted Antigen). All children with confirmed final positive result (n = 104, prevalence = 0.1%) had a follow-up visit and were submitted to a second blood collection, this time a whole blood sample. In addition, blood samples from the respective mothers and familiar members were collected. The infection was confirmed in only 32 (0.03%) of those children. From them, 20 (0.025%) had maternal positive results, suggesting congenital transmission; 11 (0.01%) had non-infected mothers, indicating a possible vectorial transmission; and in one whose mother had died the transmission mechanism could not be elucidated. In further 41 visited children the infection was confirmed only in their mothers, suggesting passive transference of maternal antibodies; in other 18, both child and mother were negative; and in 13 cases both were not localized. The 11 children that acquired the infection presumably through the vector were distributed mainly in the Northeast region of Brazil (States of Piauí, Ceará, Rio Grande do Norte, Paraíba and Alagoas), in addition to one case in Amazonas (North region) and another in Parana (South region). Remarkably, 60% of the 20 cases of probably congenital transmission were from a single State, Rio Grande do Sul, with the remaining cases distributed in other states. This is the first report demonstrating regional geographical differences in the vertical transmission of Chagas disease in Brazil, which probably reflects the predominant Trypanosoma cruzi group IId and IIe (now TcV and TcVI) found in this state. Overall, these results show that the regular and systematic control programs against the transmission of Chagas disease, together with socioeconomic changes observed in Brazil in the last decades, interrupted the vectorial transmission in Brazil, resumed in the few cases found in this national survey. Furthermore they reinforce the need for maintenance of control programs for the consolidation of this major advance in public health

Surgical-site infection risk in oncologic digestive surgery

Surgical-site infection (SSI) is the most prevalent type of hospital infection in surgical patients and is associated with an increase in hospital stay, costs and morbidity/lethality. The knowledge of the main risk factors for this type of infection is important for the establishment of prevention measures regarding modifiable risks factors. The objective of the preset study was to assess the occurrence of SSI and study the risk factors in oncologic surgeries of the digestive system at Hospital de Câncer in Barretos, São Paulo, Brazil. Individuals undergoing oncologic surgeries of the digestive system in the period of 08/01/2007 to 08/10/2008 were prospectively followed for 30 days after surgery. Possible risk factors related to the patient and to the surgical procedure were also studied. A total of 210 surgeries were analyzed, with a global SSI incidence of 23.8%. The following variables were independently associated with SSI: time and type of surgery, radiotherapy before surgery and surgeon's years of experience. The risk factors found in this study have been described by other authors and are not amenable to intervention for SSI prevention. Further studies are recommended with the objective of investigating interventions that could reduce the risk for SSI in this type of surgery

Hepatitis C among former athletes: association with the use of injectable stimulants in the past

This study was performed with the purpose of testing the hypothesis that the high prevalence of hepatitis C among former athletes is associated with their past use of injectable stimulants. The study involved the participation of 208 former professional and amateur soccer and basketball players from the region of Ribeirão Preto, Brazil, who answered a questionnaire regarding their exposure to risk factors, including the use of injectable stimulants in the time they were engaged in sporting activities. ELISA tests were used to detect infection by the hepatitis C virus, and confirmed with PCR and genotyping for the positive cases. It was observed that the former use of injectable stimulants was a practice disseminated among the participants (24.5%), reaching 50.8% in the professionals. The overall prevalence for hepatitis C was 7.2%, with values of 11% among professionals and 5.5% among amateurs. In both categories, the presence of infection was markedly higher among those who admitted past use of injectable stimulants when compared to those who denied such practice (36% and 0.8% among amateurs; 21.9% and 0% among professionals, respectively). Multivariate analysis showed that the use of those substances was the only variable associated with the risk of hepatitis C. This confirms previous observations, performed with reduced sample sizes and without comparison groups, which indicated that the use of injectable vitamins was a risk factor of hepatitis C among former athletes.CNPqUSP - FAEP