Performance of glycated haemoglobin (HbA1c) as a screening test for diabetes and impaired glucose tolerance (IGT) in a high risk population--the Brazilian Xavante Indians.

AIMS: To examine the properties of HbA1c to detect diabetes and IGT in adult Brazilian Xavante Indians, a high risk population for diabetes. METHODS: The survey was carried out between October 2010 and January 2012 and based on a 75 g oral glucose tolerance test (OGTT). Basal and 2h capillary glycaemia were measured by HemoCue Glucose 201+; HbA1c using an automated high-performance liquid chromatography analyzer (Tosoh G7). RESULTS: 630 individuals aged ≥ 20 years were examined and 80 had a previous diagnosis of diabetes. Sensitivity, specificity and accuracy for HbA1c ≥ 6.5% (≥ 48 mmol/mol) were 71.3%, 90.5% and 87.2%. The areas under the ROC curve (AUC) was 0.88 (95%CI: 0.83-0.93). To identify IGT, HbA1c values between 5.7% and 6.4% (39-47 mmol/mol) presented sensitivity, specificity and accuracy of 87.2%, 24.7% and 51.4%, with an AUC of 0.62 (95%CI: 0.57-0.67). CONCLUSIONS: The ADA/WHO proposed cut-off of 6.5% (48 mmol/mol) for HbA1c was adequate to detect diabetes among the Xavante. However, the performance of the ADA proposed cut-off points for pre-diabetes, when used to detect IGT was inadequate and should not be recommended.

[Survival of AIDS patients in a city in southeastern Brazil]. / Sobrevivência de pacientes com AIDS em uma cidade do sudeste brasileiro.

OBJECTIVE: To assess survival in patients diagnosed with AIDS in the city of Ribeirão Preto, Brazil, between 1986 and 1997. METHODS: The epidemiological records of 2,214 patients diagnosed during the study period were retrospectively reviewed. From those, 1,231 patients with at least 30 days of follow-up after the date of diagnosis were included in the study. Information concerning deaths was obtained from hospitals and vital-records offices. RESULTS: Survival for the group as a whole was 310 days (10.3 months) over the period of 1986 through 1997. Median survival was 362 days for 1986 to 1990, 260 days for 1991 to 1995, and 864 days for 1996 and 1997. The Kaplan-Meier survival curves and the log-rank test showed significant differences for the following variables: sex, age, period when diagnosis was made, and presence of candidiasis and of cerebral toxoplasmosis. Cox's regression showed an association between reduction of survival and the following variables: age (in comparison to individuals younger than 15 years, hazard ratio = 1.435 for age between 15 and 34 years, and 1.681 for age above 35 years); period of diagnosis (in comparison to the period of 1996 and 1997, hazard ratio = 1.682 for the period from 1986 to 1990, and 2.324 for the period from 1991 to 1995); and presence of candidiasis (hazard ratio = 1.391). The hazard ratio for the presence of cerebral toxoplasmosis was 1.063, with a probability value close to the limit of significance. CONCLUSIONS: Our results show a striking increase in survival in 1996 and 1997, coinciding with the availability and utilization of highly active antiretroviral drugs.

Echocardiographic characteristics of patients with sickle cell anaemia in Sergipe, Brazil.

This study describes the cardiac size and function of patients with sickle cell anaemia, in Segipe, Brazil, and its association to the clinical severity, duration of illness and haemoglobin levels. Heart measurements were obtained by echocardiography from 38 children and adolescents and compared to international reference values. Sickle cell patients had increased left atrial and ventricular dimensions in systole and an increased end diastolic septal and left ventricular free wall thickness. These findings correlated with age. There were no abnormalities in the ejection or shortening fractions. These results suggest early haemodynamic changes with progressive cardiac chamber dilation and diastolic dysfunction that become increasingly abnormal with growth.

Transformation and trends in preventive and social medicine education at the undergraduate level in a Brazilian medical school.

In the present study we discuss some transformations in undergraduate training in Preventive and Social Medicine in the Department of Social Medicine of the Faculty of Medicine of Ribeiro Preto, University of So Paulo, from 1993 to 1999. Aspects of the relationship between medical training and the reorganization of local services of the Brazilian national health system, and between graduate teaching in Preventive and Social Medicine and medical education as a whole are discussed. The crisis in Preventive and Social Medicine and its influence of medical training are evaluated. Trends for the application of a body of knowledge of the specialty and for the relationship between the department and the medical school are discussed.

Childhood and adolescent growth of patients with sickle cell disease in Aracaju, Sergipe, north-east Brazil.

Sickle cell disease (SCD) is the most prevalent inherited monogenic pathology in South America. Although children with SCD have normal birthweight, weight deficit is often seen from early childhood. On the other hand, paradoxically, normal final height associated with delayed puberty has been reported from Brazil and Jamaica. This cross-sectional study describes the growth pattern by age and sex in 76 children and adolescents with SCD in Sergipe, north-east Brazil with a median age of 110 months. Median weights and heights for age were below the NCHS standards. The weight and height deficits were statistically significant for boys of all ages, except for 7-year-olds. Most girls have median weights and heights below the NCHS standards but this only becomes statistically significant at 15 years of age. Family channels were calculated from the parents' heights. The observed height was lower than the expected percentile value for the family in seven (41%) children, equal to expected family height in six (35%) and above expected family height in four (24%) of 17 teenagers. Our findings suggest that Brazilian children with SCD do not attain normal height and weight. It is therefore likely that, although maximum height and weight velocity occur significantly later than normal due to delayed puberty, the magnitude of this spurt is less than normal.

Dengue control in Ribeirão Preto, São Paulo, Brazil.

Following an epidemic of type I dengue in late 1990, the municipality of Ribeirão Preto (State of São Paulo, Brazil) assumed direct responsibility for the control of Aedes aegypti larvae. Control activities are presented in this report and are based on popular participation in environmental management. Massive use of the communications media, participation by schoolchildren, constant contact with the population, and integration of various public agencies are the program's priorities. Although the drop in the number of susceptibles may have played a role in the reduction of cases after the initial epidemic, the intense preventive campaign certainly helped quell the disease in the city, since changes were observed in the behavior of the population towards potential breeding sites. The occurrence of new cases in recent years appears to be related to greater circulation of the virus in both the State of São Paulo and Brazil as a whole, indicating the need for control measures at the national and continental level, without which it will be difficult to maintain low transmission rates, even in areas submitted to intense preventive work

Diarrhoea mortality in Aracaju, Brazil.

We report diarrhoea mortality rates in the city of Aracaju, Brazil from 1992 to 1994 when there were 318 deaths due to diarrhoea. Eighty-nine per cent of deaths occurred in infants: 53.1% were boys and 78.9% died in hospital. Diarrhoea mortality rates for children under 5 years of age were 2.63, 1.78 and 1.28 for 1992, 1993 and 1994, respectively. The district with the most slums and least sewerage services had the highest mortality rates (4.29, 2.53 and 1.87 for 1992, 1993 and 1994, respectively) and the district with most services and fewest slums had the lowest rates each year (0.79, 0.55 and 0.38). Malnutrition was associated with diarrhoea on 26.5% of death certificates. Mortality rates fell during the study period but still remained high in infants from poor areas of the city. Study of the geographical distribution of mortality allowed identification of priority areas for targeted interventions.

[Course of serologic positivity to Chagas disease in a rural community in Brazil]. / Evolução da positividade sorológica para a doença de Chagas numa comunidade rural brasileira.

In order to assess the evolution of seropositivity for Chagas' disease in the rural community of Cássia dos Coqueiros, in São Paulo state, we compared two cross-sectional studies performed at that site in 1971-1972 and in 1989-1991. In the first survey the complement fixation test was used to determine seropositivity for the disease. In this study, the total prevalence of Chagas' disease was found to be 16.6%, with values ranging from 2.9 to 61.9% (in the 10-19 and 50-59 year age groups, respectively). In the 1989-1991 study, in which indirect immunofluorescence was used, the total prevalence dropped to 10.1%, with a minimum of 0.4% (in the 10-19 year age group) and a maximum of 44.8% (in persons over 60 years of age). Among subjects born in Cássia dos Coqueiros, the 1989-1991 study showed seropositivity after age 38, with only one exception (a 24-year-old man). The drop in the seropositivity index for Chagas' disease in Cásia dos Coqueiros during the period under study can be partially attributed to socioeconomic factors, such as improved living conditions and the progressive abandonment of rural areas. Thus, our results point to the spraying of households with residual insecticides, which began in 1950, as the pivotal factor in the fight against triatomine bugs and in disease control. These results suggest that transmission may have been interrupted as early as the latter part of 1954 and later consolidated as a result of improved socioeconomic conditions and the elimination of Triatoma infestans from the study area.

[Single larva sampling for Aedes aegypti surveillance]. / Amostragem por larva-única na vigilância de Aedes aegypti.

Buildings in Araraquara city, Southeastern Brazil, were searched during a year for the presence of Aedes larvae using single larva sampling in order to check the single-larva methodology. In those breeding places in which Aedes larvae were found, one of them was collected. As a control, after the single larva had been collected, all the larvae from the breeding place were collected for later identification. This process was repeated in the laboratory. Of the 447 domiciles searched, 12 were considered positive and 20 breeding places were found. Of the breeding places, 13 contained Aedes larvae, 5 both Aedes and Culex larvae and 2 Culex larvae only. The results show that all the breeding places in the field were properly recognized showing the method may be used for Aedes surveillance in cities infested with one species only or without any domiciliary infestation.

Dengue serologic survey in Ribeirão Preto, São Paulo, Brazil.

The city of Ribeirão Preto suffered a dengue 1 epidemic that began in November 1990 and ended in March 1991. A serologic survey designed to detect IgG antibodies to the four dengue serotypes and other flaviviruses was carried out in Ribeirão Preto during September and October of 1992. Dengue 1 antibodies were detected in 5.4% of the survey participants. Significantly higher seropositivity (9.3%) was found among subjects residing in the Northwest Sector of Ribeirão Preto than among those living in the city's other three sectors. The Northwest Sector also exhibited relatively high levels of breeding sites used by the Aedes aegypti vector, the highest number of reported dengue cases of any sector, and relatively poor socioeconomic conditions. The fact that the epidemic was limited mainly to the Northwest Sector probably resulted mainly from intense vector control and educational measures undertaken in response to the outbreak. As of the 1992 survey, most of the city's population remained vulnerable to dengue 1 infection; however, an estimated 23,000 with dengue 1 antibodies appeared to be at relatively high risk of developing dengue hemorrhagic fever/dengue shock syndrome in the event of infection with dengue 2. Both of these considerations indicate an ongoing need to maintain dengue education and vector control measures.

[Dengue epidemic in Ribeirão Preto, SP, Brazil: a preliminary note]. / Epidemia de dengue em Ribeirão Preto, SP, Brasil: nota prévia.

A preliminary note on an outbreak of dengue which occurred in the city of Ribeirão Preto, State of S. Paulo, Brazil, from November 1990 to March 1991, is given. One case of Level II Dengue Hemorrhagic Fever/Dengue Shock Syndrome (DHF/DSS) and two deaths associated with dengue related shock are described. Clinicians and epidemiologists are alerted to the possibility of sporadic DHF/DSS cases during outbreaks of classical dengue in formerly free areas.

Hepatic regeneration after hepatectomy in schistosomatic fibrosis.

After partial hepatectomy (approximately 30%), the labelled hepatocyte index (LHI) of the normal mouse is increased and reaches its highest value 48 h after surgery. In mice with schistosomatic fibrosis (SF), the LHI was lower than in the controls at 24, 48 and 72 h after hepatectomy.