Liver transplantation at a University Hospital, Faculty of the Medicine of Ribeirao Preto, University of Sao Paulo: Results for the first 60 recipients

The purpose of the present article was to present the series operated by a Liver Transplant Group of the interior of the State of Sao Paulo, Brazil. Sixty patients were transplanted from May 2001 to May 2007. Thirty percent of the patients had alcoholic cirrhosis. 18.3% had C virus-induced cirrhosis, 10% had C virus- and alcohol-induced cirrhosis, 6% had B virus-induced cirrhosis, 13.3% had cryptogenic cirrhosis, 8.3% autoimmune cirrhosis, 13.3% had familial amyloidotic polyneuropathy (FAP), and 13.3% had hepatocellular carcinomas. The series was divided by a chronological criterion into two periods: A (n = 42) and B (n = 18) with the latter group operated based upon the Model for End-stage Liver Disease (MELD) criterion. Sixty-nine percent were men. Age ranged from 14 to 66 years. Period A included 12% Child A: 59.2%, Child B; 24%, Child C; and 4.8%, FAR Period B comprises 22.2% Child A: 11.1%, Child B: 33.3%, Child C: and 33.3%, FAP. MELD scores ranged from 8 to 35 for period A and from 14 to 31 for period B. Intraoperative mortality was 2/42 patients for period A and 0/18 for period B, overall postoperative mortality was 40% including for period A, 35% among Child B and C patients, and 5 % among FAP and Child A patients (P <.05) and 16.6% for period B among 11. 1 % Child B patients and 5.5 % FAP patients; 3.3 % of patients required retransplantation due to hepatic artery thrombosis. Real postoperative survival was 60% during period A and 83.3% during period B, with an overall survival rate of 67% for the two periods. The present results show levels of postoperative mortality, (especially during period B), and survival rates similar to those reported by several other centers in Brazil.

Relation between alcohol consumption and traffic violations and accidents in the region of Ribeirao Preto, Sao Paulo State

In recent years, alcohol consumption has been considered an important public health problem. Ethanol, the alcohol used in beverages, is a drug that affects the central nervous system (CNS) and impairs driving skills and co-ordination, increasing risk of deaths and injuries derived from crashes and road accidents. Consumption of alcoholic beverages is implicated with premature deaths, injuries and damages caused by motor vehicle crashes, which result in high costs to government and society. Considering that alcohol consumption is the main responsible factor for deaths and disabilities in young people, the aim of this work was to evaluate the prevalence of blood alcohol in offenders and/or fatal and non-fatal victims of traffic occurrences in the region of Ribeirao Preto, Sao Paulo State, from 2005 to 2007. The results revealed that in 2134 cases investigated, blood alcohol positivity was generally found in young adults, 25-45 years old and male. The study showed the high risk of drinking and driving and the importance in establishing actions of prevention and intervention to promote the reduction in the number of traffic occurrences related to consumption of alcoholic beverages. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

Rubella Vaccination of Unknowingly Pregnant Women: The Sao Paulo Experience, 2001

Background. Rubella vaccination is contraindicated during pregnancy. During mass immunization of women of childbearing age against rubella, women unknowingly pregnant may be vaccinated. To evaluate the effects of rubella vaccination during pregnancy, the Brazilian state of Sao Paulo conducted a follow-up study of pregnant women vaccinated during a rubella campaign in 2001. Methods. Women vaccinated during pregnancy were reported to a national surveillance system. In the state of Sao Paulo, follow-up of vaccinated women included household interviews. Serum samples from vaccinated women were tested for antirubella antibodies to classify susceptibility to rubella infection. Children born to susceptible mothers were tested for evidence of congenital rubella infection and evaluated for signs of congenital rubella syndrome. Results. The Sao Paulo State Health Department received 6473 notifications of women vaccinated during pregnancy. Serology performed for 5580 women identified 811 (15%) that were previously susceptible. Incidence of spontaneous abortion or stillbirth among previously susceptible vaccinated women was similar to women with prior immunity. Twenty-seven (4.7%) of 580 newborns tested had evidence of congenital rubella infection; none had congenital rubella syndrome. Conclusions. Mass rubella vaccination of women of childbearing age was not associated with adverse birth outcomes or congenital rubella syndrome among children born to women vaccinated during pregnancy.

Determinants of the use of health care services: multilevel analysis in the Metropolitan Region of Sao Paulo

OBJECTIVE To evaluate the individual and contextual determinants of the use of health care services in the metropolitan region of Sao Paulo.METHODS Data from the Sao Paulo Megacity study – the Brazilian version of the World Mental Health Survey multicenter study – were used. A total of 3,588 adults living in 69 neighborhoods in the metropolitan region of Sao Paulo, SP, Southeastern Brazil, including 38 municipalities and 31 neighboring districts, were selected using multistratified sampling of the non-institutionalized population. Multilevel Bayesian logistic models were adjusted to identify the individual and contextual determinants of the use of health care services in the past 12 months and presence of a regular physician for routine care.RESULTS The contextual characteristics of the place of residence (income inequality, violence, and median income) showed no significant correlation (p > 0.05) with the use of health care services or with the presence of a regular physician for routine care. The only exception was the negative correlation between living in areas with high income inequality and presence of a regular physician (OR: 0.77; 95%CI 0.60;0.99) after controlling for individual characteristics. The study revealed a strong and consistent correlation between individual characteristics (mainly education and possession of health insurance), use of health care services, and presence of a regular physician. Presence of chronic and mental illnesses was strongly correlated with the use of health care services in the past year (regardless of the individual characteristics) but not with the presence of a regular physician.CONCLUSIONS Individual characteristics including higher education and possession of health insurance were important determinants of the use of health care services in the metropolitan area of Sao Paulo. A better understanding of these determinants is essential for the development of public policies that promote equitable use of health care services.

Nocturia is not associated with falls among the elderly: a population study in the city of Sao Paulo

Introduction: the present study aims to evaluate the association between nocturia and falls in a group of community-living elderly men in the city of Sao Paulo (Brazil). Material and methods: under the coordination of the Pan American Health Organization and World Health Organization, a multicenter study named Health, Welfare and Aging (SABE Study) is being conducted to evaluate the living and health conditions of older people in Latin America and Caribbean. In Brazil, this study is evaluating the elderly population (60 years or more) in Sao Paulo since 2000. The presence of nocturia was taken as the response ""yes"" to the question ""Do you need to void three times or more at night?"". The presence of falls was also taken as the response ""yes"" to the question ""Did you have any fall during the last 12 months?"" The intergroup analysis used was the logistic regression. Results: total of 865 men was interviewed, mean age 68 years. It was observed high prevalence of nocturia and falls in all groups, with higher prevalence of both in the eldest group (p < 0.001), however, the association of nocturia and falls was not statistically significant in any of the groups (p = 0.45). Conclusion: this is one of the pioneering studies that assess only the male population, showing that nocturia was not significantly associated with falls. Nocturia and falls are highly prevalent conditions in the elderly, but no association was found between both, so that these variables may be correlated to age and other clinical conditions. (C) 2010 AEU. Published by Elsevier Espana, S.L. All rights reserved.

Health surveys and use of maternal and child health care services in three municipalities within the Sao Paulo metropolitan area

Objectives. To describe the changes in the use of maternal and child health care services by residents of three municipalities-Embu, Itapecerica da Serra, and Taboao da Serra-in the Sao Paulo metropolitan area, 12 years after the implementation of the Unified Health System (SUS) in Brazil, and to analyze the potential of population-based health care surveys as sources of data to evaluate these changes. Methods. Two population-based, cross-sectional surveys were carried out in 1990 and 2002 in municipalities located within the Sao Paulo metropolitan area. For children under 1 year of age, the two periods were compared in terms of outpatient services utilization and hospital admission; for the mothers, the periods were compared in terms of prenatal care and deliveries. In both surveys, stratified and multiple-stage conglomerate sampling was employed, with standardization of interview questions. Results. The most important changes observed were regarding the location of services used for prenatal care, deliveries, and hospitalization of children less than 1 year of age. There was a significant increase in the use of services in the surrounding region or hometown, and decrease in the utilization of services in the city of Sao Paulo (in 1990, 80% of deliveries and almost all admissions for children less than 1 year versus 32% and 46%, respectively, in 2002). The use of primary care units and 24-hour walk-in clinics also increased. All these changes reflect care provided by public resources. In the private sector, there was a decrease in direct payments and payments through company-paid health insurance and an increase in payments through self-paid health insurance. Conclusions. The major changes observed in the second survey occurred simultaneous to the changes that resulted from the implementation of the SUS. Population-based health surveys are adequate for analyzing and comparing the utilization of health care services at different times.

Drizzle and Fog Analysis in the Sao Paulo Metropolitan Area: Changes 1933-2005 and Correlations with other Climate Factors

In order to improve our understanding of climate change, the aim of this research project was to study the climatology and the time trends of drizzle and fog events in the Sao Paulo Metropolitan Area, and the possible connections of this variability with the sea surface temperature (SST) of the Atlantic and Pacific Oceans. The climatology of both phenomena presents differences and similarities. Fog shows a marked maximum frequency in winter and a minimum frequency in summer, while the seasonal differences of drizzle occurrence are less pronounced, there is a maximum in spring, whereas the other seasons present smaller and similar numbers of events. Both phenomena present a negative trend from 1933 to 2005 which is stronger for fog events. A multivariate statistical analysis indicates that the South Atlantic SST could increase warm temperature advection to the continent. This could be one of the responsible factors for the negative tendency in the number of both fog and drizzle events.

Prevalence of Mycoplasma genitalium among HIV-infected men in Sao Paulo city detected by realtime polymerase chain reaction

Genital mycoplasmas are natural inhabitants of the male urethra and are potentially pathogenic species playing an aetiological role in both genital infections and male infertility. This study aims to determine the presence of Mycoplasma genitalium DNA in urine samples of HIV-1-infected men in Sao Paulo city. Realtime polymerase chain reaction (PCR) was performed using the primers My-ins and Mgso-2 and the Taqman probe Mgen-P1 as described previously. A total of 223 HIV-1-infected men were tested with a mean age of 44 years. Thirteen (5.8%) presented M. genitalium in urine and the co-infection was more common among homosexual men (76.9% versus 51.9%, P < 0.26). In conclusion, realtime PCR was a useful and rapid method for detecting M. genitalium DNA in urine samples. Further studies should be conducted to assess the clinical significance of these results on HIV transmission and its impact on HIV viral load.

The Sao Paulo stock exchange and the economic stabilization

The inflationary stabilization recently observed in Brazil brings a lot of changes in all aspects of the country’s economic life. In this work we look at the impacts on the stock market, specifically at Bovespa - the São Paulo Stock Exchange. We analyze the leading variables and statistics that describe Bovespa’s behavior, such as volatility and systematic risk, comparing the four years preceding and the four years after 1994, when the Real Plan was implemented. In order to eliminate exogenous influences, we use control series made with international Stock Exchanges Indexes. The results show that after 1994 there was reduced volatility, increased trade volume, reduced efficiency of the Bovespa Index and no changes in systematic risk.

Sedimentation rates of tripton in Jurumirim Reservoir (São Paulo, Brazil)

Sedimentation rates of particulate material and some physicochemical parameters of water were determined in October, January, April and July 1990-91 at seven stations in the Jurumirim Reservoir (São Paulo, Brazil), three located in the Paranapanema arm, three in the Taquari arm and one near the dam. Higher sedimentation rates of tripton were found in the Paranapanema arm, followed by those from the Taquari arm and the dam. Suspended matter (2.5-48.7 mg · 1-1) and chlorophyll-a (0.7-8.1 mg · m-3) concentrations in the Paranapanema arm were in general higher resulting in lower water transparency (0.3-1.7m) than in the Taquari arm. Temporal and spatial variations in the tripton sedimentation rates were mainly influenced by allochthonous input at the stations near the river mouth. The settling fluxes at station near the dam of the reservoir were affected rather by a small autochthonous production (65 g C ass m-2 ;yr-1), indicated by a higher organic content (64-87%). Therefore, sedimentation rates measured by bottom traps were affected by sediment ressuspension especially at isothermal conditions. With respect to sedimentation, the riverine, the transition and the lacustrine zones commonly found in reservoires could be distinguished. The extent of the riverine zone in each arm of the Jurumirim Reservoir depends on the seasonal change of allochthonous input.

Geothermal investigations in an area of induced seismic activity, northern São Paulo State, Brazil

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Distribution of stream macroalgae in the eastern Atlantic Rainforest of São Paulo State, southeastern Brazil

Fifty-two stream segments were sampled from 16 August to 13 September in 1993 in the eastern Atlantic Rainforest of São Paulo State, southeastern Brazil (22°55′-25°00′S, 44°48′-48°03′W). Forty-two macroalgal subgeneric taxa were found and the most widespread species were Audouinella pygmaea (21% of sites), Compsopogon leptoclados and Microcoleus subtorulosus (19%). Macroalgal species number per sampling site ranged from 0 to six (2.6 ± 1.7) and was positively correlated to species abundance, whereas species cover ranged from 0 to 70% of the stream bed (15.5 ± 20.8%). No significant correlation was found among macroalgal species number and abundance with any physical or chemical variable analyzed. Most sites were dominated by one or few macroalgal species, mainly, Audouinella macrospora, C. leptoclados and M. subtorulosus. No significant difference was found between the frequency distribution of variables measured for streams and for total macroalgae but the most widespread species (A. pygmaea) differed significantly for current velocity, specific conductance, turbidity and pH. Overall means for macroalgal occurrence include the following values: temperature (X̄ = 19.9°C), current velocity (X̄ = 45 cm s-1), oxygen saturation (X̄ = 66%), specific conductance (X̄ = 59.6 μS cm-1), turbidity (X̄ = 5 NTU) and pH (X̄ = 7.1). This pattern of patchy distribution and dominance by few species has been suggested as typical of stream macroalgal communities and has been ascribed to the rapid fluctuation of physical and chemical conditions. Total macroalgal species richness as well as mean species number per sampling site were considerably lower than found in similar studies of other regions. The Intermediate Disturbance Hypothesis was applied to explain these results: the same factor (high precipitation) responsible for the maintainance of the high species diversity in the surrounding forest can be, paradoxically, a constraint to the development of a more diverse macroalgal flora in streams. © 1996 Kluwer Academic Publishers.

Comportamento fractal de tracos de fraturas na borda sul do macico granitico de itu, estado de Sao Paulo

Fractal geometry is relevant to understand and explain many natural complex geometries. Using the fractal set concept (fig. 1) many authors have shown that shorelines, landscapes and fractures follow a fractal behaviour. These authors have developed many methods, including the Cantor's Dust Method (CDM) (VELDE et al., 1992), a linear method of analysis adapted for the determination of two-dimensional phenomena. The Itu Granitic Complex (IGC) is a wide granitic body that that crops out at northwest of Cabreuva City, Sao Paulo State (fig. 2) and was affected in its south border by dextral Itu-Jundiuvira Shear Zone (IJSZ) that produced fractures and alignment of feldspars crystals. The different types of fractures (compression, distension and shear) was discriminated from the relationship between them and medium stress ellipsoid of IJSZ (fig. 3). A modified version of CDM was used to study a possible fractal behaviour of the fracture traces in the south border of IGC. The main modification was the use only one direction of analysis (NE/SW). Four parallel profiles were traced with lengths between 9.75km and 12.75km, each one them was divided into six classes of segments (x) with 375m, 500m, 750m, 1.000m, 1.250m and 1.500m. The parameter (N) is provided by he rate between profile length and choiced segment. For each x the number of intervals is counted with at least one event (fracture intersection) which supplied the parameter(n). The n/N rate provide the parameter (p) that represents the relationship between frequency of events and x. And finally the parameters p and x were plotted in a logarithmic graphics (fig. 4) that provide a line with such a declivity (1) which is related to effective dimension (De). In theory, granitics bodies are isotropics and they would have a same fractal dimension in all segments, but the logarithmic graphics (fig. 4) show that fracture traces of IGC has a fractal behaviour in a restrict interval. This fact probably occurs from the passage of a ductil-brittle deformation condition to a more brittle deformation condition of IGC.

Phytochemical evidence for the plant origin of Brazilian propolis from Sao Paulo state

Propolis and plant secretions from three species, most frequently mentioned as botanical sources of the bee glue in Brazil (Baccharis dracunculifolia, Araucaria angustifolia and Eucalyptus citriodora) have been investigated using GC-MS. Based on chemical evidence, B. dracunculifolia was shown to be the main propolis source in Sao Paulo state. The antibacterial and antifungal activities of all four materials were also tested, the most active being propolis and Baccharis leaf exudate.