Amerindian women of the Brazilian Amazon and STD.

Papanicolaou tests, PCR for HPV, C. trachomatis, HSV-1/2 and N. gonorrhoea, and Hybrid Capture II were performed for high- and low-risk HPV groups during screening for cervical cancer in 49 women of the Parakana tribe. Cytological diagnoses of HPV were suggested in three samples: PCR showed 12 (22.4%) cases of DNA positive HPV, 16 (1), 18 (2), 58 (3), 39 (1), 61 (1), 33 (1), 35 (1), unknown (2), and HCII analyzed 48 samples: 19 positive (39.58%) for the high-risk group and four (18.33%) for the low-risk group. The prevalence of HPV was 42.85% (p = 0.001) by molecular biology methods. The largest viral load was 1588.11 pg/ml for HPV 39 in a 16-year-old. PCR was positive for C. trachomatis and negative for HSV-1/2 and N. gonorrhoea. Parakana women present a high risk for the development of cervical cancer.

Human papillomaviruses in Amerindian women from Brazilian Amazonia.

We evaluated the prevalence of human papillomavirus (HPV) infection in Amerindian women from a tribe in Brazilian Amazonia. Demographic data, pap smears and cervical samples for HPV DNA detection by polymerase chain reaction (PCR) were obtained for women aged above 10 years old. In total, 79 (85.9%) out of 92 eligible women who lived there were interviewed; all women already had engaged in sexual activity. Seventy-eight and 49 women allowed collection of pap smears and PCR samples, respectively. Cytological signs of HPV infection were observed in 11 patients; 6 of these were probed for HPV infection and 1 shown to be HPV 16. Overall prevalence of HPV infection detected by PCR was 14.3%. Three patients presented high-risk HPV DNA types:two HPV 16 and one co-infection of HPV 16 and 58. Cervical infection by oncogenic HPV types occurs in Amerindian women and cervical cancer screening should be a priority in this setting.

Clinical factors and prognosis in non-small cell lung cancer.

We evaluated the relationship of clinical characteristics and survival in 1,635 patients with non-small cell lung cancer (NSCLC) treated in Brazil. The following variables were included: sex, age, smoking, Karnofsky's performance status (PS), weight loss, symptoms at diagnosis (cough, dyspnea, hemoptysis, chest pain, wheezing, and hoarseness), presence of superior vena cava syndrome (SVCS), histologic type, TNM stage, and therapeutic modality (surgery, chemotherapy [CT] and radiotherapy [RT]). Multivariate prognostic models were obtained by Cox regression. Patients unsuitable for surgery or who had recidivant disease were elected to further RT and/or CT, and long-term results in this group were equivalent to those in the group treated only by surgery. A diagnosis of bronchioloalveolar carcinoma, small tumors, absence of hoarseness, treatment by surgery, and RT were independent factors related to good overall survival in stage I and II. Weight loss and clinical signs of SVCS were related to poor prognosis in stage III. PS, diagnosis of adenocarcinoma or undifferentiated carcinoma, absence of weight loss and dyspnea, NO or N1 disease, ability to receive RT, CT, and to perform some palliative surgical procedure were good prognostic factors in stage IV. Clinical features of patients with NSCLC at diagnosis offer additional information to estimate their prognosis.

[Mortality risk factors in patients over 65 years of age hospitalized in a São Paulo, Brasil university hospital]. / Factores de riesgo de mortalidad en personas mayores de 65 años internadas en un hospital universitario, São Paulo, Brasil.

Various studies show that age in itself is not an independent predictive factor for the survival of critically ill older persons. In spite of that fact, people over 65 tend not to have access to the most-sophisticated diagnostic and therapeutic resources. With the continued aging of the population, it is increasingly important to be able to determine the mortality risk factors that affect the survival possibilities of hospitalized older people, especially in emergency situations. The objective of this study was to analyze the risk factors related to mortality among people over 65 admitted to the emergency service of the Santa Casa Hospital of São Paulo, a third-level academic institution. The study was based on a nonconditional logistic regression analysis of personal data in the clinical histories and other documents of the hospitalized patients. From July 1993 through March 1994, 599 patients over 65 were hospitalized. They included 326 men (54.4%) and 273 women (45.6%), with a median age of 73.3 years. The primary reasons for admission were pneumonia (14.4%), cerebrovascular disease (11.5%), and congestive heart failure (8.2%). There were 160 deaths among the group. Those who died had a median stay in the hospital of 4 days (range, 1 to 72), which was similar to that of those who survived (median, 3 days; range, 0 to 35 days; P = 0.29). According to multivariate analysis, factors predictive of survival were hypertension (odds ratio = 0.39; 95% CI: 0.23 to 0.68), chronic obstructive pulmonary disease (OR = 0.45; 95% CI: 0.22 to 0.95), and diabetes mellitus (OR = 0.50; 95% CI: 0.27 to 0.91). This was true regardless of sex, age, race, compliance with treatment, initial diagnosis, and other pathological conditions present. On the other hand, two factors were predictive of mortality during hospitalization. They were the presence of extrapulmonary infections (OR = 2.34; 95% CI: 1.13 to 4.86) and the number of preexisting illnesses: one (OR = 2.78; 95% CI: 1.56 to 4.96), two (OR = 4.56; 95% CI: 2.28 to 9.15), and three or more (OR = 15.88; 95% CI: 6.49 to 38.85). This study shows that improving the diagnosis and treatment of infections can reduce mortality of elderly persons admitted to emergency services. Rather than age, the multiplicity of diseases was the factor that increased the risk of death among these patients. There is no justification for using age alone to limit the access that older patients have to better diagnosis and treatment resources, if these resources can result in better survival rates, fewer disabilities, or a better quality of life.

A mathematical approach for estimating reference values for weight-for-age, weight-for-height and height-for-age.

Anthropometry is widely used to monitor infant growth and to estimate child nutritional status. Current evidence suggests that existent growth curves are not adequate for use with all infants and researchers sought to identify another data set suitable for development as a new international growth reference. In this article we cast about unconditional limits for growth monitoring from raw data on age, sex, height and weight. Anthrompometric data from children aged 1 to 9 years from two studies on malnutrition in Brazil was analyzed. Data on age, sex, weight, height and body mass index from 141 Amerindian children was used to develop mathematical models to predict percent of NCHS medians for weight-for-age, weight-for-height, and height-for-age using multiple linear regression. Data from 251 children in a non-indian seaside village was used for cross-validation. Six age-specific equations were obtained with coefficients of determination greater than 0.96. Coefficients of correlation between NCHS-derived and model-derived values into the validation data set were greater than 0.96 for weight-for-age, greater than 0.99 for weight-for-height, and near 1.00 for height-for-age. It remains to be seen if one can achieve universal linear models from more representative samples, using the approach described here. Perhaps establishing a mathematical relation among anthropometric data would result in absolute individual limits for growth monitoring. They may even be as important to infant nutritional assessment as growth reference values.

Estudo preliminar para detecçäo de cérvico-vaginites e lesöes precursoras do câncer de colo uterino, em índias da tribo Parakanä / Preliminary study on low-trait genital infection and cervical epithelial dysplasia in indian of the Parakanä tribe

OBJETIVO. Avaliaçao preliminar da freqüência de inflamaçoes genitais e lesoes precursoras do câncer cérvico-uterino em um grupo indígena isolado da Amazônia oriental brasileira. MATERIAL E MÉTODO. Estudo transversal, dirigido às mulheres maiores de dez anos das aldeias Maroxewara e Paranatinga, da tribo Parakana. Foram obtidas informaçoes demográficas, etno-culturais, tocoginecológicas; procedeu-se a um exame físico e ginecológico, com coleta de material para bacterioscopia e colpocitologia oncótica.RESULTADOS. Foram examinadas 80 mulheres (89,9 por cento), das quais 69 foram avaliadas laboratorialmente; 14(20,3 por cento) estavam grávidas. Na aldeia Paranatinga, a bacterioscopia revelou um maior número de mulheres com ausência de flora Döderlein (60,0 por cento vs.29,l por cento). Na colpocitologia, o padrao mais encontrado foi o inflamatório (91,5 por cento); das colpites de etiologia específica (63,1 por cento), em 63,4 por cento suspeitou-se de infecçao por Gardenerella vaginalis, em 7,3 por cento por Trichomonas vaginalis, e em 4,9 por cento por microrganismos semelhantes à Candida sp. Em 23,2 por cento dos esfregaços havia alteraçoes citopatológicas relacionadas à infecçao por papilomavírus humano (PVH). As alteraçoes celulares sugeriram NIC I em um caso, NIC II em outro e carcinoma epidermóide em uma índia de 48 anos; nos três casos, foi proposta a posterior realizaçao de biópsia dirigida e avaliaçao clínica em ambientes hospitalar. Conclusoes. A maioria das mulheres Parakanas apresenta alguma patologia cervical, a maior parte das quais de menor gravidade. Apresentam, ainda, início precoce da vida sexual, multiplicidade de parceiros, curto intervalo interparto e alteraçoes citopatológicas sugestivas de infecçao pelo PVH, condiçoes de risco para transmissao sexual de doenças e desenvolvimento de câncer cérvico-uterino.

[Preliminary study on low-trait genital infection and cervical epithelial dysplasia in women from the Parakanä tribe of South America]. / Estudo preliminar para detecção de cérvico-vaginites e lesões precursoras do câncer de colo uterino, em índias da tribo Parakanã.

BACKGROUND: We evaluated the occurrence of low-trait genital infection and cervical epithelial dysplasia in women from a South-american indian tribe in the Brazilian Amazonia. METHODS: Cross-sectional study of women older than 10 years from two indian settlements of the Parakanã tribe: Paranatinga and Maroxewara. Demographic data and information about sexual behavior as well as obstetric/gynaecological history were recorded. Two gynecologists examined 80 patients (89.9%), and collected vaginal and cervical specimens of 69 indians for further laboratory analysis, by Gram stain and Papanicolaou method. Fourteen (20.3%) women resulted to be pregnant. RESULTS: Parakanã women begin sexual activity early, after menarche; they have multiple sexual partners; are multiparous. Some of his partners already had intercourse with women of our society. In Paranatinga, vaginal discharges were a very frequent sign and not age-related, and women presented high frequency of disturbances on lactobacilli flora, greater than among inhabitants of Maroxewara. Pap smears in 91.5% of all patients showed inflammatory pattern. When found an possible etiologic agent (61.3%), in 63.4% it was Gardnerella vaginalis, in 7.3% Trichomonas vaginalis and in 4.9% Candida sp. In 23.2% of smears cythophatic signs related to infection by human papillomavirus were identified. One case had morphological changes compatible with cervical intraepithelial neoplasia grade I, another with CIN II and, in a 48 year old indian, cervical cancer. CONCLUSIONS: Near all women had some grade of cervical disease. Measure HPV-infection prevalence among Parakanã indians with adequate methods may improve our understanding about worldwide occurrence of HPV infections. Established risk factors for cancer of the cervix and sexually transmitted diseases were common in this tribe.

[Psychosocial and sexual aspects of pregnant adolescents at Belém-Pará]. / Aspectos psicossociais e sexuais de gestantes adolescentes em Belém-Pará

Pregnancy is a major factor that modifies psychosocial aspects of the adolescents. A study with 120 pregnant adolescents aged 12 to 18 years, without regarding gestational age, was carried out at Prenatal Risk Program in the Secretaria Estadual de Saúde, Belém-Pará, from 10/1991 to 04/1992. At the first encounter, it was made an approach of psychosocial and sexual subjects, with the following results: onset of menarche primarily between 12-13 years old (median 12.2 years old); beginning of sexual practice at 14 years old in 50.9% of the adolescents. 56.6% were pregnant at 16 years old. Most of the adolescents (98.4%) first had sexual intercourse with their boy friends and by their own wish (72.5%). In one year of loving affair, 67.5% of the adolescents have already begun sexual activities, this attitude more prevalent among the younger(79.4%). Adolescents had learned about sexuality mainly from mates (65.1%). Although 55.9% of the adolescents were aware of some contraceptive method, just 13.3% of them used one. The majority of the pregnant adolescents (96.7%) were financially supported by their families. Respectively, 30.3% and 32.1% of these girls left school before or during pregnancy. The risk factors that may contribute to an early and unintended pregnancy among adolescents, specially the younger ones, were pointed out: little information about sex and contraceptive methods, limited practice on their use and a high rate of precocious sexual activities.

[Epidemiology of hepatitis B, C and D viruses among indigenous Parakanã tribe in the Eastern Brazilian Amazon Region]. / Epidemiologia dos vírus das hepatites B, C e D na tribo indígena parakanã, Amazônia Oriental Brasileira.

This study sought to establish the prevalence of infection with the hepatitis B, C, and D viruses (HBV, HCV, and HDV) and to describe their transmission among the Parakanã, an indigenous tribe in Pará State, Brazil. This tribe's first contacts with broader Brazilian society occurred in the 1970s and 1980s. As of October 1992, the tribe consisted of 350 individuals, of whom 222 lived in the village of Paranatinga and 128 in the village of Maroxewara. Serum samples from 96.9% of this population were tested for markers of infection with the above-named viruses by means of enzyme immunoassays. Another 106 serum samples collected from Parakanã in the 1970s were also tested. The results obtained with the modern samples showed an overall prevalence of HBV infection of 84.7% among the residents of Paranatinga, 14.4% of whom were carriers. In Maroxewara, the overall prevalence of infection was only 17.7% and no carriers were detected in the study population. HBV carriers were negative for markers of HDV infection. The prevalence of HCV infection, confirmed by immunoblot, was 1.4% and 1.6% in Paranatinga and Maroxewara, respectively. Among the notable findings of this study were that horizontal transmission of HBV takes place at an early age in Paranatinga; that HBV infection prevalences differ greatly between two nearby villages belonging to the same tribe; that HCV infection was detected in both villages; and, from the historic sera, that the prevalence of HBV infection was low and HCV infection was absent during the first years in which the Parakanã people had outside contact.

Falciparum malaria. Epidemiology in Latin America, biologic and clinical considerations, treatment, and prophylaxis.

Falciparum malaria has become a major problem to health planning in Latin America, particularly because widespread drug-resistant strains of P. falciparum have been observed. This article reviews some current considerations in the treatment and management of falciparum malaria in this region.

[Nutritional status of children under 5 years of age in indian villages of the Parakaña tribe in Brazil's eastern Amazonia]. / Evolução do estado nutricional de menores de 5 anos em aldeias indígenas da Tribo Parakanã, na Amazônia Oriental Brasileira (1989-1991).

The evolution of the nutritional status of children under 5 years of age living in two Indian settlements of the Parakanã tribe, Maroxewara and Paratininga, situated in the southeast of Pará State (Brazil), with less than 20 years of direct contact with our society, was studied. The main purpose of this study was to register the effects of the preventive and curative health activities of the "Parakanã Program" (created by an agreement between the National Indian Foundation- FUNAI and Northern Hydroelectric Project- ELETRONORTE), undertaken with the technical cooperation of the Tropical Medicine Center (Federal University of Pará). Anthropometric data were obtained in there cross-sectional studies (April 89; January 90 and October 91) for the purpose of evaluating the prevalence of malnutrition by means of Gomez's, Waterlow's and WHO criteria. The evolution of nutritional status was evaluated in the light of the rate of growth and accepting weight increments superior to those expected among well-nourished children as a goal. Seventy children (87.5% of all the 0-5 years-olds living there) were followed through throughout the studies. Prevalence of malnutrition was greater in Paranatinga than in Maroxewara, possibly because the former was more populous and had had longer inter-racial contact. Paranatinga's anthropometric indices (wt/age, ht/age and wt/ht) were the lower. Most of the severe forms of malnutrition were found there too. Children between six months and 2 years old were the most affected.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prevalence of antibodies to hepatitis C (anti HCV) in blood donors in Rio de Janeiro, Brazil. Its relation to ALT and anti HBC]. / Prevalência do anticorpo contra hepatite C (anti VHC) em doadores de sangue no Rio de Janeiro, Brasil. Sua relação com ALT e anti HBC.

UNLABELLED: We have studied 933 volunteer blood donors from May to July, 1990. After a interview and screening tests for syphilis, Chagas disease, malaria and HIV, they underwent an enzyme immunoassay for HBsAg, anti HBc and anti HCV antibodies. Alanine aminotransferase (ALT) serum levels were determined by auto analyser. Most blood donors were male with mean age of 33 years (19-65). Anti HCV prevalence was 3.1% (29 from 933 blood donors). Among anti HCV+, blood donors, 44.8% (13/29) had ALT 40 UI/L, 31% (9/29) were anti HBc+ and 17.2% (5/29) had both surrogate markers simultaneously. From 109 donors with ALT 40 UI/L, 13 (11.9%) were anti HCV+, while among 153 anti HBc+ donors, the anti HCV was 5.8%. CONCLUSIONS: 1) we found a higher anti HCV prevalence among our blood donors than previous published reports from other countries; 2) our data show that surrogate assays do not adequately identify anti HCV blood donors, 41.4% of them would not have been excluded by anti HBc and ALT tests alone; 3) there were a correlation between anti HCV positivity with a sample to cutoff optical density ratio equal or greater than 4 and elevated ALT serum levels.