Escola Bahiana de Medicina e Saude Publica

Salvador, Brazil

Escola Bahiana de Medicina e Saude Publica

Salvador, Brazil
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Bahiense-Oliveira M.,Escola Bahiana de Medicina e Saude Publica | Rocha P.N.,Federal University of Bahia
Memorias do Instituto Oswaldo Cruz | Year: 2011

Distinct patterns of glomerular lesions, including membranoproliferative glomerulonephritis and focal segmental glomerulosclerosis, are associated with infection by Schistosoma mansoni or Schistosoma japonicum. Evidence suggests that immune complex deposition is the main mechanism underlying the different forms of schistosomal glomerulonephritis and that immune complex deposition may be intensified by portal hypertension. The relationship between focal segmental glomerulosclerosis and schistosomiasis remains poorly understood. A clinicopathologic classification of schistosomal glomerulopathies was proposed in 1992 by the African Association of Nephrology. In Brazil, mass treatment with oral medications has led to a decrease in the occurrence of schistosomal glomerulopathy. In a survey of renal biopsies performed in Salvador, Brazil, from 2003-2009, only 24 (4%) patients were identified as positive for S. mansoni infection. Among these patients, only one had the hepatosplenic form of the disease. Focal segmental glomerulosclerosis was found in seven patients and membranoproliferative glomerulonephritis was found in four patients. Although retrospective studies on the prevalence of renal diseases based on kidney biopsies may be influenced by many patient selection biases, a change in the distribution of glomerulopathies associated with nephrotic syndrome was observed along with a decline in the occurrence of severe forms of schistosomiasis.

Duarte G.V.,Federal University of Bahia | da Silva L.P.,Escola Bahiana de Medicina e Saude Publica
Anais Brasileiros de Dermatologia | Year: 2014

In the absence of ideal biomarkers, the research for clinical markers correlated to the severity of psoriasis and/or its comorbidities becomes crucial. Recently, studies have shown positive correlation between body mass index and prevalence and severity of psoriasis. Abdominal circumference showed stronger correlation with disease severity than body mass index. We evaluated the waist-to-height ratio in a sample of 297 adult patients with psoriasis and observed that it has a significant correlation with body mass index and PASI, and together with body mass index allows the identification of central obesity, reducing its subdiagnosis. © 2014 by Anais Brasileiros de Dermatologia.

Guindalini R.S.C.,University of Sao Paulo | Mathias Machado M.C.,Escola Bahiana de Medicina e Saude Publica | Garicochea B.,Hospital Sirio Libanes
Molecular Diagnosis and Therapy | Year: 2013

Survivin, a member of the inhibitor of apoptosis protein family, is one of the most cancer-specific proteins identified to date. Survivin expression is low or undetectable in most adult tissues, but, alternatively, is overexpressed in a large number of tumors. This multifunctional protein is recognized as a key regulator in apoptosis, proliferation and angiogenesis in the tumor environment. Several studies have shown a correlation between survivin upregulation and poor cancer prognosis, and, as expected, its downregulation or inactivation leads to inhibition of tumor growth. Therefore, survivin has attracted increasing attention both as a potential cancer biomarker and as a new target for anticancer therapies. This review summarizes and discusses survivin expression and its potential as a prognostic and diagnostic biomarker in different types of tumors, as well as provides an overview of the current therapeutic challenges of targeting survivin as a treatment strategy. © 2013 Springer International Publishing Switzerland.

Non-industrial labor is still widespread in Brazil. An appropriate approach ought to consider different social specificities from those of salaried- work relations. The scope was to examine non-industrial work practices, specifically those of extractive shellfishing, and their relation to health conditions in a small-scale fishing community. It focused on the cadences and time contingencies, as well as other working conditions, related to the development of ailments such as repetitive strain injury - RSI. A qualitative-ethnographic study was conducted between 2005 and 2007 in a community of 800 inhabitants, located on Maré Island in the state of Bahia. In a population consisting of fishing households, thirty families were interviewed, observed at work and - in cases of suspected RSI - referred to a specialized health service. The seriousness of the working conditions became evident, especially with respect to RSI. By way of illustration, an average frequency of 10,200 repetitive movements per hour were verified in extractive shellfishing, while the official Brazilian norm (NR17) for a keyboarder establishes a maximum of 8,000 movements per hour. This suggests that women shellfishers ought to be included in repetitive strain injury risk groups.

Da Silva F.F.,Escola Bahiana de Medicina e Saude Publica | Levy R.A.,Federal University of Rio de Janeiro | De Carvalho J.F.,Centro Medico Do Hospital Alianca
Journal of Immunology Research | Year: 2014

A major cause of morbidity and mortality in the context of the antiphospholipid syndrome (APS) is the occurrence of thrombotic events. Besides the pathogenic roles of antiphospholipid antibodies (aPL), other risk factors and medical conditions, which are conditions for traditional risk of an individual without the APS, can coexist in this patient, raising their risk of developing thrombosis. Therefore, the clinical and laboratory investigation of comorbidities known to increase cardiovascular risk in patients with antiphospholipid antibody syndrome is crucial for the adoption of a more complete and effective treatment. Experimental models and clinical studies show evidence of association between APS and premature formation of atherosclerotic plaques. Atherosclerosis has major traditional risk factors: hypertension, diabetes mellitus, obesity, dyslipidemia, smoking, and sedentary lifestyle that may be implicated in vascular involvement in patients with APS. The influence of nontraditional risk factors as hyperhomocysteinemia, increased lipoprotein a, and anti-oxLDL in the development of thromboembolic events in APS patients has been studied in scientific literature. Metabolic syndrome with all its components also has been recently studied in antiphospholipid syndrome and is associated with arterial events. © 2014 Felipe Freire da Silva et al.

Correia L.C.,Escola Bahiana de Medicina e Saude Publica
Arquivos brasileiros de cardiologia | Year: 2010

BACKGROUND: Low socioeconomic (SE) status has been associated to inflammation and predictors of C-reactive protein (CRP) have been investigated by studies performed in developed countries. This study aimed to identify predictors of CRP in individuals of very low SE level in a developing country and evaluate whether CRP is related to SE status in this scenario. OBJECTIVE: Eight-two individuals of very low SE level were recruited from a poor, semi-rural community in Brazil. Thirty-two individuals of high socioeconomic level comprised a comparison sample. High-sensitivity CRP was measured by nephelometry. METHODS: Eight-two individuals of very low SE level were recruited from a poor, semi-rural community in Brazil. Thirty-two individuals of high socioeconomic level comprised a comparison sample. High-sensitivity CRP was measured by nephelometry. RESULTS: In the low SE individuals, independent predictors of CRP were body mass index > 25 Kg/m(2) (P<0.001), smoking (P=0.005) and acute infection conditions (P=0.049). The low SE group (median=2.02 mg/l; interquartile range 0.92 - 4.95 mg/dl) had higher CRP levels compared to the high SE group (1.16 mg/l, interquartile range 0.55 - 2.50 mg/dl, P=0.03). Body mass index tended to be higher (27 +/- 4.9 kg/m(2) vs 25.5 +/- 3.2 kg/m(2); P=0.07) and the prevalence of acute infection greater (32% vs 3%, P=0.002) in the low SE group. After overweight individuals and those with infectious conditions were excluded, the CRP levels were similar between the groups with low and high SE levels (0.93 mg/l vs 1.08 mg/l, P=0.28). CONCLUSION: Adiposity, infection conditions and smoking are predictors of CRP in individuals with very low SE level. The first two factors determine greater level of inflammation in low SE individuals when compared to the high SE counterparts.

Almeida F.A.,Escola Bahiana de Medicina e Saude Publica
Arquivos brasileiros de cardiologia | Year: 2010

BACKGROUND: There is a high global and cardiovascular mortality rate among patients who need hemodialysis. OBJECTIVE: To assess global and cardiovascular mortality and to identify the risk factors in patients who undergo hemodialysis. METHODS: Observational, prospective study. A total of 334 patients were studied within three years. Primary outcomes: global and cardiovascular mortality. Survival was assessed through Kaplan-Meier method, and the risk variables were identified by means of bivariate and multivariate Cox regression. RESULTS: A total of 189 men (56.6%), aging 48.8 +/- 14.2, majority non-white (295, 88.3%) and who did finished the elementary school (211, 63.2%). Global mortality rate was 21.6%, with a 50% rate of 146-month survival; cardiovascular mortality rate was 41.7% (30/72), with a 75% rate of 141-month survival. In the bivariate analysis, the relative risk (RR) for non-cardiovascular and cardiovascular death increased when age > or =60 years old was Hb < or =9.0 g/dl and fast glycemia > or =126 mg/dl. Only non-cardiovascular death with low school grade and widow, Hb<11.0 g/dl, Ht<33.0%, fast glycemia > or =100 mg/dl, Ca product x P<42 and creatinine > or =9.2 mg/dl decreased with blood pressure (BP) > or =140/90 mmHg (before hemodialysis session) and Ht>36%; Obit due only to cardiovascular factors increased with creatinine > or =9.4 mg/dl. In the multivariate analysis, non-cardiovascular and cardiovascular RR increased with age > or =60 years old and Hb<9 g/dl; cardiovascular death RR increased with glycemia > or =126 mg/dl, and non-cardiovascular death RR increased with urea removal rate in hemodialysis (Kt/V) <1,2. CONCLUSION: Global and cardiovascular mortality of patients who need hemodialysis is high. Independent risk factors for non cardiovascular and cardiovascular causes of death were age >60 years old and Hb<9 g/dl, for cardiovascular cause of death only, was fasting blood glucose > or =126 mg/dL, and for non-cardiovascular cause of death, Kt/V<1,2.

Lins C.F.,Escola Bahiana de Medicina e Saude Publica | Santiago M.B.,Escola Bahiana de Medicina e Saude Publica
European Radiology | Year: 2015

Objectives: The aim of this systematic review is to describe the scientific evidence regarding sonographic findings of joints in SLE patients. Methods: Seven databases were searched (PubMed, ScienceDirect, Scopus, Cochrane, EMBASE, LILACS, and SciELO) for articles from 1950 to January 2015. The keywords used for selecting articles include “lupus”, “ultrasound imaging”, “ultrasonography”, “synovitis”, “tenosynovitis”, and “arthritis”. Results: A total of 12 articles were included in the final analysis. In total, 610 SLE patients and 1,091 joints were studied. Most patients underwent bilateral joint examination by US. A total of 888 hands and wrists, 154 ankles/feet, and 56 knees were examined. Effusion was identified in 602 joints, synovitis in 213, tenosynovitis in 210, synovial hypertrophy in 150, and bone erosions in 73 cases. The majority of the studies demonstrated higher frequency of musculoskeletal abnormalities on US than those observed on physical examination. Conclusion: US seems to be a valuable tool to identify subclinical joint manifestations in SLE. Prospective studies are necessary to determine if those patients with subclinical joint abnormalities have a higher risk for the development of chronic deformities as those seen in Jaccoud’s Arthropathy. Key Points: • Musculoskeletal involvement occurs in more than 90 % of SLE cases. • Arthralgia or tender/swollen joints found on physical examination showed more US findings. • Patients without joint symptoms or physical examinations changes showed musculoskeletal sonographic findings. • US became a useful tool for rheumatologists. • A substantial number of asymptomatic patients show abnormalities at musculoskeletal US. © 2015, European Society of Radiology.

Cal S.F.,Rheumatology Ambulatory | Santiago M.B.,Escola Bahiana de Medicina e Saude Publica
Psychology, Health and Medicine | Year: 2013

Resilience (RS) concerns human beings capacity to respond positively to adverse situations they face, enabling individuals to achieve, maintain, or recover physical or emotional health after devastating illness, losses, or other stressful situations. RS can be an important factor in health promotion. The aim of this study was to evaluate RS in patients with systemic lupus erythematosus (SLE). Forty-five SLE patients participated in this study and were evaluated by both Mini International Neuropsychiatric and Wagnild and Young scales. Of these, 8.9% had low RS (score < 121), 71% medium score (between 121 and 146), and 20% high RS (score > 146). Patients over 35 years of age had the highest scores on the RS scale and patients at risk of committing suicide presented the lowest RS scores, possibly due to high level of depression. Identifying risk and protective factors is important for developing psychological support strategies. © Taylor and Francis.

Santiago M.B.,Escola Bahiana de Medicina e Saude Publica
Best Practice and Research: Clinical Rheumatology | Year: 2011

Jaccoud's arthropathy (JA) is a condition characterised clinically by 'reversible' joint deformities such as swan neck, thumb subluxation, ulnar deviation, 'boutonniere' and hallux valgus, along with an absence of articular erosions on a plain radiograph. JA was initially described in patients with rheumatic fever (RF), but as this disorder has become rare the main clinical entity associated to JA at present is systemic lupus erythematosus (SLE). JA has also been described in other connective tissue diseases, infections and neoplasia. In general, its prevalence in either SLE or RF is around 5%. The etiopathogenic mechanisms of JA are not known, but some authors have suggested an association with hypermobility syndrome. Several studies have attempted to identify an association of different antibodies with JA in SLE patients, but their findings do not allow for the drawing of any definite conclusions. Newer imaging techniques such as magnetic resonance and high-performance ultrasonography have revealed the presence of small erosions in joints of a few patients with JA. Presently, the therapy for JA is conservative and based on the use of non-hormonal anti-inflammatory drugs, low doses of corticosteroids, methotrexate and antimalarials. The role of surgery through either the realignment of soft tissue around the joint - or more aggressive procedures such as arthrodesis, silastic implant and arthroplasty - needs to be proven. © 2011 Elsevier Ltd. All rights reserved.

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