ABSTRACT This study describes difficulties in the monitoring of a child born during an oral outbreak of Chagas disease, in which there are several indications that the transmission occurred through the congenital route: 1. the mother was in the third trimester of pregnancy when she was infected; 2. She presented high parasitemia at the time of delivery; 3. In both, the mother and her daughter, T. cruzi was classified as DTU TcIV. The parasites were not found in the blood at birth and the infection was detected only three months later in an asymptomatic infant. As the mother and her child live in a highly endemic area, vector transmission could not be excluded during this period.

OBJECTIVE:To characterize the findings of behavioral hearing assessment in HIV-positive individuals who received and did not receive antiretroviral treatment.METHODS:This research was a cross-sectional study. The participants were 45 HIV-positive individuals (18 not exposed and 27 exposed to antiretroviral treatment) and 30 control-group individuals. All subjects completed an audiological evaluation through pure-tone audiometry, speech audiometry, and high-frequency audiometry.RESULTS:The hearing thresholds obtained by pure-tone audiometry were different between groups. The group that had received antiretroviral treatment had higher thresholds for the frequencies ranging from 250 to 3000 Hz compared with the control group and the group not exposed to treatment. In the range of frequencies from 4000 through 8000 Hz, the HIV-positive groups presented with higher thresholds than did the control group. The hearing thresholds determined by high-frequency audiometry were different between groups, with higher thresholds in the HIV-positive groups.CONCLUSION:HIV-positive individuals presented poorer results in pure-tone and high-frequency audiometry, suggesting impairment of the peripheral auditory pathway. Individuals who received antiretroviral treatment presented poorer results on both tests compared with individuals not exposed to antiretroviral treatment.

O objetivo deste estudo foi identificar aspectos da revelação do diagnóstico da infecção pelo HIV a crianças e adolescentes relevantes para a melhoria do cuidado de sua saúde. Trata-se de estudo qualitativo envolvendo entrevistas em profundidade e grupo focal com adolescentes vivendo com HIV/AIDS e seus pais ou cuidadores, em serviços de referência nas cidades de São Paulo e Santos, Brasil. Os resultados apontam como principais razões para a revelação: má adesão ao tratamento, iminência de início da vida sexual, demanda da criança ou adolescente e abordagem inadequada de profissional. A revelação mostrou-se momento crítico, com repercussões sobre projetos e horizontes de vida dos adolescentes. As mais problemáticas foram narradas por adolescentes infectados por via sexual e por uso de drogas. Apesar do impacto negativo inicial, a revelação repercutiu positivamente sobre os cuidados de saúde, com melhoria do diálogo com cuidadores e serviços. Os adolescentes enfatizaram ainda a necessidade de receber informações claras e honestas. Conclui-se pela necessidade de otimizar o processo de revelação, tratando-o como tarefa de longo prazo, negociada ativamente com a família e conduzida por equipes multidisciplinares.

The purpose of this study was to identify relevant issues in the disclosure of HIV-positive status in children and adolescents, aiming to improve the quality of their healthcare. A qualitative study included adolescents living with HIV/ AIDS and their parents and caregivers at AIDS reference services in São Paulo and Santos, Brazil. In-depth interviews and focus group were used. The main reasons for disclosure were: poor treatment adherence, sexual maturity, adolescent's request, and inadequate procedures by medical staff. Disclosure was a critical moment for adolescents, with a strong impact on their life plans and horizons. Adolescents infected through sexual transmission and drug use reported the most problematic scenes involved in disclosure. Despite its initial negative impact, disclosure resulted in improved healthcare and better dialogue among the adolescents, caregivers, and healthcare providers. The adolescents also requested clear, no-nonsense, honest information. The authors conclude that health services need to actively provide an adequate approach to facilitate disclosure of HIV-positive status to children and adolescents, realizing that it is a long-term process supported by the family and a multidisciplinary team.

Verificar a validade e reprodutibilidade do questionário Baecke de avaliação da atividade física habitual para portadores do HIV/AIDS. Foram estudadas trinta pessoas na análise da validação. Os escores de atividade física ocupacional (AFO), exercício físico no lazer (EFL), atividades de lazer e locomoção (ALL) e escore total (ET) foram comparados com o consumo de oxigênio de pico, carga de pico e gasto energético. Na análise da reprodutibilidade, foram estudadas 29 pessoas (intervalo entre 15-30 dias). O coeficiente de correlação de Pearson foi utilizado para validação. O coeficiente de correlação intraclasse, teste t-pareado e Bland-Altman foram utilizados para reprodutibilidade. O VO2 pico e a carga de pico foram correlacionados, significativamente com o EFL (r = 0,41; r = 0,43, respectivamente). O gasto energético foi correlacionado, significativamente, com o AFO (r = 0,64). Os coeficientes de correlação intraclasse foram de 0,70 ou superiores para AFO, EFL e ET. Não houve diferenças significativas nas médias dos escores entre as duas medidas, e o método de Bland-Altman mostrou boa concordância para todos os escores. O questionário Baecke mostrou-se válido para avaliação da atividade física habitual em portadores do HIV/AIDS.

This study evaluates the validity and reliability of the Baecke questionnaire on habitual physical activity when applied to a population of HIV/AIDS subjects. Validity was determined by comparing measurements for 30 subjects of peak oxygen uptake, peak workload, and energy expenditure with scores for occupational physical activity (OPA), physical exercise in leisure (PEL), leisure and locomotion activities (LLA), and total score (TS). Reliability was determined by testing and retesting 29 subjects at intervals of 15-30 days. Validity was evaluated with the Pearson correlation and reliability analyses were done using the intraclass correlation, paired Student t-test, and Bland-Altman methods. Peak VO2 and peak workload had significant correlation with PEL (r = 0.41; r = 0.43; respectively). Energy expenditure had a significant correlation with OPA (r = 0.64). The intraclass coefficients were 0.70 or more for OPA, PEL and TS. There was no difference in OPA, PEL, LLA and TS between the two evaluations. The Bland-Altman methods showed that there was good agreement between the measurements for all habitual physical activities scores. Results show that the Baecke questionnaire is valid for the evaluation of habitual physical activity among people living with HIV/AIDS.

Verificar a validade e reprodutibilidade do questionário Baecke de avaliação da atividade física habitual para portadores do HIV/AIDS. Foram estudadas trinta pessoas na análise da validação. Os escores de atividade física ocupacional (AFO), exercício físico no lazer (EFL), atividades de lazer e locomoção (ALL) e escore total (ET) foram comparados com o consumo de oxigênio de pico, carga de pico e gasto energético. Na análise da reprodutibilidade, foram estudadas 29 pessoas (intervalo entre 15-30 dias). O coeficiente de correlação de Pearson foi utilizado para validação. O coeficiente de correlação intraclasse, teste t-pareado e Bland-Altman foram utilizados para reprodutibilidade. O VO2 pico e a carga de pico foram correlacionados, significativamente com o EFL (r = 0,41; r = 0,43, respectivamente). O gasto energético foi correlacionado, significativamente, com o AFO (r = 0,64). Os coeficientes de correlação intraclasse foram de 0,70 ou superiores para AFO, EFL e ET. Não houve diferenças significativas nas médias dos escores entre as duas medidas, e o método de Bland-Altman mostrou boa concordância para todos os escores. O questionário Baecke mostrou-se válido para avaliação da atividade física habitual em portadores do HIV/AIDS.

This study evaluates the validity and reliability of the Baecke questionnaire on habitual physical activity when applied to a population of HIV/AIDS subjects. Validity was determined by comparing measurements for 30 subjects of peak oxygen uptake, peak workload, and energy expenditure with scores for occupational physical activity (OPA), physical exercise in leisure (PEL), leisure and locomotion activities (LLA), and total score (TS). Reliability was determined by testing and retesting 29 subjects at intervals of 15-30 days. Validity was evaluated with the Pearson correlation and reliability analyses were done using the intraclass correlation, paired Student t-test, and Bland-Altman methods. Peak VO2 and peak workload had significant correlation with PEL (r = 0.41; r = 0.43; respectively). Energy expenditure had a significant correlation with OPA (r = 0.64). The intraclass coefficients were 0.70 or more for OPA, PEL and TS. There was no difference in OPA, PEL, LLA and TS between the two evaluations. The Bland-Altman methods showed that there was good agreement between the measurements for all habitual physical activities scores. Results show that the Baecke questionnaire is valid for the evaluation of habitual physical activity among people living with HIV/AIDS.

O objetivo deste estudo foi identificar aspectos da revelação do diagnóstico da infecção pelo HIV a crianças e adolescentes relevantes para a melhoria do cuidado de sua saúde. Trata-se de estudo qualitativo envolvendo entrevistas em profundidade e grupo focal com adolescentes vivendo com HIV/AIDS e seus pais ou cuidadores, em serviços de referência nas cidades de São Paulo e Santos, Brasil. Os resultados apontam como principais razões para a revelação: má adesão ao tratamento, iminência de início da vida sexual, demanda da criança ou adolescente e abordagem inadequada de profissional. A revelação mostrou-se momento crítico, com repercussões sobre projetos e horizontes de vida dos adolescentes. As mais problemáticas foram narradas por adolescentes infectados por via sexual e por uso de drogas. Apesar do impacto negativo inicial, a revelação repercutiu positivamente sobre os cuidados de saúde, com melhoria do diálogo com cuidadores e serviços. Os adolescentes enfatizaram ainda a necessidade de receber informações claras e honestas. Conclui-se pela necessidade de otimizar o processo de revelação, tratando-o como tarefa de longo prazo, negociada ativamente com a família e conduzida por equipes multidisciplinares.

The purpose of this study was to identify relevant issues in the disclosure of HIV-positive status in children and adolescents, aiming to improve the quality of their healthcare. A qualitative study included adolescents living with HIV/ AIDS and their parents and caregivers at AIDS reference services in São Paulo and Santos, Brazil. In-depth interviews and focus group were used. The main reasons for disclosure were: poor treatment adherence, sexual maturity, adolescent's request, and inadequate procedures by medical staff. Disclosure was a critical moment for adolescents, with a strong impact on their life plans and horizons. Adolescents infected through sexual transmission and drug use reported the most problematic scenes involved in disclosure. Despite its initial negative impact, disclosure resulted in improved healthcare and better dialogue among the adolescents, caregivers, and healthcare providers. The adolescents also requested clear, no-nonsense, honest information. The authors conclude that health services need to actively provide an adequate approach to facilitate disclosure of HIV-positive status to children and adolescents, realizing that it is a long-term process supported by the family and a multidisciplinary team.

OBJETIVO: Validar métodos de estimativas da gordura corporal (somatória de espessura de dobras cutâneas, circunferência da cintura (CC) e razão cintura-quadril (RCQ)) em portadores do HIV/Aids, tendo como padrão ouro a absortometria por dupla emissão de raios-X (Dexa) e a tomografia computadorizada de abdômen (TCA). MÉTODOS: Foram estudados 15 portadores do HIV/Aids tratados em uma unidade de saúde coligada a um hospital público universitário, São Paulo. Foram medidas a gordura subcutânea total (GST) mediante a somatória da espessura de sete dobras (bíceps, tríceps, subescapular, axilar média, supra-ilíaca, abdominal e panturrilha medial), a gordura subcutânea central (GSC) (somatória da espessura de quatro dobras) e a gordura subcutânea de membros (GSM) (somatória da espessura de três dobras). A GST, GSC e GSM foram comparadas com as medidas de gordura obtidas pela Dexa. A CC, a RCQ e a GSC foram comparadas com as medidas de gordura obtidas pela TCA. Na análise estatística, utilizou-se o coeficiente de correlação de Pearson (r) e foi utilizado o teste de Mann-Whitney. RESULTADOS: A gordura medida pela Dexa foi correlacionada com GST, a GSC e GSM, mesmo após o ajuste pela idade (r>0,80 para todos). A gordura total de abdômen medida pela TCA foi correlacionada com a CC, RCQ e a GSC após o ajuste pela idade (r>0,80 para todos). CONCLUSÕES: Os métodos de estimativa da gordura corporal devem ser escolhidos de acordo com o tipo de gordura a ser avaliada e podem ser utilizados em pesquisas e nos serviços de saúde como alternativa à Dexa e TCA para portadores do HIV/Aids.

OBJECTIVE: To validate different methods for estimating HIV/Aids patients' body fat: total body skinfold thickness, central (trunk) skinfold thickness, peripheral (limb) skinfold thickness, waist circumference (WC) and waist-to-hip ratio (WHR). Dual-energy X-ray absorptiometry (DEXA) and computed tomography of the abdomen (CTA) were used as the gold standard. METHODS: An analysis was done on 15 adult HIV/Aids patients (10 men and 5 women) who were being treated at an Aids clinic at a public university hospital, Sao Paulo, Brazil. Their total subcutaneous fat (TSF) was estimated from the sum of the thicknesses of the biceps, triceps, subscapular, midaxillary, suprailiac, abdominal and medial calf skinfolds. The central subcutaneous fat (CSF) was estimated by summing the subscapular, axillary, suprailiac and abdominal skinfold measurements. The peripheral subcutaneous fat (PSF) was estimated by summing the biceps, triceps and medial calf skinfold measurements. These were compared with Dexa. The WC, WHR and CSF were compared with CTA. In the statistical analysis, the Pearson correlation coefficient (r) and Mann-Whitney test were utilized. RESULTS: There was a correlation between fat mass measured by DEXA and by TSF, CSF and PSF, even after adjusting for age (r>0.80 for all). WC, WHR and CSF presented correlation with total abdominal fat measured by CTA, even after adjusting for age (r>0.80 for all). CONCLUSIONS: The methods for estimating body fat should be chosen according to the type of fat to be evaluated and can be used in research and healthcare services instead of DEXA and CTA for HIV/AIDS patients.

OBJETIVO: Validar métodos de estimativas da gordura corporal (somatória de espessura de dobras cutâneas, circunferência da cintura (CC) e razão cintura-quadril (RCQ)) em portadores do HIV/Aids, tendo como padrão ouro a absortometria por dupla emissão de raios-X (Dexa) e a tomografia computadorizada de abdômen (TCA). MÉTODOS: Foram estudados 15 portadores do HIV/Aids tratados em uma unidade de saúde coligada a um hospital público universitário, São Paulo. Foram medidas a gordura subcutânea total (GST) mediante a somatória da espessura de sete dobras (bíceps, tríceps, subescapular, axilar média, supra-ilíaca, abdominal e panturrilha medial), a gordura subcutânea central (GSC) (somatória da espessura de quatro dobras) e a gordura subcutânea de membros (GSM) (somatória da espessura de três dobras). A GST, GSC e GSM foram comparadas com as medidas de gordura obtidas pela Dexa. A CC, a RCQ e a GSC foram comparadas com as medidas de gordura obtidas pela TCA. Na análise estatística, utilizou-se o coeficiente de correlação de Pearson (r) e foi utilizado o teste de Mann-Whitney. RESULTADOS: A gordura medida pela Dexa foi correlacionada com GST, a GSC e GSM, mesmo após o ajuste pela idade (r>0,80 para todos). A gordura total de abdômen medida pela TCA foi correlacionada com a CC, RCQ e a GSC após o ajuste pela idade (r>0,80 para todos). CONCLUSÕES: Os métodos de estimativa da gordura corporal devem ser escolhidos de acordo com o tipo de gordura a ser avaliada e podem ser utilizados em pesquisas e nos serviços de saúde como alternativa à Dexa e TCA para portadores do HIV/Aids.

OBJECTIVE: To validate different methods for estimating HIV/Aids patients' body fat: total body skinfold thickness, central (trunk) skinfold thickness, peripheral (limb) skinfold thickness, waist circumference (WC) and waist-to-hip ratio (WHR). Dual-energy X-ray absorptiometry (DEXA) and computed tomography of the abdomen (CTA) were used as the gold standard. METHODS: An analysis was done on 15 adult HIV/Aids patients (10 men and 5 women) who were being treated at an Aids clinic at a public university hospital, Sao Paulo, Brazil. Their total subcutaneous fat (TSF) was estimated from the sum of the thicknesses of the biceps, triceps, subscapular, midaxillary, suprailiac, abdominal and medial calf skinfolds. The central subcutaneous fat (CSF) was estimated by summing the subscapular, axillary, suprailiac and abdominal skinfold measurements. The peripheral subcutaneous fat (PSF) was estimated by summing the biceps, triceps and medial calf skinfold measurements. These were compared with Dexa. The WC, WHR and CSF were compared with CTA. In the statistical analysis, the Pearson correlation coefficient (r) and Mann-Whitney test were utilized. RESULTS: There was a correlation between fat mass measured by DEXA and by TSF, CSF and PSF, even after adjusting for age (r>0.80 for all). WC, WHR and CSF presented correlation with total abdominal fat measured by CTA, even after adjusting for age (r>0.80 for all). CONCLUSIONS: The methods for estimating body fat should be chosen according to the type of fat to be evaluated and can be used in research and healthcare services instead of DEXA and CTA for HIV/AIDS patients.

Resistência in vivo e in vitro do Plasmodium falciparum à cloroquina, amodiaquina e quinino na Amazônia Brasileira. Com o propósito de avaliar a resistência do Plasmodium falciparum às drogas antimaláricas, rotineiramente empregadas no Brasil, os autores acompanharam dez pacientes com malária falciparum adquirida na Amazônia brasileira. Os pacientes foram submetidos a estudo in vivo de sensibilidade a drogas, após tratamento com derivados 4-aminoquinoleínicos (cloroquina e amodiaquina) ou quinino. A absorção das drogas foi verificada através de testes padronizados de excreção urinária de antimaláricos. Oito pacientes puderam ser seguidos por 28 dias. Dentre eles detectou-se resistência in vivo (em nível de R I e R II) em todos os pacientes tratados com 4-aminoquinoleínas. Um paciente tratado com quinino exibiu padrão de resistência R III ao tratamento. Alíquotas de sangue periférico dos mesmos pacientes foram ainda submetidas a microtestes in vitro de sensibilidade a antimaláricos. Em nove microtestes houve desenvolvimento satisfatório de esquizontes. Destes detectou-se resistência in vitro à cloroquina e amodiaquina em 100% e ao quinino em 11,11% das amostras. Através da análise de probitos calcularam-se as concentrações de cloroquina, amodiaquina e quinino, capazes de inibir o crescimento in vitro de esquizontes (Cl50, Cl90 e Cl99). Em seis pacientes observou-se concordância entre os achados in vivo e in vitro. Os resultados ressaltam o alto grau de resistência do P. falciparum às 4-aminoquinoleínas e indicam um aumento na resistência do parasita ao quinino na Amazônia brasileira. Reitera-se, assim, a necessidade de monitoração contínua da sensibilidade a antimaláricos, com o intuito de recomendar esquemas mais eficazes na terapêutica da malária por P. falciparum

In order to study the chemoresistance of Plasmodium falciparum to commonly used antimalarial drugs in Brazil the authors have studied ten patients with falciparum malaria, acquired in the Brazilian Amazon region. Patients were submitted to in vivo study of drug sensitivity, after chemotherapy with either 4-aminoquinolines (chloroquine or amodiaquine) or quinine. Adequate drug absorption was confirmed by standard urine excretion tests for antimalarials. Eight patients could be followed up to 28 days. Among these in vivo resistance (R I and R II responses) was seen in all patients who received 4-amino-quinolines. One patient treated with quinine exhibited a R III response. Peripheral blood samples of the same patients were submitted to in vitro microtests for sensitivity to antimalarials. Out of nine successful tests, resistance to chloroquine and amodiaquine was found in 100% and resistance to quinine in 11.11% of isolates. Probit analysis of log dose-response was used to determine effective concentrations EC50, EC90 and EC99 to the studied drugs. Good correlation between in vivo and in vitro results was seen in six patients. The results emphasize high levels of P. falciparum resistance to 4- aminoquinolines and suggest an increase in resistance to quinine in the Brazilian Amazon region, reinforcing the need for continuous monitoring of drug sensitivity to adequate chemotherapy according to the most efficacious drug regimens