Papers by Joao Guilherme Alves
BMJ open, Jan 16, 2018
To describe the neurodevelopment of children with congenital Zika syndrome during the second year... more To describe the neurodevelopment of children with congenital Zika syndrome during the second year of life. Case series study. Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Pernambuco, Brazil. 24 children with congenital Zika syndrome born with microcephaly during the Zika outbreak in Brazil in 2015 and followed up at the IMIP during their second year of life. Denver Developmental Screening Test II, head circumference and clinical neurological examination. All children presented neurodevelopmental delay: for an average chronological age of 19.9 months, language was equivalent to that of age 2.1 months, gross motor 2.7 months, fine motor/adaptive 3.1 months and personal/social 3.4 months. Head circumference remained below the third percentile for age and gender, and growth rate up to the second year of life was 10.3 cm (expected growth 13 cm). Muscle tone was increased in 23 (95.5%) of 24 children, musculotendinous reflexes were increased in the whole sample and c...
Evolution, medicine, and public health, 2017
Patterns of fetal growth predict non-communicable disease risk in adult life, but fetal growth va... more Patterns of fetal growth predict non-communicable disease risk in adult life, but fetal growth variability appears to have a relatively weak association with maternal nutritional dynamics during pregnancy. This challenges the interpretation of fetal growth variability as 'adaptation'. We hypothesized that associations of maternal size and nutritional status with neonatal size are mediated by the dimensions of the maternal pelvis. We analysed data on maternal height, body mass index (BMI) and pelvic dimensions (conjugate, inter-spinous and inter-cristal diameters) and neonatal gestational age, weight, length, thorax girth and head girth (= 224). Multiple regression analysis was used to identify independent maternal predictors of neonatal size, and the mediating role of neonatal head girth in these associations. Pelvic dimensions displaced maternal BMI as a predictor of birth weight, explaining 11.6% of the variance. Maternal conjugate and inter-spinous diameters predicted neo...
PloS one, 2017
To report the echocardiographic evaluation of 103 infants with presumed congenital Zika syndrome.... more To report the echocardiographic evaluation of 103 infants with presumed congenital Zika syndrome. An observational retrospective study was performed at Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Brazil. 103 infants with presumed congenital Zika syndrome. All infants had microcephaly and head computed tomography findings compatible with congenital Zika syndrome. Zika IgM antibody was detected in cerebrospinal fluid samples of 23 infants. In 80 infants, the test was not performed because it was not available at that time. All infants had negative serology for HIV, syphilis, rubella, cytomegalovirus and toxoplasmosis. A complete transthoracic two-dimensional, M-mode, continuous wave and pulsed wave Doppler and color Doppler echocardiographic (PHILIPS HD11XE or HD15) examination was performed on all infants. 14/103 (13.5%) echocardiograms were compatible with congenital heart disease: 5 with an ostium secundum atrial septal defect, 8 had a hemodynamically ins...
The New England journal of medicine, Jun 6, 2016
To the Editor: Zika virus (ZIKV) is a mosquito-borne flavivirus that is transmitted primarily by ... more To the Editor: Zika virus (ZIKV) is a mosquito-borne flavivirus that is transmitted primarily by Aedes aegypti mosquitoes.(1) Starting in May 2015, an outbreak of ZIKV infection has been reported in Brazil in association with an increasing number of neonates with congenital microcephaly in ZIKV-affected regions.(1) In these areas, the prevalence of congenital microcephaly increased by a factor of 20 over the prevalence before the outbreak.(1) ZIKV RNA has been identified in the brain of a fetus with congenital microcephaly.(2) In addition, ZIKV RNA was identified in the amniotic fluid of two women whose fetuses had congenital microcephaly detected on . . .
Diabetology & Metabolic Syndrome, 2015
Aim: To compare microvascular reactivity assessed in the skin using laser Doppler fluximetry (LDF... more Aim: To compare microvascular reactivity assessed in the skin using laser Doppler fluximetry (LDF) in women with gestational diabetes mellitus (GDM) and gestational age-matched control during pregnancy. Methods: 110 pregnant women at~33 weeks gestation participated in the study. Skin microvascular reactivity was evaluated by LDF, at rest, during the response to brief arterial occlusion (post occlusive hyperaemic response) and during sympathetically mediated vasoconstrictor response to deep inspiratory breath hold. Results: No statistically significant differences were found in the microvascular variables studied (resting and maximum rate flux, post-ischaemic reactive hyperaemia and deep inspiratory breath holds) between +GDM and-GDM groups women. In women with GDM there was a negative correlation between resting flux and the response to the oral glucose tolerance test (OGTT), r =-0.282 (p = 0.037). There was also a negative correlation between the response to the OGTT and the sympathetically mediated constrictor response to inspiratory breath holds (r =-.298, p = .030) but not in women with GDM (r = .102, r = .468). Conclusion: Attenuated microvascular reactivity as an early marker of endothelial dysfunction is not present in women with GDM when assessed during pregnancy.
Cadernos de Saúde Pública, 2008
Associação da obesidade com doenças crônicas tem se mostrado mais intensa nas áreas carentes. Exa... more Associação da obesidade com doenças crônicas tem se mostrado mais intensa nas áreas carentes. Examinamos o efeito de um programa de exercício físico para crianças com excesso de peso, em uma favela do Recife, Pernambuco, Brasil, por meio de um ensaio comunitário, randomizado, com 78 crianças. Um grupo (n = 39) recebeu três aulas semanais de exercícios físicos durante seis meses. Não foi realizada nenhuma intervenção em relação à alimentação. A análise por intenção de tratamento demonstrou que todas as crianças apresentaram aumento significativo de peso. Entretanto, esse aumento foi menor no grupo que sofreu a intervenção (diferença média entre os grupos; -1.37; IC95%: -2,00; -0,74). Em relação ao índice de massa corporal (IMC), também foi verificada uma diferença significativa (p = 0,049) entre os dois grupos (diferença média entre os grupos; -0,53; IC95%: -1,06; -0,002). Na análise restrita às crianças que completaram o estudo (intervenção = 30 e controle = 38), os resultados foram...
American journal of physiology. Endocrinology and metabolism, 2002
We examined the independent relationships among various visceral and abdominal subcutaneous adipo... more We examined the independent relationships among various visceral and abdominal subcutaneous adipose tissue (AT) depots, glucose tolerance, and insulin sensitivity in 89 obese men. Measurements included an oral glucose tolerance test (OGTT), glucose disposal by euglycemic clamp, and abdominal and nonabdominal (e.g., peripheral) AT by magnetic resonance imaging (MRI). OGTT glucose and glucose disposal rates were related (P < 0.05) to visceral AT (r = 0.50 and -0.41, respectively). These observations remained significant (P < 0.05) after control for nonabdominal and abdominal subcutaneous AT, and maximal O(2) consumption (VO(2 max)). Abdominal subcutaneous AT was not a significant correlate (P > 0.05) of any metabolic variable after control for nonabdominal and visceral AT and VO(2 max). Division of abdominal subcutaneous AT into deep and superficial depots and visceral AT into intra- and extraperitoneal AT depots did not alter the observed relationships. Further analysis matc...
BMC Pregnancy and Childbirth, 2014
Background: Preterm birth is the leading cause of infant mortality globally, including Brazil. We... more Background: Preterm birth is the leading cause of infant mortality globally, including Brazil. We will evaluate whether oral magnesium citrate reduces the risk of placental dysfunction and its negative consequences for both the fetus and mother, which, in turn, should reduce the need for indicated preterm delivery. Methods/Design: We will complete a multicenter, randomized double-blind clinical trial comparing oral magnesium citrate 150 mg twice daily (n = 2000 women) to matched placebo (n = 1000 women), starting at 12 1/7 to 20 6/7 weeks gestation and continued until delivery. We will include women at higher risk for placental dysfunction, based on clinical factors from a prior pregnancy (e.g., prior preterm delivery, stillbirth or preeclampsia) or the current pregnancy (e.g., chronic hypertension, pre-pregnancy diabetes mellitus, maternal age > 35 years or pre-pregnancy maternal body mass index > 30 kg/m 2). The primary perinatal outcome is a composite of preterm birth < 37 weeks gestation, stillbirth > 20 weeks gestation, neonatal death < 28 days, or SGA birthweight < 3rd percentile. The primary composite maternal outcome is preeclampsia arising < 37 weeks gestation, severe non-proteinuric hypertension arising < 37 weeks gestation, placental abruption, maternal stroke during pregnancy or ≤ 7 days after delivery, or maternal death during pregnancy or ≤ 7 days after delivery. Discussion: The results of this randomized clinical trial may be especially relevant in low and middle income countries that have high rates of prematurity and limited resources for acute newborn and maternal care. Trial registration: ClinicalTrials.gov Identifier NCT02032186, registered December 19, 2013.
Jornal de Pediatria, 2004
Trials, 2011
Background: Cardiovascular disease is the leading cause of death in Brazil, and hypertension is i... more Background: Cardiovascular disease is the leading cause of death in Brazil, and hypertension is its major risk factor. The benefit of its drug treatment to prevent major cardiovascular events was consistently demonstrated. Angiotensin-receptor blockers (ARB) have been the preferential drugs in the management of hypertension worldwide, despite the absence of any consistent evidence of advantage over older agents, and the concern that they may be associated with lower renal protection and risk for cancer. Diuretics are as efficacious as other agents, are well tolerated, have longer duration of action and low cost, but have been scarcely compared with ARBs. A study comparing diuretic and ARB is therefore warranted. Methods/design: This is a randomized, double-blind, clinical trial, comparing the association of chlorthalidone and amiloride with losartan as first drug option in patients aged 30 to 70 years, with stage I hypertension. The primary outcomes will be variation of blood pressure by time, adverse events and development or worsening of microalbuminuria and of left ventricular hypertrophy in the EKG. The secondary outcomes will be fatal or non-fatal cardiovascular events: myocardial infarction, stroke, heart failure, evidence of new subclinical atherosclerosis and sudden death. The study will last 18 months. The sample size will be of 1200 participants for group in order to confer enough power to test for all primary outcomes. The project was approved by the Ethics committee of each participating institution. Discussion: The putative pleiotropic effects of ARB agents, particularly renal protection, have been disputed, and they have been scarcely compared with diuretics in large clinical trials, despite that they have been at least as efficacious as newer agents in managing hypertension. Even if the null hypothesis is not rejected, the information will be useful for health care policy to treat hypertension in Brazil.
Revista Brasileira de Medicina do Esporte, 2005
FUNDAMENTOS E OBJETIVOS: Inatividade física é importante fator de risco para as doenças crônicas.... more FUNDAMENTOS E OBJETIVOS: Inatividade física é importante fator de risco para as doenças crônicas. Os resultados da literatura são controvertidos em relação à prática de atividades esportivas na infância e adolescência e atividade física na vida adulta. O objetivo deste estudo foi verificar em adultos jovens a freqüência de atividade física de lazer (AFL) e determinar se a prática de esportes durante a adolescência influenciou esta atividade. MÉTODOS: Foi realizado um estudo transversal, tipo inquérito, no período de novembro de 2003 a abril de 2004, em 170 alunos do curso médico que realizaram o estágio de internato em pediatria e tocoginecologia no Instituto Materno Infantil de Pernambuco (IMIP). Foram considerados como atletas aqueles que afirmaram terem praticado algum tipo de esporte durante pelo menos dois anos consecutivos, entre a faixa etária dos 10 aos 19 anos. Atividade física desenvolvida atualmente foi aferida através da informação sobre AFL, na última semana que anteced...
Jornal de Pediatria, 2009
Objective: To assess the prevalence of overweight and obesity and its association with physical a... more Objective: To assess the prevalence of overweight and obesity and its association with physical activity levels in children living in favelas in the city of Recife, state of Pernambuco, Brazil. Methods: A cross-sectional study was performed with 973 children ranging from 7 to 10 years old, all from two favelas in Recife, Fragoso and Caranguejo (total population of 9,315); of the 973 children assessed, 733 were included in the study. Overweight was defined as body mass index (BMI) equal to or above the 85th percentile, and obesity as BMI equal to or above the 95th percentile, using Centers for Disease Control and Prevention growth charts. Physical activity level was assessed by the Physical Activity Questionnaire for Older Children (PAQ-C). Children with scores ≥ 3 were considered active, while those with scores < 3 were considered inactive. Results: Of the 733 children studied, overweight and obesity were observed in 92 (12.6%). There was no statistical association between physical inactivity and sex, income, maternal schooling, number of siblings and hours of television. However, more children with physical inactivity were observed among overweight or obese children, 66/92 (71.6%) vs. 363/641 (56.7%) (p = 0.008). Conclusions: The prevalence of overweight and obesity is high, and is associated with physical inactivity in children living in favelas in the city of Recife, Brazil.
Revista Paulista de Pediatria, 2009
OBJETIVO: Determinar a frequência e os principais fatores associados a sobrepeso e obesidade em c... more OBJETIVO: Determinar a frequência e os principais fatores associados a sobrepeso e obesidade em crianças moradoras de uma favela do Nordeste do Brasil. MÉTODOS: Estudo transversal com amostra de 86 crianças (40 eutróficas e 46 sobrepeso/obesas), com idade entre cinco e nove anos, selecionadas em um universo de 508 crianças nesta faixa etária, avaliadas e cadastradas na Unidade de Saúde da Família (USF). Para definição de sobrepeso/obesidade, foram utilizados os pontos de corte estabelecidos por Cole et al. Pesquisaram-se variáveis biológicas, socioeconômicas, hábitos alimentares, tempo em frente à televisão e sedentarismo. Para a análise dos dados foram empregados os testes de associação, sendo significante p<0,05. RESULTADOS: A frequência de sobrepeso/obesidade entre as 508 crianças foi 13%. Ingestão calórica excessiva, consumo de refresco artificial açucarado e sedentarismo foram os fatores associados ao sobrepeso e à obesidade. CONCLUSÕES: A frequência de sobrepeso/obesidade f...
Sao Paulo Medical Journal, 2007
CONTEXT AND OBJECTIVE: Several studies in developed countries have documented that a significant ... more CONTEXT AND OBJECTIVE: Several studies in developed countries have documented that a significant percentage of children are given inappropriate doses of acetaminophen and ibuprofen. The objective of this paper was to investigate parents’ accuracy in giving dipyrone and acetaminophen to their children, in a poor region. DESIGN AND SETTING: Cross-sectional study at the pediatric emergency department of Instituto Materno-Infantil Prof. Fernando Figueira, a teaching hospital in Pernambuco. METHODS: The inclusion criteria were age between 3 and 36 months, main complaint of fever and at least one dose of dipyrone or acetaminophen given to the child during the 24 hours preceding their arrival at the emergency department. The mothers were asked for demographic information and about the antipyretic doses given, which were compared with the recommended dosage. RESULTS: Among the 200 patients studied, 117 received dipyrone and 83 received acetaminophen. Overall, 75 % received an incorrect dose...
Journal of Urban Health, 2011
The aim of this study was to ascertain the prevalence of physical inactivity and examine the role... more The aim of this study was to ascertain the prevalence of physical inactivity and examine the role of potential predictors in a very low-income adult population in a slum located in Recife city, northeast of Brazil. A cross-sectional study was conducted with 1,176 subjects aged 20-60 years residing in a slum. Using the short version of the International Physical Activity Questionnaire, 307 (26.1%) study participants-97 (23.8%) men and 210 (27.3%) women-have a low physical activity score (METminutes per week). Increased age was associated with physical inactivity only in people without overweight/obesity. Low physical activity was less common (i.e., respondents were more active) than in other Brazilian population-based studies. These results suggest that the relationship between physical activity and socioeconomic level is more complex and depends on the internal characteristics of the community.
Journal of Tropical Pediatrics, 1997
The findings of transfontanelle ultrasonography, undertaken in 36 infants with clinical evidence ... more The findings of transfontanelle ultrasonography, undertaken in 36 infants with clinical evidence of centra] nervous system (CNS) disorders, were compared with the findings of cranial computed tomography (CT). Considering the CT scan findings as gold standard, cranial ultrasonography had a sensitivity of 82 percent and a specificity of 75 percent in identifying cerebral pathology. The positive predictive value was 92 per cent and negative predictive value was 45 per cent.
Evidence-Based Complementary and Alternative Medicine, 2012
Background. Infantile colic is a distressing and common condition for which there is no proven st... more Background. Infantile colic is a distressing and common condition for which there is no proven standard treatment.Objective. To compare the efficacy ofMentha piperitawith simethicone in treatment for infantile colic.Methods. A double-blind crossover study was performed with 30 infants attending IMIP, Recife, Brazil. They were randomized to useMentha piperitaor simethicone in the treatment of infantile colic during 7 days with each drug. Primary outcomes were mother_s opinion about responses to the treatment, number of daily episodes of colic, and time spent crying, measured by a chronometer. Mann-Whitney and chi-square tests were used to compare the results. This study was previously approved by the Ethical Committee in Research at IMIP.Results. At baseline daily episodes of infantile colic was 3.9 (±1.1) and the mean crying time per day was 192 minutes (±51.6). At the end of the study daily episodes of colic fell to 1.6 (±0.6) and the crying duration decreased to 111 (±28) minutes....
J. bras. neurocir, 2009
Resumo: Durante a última década tem se consolidado o conceito de que diversas doenças apresentada... more Resumo: Durante a última década tem se consolidado o conceito de que diversas doenças apresentadas na vida adulta iniciamse e relacionam-se com condições da gestação, nascimento einfância. A doença vascular cerebral-intimamente ligada à aterosclerose e ...
BMC Research Notes, 2012
Background: Pregnancy in adolescents is a worldwide health problem and has been mostly common in ... more Background: Pregnancy in adolescents is a worldwide health problem and has been mostly common in poor populations. It is not clear if socioeconomic or biological factors are the main determinants of perinatal adverse outcomes in pregnant adolescents. Adolescents under 15 years old may present a high growth rate which may contribute to impair fetal growth. Our aim is to compare perinatal characteristics among early (aged 10 to 14 years) and late (aged 15 to 19 years) pregnant adolescents. Methods: A cross-sectional study was performed using data from Pernambuco State 2009, obtained from DATASUS/SISNAC, a Brazilian Government, open-access public health database. Maternal and neonatal outcomes were compared between early (aged 10-14 years) and late (aged 15-19 years) pregnant adolescents. Family income was compared between early and late pregnant adolescents using a sample of 412 subjects evaluated at Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) during 2011. Statistical comparisons were made using the chi-square test was used with a significant level of 0.05; bivariate and multivariate analysis were performed. This project was approved by the Institutional Ethics Review Board. Results: Data from 31,209 pregnant adolescents were analyzed. 29,733 (95.2%) were aged 15 to 19 years and 1,476 (4.7%) were aged 10 to 14 years. There were significant differences with respect to marital status, education level and number of prenatal visits of mothers aged 10 to 14 years compared to 15 to 19 years. Of importance, early adolescents had a greater rate of neonates born premature and with low birth weight. Prematurity and low birth weight remained statistically significant after multivariate analysis. Conclusions: Early aged adolescents may have an increased risk of prematurity and low birth weight. These findings highlight the potential role of biological factors in newborn outcomes in pregnant adolescents.
Arquivos Brasileiros de Cardiologia, 2006
Objective: To describe the prevalence of dyslipidemia and overweight among children and adolescen... more Objective: To describe the prevalence of dyslipidemia and overweight among children and adolescents in the state of Pernambuco, Brazil. Methods: During clinical evaluation, a questionnaire was completed through interviews with parents and included personal details of the children and adolescents. An exclusion criterion was personal or parental history of diabetes or coronary artery disease (CAD). Blood samples were collected from subjects who had been fasting for 12 hours, and the following evaluations were performed using enzymatic methods: serum Total Cholesterol, LDL-Cholesterol, HDL-Cholesterol and Triglycerides. Data were analyzed using the SPSS 11.5 statistical package including Student's t test and Fisher's exact test. Results: Of the 414 children and adolescents analyzed in the present study, about 30% presented an atherogenic lipid profile, characterized by higher levels of Triglyceride, Total and LDL-Cholesterol. The prevalence of overweight in this sample from Pernambuco was 4%. Girls had higher levels of Triglycerides and Total Cholesterol than boys. Children and adolescents presented the same values of lipid on blood that is not expected for children in this phase of development. Conclusion: In the present population, an unfavorable lipid profile among children and adolescents from Pernambuco suggests that programs targeting the prevention of cardiovascular disease and obesity must begin early in life.
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Papers by Joao Guilherme Alves