ALFESIO LUIS FERREIRA BRAGA
Projetos de Pesquisa
Unidades Organizacionais
LIM/05 - Laboratório de Poluição Atmosférica Experimental, Hospital das Clínicas, Faculdade de Medicina
33 resultados
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Agora exibindo 1 - 10 de 33
conferenceObject EXPOSURE TO ENVIRONMENTAL FACTORS DURING PREGNANCY AND AFTER BIRTH TO THE BEGINNING OF JUVENILE IDIOPATHIC ARTHRITIS(2015) FRANCA, C. M. P.; SALLUM, A. M. E.; SILVA, C. A.; AIKAWA, N. E.; BRAGA, A. L. F.; FARHAT, S. C. L.- Risk Factors Associated with Juvenile Idiopathic Arthritis: Exposure to Cigarette Smoke and Air Pollution from Pregnancy to Disease Diagnosis(2018) FRANCA, Camila Maria Paiva; SALLUM, Adriana Maluf Elias; BRAGA, Alfesio Luis Ferreira; STRUFALDI, Fernando Louzada; SILVA, Clovis Artur Almeida; FARHAT, Sylvia Costa LimaObjective. To evaluate exposure to environmental factors inhaled during pregnancy and after birth until juvenile idiopathic arthritis (JIA) diagnosis among residents of a large city. Methods. This is an exploratory case-control study that consists of 66 patients with JIA and 124 healthy controls matched by age and sex, living in the Sao Paulo, Brazil, metropolitan area until JIA diagnosis, and whose mothers had resided in this region during pregnancy. A structured and reliable questionnaire (k index for test-retest was 0.80) assessed demographic data, gestational and perinatal-related factors, and exposure to inhalable environmental elements during pregnancy and after birth (occupational exposure to inhalable particles and/or volatile vapor, exposure to cigarette smoke, and the presence of industrial activities or gas stations near the home, work, daycare, or school). Tropospheric pollutants included particulate matter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O-3), and carbon monoxide (CO). Results. During pregnancy, intrauterine cigarette smoke exposure (OR 3.43, 95% CI 1.45-8.12, p = 0.005) and maternal occupational exposure (OR 13.69, 95% CI 4.4-42.3, p < 0.001) were significant independent risk factors for JIA diagnosis. In contrast, maternal employment (OR 0.06, 95% CI 0.02-0.2, p < 0.001) and ideal maternal weight gain (OR 0.36, 95% CI 0.2-0.8, p = 0.017) presented negative associations. Secondhand smoke exposure from birth to JIA diagnosis (OR 3.6, 95% CI 1.8-7.3, p < 0.001) and exposure to O-3 during the second year of life (OR 2.76, 95% CI 1.20-6.37, p = 0.017) were independent and significant risk factors for the pathogenesis of JIA. Conclusion. In our study, cigarette smoke exposure (intrauterine and after birth), exposure to O-3 in the second year of life, and maternal occupational exposure were identified as potential risk factors for JIA, warranting further study.
- Correlation Between Signs and Symptoms of Ocular Surface Dysfunction and Tear Osmolarity With Ambient Levels of Air Pollution in a Large Metropolitan Area(2013) TORRICELLI, Andre A. M.; NOVAES, Priscila; MATSUDA, Monique; BRAGA, Alfesio; SALDIVA, Paulo H. N.; ALVES, Milton R.; MONTEIRO, Mario L. R.Purpose: To evaluate the effect of high levels of environmental air pollution on tear osmolarity and its possible correlation with clinical signs and symptoms. Methods: This was a panel study involving 71 taxi drivers and traffic controllers from Sao Paulo, Brazil. Mean individual levels of 24-hour exposure to nitrogen dioxide (NO2) and particulate matter smaller than 2.5 mu m (PM2.5) were assessed on 4 different occasions. On the first and third visits, subjects were submitted to clinical evaluations including the administration of the Ocular Surface Disease Index questionnaire, slit-lamp examination, estimation of tear breakup time (BUT), the Schirmer test, and vital staining of the cornea and conjunctiva. On the second and fourth visits, tear samples were collected for osmolarity assays. Statistical analysis was performed using generalized estimating equations. Results: Although the taxi drivers and traffic controllers in our sample were exposed to high levels of NO2 and PM2.5, few symptoms were reported on the Ocular Surface Disease Index questionnaire. BUT values were reduced, whereas vital staining and Schirmer test mean results were within normal limits, despite considerable variability. A significant and negative correlation was found between PM2.5 levels and tear film osmolarity levels (P < 0.05). An increase of 10 mu g/m(3) in PM2.5 was associated with a 10.9 mOsm/kg decrease in tear osmolarity. There also was a negative correlation, although not statistically significant, between NO2 and tear osmolarity. Conclusions: Exposure to air pollution reduces tear film stability and influences tear film osmolarity. Combining clinical examination with the assessment of tear osmolarity may help understand ocular surface response to high levels of air pollution.
- Exposure to Air Pollutants and Disease Activity in Juvenile-Onset Systemic Lupus Erythematosus Patients(2015) FERNANDES, Elisabeth C.; SILVA, Clovis A.; BRAGA, Alfesio L. F.; SALLUM, Adriana M. E.; CAMPOS, Lucia M. A.; FARHAT, Sylvia C. L.ObjectiveTo investigate the association between exposure to air pollutants in the Sao Paulo metropolitan area and disease activity in juvenile-onset systemic lupus erythematosus (SLE) patients. MethodsA longitudinal panel study based on 409 consecutive visits of juvenile-onset SLE patients living in the Sao Paulo metropolitan area was carried out. Disease activity was evaluated in accordance with the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), and the patients were divided into 2 groups: those with SLEDAI scores 8 and those with SLEDAI scores >8. Daily concentrations of inhaled particulate matter (PM10), sulfur dioxide, nitrogen dioxide (NO2), ozone, and carbon monoxide (CO) were evaluated on the 21 days preceding the medical visits. A generalized estimation equation model was used to assess the impact of these measurements on SLEDAI-2K scores, considering the fixed effects for repetitive measurements. The models were adjusted for erythrocyte sedimentation rate, corticosteroid use (daily and cumulative doses), antimalarial use, the use of immunosuppressive agents, the presence of infection 20 days preceding the medical appointment, and the minimum temperature and relative humidity outdoors. ResultsPM(10), NO2, and CO were risk factors for juvenile-onset SLE disease activity (SLEDAI-2K score >8) approximately 2 weeks after exposure. A 13.4 g/m(3) increase in the PM10 moving average (from lag 12 to lag 15) was associated with a 34% increase (95% confidence interval 7.0-68.0) in the risk of a SLEDAI-2K score >8. ConclusionThis is the first study to show that exposure to inhaled pollutants may increase the risk of disease activity in children with juvenile-onset SLE in a large urban center.
- Influence of environmental contamination on pregnancy outcomes(2015) GUIMARAES, Mariana Tavares; CUNHA, Michele Granato; CARVALHO, Daniele Pena; RIBEIRO, Tatyana Sampaio; MARTINS, Lourdes Conceicao; BRAGA, Alfesio Luis Ferreira; PEREIRA, Luiz Alberto AmadorThis study aims to compare pregnancy outcomes in four contaminated areas to those observed in a non-contaminated area of similar socioeconomic status. A cross-sectional study was carried out. A structured and pre-tested questionnaire was administered to population-based samples of 788-920 families in each of the five studied areas. The exposure assessment used was an ecological measure. Using logistic regression, odds of several pregnancies outcomes (pregnancy occurrence, miscarriage, stillbirth, prematurity, low birth weight, congenital malformation, and multiple births) were estimated after adjustment for potential confounders such as socioeconomic, demographic, and substance abuse factors. We adopted a statistical significance level of 5 %. In three of the four exposed areas, pregnancy occurrence was reduced in comparison to the control area (Area 2, odds ratio (OR) = 0.68, 95 % CI = 0.54-0.86; Area 3, OR = 0.76, 95 % CI = 0.60-0.97; Area 4, OR = 0.71, 95 % CI = 0.56-0.90). Also, a significantly increased odds of miscarriage for living in Area 3 (OR = 1.83, 95 % CI = 1.07-3.12) was found. The other pregnancy outcomes were not significantly elevated in the exposed areas. In conclusion, this study shows evidence of reduced pregnancy occurrence and increased miscarriage occurrence in some of the contaminated areas, compared to the control area.
- PERSONAL EXPOSURE TO AIR POLLUTION INFLUENCED DISEASE ACTIVITY AND EXHALED BREATH BIOMARKERS: A PROSPECTIVE STUDY IN A CHILDHOOD-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS POPULATION(2016) GOULART, M. F. G.; ALVES, A. G. F.; BRAGA, A. L. F.; SALUM, A. M. E.; PEREIRA, L. A. A.; COIMBRA, A. J. F.; CARVALHO, T. D. S.; NAKAGAWA, N. K.; SILVA, C. A.; FARHAT, S. C. L.
- Occupational effect of sugarcane biomass burning on the conjunctival mucin profile of harvest workers and residents of an adjacent town - A Brazilian panel study(2020) MATSUDA, Monique; BRAGA, Alfesio L. F.; MARQUEZINI, Monica Valeria; MONTEIRO, Mario L. R.; SALDIVA, Paulo H. N.; SANTOS, Ubiratan dePre-harvest burning of sugarcane fields produces large amounts of air pollutants which are known to cause health problems, including ocular surface abnormalities. In this study, we evaluated the effect of biomass burning on mucus quality and mucin gene expression (MUC1, MUC5AC, MUC16) in the conjunctiva of sugarcane workers (SWs) and residents of an adjacent town (RTs). Impression cytology samples of the inferior tarsal and bulbar conjunctiva of 78 SWs and 32 RTs were collected before (T1) and immediately after (T2) a 6-month harvest period. The neutral, acid and total mucus content of goblet cells was determined by PAS and AB staining. The levels of MUC5AC, MUC1 and MUC16 mRNA in the conjunctiva were measured by real-time PCR. Compared to RTs, SWs had higher levels of bulbar acid mucus and MUC16 mRNA and tarsal MUC5AC mRNA at T2 and lower levels of neutral mucus at T1 and T2. In the SW group, MUC1 mRNA levels were higher at T2 than at T1, but the levels of neutral and acid mucus were similar. In the RT group, acid mucus decreased and neutral mucus increased in the bulbar and tarsal conjunctiva at T2. In conclusion, our findings show that sugarcane harvesting is associated with abnormalities in mucus quality and content and changes in mucin mRNA levels on the ocular surface. This may help explain the ocular inflammatory signs and symptoms observed in subjects exposed to air pollutants and high temperatures from sugarcane biomass burning.
- Ambient levels of air pollution induce clinical worsening of blepharitis(2012) MALERBI, Fernando Korn; MARTINS, Lourdes Conceicao; SALDIVA, Paulo Hilario Nascimento; BRAGA, Alfesio Luis FerreiraBackground: Even though air pollutants exposure is associated with changes in the ocular surface and tear film, its relationship to the clinical course of blepharitis, a common eyelid disease, had not yet been investigated. Our objective was to investigate the correlation between air pollution and acute manifestations of blepharitis. Method: We recorded all cases of changes in the eyelids and ocular surface, and rated clinical findings on a scale from zero (normal) to two (severe alterations). Daily values of carbon monoxide, particulate matter smaller than 10 mu m in diameter and nitrogen dioxide concentrations and meteorological variables (temperature and relative humidity) in the vicinity of the medical service were obtained. Specific linear regression models for each outcome were constructed including pollutants as independent variables (single pollutant models). Temperature and humidity were included as confounding variables. Results: increases of 28.8 mu g/m(3) in the concentration of particulate matter and 1.1 ppm in the concentration of CO were associated with increases in cases of blepharitis on the day of exposure (5 cases, 95% CI: 1-10 and 6 cases, 95% CI: 1-12, respectively). Conclusion: Exposure to usual air pollutants concentrations present in large cities affects, in a consistent manner, the eyes of residents contributing to the increasing incidence of diseases of the eyelid margin.
- Inhaled ultrafine particles, epigenetics and systemic autoimmune rheumatic diseases(2020) FARHAT, Sylvia Costa Lima; YARIWAKE, Victor Yuji; VERAS, Mariana Matera; BRAGA, Alfesio Luis Ferreira; MALUF, Adriana Elias; SILVA, Clovis Artur
- Mean air temperature as a risk factor for stroke mortality in Sao Paulo, Brazil(2018) IKEFUTI, Priscilla V.; BARROZO, Ligia V.; BRAGA, Alfesio L. F.In Brazil, chronic diseases account for the largest percentage of all deaths among men and women. Among the cardiovascular diseases, stroke is the leading cause of death, accounting for 10% of all deaths. We evaluated associations between stroke and mean air temperature using recorded mortality data and meteorological station data from 2002 to 2011. A time series analysis was applied to 55,633 mortality cases. Ischemic and hemorrhagic strokes (IS and HS, respectively) were divided to test different impact on which subgroup. Poisson regression with distributed lag non-linear model was used and adjusted for seasonality, pollutants, humidity, and days of the week. HS mortality was associated with low mean temperatures for men relative risk (RR) = 2.43 (95% CI, 1.12-5.28) and women RR = 1.39 (95% CI, 1.03-1.86). RR of IS mortality was not significant using a 21-day lag window. Analyzing the lag response separately, we observed that the effect of temperature is acute in stroke mortality (higher risk among lags 0-5). However, for IS, higher mean temperatures were significant for this subtype with more than 15-day lag. Our findings showed that mean air temperature is associated with stroke mortality in the city of So Paulo for men and women and IS and HS may have different triggers. Further studies are needed to evaluate physiologic differences between these two subtypes of stroke.