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PURPOSE: Invasive ductal breast cancer (IDC) is heterogeneous. Staging and immunohistochemistry (IH) allow for effective therapy but are not yet ideal. Women with Luminal B tumors show an erratic response to treatment. This prospective study with 81 women with breast cancer aims to improve the prognostic stratification of Luminal B patients. METHODS: This is a prospective translational study with 81 women with infiltrating ductal carcinoma, grouped by TNM staging and immunohistochemistry, for survival analysis, and their correlations with the chemokines. Serum measurements of 13 chemokines were performed, including 7 CC chemokines [CCL2(MCP1), CCL3(MIP1α), CCL4(MIP1ß), CCL5(Rantes), CCL11(Eotaxin), CCL17(TARC), CCL20(MIP3α)], 6 CXC chemokines [CXCL1(GroAlpha), CXCL5(ENA78), CCXCL8(IL-8), CXCL9(MIG), CXCL10(IP10), CXCL11(ITAC)]. RESULTS: Overall survival was significantly dependent on tumor staging and subtypes by immunohistochemistry, with a median follow-up time the 32.87 months (3.67-65.63 months). There were age correlations with IP10/CXCL10 chemokines (r = 0.4360; p = 0.0079) and TARC/CCL17 (Spearman + 0.2648; p = 0.0360). An inverse correlation was found between body weight and the chemokines Rantes/CCL5 (r = - 0.3098; p = 0.0169) and Eotaxin/CCL11 (r = - 0.2575; p = 0.0470). Smokers had a higher concentration of MIP3α/CCL20 (Spearman + 0.3344; p = 0.0267). Luminal B subtype patients who expressed lower concentrations of ENA78/CXCL5 (≤ 254.83 pg/ml) (Log-Rank p = 0.016) and higher expression of MIP1ß/CCL4 (> 34.84 pg/ml) (Log-Rank p = 0.014) had a higher risk of metastases. CONCLUSION: Patients with Luminal B breast tumors can be better stratified by serum chemokine expression, suggesting that prognosis is dependent on biomarkers other than TNM and IH.

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Background: Epidermal growth factor receptor (EGFR) overexpression has been considered a poor prognostic factor in breast cancer. Methodology: A prospective study of 206 women with breast cancer analysed by stages (I, II, III and IV) and by immunohistochemical subtype (Luminal A, Luminal B, HER2+ and triple-negative (TN)); 89 healthy controls with normal recent mammography were included. The EGFR measured in the serum (sEGFR) was detected by the Enzyme-Linked Immunosorbent Assay (ELISA) method (R&D Systems kit DY231) collected by blood before any treatment in patients. Kaplan-Meier method and Cox regression were carried out to obtain the prognostic value, considering significance if p < 0.05. Results: With a median follow-up of 36.6 months, 47 deaths occurred. Multivariable Cox regression showed difference of overall survival (OS) associated with sEGFR levels (sEGFR ≤ or > 47.8 ng/mL) in patients with TN cancers, but not of Luminal A, Luminal B or HER2+ subtypes; adjusted by stage, the death risk increased by approximately 415% [hazard ratio (HR): 5.149 (1.900-13.955), p = 0.001] for patients with sEGFR > 47.8 ng/mL compared to patients with a lower sEGFR value. There was no significant correlation of sEGFR with staging, histological tumour grade (G1/G2/G3), Ki67 (< or ≥14%) or body mass index. Conclusions: Increased sEGFR expression in patients with TN tumours is a significant predictor of lower OS and its quantification is inexpensive and straightforward.

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Background: The luminal subtype accounts for ~70% of newly diagnosed breast cancer patients. Although it has a better prognosis, approximately 30% of them develop a late relapse. Identifying those patients is of interest to improve treatment decisions. Methods: A retrospective observational, single-centre study based on data from medical records of 572 non-metastatic (I-III) invasive ductal breast carcinoma patients, 448 with luminal tumours and 124 with triple-negative tumours. Kaplan-Meier, Cox regression and time-dependent Cox regression were carried out to obtain the prognosis value of risk factors. Results: During a median observation of 5.5 years, 105 distant metastasis events and 105 all-cause deaths were observed. In addition to known clinicopathological factors (i.e., age, tumour size and lymph node metastasis), the high semi-quantitative expression of both hormone receptors was associated with distant metastasis-free survival (DMFS) (adjusted hazard ratio (HaR): 0.524 (0.316-0.867), p = 0.012) and overall survival (OS) (adjusted HaR: 0.486 (0.286-0.827), p = 0.008). The stratified analysis made it possible to identify risk modification factors. Subsequent stratification by histological grade, Ki-67 and semi-quantitative PR expression or, mainly, the composite semi-quantitative expression of hormone receptors (cHR) enabled the identification of luminal breast cancer patients of adjuvant schema at higher risk for metastasis and death. However, initial analyses including patients of neoadjuvant therapy pointed to a path of subsequent stratification by cHR and histological grade, also enabling grouping of luminal breast cancer patients with similar prognosis for DMFS (cHR ≤ 4+ G2 or G3 versus triple-negative, adjusted HaR: 0.703 (0.415-1.189), p = 0.189) and OS (cHR ≤4+ G2 or G3 versus triple-negative, adjusted HaR: 0.662 (0.403-1.088), p = 0.104). Conclusion: The semi-quantitative expression of both cHR, Ki-67 proliferation index and histological grade can identify luminal breast cancer patients at greater risk of developing metastasis and death when combined in a hierarchical fashion, and could be useful for a better prognosis stratification in services from low- and middle-income countries.

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Background: Tumour lymphovascular invasion is not routinely assessed in all pathology services, and whether reporting it quantitatively or qualitatively is the main factor associated with the loss of this prognostic event. This study aimed to analyse the prognostic value of qualitatively reported lymphovascular invasion in patients with invasive breast ductal carcinoma. Methods: This was a retrospective, single-center study, enrolling a total of 426 patients with invasive ductal carcinoma of the breast with a report of lymphovascular invasion, with a median follow-up of approximately 4.5 years. Kaplan-Meier and Cox regression was performed to obtain the predictive value of lymphovascular invasion. Propensity score matching was performed to reduce bias by standardising factors with significant differential distribution of lymphovascular invasion status. Results: Lymphovascular invasion was present in 197 (49.2%) patients. Multivariate Cox regression showed that lymphovascular invasion independently increases the risk of death by almost two times (adjusted hazard ratio (HR): 2.045 (1.226-3.406), p = 0.006) and the risk of distant metastasis by more than two times (adjusted HR: 2.373 (1.404-4.010), p = 0.001). Subgroup analysis after matching by propensity score in adjuvant-only patients showed that the lymphovascular invasion is a factor of increased death in N- patients (adjusted HR: 12.597 (1.624-97.728), p = 0.015) and of distant metastasis-free survival in N+ patients (adjusted HR: 4.862 (1.649-14.335), p = 0.004) and almost for N- patients (adjusted HR 7.905 (0.969-64.509), p = 0.004). Conclusion: The presence of lymphovascular invasion is a predictor of worse prognosis in patients with invasive ductal carcinoma of the breast, even with metastatic lymph node disease (N1-N3).

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BACKGROUND: Breast cancer is a heterogeneous disease with overexpression of several receptors, such as human epidermal receptor 2 (HER2), which is a prognostic and predictive biomarker for treatment with the anti-HER2 monoclonal antibody trastuzumab. This study aimed to test the contribution of this regimen in patients with overexpression/amplification of HER2 for periods shorter than the 1-year treatment recommendation. METHODS: A retrospective single-centre study involving 155 patients with non-metastatic (stages I-III) invasive ductal HER2+ breast carcinoma, with a median follow-up of 48.9 months after completion of adjuvant therapy, except endocrine therapy. RESULTS: About 60% of patients received trastuzumab therapy for a median time of 365 days. Although the use of trastuzumab for a short period has provided some benefit, analyses of survival with a continuous dependent variable have revealed a minimum time for improved survival. In the multivariate analysis by Cox regression, trastuzumab use duration exceeding 9 weeks resulted in protection against distant metastasis (adjusted HR: 0.307 (0.139-0.678), p = 0.004), disease progression (adjusted hazard ratio (HR) 0.353 (0.175-0.714), p = 0.004) and death (adjusted HR: 0.267 (0.105-0.678), p = 0.005), being superior to multimodal systemic therapy with chemotherapy and to endocrine therapy without trastuzumab, but inferior to almost 1 year of administration of this monoclonal antibody, especially regarding overall survival (adjusted HR: 0.203 (0.069-0.596), p = 0.004). CONCLUSION: Despite showing some benefits, the protective effect derived from a suboptimal time of trastuzumab exposure is inferior to the standard course of 1 year.

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BACKGROUND: Contamination of the hospital environment with multi-resistant (MDR) Staphylococcus increases the risk of infection. The aim of this study is to identify the MDR species of Staphylococcus on inanimate surfaces, in air, and in clinical samples, and analyze the risk factors that correlate with the occurrence of infections in a Neonatal Intensive Care Unit. METHODS: Samples of inanimate surfaces and air were taken using a premoistened swab (0.9% sodium chloride) and spontaneous air sedimentation, respectively. The clinical isolates were recovered from infected neonates. The isolates (environmental and clinical) were identified by matrix-assisted laser desorption ionization-time of flight and the resistance profile was calculated using the disk diffusion agar technique. RESULTS: In total, 181 isolates were obtained, 93 from (surfaces), 18 from the air, and 70 clinical samples. S. epidermidis was the most frequent species (66.8%), and the failure rate in air cleaning was 100%. More than 60% of the isolates were MDR, and the majority of clinical isolates (60.4%) had a resistance profile identical to that of the environmental isolates. CONCLUSION: Staphylococcus spp. were found in most of the analyzed samples, with a high frequency of MDR isolates, demonstrating the importance of the hospital environment as a reservoir, and the need for infection control measures, and rational use of antimicrobials.

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Background and objectives: Healthcare-Associated Infections are a problem reported by hospitals worldwide, increasing patient morbidity and mortality, prolonging hospitalization, and increasing health care costs. The hands of health professionals are still the main source of infections, making hand hygiene extremely important for spreading infection control. The objective of this study was to analyze the presence of bacteria on the hands of health professionals after hygiene with alcohol gel in a Neonatal Unit and describe the resistance of microorganisms to antimicrobials. Methods: Hand samples were collected using the modified glove-juice method on both occasions, before and after hand hygiene with alcohol gel. Bacteria were identified by MALDI-TOF and susceptibility tests according to Clinical and Laboratory Standards Institute document M100-E29. Results: A total of 214 samples were obtained, of which 104 (48.6%) showed bacterial growth before hand hygiene and 52 (24.3%) after hand hygiene with alcohol gel. There were 217 isolates from the cultures, of which coagulase-negative Staphylococcus was the most frequent with 41 (27.2%) and 24 (36.4%) positive cultures, respectively before and after hand hygiene. The second most frequent microorganism was Klebsiella pneumoniae with 32 (21.2%) and 16 (24.2%), respectively before and after hand hygiene. Multidrug resistance to antimicrobials was detected in 58.1% of gram-positive bacteria and in 34.3% of gram-negative bacteria. Conclusion: A decrease was observed, but not an elimination of the microbial load after hand hygiene with alcohol gel, demonstrating the need for improvements in hand hygiene.(AU)

Justificativa e objetivos: As Infecções Relacionadas à Assistência à Saúde são um problema relatado por hospitais em todo o mundo, aumentando a morbimortalidade dos pacientes, prolongando a hospitalização e aumentando os custos dos cuidados de saúde. As mãos dos profissionais de saúde ainda são a principal fonte de infecções, tornando a higienização das mãos extremamente importante para a disseminação do controle de infecções. O objetivo deste estudo foi analisar a presença de bactérias nas mãos de profissionais de saúde após higienização com álcool gel em uma Unidade Neonatal e descrever a resistência dos microrganismos aos antimicrobianos. Métodos: Amostras de mãos foram coletadas pelo método luva-suco modificado em ambas as ocasiões, antes e após a higienização das mãos com álcool gel. As bactérias foram identificadas por MALDI-TOF e testes de suscetibilidade de acordo com o documento M100-E29 do Clinical and Laboratory Standards Institute. Resultados: Obteve-se um total de 214 amostras, das quais 104 (48,6%) apresentaram crescimento bacteriano antes da higienização das mãos e 52 (24,3%) após a higienização das mãos com álcool gel. Foram 217 isolados das culturas, sendo Staphylococcus coagulase-negativo o mais frequente com 41 (27,2%) e 24 (36,4%) culturas positivas, respectivamente antes e após a higienização das mãos. O segundo microrganismo mais frequente foi Klebsiella pneumoniae com 32 (21,2%) e 16 (24,2%), respectivamente antes e após a higienização das mãos. A multirresistência aos antimicrobianos foi detectada em 58,1% das bactérias gram-positivas e em 34,3% das bactérias gram-negativas. Conclusão: Observou-se diminuição, mas não eliminação da carga microbiana após higienização das mãos com álcool gel, demonstrando a necessidade de melhorias na higienização das mãos.(AU)

Justificación y objetivos: Las Infecciones Asociadas a la Atención de la Salud son un problema reportado por los hospitales a nivel mundial, aumentando la morbimortalidad de los pacientes, prolongando la hospitalización y aumentando los costos de la atención médica. Las manos de los profesionales de la salud siguen siendo la principal fuente de infecciones, por lo que la higiene de manos es extremadamente importante para el control de infecciones. El objetivo de este estudio fue analizar la presencia de bacterias en las manos de los profesionales de la salud después de la higiene con alcohol en gel en una Unidad Neonatal y describir la resistencia de los microorganismos a los antimicrobianos. Métodos: Se recogieron muestras de manos mediante el método guante-jugo modificado en ambas ocasiones, antes y después de la higiene de manos con alcohol en gel. Las bacterias se identificaron mediante MALDI- -TOF y pruebas de susceptibilidad de acuerdo con el documento M100-E29 del Clinical and Laboratory Standards Institute. Resultados: Se obtuvieron un total de 214 muestras, de las cuales 104 (48,6%) presentaron crecimiento bacteriano antes de la higiene de manos y 52 (24,3%) después de la higiene de manos con alcohol en gel. Hubo 217 aislamientos de los cultivos, de los cuales el Staphylococcus coagulasa negativo fue el más frecuente con 41 (27,2%) y 24 (36,4%) cultivos positivos, respectivamente antes y después de la higiene de manos. El segundo microorganismo más frecuente fue Klebsiella pneumoniae con 32 (21,2%) y 16 (24,2%), respectivamente antes y después de la higiene de manos. Se detectó multirresistencia a los antimicrobianos en el 58,1% de las bacterias grampositivas y en el 34,3% de las bacterias gramnegativas. Conclusión: Se observó una disminución, pero no una eliminación de la carga microbiana después de la higiene de manos con alcohol en gel, lo que demuestra la necesidad de mejoras en la higiene de manos.(AU)

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Some species of Klebsiella, such as Klebsiella pneumoniae and Klebsiella oxytoca, are important nosocomial pathogens frequently involved in outbreaks in Neonatal Intensive Care Units (NICU) and have the ability to form a biofilm. This study aims to evaluate the biofilm production of K. pneumoniae and K. oxytoca isolates collected from the hands of health professionals, neonates' blood and the environment of a Brazilian NICU, using three colorimetric methods and a classical method of counting the colony-forming units and compare the analysis among these techniques. The biofilm formation was carried out by the microplate technique, using three colorimetric assays: crystal violet, safranin and 2,3-bis (2-methoxy-4-nitro-5-sulfophenyl) -5 [(phenylamino) arbonyl] - 2H-tetrazolium hydroxide (XTT). Also, colony-forming units were determined. Twenty-eight isolates of K. pneumoniae were collected from the blood, hands and environment and five of K. oxytoca from the hands and environment. All of them were strong biofilm producers, but K. pneumoniae isolates produced more biofilm than K. oxytoca when compared to the American Type Culture Collection (ATCC) strains used as positive controls. The number of viable cells in the biofilm produced by K. pneumoniae isolated from blood was significantly higher than in the control sample. Regarding the three colorimetric tests used in the study, the violet crystal obtained a higher absorbance average. The use of crystal-violet and XTT in the evaluation of biofilm in vitro make possible a complete analysis, since that it can quantify the total biomass (including the extracellular matrix) and evaluate the metabolic activity. In conclusion, this study identified isolates of K. pneumoniae and K. oxytoca that produce biofilms in the NICU and the bloodstream of neonates. This fact deserves attention since these patients are immunocompromised. The best methods will be chosen to answer research questions by always adopting more than one method so that more than one parameter or component of the biofilm is analyzed.

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Peanut, Arachis hypogaea (Linnaeus, 1753) is an allotetraploid cultivated plant with two subgenomes derived from the hybridization between two diploid wild species, A. duranensis (Krapovickas & W. C. Gregory, 1994) and A. ipaensis (Krapovickas & W. C. Gregory, 1994), followed by spontaneous chromosomal duplication. To understand genome changes following polyploidy, the chromosomes of A. hypogaea, IpaDur1, an induced allotetraploid (A. ipaensis × A. duranensis)4x and the diploid progenitor species were cytogenetically compared. The karyotypes of the allotetraploids share the number and general morphology of chromosomes; DAPI+ bands pattern and number of 5S rDNA loci. However, one 5S rDNA locus presents a heteromorphic FISH signal in both allotetraploids, relative to corresponding progenitor. Whilst for A. hypogaea the number of 45S rDNA loci was equivalent to the sum of those present in the diploid species, in IpaDur1, two loci have not been detected. Overall distribution of repetitive DNA sequences was similar in both allotetraploids, although A. hypogaea had additional CMA3+ bands and few slight differences in the LTR-retrotransposons distribution compared to IpaDur1. GISH showed that the chromosomes of both allotetraploids had preferential hybridization to their corresponding diploid genomes. Nevertheless, at least one pair of IpaDur1 chromosomes had a clear mosaic hybridization pattern indicating recombination between the subgenomes, clear evidence that the genome of IpaDur1 shows some instability comparing to the genome of A. hypogaea that shows no mosaic of subgenomes, although both allotetraploids derive from the same progenitor species. For some reasons, the chromosome structure of A. hypogaea is inherently more stable, or, it has been at least, partially stabilized through genetic changes and selection.

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A relação médico-paciente é um processo especial de interação humana, que é a base da prática clínica. Questões provenientes da aprendizagem dessa relação constituem a parte mais difícil na formação de um médico. Os estudantes possuem ao longo do curso diferentes oportunidades de estabelecer relação com o paciente, construindo habilidades para o desenvolvimento de uma comunicação efetiva que subsidia uma relação médico paciente de qualidade. Nesse trabalho objetivou-se conhecer qual é a percepção dos estudantes de uma faculdade filantrópica de Belo Horizonte sobre seu preparo no processo de ensino-aprendizagem da relação médico-paciente. Trata-se de uma pesquisa exploratória, de caráter qualitativo, financiada pela FAPEMIG. Os entrevistados foram estudantes de medicina, escolhidos aleatoriamente, do quarto, quinto e sexto anos. A análise de dados foi feita com base no discurso de Bardin. Os dados evidenciaram que na visão dos estudantes as disciplinas práticas têm contribuído de forma mais significativa na construção da relação médico paciente. Essa relação tem tido como foco uma abordagem clínica orientada por uma visão de saúde ainda biologicista, que considera a anamnese biológica mais relevante. Essa visão dos estudantes, muitas vezes, faz com que priorizem os aspectos técnicos da consulta em detrimento da atenção integral do paciente. A relação médico-paciente efetiva é a base fundamental para garantir sucesso na identificação de demandas de saúde dos sujeitos. É imprescindível que o estudante aprenda e aperfeiçoe essa habilidade durante sua formação. Conhecer a percepção dos estudantes sobre seu preparo nesse processo coloca-se como estratégia de avaliação da formação que têm recebido. (AU)

The doctor-patient relationship is a special process of human interaction, which is the basis of clinical practice. Issues arising from learning this relationship are the most difficult part of a doctor's training. Throughout the course students have different opportunities to establish relationships with the patient, building skills for the development of effective communication that supports a quality patient medical relationship. This study aimed to know the perception of the students of a philanthropic college in Belo Horizonte about their preparation in the teaching-learning process of the doctor-patient relationship. This is an exploratory research, of a qualitative nature, financed by FAPEMIG. The interviewees were randomly chosen medical students of the fourth, fifth and sixth years. Data analysis was based on Bardin's discourse. The data showed that in the students' view the practical disciplines have contributed in a more significant way in the construction of the patient medical relation. This relationship has focused on a clinical approach guided by a health vision that is still biological, which considers biological anamnesis more relevant. This view of students often makes them prioritize the technical aspects of the consultation to the detriment of comprehensive patient care. The effective doctor-patient relationship is the fundamental basis for ensuring success in identifying the subjects' health demands. It is imperative that the student learn and perfect this skill during their training. Knowing the students' perception about their preparation in this process poses as a strategy to evaluate the training they have received. (AU)

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Partindo das relevantes conquistas no campo da enfermagem e evidenciando o importante papel das consultas de enfermagem nas práticas das instituições de saúde e seu direcionamento na atenção primária, buscamos com este trabalho conhecer qual a realidade das consultas de enfermagem realizadas em um Serviço de Saúde Comunitária, descrever as consultas de enfermagem conforme as variáveis em estudo e o perfil dos usuários que fazem uso de tal. Acreditamos que apesar do grande caminho já percorrido, as consultas de enfermagem ainda são um espaço a ser conquistado pelo profissional, assim ressaltamos a importância de estar apropriado desta ferramenta de trabalho tão importante em nossa profissão. Foi desenvolvida uma pesquisa quantitativa do tipo descritiva cujos sujeitos do estudo foram usuários que agendaram consultas de enfermagem, em duas Unidades de Saúde do Serviço de Saúde Comunitária do Grupo Hospitalar Conceição, no período de desenvolvimento do estudo e também as profissionais enfermeiras e residentes de enfermagem do primeiro ano, que atuam nas respectivas Unidades de Saúde. Foram avaliadas um total de 181 consultas de enfermagem. Os resultados encontrados apontaram que maioria das usuárias 88,38% e 90,52% são mulheres e maior parte das consultas realizadas (56%), são de saúde da mulher os índices de absenteísmo encontrados nas consultas chamam atenção principalmente em uma das unidades e nota-se que este é maior em pacientes que não possuem vínculo com as profissionais

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O presente estudo tem por propósito a análise da organizaçäo do processo de trabalho da enfermagem, considerando a concepçäo dos trabalhadores acerca do processo educativo e suas relaçöes com o modelo assistencial vigente, em um hospital geral público de Belo Horizonte...

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