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BACKGROUND: Admixture occurs between different ethnic human populations. The global colonization in recent centuries by Europeans led to the most significant admixture in human history. While admixture may enhance genetic diversity for better fitness, it may also impact on human health by transmitting genetic variants for disease susceptibility in the admixture population. The admixture by Portuguese global exploration initiated in the 15th century has reached over 20 million of Portuguese-heritage population worldwide. It provides a valuable model to study the impact of admixture on human health. BRCA1 and BRCA2 (BRCA) are two of the important tumor suppressor genes. The pathogenic variation (PV) in BRCA is well determined to cause high risk of hereditary breast and ovarian cancer. Tracing the distribution of Portuguese BRCA PV in Portuguese-heritage population will help to understand the impact of admixture on cancer susceptibility in modern humans. In this study, we analyzed the distribution of the Portuguese-originated BRCA variation in Brazilian population, which has high degree Portuguese-heritage. METHODS: By comprehensive data mining, standardization and annotation, we generated a Portuguese-derived BRCA variation dataset and a Brazilian-derived BRCA variation dataset. We compared the two BRCA variation datasets to identify the BRCA variants shared between the two populations. RESULTS: The Portuguese-derived BRCA variation dataset consists of 220 BRCA variants including 78 PVs from 11,482 Portuguese cancer patients, 93 (42.2%) in BRCA1 and 127 (57.7%) in BRCA2. Of the 556 Portuguese BRCA PV carriers carrying the 78 PVs, 331 (59.5%) carried the three Portuguese-BRCA founder PVs of BRCA1 c.2037delinsCC, BRCA1 c.3331_3334del and BRCA2 c.156_157insAlu. The Brazilian-derived BRCA variation dataset consists of 255 BRCA PVs from 7,711 cancer patients, 136 (53.3%) in BRCA1 and 119 (46.6%) in BRCA2. We developed an open database named dbBRCA-Portuguese ( https://genemutation.fhs.um.edu.mo/dbbrca-portuguese/ ) and an open database named dbBRCA-Brazilian ( https://genemutation.fhs.um.edu.mo/dbbrca-brazilian ) to host the BRCA variation data from Portuguese and Brazilian populations. We compared the BRCA PV datasets between Portuguese and Brazilian populations, and identified 29 Portuguese-specific BRCA PVs shared between Portuguese and Brazilian populations, 14 in BRCA1 including the Portuguese founder BRCA1 c.3331_3334del and BRCA1 c.2037delinsCC, and 15 in BRCA2 including the Portuguese founder BRCA2 c.156_157insAlu. Searching the 78 Portuguese BRCA PVs in over 5,000 ancient human genomes identified evolution origin for only 8 PVs in Europeans dated between 37,470 and 3,818 years before present, confirming the Portuguese-specificity of Portuguese BRCA PVs; comparing the 78 Portuguese BRCA PVs Portuguese, 255 Brazilian BRCA PVs, and 134 African BRCA PVs showed little overlapping, ruling out the possibility that the BRCA PVs shared between Portuguese and Brazilian may also be contributed by African. CONCLUSION: Our study provides evidence that the admixture in recent human history contributed to cancer susceptibility in modern humans.
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Proteína BRCA1 , Proteína BRCA2 , Humanos , Proteína BRCA2/genética , Proteína BRCA1/genética , Portugal , Feminino , Predisposição Genética para Doença , Brasil , Variação Genética , Neoplasias da Mama/genética , Neoplasias Ovarianas/genéticaRESUMO
ABSTRACT With an estimated approximately 2 million deaths per year, diabetes is one of the top 5 deadliest noncommunicable diseases globally. Although this disease is not fatal, the degradation of the patient's health due to a bad plan to control their glucose levels can have a fatal outcome. In order to lay the foundations for the development of a device that allows estimating glucose levels in some body fluid, we present the results obtained not only for the estimation of glucose in deionized water, but also describe the development and configuration of the created device. After analyzing 50 signals obtained from 5 different glucose concentrations, the feasibility of using the developed device for the analysis is evident, since, considering the K-Nearest Neighbors (KNN) algorithm, all the signals were associated correctly to the glucose group to which they belong.
RESUMEN Con un estimado de aproximadamente 2 millones de muertes por año, la diabetes es una de las 5 enfermedades no transmisibles más mortales a nivel mundial. Aunque esta enfermedad no es mortal, el deterioro de la salud del paciente por un mal plan para controlar sus niveles de glucosa puede tener un desenlace fatal. Con el fin de sentar las bases para el desarrollo de un dispositivo que permita estimar los niveles de glucosa en algún fluido corporal, presentamos los resultados obtenidos no solo para la estimación de glucosa en agua desionizada, sino que también describimos el desarrollo y configuración del dispositivo creado. Luego de analizar 50 señales obtenidos a partir de 5 concentraciones de glucosa diferentes, se evidencia la factibilidad de utilizar el dispositivo desarrollado para el análisis, ya que, considerando el algoritmo K-Nearest Neighbors (KNN), todas las señales se asociaron correctamente al grupo de glucosa al que pertenecen.
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Various immunopathological events characterize the systemic acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Moreover, it has been reported that coronavirus disease 2019 (COVID-19) vaccination and infection by SARS-CoV-2 induce humoral immunity mediated by B-cell-derived antibodies and cellular immunity mediated by T cells and memory B cells. Immunoglobulins, cytokines, and chemokines play an important role in shaping immunity in response to infection and vaccination. Furthermore, different vaccines have been developed to prevent COVID-19. Therefore, this research aimed to analyze and compare Fourier-transform infrared (FTIR) spectra of vaccinated people with a positive (V-COVID-19 group) or negative (V-Healthy group) real-time quantitative reverse transcription-polymerase chain reaction (RT-qPCR) test, evaluating the immunoglobulin and cytokine content as an immunological response through FTIR spectroscopy. Most individuals that integrated the V-Healthy group (88.1%) were asymptomatic; on the contrary, only 28% of the V-COVID-19 group was asymptomatic. Likewise, 68% of the V-COVID-19 group had at least one coexisting illness. Regarding the immunological response analyzed through FTIR spectroscopy, the V-COVID-19 group showed a greater immunoglobulins G, A, and M (IgG, IgA, and IgM) content, as well as the analyzed cytokines interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-É), and interleukins 1ß, 6, and 10 (IL-1ß, IL-6, and IL-10). Therefore, we can state that it was possible to detect biochemical changes through FTIR spectroscopy associated with COVID-19 immune response in vaccinated people.
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COVID-19 , SARS-CoV-2 , Humanos , Espectroscopia de Infravermelho com Transformada de Fourier , Citocinas , Imunidade HumoralRESUMO
ABSTRACT COVID-19 is an infectious disease caused by the SARS-CoV-2 virus. This virus's spread is mainly through droplets released from the nose or mouth of an infected person. Although vaccines have been developed that effectively reduce the effects that this viral infection causes, the most effective method to contain the virus's spread is numerous tests to detect and isolate possible carriers. However, the response time, combined with the cost of actual tests, makes this option impractical. Herein, we compare some machine learning methodologies to propose a reliable strategy to detect people positive to COVID-19, analyzing saliva spectra obtained by Fourier transform infrared (FTIR) spectroscopy. After analyzing 1275 spectra, with 7 strategies commonly used in machine learning, we concluded that a multivariate linear regression model (MLMR) turns out to be the best option to identify possible infected persons. According to our results, the displacement observed in the region of the amide I of the spectrum, is fundamental and reliable to establish a border from the change in slope that causes this displacement that allows us to characterize the carriers of the virus. Being more agile and cheaper than reverse transcriptase polymerase chain reaction (RT-PCR), it could be reliably applied as a preliminary strategy to RT-PCR.
RESUMEN La COVID-19 es una enfermedad infecciosa ocasionada por el virus SARS-CoV-2. La propagación de este virus se produce principalmente a través de gotitas liberadas por la nariz o la boca de una persona infectada. Aunque se han desarrollado vacunas que permiten reducir efectivamente los efectos que esta infección viral provoca, el método más eficaz para contener la propagación del virus son las numerosas pruebas para detectar y aislar los posibles portadores. Sin embargo, el tiempo de respuesta, combinado con el costo de las pruebas reales, hace que esta opción sea poco práctica. Aquí, comparamos algunas metodologías de machine learning para proponer una estrategia confiable para detectar personas positivas a COVID-19 analizando espectros de saliva obtenidos por espectroscopia infrarroja transformada de Fourier (FTIR). Tras analizar 1275 espectros, con 7 estrategias comúnmente empleadas en el área de machine learning, concluimos que un modelo de regresión lineal multivariante (MLMR) resulta ser la mejor opción para identificar posibles infectados. De acuerdo con nuestros resultados, el desplazamiento observado en la región de la amida I del espectro, resulta fundamental y confiable para establecer una frontera a partir del cambio de pendiente que este provoca. Al ser más ágil y económica que la reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR), podría aplicarse confiablemente como estrategia preliminar a RT-PCR.
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Diabetes is one of the top 5 non-communicable diseases that occur worldwide according to the World Health Organization. Despite not being a fatal disease, a late diagnosis as well as poor control can cause a fatal outcome, because of that, several studies have been carried out with the aim of proposing additional techniques to the gold standard to assist in the diagnosis and control of this disease in a non-invasive way. Considering the above, and in order to provide a solid starting point for future researches, we share a primary research dataset with 1040 saliva samples obtained by Fourier Transform Infrared Spectroscopy considering the Attenuated Total Reflectance method. Database include: gender, age, individuals (patients) with/without diabetes, the glucose value, and the result to the A1C test for the diabetic population. We believe that sharing dataset as is could increase experimentation, research, and analysis of spectra through different strategies broaden its range of applicability by chemists, doctors, physicists, computer scientists, among others, to identify the effects that the virus causes in the body and to propose possible clinical treatments as well as to develop devices that allow us to assist in the characterization of possible carriers.
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The process of selecting an artificial intelligence (AI) model to assist clinical diagnosis of a particular pathology and its validation tests is relevant since the values of accuracy, sensitivity and specificity may not reflect the behavior of the method in a real environment. Here, we provide helpful considerations to increase the success of using an AI model in clinical practice.
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Inteligência Artificial , Humanos , Sensibilidade e EspecificidadeRESUMO
The coronavirus disease 2019 (COVID-19) is the latest biological hazard for the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Even though numerous diagnostic tests for SARS-CoV-2 have been proposed, new diagnosis strategies are being developed, looking for less expensive methods to be used as screening. This study aimed to establish salivary vibrational modes analyzed by attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectroscopy to detect COVID-19 biological fingerprints that allow the discrimination between COVID-19 and healthy patients. Clinical dates, laboratories, and saliva samples of COVID-19 patients (N = 255) and healthy persons (N = 1209) were obtained and analyzed through ATR-FTIR spectroscopy. Then, a multivariate linear regression model (MLRM) was developed. The COVID-19 patients showed low SaO2, cough, dyspnea, headache, and fever principally. C-reactive protein, lactate dehydrogenase, fibrinogen, D-dimer, and ferritin were the most important altered laboratory blood tests, which were increased. In addition, changes in amide I and immunoglobulin regions were evidenced in the FTIR spectra analysis, and the MLRM showed clear discrimination between both groups. Specific salivary vibrational modes employing ATR-FTIR spectroscopy were established; moreover, the COVID-19 biological fingerprint in saliva was characterized, allowing the COVID-19 detection using an MLRM, which could be helpful for the development of new diagnostic devices.
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Teste para COVID-19/métodos , COVID-19/diagnóstico , Saliva/química , Espectroscopia de Infravermelho com Transformada de Fourier/métodos , Adulto , Idoso , Feminino , Humanos , Imunoglobulinas/análise , Masculino , Pessoa de Meia-Idade , Oxigênio/análise , SARS-CoV-2/isolamento & purificaçãoRESUMO
On February 11, 2020, the World Health Organization officially announced the coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as an emerging recent pandemic illness, which currently has approximately taken the life of two million persons in more than 200 countries. Medical, clinical, and scientific efforts have focused on searching for new prevention and treatment strategies. Regenerative medicine and tissue engineering focused on using stem cells (SCs) have become a promising tool, and the regenerative and immunoregulatory capabilities of mesenchymal SCs (MSCs) and their exosomes have been demonstrated. Moreover, it has been essential to establishing models to reproduce the viral life cycle and mimic the pathology of COVID-19 to understand the virus's behavior. The fields of pluripotent SCs (PSCs), induced PSCs (iPSCs), and artificial iPSCs have been used for this purpose in the development of infection models or organoids. Nevertheless, some inconveniences have been declared in SC use; for example, it has been reported that SARS-CoV-2 enters human cells through the angiotensin-converting enzyme 2 receptor, which is highly expressed in MSCs, so it is important to continue investigating the employment of SCs in COVID-19, taking into consideration their advantages and disadvantages. In this review, we expose the use of different kinds of SCs and their derivatives for studying the SARS-CoV-2 behavior and develop treatments to counter COVID-19.
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The World Health Organization has declared that diabetes is one of the four leading causes of death attributable to non-communicable diseases. Currently, many devices allow monitoring blood glucose levels for diabetes control based mainly on blood tests. In this paper, we propose a novel methodology based on the analysis of the Fourier Transform Infrared (FTIR) spectra of saliva using machine learning techniques to characterize controlled and uncontrolled diabetic patients, clustering patients in groups of a low, medium, and high glucose levels, and finally performing the point estimation of a glucose value. After analyzing the obtained results with Support Vector Machines (SVM), Artificial Neural Networks (ANN), and Linear Regression (LR), we found that using ANN, it is possible to carry out the characterizations mentioned above efficiently since it allowed us to identify correctly the 540 spectra that make up our database studying the region 4000-2000 cm-1.
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Diabetes Mellitus Tipo 2 , Saliva , Diabetes Mellitus Tipo 2/diagnóstico , Análise de Fourier , Humanos , Aprendizado de Máquina , Espectroscopia de Infravermelho com Transformada de FourierRESUMO
La cicatrización de la piel es un proceso complejo y organizado que involucra tres fases: inflamatoria, proliferativa y de remodelación. Es indispensable el análisis de este proceso biomolecularmente para investigar y proponer nuevas estrategias terapéuticas que mejoren la cicatrización o promuevan la regeneración. El objetivo de este proyecto fue analizar histológica y biomolecularmente mediante microespectroscopía infrarroja por transformada de Fourier (MFTIR) y su función de mapeo bioquímico, muestras de lesiones excisionales de piel, comparando los cambios morfológicos y espectroscópicos entre piel sana y piel cicatrizada. Se estandarizó un modelo de lesión excisional de piel en ratones hembra de la cepa NIH de 8 semanas de edad (n=16), provocando una herida excisional de 1 cm2. Se analizó piel sana (día 0) y cicatrizada (día 15 post-lesión) morfométrica, histológica y biomolecularmente mediante análisis fotográfico, técnica histológica y MFTIR con su función de mapeo. El análisis morfométrico demostró una reducción del área de la herida en un 87,6 % al día 15 post-lesión. Histológicamente, en la piel cicatrizada se evidenció un adelgazamiento de la epidermis y menor celularidad en la dermis, observándose la formación de tejido de granulación y fibras de colágena desorganizadas. Espectroscópicamente, se apreciaron cambios entre los dos grupos de estudio, principalmente en las bandas de lípidos y en la región de proteínas. El cálculo de las áreas bajo la curva y el mapeo bioquímico mostraron menor concentración de queratina y colágena en la piel cicatrizada, así como desorganización de las fibras de colágena. Se demostró la capacidad de la MFTIR para caracterizar de forma precisa los cambios biomoleculares en la cicatrización, entre ellos la cantidad de queratina, colágena, y el depósito y ordenamiento de las fibras de colágena asociadas a su maduración.
The skin cicatrization is a complex and organized process that involves three phases: inflammatory, proliferative, and remodeling. It is essential to analyze this process biomolecularly, in order to investigate and propose new therapeutic strategies that improve the healing or promote regeneration. The objective of this project was to analyze histological and biomolecularly through Fourier Transform infrared microspectroscopy (FTIRM) and its biochemical mapping function, samples of an excisional skin wound, comparing the morphological and spectroscopic changes between healthy skin and scarred skin. An excisional skin wound healing model was standardized using female, NIH strain 8-week-old mice (n = 16), provoking an excisional wound of 1 cm2. Healthy skin (day 0) and scarring skin (day 15 post-injury) were morphometrical, histological, and biomolecularly analyzed by digital picture analysis, histological technique, and FTIRM with its mapping function. The morphometric analysis showed a reduction of the wound area of 87.6 % at day 15 after wound. Histologically, in the scarred skin a thinning of the epidermis was evidenced, besides reduced cellularity in the dermis, granulation tissue formation, and disorganized collagen fibers were observed. Spectroscopically, changes between the study groups were appreciated, mainly in the lipid bands and in the protein region. The calculation of the areas under the curve and the biochemical mapping showed a lower concentration of keratin and collagen in the scarred skin, as well as collagen fibers disorganization. The ability of the FTIRM to accurately characterize biomolecular changes in cicatrization process was demonstrated, such as the amount of keratin, collagen, and the deposition and ordering of the collagen fibers associated with their maturation.
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Animais , Feminino , Camundongos , Pele/lesões , Cicatrização/fisiologia , Espectroscopia de Infravermelho com Transformada de Fourier , Pele/patologia , Fenômenos Fisiológicos da Pele , Modelos Animais de DoençasRESUMO
INTRODUCTION: The stress fractures (SFs) are a common condition in athletes and military recruits, characterized by partial fracture caused by repetitive applications of stresses that are lower than the stress required to fracture the bone in a single loading. Fourier transform infrared (FTIR) spectroscopy gives information about the bone composition and also can determine the amount of a molecule. For this reason, the FTIR spectroscopy may be used as a tool for diagnosis of certain bone diseases related to the bone strength. In this research, we established the contributions of mineral and collagen properties to SF risk through FTIR spectroscopy, analyzing the biochemical profile differences between the healthy bone and the bone with an SF. MATERIALS AND METHODS: Previous written informed consent was obtained, and samples of the hip with an SF (n = 11) and healthy bone from the femur with traumatic fracture (n = 5) were obtained and analyzed employing FTIR spectroscopy and its biochemical mapping function. Then, using FTIR spectra and the map, the collagen content and ratios corresponding to matrix maturity, mineralization, carbonate substitution, acid phosphate substitution, and crystallinity were calculated. Moreover, a histopathological analysis through Masson's staining was conducted. RESULTS: The biochemical analysis showed that the bone with an SF presented a bone immaturity characterized by a higher content of collagen, lower matrix maturity, mineralization, carbonate and acid phosphate substitutions, and greater crystallinity compared to the healthy bone, being checked by the ratio analysis and biochemical mapping. Besides, Masson's stain showed a higher collagen content in the bone with an SF. CONCLUSIONS: The bone with an SF presented alterations in its biochemical composition, showing bone immaturity, which broadens the panorama of the condition to investigate future treatments or prophylactic techniques.
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Osso e Ossos/diagnóstico por imagem , Fraturas de Estresse/diagnóstico , Espectroscopia de Infravermelho com Transformada de Fourier/métodos , Adolescente , Adulto , Osso e Ossos/química , Osso e Ossos/patologia , Calcificação Fisiológica , Colágeno/química , Fêmur/química , Fraturas de Estresse/patologia , Humanos , México , Minerais/análise , Fosfatos/análise , Adulto JovemRESUMO
RESUMO Os cursos de educação médica têm implementado disciplinas e módulos que aproximem os discentes da realidade da saúde nacional, a fim de se adequarem às crescentes necessidades de reorganização da formação médica. O presente artigo relata uma experiência de acadêmicos de Medicina da Universidade Estadual de Santa Cruz (UESC) com as atividades e ações incluídas no módulo de Gestão e Rede de Atenção à Saúde, parte da Prática de Integração Ensino-Serviço-Comunidade (PIESC), como proposta de reorientação do currículo na aquisição de habilidades de liderança e gerenciamento de recursos físicos e humanos em saúde. A proposta foi inserir os discentes em diferentes níveis de complexidade tecnológica do SUS a fim de contextualizar o estudo da Rede de Atenção à Saúde (RAS) por meio de vivências e pesquisa-ação em serviços de saúde situados nos diferentes níveis de atenção. Para isso, foram realizadas entrevistas semiestruturadas com profissionais e usuários em cada ambiente visitado. Tais vivências ampliaram a visão dos acadêmicos sobre os serviços de saúde, possibilitando um melhor entendimento da estruturação da RAS, bem como um dimensionamento dos entraves encontrados nos diferentes cenários e proporcionando uma experiência in loco das críticas e dificuldades apresentadas e vividas por usuários e profissionais. Percebeu-se que não há resolutividade dos problemas de saúde dos usuários nos serviços, bem como existe uma falta de entendimento destes acerca de seus direitos e da continuidade da atenção à saúde nos diferentes níveis de atenção. Explicitou-se que as instâncias primárias de atenção não funcionam como porta de entrada adequada, o que culmina com a desestruturação da RAS observada. A experiência relatada neste artigo demonstrou um modo dinâmico de abordar a temática da Gestão e Rede de Atenção à Saúde, além de contribuir para a formação do estudante de Medicina, já que possibilitou um melhor entendimento da rede quanto às práticas em saúde e às dimensões do processo saúde-doença implicados na gestão do SUS.
ABSTRACT Medical courses in Brazil have implemented subjects and modules that aim to bring students closer to actual national health concerns, as one way of adapting to the growing needs for medical training reorganization. Thus, this article reports on the experience of medical students at the Universidade Estadual de Santa Cruz (UESC) [State University of Santa Cruz] with activities and actions included in the Health Care Network and Management module, part of the Teaching-Service-Community Intergration Practice (PIESC), as a proposal for the reorientation of the curriculum and acquisition of leadership skills and management of physical and human resources in health. The proposal was to insert the students at different levels of technological complexity of the Unified Health System (SUS) in order to contextualize the study of the Health Care Network (RAS) through experiences and action research in health services located at different care levels. Semi-structured interviews with professionals and users were therefore performed in each visited environment. These experiences served to broaden the students' vision of health care networks, enabling a better understanding of how the services are structured, as well as of the magnitude of the obstacles found in different scenarios, providing an in loco experience of the criticisms and difficulties faced by users and professionals. It was noticed that user health problems are often not resolved within the health care services, and the users lack understanding of their health rights. A lack of continuity of the health care was also observed through the various health care levels. Thus, it is concluded that the instances of primary care fail to offer adequate gateway services, culminating in the breakdown of the observed network. The experiment reported in this article demonstrated a dynamic way to approach the issue of Health Care Network Management, contributing to medical student training, as it enabled a better understanding of the network in terms of the health practices and the dimensions of the health-disease process involved in the management of the SUS.
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PURPOSE: To assess the outcomes of severe retinopathy of prematurity (ROP) in zone I or posterior zone II, and of aggressive posterior ROP treated with a single dose of intravitreal ranibizumab (IVR) as monotherapy. DESIGN: Retrospective study. PARTICIPANTS: The study included premature babies diagnosed with aggressive posterior ROP or ROP 3+ in zone I or posterior zone II. METHODS: Intravitreal injection of 0.25 mg (0.025 mL) ranibizumab was performed in the operating room. A disposable 1-mL syringe with a 30-gauge needle was used. MAIN OUTCOME MEASURES: Favorable outcome was considered regression of ROP after treatment (meaning regression of the retinal neovascularization and plus disease). Unfavorable outcome was progression to stages 4 and 5 of ROP. RESULTS: The study included 43 infants (85 eyes). The mean birth weight and gestational age were 1276±302 g and 29.7±2.0 weeks, respectively. The mean postmenstrual age at ROP diagnosis was 36±2.7 weeks and at treatment was 37.2±2.2 weeks. All 85 eyes demonstrated total regression of plus disease after a single dose of IVR. Twelve infants (29.2%) developed full vascularization of the peripheral retina in both eyes. Twenty-two infants (43 eyes [53.6%]) developed ROP reactivation at a mean interval of 7.1±3 weeks (range, 3-15 weeks) after IVR and needed rescue laser treatment of the peripheral avascular retina. The mean postmenstrual age at rescue laser was 43±3.2 weeks (range, 35.5-54.5 weeks). Six patients (11.6%) had persistent peripheral avascular retina in zone II for >6 months (or 24 weeks) after IVR treatment. CONCLUSIONS: Although there was complete regression of plus disease in all treated eyes, only 29.2% of the patients reached complete peripheral retinal vascularization. There was a disease reactivation in 53.6% of the patients and they needed additional laser therapy. The results of IVR treatment in severe ROP, even when initial control of the disease was achieved, did not eliminate the risk of late reactivation of the disease by retinal neovascularization. Some of the treated patients may achieve a permanent interruption in the development of the peripheral retinal vascularization.
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RESUMO O câncer de mama pode ser considerado, atualmente, um problema de saúde pública devido a sua crescente incidência e índices de letalidade. Diante disso, o movimento Outubro Rosa visa chamar a atenção da população a respeito dessas neoplasia em mulheres de todo o mundo, de modo que suas ações têm por objetivo comum realizar o diagnóstico precoce no intuito de diminuir a mortalidade em decorrência dessa neoplasia. Dessa forma, o presente artigo objetiva relatar a experiência de acadêmicos do curso de Medicina da Universidade Estadual de Santa Cruz, no Módulo de Práticas de Integração Ensino, Serviço e Comunidade III (Piesc III), numa ação conjunta com a Equipe de Saúde da Família (ESF) de Iguape, em Ilhéus (BA), no contexto do movimento Outubro Rosa, objetivando também compartilhar considerações sobre a formação médica levantadas pelo grupo acerca da vivência descrita. No período, realizou-se abordagem inicial na sala de espera, anamnese dirigida e foi feito o exame físico das mamas das pacientes que compareceram à Unidade de Saúde da Família. A experiência não consistiu apenas em identificar pacientes com suspeita de câncer de mama e quantificar os dados, mas numa oportunidade de exercício da Educação e Comunicação em Saúde e de desenvolvimento da relação médico-paciente. Ainda permitiu aos acadêmicos reconhecer e entender melhor as dificuldades das usuárias em relação à prevenção e promoção da saúde das mamas, sendo que se observou que diversas mulheres não estavam familiarizadas com os temas abordados. O estudante de Medicina precisa compreender que o conhecimento teórico-prático se reconstrói em cada paciente com contexto histórico específico e com diferentes visões e interpretações dos conceitos de saúde e doença. Além disso, o profissional médico deve exercitar, desde a graduação, habilidades que extrapolam o ortodoxo trabalho médico, assumindo também uma postura de multiplicador de cidadania, um agente propagador de direitos e deveres.
ABSTRACT The breast cancer can now be considered a public health problem due to its increasing incidence and lethality rates. In view of this, the October Rosa mobilization aims at drawing the population’s attention regarding this neoplasm in women from all over the world, so that their common objective is to perform the early diagnosis in order to reduce mortality due to this neoplasm. Thus, the following article describes the experiences of undergraduate medical students at the Universidade Estadual de Santa Cruz (Uesc) regarding the practice module on Integrated Teaching with Community Health and Service, as part of a joint initiative with a Family Health Team in the outskirts of Ilhéus, Bahia, Brazil, within the context of the “Pink October” movement, also aiming to share thoughts on the medical degree raised by the group on the experience described. As part of the Pink October initiative, the students were given the opportunity to take a clinical approach in the waiting room, collecting information and performing physical examinations on patients who appear at the Family Health Unit. This experience was not only intended to identify patients with suspected cancer and measure the data collected, but was also designed to provide the students the opportunity to put their health education and communication skills into practice, developing the doctor-patient relationship. It also allows academics to better recognize and understand users’ difficulties in preventing and promoting breast health. In this context, it was observed that several women were not familiar with the recommended techniques for the breast self-exam (???). Medical students must understand that practical and theoretical knowledge is reconstructed with every single patient according to their specific historical context and varying viewpoints and interpretations of the concepts of health and disease. In addition, the medical professional must exercise, from the undergraduate, skills that extrapolate the orthodox medical work, also assuming a position of multiplier of citizenship, a propagating agent of rights and duties.
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PURPOSE: The aim of the study was to assess the outcomes of severe retinopathy of prematurity (ROP) in zone I or posterior zone II treated with intravitreal ranibizumab (IVR) as monotherapy or combined treatment with laser photocoagulation. METHODS: This is a retrospective study analyzing clinical records of the included patients. Patients were divided into two groups: group 1 included patients who received only IVR treatment; and group 2 was subdivided into group 2A - including patients with IVR as initial treatment and complementary laser photocoagulation if retinal neovascularization or plus disease did not regress, and group 2B - including patients with initial laser photocoagulation and IVR as rescue therapy. Favorable outcomes were regression of the retinal neovascularization and plus disease, meaning control of the disease. Unfavorable outcomes were progression to stages 4 and 5 of ROP. RESULTS: Fifty-seven eyes were included in the study. Mean birth weight and gestational age were 1,281±254 g and 29.5±2.1 weeks, respectively. Group 1 comprised of 16 eyes, with favorable outcomes in 14 eyes (87.5%). Group 2 comprised of 41 eyes, with favorable outcomes in 29 eyes (70.7%), in a mean follow-up period of 12.8 months. CONCLUSION: IVR was effective to treat severe cases of ROP as a primary or a combined treatment. Forty-three of the 57 treated eyes (75.4%) achieved regression of ROP and favorable outcomes.
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This paper demonstrates multiple benefits of intravitreal bevacizumab (IVB) on diabetic retinopathy (DR) including diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) at 24 months of followup. This is a retrospective multicenter interventional comparative case series of intravitreal injections of 1.25 or 2.5 mg of bevacizumab for DME, PDR without tractional retinal detachment (TRD), and patients who experienced the development or progression of TRD after an intravitreal injection of 1.25 or 2.5 mg of bevacizumab before vitrectomy for the management of PDR. The results indicate that IVB injections may have a beneficial effect on macular thickness and visual acuity (VA) in diffuse DME. Therefore, in the future this new therapy could complement focal/grid laser photocoagulation in DME. In PDR, this new option could be an adjuvant agent to panretina photocoagulation so that more selective therapy may be applied. Finally, TRD in PDR may occur or progress after IVB used as an adjuvant to vitrectomy. Surgery should be performed 4 days after IVB. Most patients had poorly controlled diabetes mellitus associated with elevated HbA1c, insulin administration, PDR refractory to panretinal photocoagulation, and longer time between IVB and vitrectomy.
RESUMO
Diabetic retinopathy (DR) remains the major threat to sight in the working age population. Diabetic macular edema (DME) is a manifestation of DR that produces loss of central vision. Proliferative diabetic retinopathy (PDR) is a major cause of visual loss in diabetic patients. In PDR, the growth of new vessels is thought to occur as a result of vascular endothelial growth factor (VEGF) release into the vitreous cavity as a response to ischemia. Furthermore, VEGF increases vessel permeability leading to deposition of proteins in the interstitium that facilitate the process of angiogenesis and macular edema. This review demonstrates multiple benefits of intravitreal bevacizumab (IVB) on DR including DME and PDR at 24 months of follow up. The results indicate that IVB injections may have a beneficial effect on macular thickness and visual acuity (VA) in diffuse diabetic macular edema. Therefore, in the future this new therapy could replace or complement focal/grid laser photocoagulation in DME. In PDR, this new option could be an adjuvant agent to pan-retina photocoagulation so that more selective therapy may be applied. In addition, we report a series of patients in which tractional retinal detachment developed or progressed after adjuvant preoperative IVB in severe PDR.
Assuntos
Anticorpos Monoclonais/administração & dosagem , Retinopatia Diabética/tratamento farmacológico , Adulto , Idoso , Inibidores da Angiogênese/administração & dosagem , Animais , Anticorpos Monoclonais Humanizados , Bevacizumab , Proliferação de Células/efeitos dos fármacos , Retinopatia Diabética/diagnóstico , Feminino , Seguimentos , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico , Edema Macular/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Tomografia de Coerência ÓpticaRESUMO
PURPOSE: To report the 24-month anatomic and Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) response after primary intravitreal bevacizumab (IVB) (Avastin; Genentech Inc., San Francisco, CA) (1.25 or 2.5 mg) in patients with subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). DESIGN: Retrospective, multicenter, interventional, comparative case series. PARTICIPANTS: We reviewed the clinical records of 180 consecutive patients (207 eyes) with subfoveal CNV secondary to AMD at 9 centers from 8 countries. METHODS: Patients were treated with at least 1 injection of IVB 1.25 mg (124 eyes [59.9%]) or 2.5 mg (83 eyes [40.1%]). Patients underwent ETDRS BCVA testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at baseline and 1-, 3-, 6-, 12-, and 24-month visits. MAIN OUTCOME MEASURES: Changes in BCVA and OCT. RESULTS: The mean age of our patients was 74.3±7.5 years. The mean number of IVB injections per eye was 5.1 (range, 1-24 injections). In the 1.25 mg group, baseline BCVA improved from 20/235 (logarithm of the minimum angle of resolution [logMAR] 1.07) to 20/172 (logMAR 0.92) at 24 months (P<0.0001). Similar BCVA changes were observed in the 2.5 mg group. At baseline, the mean central macular thickness (CMT) by OCT in the 1.25 mg group was 308.4±127.52 µm, which was reduced to 269.35±97.92 µm, 262.1±94.81 µm, 264.03±97.06 µm, 245.91±89.52 µm, and 249.27±89.14 µm at 1, 3, 6, 12, and 24 months, respectively (P<0.0001). Similar changes were observed in the 2.5 mg group. In the 2.5 mg group, systemic complications included 2 new cases (2.6%) of arterial hypertension, 1 case (1.3%) of stroke, and 1 case (1.3%) of death. CONCLUSIONS: Primary IVB at a dose of 1.25 or 2.5 mg seems to provide stability or improvement in BCVA, OCT, and FA in subfoveal CNV secondary to AMD at 24 months. Our results show no significant difference regarding BCVA with IVB at doses of 1.25 or 2.5 mg.
Assuntos
Inibidores da Angiogênese/administração & dosagem , Anticorpos Monoclonais/administração & dosagem , Neovascularização de Coroide/tratamento farmacológico , Degeneração Macular/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Humanizados , Bevacizumab , Neovascularização de Coroide/etiologia , Neovascularização de Coroide/fisiopatologia , Feminino , Angiofluoresceinografia , Seguimentos , Fóvea Central , Humanos , Injeções , Degeneração Macular/complicações , Degeneração Macular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Tomografia de Coerência Óptica , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/fisiologia , Corpo VítreoRESUMO
PURPOSE: To report the 24-month anatomic and Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) response after primary intravitreal bevacizumab (Avastin; Genentech, Inc., San Francisco, CA; 1.25 or 2.5 mg) in patients with diffuse diabetic macular edema (DDME). In addition, a comparison of the 2 different doses of intravitreal bevacizumab (IVB) used is presented. DESIGN: Retrospective, multicenter, interventional, comparative case series. PARTICIPANTS: The clinical records of 115 consecutive patients (139 eyes) with DDME at 11 centers from 8 countries were reviewed. METHODS: Patients were treated with at least 1 intravitreal injection of 1.25 or 2.5 mg of bevacizumab. All patients were followed up for 24 months. Patients underwent ETDRS BCVA testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at the baseline, 1-, 3-, 6-, 12-, and 24-month visits. MAIN OUTCOME MEASURES: Changes in BCVA and OCT results. RESULTS: The mean age of the patients was 59.4+/-11.1 years. The mean number of IVB injections per eye was 5.8 (range, 1-15 injections). In the 1.25-mg group at 1 month, BCVA improved from 20/150 (0.88 logarithm of the minimum angle of resolution [logMAR] units) to 20/107, 0.76 logMAR units (P<0.0001). The mean BCVA at 24 months was 20/75 (0.57 logMAR units; P<0.0001). Similar BCVA changes were observed in the 2.5-mg group: at 1 month, BCVA improved from 20/168 (0.92 logMAR units) to 20/118 (0.78 logMAR units; P = 0.02). The mean BCVA at 24 months was 20/114 (0.76 logMAR units; P<0.0001). In the 1.25-mg group, the mean central macular thickness (CMT) decreased from 466.5+/-145.2 microm at baseline to 332.2+/-129.6 microm at 1 month and 286.6+/-81.5 microm at 24 months (P<0.0001). Similar results were obtained in the 2.5-mg group. CONCLUSIONS: Primary IVB at doses of 1.25 to 2.5 mg seem to provide stability or improvement in BCVA, OCT, and FA in DDME at 24 months. The results show no evident difference between IVB at doses of 1.25 or 2.5 mg.