RESUMO

OBJECTIVES: To test the hypothesis that higher level of purpose in life is associated with lower likelihood of dementia and mild cognitive impairment (MCI) in older Brazilians. METHODS: As part of the Pathology, Alzheimer's and Related Dementias Study (PARDoS), informants of 1,514 older deceased Brazilians underwent a uniform structured interview. The informant interview included demographic data, the Clinical Dementia Rating scale to diagnose dementia and MCI, the National Institute of Mental Health Diagnostic Interview Schedule for depression, and a 6-item measure of purpose in life, a component of well-being. RESULTS: Purpose scores ranged from 1.5 to 5.0 with higher values indicating higher levels of purpose. On the Clinical Dementia Rating Scale, 940 persons (62.1%) had no cognitive impairment, 121 (8.0%) had MCI, and 453 (29.9%) had dementia. In logistic regression models adjusted for age at death, sex, education, and race, higher purpose was associated with lower likelihood of MCI (odds ratio = .58; 95% confidence interval [CI]: .43, .79) and dementia (odds ratio = .49, 95% CI: .41, .59). Results were comparable after adjusting for depression (identified in 161 [10.6%]). Neither race nor education modified the association of purpose with cognitive diagnoses. CONCLUSIONS: Higher purpose in life is associated with lower likelihood of MCI and dementia in older black and white Brazilians.

Assuntos

Doença de Alzheimer , Disfunção Cognitiva , Humanos , Idoso , Doença de Alzheimer/diagnóstico , Brasil/epidemiologia , Progressão da Doença , Sensibilidade e Especificidade , Disfunção Cognitiva/diagnóstico

RESUMO

BACKGROUND: While dementia has been associated with specific causes of death, previous studies were relatively small autopsy series or population-based studies lacking autopsy confirmation and were restricted to Non-Latinx Whites. Here, we examine the association of dementia with autopsy-verified causes of death in racially-diverse older Brazilians. METHODS: As part of the Pathology, Alzheimer´s and Related Dementias Study (PARDoS), a community-based study in Brazil, we included 1941 racially-diverse deceased, 65 years or older at death. We conducted a structured interview with legal informants including the Clinical Dementia Rating (CDR) Scale for dementia proximate to death. Causes of death were assessed after full-body autopsy and macroscopic examination of the brain, thoracic and abdominal/pelvic organs. Up to four causes of death were reported for each decedent. Causes of death were classified as circulatory, infectious, cancer and other. Logistic regression was used to determine associations of dementia with cause of death, controlling for age, sex, race, and education. RESULTS: Dementia was associated with a higher odds of an infectious cause of death (OR = 1.81, 95%CI:1.45-2.25), and with a lower odds of a circulatory disease as cause of death (OR = 0.69, 95%CI:0.54-0.86) and cancer as cause of death (OR = 0.41, 95%CI:0.24-0.71). Dementia was associated with a higher odds of pneumonia (OR = 1.92, 95%CI:1.53-2.40) and pulmonary embolism (OR = 2.31, 95%CI:1.75-3.05) as causes of death and with a lower odds of acute myocardial infarction (OR = 0.42, 95%CI:0.31-0.56) and arterial disease (OR = 0.76, 95%CI:0.61-0.94) as causes of death. CONCLUSION: Racially-diverse older Brazilians with dementia had a higher odds of an infectious cause of death and a lower odds of cancer and circulatory disease as causes of death than those without dementia.

Assuntos

Causas de Morte , Demência/complicações , Idoso , Idoso de 80 Anos ou mais , Autopsia , Brasil , Demência/etnologia , Escolaridade , Feminino , Humanos , Masculino

RESUMO

INTRODUCTION: Knowledge is limited about behavioral and psychological symptoms of mild cognitive impairment (MCI) and dementia in racial and ethnic minorities. METHODS: As part of the Pathology, Alzheimer's and Related Dementias Study (PARDoS), we interviewed knowledgeable informants of 2319 older Brazilian decedents (67% white, 11% black, 22% mixed) using the informant portion of the Clinical Dementia Rating Scale to classify MCI and dementia and the Neuropsychiatric Inventory to assess behavioral and psychological symptoms. RESULTS: We identified four clusters of neuropsychiatric symptoms: agitation, affect/apathy, psychosis, and behavioral problems. On the Clinical Dementia Rating Scale, 1407 had no cognitive impairment, 180 had MCI, and 732 had dementia. Both MCI and dementia were associated with symptoms in each behavioral/psychological cluster (all P's < .001). There was little evidence of racial differences in the association of MCI and dementia with these neuropsychiatric symptoms. CONCLUSION: MCI and dementia are associated with elevated behavioral and psychological symptoms in older black and white Brazilians.

RESUMO

BACKGROUND: Literacy is more consistently reported than education as protective against dementia in developing regions. OBJECTIVE: To study the association of verbal literacy, numeracy, and music literacy with dementia in older Black and White Brazilians with a broad spectrum of education. METHODS: We studied 1,818 Black, Mixed-race, and White deceased Brazilians 65 years or older at death (mean = 79.64). Data were retrospectively obtained within 36 hours after death in a face-to-face interview with an informant, usually a family member. Dementia was classified using the Clinical Dementia Rating (CDR) scale. Three forms of literacy were ascertained: verbal literacy (10 questions: reading and writing), numeracy (3 questions: multiplication, percentages, and use of a calculator), and music literacy (1 question: reading music). Black (11%) and Mixed-race (23%) older adults were combined in analyses. Models adjusted for age and sex. RESULTS: Dementia was identified in 531 people. Participants had 0 to 25 years of education (median = 4). More literacy was associated with lower odds of dementia (all p≤0.039). Participants that read music had about half the odds of having dementia. Participants in the highest quartile of numeracy and verbal literacy had respectively 27%and 15%lower odds of having dementia compared to the lowest quartile. Literacy was lower in Blacks (p < 0.001, except music p = 0.894) but the effect of literacy on dementia was similar (interaction p > 0.237). In secondary analyses, playing instruments without reading music was not associated with dementia (p = 0.887). CONCLUSION: In a large sample of Brazilians, verbal literacy, numeracy, and music literacy were associated with lower odds of dementia. The effect was similar across races.

Assuntos

Morte , Demência/epidemiologia , Escolaridade , Etnicidade/estatística & dados numéricos , Alfabetização , Música , Idoso , Brasil/epidemiologia , Família , Humanos , Entrevistas como Assunto , Matemática , Leitura , Estudos Retrospectivos , Redação

RESUMO

OBJECTIVE: To examine the link between social and emotional isolation and likelihood of dementia among older black and white Brazilians. DESIGN: Cross-sectional clinical-pathological cohort study. SETTING: Medical center in Sao Paulo, Brazil. PARTICIPANTS: As part of the Pathology, Alzheimer's and Related Dementias Study, we conducted uniform structured interviews with knowledgeable informants (72% children) of 1,493 older (age > 65) Brazilian decedents. MEASUREMENTS: The interview included measures of social isolation (number of family and friends in at least monthly contact with decedent), emotional isolation (short form of UCLA Loneliness Scale), and major depression plus the informant portion of the Clinical Dementia Rating Scale to diagnose dementia and its precursor, mild cognitive impairment (MCI). RESULTS: Decedents had a median social network size of 8.0 (interquartile range = 9.0) and a median loneliness score of 0.0 (interquartile range = 1.0). On the Clinical Dementia Rating Scale, 947 persons had no cognitive impairment, 122 had MCI, and 424 had dementia. In a logistic regression model adjusted for age, education, sex, and race, both smaller network size (odds ratio [OR] = 0.975; 95% confidence interval [CI]: 0.962, 0.989) and higher loneliness (OR = 1.145; 95% CI: 1.060, 1.237) were associated with higher likelihood of dementia. These associations persisted after controlling for depression (present in 10.4%) and did not vary by race. After controlling for depression, neither network size nor loneliness was related to MCI. CONCLUSION: Social and emotional isolation are associated with higher likelihood of dementia in older black and white Brazilians.

RESUMO

BACKGROUND: Self-reported discrimination is a source of psychosocial stress that has been previously associated with poor cognitive function in older African Americans without dementia. OBJECTIVE: Here, we examine the association of discrimination with dementia and cognitive impairment in racially diverse older Brazilians. METHODS: We included 899 participants 65 years or older (34.3% Black) from the Pathology, Alzheimer's and Related Dementias Study (PARDoS), a community-based study of aging and dementia. A structured interview with informants of the deceased was conducted. The interview included the Clinical Dementia Rating (CDR) Scale for the diagnosis of dementia and cognitive impairment proximate to death and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a second measure of cognitive impairment. Informant-reported discrimination was assessed using modified items from the Major and Everyday Discrimination Scales. RESULTS: Discrimination was reported by informants of 182 (20.2%) decedents and was more likely reported by informants of Blacks than Whites (25.3% versus 17.6%, p = 0.006). Using the CDR, a higher level of informant-reported discrimination was associated with higher odds of dementia (OR: 1.24, 95% CI 1.08 -1.42, p = 0.002) and cognitive impairment (OR: 1.21, 95% CI: 1.06 -1.39, p = 0.004). Similar results were observed using the IQCODE (estimate: 0.07, SE: 0.02, p = 0.003). The effects were independent of race, sex, education, socioeconomic status, major depression, neuroticism, or comorbidities. CONCLUSION: Higher level of informant-reported discrimination was associated with higher odds of dementia and cognitive impairment in racially diverse older Brazilians.

Assuntos

Disfunção Cognitiva/etnologia , Disfunção Cognitiva/epidemiologia , Demência/etnologia , Demência/epidemiologia , Família , Discriminação Social/psicologia , Idoso , Idoso de 80 Anos ou mais , Brasil , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/psicologia , Demência/psicologia , Família/etnologia , Família/psicologia , Feminino , Humanos , Entrevistas como Assunto , Masculino , Testes de Estado Mental e Demência/estatística & dados numéricos , Estresse Psicológico/psicologia

RESUMO

OBJECTIVE: Exposure to negative life events (NLEs) and neuroticism are associated with dementia. It is unknown whether neuroticism explains or modifies the association of NLEs with dementia in older Black and White Brazilians. METHODS: A total of 1747 decedents 65 years and older White and Black (11% Black and 23% Mixed) Brazilians, 53% women, were included in the analyses. Data were obtained in a face-to-face interview with an informant (71% their children) who knew the decedents for 47 years on average. Dementia was classified using the Clinical Dementia Rating. NLEs were assessed with a 10-item scale involving common problems (e.g., death, illness, alcoholism, and financial). Neuroticism was assessed with a 6-item neuroticism scale adapted from the NEO Five-Factor Inventory. Models adjusted for age, sex, and education. Black and mixed-race were combined in the analyses. RESULTS: NLEs (median of 2) were more common in Blacks than Whites (2.04 vs. 1.82, p = 0.007). More NLEs increased the odds of dementia (OR = 1.112, ß = 0.106, p = 0.002), similarly in Blacks and Whites (ß interaction  = 0.046, p = 0.526). More NLEs were also associated with higher neuroticism (ß = 0.071, p < 0.0001), in Whites but not in Blacks (ß interaction  = -0.048, p = 0.006). Neuroticism was associated with higher odds of dementia (OR = 1.658, ß = 0.506, p=<0.001), in Whites but not in Blacks (ß interaction  = -0.420, p = 0.040). Overall, 34% of the effect of NLEs on dementia was associated with the underlying neuroticism trait in Whites (65%, Indirect OR = 1.060, p < 0.001) but no association was evident in Blacks (6%, Indirect OR = 1.008, p = 0.326). Neuroticism did not moderate the association of NLEs with dementia (OR = 0.979, ß = -0.021, p = 0.717). CONCLUSION: The association of NLEs and dementia is partially explained by neuroticism in older White but not in Blacks Brazilians.

Assuntos

Negro ou Afro-Americano , Demência , Idoso , Brasil/epidemiologia , Feminino , Humanos , Masculino , Neuroticismo , População Branca

Assuntos

Neoplasias Bucais/patologia , Neoplasias Nasais/patologia , Rabdomiossarcoma Alveolar/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Criança , Irradiação Craniana , Ciclofosfamida/administração & dosagem , Cistos/diagnóstico , Dactinomicina/administração & dosagem , Diagnóstico Diferencial , Feminino , Humanos , Mucosa Bucal/patologia , Neoplasias Bucais/diagnóstico por imagem , Neoplasias Bucais/tratamento farmacológico , Neoplasias Bucais/radioterapia , Mucosa Nasal/patologia , Neoplasias Nasais/diagnóstico por imagem , Neoplasias Nasais/tratamento farmacológico , Neoplasias Nasais/radioterapia , Rabdomiossarcoma Alveolar/diagnóstico por imagem , Rabdomiossarcoma Alveolar/tratamento farmacológico , Rabdomiossarcoma Alveolar/radioterapia , Ultrassonografia , Vincristina/administração & dosagem

RESUMO

Carcinosarcomas are a very rare group of true malignant tumors of the salivary gland. As the name indicates, the tumor is composed of an epithelial and a mesenchymal component, both malignant. We report a case of carcinosarcoma of the submandibular gland in an 86-year-old woman. The epithelial component showed a squamous carcinoma phenotype, whereas the mesenchymal component was morphologically similar to a fibrosarcoma. The epithelial component was strongly positive for CK13, CK14, and AE1/AE, and groups of positive cells were seen for CK19 and vimentin. The whole mesenchymal component was positive for vimentin, negative for cytokeratins, and focal cells were positive for smooth- muscle actin. Both components were strongly positive for P53 and Cyclin D1, and focally positive for MDM2. Rare multinucleated giant cells showed expression of CD68, and focal dendritical cells on carcinomatous nests were positive for S-100. The CK7, CK8, Factor XIIIa, c-erbB-2, P16, CDK-4, Rb1, and E2F-1 were not detected in these 2 groups of malignant cell populations.

Assuntos

Carcinossarcoma/química , Carcinossarcoma/patologia , Neoplasias da Glândula Submandibular/química , Neoplasias da Glândula Submandibular/patologia , Idoso de 80 Anos ou mais , Ciclina D1/análise , Feminino , Humanos , Técnicas Imunoenzimáticas , Queratinas/análise , Proteína Supressora de Tumor p53/análise , Vimentina/análise

RESUMO

BACKGROUND: Currently numerous countries in Asia, Africa and Europe are encountering highly pathogenic avian influenza (AI) infections in poultry and humans. In the Americas, home of the world's largest poultry exporters, contingency plans are being developed and evaluated in preparation for the arrival of these viral strains. OBJECTIVES: With this cross-sectional study, to our knowledge the first in its kind in Central or South America, we sought to learn if Peruvian poultry workers had evidence of previous AI infection and if so, to determine risk factors for infection. METHODS: We performed a cross-sectional seroprevalence study among 149 workers on a Peruvian poultry farm (133 exposed to poultry and 17 non-exposed controls), serum samples were tested for human influenza virus exposure using a hemagglutination inhibition (HI) assay. Microneutralization assays were performed on all serum samples to detect antibodies against prototypic avian influenza (AI) strains H4 through H12. RESULTS: Using multivariate proportional odds modeling we found that the prevalence of elevated titers against AI viruses was low in both groups, exposed and non-exposed controls. CONCLUSIONS: No evidence of previous avian influenza infection among Peruvian poultry workers was found in this first cross-sectional study performed in South America. This first occupational study of AI in Latin America was encouraging, but it likely reflects the sector of poultry production with higher biosecurity.

Assuntos

Doenças dos Trabalhadores Agrícolas/prevenção & controle , Influenza Aviária/epidemiologia , Adolescente , Adulto , Idoso , Doenças dos Trabalhadores Agrícolas/imunologia , Doenças dos Trabalhadores Agrícolas/virologia , Animais , Galinhas , Estudos Transversais , Feminino , Testes de Inibição da Hemaglutinação , Humanos , Influenza Aviária/transmissão , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional , Peru , Aves Domésticas , Adulto Jovem

RESUMO

Larva migrans is a condition caused by subcutaneous or visceral migration of parasite larvae, usually Ancylostoma braziliense, and is characterized by pruriginous or serpiginous lesions. This article describes a case of larva migrans involving the oral mucosa in a 24-year-old woman.

Assuntos

Larva Migrans/patologia , Mucosa Bucal/parasitologia , Adulto , Ancylostoma/isolamento & purificação , Animais , Antinematódeos/uso terapêutico , Feminino , Humanos , Larva Migrans/tratamento farmacológico , Mucosa Bucal/patologia , Tiabendazol/uso terapêutico

RESUMO

We retrospectively studied 420 pharyngeal swab specimens collected from Peruvian and Argentinean patients with influenzalike illness in 2002 and 2003 for evidence of human metapneumovirus (HMPV). Twelve specimens (2.3%) were positive by multiple assays. Six specimens yielded HMPV isolates. Four of the 6 isolates were of the uncommon B1 genotype.

Assuntos

Metapneumovirus , Infecções por Paramyxoviridae/epidemiologia , Adolescente , Adulto , Linhagem Celular , Criança , Pré-Escolar , Feminino , Glicoproteínas/genética , Humanos , Masculino , Metapneumovirus/classificação , Metapneumovirus/genética , Metapneumovirus/isolamento & purificação , Dados de Sequência Molecular , Infecções por Paramyxoviridae/virologia , Peru/epidemiologia , Faringe/virologia , Filogenia , Vigilância da População , Análise de Sequência de DNA , Manejo de Espécimes/métodos , Proteínas Virais/genética

RESUMO

Adult T-cell leukemia/lymphoma (ATL/L) is a rare malignant neoplasm linked to human T-cell lymphotropic virus type 1 (HTLV-1). This virus has been identified in Japan, the Caribbean, and, more recently, Brazil. We report a case of ATL/L (lymphoma-type) affecting a 30-year-old Brazilian woman. She presented a painful and ulcerated lesion on her hard palate mucosa. Conventional radiographs and computed tomography revealed the involvement of several bones plus the lung and axillary lymph nodes. Histopathological and immunohistochemical analyses of oral biopsy confirmed a T-cell non-Hodgkin's lymphoma. Final diagnosis of ATL/L was made based on HTLV-1 positivity. She underwent multiple cycles of chemotherapy, which produced some improvement, but she died as a consequence of pulmonary and hepatic complications 4 months after the initial diagnosis. Besides the process of diagnosing and typing a malignant lymphoma, this article outlines the value of computed tomography and the necessity of performing HTVL-1 investigation in patients with a diagnosis of lymphoma of T-cell lineage.

Assuntos

Leucemia-Linfoma de Células T do Adulto/complicações , Leucemia-Linfoma de Células T do Adulto/patologia , Neoplasias Palatinas/etiologia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Brasil , Evolução Fatal , Feminino , Vírus Linfotrópico T Tipo 1 Humano/isolamento & purificação , Humanos , Imuno-Histoquímica , Leucemia-Linfoma de Células T do Adulto/diagnóstico por imagem , Antígenos Comuns de Leucócito/análise , Neoplasias Palatinas/diagnóstico por imagem , Neoplasias Palatinas/patologia , Proteína Tirosina Fosfatase não Receptora Tipo 1 , Tomografia Computadorizada por Raios X

RESUMO

PTEN é um gene supressor de tumor, que resulta na proteína citoplasmática de mesmo nome, e possui a capacidade de modular a apoptose e o ciclo celular, assim como de inibir a migração celular. Por outro lado, o oncogene Akt promove a sobrevida celular e impede a apoptose. A ativação de Akt é inversamente relacionada com a ausência de PTEN em uma variedade de neoplasias malignas. Neste estudo, linhagens celulares derivadas de carcinoma epidermóide bucal (HN6, HN30, HN31 e uma linhagem de células controle, HaCat) foram submetidas ao método de invasão in vitro e clones celulares altamente invasivos foram isolados. Através das técnicas de imunofluorescência e Western blot foi verificada a expressão de ambas as proteínas nos novos clones (denominados HN6.1, HN30.1, HN31.1 e HaCat.1) e comparada às linhagens controle. A técnica da zimografia também foi realizada, desde que várias metaloproteinases (MMPs) têm demonstrado possuir papel importante no processo de invasão e metástase dos CEB. Nossos resultados revelaram que todas as linhagens celulares e seus respectivos clones invasivos mostraram marcação citoplasmática e nuclear para PTEN e pAkt, respectivamente. A exceção foi a HaCat.1 que apresentou marcação predominantemente citoplasmática para pAkt. A análise do Western blot revelou que os clones invasivos expressam menor quantidade de PTEN, não significantes estatisticamente. Essa diminuição foi expressiva somente na linhagem HaCat.1 (p<0.05). Em relação ao pAkt, foi observado uma discreta superexpressão dessa proteína nas linhagens invasivas de CEB. Contrariamente, a linhagem HaCat.1 sofreu uma significante diminuição de pAkt (p<0,05). Finalmente, a zimografia mostrou um discreto aumento de MMP-2 latente e/ou um significante aumento de MMP-9 ativa em todos os clo nes invasivos. Nossos resultados sugerem que não há uma relação inversa consistente e significativa entre as proteínas PTEN e Akt no processo de invasão in vitro com células derivadas de CEB. Não há som...

Assuntos

Carcinoma de Células Escamosas , Técnicas In Vitro , Metaloproteases , Patologia Bucal

Assuntos

Linhagem Celular , Laminina , Mioepitelioma , Neoplasias das Glândulas Salivares

RESUMO

Neoplasias de glândulas salivares originárias do ducto intercalado apresentam grande quantidade de matriz extracelular. Em trabalho anterior (Freitas et al., 1999), observamos que o colágeno I é fator de crescimento para células de uma dessas neoplasias, o carcinoma adenóide cístico. Agora avaliamos in vitro o papel do colágeno I na morfodiferenciaçäo do adenoma pleomórfico, do mioepitelioma e do carcinoma adenóide cístico. Para tanto utilizamos linhagens celulares derivadas dessas três neoplasias de glândula salivar (AP4, M1 e CAC2, respectivamente). As células foram crescidas durante 5 dias em preparaçäo tridimensional de colágeno I, numa situaçäo semelhante ao que ocorreria na neoplasia in vivo. Células controle cresceram sobre vidro. O efeito do colágeno I nas células AP4, M1 e CAC2 foi avaliado através da microscopia eletrônica de varredura. Observamos morfodiferenciaçäo em duas das três linhagens estudadas. A linhagem M1 apresentou células de formato poligonal ou arredondado, ao passo que as células CAC2 exibiram formaçäo de estruturas pseudocísticas. A linhagem AP4 apresentou células fusiformes e dendríticas semelhantes às células controle. Sugerimos que o colágeno I é um fator regulador dos fenótipos tanto do mioepitelioma, como do carcinoma adenóide cístico

Assuntos

Adenoma Pleomorfo , Carcinoma Adenoide Cístico/patologia , Colágeno , Mioepitelioma , Neoplasias das Glândulas Salivares/patologia , Linhagem Celular , Matriz Extracelular , Microscopia Eletrônica de Varredura