RESUMO
BACKGROUND: It is not well established whether depression leads to weight loss or weight gain, or whether a relationship exists among depression, social anxiety, and weight status. The aim of this study was to evaluate the synergic association among social anxiety, depressive symptoms, and waist circumference (WC) during adolescence and examine whether depression mediated the relationship between social anxiety and WC. METHODS: A cross-sectional study was performed with 1296 adolescents from a northeastern district in Brazil. It was used the Social Anxiety Scale for Adolescents (SAS-A) to evaluate symptoms of social anxiety and the Depression Scale of the Center for Epidemiologic Studies (CES-D) for symptoms of depression. Structural equation modeling was used to determine whether depression, social anxiety, and WC were synergically associated. Analysis was adjusted for sex, age, height, and mother's educational level. RESULTS: Symptoms of social anxiety were directly associated with symptoms of depression and WC, whereas symptoms of depression were not associated with WC. LIMITATIONS: This is a cross-sectional study, and so we cannot infer causality in the interpretation of results. CONCLUSION: Social anxiety was found to be associated with depressive symptoms and WC. General medical doctors and health practitioners who observe overweight adolescents with any symptoms of anxiety might consider a thorough evaluation of the patient's mental health.
Assuntos
Ansiedade/fisiopatologia , Ansiedade/psicologia , Depressão/fisiopatologia , Obesidade Infantil/psicologia , Circunferência da Cintura , Adolescente , Brasil , Estudos Transversais , Depressão/psicologia , Feminino , Humanos , Masculino , Obesidade Infantil/fisiopatologia , Escalas de Graduação PsiquiátricaRESUMO
We investigated the longitudinal associations among physical activity (PA), motor competence (MC), cardiorespiratory fitness (VO2peak ), and body fatness across 7 years, and also analyzed the possible mediation effects of PA, MC, and VO2peak on the relationships with body fatness. This was a seven-year longitudinal study with three measuring points (mean ages [in years] and respective sample size: 6.75±0.37, n=696; 9.59±1.07, n=617; 13.35±0.34, n=513). PA (moderate-to-vigorous PA-MVPA and vigorous PA-VPA) was monitored using accelerometers. MC was assessed by the "Körperkoordinationstest für Kinder-KTK" test battery. VO2peak was evaluated using a continuous running protocol until exhaustion. Body fatness was determined by the sum of four skinfolds. Structural equation modeling was performed to evaluate the longitudinal associations among PA, MC, VO2peak, and body fatness and the potential mediation effects of PA, MC, and VO2peak . All coefficients presented were standardized (z-scores). MC and VO2peak directly influenced the development of body fatness, and VO2peak mediated the associations between MVPA, VPA, MC, and body fatness. MC also mediated the associations between MVPA, VPA, and body fatness. In addition, VO2peak had the largest total association with body fatness (ß=-0.431; P<.05), followed by MC (ß=-0.369; P<.05) and VPA (ß=-0.112; P<.05). As PA, MC, and VO2peak exhibited longitudinal association with body fatness, it seems logical that interventions should strive to promote the development of fitness and MC through developmentally appropriate physical activities, as the synergistic interactions of all three variables impacted body fatness.
Assuntos
Adiposidade , Aptidão Cardiorrespiratória , Exercício Físico , Aptidão Física , Actigrafia , Adolescente , Criança , Feminino , Humanos , Estudos Longitudinais , Masculino , Consumo de OxigênioRESUMO
Cancer-related fatigue (CRF) is the most stressful and prevalent symptom in paediatric oncology patients. This integrative review aimed to identify, analyse and synthesise the evidence of non-pharmacological intervention studies to manage fatigue and psychological stress in a paediatric population with cancer. Eight electronic databases were used for the search: PubMed, Web of Science, CINAHL, LILACS, EMBASE, SCOPUS, PsycINFO and the Cochrane Library. Initially, 273 articles were found; after the exclusion of repeated articles, reading of the titles, abstracts and the full articles, a final sample of nine articles was obtained. The articles were grouped into five categories: physical exercise, healing touch, music therapy, therapeutic massage, nursing interventions and health education. Among the nine studies, six showed statistical significance regarding the fatigue and/or stress levels, showing that the use of the interventions led to symptoms decrease. The most frequently tested intervention was programmed physical exercises. It is suggested that these interventions are complementary to conventional treatment and that their use can indicate an improvement in CRF and psychological stress.
Assuntos
Fadiga/terapia , Neoplasias/complicações , Estresse Psicológico/terapia , Adolescente , Criança , Pré-Escolar , Métodos Epidemiológicos , Fadiga/etiologia , Humanos , Lactente , Estresse Psicológico/etiologiaRESUMO
AIMS: This study aimed to evaluate the in vitro activity of miltefosine and levamisole against strains of Coccidioides posadasii in the filamentous phase and strains of Histoplasma capsulatum in filamentous and yeast phases. METHODS AND RESULTS: Strains of C. posadasii in the filamentous phase (n = 22) and strains of H. capsulatum in filamentous (n = 40) and yeast phases (n = 13) were, respectively, submitted to broth macrodilution and broth microdilution methods, as described by the Clinical and Laboratory Standards Institute, to determine the minimum inhibitory concentration (MIC) and the minimum fungicidal concentration (MFC) of miltefosine and levamisole. The effect of the drugs on cell membrane permeability under osmotic stress conditions and total ergosterol production were also assessed, along with quantification of extravasated molecules. The results show the inhibitory effect of levamisole and miltefosine against C. posadasii and H. capsulatum and the effect of these drugs on ergosterol synthesis and the permeability of the plasma membrane using subinhibitory concentrations against strains subjected to osmotic stress. Levamisole was also able to cause the release of nucleic acids. CONCLUSIONS: Miltefosine and levamisole are capable of inhibiting the in vitro growth of C. posadasii and H. capsulatum, probably by altering the permeability of the cellular membrane. SIGNIFICANCE AND IMPACT OF THE STUDY: This work presents alternatives for the treatment of histoplasmosis and coccidioidomycosis, raising the possibility of the use of miltefosine and levamisole as adjuvants in antifungal therapy, providing perspectives for the design of in vivo studies.
Assuntos
Antifúngicos/farmacologia , Coccidioides/efeitos dos fármacos , Ergosterol/biossíntese , Histoplasma/crescimento & desenvolvimento , Levamisol/farmacologia , Fosforilcolina/análogos & derivados , Permeabilidade da Membrana Celular/efeitos dos fármacos , Coccidioides/crescimento & desenvolvimento , Coccidioides/metabolismo , Histoplasma/efeitos dos fármacos , Histoplasma/metabolismo , Testes de Sensibilidade Microbiana , Fosforilcolina/farmacologiaRESUMO
The Kalanchoe pinnata Lam. is a bush species of the Crassulaceae that is distinguished by its important medicinal properties. Its leaves are used as cataplasm to treat headaches and wounds. There is evidence for a hypotensive and anti-inflammatory effect. Techniques of plant tissue culture have been applied to plant species that produce substances likely to be explored in pharmacology, cell suspension being the main technique. At the industrial level, this method utilizes bioreactors in order to produce secondary metabolites on a large scale. The objective of this study was to evaluate the effects of in vitro combinations of 2,4-dichlorophenoxiacetic acid (2,4-D) and benzylaminopurine (BA) on callus induction in leaf explants of K. pinnata. Leaf fragments were inoculated in MS medium supplemented with 3.0% sucrose, 0.8% agar and factorial combinations of 2,4-D (0.00, 4.52, 9.06, 18.12 µM) and BA (0.00, 4.44, 8.88, 17.76 µM). The cultures were kept in the darkness at 24±2ºC for 50 days. The percentage of callus induction and the area of explants covered by callus cells were evaluated. In the absence of growth regulators, callus induction did not occur, with necrosis of all explants. The highest percentage of callus induction was 100%, obtained with the combination of 9.06 µM 2,4-D and 8.88 µM BA, but the calluses covered only 25% of the leaf area. The most efficient combination was 4.52 µM 2,4-D and 8.88 µM BA, resulting in 91% callus induction with 50 to 100% of the explants being covered by callus cells.
Kalanchoe pinnata Lam. é uma espécie arbustiva da família Crassulaceae que apresenta interessantes propriedades medicinais. Suas folhas são utilizadas em cataplasma para tratar enxaqueca e ferimentos. Há evidência de seu efeito como hipotensiva e anti-inflamatória. Técnicas de cultura de tecidos vegetais têm sido aplicadas para espécies que possuem substâncias passíveis de exploração na farmacologia, sendo a suspensão celular a principal técnica utilizada. A nível industrial, este método utiliza biorreatores para produzir metabólitos secundários em larga escala. Este estudo teve como objetivo avaliar os efeitos in vitro de combinações do ácido 2,4-diclorofenoxiacético (2,4-D) e de benzilaminopurina (BAP) na indução de calos em explantes foliares de K. pinnata. Fragmentos foliares foram inoculados em meio MS contendo 3% de sacarose, 0,8% de ágar e combinações fatoriais de 2,4-D (0,00; 4,52; 9,06 e 18,12 µM) e BAP (0,00; 4,44; 8,88 e 17,76 µM). Os cultivos foram mantidos no escuro, a 24±2ºC por 50 dias. A porcentagem de indução de calos e a área dos explantes coberta por células de calos foram avaliadas. Na ausência de reguladores de crescimento não ocorreu indução de calos, com necrose de todos os explantes. A porcentagem mais alta de indução de calos foi de 100%, obtida com a combinação de 9,06 µM de 2,4-D e 8,88 µM de BAP, mas estes calos cobriram apenas 25% da área foliar. A combinação mais eficiente foi de 9,06 µM de 2,4-D e 8,88 µM de BAP, que resultou em 91% de indução e 50 a 100% da área dos explantes coberta por células de calos.
Assuntos
Reguladores de Crescimento de Plantas/análise , Kalanchoe/classificação , Plantas Medicinais/classificação , Ácido 2,4-Diclorofenoxiacético/farmacologiaRESUMO
This study evaluated the in vitro interaction between ciprofloxacin (CIP) and classical antifungals against Histoplasma capsulatum var. capsulatum in mycelial (n = 16) and yeast-like forms (n = 9) and Coccidioides posadasii in mycelial form (n = 16). This research was conducted through broth microdilution and macrodilution, according to Clinical Laboratory Standards Institute. Inocula were prepared to obtain from 0.5 × 10(3) to 2.5 × 10(4) cfu ml(-1) for H. capsulatum and from 10(3) to 5 × 10(3) cfu ml(-1) for C. posadasii. Initially, minimum inhibitory concentration (MIC) for each drug alone was determined. Then, these MICs were used as the highest concentration for each drug during combination assays. The procedures were performed in duplicate. For all combination assays, MICs were defined as the lowest concentration capable of inhibiting 80% of visible fungal growth, when compared to the drug-free control. Drug interaction was evaluated by paired sample t-Student test. The obtained data showed a significant MIC reduction for most tested combinations of CIP with antifungals, except for that of CIP and voriconazole against yeast-like H. capsulatum. This study brings potential alternatives for the treatment of histoplasmosis and coccidioidomycosis, raising the possibility of using CIP as an adjuvant antifungal therapy, providing perspectives to delineate in vivo studies.
Assuntos
Antifúngicos/farmacologia , Ciprofloxacina/farmacologia , Coccidioides/efeitos dos fármacos , Histoplasma/efeitos dos fármacos , Caspofungina , Coccidioides/crescimento & desenvolvimento , Avaliação Pré-Clínica de Medicamentos , Sinergismo Farmacológico , Equinocandinas/farmacologia , Histoplasma/crescimento & desenvolvimento , Lipopeptídeos , Testes de Sensibilidade Microbiana , Micélio/efeitos dos fármacos , Pirimidinas/farmacologia , Triazóis/farmacologia , VoriconazolRESUMO
O presente trabalho teve como objetivo investigar a composição química e avaliar a atividade inseticida do extrato acetônico das raízes de Piper alatabaccum sobre Hypothenemus hampei. As raízes foram coletadas no campus da Universidade Federal de Rondônia, em Porto Velho-RO. Diluições de 100,0, 50,0, 25,0, 5,0 e 0,5 mg mL-1 foram utilizadas para exposição na superfície contaminada e aplicação tópica. No teste de repelência, utilizou-se as diluições de 25,0 e 100,0 mg mL-1. As avaliações ocorreram durante 48 horas após a exposição ao extrato. O extrato foi eficiente na mortalidade em aplicação tópica e superfície contaminada, não sendo eficiente no efeito de repelência. Estes resultados apontam para o elevado potencial inseticida do extrato de P. alatabaccum no controle de H. hampei. Identificou-se cinco compostos, sendo três amidas, dihydropiplartine piperovatina e piplartina, e duas flavona, 3',4',5,5',7 pentamethoxyflavone e 5,5',7-trimetóxi-3',4'-methylenedioxyflavone.
The purpose of this work was to investigate the chemical composition and to evaluate the insecticidal activity of the acetonic extract of Piper alatabaccum roots on Hypothenemus hampei. Roots of P. alatabaccum were collected at the University of Rondônia in Porto Velho-RO. Dilutions of 100.0, 50.0, 25.0, 5.0 and 0.5 mg mL-1 were used for exposition in the contaminated surface and for topical application. For the repellence test, 25.0 and 100.0 mg mL-1 dilutions were used. The evaluations occurred during 48 hours after exposure to the extract. The extract was efficient in terms of mortality, but no repellence was observed in the bioassays. These results pointed out the high insecticidal potential of the P. alatabaccum extract to control H. hampei. Five compounds, three amids, piperovatine, dihydropiplartine and piplartine, and two flavones, 3',4',5,5',7-pentamethoxyflavone and 5,5',7-trimethoxy-3',4' methylenedioxyflavone were identified.
Assuntos
Pragas da Agricultura , Piper/química , Controle Biológico de Vetores/métodos , Raízes de Plantas/efeitos adversos , Coffea/classificação , Repelentes de InsetosRESUMO
O óleo essencial das folhas de Schinus terebinthifolius foi obtido por hidrodestilação e analisado por CG-EM. O rendimento do óleo foi de 0,8%, sendo identificados 37 constituintes químicos. Os componentes principais foram germacreno D (25,0%), (E)-ß-cariofileno (17,5%) e δ -elemeno (10,5%). O óleo essencial foi diluído em acetona nas concentrações de 10-2 a 10-8 e aplicado aos insetos (Hypothenemus hampei) por aplicação tópica e exposição em superfície contaminada. As taxas de mortalidade foram avaliadas após 24 e 48 horas do início do experimento. A aplicação em superfície contaminada resultou em 25% de mortalidade no controle, enquanto nas diluições de 10-2 a 10-8 foram observados 100,0 a 30,0% de mortalidade. Na aplicação tópica, observou-se 27,5% de mortalidade no controle e 97,5 a 77,5% nas diluições de 10-2 a 10-8.
The essential oil from the leaves of Schinus terebinthifolius was obtained by hydrodistillation and was analyzed by GC-MS. The oil yield was 0.8%, and 37 chemical constituents were identified. The main components were germacrene D (25.0%), (E)-ß-cariophyllene (17.5%) and δ-elemene (10.5%). The essential oil was diluted in acetone in concentrations of 10-2 to 10-8 and it was applied to insects (Hypothenemus hampei) by topical application and exposure to contaminated surface. Mortality rates were evaluated after 24 and 48 hours. The contaminated surface application resulted in 25.0% of mortality in control while the dilutions of 10-2 to 10-8 resulted in 100% to 30.0% of mortality respectively. In the topical application, it was observed 27.5% of mortality in control and 97.5 to 77.5% of mortality in dilutions of 10-2 to 10-8
Assuntos
Óleos Voláteis/síntese química , Controle de Pragas , Anacardiaceae/classificação , Café/metabolismo , Inseticidas/administração & dosagemRESUMO
This study aimed to evaluate the in vitro combination of farnesol and ß-lactams against Burkholderia pseudomallei. A total of 12 ß-lactamase-positive strains were tested according to CLSI standards. All strains were inhibited by farnesol, with MICs ranging from 75 to 150 µM. The combination of this compound with ß-lactams resulted in statistically significant ß-lactam MIC reduction (P ≤ 0.05). This study provides new perspectives for the use of farnesol combined with ß-lactam antibiotics against strains of B. pseudomallei.
Assuntos
Antibacterianos/farmacologia , Burkholderia pseudomallei/efeitos dos fármacos , Farneseno Álcool/farmacologia , beta-Lactamas/farmacologia , Burkholderia pseudomallei/crescimento & desenvolvimento , Farmacorresistência Bacteriana , Sinergismo Farmacológico , Testes de Sensibilidade Microbiana , beta-Lactamases/metabolismoRESUMO
Melioidosis, a severe infectious disease caused by Burkholderia pseudomallei that is prevalent in Southeast Asia and Northern Australia, has been sporadically reported in Brazil since 2003. We report a case of aortic aneurysm with blood culture positive for B. pseudomallei. The phylogenetic analysis of 16S ribosomal DNA showed this isolate to be evolutionarily grouped with the MSHR346 strains from Thailand.
Assuntos
Aneurisma Infectado/microbiologia , Burkholderia pseudomallei/genética , Burkholderia pseudomallei/isolamento & purificação , Melioidose/microbiologia , Idoso , Brasil , Humanos , Masculino , Melioidose/mortalidade , Filogenia , RNA Ribossômico 16S/genética , TailândiaRESUMO
The composition of termite assemblages was analyzed in three caatinga sites of the Estação Ecológica do Seridó, located in the municipality of Serra Negra do Norte, in the state of Rio Grande do Norte, Brazil. These sites have been subjected to selective logging, and cleared for pasture and farming. A standardized sampling protocol for termite assemblages (30h/person/site) was conducted between September 2007 and February 2009. At each site we measured environmental variables, such as soil pH and organic matter, necromass stock, vegetation height, stem diameter at ankle height (DAH) and the largest and the smallest crown width. Ten species of termites, belonging to eight genera and three families, were found at the three experimental sites. Four feeding groups were sampled: wood-feeders, soil-feeders, wood-soil interface feeders and leaf-feeders. The wood-feeders were dominant in number of species and number of encounters at all sites. In general, the sites were not significantly different in relation to the environmental variables measured. The same pattern was observed for termite assemblages, where no significant differences in species richness, relative abundance and taxonomic and functional composition were observed between the three sites. The agreement between composition of assemblages and environmental variables reinforces the potential of termites as biological indicators of habitat quality.
Assuntos
Ecossistema , Isópteros , Animais , Brasil , Meio Ambiente , Isópteros/classificação , Densidade DemográficaRESUMO
This study aimed to characterize the structure of the herb stratum in relation to light availability in the Submontane Atlantic Rain Forest at the Carlos Botelho State Park, SP, Brazil. Fortyone 10 x10 m plots were established under the closed canopy (18 plots), small and medium canopy gaps (11) and large canopy gaps dominated by Guadua tagoara (Ness) Kunth (12). Inside each plot, the line intercept method was applied to assess soil coverage as an estimate of density of herb stratum vegetation. Hemispherical photographs were taken at the centre of the plots to evaluate the annual light regime. Overall, Calathea communis Wanderley and S. Vieira had the greater mean coverage, followed by woody seedlings, ground ferns and other herbs (mainly, Araceae, Acanthaceae, Amaranthaceae and Cyperaceae). There were strong correlations among several groups of the herb stratum, such as the negative correlations between woody seedlings with the coverage of C. communis and with rocks. The analysis of the hemispherical photographs confirmed the difference among environments that led to significant differences in the soil coverage of the herb stratum vegetation but woody seedlings. For instance, C. communis showed great coverage in large gaps while ferns were more abundant in small and medium gaps and in the understorey. Other herbs, in turn, demonstrated bigger soil coverage in small and medium gaps. Although this study represents a rough assessment of the structure and composition of the herb stratum, the results found here illustrated the evident relation between herb species density and the environmental variation promoted by changes on canopy structure and topography.
Assuntos
Ecossistema , Luz Solar , Zingiberales/crescimento & desenvolvimento , Brasil , Estações do Ano , Especificidade da Espécie , Árvores , Clima Tropical , Zingiberales/classificaçãoRESUMO
This study aimed to characterize the structure of the herb stratum in relation to light availability in the Submontane Atlantic Rain Forest at the Carlos Botelho State Park, SP, Brazil. Fortyone 10 x10 m plots were established under the closed canopy (18 plots), small and medium canopy gaps (11) and large canopy gaps dominated by Guadua tagoara (Ness) Kunth (12). Inside each plot, the line intercept method was applied to assess soil coverage as an estimate of density of herb stratum vegetation. Hemispherical photographs were taken at the centre of the plots to evaluate the annual light regime. Overall, Calathea communis Wanderley and S. Vieira had the greater mean coverage, followed by woody seedlings, ground ferns and other herbs (mainly, Araceae, Acanthaceae, Amaranthaceae and Cyperaceae). There were strong correlations among several groups of the herb stratum, such as the negative correlations between woody seedlings with the coverage of C. communis and with rocks. The analysis of the hemispherical photographs confirmed the difference among environments that led to significant differences in the soil coverage of the herb stratum vegetation but woody seedlings. For instance, C. communis showed great coverage in large gaps while ferns were more abundant in small and medium gaps and in the understorey. Other herbs, in turn, demonstrated bigger soil coverage in small and medium gaps. Although this study represents a rough assessment of the structure and composition of the herb stratum, the results found here illustrated the evident relation between herb species density and the environmental variation promoted by changes on canopy structure and topography.
O objetivo deste estudo foi caracterizar a estrutura do estrato herbáceo em relação à disponibilidade de luz na Floresta Pluvial Atlântica Submontana do Parque Estadual Carlos Botelho, SP, Brasil. Para tanto, foram instaladas 41 parcelas de 10 x 10 m em ambientes sob o dossel fechado (18 parcelas), em clareiras pequenas e médias (11), e em clareiras grandes com dominância de Guadua tagoara (Ness) Kunth (12). Em cada parcela a percentagem de cobertura de solo, avaliada através do método de interceptação em linha, foi usada como estimativa da densidade da vegetação do estrato herbáceo. Fotografias hemisféricas foram tomadas ao centro de cada uma das parcelas para avaliar o regime anual de luz nos ambientes. No geral, a maior média obtida foi para Calathea communis Wanderley e S. Vieira, seguida por plântulas de regenerantes lenhosos, pteridófitas terrestres e outras ervas (principalmente Araceae, Acanthaceae, Amaranthaceae e Cyperaceae). Houve ainda fortes correlações entre vários grupos do estrato herbáceo, como as correlações negativas entre plântulas de regenerantes com a cobertura de C. communis e de rochas. A análise das fotografias hemisféricas confirmou a existência de ambientes com diferentes regimes de luz, que promoveram diferenças significativas na cobertura do solo de todos os grupos do estrato herbáceo, exceto para plântulas de regenerantes. Por exemplo, C. communis apresentou grande cobertura nas grandes clareiras, enquanto que as pteridófitas terrestres foram mais abundantes no subbosque e nas clareiras pequenas e médias. O grupo Outras Ervas, por sua vez, apresentou maiores coberturas nas clareiras pequenas e médias. Apesar de representar uma análise grosseira da estrutura e composição, os resultados encontrados aqui ilustraram uma evidente relação entre a densidade de formas de vida herbácea e as variações ambientais promovidas por mudanças na estrutura do dossel da floresta e na topografia.
Assuntos
Ecossistema , Luz Solar , Zingiberales/crescimento & desenvolvimento , Brasil , Estações do Ano , Especificidade da Espécie , Árvores , Clima Tropical , Zingiberales/classificaçãoRESUMO
The main objective of this work is to study the technical viability of using the effluent generated in paper machines (white water) in the wash presses of the bleaching stage, reducing fresh water consumption. As a case study, the industrial process of Ripasa S.A. Celulose e Papel was evaluated. White water rate is about 700 m3/h and it is not possible to reuse all this volume in the bleaching stage without causing operational problems (fouling in tubes and clogging in the screens). A mass balance of the bleaching unit was developed in an electronic spreadsheet in order to evaluate the possibility of reducing fresh water consumption, using only a fraction of the available white water in the wash presses. To achieve this objective some physical-chemistry properties of the white water stream and of other streams of the process were determined. The maximum concentration of some non-process elements (Si, Ca, Mn and Fe), which could accumulate in the process, were determined in order to establish some parameters to allow process integration of the streams involved, considering operational constraints. The results obtained have shown that it is possible to reduce approximately by 13% the consumption of fresh water and this methodology has been satisfactory.
Assuntos
Conservação dos Recursos Naturais , Resíduos Industriais , Eliminação de Resíduos Líquidos/métodos , Purificação da Água/métodos , Cálcio/química , Fenômenos Químicos , Físico-Química , Conservação dos Recursos Naturais/economia , Estudos de Viabilidade , Ferro/química , Manganês/química , Papel , Rios/química , Silício/químicaRESUMO
BACKGROUND: Laryngeal carcinoma involving anterior vocal commissure (AVC) represents a great challenge for staging and treatment. OBJECTIVES: To compare laryngoscopy and computed tomography (CT) scan efficiency in staging tumors extending to the AVC. We also analyzed the helicoidal axial CT scan accuracy in recognizing this larynx subregion invasion. MATERIAL AND METHODS: Fifty-two glottic and supraglottic laryngeal squamous cell carcinoma patients with tumoral extension to the AVC were prospectively studied from August 2001 to August 2003 at the National Cancer Institute (Rio de Janeiro, Brazil). All patients underwent videolaryngoscopic examination and direct laryngoscopy for lesion extension analysis and biopsy. After AVC helicoidal axial CT scan with sagittal and coronal 1.0 mm thick reconstruction, patients were submitted to surgical treatment. The same pathologist analyzed all surgical specimens. RESULTS: When compared with pathologic stage, clinical endoscopic classification was correct in 40.38% of cases (40% for T1, 29.41% for T2, 46.43% for T3, and 50% in T4). Helicoidal axial CT scan accuracy for AVC tumors was 75% (P = .0001), being more important for T2 (62.50%), T3 (73.91%), and T4 (88.24%) lesions. Identification of radiologic signs described as gross radiologic anterior commissure involvement (GRACI) increased radiologic image staging accuracy to over 96%. CONCLUSIONS: Endoscopic evaluation understaged tumors in all clinical stages but really T1. Helicoidal axial CT scan reformatted to 1.0 mm thick played an important role in correctly staging more advanced AVC laryngeal tumors. Radiologic signs, here identified as GRACI, may be very helpful for tomographic staging and patient treatment.
Assuntos
Carcinoma de Células Escamosas/diagnóstico , Neoplasias Laríngeas/diagnóstico , Prega Vocal/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Carcinoma de Células Escamosas/patologia , Feminino , Glote/patologia , Humanos , Processamento de Imagem Assistida por Computador/métodos , Neoplasias Laríngeas/patologia , Laringoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Estudos Prospectivos , Cartilagem Tireóidea/patologia , Tomografia Computadorizada Espiral/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Gravação em VídeoRESUMO
A retrospective study was undertaken of patients with T1N0M0 squamous cell carcinoma of the oral tongue and floor of the mouth who underwent surgical treatment between 1985 and 1995. Evaluation of two groups of patients (neck dissection versus observation) was made according to the management of the neck. Results were obtained regarding the presence of occult metastases, recurrence in the neck, treatment failure, results of salvage treatment, and disease-free survival. Forty-nine patients underwent surgical treatment: 25 resection of primary and 24 resection plus neck dissection. Overall incidence of regional metastases was 24.5%. Eight patients (16%) developed recurrence of the disease. Seven (14%) had regional recurrences (including 1 with distant metastases) and 1(2%) had local recurrence. Twenty-four percent of patients from the resection of primary group developed neck recurrences in comparison with 4% of the resection plus neck dissection group (P = 0.05). Overall salvage rate was 37.5%. Second primary tumors developed in 16% of patients. Patients who underwent elective neck dissection had a 23% higher disease-free survival rate compared with those who underwent resection of the tumor alone (P = 0.03). The findings of this study stress the importance of control of the neck in early oral cancer. Elective neck dissection significantly improved regional control of the disease.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Bucais/cirurgia , Recidiva Local de Neoplasia/terapia , Terapia de Salvação , Neoplasias da Língua/cirurgia , Adulto , Idoso , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Soalho Bucal/patologia , Neoplasias Bucais/mortalidade , Neoplasias Bucais/patologia , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Observação , Probabilidade , Prognóstico , Estudos Retrospectivos , Estatísticas não Paramétricas , Taxa de Sobrevida , Neoplasias da Língua/mortalidade , Neoplasias da Língua/patologia , Resultado do TratamentoRESUMO
OBJECTIVES: To assess whether supracricoid laryngectomy with cricohiodoepiglottopexy could successfully reach the cure and preserve the voice in glottic laryngeal cancer, we studied 27 patients with T2/T3 squamous cell carcinoma of the larynx treated in our institution with cricohiodoepiglottopexy. STUDY DESIGN: A retrospective analysis has been carried out between 1995 through 1997. We classified 11 patients as T2N0M0 and 16 patients as T3N0M0. Nineteen patients had bilateral selective lateral neck dissection, 3 patients had unilateral lateral neck dissection, and 5 patients had undissected neck. Survival was analyzed under the Kaplan-Meyer method. RESULTS: Five patients had postoperative complications, 2 were treated with a total laryngectomy. The remaining 25 patients kept the normal airway, swallowing, and speech. None of the patients in the neck dissection group had neck metastasis. Two patients had recurrences, 1 with local recurrence was treated with a total laryngectomy and is alive without disease; the other patient had neck recurrence, was treated with radical neck dissection plus radiotherapy, and is dead of the disease. One patient had a second tumor in oropharynx treated with palliative radiotherapy and is dead of the disease. Three years disease-free survival was 75% for T2 and 79% for T3. CONCLUSIONS: This technique is useful in the treatment of selected cases of T3/T2 glottic cancer regarding the extent of disease. The incidence of complications in need of a complete laryngectomy does not compromise the functionality of this technique. The survival is comparable to patients who submitted to total laryngectomy and near-total laryngectomy, regarding the extent of the lesion.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Cartilagem Cricoide/cirurgia , Epiglote/cirurgia , Glote/cirurgia , Osso Hioide/cirurgia , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Adulto , Idoso , Carcinoma de Células Escamosas/mortalidade , Intervalo Livre de Doença , Feminino , Humanos , Incidência , Neoplasias Laríngeas/mortalidade , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Complicações Pós-Operatórias/epidemiologia , Resultado do TratamentoRESUMO
Parental involvement in the care of children who are hospitalized has been encouraged by the government in Brazil, as it has in the United Kingdom (UK). In this paper, key aspects of the UK, North American, and Latin American literature concerning parental participation are discussed, and implications for hospital care of children in Brazil are considered. A study of the division of work between nurses and the mothers (or other relatives) of 10 children hospitalized with chronic illnesses is reported. Data were collected by participant observation of child care in a Brazilian hospital. The results highlight some of the difficulties that arise in the integration of the work of mothers and nurses in hospital care of children and the fragmentation of care into "manual" and "intellectual" work. The results are considered within the theoretical framework of the model of technologic organization of work (Gonçalves, 1979, 1994). Implications for the organization of child care in the hospital are discussed.
Assuntos
Criança Hospitalizada , Doença Crônica/enfermagem , Mães , Atitude do Pessoal de Saúde , Brasil , Criança , Pré-Escolar , Doença Crônica/psicologia , Humanos , Lactente , Mães/educação , Mães/psicologia , Recursos Humanos de Enfermagem Hospitalar/psicologia , Relações Profissional-FamíliaRESUMO
Adolescents with cancer undergo suffering resulting from diagnosis, therapy and changes in their routine and family life. The objective of this study was to identify the chief causes of their suffering, identified in interviews with those patients themselves. The study population were 12 adolescents admitted to the Paediatric Clinic of the Ribeirão Preto Medical School Clinical Hospital, University of São Paulo, from the 13th. November, 1997 to 16th. December, 1997. Data were analysed by means of qualitative approach. The chief causes of suffering reported by the studied adolescents were: hospitalization, restrictions in routine activities, aggressive therapy, modification of self-image and fear of dying. The adolescents not only talked about their suffering but also offered some suggestions to lessen it, as for instance, use of central venous catheter, liberation of visiting time, reducing number of hospitalization events, efficient communication and good rapport with the attending team.
Assuntos
Adolescente Hospitalizado/psicologia , Neoplasias/psicologia , Atividades Cotidianas , Adolescente , Atitude Frente a Morte , Feminino , Humanos , Masculino , Neoplasias/diagnóstico , Neoplasias/terapia , AutoimagemRESUMO
The study aims to identify the frequency with which certificates of live birth are filled out and to analyze the data they provide. To gather the data, the authors used a model birth certificate filled out by research assistants based on information obtained from the reports on mothers and newborns. This information was then compared to data contained in the official birth certificates available in the Information Technology Division of the Municipal Health Department. The sample consisted of 911 certificates of live birth from July 1996 in the ten maternity wards of the city of Ribeirão Preto. Data analysis showed that frequency of completion of birth certificates differs by hospital, involving both physicians and administrative personnel. The authors identified a high level of agreement in the data, i.e., over 90% in 13 of 18 variables compared in the birth certificates and in half of the hospitals investigated. The disagreement occurred especially with respect to data on the number of children per mother, number of prenatal visits, mother's schooling, and father's name.