RESUMO
BACKGROUND: Isolated positive para-aortic lymph node metastasis in endometrial cancer is an uncommon event, ranging from 1% to 3%. OBJECTIVE: Our aim was to evaluate the impact of sentinel lymph node (SLN) mapping on the risk of isolated positive para-aortic lymph node metastasis. METHODS: We retrospectively evaluated a series of 426 patients who underwent SLN mapping with at least one SLN detected from January 2013 to December 2021 (SLN group) compared with a historical series of 209 cases who underwent a systematic pelvic and para-aortic lymphadenectomy between June 2007 and April 2015 (LND group). Isolated para-aortic lymph node metastasis recurrences were included in the SLN group analysis. RESULTS: In the SLN group, 168 cases (39.4%) had backup systematic lymphadenectomy, and 56 (13.1%) had positive lymph nodes compared with 34 (16.3%) in LND group (p=0.18). The SLN group had higher rates of minimally invasive surgeries (p<0.001) and presence of lymphovascular space invasion (p<0.001). Moreover, SLN group had fewer other uterine risk factors, such as high-grade tumors (p<0.001), and deep myometrial invasion (p<0.001). We found that SLN mapped outside the pelvis at pre-sacral, common iliac areas, and para-aortic regions in 2.8% (n=12), 11.5% (n=49), and 1.6% (n=7) of cases, respectively. Overall, 52 (12.2%) patients had positive SLNs, and 3 (5.7%) positive SLNs were found outside the pelvis-one in the pre-sacral region, one in the common iliac area, and one in the para-aortic region. An isolated para-aortic lymph node was found in only 2 (0.5%) cases in the SLN group compared with 7 (3.3%) cases in the LND group (p=0.004). CONCLUSIONS: SLN protocol accurately predicts lymph node status and may decrease the risk of failed identification of isolated para-aortic lymph node metastasis compared with systematic lymphadenectomy.
Assuntos
Neoplasias do Endométrio , Linfonodos , Metástase Linfática , Linfonodo Sentinela , Humanos , Feminino , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Idoso , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Linfonodos/patologia , Linfonodos/cirurgia , Biópsia de Linfonodo Sentinela/métodos , Excisão de Linfonodo/métodos , Adulto , Aorta/patologiaRESUMO
Patients with cutaneous malignancies and locoregional involvement represent a high-risk population for disease recurrence, even if they receive optimal surgery and adjuvant treatment. Here, we discuss how neoadjuvant therapy has the potential to offer significant advantages over adjuvant treatment, further improving outcomes in some patients with skin cancers, including melanoma, Merkel cell carcinoma, and cutaneous squamous-cell carcinoma. Both preclinical studies and in vivo trials have demonstrated that exposure to immunotherapy prior to surgical resection can trigger a broader and more robust immune response, resulting in increased tumor cell antigen presentation and improved targeting by immune cells, potentially resulting in superior outcomes. In addition, neoadjuvant approaches hold the possibility of providing a platform for evaluating pathological responses in the resected lesion, optimizing the prognosis and enabling personalized adaptive management, in addition to expedited drug development. However, more data are still needed to determine the ideal patient selection and the best treatment framework and to identify reliable biomarkers of treatment responses. Although there are ongoing questions regarding neoadjuvant treatment, current data support a paradigm shift toward considering neoadjuvant therapy as the standard approach for selecting patients with high-risk skin tumors.
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Terapia Neoadjuvante , Neoplasias Cutâneas , Humanos , Neoplasias Cutâneas/tratamento farmacológico , Imunoterapia , Melanoma/tratamento farmacológico , Melanoma/terapia , Carcinoma de Célula de Merkel/terapia , Carcinoma de Células Escamosas/terapiaRESUMO
Introduction melanoma patients who become stage III after a positive sentinel node biopsy (SNB) may have several patterns of recurrence patients and methods retrospective analysis of melanoma patients who have undergone SNB in a single institution from 2000 to 2015. Results There were 111 recurrences (45.1%) among 246 (20.3%) SNB positive patients and median DRFS was 77.7 months. After initial treatment, further recurrences occurred in 68 (77.3%) patients, regardless the site of initial recurrence conclusions multimodal strategies are recommended to achieve better results when managing stage III melanoma patients after a positive SNB.
Assuntos
Melanoma , Neoplasias Cutâneas , Humanos , Melanoma/cirurgia , Melanoma/patologia , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Excisão de LinfonodoRESUMO
OBJECTIVE: To evaluate the relation between mismatch repair (MMR) status and the risk of lymph node metastasis in endometrial cancer, and whether this additional data can be incorporated to current SLN (sentinel lymph node) algorithm. METHODS: We included a series of 332 women that underwent SLN mapping ± systematic lymphadenectomy from January 2013 to December 2021. Protein expressions of MLH1, MSH2, MSH6, PMS2 were examined by immuno-histochemistry and considered MMRd (deficient) when at least one protein was not expressed. RESULTS: MMRd was noted in 20.8% of cases and correlated to grade 3 (p = 0.018) and presence of lymphovascular space invasion (p = 0.032). Moreover, MMRd was an independent risk factor for lymph node metastasis (OR 2.76, 95% CI 1.36-5.62). Notably, 21.7% (15/69) cases with MMRd had lymph node metastasis compared to 9.5% (25/263) of cases with MMRp (proficient) (p = 0.005). The overall and bilateral SLN detection rates were 91.9% and 75.9%, respectively. Of the 80 (24%) cases of non-bilateral SLN detection, 66.2% had low-grade tumors (G1/G2) and myometrial invasion <50%. Considering MMR status an independent prognostic factor for lymph node metastasis, a systematic lymphadenectomy (side specific or bilateral) would forgo in 53.7% (43/80) of cases with non-bilateral detection, representing 13% (43/332) of all endometroid tumors. CONCLUSION: MMR status was independently related to lymph node metastasis in endometrioid EC. Moreover, MMR status may help to select patients that can forgo systematic lymphadenectomy in case of undetected SLN.
Assuntos
Carcinoma Endometrioide , Neoplasias do Endométrio , Linfonodo Sentinela , Humanos , Feminino , Linfonodo Sentinela/patologia , Metástase Linfática/patologia , Biópsia de Linfonodo Sentinela , Reparo de Erro de Pareamento de DNA , Carcinoma Endometrioide/cirurgia , Carcinoma Endometrioide/patologia , Excisão de Linfonodo , Neoplasias do Endométrio/patologia , Algoritmos , Linfonodos/cirurgia , Linfonodos/patologia , Estadiamento de NeoplasiasRESUMO
BACKGROUND AND OBJECTIVES: The incidence, predictive, and prognostic impact of programmed cell death (PD-L1) expression in gastric (GC) and gastroesophageal junction tumors (GEJC) treated with perioperative chemotherapy is poorly understood. We aimed to assess PD-L1 expression by immunohistochemistry (IHC) in both pre and posttreatment specimens evaluating its impact on pathological response and survival outcomes. METHODS: Retrospective cohort of patients with GC and GEJ tumors treated in a single western cancer center between 2007 and 2017. PD-L1 expression was assessed by IHC before and after neoadjuvant chemotherapy, in surgical samples, and reported as combined positive score (CPS). CPS > 1% was tested for its association with pathological response and overall survival (OS). RESULTS: We were able to assess PD-L1 expression in at least one tissue sample from 155 subjects. PD-L1 positivity rate was 20%. In 74 paired samples, a 21% discordance between PD-L1 expression in biopsy sample and surgical specimen was observed. With a median follow-up period of 60.3 months, 5-years disease-free survival was 60.5% with a median OS not reached. PD-L1 expression was neither associated with pathological response or survival outcomes. CONCLUSIONS: PD-L1 expression in the setting of locally advanced GC tumors was relatively low and can vary considering the tissue sample analyzed. This expression had no association with survival or pathological response in this population.
Assuntos
Antígeno B7-H1 , Neoplasias Gástricas , Antígeno B7-H1/metabolismo , Junção Esofagogástrica/patologia , Junção Esofagogástrica/cirurgia , Humanos , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/metabolismo , Neoplasias Gástricas/cirurgiaRESUMO
OBJECTIVE: Due to the growing evidence of sentinel lymph node (SLN) mapping in endometrial cancer (EC), our aim was to evaluate the impact of SLN mapping and other clinical-pathological variables in the risk of developing lymphocele. METHODS: We retrospectively analyzed a series of patients with ECs who underwent lymph node staging with SLN mapping with or without systematic pelvic ± para-aortic lymphadenectomy from November 2012 to January 2020. The lymphocele diagnosis was performed by computed tomography or magnetic resonance imaging. RESULTS: Of 348 patients included, 178 underwent SLN mapping only and 170 underwent SLN mapping and systematic lymphadenectomy (46.5% pelvic only; 53.5% pelvic and para-aortic). Seventy-three (21%) patients had open surgery and 275 (79%) had a minimally invasive approach. After a median follow-up of 25.4 months, the overall prevalence of lymphocele was 8.6% (n = 30), with 29 cases in a pelvic location. Lymphocele was found in 3.4% (n = 6/178) of patients submitted to SLN mapping only, compared with 14.1% (n = 24/170) among those who underwent SLN with lymphadenectomy (p = 0.009). Among those patients with lymphocele, seven (23.3%) were symptomatic and five (16.6%) required drainage. All symptomatic cases occurred in lymphoceles larger than 4 cm (p = 0.001). Neither resected lymph node count nor the type of systematic lymphadenectomy were related to the presence of lymphocele. Systematic lymphadenectomy was the only factor that emerged as a risk factor for the presence of lymphocele in multivariate analysis (odds ratio 3.68, 95% confidence interval 1.39-9.79; p = 0.009). CONCLUSIONS: Our data suggest that SLN mapping independently decreases the risk of lymphocele formation compared with full lymphadenectomy in EC.
Assuntos
Neoplasias do Endométrio , Linfocele , Linfonodo Sentinela , Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Excisão de Linfonodo , Metástase Linfática , Linfocele/diagnóstico por imagem , Linfocele/epidemiologia , Linfocele/etiologia , Estadiamento de Neoplasias , Estudos Retrospectivos , Linfonodo Sentinela/diagnóstico por imagem , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Biópsia de Linfonodo SentinelaRESUMO
BACKGROUND: Health care workers are exposed to bloodborne pathogens through occupational injuries, and the replacement of sharps by safety-engineered devices has been recommended as a key preventive measure. This recommendation has been difficult to implement in Brazil. METHODS: We conducted a retrospective study of selected data from a database of blood and body fluid exposures reported from January 2007 through December 2011 in a public general hospital in Rio de Janeiro where, from the end of 2009, a safety lancet for blood glucose testing (BGT) was introduced. A log-binomial model was used to evaluate the effect of the introduction of the safety lancet on the proportion of percutaneous injuries (PIs) during BGT in the nursing staff. RESULTS: Nursing staff had a significant reduction in rate of PIs per 100 full-time equivalents from 2007 to 2011 (P < .001), and medical residents had the highest rate throughout the same period. A reduction of PIs by small-gauge needles was observed since 2009, and injuries during BGT fell abruptly in 2010 and 2011 paralleling the number of purchased safety lancets (P < .001). CONCLUSION: The adoption of a single safety device, which required no training, significantly reduced PIs among the nursing team.
Assuntos
Equipamentos e Provisões , Testes Hematológicos/métodos , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Ferimentos Penetrantes Produzidos por Agulha/prevenção & controle , Enfermeiras e Enfermeiros , Brasil/epidemiologia , Hospitais Gerais , Hospitais Públicos , Humanos , Estudos RetrospectivosRESUMO
Introdução Os trabalhadores da saúde estão expostos a riscos biológicos no exercício da profissão, particularmente os agentes transmitidos por sangue e secreções, através de acidentes perfurocortantes. A maioria dos países implantou normatizações ou leis visando proteger estes profissionais, entre outros através da introdução de dispositivos de segurança. Desde a publicação da NR.32 em novembro 2005, as novas diretrizes vêm sendo implementadas nas unidades de saúde brasileiras, com dificuldades. Objetivos: (1) Principal: Verificar as alterações na incidência e no perfil dos acidentes perfurocortantes após a introdução de dispositivos de segurança (lanceta retrátil e catéteres para punção venosa periférica) no Hospital Federal dos Servidores do Estado a partir de 2009 em relação ao período anterior (2001-2008). (2) Secundários: Determinar os tipos de acidentes que sofreram redução. - Determinar a(s) categoria(s) profissional (is) beneficiadas pela introdução do(s) dispositivo(s) Estimar a relação entre os acréscimos de custos devidos à aquisição do(s) dispositivo(s) e a redução teórica das despesas obtida com diminuição dos acidentes. Métodos. Análise retrospectiva de um arquivo contendo os dados dos acidentes biológicos registrados entre janeiro de 2001 e dezembro de 2011 quanto a natureza do acidente, categoria profissional, tempo de profissão, tipo de instrumento, causa e/ou circunstância. Foram comparados os índices ao longo do tempo, particularmente até 2008 e de 2009 a 2011. Estimou-se também, com a ajuda de um modelo teórico, o impacto eventual de uma lanceta retrátil para coleta da glicemia capilar no orçamento da instituição. Resultados. A proporção dos acidentes perfurocortantes diminuiu a partir de 2009 em comparação com o período anterior (P<0,001). Evidenciou-se uma relação inversa entre a média do tempo de experiência dos profissionais e o número absoluto dos acidentes perfurocortantes...
Background Healthcare workers are exposed to bloodborne pathogens through occupationalinjuries and the replacement of sharps by safety-engineered devices has been recommended asa key preventive measure. This recommendation has been difficult to implement in Brazil.Objectives: (1) Primary. To evaluate the impact of safety-engineered devices (SEDs)introduced since 2008, on the profile of percutaneous exposures reported in a tertiary generalhospital in Rio de Janeiro. (2) Secondary. To determine the nature of avoided exposures, theoccupational group(s) benefited by the SEDs and the hypothetical impact of purchasing thedevice(s) on costs for the institution. Methods. Retrospective study of a database of blood andbody fluid exposures reported from January 2001 through December 2011 in a public generalhospital in Rio de Janeiro where, from the end of 2009, along with SEDs for IV usage, asafety lancet for blood glucose testing (BGT) was introduced. A log-Poisson regression modelwas used to determine the effect of selected co-variates on total percutaneous injuries (PIs)and PIs during BGT. The hypothetical impact of purchasing the safety lancet on costs wasalso analyzed. Results. An inverse relation was apparent between average length ofprofessional experience and absolute number of PIs. Nursing staff had a significant reductionin rate of PIs per 100 full-time equivalents from 2007 to 2011 (P<0.001), while medicalresidents had the highest rate throughout the same period...
Assuntos
Humanos , Glicemia , Cateterismo Periférico , Pessoal de Saúde , Ferimentos Perfurantes , Vacinas contra Hepatite BRESUMO
Group B Streptococcus (GBS) is a leading cause of infectious morbidity in newborns. We describe the prevalence of GBS colonization and the serotypes and antibiotic susceptibility profiles of isolates obtained from a cohort of human immunodeficiency virus (HIV)-infected pregnant women. This was a cross-sectional study at a centre for the prevention of mother-to-child transmission of HIV. Vaginal and rectal swabs were collected at 35-37 weeks of gestation from 158 eligible women. GBS isolates were serotyped and antimicrobial susceptibility tests performed. Patient sociodemographic characteristics, CD4 counts and viral loads were abstracted from records. The overall anogenital prevalence of GBS colonization was 49/158 (31.0%): 40/158 (25.3%) for vagina, 19/158 (12.0%) for rectum and 10/158 (6.3%) for both. Predominant serotypes were Ib (34.9%) and Ia (25.6%). All were penicillin-susceptible. Two were resistant to erythromycin (4.0%) and one to clindamycin (2.0%). The colonization rate by GBS was high in this cohort. Serotype Ib was the most frequently identified.
Assuntos
Infecções por HIV/complicações , Complicações Infecciosas na Gravidez/microbiologia , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/efeitos dos fármacos , Adulto , Antibacterianos/farmacologia , Contagem de Linfócito CD4 , Clindamicina/farmacologia , Estudos Transversais , Farmacorresistência Bacteriana , Eritromicina/farmacologia , Feminino , Humanos , Lactente , Recém-Nascido , Testes de Sensibilidade Microbiana , Penicilinas/farmacologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Prevalência , Reto/microbiologia , Sorotipagem , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae/isolamento & purificação , Vagina/microbiologia , Carga ViralRESUMO
OBJECTIVE: HIV transmission has been associated with offering a child food prechewed by an HIV-infected caregiver. We assessed awareness of prechewing and oral prewarming of food by an adult before offering it to a child among HIV-infected pregnant women and clinical investigators in 3 Latin American countries. METHODS: HIV-infected pregnant women at 12 sites (Eunice Kennedy Shriver National Institute of Child Health and Human Development International Site Development Initiative Perinatal Longitudinal Study in Latin American Countries, a prospective cohort trial) in Argentina, Brazil, and Peru were administered a screening survey about prechewing/prewarming of infant foods and cautioned against these feeding practices. Survey responses were analyzed, overall, and stratified according to country. RESULTS: Of the 401 HIV-infected pregnant women interviewed, 34% had heard about prechewing (50% from Argentina, 32% from Brazil, and 36% from Peru), 23% knew someone who prechewed food for infants, and 4% had prechewed food in the past. Seventeen percent had heard about oral prewarming of food, 13% knew someone who prewarmed food for infants, and 3% had prewarmed food for an infant in the past. Women who reported knowing someone who prechewed were more likely to also know someone who prewarmed food (P < .0001). Few site investigators anticipated that their patients would be aware of these practices. CONCLUSIONS: Prechewing food, a potential risk factor for HIV transmission, and orally prewarming food, which has not been associated with HIV transmission but might expose a child to blood from an HIV-infected adult, are not uncommon practices in Latin America. Both practices should be further investigated. Site investigator responses underscore that health care providers could be missing information about cultural practices that patients may not report unless specifically asked.
Assuntos
Transmissão de Doença Infecciosa/prevenção & controle , Infecções por HIV/transmissão , Conhecimentos, Atitudes e Prática em Saúde , Cuidado do Lactente/métodos , Alimentos Infantis/virologia , Mastigação , Adulto , Argentina , Brasil , Pré-Escolar , Estudos de Coortes , Transmissão de Doença Infecciosa/estatística & dados numéricos , Feminino , Infecções por HIV/prevenção & controle , Soropositividade para HIV , Educação em Saúde/organização & administração , Humanos , Lactente , Masculino , Relações Mãe-Filho , Avaliação das Necessidades , Peru , Estudos ProspectivosRESUMO
This study aimed to elucidate the social and behavioral factors and public health system characteristics that influenced pregnant women's adherence to prenatal care. Forty women diagnosed as HIV-positive by rapid test at delivery were included. Socioeconomic data were collected and a semi-structured interview was conducted. Eight women had > 6 prenatal visits and 12 had no visits. Interviews were submitted to qualitative content analysis. The themes fit into two blocks: those seen as hindering adherence, like unwanted pregnancy, lack of family support, prior knowledge of serological status, adverse social context, negative experiences with prenatal care, and disbelief towards prenatal care, and those facilitating adherence, like family support, valuing healthcare, wanting a tubal ligation, receptiveness by the healthcare team, and positive previous experience with prenatal care. Improving our understanding of the socio-cultural context should help promote strategies to reach such women and include them in better quality care.
Assuntos
Soropositividade para HIV/psicologia , Acessibilidade aos Serviços de Saúde/normas , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Cooperação do Paciente/psicologia , Complicações Infecciosas na Gravidez/psicologia , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Atitude do Pessoal de Saúde , Características Culturais , Feminino , Humanos , Cooperação do Paciente/estatística & dados numéricos , Gravidez , Pesquisa Qualitativa , Apoio Social , Fatores Socioeconômicos , Adulto JovemRESUMO
Objetivamos compreender os fatores sócio-comportamentais e do Sistema Único de Saúde (SUS) que, na visão de mulheres identificadas como HIV+ por teste rápido no parto, dificultaram ou impediram a adesão ao pré-natal. Foram incluídas 40 mulheres, das quais apenas oito tinham tido seis consultas ou mais. Foi utilizada a abordagem qualitativa, com entrevistas semi-estruturadas. Os dados foram analisados seguindo os preceitos da análise temática. Os resultados foram agrupados em dois blocos: os que dificultaram a adesão ao pré-natal: não aceitação da gestação, falta de apoio familiar, conhecimento prévio da soropositividade, contexto social adverso, experiências negativas de atendimento e práticas e concepções de descrédito em relação ao pré-natal, e os que favoreceram a adesão: apoio familiar, discurso de valorização do cuidado com a saúde, desejo de laqueadura tubária, acolhimento pela equipe de saúde e experiências positivas de assistência. Uma compreensão melhor do contexto sociocultural deveria permitir a construção de estratégias capazes de resgatar essas mulheres para um sistema de saúde mais acolhedor.
This study aimed to elucidate the social and behavioral factors and public health system characteristics that influenced pregnant women's adherence to prenatal care. Forty women diagnosed as HIV-positive by rapid test at delivery were included. Socioeconomic data were collected and a semi-structured interview was conducted. Eight women had > 6 prenatal visits and 12 had no visits. Interviews were submitted to qualitative content analysis. The themes fit into two blocks: those seen as hindering adherence, like unwanted pregnancy, lack of family support, prior knowledge of serological status, adverse social context, negative experiences with prenatal care, and disbelief towards prenatal care, and those facilitating adherence, like family support, valuing healthcare, wanting a tubal ligation, receptiveness by the healthcare team, and positive previous experience with prenatal care. Improving our understanding of the socio-cultural context should help promote strategies to reach such women and include them in better quality care.
Assuntos
Adulto , Feminino , Humanos , Gravidez , Adulto Jovem , Soropositividade para HIV/psicologia , Acessibilidade aos Serviços de Saúde/normas , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Cooperação do Paciente/psicologia , Complicações Infecciosas na Gravidez/psicologia , Cuidado Pré-Natal , Atitude do Pessoal de Saúde , Características Culturais , Cooperação do Paciente/estatística & dados numéricos , Pesquisa Qualitativa , Apoio Social , Fatores Socioeconômicos , Adulto JovemRESUMO
Introdução:a autonomia alimentar se define na adolescência, fase em que são mais influenciados por modismos nutricionais, podendo originar transtornos alimentares. Objetivo: identificar adolescentes do sexo feminino de escolas públicas e privadas com comportamentos de risco para o desenvolvimento de transtornos alimentares associados ao estado nutricional e rede de ensino. Materiais e métodos: foram entrevistadas e avaliadas, mediante índice de massa corporal, 100 adolescentes matriculadas em quatro escolas, sendo duas da rede pública de ensino e duas escolas privadas. Para avaliação do risco de anorexia nervosa foi aplicado o Teste de Atitudes Alimentares (EAT-26) e para identificar risco de bulimia o Teste de Investigação Bulímica de Edimburgo (BITE). Resultados: a presença de sintomas de risco para anorexia nervosa foi encontrada em 12% da amostra, sendo maior entre as adolescentes de escolas públicas. O teste (BITE) identificou sintomas de risco para bulimia em 41% da amostra, incluindo comportamento alimentar de risco em 34% e comportamento alimentar compulsivo indicando grande possibilidade de se ter bulimia em 7% das adolescentes; também com maior prevalência entre aquelas de escolas públicas. O risco para bulimia e anorexia apresentou associação positiva com estado nutricional adequado e rede pública de ensino. Conclusão: a prevalência de risco para anorexia e bulimia apresentou-se elevada na amostra estudada. Ressalta-se que as adolescentes de escolas públicas estão mais propensas aos transtornos alimentares, o que requer ações estruturadas de orientação individual e familiar visando à prevenção e o controle deste problema.
Introduction: the food sovereignty is defined in adolescence, phase that they are more influenced by nutrition fads can lead to eating disorders. Objective: identify female teenagers of public and private schools with risk behaviors the development of eating disorders associated with nutritional status and education network. Materials and Methods: we interviewed and evaluated by body mass index, 100 adolescents enrolled in four schools, two from public schools and two private schools. To assess the risk of anorexia nervosa was applied Eating Attitudes Test (EAT-26) and to identify the risk of bulimia Bulimic Investigatory Test Edinburgh (BITE). Results: the presence of symptoms at risk for anorexia nervosa was found in 12% of the sample, being higher among adolescents in public schools. The test (BITE) indentified risk for symptoms of bulimia in 41% of the sample, including feeding behavior of risk in 34% and compulsive eating behavior indicating a high possibility of having bulimia in 7% of adolescents, also most prevalent among those schools public. The risk for bulimia and anorexia presented positive association with nutritional status and public schools. Conclusion: the prevalence of risk for anorexia and bulimia was high in our sample. It is emphasized that the adolescents in public schools are more prone to eating disorders, wich requires structured actions of individual and family guidance for the prevention and control this problem
Assuntos
Humanos , Feminino , Transtornos da Alimentação e da Ingestão de Alimentos , Anorexia , Bulimia , Saúde Pública , Estudos Transversais , AdolescenteRESUMO
OBJECTIVE: To describe trends in sociodemographic, immunological and virological profiles and interventions to decrease the risk of mother-to-child HIV transmission. METHODS: Retrospective cohort study conducted at a tertiary institution in Rio de Janeiro, Brazil from January 1996 to December 2004. Analysis was performed by stratification in three time periods: 1996-1998 (P1), 1999-2001 (P2) and 2002-2004 (P3). RESULTS: In 9 years, 622 pregnancies occurred. Complications included: maternal mortality 0.3 percent, stillbirths 2.5 percent, miscarriages 0.6 percent, neonatal mortality 1.1 percent, prematurity 9.9 percent, low birth weight (LBW) 16.5 percent, congenital malformations 2.2 percent. The number of HIV-infected pregnant patients grew threefold over time reflecting increased prevalence of disease and patient identification. HIV diagnosis before pregnancy increased from 30 percent in P1 to 45 percent in P3. The proportion of pregnant women receiving highly active antiretroviral therapy increased from none (P1) to 88 percent (P3) with a significant trend towards women delivering at undetectable viral loads in later years despite a higher frequency of advanced disease. Scheduled cesarean deliveries increased from 35 percent in P1 to 48 percent in P3. Perinatal transmission rates were 2.4 percent with a decline from 3.5 percent in P1 to 1.6 percent in P3. Neonatal outcomes tended to remain constant or improve with time. A slight rise in LBW and congenital malformations were observed. CONCLUSIONS: During the observational period, HIV+ pregnant women presented with more advanced disease and lower socio-economic status. However, improved management of HIV-infected patients (associated with increased identification and increased availability of treatment) resulted into very low transmission rates similar to those of developed countries with overall improvement of patient outcomes.
OBJETIVOS: Descrever as tendências temporais nas características sociodemográficas, imunológicas e virológicas e as das condutas utilizadas para reduzir o risco da transmissão mãe-filho do HIV. MÉTODOS: Estudo de coorte retrospectivo em uma instituição de saúde terciária no Rio de Janeiro de janeiro de 1996 a dezembro de 2004. A análise utilizou a estratificação em três períodos de tempo: 1996-1998 (P1), 1999-2001 (P2) e 2002-2004 (P3). RESULTADOS: Em 9 anos, 622 gestações foram acompanhadas. As complicações foram: mortalidade materna 0,3 por cento, natimortos 2,5 por cento, abortos 0,6 por cento, mortalidade neonatal 1,1 por cento, prematuridade 9,9 por cento, baixo peso ao nascer (BPN) 16,5 por cento, malformações congênitas 2,2 por cento. O número de gestantes HIV positivo triplicou ao longo do tempo, refletindo o aumento da prevalência da doença e a melhor identificação das pacientes. O diagnóstico da infecção pelo HIV antes da gestação aumentou de 30 por cento em P1 para 45 por cento em P3. A proporção de gestantes recebendo o tratamento combinado potente aumentou de zero em P1 para 88 por cento em P3 com uma tendência significativa a ter uma carga viral abaixo do limite de detecção no parto nos últimos anos apesar de uma maior proporção de pacientes com doença mais avançada. O índice de cesarianas eletivas aumentou de 35 por cento em P1 para 48 por cento em P3. A taxa de transmissão perinatal global foi de 2,4 por cento caindo de 3,5 por cento em P1 para 1,6 por cento em P3. Os desfechos neonatais tenderam a permanecer constantes ou a melhorar ao longo do tempo. Um discreto aumento dos índices de BPN e de malformações congênitas foi observado. CONCLUSÕES: Ao longo do período de estudo aumentou a proporção de gestantes HIV positivo com doença mais avançada e com padrão socioeconômico mais baixo. Por outro lado, a melhora da abordagem terapêutica dos pacientes infectados pelo HIV, associada a uma maior detecção de casos e maior acesso...
Assuntos
Feminino , Gravidez , Recém-Nascido , Humanos , Síndrome da Imunodeficiência Adquirida , Terapia Antirretroviral de Alta Atividade , HIV , Transmissão Vertical de Doenças Infecciosas , Gravidez , Brasil , Estudos de CoortesRESUMO
OBJECTIVE: The purpose of this study was to complete an evaluation of nevirapine (NVP) toxicity in a cohort of HIV+ pregnant women. STUDY DESIGN: This was a retrospective study of 611 women followed from January 1996 to December 2003. All women who used NVP for > 7 days were included. Multivariate logistic regression was used to test independent association of CD4 and hepatitis C virus (HCV) infection related to the outcome of toxic effects of NVP. RESULTS: One hundred ninety-seven women were exposed to NVP for > 7 days, and toxicity occurred in 11 (5.6%), leading to drug discontinuation in 7 patients. One case of Stevens-Johnson syndrome occurred. No serious liver toxicity occurred except for 1 grade 4 cholestasis. Median CD4 was 344 in women without toxicities and 298 in women with toxicities. HCV was the only significant factor associated to toxicity by logistic regression (odds ratio [OR] 15.61, P = .001). CONCLUSION: NVP toxicities occurred in a very small fraction of patients and were not associated with fatalities.
Assuntos
Fármacos Anti-HIV/efeitos adversos , Infecções por HIV/tratamento farmacológico , Nevirapina/efeitos adversos , Complicações Infecciosas na Gravidez/tratamento farmacológico , Adulto , Fármacos Anti-HIV/sangue , Fármacos Anti-HIV/uso terapêutico , Contagem de Linfócito CD4 , Colestase/induzido quimicamente , Estudos de Coortes , Feminino , Infecções por HIV/sangue , Infecções por HIV/complicações , Hepatite B/complicações , Hepatite C/complicações , Humanos , Nevirapina/uso terapêutico , Gravidez , Estudos Retrospectivos , Síndrome de Stevens-Johnson/induzido quimicamenteRESUMO
Este artigo discute as razões que levam mulheres da camada média da população, entre 25 e 35 anos a prolongar sua permanência na casa dos pais, ainda que, na maioria dos casos, as condições econômico-financeiras para construir seu próprio lar estejam presentes. Foram entrevistadas sete mulheres. Em suas falas encontramos como razões preponderantes, a comodidade e o conforto encontrados na casa dos pais e a espera por um casamento como um rito de passagem para construir sua própria moradia. Com ênfase menor, priorizam uma carreira profissional; desejam manter o mesmo padrão de vida que têm na casa dos pais; há um forte vínculo de dependência afetiva entre pais e filhas. Essas jovens se encontram em meio a valores tradicionais e contemporâneos, tentando afirmar-se como sujeito numa sociedade que lhes apresenta demandas contraditórias
Assuntos
Humanos , Feminino , Adulto , Dependência Psicológica , Valores Sociais , Mulheres , Entrevistas como AssuntoRESUMO
Este artigo discute as razões que levam mulheres da camada média da população, entre 25 e 35 anos a prolongar sua permanência na casa dos pais, ainda que, na maioria dos casos, as condições econômico-financeiras para construir seu próprio lar estejam presentes. Foram entrevistadas sete mulheres. Em suas falas encontramos como razões preponderantes, a comodidade e o conforto encontrados na casa dos pais e a espera por um casamento como um rito de passagem para construir sua própria moradia. Com ênfase menor, priorizam uma carreira profissional; desejam manter o mesmo padrão de vida que têm na casa dos pais; há um forte vínculo de dependência afetiva entre pais e filhas. Essas jovens se encontram em meio a valores tradicionais e contemporâneos, tentando afirmar-se como sujeito numa sociedade que lhes apresenta demandas contraditórias (AU)
Assuntos
Humanos , Adulto , Feminino , Mulheres , Dependência Psicológica , Valores SociaisRESUMO
We report such a case of malignant syphilis in a 42-year-old HIV-infected man, co-infected with hepatitis B virus, who presented neurolues and the classical skin lesions of lues maligna. The serum VDRL titer, which was 1:64 at presentation, increased to 1:2,048 three months after successful therapy with penicillin, decreasing 15 months later to 1:8.