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Syphilis remains a significant public health concern, with serological assays being the primary method for diagnosis. However, molecular techniques have proven to be reliable tools for the diagnosis and understanding of the transmission dynamics of Treponema pallidum infection. This study aimed to evaluate the efficacy of syphilis treatment using molecular assays, perform Enhanced Centers for Disease Control and Prevention (ECDC) typing, and analyze resistance (macrolide and doxycycline) in the T. pallidum isolate. PCR assay amplified treponemal DNA only from the lesion sample, whereas qPCR was able to amplify DNA in both lesion and blood samples before treatment. Throughout the treatment follow-up, qPCR effectively did not identify treponemal DNA in the blood for up to one to two weeks after treatment. ECDC typing revealed the genotype 14 e/g in the Brazilian T. pallidum isolate, and the presence of the A2058G mutation in 23 S rRNA gene, indicating macrolide resistance. Although, the G1058C mutation in 16 S rRNA gene was not detected. Notably, qPCR demonstrated its potential for diagnosing T. pallidum in blood samples, even when the treponemal DNA levels were low, enabling more accurate and sensitive diagnosis and guiding better syphilis therapy. In addition, to the best of our knowledge, this study represents the first identification of subtype 14 e/g and azithromycin resistance in a Brazilian T. pallidum isolate.
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Antibacterianos , Sífilis , Treponema pallidum , Treponema pallidum/genética , Treponema pallidum/isolamento & purificação , Treponema pallidum/classificação , Treponema pallidum/efeitos dos fármacos , Sífilis/microbiologia , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Humanos , Brasil , Antibacterianos/uso terapêutico , Antibacterianos/farmacologia , Genótipo , Farmacorresistência Bacteriana/genética , DNA Bacteriano/genética , Masculino , Macrolídeos/farmacologia , Tipagem Molecular/métodos , Doxiciclina/uso terapêutico , Adulto , RNA Ribossômico 23S/genética , SeguimentosRESUMO
Background: Endometrial cancer is of increasing concern in several countries, including Brazil, in part because of an ageing population, declines in fertility, and the increasing prevalence of obesity. Although endometrial tumors had lagged behind other cancer types in terms of treatment improvements, molecular characterization of these tumors is paving the way for novel therapies and an expansion of the therapeutic arsenal. We aimed to help medical oncologists who manage patients with recurrent or metastatic endometrial cancer in the Brazilian healthcare setting. Methods: The panel, composed of 20 medical oncologists, convened in November 2021 to address 50 multiple-choice questions on molecular testing and treatment choices. We classified the level of agreement among panelists as (1) consensus (≥75% choosing the same answer), (2) majority vote (50% to <75%), or (3) less than majority vote (<50%). Results: Consensus was present for 25 of the 50 questions, whereas majority vote was present for an additional 23 questions. Key recommendations include molecular testing for every patient with recurrent/metastatic endometrial cancer; choice of first-line treatment according to microsatellite instability and HER2, with the addition of programmed death ligand 1 (PD-L1) and hormone receptors (HRs) for second-line therapy; carboplatin and paclitaxel as the preferred option in first-line treatment of HER2-negative disease, with the addition of trastuzumab in HER2-positive disease; pembrolizumab plus lenvatinib as a key option in second line, regardless of HER2, PD-L1 or HRs; and various recommendations regarding treatment choice for patients with distinct comorbidities. Conclusion: Despite the existing gaps in the current literature, the vast majority of issues addressed by the panel provided a level of agreement sufficient to inform clinical practice in Brazil and in other countries with similar healthcare environments.
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Diabetes mellitus, tabagismo e dislipidemia são mais prevalentes em pacientes com doença pulmonar obstrutiva crônica (DPOC), a quarta causa de mortalidade no mundo. Este estudo empregou um modelo de doença pulmonar em ratos Wistar que incorporou esses três fatores de risco e investigou os efeitos da Baccharis trimera, uma planta medicinal amplamente utilizada, uma vez que nenhum estudo avaliou seus efeitos pulmonares. Os ratos diabéticos e dislipidêmicos foram expostos à fumaça de cigarro por 4 semanas e tratados com veículo (grupo C-), extrato de B. trimera (HEBT), ou sinvastatina+insulina, por 2 semanas. O lavado broncoalveolar foi realizado para avaliar a inflamação. Os pulmões foram coletados para análises histopatológicas e do estado redox. Foi observada diminuição do peso corporal, aumento do estresse oxidativo, inflamação e alterações histopatológicas no grupo C-. HEBT reverteu essas alterações e apresentou efeito antiinflamatório moderado. O tratamento com HEBT apresentou efeitos promissores para a DPOC.
Diabetes mellitus, smoking, and dyslipidemia are more prevalent in patients with chronic obstructive pulmonary disease (COPD), the fourth leading cause of mortality worldwide. This study employed a model of lung disease in Wistar rats that incorporated these three risk factors, and investigated the effects of Baccharis trimera, a widely used medicinal plant, since no previous studies have evaluated its pulmonary effects. The diabetic and dyslipidemic rats were exposed to smoke for 4 weeks and treated with vehicle (C- group), an extract of B. trimera (HEBT), or simvastatin+insulin, for 2 weeks. The bronchoalveolar lavage was performed to evaluate inflammation. The lungs were collected for histopathological and redox state analyses. A decrease in body weight, an increase in oxidative stress, inflammation, and histopathological changes were observed in C- group. HEBT reversed these alterations and had a moderate antiinflammatory effect. Treatment with HEBT present promising effects for COPD.
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We examined the validity of the Brazilian Frequency of Suicidal Ideation Inventory (FSII-Br), an adaptation of the Frequency of Suicidal Ideation Inventory (FSII), in 946 Brazilian undergraduates. Confirmatory factor analysis of the FSII-Br demonstrated a one-factor model accounting for 62.39% of the variance in FSII-Br scores with a good FIT index. Correlation analyses demonstrated that the FSII-Br was positively correlated with both measures of suicide ideation and suicide risk (viz., depressive symptoms, anxious symptoms, and hopelessness), providing construct validity. Thus, the FSII-Br was found to be a promising tool in assessing suicide risk among Brazilian adults.
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Ansiedade , Ideação Suicida , Adulto , Brasil , Análise Fatorial , Humanos , EstudantesRESUMO
INTRODUCTION: Phyllodes tumor (PT) of the breast, particularly malignant phyllodes tumor (mPT), is a rare fibroepithelial neoplasm. A complex diagnosis is based on pathologic, radiologic, and clinical findings, with controversies about what is the best therapeutic strategy. OBJECTIVE: Our objective was to provide an overview of the clinical, pathologic, and therapeutic aspects of this rare tumor. CONCLUSIONS: mPT is a rare presentation of breast cancer and a challenge in clinical practice. A multidisciplinary approach should take into account some aspects like pathogenic mutations and hereditary syndromes. Oncologic surgery is the fundamental approach, and the use of adjuvant therapies is still controversial due to the lack of clinical trials. Treatment recommendations should be individualized according to patient risk and preferences. Prospective studies are fundamental to clarifying the best treatment for these tumors.
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Introdução: A obturação do canal radicular tem sido considerada um fator decisivo no sucesso do tratamento endodôntico. Objetivo: O objetivo da presente revisão sistemática foi avaliar estudos em animais que utilizaram parâmetros histopatológicos para determinar a influência da obturação do canal radicular no processo de reparo da periodontite apical. Métodos: As buscas foram realizadas nas bases de dados PubMed, Lilacs, Scielo, Science Direct e BBO, utilizando palavras-chave indexadas e não indexadas. Foram considerados artigos publicados no período de 2003 a 2019, e aplicados critérios de inclusão e exclusão para seleção dos artigos. Resultados: Cinco artigos atenderam aos critérios de elegibilidade e foram incluídos para análise qualitativa na revisão sistemática. Conclusão: A obturação do canal radicular, no que diz respeito ao seu limite apical, pode influenciar o reparo da periodontite apical, quando há presença de bactérias remanescentes no interior do canal. O uso de cimentos endodônticos com propriedades antimicrobianas não foi efetivo na eliminação de bactérias residuais do canal radicular e na reparação completa da periodontite apical.
Introduction: Root canal fillings are a decisive factor in the success of endodontic treatment. This systematic review evaluated animal studies using histopathological parameters to determine the effect of root canal filling on the healing of apical periodontitis. Methods: A search was conducted in PubMed, Lilacs, Scielo, Science Direct and BBO using indexed and non-indexed keywords. Studies published from 2003 to 2019 were selected according to inclusion and exclusion criteria. Results: Five animal studies met eligibility criteria and were included in the systematic review for a qualitative analysis. Conclusion: The extension of the root canal filling may affect the healing of apical periodontitis when bacteria remain in the canal. Root canal sealers with antimicrobial properties were not effective in eliminating bacteria remaining in the root canal, nor in promoting the complete healing of apical periodontitis (AU).
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Humanos , Periodontite Periapical , Obturação do Canal Radicular , Derrame de Bactérias , Cavidade Pulpar , Estudos de Avaliação como AssuntoRESUMO
Syphilis, an infectious disease considered a global public health concern, can cause stillbirths and neonatal deaths. This highlights the importance of continuous surveillance studies among women of reproductive age. A cross-sectional study was carried out to analyze the prevalence and risk factors associated with Treponema pallidum infection in women assisted by primary health care units in Dourados, a city located in Mato Grosso do Sul State, Brazil, which borders Paraguay. A questionnaire was applied to a population-based sample, blood samples were collected for syphilis testing and multivariable analyses were performed to screen associations with T. pallidum infection. The prevalence of T. pallidum infection was 6.04%. Bivariate analysis showed that women referring multiple sexual partners (c2: 6.97 [p=0.014]), income less 2 minimal wages (c2: 15.93 [p=0.003]), who did not have high school (c2: 12.64 [p=0.005]), and reporting history of STIs (c2: 7.30 [p=0.018]) are more likely to have syphilis. In the multivariate analysis, a highest prevalence ratio was observed in women with income less than 2 minimal wages (PR: 0.96 [95% CI: 0.85 - 0.97]), and who did not have high school (PR: 0.94 [95% CI: 0.90 - 0.98]). In addition, 80% of the women reported irregular use of condoms and 63.89% declared having sexual intercourses with multiple partners, which creates more opportunities for the transmission of the infection. These results highlight the need for healthcare systems to implement initiatives to monitor syphilis screening and the commitment of patients and their sexual partners to the treatment in order to achieve a decrease of new cases.
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Sífilis/epidemiologia , Treponema pallidum/isolamento & purificação , Adulto , Idoso , Brasil/epidemiologia , Cidades , Preservativos , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Saúde Pública , Estudos Soroepidemiológicos , Sífilis/diagnóstico , Sexo sem ProteçãoRESUMO
Female sex workers (FSWs) represent a high vulnerability group for the acquisition of sexual and parenteral infections such as hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. The present study aimed to determine the prevalence of serological markers and risk factors associated with exposure to HBV and HCV among FSWs in the state of Pará, Brazil. A cross-sectional study using principles of the time location sampling (TLS) method was conducted in four cities (Belém, Bragança, Barcarena, and Augusto Corrêa) of the state of Pará, from 2005 to 2006. In total, 365 FSWs were interviewed using a standardized questionnaire. Blood samples were collected and tested for serological markers of exposure to HBV and HCV using an enzyme immunoassay. The overall prevalence of exposure to HBV and HCV was 36.7% and 7.7%, respectively. The prevalence of surface antigen of HBV was 3.0%. The prevalence of anti-HBc and anti-HBc+ anti-HBs antibodies were 6.3% and 27.4%. Very few (4.7%) FSWs had vaccine immunity against HBV (anti-HBs antibodies only). The prevalence of anti-HCV antibodies was 7.7%. Low monthly income, drug usage, and unprotected sex were some of the social characteristics associated with exposure to the viruses using different analysis. The seroprevalence of HBV and HCV infections among FSWs in four cities of the state of Pará is high when compared to the general population of Brazil, but similar to those found in FSWs in other nondeveloped countries. The prevalence of HBV was higher in Belém, while the prevalence of HCV was higher in the other three cities, highlighting the importance of establishing control and prevention programs to reduce the risk of acquiring these viruses in Pará.
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Hepatite B/epidemiologia , Hepatite B/imunologia , Hepatite C/epidemiologia , Hepatite C/imunologia , Profissionais do Sexo/estatística & dados numéricos , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Cidades/epidemiologia , Estudos Transversais , Feminino , Hepacivirus/imunologia , Hepatite B/sangue , Anticorpos Anti-Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/imunologia , Hepatite C/sangue , Anticorpos Anti-Hepatite C/sangue , Humanos , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Estudos Soroepidemiológicos , Adulto JovemRESUMO
The etiology of congenital hypothyroidism (CH) is often difficult to identify, owing mainly to limitations in currently available diagnostic tests. Characteristics of the distal femoral epiphyseal (DFE) ossification center may provide important information and help identify some causes of CH. We analyzed the contribution of DFE ultrasonography in the investigation of 11 young infants with positive screening for CH. DFE ultrasonography emerged as a simple test that helped indicate the period of onset of CH and, when associated with clinical history, hormone levels, and thyroid ultrasonography, contributed to suggest the etiology of CH.
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Hipotireoidismo Congênito/diagnóstico por imagem , Hipotireoidismo Congênito/etiologia , Fêmur/diagnóstico por imagem , Epífises/diagnóstico por imagem , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , UltrassonografiaRESUMO
Female sex workers (FSWs) represent a key population for the acquisition of sexually transmitted infections (STI) due to their social vulnerability and the risks associated with their occupation. This study was conducted to describe the sociodemographic characteristics and sexual behavior among FSWs in cities in northern Brazil, to determine the prevalence of human immunodeficiency virus 1 (HIV-1) and human T-cell lymphotropic virus (HTLV-1/2) infections and to identify the circulating subtypes of these agents in this key population. A cross-sectional study using the Time Location Sampling (TLS) method was conducted among 339 FSWs in cities in the state of Pará from 2005 to 2006. Serological and molecular tests were performed to identify infections and viral subtypes, and bivariate and multivariate analyses were conducted to identify risk factors. Most FSWs were young, single, less educated and had at least one child. The prevalence of antibodies against HIV-1 and HTLV-1 was 2.3 and 1.7%, respectively. HIV-1 subtypes B (87.5%) and F1 (12.5%) were identified among FSWs, as were Cosmopolitan subtype (1a) and Transcontinental subgroup (A). Unprotected sex and illicit drug use were associated with HIV-1 and HTLV-1 infections using bivariate and multivariate analyses, and age ≥27 years was associated only with HIV. The important information highlighted here clearly indicates that the lack of actions to control and prevent pathogens in FSWs and the lack of strategies for health promotion in key populations can further aggravate the epidemiological scenario of viral infections in remote areas with low human development indices. Neglecting these facts may be causing the spread of these two viruses and their respective subtypes in the general population of northern Brazil.
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OBJECTIVE: To describe the frequency, characteristics, and factors contributing to suicide in indigenous populations in Brazil. METHOD: A systematic review of the literature was performed in PubMed, SciELO, PsycINFO, and LILACS. All population-based studies focusing on suicide among indigenous populations in Brazil were included. RESULTS: The search identified 111 articles, of which nine met the inclusion criteria. Three of these studies were performed in the Midwest and four in the North of Brazil, while two covered all Brazilian regions. The ethnic groups investigated were specified in three studies (Terena, Kadiweu, Guato, Ofaie-Xavante, Guarani, Guarani-Kaiowá, and Guarani-Nandeva). Suicide rates were highest among males, single individuals, those with 4 to 11 years of schooling, and those aged 15 to 24 years. Suicides occurred most often in the home and on weekends, mostly by hanging. The main risk factors for suicide identified in the articles were poverty, historical and cultural factors, poor wellbeing indicators, family disintegration, social vulnerability, and lack of life or future perspective. CONCLUSIONS: All the studies indicated the need to engage communities in developing strategies, considering their cosmovision and the social, historic, and cultural view of each ethnic group to minimize risk factors and reduce suicide rates.
OBJETIVO: Describir la frecuencia y las características del suicidio y sus factores contribuyentes en los pueblos indígenas brasileños. MÉTODO: Se realizó una revisión sistemática de la bibliografía a partir de las bases de datos PubMed, SciELO, PsycINFO y LILACS. Se incluyeron estudios de base poblacional enfocados en el suicidio en las poblaciones indígenas en el territorio brasileño. RESULTADOS: En la búsqueda se encontraron 111 artículos, de los cuales nueve se ciñeron a los criterios de inclusión. Se realizaron tres estudios en la región centro oeste y cuatro en la región norte, además de otros dos que abarcaron todas las regiones de Brasil. En tres estudios se citaron todas las siete etnias estudiadas (Terena, Kadiweu, Guato, Ofaie-Xavante, Guaraní, Guaraní-Kaiowá y E-Nandeva). En los estudios se demostró una mayor tasa de mortalidad por suicidio en personas solteras del sexo masculino, con 4 a 11 años de escolaridad, en el grupo de 15 a 24 años de edad, en el domicilio y en los fines de semana, principalmente por el método de ahorcamiento. Los principales factores de riesgo de suicidio fueron la pobreza, factores históricos y culturales, el índice de bienestar bajo, la desintegración de las familias, la vulnerabilidad social, y la falta de sentido de la vida y del futuro. CONCLUSIONES: Todos los estudios indicaron la necesidad de formular estrategias junto con las comunidades, dentro del marco de su cosmovisión y de los aspectos sociales, históricos y culturales de cada etnia, con el fin de reducir al mínimo los factores de riesgo y la tasa de mortalidad por suicidio.
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[RESUMO]. Objetivo. Descrever a frequência, as características e os fatores que contribuem para o suicídio em povos indígenas brasileiros. Método. Foi realizada uma revisão sistemática da literatura a partir das bases de dados PubMed, SciELO, PsycINFO e LILACS. Foram incluídos estudos de base populacional que enfocassem suicídio em populações indígenas no território brasileiro. Resultados. A busca identificou 111 artigos, dos quais nove preencheram os critérios de inclusão. Três estudos foram realizados na região Centro-Oeste, quatro na região Norte do Brasil e dois abordaram todas as regiões do Brasil. Três estudos citaram as etnias estudadas, totalizando sete etnias (Terena, Kadiweu, Guato, Ofaie-Xavante, Guarani, Guarani-Kaiowá e Guarani-Nandeva). Os estudos demonstraram maior taxa de mortalidade por suicídio em pessoas do sexo masculino, solteiros, com 4 a 11 anos de escolaridade, na faixa etária de 15 a 24 anos, no domicílio e nos finais de semana, tendo como principal método o enforcamento. Os principais fatores de risco para o suicídio foram pobreza, fatores históricos e culturais, baixos indicadores de bem estar, desintegração das famílias, vulnerabilidade social e falta de sentido de vida e futuro. Conclusões. Todos os estudos indicaram a necessidade de desenvolvimento de estratégias em conjunto com as comunidades, considerando sua cosmovisão e os aspectos sócio-histórico-culturais de cada etnia, para minimização dos fatores de risco e redução da taxa de suicídio.
[ABSTRACT]. Objective. To describe the frequency, characteristics, and factors contributing to suicide in indigenous populations in Brazil. Method. A systematic review of the literature was performed in PubMed, SciELO, PsycINFO, and LILACS. All population-based studies focusing on suicide among indigenous populations in Brazil were included. Results. The search identified 111 articles, of which nine met the inclusion criteria. Three of these studies were performed in the Midwest and four in the North of Brazil, while two covered all Brazilian regions. The ethnic groups investigated were specified in three studies (Terena, Kadiweu, Guato, Ofaie-Xavante, Guarani, Guarani-Kaiowá, and Guarani-Nandeva). Suicide rates were highest among males, single individuals, those with 4 to 11 years of schooling, and those aged 15 to 24 years. Suicides occurred most often in the home and on weekends, mostly by hanging. The main risk factors for suicide identified in the articles were poverty, historical and cultural factors, poor wellbeing indicators, family disintegration, social vulnerability, and lack of life or future perspective. Conclusions. All the studies indicated the need to engage communities in developing strategies, considering their cosmovision and the social, historic, and cultural view of each ethnic group to minimize risk factors and reduce suicide rates.
[RESUMEN]. Objetivo. Describir la frecuencia y las características del suicidio y sus factores contribuyentes en los pueblos indígenas brasileños. Método. Se realizó una revisión sistemática de la bibliografía a partir de las bases de datos PubMed, SciELO, PsycINFO y LILACS. Se incluyeron estudios de base poblacional enfocados en el suicidio en las poblaciones indígenas en el territorio brasileño. Resultados. En la búsqueda se encontraron 111 artículos, de los cuales nueve se ciñeron a los criterios de inclusión. Se realizaron tres estudios en la región centro oeste y cuatro en la región norte, además de otros dos que abarcaron todas las regiones de Brasil. En tres estudios se citaron todas las siete etnias estudiadas (Terena, Kadiweu, Guato, Ofaie-Xavante, Guaraní, Guaraní-Kaiowá y E-Nandeva). En los estudios se demostró una mayor tasa de mortalidad por suicidio en personas solteras del sexo masculino, con 4 a 11 años de escolaridad, en el grupo de 15 a 24 años de edad, en el domicilio y en los fines de semana, principalmente por el método de ahorcamiento. Los principales factores de riesgo de suicidio fueron la pobreza, factores históricos y culturales, el índice de bienestar bajo, la desintegración de las familias, la vulnerabilidad social, y la falta de sentido de la vida y del futuro. Conclusiones. Todos los estudios indicaron la necesidad de formular estrategias junto con las comunidades, dentro del marco de su cosmovisión y de los aspectos sociales, históricos y culturales de cada etnia, con el fin de reducir al mínimo los factores de riesgo y la tasa de mortalidad por suicidio.
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Grupos Populacionais , Suicídio , Revisão Sistemática , Brasil , Grupos Populacionais , Suicídio , Revisão Sistemática , Brasil , Grupos Populacionais , Suicídio , Revisão SistemáticaRESUMO
ETHNOPHARMACOLOGICAL RELEVANCE: Baccharis trimera (Less.) DC is a perennial subshrub, popularly known as "carqueja," that belongs to the Asteraceae family. Ethnobotanical studies indicate that this species is used for the treatment of diabetes and digestive and liver diseases. However, studies that sought to validate its popular use were conducted using ethanolic extracts of the plant, which does not reflect the ethnomedicinal use of this species in humans. AIM OF THE STUDY: Non-alcoholic fatty liver disease (NAFLD) is characterized by triglyceride accumulation in the liver that can progress to cirrhosis and hepatocellular carcinoma. Because of the severity of this disease, less toxic and more effective therapeutic agents need to be developed. B. trimera may be a promising therapeutic alternative, but its activity against multiple risk factors for liver disease (e.g., smoking, dyslipidemia, and diabetes mellitus) has not been studied. The present study investigated the effects of an ethnomedicinal form of a B. trimera preparation in a rat model of NAFLD that is associated with multiple risk factors. MATERIAL AND METHODS: Phytochemical analysis of the ethanolic soluble fraction of B. trimera extract was performed using ultra-performance liquid chromatography coupled to high-resolution mass spectrometry. Streptozotocin was used to induce diabetes in male Wistar rats. The rats received a 0.5% cholesterol-enriched diet and were exposed to cigarette smoke (9 cigarettes/day, 5 days/week, for 4 weeks). In the last 2 weeks, the animals were orally treated with vehicle (negative control group), B. trimera extract (30, 100, and 300 mg/kg), or insulin + simvastatin. One group of rats that was not exposed to these risk factors was also evaluated. Blood was collected for glucose, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) analysis. The liver and feces were collected for lipid quantification. The liver was additionally processed for histopathological analysis. RESULTS: The model successfully induced NAFLD and increased levels of glucose, AST, and ALT in the negative control group. Treatment with the B. trimera extract (30 and 100 mg/kg) and insulin + simvastatin decreased hepatic and fecal lipids. In contrast to insulin + simvastatin treatment, all three doses of B. trimera effectively reduced AST and ALT levels. CONCLUSION: B. trimera may be promising as a hepatoprotective agent against hepatic lesions that are caused by multiple risk factors.
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Baccharis , Diabetes Mellitus Experimental/tratamento farmacológico , Dislipidemias/tratamento farmacológico , Hepatopatia Gordurosa não Alcoólica/tratamento farmacológico , Extratos Vegetais/uso terapêutico , Substâncias Protetoras/uso terapêutico , Fumar/tratamento farmacológico , Alanina Transaminase/sangue , Animais , Aspartato Aminotransferases/sangue , Colesterol/metabolismo , Diabetes Mellitus Experimental/complicações , Diabetes Mellitus Experimental/metabolismo , Diabetes Mellitus Experimental/patologia , Dislipidemias/complicações , Dislipidemias/metabolismo , Dislipidemias/patologia , Metabolismo dos Lipídeos/efeitos dos fármacos , Fígado/efeitos dos fármacos , Fígado/metabolismo , Fígado/patologia , Masculino , Hepatopatia Gordurosa não Alcoólica/etiologia , Hepatopatia Gordurosa não Alcoólica/metabolismo , Hepatopatia Gordurosa não Alcoólica/patologia , Compostos Fitoquímicos/análise , Compostos Fitoquímicos/farmacologia , Compostos Fitoquímicos/uso terapêutico , Extratos Vegetais/química , Extratos Vegetais/farmacologia , Substâncias Protetoras/química , Substâncias Protetoras/farmacologia , Ratos Wistar , Fatores de Risco , Fumar/metabolismo , Fumar/patologia , Triglicerídeos/metabolismoRESUMO
BACKGROUND: Syphilis is a sexually transmitted infection (STI) transmitted from person to person mainly by sexual intercourse or through vertical transmission during pregnancy. Female sex workers (FSWs) are exposed especially to syphilis infection, and besides all the efforts to control the spread of STIs, syphilis prevalence is still rising, mainly occurring in low-income countries. This study aimed to investigate the syphilis prevalence, demographic characteristics and sexual habits among FSWs in the Amazon region of Brazil. METHODS: A cross-sectional study was carried out including 184 FSWs from 3 countryside cities of the state of Pará, Amazon region of Brazil. A venereal disease research laboratory test and an indirect immunoenzyme assay to test antibodies against Treponema pallidum were used for screening syphilis infection, while sexual habits and demographic data information were collected through a semi-structured questionnaire. Data was analyzed comparing groups with/without syphilis. Poisson regression models were used to estimate the reasons of prevalence (RP). RESULTS: The overall prevalence of syphilis was 14.1% (95% CI = 9.8-17.8). FSWs had between 15 and 56 years of age, most were unmarried (65.7%), had attended less than 8 years of formal education (64.1%), had between 10 and 20 partners per week (64.1%), and reported no previous history of STIs (76.1%) and regular use of condom (52.7%). Low level of education attending up to the primary school (RP adjusted = 3.8; 95% CI = 1.4-9.2) and high frequency of anal sex during the past year (RP adjusted = 9.3; 95% CI = 3.5-28.7) were associated with a higher prevalence of syphilis. CONCLUSIONS: A high prevalence of syphilis among FSWs in the Brazilian Amazon region was identified, showing that syphilis is more likely to be transmitted in FSW working in low-income areas, which is attributed to the low level of education. Anal intercourse was found as a risk factor associated with syphilis. Health programs focused on risk populations appear as a rational way to control syphilis spread, which is a rising problem in Brazil and in other several countries.
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Profissionais do Sexo/estatística & dados numéricos , Sífilis/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Cidades/estatística & dados numéricos , Preservativos/estatística & dados numéricos , Estudos Transversais , Escolaridade , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais , Sífilis/diagnóstico , Sorodiagnóstico da Sífilis , Treponema pallidum/imunologia , Adulto JovemRESUMO
RESUMO Objetivo. Descrever a frequência, as características e os fatores que contribuem para o suicídio em povos indígenas brasileiros. Método. Foi realizada uma revisão sistemática da literatura a partir das bases de dados PubMed, SciELO, PsycINFO e LILACS. Foram incluídos estudos de base populacional que enfocassem suicídio em populações indígenas no território brasileiro. Resultados. A busca identificou 111 artigos, dos quais nove preencheram os critérios de inclusão. Três estudos foram realizados na região Centro-Oeste, quatro na região Norte do Brasil e dois abordaram todas as regiões do Brasil. Três estudos citaram as etnias estudadas, totalizando sete etnias (Terena, Kadiweu, Guato, Ofaie-Xavante, Guarani, Guarani-Kaiowá e Guarani-Nandeva). Os estudos demonstraram maior taxa de mortalidade por suicídio em pessoas do sexo masculino, solteiros, com 4 a 11 anos de escolaridade, na faixa etária de 15 a 24 anos, no domicílio e nos finais de semana, tendo como principal método o enforcamento. Os principais fatores de risco para o suicídio foram pobreza, fatores históricos e culturais, baixos indicadores de bem estar, desintegração das famílias, vulnerabilidade social e falta de sentido de vida e futuro. Conclusões. Todos os estudos indicaram a necessidade de desenvolvimento de estratégias em conjunto com as comunidades, considerando sua cosmovisão e os aspectos sócio-histórico-culturais de cada etnia, para minimização dos fatores de risco e redução da taxa de suicídio.(AU)
ABSTRACT Objective. To describe the frequency, characteristics, and factors contributing to suicide in indigenous populations in Brazil. Method. A systematic review of the literature was performed in PubMed, SciELO, PsycINFO, and LILACS. All population-based studies focusing on suicide among indigenous populations in Brazil were included. Results. The search identified 111 articles, of which nine met the inclusion criteria. Three of these studies were performed in the Midwest and four in the North of Brazil, while two covered all Brazilian regions. The ethnic groups investigated were specified in three studies (Terena, Kadiweu, Guato, Ofaie-Xavante, Guarani, Guarani-Kaiowá, and Guarani-Nandeva). Suicide rates were highest among males, single individuals, those with 4 to 11 years of schooling, and those aged 15 to 24 years. Suicides occurred most often in the home and on weekends, mostly by hanging. The main risk factors for suicide identified in the articles were poverty, historical and cultural factors, poor wellbeing indicators, family disintegration, social vulnerability, and lack of life or future perspective. Conclusions. All the studies indicated the need to engage communities in developing strategies, considering their cosmovision and the social, historic, and cultural view of each ethnic group to minimize risk factors and reduce suicide rates.(AU)
RESUMEN Objetivo. Describir la frecuencia y las características del suicidio y sus factores contribuyentes en los pueblos indígenas brasileños. Método. Se realizó una revisión sistemática de la bibliografía a partir de las bases de datos PubMed, SciELO, PsycINFO y LILACS. Se incluyeron estudios de base poblacional enfocados en el suicidio en las poblaciones indígenas en el territorio brasileño. Resultados. En la búsqueda se encontraron 111 artículos, de los cuales nueve se ciñeron a los criterios de inclusión. Se realizaron tres estudios en la región centro oeste y cuatro en la región norte, además de otros dos que abarcaron todas las regiones de Brasil. En tres estudios se citaron todas las siete etnias estudiadas (Terena, Kadiweu, Guato, Ofaie-Xavante, Guaraní, Guaraní-Kaiowá y E-Nandeva). En los estudios se demostró una mayor tasa de mortalidad por suicidio en personas solteras del sexo masculino, con 4 a 11 años de escolaridad, en el grupo de 15 a 24 años de edad, en el domicilio y en los fines de semana, principalmente por el método de ahorcamiento. Los principales factores de riesgo de suicidio fueron la pobreza, factores históricos y culturales, el índice de bienestar bajo, la desintegración de las familias, la vulnerabilidad social, y la falta de sentido de la vida y del futuro. Conclusiones. Todos los estudios indicaron la necesidad de formular estrategias junto con las comunidades, dentro del marco de su cosmovisión y de los aspectos sociales, históricos y culturales de cada etnia, con el fin de reducir al mínimo los factores de riesgo y la tasa de mortalidad por suicidio.(AU)
Assuntos
Humanos , Suicídio/tendências , Características Culturais , Fatores Sociológicos , Povos Indígenas/psicologia , Brasil/epidemiologiaRESUMO
We aimed to evaluate the effects of crude glycerine purity and levels of glycerol on the fermentative profile, microorganisms counting, and nutritional value of Piatã grass silage. The experiment was carried out in a 3×3+1 completely randomized factorial design using three different types of crude glycerine [low purity (40% of glycerol), medium purity (60% glycerol), and high purity (80% glycerol)], three doses of glycerol (20, 40, and 60 g/kg DM), and a control (no crude glycerine added) as an additional treatment, which were stored for 80 days. Statistical differences were not observed on fermentative losses of the treatments tested. The increase of glycerol doses resulted in higher levels of non-fibrous carbohydrates and lower levels of fibre components. The addition of low-purity crude glycerine increased the levels of fat and in vitro digestibility of silages. The highest levels of lactic acid and acetic acid occurred in the treatments with 60 g/kg of glycerol when using crude glycerine with a low purity. The lowest lactic acid content was observed in the control treatment and in the lowest dose of glycerol. The highest glycerol dose (60 g/kg), associated with the lowest degree of crude glycerine purity (40%) resulted in the greatest nutritional value and provided the best silage conservation.(AU)
Assuntos
Silagem/análise , Fermentação/fisiologia , Glicerol/análise , Ração Animal/análise , Biocombustíveis , Valor Nutritivo/fisiologiaRESUMO
BACKGROUND: Brain metastasis (BM) is a rare event in ovarian cancer patients. The current prognostic scores that have been used for other tumors do not account for specific characteristics of ovarian cancer, such as platinum sensitivity. METHODS: This retrospective cohort study examined patients with ovarian carcinoma and BM who were treated at a single institution from January 2007 to December 2017. Clinical data on the diagnosis of BM and follow-up were collected. Cox regression was used to evaluate prognostic factors for overall survival (OS). RESULTS: Of 560 patients, 26 presented with BM. Eight patients were treated with surgery, 15 with whole-brain radiotherapy (RT), and 5 with stereotactic RT, and 4 patients received systemic treatment at the diagnosis of BM. The median OS was 10.8 months. The following factors were associated with OS: platinum-sensitive recurrence (HR 0.34, 95% CI 0.12-0.99; p = 0.049), higher number of previous treatment lines (HR 1.57, 95% CI 1.12-2.19; p = 0.008), ECOG performance status (HR 2.52, 95% CI 1.24-5.09; p = 0.010), and longer interval from initial diagnosis to BM (p = 0.025). Notably, the number of brain metastasis, the largest tumor size, and progression outside of the CNS were not related to survival. Platinum sensitivity was not associated with any of the classic prognostic factors in brain metastasis patients such as number or size of brain metastasis or disease progression outside the CNS strengthening the hypothesis of the importance of platinum sensitivity to the prognosis of ovarian cancer patients with BM. CONCLUSIONS: The factors related to the biological behavior of the ovarian cancer such as platinum sensitivity at the time of BM diagnosis, fewer number of previous treatment lines and interval from initial diagnosis were associated with survival in ovarian cancer patients with BM, while factors that are usually related to survival in BM in other cancers were not associated with survival in this cohort of ovarian cancer patients. The small number of patients did not allow us to exclude the prognostic role of these former factors that were not associated with survival in the present cohort.
Assuntos
Antineoplásicos/administração & dosagem , Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/terapia , Neoplasias Ovarianas/tratamento farmacológico , Compostos de Platina/administração & dosagem , Idoso , Antineoplásicos/uso terapêutico , Irradiação Craniana , Feminino , Humanos , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Compostos de Platina/uso terapêutico , Prognóstico , Análise de Regressão , Estudos Retrospectivos , Tamanho da Amostra , Análise de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: Treatment of advanced uterine cervical cancer has advanced little in the last 15 years. Although two phase III trials showed survival benefit with the addition of consolidation chemotherapy (CT) after cisplatin-based chemoradiotherapy (RTCT), it is not considered standard of care. We aimed to evaluate the benefit of consolidation CT compared to no additional treatment in patients treated with RTCT. METHODS: This is a retrospective study including 186 patients with FIGO stage IB2, IIA2, or IIB to IVB (paraaortic lymph nodes only) uterine cervical cancer who were treated with standard RTCT alone or RTCT followed by consolidation CT. Overall survival (OS), progression free survival (PFS), and the risk of distant and local relapses were compared between the two treatment groups. RESULTS: At 3 years OS was 91% versus 82.3% (p=0.027), PFS 84.3% versus 54.4% (p=0.047), and distant metastasis free survival (DMFS) 80.4% versus 62.5% (p=0.027) in favor of the consolidation CT group. Multivariate analysis confirmed the benefit of consolidation CT. There was no difference in locoregional free survival (LRFS). Positive lymph node was related to a higher risk of distant relapse. In the lymph node positive subgroup consolidation CT resulted in longer OS (p=0.050), PFS (p=0.014), and DMFS (p=0.022); in the lymph node negative subgroup there was no benefit from consolidation CT. CONCLUSIONS: Use of consolidation CT resulted in longer OS and PFS, mostly due to control of distant relapses. Patients at higher risk of distant relapse showed the greatest benefit. This data generates a hypothesis that could help to better select patients to consolidation CT.
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Figures 2 and 3 in the published version of this article contained a mistake. CCP and DCP should have been FEG and NFEG. Correct figures are presented here.
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OBJECTIVES: The aim of this study was to evaluate the influence of foraminal enlargement on the healing of induced apical periodontitis in a rat model. MATERIAL AND METHODS: Periapical lesions were bilaterally induced in mandibular first molars of 24 Wistar rats, through root canals exposure to the oral environment during 3 weeks. Endodontic treatment was performed in the mesial canal of right molars, which were separated into two experimental groups (n = 12/group). The foraminal enlargement group (FEG) received instrumentation in the entire root canal length, including the cemental canal, while in the non-foraminal enlargement group (NFEG), instrumentation was carried out 1 mm short of the apical foramen. Root canals were filled with gutta-percha and AH Plus sealer, in the same visit, 1 mm short of the apical foramen in both experimental groups. Left molars were not treated and served as a baseline control group. The animals were killed after 4 weeks, and their hemi-mandibles were prepared for radiographic and histological analysis. Data were analyzed by Student's t test and ANOVA. RESULTS: Only FEG presented lower areas of periapical radiolucency compared to the control (p < .05). Both FEG and NFEG allowed decreased inflammation intensity (p < .0001 and p < .01) and higher scores of cementum neoformation when compared to non-treated samples (p < .0001). FEG was more effective than NFEG in promoting biological seal, i.e., apical closure with cementum (p < .01). FEG, but not NFEG, showed lower scores of root resorption than the control. CONCLUSIONS: Foraminal enlargement during root canal preparation improved periapical healing in rat molars. CLINICAL SIGNIFICANCE: Foraminal enlargement has been suggested to improve disinfection at the apical portion of root canals. This procedure may favor the healing of chronic periapical lesions.