RESUMO
OBJECTIVE: To evaluate the impact of the digital rectal exam (DRE) on PSA measurements and clinical decision-making. METHODS: Healthy male volunteers between 50 and 70 years old were recruited during a 30-day public screening program. PSA levels were measured using two different methods (standard enhanced chemiluminescence immunoassay-ECLIA, and novel immunochromatography assay-ICA/rapid PSA) in the same blood sample. Two blood samples were drawn; first before DRE and the second 30-40 min after DRE. The effect of DRE on PSA levels and its impact on clinical decision-making for individual patients were evaluated based on different biopsy trigger cutoffs. RESULTS: ECLIA-PSA was measured in 74 participants both pre- and 37 ± 5 min post-DRE, mean age 57.2 ± 8.3 years, and mean prostate volume 33.6 (20-80) cm3. Both total and free ECLIA-PSA increased significantly after DRE (mean increase of 0.47 and 0.26 ng/ml, respectively, both p < 0.001). Different internationally accepted biopsy triggers were reached after DRE only: 5 total PSA > 3 ng/ml, 13 increase > 0.75 ng/ml, 3 PSA density > 0.15, and 1 free/total PSA < 0.18. On two occasions, patients were pushed away from biopsy trigger after DRE due to free/total PSA > 0.18. ICA-PSA was detectable (> 2.0 ng/ml) in 5 of 45 measured samples (11%) before DRE and 13/45 (29%) after DRE, p = 0.0316. Four among five detectable ICA-PSA tests increased after DRE. CONCLUSION: Performing DRE immediately before PSA measurement might change the clinical decision-making on a significant number of occasions (roughly 1 in 3); even though the mean increase (0.47 ng/ml) looks deceivingly small. Further studies are required that include gold standard tests (biopsy, or imaging).
Assuntos
Exame Retal Digital , Neoplasias da Próstata , Idoso , Biópsia , Humanos , Masculino , Pessoa de Meia-Idade , Próstata/patologia , Antígeno Prostático Específico , Neoplasias da Próstata/patologiaRESUMO
Este trabalho buscou identificar as principais crenças de homens acerca do Exame do Toque Retal (ETR), comparando as respostas de homens que o fizeram (G1) e dos que ainda não o fizeram (G2). Utilizou-se um questionário sociodemográfico e clínico, além da técnica de evocação de palavras. No G1, as evocações relacionadas à suscetibilidade, gravidade e benefícios do exame foram mais enfatizadas. Já no G2, destacaram-se as crenças voltadas à suscetibilidade e aos benefícios de realizar o exame. Os dados encontrados sugerem que fazer o ETR pode reforçar alguns estereótipos em relação aos aspectos negativos do exame, porém não anula os aspectos positivos. Deve-se levar em consideração a relação paciente-profissional, bem como a condução do profissional durante a realização do ETR, já que barreiras podem estar sendo reforçadas nessa situação. Enfim, aponta-se para a necessidade de trabalhar a temática da busca pelo ETR não só com a população-alvo, mas também com os profissionais de saúde
This study aimed to identify the main male beliefs about the Digital Rectal Exam (DRE) comparing the responses of men who did the exam (G1) and those who did not (G2). We used a questionnaire containing sociodemographic and clinical variables, as well as free evocations. G1 showed evocations related to the susceptibility, severity, and beliefs associated with the benefits of the exam. Among G2, beliefs about susceptibility and benefits of screening were also highlighted. The results suggest that doing DRE may reinforce some stereotypes regarding negative aspects of the examination, but they do not cancel its positive aspects at all. It is necessary to take care of the patient-professional relationship and the professional's conduct during DRE, since barriers might be strengthened in that situation. Finally, we believe it is important to clarify the perception of searching for DRE not only with the target population, but also with health professionals
Este trabajo buscó identificar las principales creencias de hombres acerca del Examen del Toque Retal (ETR), comparando las respuestas de hombres que lo hicieron (G1) y de los que aún no lo hicieron (G2). Se utilizó un cuestionario sociodemográfico y clínico, además de la técnica de evocación de palabras. En el G1, las evocaciones relacionadas con la susceptibilidad, gravedad y beneficios del examen, fueron más enfatizadas. En el G2, se destacaron las creencias volcadas a la susceptibilidad y a los beneficios de realizar el examen. Los datos encontrados sugieren que hacer el ETR puede reforzar algunos estereotipos en relación a los aspectos negativos del examen, pero no anula los aspectos positivos. Se debe tener en cuenta la relación paciente-profesional, así como la conducción del profesional durante la realización del ETR, ya que las barreras pueden estar siendo reforzadas en esa situación. En fin, se apunta a la necesidad de trabajar la temática de la búsqueda por el ETR no solo con la población objetivo, sino también con los profesionales de salud
Assuntos
Humanos , Masculino , Neoplasias da Próstata/prevenção & controle , Exame Retal DigitalRESUMO
Black men are known to have a higher risk for prostate cancer (PC). Carotenoids and retinol, linked to PC, have not been compared in different black populations at risk. We examined serum carotenoid and retinol levels between PC-free African-Caribbean (AC) Tobagonian men with a high PC risk (high-grade prostatic intraepithelial neoplasia, atypical foci or repeated abnormal PC screenings) and African-American (AA) men with elevated serum prostate-specific antigen (PSA) levels (≥4 ng/ml). AC men who participated in the 2003 lycopene clinical trial and AA men who participated in the 2001-2006 National Health and Nutrition Examination Survey were compared. Serum specimens were analysed for carotenoid (ß-carotene, α-carotene, ß-cryptoxanthin, lutein/zeaxanthin and lycopene) and retinol levels by isocratic HPLC. Quantile regression was used to examine the association between serum carotenoid and retinol levels and black ethnicity, overall and among men with elevated serum PSA. There were sixty-nine AC men and sixty-five AA men, aged 41-79 years, included. AC men were associated with lower serum lycopene and retinol levels, and higher serum α- and ß-carotenes and lutein/zeaxanthin levels compared with AA men, after adjusting for age, BMI, ever smoked cigarettes, education and hypertension (P≤0·03). Among men with elevated PSA, serum retinol was no longer statistically significant with ethnicity (P=0·06). Possible differences may be attributed to dietary intake, genetics and/or factors that influence bioavailability of these micronutrients. Prospective studies are warranted that investigate whether these differences in micronutrients between AC Tobagonian and AA men influence PC risk.
Assuntos
Negro ou Afro-Americano , Carotenoides/sangue , Neoplasias da Próstata/sangue , Vitamina A/sangue , Adulto , Idoso , Estudos Transversais , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/epidemiologia , Fatores de Risco , Trinidad e Tobago/epidemiologiaRESUMO
OBJECTIVE: To conduct and evaluate the impact of a theory-based health education intervention on awareness of prostate cancer and intention to screen among men in Western Jamaica and determine screening rates of men participating in the intervention at 6 months post-intervention. MATERIALS AND METHODS: 454 men utilizing various clinics and hospitals in Western Jamaica completed an interviewer-administered pretest survey on general prostate cancer knowledge and intention to screen. Upon completing the pretest, participants observed a prostate cancer health education intervention and immediately completed a posttest survey. RESULTS: Statistically significant improvements in the percentage of correct responses between the pretest and posttest were evident. (p < 0.05). Additionally, screening rates increased dramatically by 6 months post-intervention with over 33% of men receiving a prostate exam after participating the in the educational intervention. CONCLUSION: The theory-based educational intervention increased participants' knowledge of prostate cancer, types of screening tests, frequency of screenings and risk factors and symptoms, and was effective in increasing screening rates among the men in Western Jamaica within 6 months post- intervention. This theory-based educational intervention may be replicated to promote awareness of prostate cancer and further increase screening rates in other areas of Jamaica and other developing countries.
RESUMO
Epidemiological data show that up to 20-30% of patients with psychogenic nonepileptic seizures (PNESs), resembling drug-resistant epilepsy (DRE), are referred to tertiary epilepsy centers. Furthermore, both disorders present high psychiatric comorbidity, and video-EEG is the gold standard to make differential diagnoses. In this study, we described and compared the clinical presentation and the frequency of psychiatric disorders codified in DSM IV in two groups of patients, one with PNESs and the other with DRE, admitted in a tertiary care epilepsy center of Buenos Aires, Argentina. We included 35 patients with PNESs and 49 with DRE; all were admitted in the video-EEG unit in order to confirm an epilepsy diagnosis and determine surgical treatment possibilities. All patients underwent a neurological and psychiatric assessment, according to standardized protocol (SCID I and II; DSM IV criteria). Student's t test was performed to compare continuous variables and Chi square test to compare qualitative variables. In this study, 33 (67%) patients with DRE and 35 (100%) patients with PNESs met criteria for at least one disorder codified in Axis I of DSM IV (p=0.003). Differences in the frequency of psychiatric disorder presentation were found between groups. Anxiety disorders (16.32% vs 40%; p=0.015), trauma history (24.5% vs 48.57%; p=0.02), posttraumatic stress disorder (4.08% vs 22.85%; p=0.009), and personality cluster B disorders (18.37% vs 42.86%; p=0.02) were more frequent in the group with PNESs. Psychotic disorders were more frequent in the group with DRE (20.4% vs 2.85%; p=0.019). Depression was equally prevalent in both groups. Standardized psychiatric assessment provides information that could be used by the mental health professional who receives the referral in order to improve quality of care and smooth transitions to proper PNES treatment, which should include a multidisciplinary approach including neurology and psychiatry.
Assuntos
Epilepsia/epidemiologia , Epilepsia/psicologia , Transtornos Mentais/epidemiologia , Transtornos Psicofisiológicos/epidemiologia , Transtornos Somatoformes/epidemiologia , Adolescente , Adulto , Idoso , Argentina/epidemiologia , Eletroencefalografia , Epilepsia/diagnóstico , Epilepsia/tratamento farmacológico , Feminino , Humanos , Bateria Neuropsicológica de Luria-Nebraska , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Gravação em Vídeo , Adulto JovemRESUMO
Este trabalho é parte de uma apresentação feita em 2012, no II Encontro Internacional André Green, realizado na Asociación Psicoanalítica Argentina. O texto retoma alguns conceitos fundamentais de Green, particularmente os conceitos de pulsão, representação e pulsão de morte. Desenvolvem-se, a partir daí, algumas ideias sobre as reformulações da técnica, interpretação, construção, contratransferência imaginativa e silêncio do analista.
'This article is part of a presentation shown in 2012, during the II International André Green Meeting, which took place at the Asociación Psicoanalítica Argentina. The text considers some of Greens basic concepts, particularly the ideas of drive, representation and death drive. From this, ideas on the reformulations of the technique, interpretation, construction, imaginative countertransference and silence of the analyst are developed.
Este trabajo es parte de una presentación realizada en el II Encuentro Internacional André Green del año 2012, en la Asociación Psicoanalítica Argentina. El texto retoma algunos conceptos fundamentales de Green, en particular los conceptos de pulsión, representación y pulsión de muerte. De ahí se desarrollan algunas ideas sobre las reformulaciones de la técnica, interpretación, construcción, contratransferencia imaginativa y silencio del analista.
RESUMO
There were used 21,702 test day milk yields from 2,429 first parity Holstein breed cows, daughters of 2,031 dams and 233 sires, distributed over 33 herds in the state of Rio Grande do Sul, from 1992 to 2003. Genetic parameters for three measures of lactation persistency (PS1, PS2 e PS3) and for milk production to 305 days (P305) were evaluated. A random regression model adjusted by fourth order Legendre polynomial was used. The random regression model adjusted to test day between the sixth and the 305th lactation day included the herd-year-season of the test day, the age of the cow at the parturition effects and the order fourth Legendre polinomial parameters, for modeling the milk production average curve of the population, and parameters of the same polinomial for modeling the random additive genetic and permanent environmental effects. The estimated heritabilities were 0.05, 0.08 and 0.19, respectively to PS1, PS2 and PS3, and 0.25 to P305, suggesting the possibility of a genetic gain by selection for PS3 and P305. The genetic correlations between persistency measurements and P305 ranged from -0.05 to 0.07, suggesting being, persistency and milk yield, characteristics determined by different gene groups, and that the selection for P305, usually done, do not promote genetic progress for persistency.
Foram utilizados 21.702 registros de produção de leite no dia do controle de 2.429 vacas primíparas da raça Holandesa, filhas de 233 touros, coletados em 33 rebanhos do Estado do Rio Grande do Sul, entre 1992 e 2003, para estimar parâmetros genéticos, para três medidas de persistência (PS1, PS2 e PS3) e para a produção de leite até 305 dias (P305) de lactação. Os modelos de regressão aleatória ajustados aos controles leiteiros entre o sexto e o 300o dia de lactação incluíram o efeito de rebanho-ano-mês do controle, a idade da vaca ao parto e os parâmetros do polinômio de Legendre de ordem quatro, para modelar a curva média da produção de leite da população e os parâmetros do mesmo polinômio, para modelar os efeitos aleatórios genético-aditivo direto e de ambiente permanente. As estimativas de herdabilidade obtidas foram 0,05, 0,08 e 0,19, respectivamente, para PS1, PS2 e PS3 e 0,25, para P305 sugerindo a possibilidade de ganho genético por meio da seleção para PS3 e para P305. As correlações genéticas entre as três medidas de persistência e P305, variaram de -0,05 a 0,07, indicando serem persistência e produção, características determinadas por grupos de genes diferentes. Assim, consequentemente, a seleção para P305, geralmente praticada, não promove progresso genético para a persistência.
RESUMO
There were used 21,702 test day milk yields from 2,429 first parity Holstein breed cows, daughters of 2,031 dams and 233 sires, distributed over 33 herds in the state of Rio Grande do Sul, from 1992 to 2003. Genetic parameters for three measures of lactation persistency (PS1, PS2 e PS3) and for milk production to 305 days (P305) were evaluated. A random regression model adjusted by fourth order Legendre polynomial was used. The random regression model adjusted to test day between the sixth and the 305th lactation day included the herd-year-season of the test day, the age of the cow at the parturition effects and the order fourth Legendre polinomial parameters, for modeling the milk production average curve of the population, and parameters of the same polinomial for modeling the random additive genetic and permanent environmental effects. The estimated heritabilities were 0.05, 0.08 and 0.19, respectively to PS1, PS2 and PS3, and 0.25 to P305, suggesting the possibility of a genetic gain by selection for PS3 and P305. The genetic correlations between persistency measurements and P305 ranged from -0.05 to 0.07, suggesting being, persistency and milk yield, characteristics determined by different gene groups, and that the selection for P305, usually done, do not promote genetic progress for persistency.
Foram utilizados 21.702 registros de produção de leite no dia do controle de 2.429 vacas primíparas da raça Holandesa, filhas de 233 touros, coletados em 33 rebanhos do Estado do Rio Grande do Sul, entre 1992 e 2003, para estimar parâmetros genéticos, para três medidas de persistência (PS1, PS2 e PS3) e para a produção de leite até 305 dias (P305) de lactação. Os modelos de regressão aleatória ajustados aos controles leiteiros entre o sexto e o 300o dia de lactação incluíram o efeito de rebanho-ano-mês do controle, a idade da vaca ao parto e os parâmetros do polinômio de Legendre de ordem quatro, para modelar a curva média da produção de leite da população e os parâmetros do mesmo polinômio, para modelar os efeitos aleatórios genético-aditivo direto e de ambiente permanente. As estimativas de herdabilidade obtidas foram 0,05, 0,08 e 0,19, respectivamente, para PS1, PS2 e PS3 e 0,25, para P305 sugerindo a possibilidade de ganho genético por meio da seleção para PS3 e para P305. As correlações genéticas entre as três medidas de persistência e P305, variaram de -0,05 a 0,07, indicando serem persistência e produção, características determinadas por grupos de genes diferentes. Assim, consequentemente, a seleção para P305, geralmente praticada, não promove progresso genético para a persistência.
RESUMO
Double repetitive element (DRE) PCR amplification is a simple Mycobacterium tuberculosis typing method, however amplification failure or poor resolution of bands commit its efficacy. In order to verify if whether or not these features could be minimized by improving DNA extraction procedures or Taq polymerise quality, DRE-PCR was performed on 24 M. tuberculosis DNA samples extracted by heat-shock, mechanical and enzymatic methods applying conventional and hot start Taq pol. We demonstrated that when dealing with the Mycobacterium tuberculosis DRE-PCR typing method, Taq pol of better quality might be more important to improve amplification than the DNA extraction method.
Amplificação de duplo elemento repetido (DRE) por PCR é um método simples para tipagem de Mycobacterium tuberculosis, entretanto falha ou a baixa resolução das bandas na amplificação compromete a eficiência do método. Com o objetivo de verificar se estes problemas podem ou não ser minimizados pela utilização de diferentes procedimentos de extração de DNA ou de qualidades de Taq polimerase, DRE-PCR foi ensaiado em 24 amostras de DNA de M. tuberculosis extraídos pelos métodos de choque-térmico, - mecânico e enzimático utilizando Taq polimerase convencional e hot start Taq pol. Foi demonstrado que a qualidade da Taq pol utilizada talvez seja mais importante para uma melhor amplificação que o método de extração de DNA empregado.
RESUMO
Strains of Mycobacterium tuberculosis were compared using two DNA fingerprinting techniques: Restriction Fragment Length Polymorphism (RFLP) and Double-Repetitive-Element-PCR (DRE-PCR). Two of these strains: IH1 (susceptible to isoniazid) and IH2 (resistant to isoniazid) were recovered from cases of pulmonary tuberculosis which occurred in two brothers who lived together. The first one was recognized on July 1999, and the second was diagnosed one year later. IH1 and IH2 showed the same pattern of bands with both molecular tests. These results suggest that single drug chemoprophylaxis may occasionally select resistant strains for that drug, which can eventually cause disease and be recognized through these tests. Strains IH3, IH4 and IH5 were obtained from sputum samples of 3 different patients, and intra-laboratory cross-contamination was suspected when it was realized that the 3 positive materials had been consecutively processed the same day by the same worker in the same biological safety cabinet. Again, the 3 strains revealed identical band patterns with RFLP and DRE-PCR, confirming the posed suspicion. The results with DRE-PCR were obtained after only 8 hours of work, without the need for subcultures. This procedure allows quick correction of treatment conducts, avoiding unnecessary exposure of people and bacteria to antimicrobial drugs.
Se compararon cepas de Mycobacterium tuberculosis utilizando 2 procedimientos de ADN fingerprinting: polimorfismo de los fragmentos de restricción (RFLP) y Double-Repetitive-Element-PCR (DRE-PCR). Dos de las cepas: IH1 (susceptible a isoniazida) e IH2 (resistente a isoniazida) se recuperaron a partir de casos de tuberculosis pulmonar que ocurrieron en dos hermanos convivientes. La primera fue aislada en julio de 1999 y la segunda un año después. IH1 e IH2 mostraron el mismo patrón de bandas por ambos procedimientos. Estos resultados sugieren que la quimioprofilaxis con una sola droga puede ocasionalmente seleccionar mutantes resistentes, las cuales pueden causar enfermedad y ser reconocidas por estos procedimientos. Las cepas IH3, IH4 e IH5 fueron aisladas de 3 pacientes diferentes, y examinadas por probable contaminación cruzada dentro del laboratorio ya que fueron procesadas el mismo día, por el mismo operador y en la misma cabina de seguridad biológica. Nuevamente, las 3 cepas revelaron el mismo patrón de bandas por RFLP y por DRE-PCR, confirmando la sospecha. Los resultados de la DRE-PCR se obtuvieron luego de 8 horas de trabajo, sin necesidad de subcultivos. Esta técnica permitiría la rápida correción de pautas de tratamiento, evitando la exposición innecesaria de personas y bacterias a drogas antimicrobianas.