Lower breast cancer survival among Black women in Brazil: a population-based retrospective study.

OBJECTIVES: To analyze the rates of breast cancer survival among Black and White women according to age and stage at diagnosis. STUDY DESIGN: A retrospective cohort study. METHODS: The study examined women registered in the population-based cancer registry of Campinas in 2010-2014. The primary variable was the declared race (White or Black). Other races were excluded. Data were linked with the Mortality Information System, and missing information was accessed by active search. Overall survival (OS) was calculated by the Kaplan-Meier method, comparisons were done by chi-squared tests, and hazard ratios were examined by Cox regression. RESULTS: The total numbers of new cases of staged breast cancer among Black and White women were 218 and 1522 cases, respectively. The rates of stages III/IV were 35.5% among White women and 43.1% among Black women (P = 0.024). The frequencies among White and Black women under 40 years old were 8.0% and 12.4% (P = 0.031), 19.6% and 26.6% (P = 0.016) for ages of 40-49 years, and 23.8% and 17.4% (P = 0.037) for ages of 60-69 years, respectively. The mean OS was 7.5 years (7.0; 8.0) among Black women and 8.4 years (8.2; 8.5) among White women. The 5-year OS was 72.3% among Black women and 80.5% among White women (P = 0.001). Black women had an age-adjusted risk of death that was 1.7 times higher (1.33; 2.20). The risk was 6.4 times higher for diagnoses in stage 0 (1.65; 24.90) and 1.5 times for diagnoses in stage IV (1.04; 2.17). CONCLUSION: The 5-year OS for women with breast cancer was significantly lower among Black women than White women. Black women were more frequently diagnosed in stages III/IV, and their age-adjusted risk of death was 1.7 times higher. Differences in access to care may explain these differences.

Although it induces synchronized ovulation, hCG reduces the fertility of Santa Ines ewes submitted to TAI / Embora induza a ovulação sincronizada, hCG reduz a fertilidade de ovelhas Santa Inês submetidas à IATF

The aim of this study was to evaluate hCG treatment on ovarian response and on pregnancy rate using a 9-day oestrus synchronization protocol in Santa Ines ewes. On a random oestrus cycle day, ewes received an intravaginal progesterone device (Primer-PR®, Tecnopec, Brazil). Nine days later (Day 9), 30µg of d-cloprostenol (Prolise®, Syntex, Argentina) and 250IU of eCG (Folligon®, Intervet, Brazil) were administered and the progesterone device was removed. This moment, the ewes were randomly assigned on two groups: Control Group and hCG Group. In the hCG Group, the ewes received 500IU of hCG (Vetecor®, Hertape-Calier, Spain) 24h after device removal. In the Control Group, the ewes did not receive any ovulation inductor. Control and hCG Groups ewes were inseminated 60h and 48h after device removal, respectively. There was no difference between the groups regarding the first ovulatory follicle diameter and the second ovulatory follicle. hCG Group ewes had shorter interval between device removal and ovulation (Control: 79.9±15.4h and hCG: 54.7±4.9h; P=0.001) and more synchronized ovulations. However, the treatment with hCG decreased the pregnancy rate after TAI (P=0,009). In conclusion, hCG administration improves ovulatory synchronisation, but causes a decrease in the pregnancy rate.(AU)

Avaliou-se o tratamento com hCG na resposta ovariana e na taxa de prenhez utilizando protocolo de sincronização do estro de nove dias em ovelhas Santa Inês. As ovelhas receberam um dispositivo intravaginal de progesterona em fase aleatória do ciclo (dia zero= D0). No momento da remoção do dispositivo (D9), as fêmeas receberam 30µg de d-cloprostenol (Prolise®, Syntex, Argentina) e 250UI de eCG (Folligon®, Intervet, Brasil). Nesse momento, as ovelhas foram aleatoriamente distribuídas em dois grupos de tratamento: controle sem indução de ovulação e tratamento com 500UI hCG para indução de ovulação. As ovelhas dos grupos controle e hCG foram inseminadas 60h e 48h após a remoção do dispositivo, respectivamente. Não houve diferença entre os grupos para o diâmetro do primeiro e do segundo folículo pré-ovulatório. As avelhas do grupo hCG apresentaram menor intervalo entre a remoção do dispositivo e a ovulação (grupo controle: 79.9±15.4h e grupo hCG: 54.7±4.9h; P=0.001) e maior sincronização das ovulações. No entanto, o tratamento com hCG diminuiu a taxa de prenhez após a IATF (P=0,009). Conclui-se que, apesar de a administração de hCG aumentar a sincronização da ovulação, reduz a taxa de prenhez.(AU)

Treatment abandonment in feline sporotrichosis - study of 147 cases.

This study describes the epidemiological, clinical and mycological aspects of feline sporotrichosis cases attending the Laboratory of Clinical Research on Dermatozoonosis in Domestic Animals - Evandro Chagas Clinical Research Institute (LAPCLIN-DERMZOO/IPEC/FIOCRUZ), from 1998 to 2005. It was possible to get in contact with 147 (19.2%) cat owners. One hundred and thirteen (76.9%) cats were male, 117 (79.6%) had no defined race and 87 (59.2%) were sexually intact. The age ranged from 72 to 216 months (median = 108 months). Nineteen cats were reassessed: eleven (57.8%) were male, thirteen (36.8%) were breed and fifteen (47.3%) castrated. Fourteen (52.6%) animals lived at home and did not roamed the streets. Seven (36.8%) had normal clinical findings and negative mycological examination. Twelve (63.1%) cats had skin lesions compatible with sporotrichosis. Thirty-one (21%, n = 147) cats disappeared after abandoning treatment, 36 (24.5%, n = 147) were alive and 80 (54.4%, n = 147) had died. Causes of death informed by the owners were: sporotrichosis in 35 (43.7%, n = 80), accidental death in 27 (33.7%, n = 80) and other diseases in 18 (22.5%, n = 80). Withdrawal of treatment occurred mainly at the time of clinical improvement and may represent a serious obstacle to the control of sporotrichosis.

Proposal of a histopathological predictive rule for the differential diagnosis between American tegumentary leishmaniasis and sporotrichosis skin lesions.

BACKGROUND: American tegumentary leishmaniasis (ATL) and sporotrichosis exhibit similar histopathology and low frequencies of microorganism detection. OBJECTIVES: This study seeks to identify microscopic alterations that can distinguish between these diseases. METHODS: Haematoxylin and eosin stained slides of 171 ATL and 97 sporotrichosis samples from active cutaneous lesions were examined for histopathological alterations. The lesions were diagnosed by isolating the agent (which was not visible) in culture. An intuitive diagnosis was assigned to each slide. The strength of the association between the histopathological findings and the diagnosis was estimated by an odds ratio, and each finding was graded according to a regression model. A score was assigned to each sample based on the histopathological findings. A study of the interobserver reliability was performed by calculating kappa coefficients of the histopathological findings and intuitive diagnoses. RESULTS: The markers 'macrophage concentration', 'tuberculoid granuloma' and 'extracellular matrix degeneration' were associated with ATL. 'Suppurative granuloma', 'stellate granuloma', 'different types of giant cells', 'granulomas in granulation tissue' and 'abscess outside the granuloma' were associated with a diagnosis of sporotrichosis. 'Macrophage concentration' and 'suppurative granuloma' had the highest (substantial and almost perfect, respectively) reliability. The regression model score indicated 92.0% accuracy. The intuitive diagnosis had 82.5% diagnostic accuracy and substantial reliability. CONCLUSIONS: Taking into account the clinical and epidemiological context, some histopathological alterations might be useful for the differential diagnosis between ATL and sporotrichosis cutaneous lesions in cases in which the aetiological agent is not visible.

Underreporting of cocaine and marijuana during the thrid trimester of gestation among pregnant adolescents

Objetive: The aim of this study is to check the validity of the self-report of drug use by pregnant adolescents, by comparing their responses to a structured interview about their use of cocaine and marijuana during the pregnancy with an analysis of their hair. Results: Hair analysis detected the use of cocaine and/or marijuana, 17 (1,7%) used only cocaine, and 3 (0,3%) used both drugs. None of the patients had reported the use of these substances in their interview with healthcare profissionals. Conclusion: Althougth the prevalence of the use of drugs during pregnancy is significant despite consistent evidence about the compromise of the neurobehavioral development of the newborns that are exposed to drugs during the prenatal period, drugs use is frequently not reported. Therefore, more sensitive methods of detection should be used so that appropriate medical and psychosocial interventions com be implemented for the mothers as well as for their children. (AU)

The autologous superficial femoral artery as a substitute for the carotid axis in oncologic surgery. Three new cases and a review of the literature.

When neck cancer affects the carotid artery, the best therapeutic option is to remove the tumor en bloc, including the affected vessels. When the carotid artery is revascularized, the usual practice according to the literature is to replace the defective carotid artery with an autologous graft from the saphenous vein, although it is also possible to use an autologous superficial femoral artery (SFA). The use of the SFA in oncologic surgery does not seem to be widespread; in fact, we only found 7 references (67 cases). Here we report three cases in which the SFA was employed and offer a review of the literature. The SFA has advantages and disadvantages in comparison with the saphenous vein. The need for interdisciplinary collaboration (otorhinolaryngology/vascular surgery) is very important, especially in situations where the saphenous vein is not available.

An epidemic of sporotrichosis in Rio de Janeiro, Brazil: epidemiological aspects of a series of cases.

The first epidemic of sporotrichosis in humans as a result of zoonotic transmission was identified in Rio de Janeiro, Brazil, in 1998. A cross-sectional study was conducted applying questionnaires to patients seen in 2002 at Evandro Chagas Clinical Research Institute, Fiocruz, with a confirmed diagnosis of sporotrichosis. A total of 73 dwellings were studied, where 255 individuals, including 94 patients and 161 healthy household contacts, lived with 133 cats with sporotrichosis. Most dwellings were houses with 83% having complete basic sanitation. Among patients, there was a predominance of women with a median age of 41 years who were engaged in domestic activities. These women contracted the disease twice more often than men. The prevalence of sporotrichosis was four times higher among patients caring for animals, irrespective of gender. In the current epidemic of sporotrichosis, taking care of sick cats was the main factor associated with transmission of the disease to humans.

Nitric oxide prevents the bacterial translocation and inhibits the systemic inflammatory response produced by implantation of a vascular prosthesis followed by Zymosan A.

OBJECTIVE AND DESIGN: To evaluate the beneficial effects of exogenous NO and its levels of action in a model of SIRS/Bacterial Translocation (BT) induced by two sequential insults. MATERIAL OR SUBJECTS: Eighty-six Wistar rats were submitted to different treatments and their tissue and blood samples were accessed at the end of the experiment. TREATMENT: Nitric Oxide was compared to Gentamicin as the tested guideline for our study. METHODS: Dacron graft implantation (first insult) and subsequent administration of Zymosan A((R)) (second insult) were performed in Wistar rats. The animals were divided into 6 groups: I) No manipulation (BASAL: ); II) Laparotomy (L) + mineral oil (SHAM: ); III) L + Graft-Zymosan (GZ) (CONTROL: ); IV) L + GZ + Antibiotic (A) (ASSAY: I); V) L + GZ + NO (ASSAY: II) and VI) L + GZ + A + NO (ASSAY: III). Determinations: Survival, Bacterial Translocation, myeloperoxidase (MPO), Cytokines (TNF-alpha, IL-1beta, IFN-gamma), Oxygen Free Radical (OFR) SOA and detoxifying enzymes (SOD, Superoxide Dismutase, CAT, Catalase and GPX, Glutathione Peroxidase), Cell Adhesion Molecules, CAMs (ICAM-1, VCAM-1 and PECAM-1) and Nuclear Transcription Factor, NFkappaB. RESULTS: The model established induced a mortality rate of 20% and generated BT in all samples. It also significantly increased all variables, with P < 0.001 for MPO and all Cytokines; P < 0.01 for all OFR, and P < 0.05 for CAMs and for NFkappaB. Treatment with A reduced mortality to 0%, significantly decreased BT, MPO, Cytokines and OFR (P < 0.05), but did not reduce CAMs or NFkappaB. NO, either alone or associated, reduced mortality to 0% and abolished BT, significantly decreasing nearly all the variables studied (P < 0.001 for MPO and all Cytokines; P < 0.01 for OFR, and P < 0.05 for CAMs and for NFkappaB). CONCLUSIONS: The exogenous administration of NO before the two sequential insults prevented BT and controlled SIRS peripherally and at both cellular and transcriptional level in a lasting manner. In contrast, antibiotic treatment only exerted its action at peripheral level. The association of both treatments did not provide any important advantages.

The relationship between parental nutritional status and overweight children/adolescents in Rio de Janeiro, Brazil.

BACKGROUND: The association between overweight parents and overweight children/adolescents was investigated in Rio de Janeiro, Brazil between 1995 and 1996, controlling for the influence of socio-economic and demographic factors. METHODS: Data were obtained from a two-stage, residence-based, random sample survey of children and adolescents aged 6-19 years and their parents. Body mass index (BMI) was used to classify nutritional status. Initially, a logistic regression model was built, using an indicator of parental weight (maternal BMI) as one of the independent variables and the child/adolescent's BMI as the dependent variable. Following that, the association between socio-economic and demographic variables and overweight children/adolescents was analysed in a univariate analysis. These variables were pre-selected for inclusion in the logistic model, provided that their levels of statistical significance were below P=0.25, and were added to the model individually according to the order of association strength in the univariate analysis. Finally, variables were retained in this model at a significance level of P=0.05. RESULTS: This study found that 20.7% of girls and 26.9% of boys were overweight, with a larger prevalence among children aged less than 9 years. In addition to maternal BMI, the predictors of overweight children and adolescents were age, gender and the number of people in a house. CONCLUSIONS: These results demonstrate the relationship between maternal nutritional status and overweight children and adolescents, suggesting that obesity-prevention programmes should be focused on the family.

Haematogenous spread of Sporothrix schenckii in cats with naturally acquired sporotrichosis.

The recovery of Sporothrix schenckii from blood samples is rare, and the diagnosis of systemic sporotrichosis is usually made at necropsy. In this report, S schenckii was isolated from two or more internal organs of nine necropsied cats with naturally acquired sporotrichosis. Haematogenous spread was demonstrated in vivo by the isolation of S schenckii from the peripheral blood of 17 (n = 49, 34.4 per cent) cats. Feline leukaemia virus (FeLV) was not detected, and co-infection with feline immunodeficiency virus (FIV), observed in nine cases (n = 43, 20.9 per cent), apparently did not affect the isolation of S schenckii from peripheral blood or from the internal organs.

[Differential patterns of neonatal and post-neonatal mortality rates in Goiânia, Brazil, 1992-1996: use of spatial analysis to identify high-risk areas]. / Diferenças no padrão de ocorrência da mortalidade neonatal e pós-neonatal no Município de Goiânia, Brasil, 1992-1996: análise espacial para identificação das áreas de risco.

The aim of this study was to investigate the spatial pattern of neonatal and post-neonatal mortality in the city of Goiânia, Central Brazil. Analyses were based on linked birth and death certificates relating to 101,000 in-hospital live births from mothers residing in the city of Goiânia over the 1992-1996 period. Overall neonatal and post-neonatal mortality probabilities were calculated using the linked database. The empirical Bayes method was applied to smooth the estimated rates and minimize random fluctuation. Spatial units of analysis were 65 urban districts, corresponding to the urban planning sectors. The following exploratory spatial analyses were applied: "global" Moran's I statistic, local Moran LISA map, and Gi* local statistics. For both neonatal and post-neonatal mortality there was statistically significant spatial autocorrelation. Results of post-neonatal mortality showed a high-risk cluster located on the outskirts of the city. For the neonatal period, a heterogeneous mortality pattern was found with high-risk districts in all regions, including central areas.

Sporotrichosis: an emergent zoonosis in Rio de Janeiro.

During the period from 1987 to 1998, 13 cases of human sporotrichosis were recorded at the Research Center Evandro Chagas Hospital (CPqHEC) in Rio de Janeiro. Two of these patients related scratch by a sick cat. During the subsequent period from July 1998 to July 2000, 66 human, 117 cats and 7 dogs with sporotrichosis were diagnosed at the CPqHEC. Fifty-two humans (78.8%) reported contact with cats with sporotrichosis, and 31 (47%) of them reporting a history of a scratch or bite. This epidemic, unprecedented in the literature, involving cats, dogs and human beings may have started insidiously before 1998.

Factors associated with overweight and central body fat in the city of Rio de Janeiro: results of a two-stage random sampling survey.

The purpose of the survey was to investigate the association of overweight (body mass index, BMI) and central body fat distribution (waist/hip girth ratio WHR) with socio-economic, demographic, lifestyle and dietary variables in the adult population of Rio de Janeiro City, Brazil, 1995-1996. A two-stage random sample population-based survey was performed, with 1455 males and 1906 females above 20 y old resident in Rio de Janeiro City, Brazil. Data were obtained by direct interview and physical examination of the subjects. The intake of selected nutrients (fat, saturated fat, cholesterol) and energy was obtained from a semi-quantitative food frequency questionnaire (FFQ). Variables with at least a marginal univariate association with the dependent variables (BMI and WHR) were selected as predictors in two logistic regression models, and variables statistically significant (P<0.05) were retained in them. Overweight prevalence was 44.9%, and 39.2% of the subjects had excessive central body fat distribution (elevated WHR). The proportions of subjects with an excessive intake of fat, saturated fat and cholesterol were respectively 31%, 42% and 47%. For the BMI model, the variables retained were age (OR=1.5, 95% CI=1.3-1.7), schooling (OR=1.7, 1.4-1.9) and smoking (OR=0.8; 0.7-0.9); and for WHR, age (OR=1.8, 1.5-2.1), schooling (OR=2.2, 1.9-2.6), occupation (OR=1.8, 1.1-2.0) and gender (OR=3.9, 3.2-4.7). Obesity and excessive central body fat are highly prevalent health problems in the studied population. As suggested by the identified risk factors, they should be urgently addressed through health nutrition education and physical activity programs; particularly those directed to the middle aged and female groups.

[Differences between the nutritional status of children in public preschools and nutritional transition] / As diferenças de estado nutricional em pré-escolares de rede pública e a transição nutricional.

OBJECTIVE: To verify if there are different patterns of nutritional status among preschool children, and if these patterns deserve special interventions. METHODS: This cross-sectional study included 1,200 children from public preschools in Cosmópolis, a small town in the state of São Paulo. The z scores indices for height/age, weight/age, and weight/height were analyzed in terms of age, sex, type of school, and school location. RESULTS: Anthropometric indices were similar to those of the reference population (NCHS). Males had lower indices than females. Important differences in anthropometric indices were found among children from different schools. Higher prevalence of moderate deficits in height and weight was observed in children from non-downtown areas, while higher prevalence of obesity was found in children from downtown areas. However, the prevalence of obesity was higher than the prevalence of malnutrition even in schools located in non-downtown areas. CONCLUSIONS: We concluded that even in a small city and in a relatively homogeneous group, it is possible to detect different nutritional patterns in subgroups of the population. The differences related to nutritional status, and the high prevalence of obesity among children from public schools, point out the need for different approaches and interventions.

[Risk factors for neonatal and post-neonatal mortality in the Central-West region of Brazil: linkage between live birth and infant death data banks]. / Fatores de risco para mortalidade neonatal e pós-neonatal na Região Centro-Oeste do Brasil: linkage entre bancos de dados de nascidos vivos e óbitos infantis.

This article focused on risk factors for neonatal and post-neonatal mortality by linking live births and infant death records. The study was conducted in the municipality of Goiânia, in the Central-West region of Brazil. A total of 20,981 live births and 342 infant deaths constitute the retrospective cohort. Neonatal and post-neonatal mortality risks were estimated in this cohort study of live births by logistic regression. In the neonatal period, the highest ORs were for delivery in public hospitals (OR = 2.28; 95% CI 1.57-3.32), pre-term neonates (OR = 8.94; 95% CI 5.85-13.67), and low birth weight (OR = 8.92; 95% CI 5.77-13.79). Cesarean delivery appeared as a protective factor (OR = 0.58; 95% CI 0.43-0.78). For post-neonatal mortality, the highest ORs were for illiterate mothers (OR = 6.25; 95% CI 1.25-31.27), low birth weight (OR = 3.12; 95% CI 1.67-5.84), and delivery in public hospitals (OR = 2.65; 95% CI 1. 13-6.23). The linkage identified socioeconomic variables that were more important risk factors for post-neonatal than neonatal mortality.

[Risk factors in the occurence of short stature of preschool children]. / Fatores de risco na ocorrência de déficit estatural em pré-escolares.

A case-control study was conducted to know the magnitude of the effect of main risk factors for short stature of pre-school children in a city in São Paulo State, in 1995. An anthropometric survey carried out with all children (1201) attending public pre-school classes was used to select the case and the control groups. It was selected a random sample of 165 children among those with stature/age (-1 z score (case) and another sample of 165 among those with stature/age ( +1 z score (control). The mothers or persons responsible for these children were interviewed in order to obtain information on demographic, maternal and socio-economic variables. The multiple logistic hierarchical analysis showed the following variables as associated with pre school children's short stature: mother's educational level (OR = 2,1; CI: 1,1-3,8); per capita family income (0,5 SM (OR = 3,4; CI: 1,5-8,0); number of persons in the house (6 (OR = 3,7; CI: 1,5-9,0); number of domestic equipment (1 (OR = 4,4; CI: 1,8-10,7 ); birth length <48 cm (OR = 7,4; CI: 2,3-23,7 ), mother's stature ( 156,6 cm (OR = 5,9 CI 3,1-11,0) and father's stature (169,5 cm (OR = 4,2; CI: 2,1-8,6). We found that even in a population of preschool children without nutritional deficiency (as measured by the usual anthropometric index) it is possible to observe the effect of socio economic variables in children stature.

Pioderma gangrenoso: una enfermedad compleja, revision y actualización / Pyoderma gangrenosum

El propósito de este artículo es una puesta al día de los criterios diagnóstico y evaluación de los diferentes tratamientos de pioderma gangrenoso. El P.G. tiene cuatro formasa clínicas y variantes histológicas. Está asociado frecuentemente a enfermedades sistémicas. Hay diferentes clases de tratamiento para esta enfdermedad, ambos local y sistémico de acuerdo al tipo de P. G

[Risk factors for persistent diarrhea in hospitalized children]. / Fatores de risco para diarréia persistente em crianças hospitalizadas.

A case control study was done among prospectively hospitalized children aged 1-24 months. The aim of the study was to identify the risk factors associated with persistent diarrhea in children. Sixty one children with diarrhea persisting for more than 14 days, observed at the hospital, were included in the investigation as cases and 133 hospitalized children with acute diarrhea was studied as controls. The risk factors studied for association with persistent diarrhea were mother's level of education, weight at birth, use of breast feeding, presence of diarrhea during the three months before hospitalization and nutritional status of the children at the moment of the hospitalization. Mother's level of education (OR = 10.62), the frequency of diarrhea during the three months before hospitalization (OR = 3.62), weight at birth (OR = 6.36) and the use of breast feeding as the only source of food intake (OR = 2.30) were found to be associated with long term diarrhea. When evaluated by the Z score of the weight/age (OR = 20.02), weight/length (OR = 21.13) and length/age (OR = 6.64) ratios, there was a positive correlation between the occurrence of diarrhea and the level of malnutrition. It is concluded that persistent diarrhea is strongly associated with undernutrition and with inherent factors related with it.