Quality of life after total laryngectomy: impact of different vocal rehabilitation methods in a middle income country.

INTRODUCTION: The impact of advanced laryngeal cancer and its extensive surgical treatments cause significant morbidity for these patients. Total laryngectomy impacts essential functions such as breathing, communication and swallowing, and may influence the quality of life as well as affecting the social life of laryngeal cancer patients. OBJECTIVE: Describe the quality of life and analyze the factors associated with the reduced quality of life in patients who have undergone total laryngectomy. METHOD: Observational cross-sectional study was carried out to evaluate the quality of life of patients who had undergone total laryngectomy due to laryngeal cancer. The fourth version of the UW-QOL Quality of Life Assessment Questionnaire from Washington University, validated for Portuguese, was used. RESULTS: The study population was 95 patients, and the mean composite score of the QOL was 80.4. In the subjective domains the majority of the patients (38.9%) reported they felt much better at present compared to the month before being diagnosed with cancer. When questioned about how they evaluated their health-related quality of life, there was a predominance of those who considered it good (43.2%), and most considered they had a good quality of life (46.3%) considering personal well-being. The overall quality of life was considered good to excellent by 83.2% of the patients. Patients with tracheoesophageal prosthesis reported a better quality of life, compared to patients using an electrolarynx or esophageal voice. CONCLUSION: The high mean value of the composite score for quality of life revealed that the patients assessed their quality of life positively. The absence of vocal emission was the only variable associated with a lower quality of life within the composite score according to the UW-QOL questionnaire.

Prognostic factors associated with overall survival in patients with oral cavity squamous cell carcinoma.

BACKGROUND: Low socioeconomic status, increasing age, and poor lifestyle behaviors are associated with poor survival in patients with oral cavity squamous cell carcinoma (OCSCC). To determine the overall survival (OS) and the risk of OCSCC death by tumor subsite. MATERIAL AND METHODS: A retrospective cohort study of OCSCC patients diagnosed from 2007 to 2009 and treated at a single cancer center in Rio de Janeiro, Brazil. Patient information was obtained from the Hospital Cancer Registry (HCR) database and complemented by individual search of physical and electronic medical records. Descriptive statistics of population characteristics were computed. OS was estimated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards regression analyses were used to estimate the risk of death by tumor subsite. RESULTS: Seven hundred and three patients with OCSCC were identified. Most patients were men (77.4%) with low levels of education (67.5%), who drank (73.9%) and smoked (79.7%). The most prevalent tumor site was the tongue (45.4%), 73.4% of patients had advanced (clinical stage III or IV) OCSCC at diagnosis and 74.1% died during follow-up. For the entire cohort, the OS was 39.1% at two years and 27.9% at five years. The median survival time was 1.4 years (95%CI: 1.2‒1.5). Non-operative treatment (HR: 3.11; 95%CI: 2.26‒4.29; p<0.001), advanced stage (HR 2.14; 95%CI 1.68-2.74; p<0.001), and age >60 years at diagnosis (HR: 1.37; 95%CI: 1.15‒1.64; p<0.001) were independently associated with the risk of death. However, these factors varied by tumour subsite. CONCLUSION: Analysis of specific subsites of the oral cavity revealed substantial differences in prognostic factors associated with poor survival in OCSCC.

Delay in breast cancer diagnosis: a Brazilian cohort study.

OBJECTIVES: To evaluate the delay in breast cancer (BC) diagnosis and its risk factors. STUDY DESIGN: A cohort study of BC patients referred to treatment at oncological reference hospital, Brazil. Delay in BC diagnosis was defined as a time interval ≥90 days between the first contact with a care provider and a BC diagnosis. METHODS: The association between independent variables and delay was performed by univariate analysis and multiple logistic regression. RESULTS: Five hundred and twenty-six women were included in the study. Delay was observed in 68.8% and was associated with performing histopathological examination at oncological reference hospital (odds ratio [OR]: 3.96, 95% confidence interval [CI]: 1.91-8.20) or at another public health service (OR: 2.31; 95% CI: 1.50-3.56) and attending gynecological consultations annually (OR: 3.24; 95% CI: 1.97-5.33) or every 2-3 years (OR: 2.86; 95% CI: 1.55-5.28). Patients who presented a lump as the first sign or symptom had a lower chance of delay (OR: 0.43; 95% CI: 0.29-0.65). CONCLUSIONS: Improvements in the structure and access to health services are needed to reduce the time to diagnosis.

Factors associated with quit attempts and smoking cessation in Brazil: findings from the International Tobacco Control Brazil Survey.

OBJECTIVES: This study aimed to identify factors associated with attempting to quit and successful smoking cessation in a population-based sample of Brazilian smokers. STUDY DESIGN: This is a prospective cohort study. METHODS: Data came from the first two waves of the International Tobacco Control Brazil Survey, conducted in 2009 and 2012/2013 in three cities: Rio de Janeiro, São Paulo, and Porto Alegre. Data were collected from 488 adults (aged ≥18 years) who smoked at Wave 1 and who were resurveyed at Wave 2. Crude and adjusted relative risks for two outcomes (making a quit attempt between Wave 1 and Wave 2 and successfully quitting by Wave 2) were estimated. Multivariable multilevel logistic regression models were used, whereby variables were added to the models in a series of blocks. RESULTS: Nearly two-thirds (65.6%) of smokers attempted to quit between waves, and 23.4% had quit at Wave 2. Intention to quit smoking at Wave 1 was the only variable associated with attempt to quit by Wave 2 (odds ratio [OR] = 2.85; 95% confidence interval [CI] 1.64-4.94; P < 0.001). Smokers of higher socio-economic status (OR high versus low = 1.80; 95% CI 1.05-3.10; P = 0.03) and lower nicotine dependence (OR low Heaviness of Smoking Index [HSI] versus high HSI = 1.94; 95% CI 1.10-3.43; P = 0.02) were more likely to successfully quit. The presence of another adult smoker at home was negatively related to successful quitting (OR = 0.50; 95% CI 0.26-0.94; P = 0.03). CONCLUSIONS: These results are generally consistent with prior research and have potential to inform governmental interventions to promote tobacco cessation, particularly among disadvantaged groups.

Expression analysis of thrombospondin 2 in prostate cancer and benign prostatic hyperplasia.

Thrombospondin 2 (TSP2) is a protein with important roles in different tumor types, mainly related to tumor inhibition. However, there are limiting data regarding TSP2 in prostate cancer (PCa) and benign prostatic hyperplasia (BPH). We aimed to investigate TSP2 transcript and protein expression in tumoral and non-tumoral prostate tissues and cell lines, and its implications for PCa diagnosis and progression. TSP2 transcript expression was evaluated by real time PCR in PCa and BPH tissue samples and in tumoral and non-tumoral cell lines. TSP2 protein expression analysis was conducted by immunohistochemistry in a tissue microarray (TMA) containing PCa and BPH tissue samples. TSP2 transcript was down-regulated in PCa tissue samples and cell lines, when compared to BPH and non-tumoral samples (P<0.01). Receiver Operating Curve (ROC) analysis demonstrated that TSP2 transcript levels can better distinguish PCa from BPH tissue samples (P<0.01) than serum PSA levels (P=0.299). TSP2 protein expression has been observed in the cytoplasm of both PCa and BPH epithelial and stromal compartments. TSP2 stromal staining scores were significantly lower in PCa than in BPH tissues (P<0.01), while similar TSP2 epithelial staining patterns were observed in both diseases. Notably, the TSP2 epithelial staining score was significantly correlated to vascular invasion and biochemical recurrence in PCa tissue samples (P<0.05). Our data indicate that TSP2 is down-regulated at PCa tissues and cell lines, especially at stroma compartment, which could be related to PCa progression. TSP2 levels could potentially be applied for differential PCa and BPH diagnosis.

Expression analysis of osteopontin mRNA splice variants in prostate cancer and benign prostatic hyperplasia.

Osteopontin splicing isoforms (OPN-SI) present differential expression patterns and specific tumor roles. Our aims were to characterize OPN-SI expression in prostate cancer (PCa) and benign prostate hyperplasia (BPH) tissues, besides evaluating their potential as biomarkers for PCa diagnosis and prognostic implications. Prostatic tissue specimens were obtained from 40 PCa and 30 benign prostate hyperplasia (BPH) patients. Quantitative real time PCR (qRT-PCR) was used to measure OPN-SI mRNA expression. Immunohistochemical analysis was performed using an anti-OPNc polyclonal antibody. Biostatistical analyses evaluated the association of OPN-SI and total Prostate Specific Antigen (PSA) serum levels with clinical and pathological data. PCa tissue samples presented significantly higher levels of OPNa, OPNb and OPNc transcripts (p<0.01) than in BPH specimens. OPN-SI mRNA expression were positively correlated with Gleason Score (p<0.01). ROC curves and logistic regression analyses demonstrated that OPN-SI and PSA were able to distinguish PCa from BPH patients (p<0.01). The OPNc isoform was the most upregulated variant and the best marker to distinguish patients' groups, presenting sensitivity and specificity of 90% and 100%, respectively. Immunohistochemistry analysis also demonstrated OPNc upregulation in PCa samples as compared to BPH tissues. OPNcprotein was also strongly stained PCa tissues presenting High Gleason Score. Multivariate analysis indicated that OPNc expression levels above the cut-off value presented a chance 4-fold higher for PCa occurrence. We conclude that OPN-SI were overexpressed in PCa tissues, strongly associated with PCa occurrence and with tumor cell differentiation. Our results suggest OPNc splicing isoform as an important biomarker contributing to improve PCa diagnosis and prognosis, besides providing insights into early steps of PCa carcinogenesis.

A systematic review and meta-analysis of the cyclic alternating pattern across the lifespan.

BACKGROUND: Cyclic alternating pattern (CAP) is the electroencephalogram (EEG) pattern described as a marker of sleep instability and assessed by NREM transient episodes in sleep EEG. It has been associated with brain maturation. The aim of this review was to evaluate the normative data of CAP parameters according to the aging process in healthy subjects through a systematic review and meta-analysis. METHODS: Two authors independently searched databases using PRISMA guidelines. Discrepancies were reconciled by a third reviewer. Subgroup analysis and tests for heterogeneity were conducted. RESULTS: Of 286 studies, 10 submitted a total of 168 healthy individuals to CAP analysis. Scoring of CAP can begin at 3 months of life, when K-complexes, delta bursts, or spindles can be recognized. Rate of CAP increased with age, mainly during the first 2 years of life, then decreased in adolescence, and increased in the elderly. The A1 CAP subtype and CAP rate were high in school-aged children during slow-wave sleep (SWS). A1 CAP subtypes were significantly more numerous in adolescents compared with other groups, while the elderly showed the highest amounts of A2 and A3 CAP subtypes. Our meta-analysis registered the lowest CAP rate in infants younger than 2 years old and the highest in the elderly. CONCLUSIONS: This review summarized the normative data of CAP in NREM sleep during the aging process. The CAP rate increased with age and sleep depth, especially during SWS. Parameters of CAP may reflect gender hormonal effects and neuroplasticity. More reports on CAP subtypes are needed for their reference values establishment.

Long-term MS secondary progression: Derivation and validation of a clinical risk score.

OBJECTIVE: The risk of progression of multiple sclerosis (MS) related to the association of prognostic factors present at disease onset has rarely been explored. We aimed to construct a clinical risk score for MS long-term progression that could be easily applied in clinical practice. PATIENTS AND METHODS: Among 432 patients with MS, 288 patients were selected as a derivation sample for identification of the knowledge prognostic factors more associated with long-term progression. One point was given to each risk factor identified as statistically significant by the adjusted model, and the sum of the points gave the overall risk score. Subsequently the score was applied to the remaining 144 patients to confirm if those with higher scores had reached MS secondary progression. RESULTS: The prognostic factors identified as independently associated with long-term progression were: no specific MS treatment before EDSS 3, age of onset older than 30 years, pyramidal and cerebellar impairment as the first manifestation of disease, time interval between the first and second relapses less than 2 years, and African ancestry. There was no significant difference between expected and observed number of patients in progression (44 vs. 31, p = 0.966), indicating that the score was able to predict the progression in the validation sample. There was no significant difference between patients with low risk (≤ 2 points) (p = 0.98) and high risk (≥ 3 points) (p = 0.48) in the derivation versus validation samples. In the derivation sample, the patients with three or more points had a 2.8-fold increased risk of progression [hazard ratio (HR): 2.8; 95 % confidence interval (CI): 1.2-6.3; p = 0.014). CONCLUSION: The score proposed was capable of predicting long-term MS progression.

Obstructive sleep apnea in patients with chronic rhinosinusitis with nasal polyps: a cross-sectional study.

INTRODUCTION: Adults with chronic rhinosinusitis with nasal polyps (CRSwNP) often suffer from sleep disruption and sleep apnea. As the apneic profile of CRSwNP may differ from obstructive sleep apnea (OSA) classic patients without nasal polyps (NP), it may prove useful to define a new profile for OSA screening in these patients. The aim of the current study was to compare baseline characteristics and apneic profile of OSA patients with CRSwNP to OSA patients without NP. MATERIALS AND METHODS: Thirty-one apneic patients with CRSwNP and 62 apneic cases without NP were included in our study. Both groups underwent nasal endoscopy, Epworth Sleepiness Scale (ESS) evaluation, and overnight polysomnography (PSG). We additionally accessed anthropometric characteristics such as snoring, tiredness, observed apnea, high blood pressure, body mass index (BMI), age, neck circumference, male gender, and OSA risk via the STOP-Bang questionnaire. RESULTS: Although the patients were matched according to age and gender, the median BMI and STOP-Bang score were significantly higher in patients with OSA than in those with OSA and CRSwNP. Notably, the median ESS showed low somnolence and a low median apnea-hypopnea index in patients with CRSwNP, despite the fact that the lowest median oxygen saturation was not significantly different between groups. CONCLUSIONS: Anthropometric characteristics in individuals with apnea caused by CRSwNP were significantly different from those in individuals with typical. This finding will improve screening and treatment of apneic patients CRSwNP.

Malnutrition associated with nutrition impact symptoms and localization of the disease: Results of a multicentric research on oncological nutrition.

BACKGROUND & AIMS: Malnutrition in cancer is an independent factor associated with negative clinical outcomes. The aim was to evaluate the prevalence and independent risk factors for malnutrition in hospitalized cancer patients using the Patient-Generated Subjective Global Assessment (PG-SGA). METHODS: We evaluated 4783 cancer patients, aged ≥20 years, in a hospital-based, multicenter, cross-sectional study. Patients were classified as well-nourished (PG-SGA Stage A), moderate/suspected malnutrition (PG-SGA Stage B), or severely malnourished (PG-SGA Stage C), and provided a score to define required nutritional interventions. Multivariate analysis was composed of the odds ratio (OR) estimated by ordinal polytomous logistic regression. RESULTS: 45.3% were classified as Stage B and 11.8% as Stage C. Moreover, 45.3% of the patients presented a need for nutritional intervention. The variables that presented the highest ORs for Stage B or Stage C were: problems with swallowing (OR 2.8, 95% confidence interval (CI) 2.2-3.4, p < 0.001), loss of appetite (OR 1.9, 95% CI 1.6-2.3, p < 0.001), vomiting (OR 1.8, 95% CI 1.5-2.3, p < 0.001), presence of more than 3 nutrition impact symptoms (OR 8.3, 95% CI 5.8-12, p < 0.001), and cancer site: lung (OR 4.6, 95% CI 3.2-6.6, p < 0.001), upper digestive cancer (OR 3.7, 95% CI 2.7-5.2, p < 0.001), and head and neck cancer (OR 3.7, 95% CI 2.7-5.2, p < 0.001). The score for Worksheet 4 on the PG-SGA had a higher association with malnutrition (OR 7.3, 95% CI 6.6-8.2, p < 0.001). CONCLUSIONS: Malnutrition is highly prevalent in cancer patients in Brazil, and is associated with nutritional impact symptoms, cancer site and age ≥65 years.

Multiple sclerosis in Brazil: A systematic review.

BACKGROUND: The natural history of multiple sclerosis (MS) in Brazil has been available in different regions of country. There is no nationwide population-based studies that express general data in Brazil. OBJECTIVE: To review and synthesize available data about MS in Brazil. MATERIAL AND METHODS: Systematic review was performed through a search of medical literature databases to identify Brazilian studies published during 1990-2012. DATA SOURCES: PubMed, SciELO, and Lilacs. KEYWORDS: "Brazil" or "Brazilian" combined with the following terms: "multiple sclerosis", "clinical profile", "demographic profile", "natural history", "clinical course", "pediatric", or "familial form". RESULTS: In total of 45 pediatric and 1922 adult patients, the median age at onset was 10 years in pediatric patients and 32 years in adult patients. Women were more affected. Motor-control complaints and relapsing-remitting phenotype at onset were the most common. Predictors to disability and progression were number of relapses during the first year of disease, older age, male gender and African ancestry. CONCLUSIONS: The profile of the MS in Brazilian seems to correspond to that observed in high-MS-prevalence areas. African ancestry is a risk factor to disability and progression early. In Brazil, factors that limit MS incidence do not interfere with the clinical pattern and outcomes.

Impact of a false positive blood culture result on the management of febrile children.

OBJECTIVE: To evaluate the impact of a preliminary positive blood culture result, subsequently confirmed to be a false positive blood culture result on rate of hospitalization, antibiotic therapy and use of microbiologic tests. DESIGN: Retrospective chart review. PATIENTS AND METHODS: Children between 1 month and 18 years old on whom a blood culture was performed were eligible, excluding those with an underlying condition for whom a false positive blood culture may be difficult to assess. During the 1-year study period 9959 blood cultures were performed of which 778 (7.8%) produced growth. Charts of 81 patients with a false positive blood culture were reviewed and compared with those of 162 patients with a true negative blood culture. Patients already hospitalized when blood culture was drawn (n = 24) were analyzed separately from those who were not (n = 219). Among these, patients were divided into those who were followed as outpatients (n = 104) and hospitalized (n = 115). RESULTS: Both groups (false positive vs. true negative) were comparable for age, sex, temperature at consultation, white blood cell count and illness severity. Twenty-six percent of patients followed as outpatients who had a false positive blood culture were hospitalized because of a preliminary positive blood culture result. Among patients hospitalized at the initial assessment, the frequency of antibiotic therapy (91% vs. 71%, P < 0.01), the frequency of use of intravenous antibiotics (80% vs. 58%, P < 0.01) and the percentage of unwarranted antibiotic prescription (13% vs. 0%, P < 0.01) were significantly greater in the false positive group than in the true negative group. The same results were found for each of these outcomes among the group of patients followed as outpatients (61% vs. 28%, P < 0.01, 17% vs. 0%, P < 0.01 and 39% vs. 0%, P < 0.01) for false positive vs. true negative, respectively. Patients with false positive blood cultures had more blood cultures drawn subsequently (P < 0.01). Children already hospitalized when the blood culture was obtained did not show significant differences in main outcomes. CONCLUSIONS: False positive blood culture results generate unnecessary hospitalizations, antibiotic therapy and use of microbiologic tests.

An outbreak of Bacillus species in a cancer hospital.

Bacillus species were recovered from the blood cultures of 39 oncology patients over 14 weeks. A matched case-control study showed a strong association of Bacillus species bacteremia with use of calcium gluconate solution (odds ratio=25.0) and of central venous lines (odds ratio=8.8). Stopping use of the implicated calcium gluconate vials controlled the outbreak.

Risk index for prediction of surgical site infection after oncology operations.

INTRODUCTION: Several studies have shown that surgical site infections represent most hospital-acquired infections, with the major impact being on average hospital stay and cost of hospitalization. METHODS: To develop a risk model for prediction of surgical site infections in cancer patients undergoing operative procedures and identify those with high probability of infection we performed a prospective cohort study in a tertiary cancer care hospital in Rio de Janeiro, Brazil. Risk factors were studied in single and multivariate analyses. RESULTS: Over a 24-month period, 1205 patients underwent operations for malignant disease. The overall surgical site infection rate was 17.3%. A multivariate stepwise logistic regression model identified six independent predictive risk factors: contaminated and infected operations, surgical duration greater than 280 minutes, male sex, prior radiotherapy, American Society of Anesthesiology class III to V, and antimicrobial prophylaxis not according to protocol. On the basis of individual risk scores, two groups of patients were identified: a low-risk (score < or = 8; surgical site infection rate 10%) and a high-risk group (score > or = 9; surgical site infection rate 33.6%; relative risk 3.4; 95% confidence interval 2.6 to 4.4). CONCLUSION: The oncology risk model allowed for the identification of a high-risk score group of patients and implementation of a more efficient and selective intervention program.

Risk factors for infectious complications after abdominal surgery for malignant disease.

BACKGROUND: The emergence of nosocomial infection as a serious complication after intraabdominal operations for cancer prompted us to identify major independent risk factors associated with postoperative infection. METHODS: Risk factors were studied in single and multivariate analyses. Variables considered were remote infection, antimicrobial prophylaxis, preoperative stay, chemotherapy, radiotherapy, weight loss, elective versus emergency operation, wound class, duration of operation, drains, sex, age, and physical status. RESULTS: During 24 months, 236 patients were entered in the study. The overall postoperative infection rate was 45.7%; the surgical site infection rate was 22.4%. Multivariate analysis identified three independent variables: duration of operation longer than 5 hours (odds ratio 6.41, 95% confidence interval 3.28 to 12.54), presence of remote infection at operation (odds ratio 3.76, 95% confidence interval 1.76 to 8.03), and preoperative stay longer than 22 days (odds ratio 2.03, 95% confidence interval 1.04 to 3.95). The relative risk of infection increased from 3.0 when one risk factor was present to 7.3 when all three risk factors were present. CONCLUSIONS: The predictive power of our final multivariate risk index clearly groups these patients according to differing risk for postoperative infection. This classification contributes substantially to the effectiveness of infection control strategies to prevent the occurrence of postoperative infection in the high-risk population of patients with cancer.

Nosocomial infections in an oncology intensive care unit.

INTRODUCTION: Treatment of cancer has contributed to a growing number of immunocompromised patients with life-threatening nosocomial infections (NI). High mortality with considerable cost is observed when they are admitted to the intensive care unit (ICU). Few studies on infection control and surveillance have been undertaken in this population group. METHODS: All patients treated at a six-bed medical-surgical oncology ICU for > 48 hours were prospectively observed for the development of an NI and the influence of device utilization on infection rates. The analysis used the standard definitions of the National Nosocomial Infection Surveillance System Intensive Care Unit surveillance component. RESULTS: From September 1993 through November 1995, 370 infections occurred in 623 patients during 4034 patient-days, for an overall rate of 50.0 per 100 patients or 91.7 per 1000 patient-days. Pneumonia (28.9%), urinary tract infections (25.6%), and bloodstream infections (24.1%) were the main types of infection. The most common microorganisms isolated were Enterobacteriaceae (29.7%), fungi (22.2%), and Pseudomonas aeruginosa (13.2%). The median device utilization ratios were 0.63, 0.83, and 0.86 for ventilator, indwelling urinary catheter, and central venous catheter, respectively. The highest median device-specific associated infection rate was 41.7 for ventilator. The median for the average length of stay was 8.8 days, and the average severity of illness score was 4.0. There was a strong positive correlation between the overall NI patient rate and device utilization (r = 0.56, p < 0.01), average severity of illness score (r = 0.54, p < 0.01), and average length of stay (r = 0.67, p < 0.01). No correlations were statistically significant when patient-days were used in the denominator. Among the devices only the number of central venous catheter days was significantly correlated with infections (r = 0.51, p = 0.01). The NI patient-day rates were progressively higher the longer the patients stayed in the ICU. CONCLUSIONS: The high rates reported in this study may reflect a combination of several factors related to the underlying illness, neutrophil count, and exposure to invasive procedures. The adjusted infection rates described here provide specific surveillance data for further interhospital comparisons and also to assess the influence of invasive medical interventions, allowing the implementation of preventable measures to control infections.

[Mortality descriptors in HIV inpatients]. / Infecção pelo HIV: descritores de mortalidade em pacientes hospitalizados.

OBJECTIVE: To assess the clinical-epidemiological descriptors of inpatient mortality in persons infected with the human immunodeficiency virus (HIV). METHOD: All adult HIV/AIDS patients hospitalized at a university hospital in 1990, 1992 and 1994 were studied retrospectively. Descriptive statistics for all variables of interest were generated. Chi-square test and Fisher's exact test were performed to compare categorical variables. Means were compared using the Student t test. Stepwise logistic regression was used to identify the odds of dying associated with each risk factor. RESULTS: Two hundred and forty patients were included in the study. Between 1990 and 1994 the mean age rose from 35 to 36.9 years, the male/female ratio decreased from 9.8 to 2.0, the non-white proportion increased from 18.5 to 41.3% and the mean time between detection of HIV infection and hospitalization rose from 0.7 to 2.5 years. In addition, length of stay dropped from 31.3 to 25.3 days and the proportion of patients being followed up in the outpatient clinic of the University Hospital increased from 47.8 to 83.3%. Respiratory infections were the main cause of hospitalization (58.0%). Oral candidiasis (27.1%), tuberculosis (18.3%). Pneumocystis carinii pneumonia (15.4%) and toxoplasmic encephalitis (10.4%) were the most frequent opportunistic infections. Multivariate analysis showed that the factors associated with a worse outcome included the length of stay less than or equal to 7 days (Odds Ratio [OR] = 3.88; p = 0.02) and no outpatient follow-up at the Hospital (OR = 3.29; p = 0.01). CONCLUSION: Identification of independent risk factors for death may help in the implementation of more efficient interventions directed towards inpatients with HIV/AIDS.

Epidemiology of bloodstream infections at a cancer center.

CONTEXT: Cancer patients are at unusually high risk for developing bloodstream infections (BSI), which are a major cause of in-hospital morbidity and mortality. OBJECTIVE: To describe the epidemiological characteristics and the etiology of BSI in cancer patients. DESIGN: Descriptive study. SETTING: Terciary Oncology Care Center. PARTICIPANTS: During a 24-month period all hospitalized patients with clinically significant BSI were evaluated in relation to several clinical and demographic factors. RESULTS: The study enrolled 435 episodes of BSI (349 patients). The majority of the episodes occurred among non-neutropenic patients (58.6%) and in those younger than 40 years (58.2%). There was a higher occurrence of unimicrobial infections (74.9%), nosocomial episodes (68.3%) and of those of undetermined origin (52.8%). Central venous catheters (CVC) were present in 63.2% of the episodes. Overall, the commonest isolates from blood in patients with hematology diseases and solid tumors were staphylococci (32% and 34.7%, respectively). There were 70 episodes of fungemia with a predominance of Candida albicans organisms (50.6%). Fungi were identified in 52.5% of persistent BSI and in 91.4% of patients with CVC. Gram-negative bacilli prompted the CVC removal in 45.5% of the episodes. Oxacillin resistance was detected in 26.3% of Staphylococcus aureus isolates and in 61.8% of coagulase-negative Staphylococcus. Vancomycin-resistant enterococci were not observed. Initial empirical antimicrobial therapy was considered appropriate in 60.5% of the cases. CONCLUSION: The identification of the microbiology profile of BSI and the recognition of possible risk factors in high-risk cancer patients may help in planning and conducting more effective infection control and preventive measures, and may also allow further analytical studies for reducing severe infectious complications in such groups of patients.

Prevalence of BRCA1 and BRCA2 gene mutations in families with medium and high risk of breast and ovarian cancer in Brazil.

Of all malignant neoplasias affecting women, breast cancer has the highest incidence rate in Brazil. The objective of the present study was to determine the frequency of genetic modifications in families with medium and high risk for breast and ovarian cancer from different regions of Brazil. An exploratory, descriptive study was carried out on the prevalence of the BRCA1 and BRCA2 mutations in case series of high-risk families for breast and/or ovarian cancer. After heredogram construction, a blood sample was taken and DNA extraction was performed in all index cases. The protein truncation test was used to screen for truncated mutations in exon 11 of the BRCA1 gene and in exons 10 and 11 of the BRCA2 gene. Of the 612 individuals submitted to genetic testing, 21 (3.4%), 19 women and 2 men, had mutations in the BRCA1 or BRCA2 genes. Of the 19 BRCA1 mutations found in the 18 participants, 7 consisted of ins6kb mutations, 4 were 5382insC, 3 were 2156delGinsCC, 2 were 185delAG, 1 was C1201G, 1 was C3522T, and 1 was 3450del4. With respect to the BRCA2 gene, 3 mutations were found: 5878del10, 5036delA and 4232insA (one case each). The prevalence of germline mutations in the BRCA1 and BRCA2 genes found in the present study was lower than reported by other studies on high-risk Brazilian populations. The inclusion of individuals with medium risk may have contributed to the lower prevalence observed.