Prostate Cancer in Renal Transplant Recipients: Diagnosis and Treatment.

BACKGROUND: We currently know that prostate cancer (Pca) risk is reduced in patients undergoing kidney transplantation. However, its impact and treatment are not widely studied. METHODS: This was a retrospective study of male patients submitted to kidney transplantation in our center from 1980 to 2016 evaluating incidence, treatment, and follow-up of Pca in our population. RESULTS: In 1805 patients undergoing kidney transplantation, 20 men were diagnosed with Pca, leading to an incidence of 1.1%. Median age at renal transplantation was 53.4 years with a median age at diagnosis of Pca of 61.2 years. Initial median prostate-specific antigen (PSA) was 6 ng/mL and Gleason score was 7 (3 + 4) in about 50% of cases. Bone metastasis developed in 10% and no visceral metastases were diagnosed. The majority of patients were submitted to radical prostatectomy and bilateral pelvic lymph node dissection. Some other cancers occurred in these patients such as skin and pulmonary cancers. In 35% of the cases, the graft was lost. The main cause of patient death was cardiovascular. The mean graft survival was about 14 years. The majority of patients are alive with functioning grafts (65%). CONCLUSION: In our center the clinical incidence of Pca in patients undergoing kidney transplantation is 1.1% and surgical treatment seems to be a good initial option.

O rápido processo de envelhecimento populacional do Brasil: sérios desafios para as políticas públicas / The rapid process of aging in Brazil: serious challenges for public policies

Já são sentidos, no Brasil, os efeitos positivos da transição na estrutura etária (TEE), por exemplo, nos serviços de saúde à infância e na educação. O crescimento diferenciado previsto para a população em idade ativa (PIA), nas próximas décadas, constitui uma nova janela de oportunidades. Com efeito, a combinação do segmento sênior da força de trabalho (idades 25 a 64) - que apresenta crescimento alto - com o segmento júnior (15 a 24 anos) - que registra taxas de crescimento muito baixas ou negativas - aponta para uma tendência de diminuição da pressão demográfica por empregos novos. A qualificação da futura força de trabalho torna-se componente imprescindível para um equilíbrio intergeracional, social e econômico, mais justo. Devido à TEE novos desafios emergem relacionados à expansão da população idosa. Se a atual transferência per capita do governo for mantida constante, a diferença entre receitas e despesas aumentará, provocando um insuportável déficit fiscal. A anunciada crise, causada pelo envelhecimento da população, e o atual sistema irracional previdenciário devem ser matéria de urgente discussão na sociedade brasileira. É extremamente importante aproveitar as oportunidades geradas pela TEE e se preparar para enfrentar os novos desafios dela decorrentes.

The positive effects of the recent age structure transition (AST) in Brazil can be seen in children's health services, education and other areas. The higher growth rate estimated for the economically active population in coming decades constitutes a new area of opportunities. The combination of the older segment of the labor force (ages 25 to 64), which is showing high growth, with the junior segment (ages 15 to 24), which is showing very low or even negative growth rates, indicates a trend toward reducing the demographic pressure for new jobs. The training of the future labor force has become an indispensable component for a more just intergenerational, social and economic balance. Due to the age structure transition, new challenges are emerging related to the expansion of the older population. If the present per capita transfer of funds from the government is maintained constant, the difference between revenue and expenses will increase, causing an unsustainable fiscal deficit. The expected crisis brought about by the aging of the population and the current irrational social security system must be urgently discussed in Brazilian society. The best must be made of the opportunities generated by age structure transition in order to prepare to face the new resulting challenges.

Association of white blood cell count with systolic blood pressure within the normotensive range.

Hypertension and inflammation promote cardiovascular disease (CVD). Even high normal systolic blood pressure (SBP) is associated with increased CVD risk. We assessed the relationship of elevated SBP within the normotensive range and white blood cell (WBC) count. This is a cross-sectional study of 3484 white asymptomatic individuals (mean age: 43+/-8 years, 79% males) without hypertension with SBP<140 mm Hg. White blood cell count >or=75th percentile (8.35 x 10(9) cells/l) was considered cutoff for elevated WBC. Subjects were classified into three levels of SBP (first: <120 mm Hg, n=1,176, 34%; second: 120-129 mm Hg, n=1,654, 47%; third: 130-139 mm Hg, n=654, 19%). Mean WBC count increased linearly across SBP categories (first: 6.14+/-1.54, second: 6.20+/-1.52, third: 6.41+/-1.62, P=0.02 for trend). There was a linear increase in prevalence of elevated WBC across higher SBP categories (22, 24 and 28%, P=0.02). As compared to those with SBP<120 mm Hg, in multivariate linear regression analyses (adjusting for age, gender, smoking status, diabetes, body mass index, physical activity, cholesterol/high-density lipoprotein cholesterol ratio) WBC count was significantly higher among participants with SBP 130-139 mm Hg (regression coefficient: 2.64, 95% confidence interval: 1.04-4.24, P=0.001). Odds ratio for prevalence of elevated WBC with SBP<120 mm Hg as reference group was 1.14 (0.92-1.41) for SBP 120-129 mm Hg and 1.50 (1.15-1.92) for SBP 130-139 mm Hg. In conclusion, Higher SBP within the normotensive range is also associated with elevated WBC count. Further studies are needed to clarify the role of inflammation in high normal SBP and associated CVD risk.

Avaliação comparativa, aberta e randomizada da atividade anti-hipertensiva da nifedipinina e de cloridrato de prazosin / Comparative open and randomized evaluation of the antihypertensive activity of nifedipine and prazosin hydrochloride

Trinta portadores de hipertensäo leve ou moderada foram submetidos a uma avaliaçäo comparativa, aberta e "randomizada" de 12 semanas, durante a qual as doses diárias de nifedipina (em nova formulaçäo retard) e de cloridrato de prazozin foram tateadas, com o objetivo de reduzir a pressäo diastólica a um valor igual ou inferior a 90 mm Hg. Concomitante ao uso de ambas as substâncias, observou-se diminuiçäo significativa (p < 0,001) das pressöes sistólica e diastólica, assim como da freqüência cardíaca. O efeito anti-hipertensivo da nifedipina mostrou-se mais precoce (p < 0,05) e superior (p < 0,02) ao do cloridrato de prazosin. Esta substância mostrou-se de difícil manuseio, pois a dose ótima para a maioria dos pacientes foi alcançada no fim da observaçäo e o ajuste da dose individual foi acompanhado de freqüentes hipotensöes. Ambas as substâncias foram bem toleradas, porém, um paciente teve sua terapia com nifedipina interrompida em virtude de "flush" e edema de membros inferiores, apesar de importante efeito anti-hipertensivo

Sindrome de Noonan / Noonan syndrome

Os autores relatam um caso de sindrome de Noonan em uma menina de 15 anos, portadora de estenose pulmonar valvar associada a defeito do septo atrial. O diagnostico foi baseado nos achados do exame clinico.Salientam a pouca frequencia com que a sindrome e diagnosticada e a importancia de seu reconhecimento e melhor caracterizacao