Adipose Tissue-Derived Stromal/Stem Cells Transplantation with Cholecalciferol Supplementation in Recent-Onset Type 1 Diabetes Patients: Twelve Months Follow-Up.

To evaluate safety and therapeutic effect along 12 months of allogenic adipose tissue-derived stromal/stem cells (ASCs) transplantation with cholecalciferol (VITD) in patients with recent-onset type 1 diabetes (T1D). Prospective, phase II, open trial, pilot study in which patients with recent onset T1D received ASCs (1xKgx106 cells) and VITD 2000UI/day for 12 months (group 1) and were compared to controls with standard insulin therapy (group 2). Adverse events, C-peptide area under the curve (CPAUC), insulin dose, HbA1c and frequency of FoxP3+ in CD4+ or CD8+ T-cells(flow cytometry) were evaluated at baseline(T0), after 3(T3), 6(T6) and 12 months(T12). Eleven patients completed follow up (7:group 1;4:group 2). Group 1 had lower insulin requirement at T3(0.24±0.18vs0.53±0.23UI/kg,p=0.04), T6(0.24±0.15vs0.66±0.33 UI/kg,p=0.04) and T12(0.39±0.15vs0.74±0.29 UI/Kg,p=0.04).HbA1c was lower at T6 (50.57±8.56vs72.25±10.34 mmol/mol,p=0.01), without differences at T12 (57.14±11.98 in group 1 vs. 73.5±14.57 mmol/min in group 2, p=0.16). CPAUC was not significantly different between groups at T0(p=0.07), higher in group 1 at T3(p=0.04) and T6(p=0.006), but similar at T12(p=0.23). IDAA1c was significantly lower in group 1 than group 2 at T3,T6 and T12 (p=0.006, 0.006 and 0.042, respectively). IDDA1c was inversely correlated to FoxP3 expression in CD4 and CD8+ T cells at T6 (p<0.001 and p=0.01, respectively). In group 1, one patient had recurrence of a benign teratoma that was surgically removed, not associated to the intervention. ASCs with VITD without immunosuppression were safe and associated lower insulin requirements, better glycemic control, and transient better pancreatic function in recent onset T1D, but the potential benefits were not sustained.

Unfavorable Outcomes in Tuberculosis: Multidimensional Factors among Adolescents in Rio de Janeiro, Brazil.

Since 2018, adolescents have been included as a target group for tuberculosis (TB) surveillance by the WHO. However, they are considered a neglected population, as there are considerable gaps in information about them. We aimed to analyze the risk factors for unfavorable TB treatment outcomes among adolescents in Rio de Janeiro, a Brazilian city with a high burden of TB. This is a retrospective study of adolescents (10-18 years) with TB notified in Rio de Janeiro, from four national database systems, covering 2014-2016. "Extreme vulnerability" was defined as adolescents who presented one of the following characteristics: homelessness, incarceration, tobacco use, illicit drug use, or alcohol abuse. Logistic regression analysis was used to identify factors associated with favorable (cure/completed treatment) and unfavorable outcomes (lost to follow-up, death, and treatment failure). A total of 725 adolescents with TB were included: 610 (84.1%) were cured, 94 (13%) were lost to follow-up, six (0.8%) died because of TB, 13 (1.8%) died because of other causes, and two (0.3%) failed treatment. Unfavorable outcomes were associated with retreatment (adjusted odds ratio [aOR]: 4.51; 95% CI: 2.23-9.17), TB-HIV coinfection (aOR: 10.15; 95% CI: 4.15-25.34), extreme vulnerability (aOR: 3.01; 95% CI: 1.70-5.33), and living in the two districts (3.1 and 3.3) with worst conditions: large population and rates of homicides and shantytowns (aOR: 4.11; 95% CI: 1.79-9.46 and aOR: 5.35; 95% CI: 2.20-13.03, respectively). Our findings underscore the need for strengthening early identification and interventions for adolescents at high risk of unfavorable outcomes, especially those living in shantytowns.

Lower socioeconomic status is independently associated with shorter survival in Hodgkin Lymphoma patients-An analysis from the Brazilian Hodgkin Lymphoma Registry.

Socioeconomic status (SES) is a well-known determinant of outcomes in cancer. The purpose of this study was to analyze the impact of the SES on the outcomes of Hodgkin lymphoma (HL) patients from the Brazilian Prospective HL Registry. SES stratification was done using an individual asset/education-based household index. A total of 624 classical HL patients with diagnosis from January/2009 to December/2014, and treated with ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine), were analyzed. The median follow-up was 35.6 months, and 33% were classified as lower SES. The 3-year progression- free survival (PFS) in higher and lower SES were 78 and 64% (p < 0.0001), respectively. The 3-year overall survival (OS) in higher and lower SES were 94 and 82% (p < 0.0001), respectively. Lower SES patients were more likely to be ≥ 60 years (16 vs. 8%, p = 0.003), and to present higher risk International Prognostic score (IPS) (44 vs. 31%, p = 0.004) and advanced disease (71 vs. 58%, p = 0.003). After adjustments for potential confounders, lower SES remained independently associated with poorer survival (HR = 3.12 [1.86-5.22] for OS and HR = 1.66 [1.19-2.32] for PFS). The fatality ratio during treatment was 7.5 and 1.3% for lower and higher SES (p = 0.0001). Infections and treatment toxicity accounted for 81% of these deaths. SES is an independent factor associated with shorter survival in HL in Brazil. Potential underlying mechanisms associated with the impact of SES are delayed diagnosis and poorer education. Educational and socio-economic support interventions must be tested in this vulnerable population.

Endobronchial ultrasound in real life: primary diagnosis and mediastinal staging of lung cancer in patients submitted to thoracic surgery.

BACKGROUND: Since the first articles published for over 10 years ago, endobronchial ultrasound (EBUS) has gained a strong scientific backing and has been incorporated into routine medical practice in pulmonology and thoracic surgery centers. How is EBUS performing outside the scientific environment, as a diagnostic and mediastinal staging tool in a subset of patients that undergo thoracic surgery, is an interesting question. METHODS: This study evaluated consecutive patients who, during the period from January 2010 to August 2012, were submitted to EBUS and later to thoracic surgery. The samples obtained by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) were compared to surgical samples. The primary endpoint was the proportion of patients with a final diagnosis of non-small cell lung cancer (NSCLC) by EBUS-TBNA correctly subtyped. The secondary endpoint was the negative predictive value (NPV) of EBUS-TBNA for mediastinal staging of lung cancer. RESULTS: Two hundred eighty seven patients were studied. Considering 84 patients with a final diagnosis of NSCLC by EBUS-TBNA, 79 % (CI 95 % 70.1-87.3) were correctly subclassified. The NPV of EBUS-TBNA for mediastinal staging was 89 % (IC 95 % 84.9-92.7). From a total of 21 false negative cases of mediastinal staging, 16 (76 %) did not undergo positron emission tomography-computed tomography (PET-CT) before the EBUS and in 15 (71 %) the affected lymph node chain was not punctured by EBUS-TBNA. Ten (47 %) patients had only lymph node metastases not directly accessible by the EBUS. CONCLUSIONS: Performed in hospital routine and in patients submitted to thoracic surgery, EBUS-TBNA proved to be a good tool for proper pathological diagnosis of lung cancer. The negative predictive value of 89 % for mediastinal staging of lung cancer is comparable to that reported in previous studies, but the relatively high number of 21 false negative cases points to the need for standardization of routine strategies before, during and after EBUS.

A COCONUT EXTRA VIRGIN OIL-RICH DIET INCREASES HDL CHOLESTEROL AND DECREASES WAIST CIRCUMFERENCE AND BODY MASS IN CORONARY ARTERY DISEASE PATIENTS.

INTRODUCTION: saturated fat restriction has been recommended for coronary arterial disease, but the role of coconut oil (Cocos nucifera L.) extra virgin, lauric acid source in the management of lipid profile remains unclear. OBJECTIVE: to evaluate the effect of nutritional treatment associated with the consumption of extra virgin coconut oil in anthropometric parameters and lipid profile. METHODS: we conducted a longitudinal study of 116 adults of both sexes presenting CAD. Patients were followed in two stages: the first stage (basal-3 months), intensive nutritional treatment. In the second stage (3-6 months), the subjects were divided into two groups: diet group associated with extra virgin coconut oil consumption (GDOC) and diet group (DG). Held monthly anthropometric measurements: body mass, waist circumference (WC), neck circumference (PP), body mass index (BMI). Gauged to collected blood pressure and blood samples were fasted for 12 hours, for total cholesterol analysis and fractions apoproteins (Apo A-1 and B), glucose, glycated hemoglobin (HbA1C), insulin (I). Comparing the averages at the beginning and end of the study employing the paired Student t-independent. And set the diastolic blood pressure by BMI using ANOVA. Analyses were performed using the SPSS statistical package, being significant p < 0.05. RESULTS: the mean age of the population was 62.4 ± 7.7 years, 63.2% male, 70% elderly, 77.6% infarcted, 52.6% with angina, hypertension and dyslipidemia 100%. In the first stage the nutritional treatment reduced body weight, WC, BMI and PP and insulin concentrations, HbA1C, HOMA-IR and QUICK, without changing the other parameters. In the second stage of the study, it was observed that the GDOC maintained the reduction of body mass, BMI, WC, with a significant difference between groups for DC (-2.1 ± 2,7 cm; p < 0.01). In addition, there was an increase in HDL-C concentrations, Apo A, with significant difference in GD, only for HDL-C (3.1 ± 7.4 mg/dL; p = 0.02). CONCLUSION: it was observed that the nutritional treatment associated with extra virgin coconut oil consumption reduced the CC and increased HDL-C levels in patients with CAD.

Introducción: el aceite de coco (Cocos nucifera L.) virgen extra contiene una alta proporción de ácidos grasos de cadena media que parecen contribuir a la reducción del peso y podría ayudar en la prevención secundaria de la enfermedad arterial coronaria (EAC). Objetivo: evaluar el efecto del tratamiento nutricional asociado con el consumo de aceite de coco virgen extra en los parámetros antropométricos y el perfil lipídico. Métodos: se realizó un estudio longitudinal de 116 adultos de ambos sexos que presentan CAD. Los pacientes fueron seguidos en dos etapas: en la primera etapa (basal-3 meses), se llevo a cabo un tratamiento nutricional intensivo. En la segunda etapa (3-6 días), los sujetos fueron divididos en dos grupos: grupo asociado con el consumo de aceite extra virgen de coco (GDOC) y el grupo de dieta (GD). Se realizaron mediciones mensuales antropométricas: peso, circunferencia de la cintura (CC), circunferencia del cuello (PP) e índice de masa corporal (IMC). Se tomó la presión arterial y muestras de sangre recogidas en ayunas durante 12 horas para el análisis de colesterol total y lipoproteínas, apoproteínas (Apo A-1 y B), glucosa, hemoglobina glucosilada (HbA1c) e insulina (I). Se compararon los promedios al principio y al final del estudio mediante el test t de Student-independiente. Se ajustó la presión arterial diastólica por el IMC mediante ANOVA. Los análisis se realizaron con el paquete estadístico SPSS, siendo significativa p < 0.05. Resultados: la edad media de la población fue de 62,4 ± 7,7 años, el 63,2% hombres, 70% mayores, el 77,6% con infarto de miocardio, el 52,6% con angina de pecho y el 100% con hipertensión arterial y dislipidemia. En la primera etapa del tratamiento nutricional se redujeron las concentraciones de insulina, peso, WC, IMC y PP, HbA1C, HOMA-IR y rápido, sin cambiar otros parámetros. En la segunda etapa del estudio se observó que la GDOC mantiene la reducción del peso, BMI, WC, con una diferencia significativa entre los grupos para DC (-2,1 ± 2,7 cm; p < 0,01). Además, se produjo un aumento en las concentraciones de HDL-C, Apo A, con una diferencia significativa en GD, solo para HDL-C (3,1 ± 7,4 mg/dl; p = 0,02). Conclusión: se observó que el tratamiento nutricional asociado con el consumo de aceite de coco virgen extra redujo la CC e incrementó los niveles de HDL-C en pacientes con CAD.

Analysis of interobserver reproducibility in grading histological patterns of dysplastic nevi* / Avaliação da reprodutibilidade interobservador da graduação de padrões histológicos dos nevos displásicos

Dysplastic nevi are among the most important cutaneous melanoma simulators. They are important risk markers for this neoplasia and can be its potential precursors. Some authors found a statistically significant relationship between the degree of dysplasia and the risk for developing melanoma. However, reproducibility of grading criteria ranged from poor to fair in the researched articles. To test the reproducibility of the grading criteria proposed by Sagebiel et al. regarding dysplastic nevi. Histological specimens of 75 dysplastic nevi were graded, independently and in a blinded fashion, according to preestablished criteria, by a panel of 10 pathologists with different levels of experience. Diagnostic agreement was calculated using weighted kappa and intraclass correlation coefficients. The average of weighted kappa values was 0.13 for all observers, 0.12 for dermatopathologists, 0.18 for general pathologists and 0.05 for residents. Intraclass correlation coefficient values were 0.2 for all observers, 0.18 for dermatopathologists, 0.33 for general pathologists and 0.15 for residents. Histopathological grading for dysplastic nevi was not reproducible in this Brazilian series, so the criteria used are not a helpful histopathological parameter for clinicopathological correlation. .

Nevos displásicos estão entre os mais importantes simuladores de melanoma. São marcadores de risco para o desenvolvimento dessa neoplasia e podem ser seus precursores. Alguns autores observaram uma relação estatisticamente significativa entre o grau de displasia e o risco de desenvolvimento de melanoma. No entanto, a reprodutibilidade dos critérios para graduação variou de ruim a razoável nos artigos consultados. Testar a reprodutibilidade da graduação proposta por Sagebiel et al. para os nevos displásicos. Seções histológicas de setenta e cinco nevos displásicos foram graduadas, de forma independente e anônima, segundo critérios pré-estabelecidos, por um painel de 10 patologistas com diferentes níveis de experiência. A concordância diagnóstica foi calculada usando os coeficientes de kappa ponderado e de correlação intraclasse. A média dos valores de kappa ponderado foi de 0,13 para todos os observadores, de 0,12 para os dermatopatologistas, de 0,18 para os patologistas gerais e de 0,05 para os residentes. Os valores dos coeficientes de correlação intraclasse foram 0,2 para todos os observadores, 0,18 para os dermatopatologistas, 0,33 para os patologistas gerais e 0,15 para os residentes. A graduação histopatológica dos nevos displásicos não foi reprodutível nesta ...

Modelo preditivo de mortalidade em idosos com choque séptico / Simple model of morbility of elderly with septic shock

Objetivo:Elaborar um modelo prognóstico simples de mortalidade em idoso com choque séptico, internados em unidade de terapia intensiva (UTI).Métodos: Coorte prospectiva de 67 pacientes idosos consecutivos (idade maior ou igual 65 anos), internados em uma UTI clínica, no período de 32 meses, tendo monitoração da artéria pulmonar devido ao choque séptico. Para o modelo de regressão logística empregou-se como variável dependente o óbito e como variáveis independentes apenas aquelas estatisticamente significativas na análise univariada: o APACHE II, a presença de doenças cardiovasculares prévias (hipertensão arterial) sistêmica, diabetes mellitus...