Differential survival of Brazilian patients with diffuse large B-cell lymphoma with and without HIV infection.

OBJECTIVE: Combinatorial antiretroviral therapy provided improvement of HIV patients' immune function and a decrease in the incidence of non-Hodgkin lymphoma (NHL). Diffuse large B-cell lymphoma (DLBCL) is one of the most common NHL forms affecting HIV+ patients. The present study aimed to evaluate the impact of HIV infection on the prognosis of patients treated for DLBCL in a reference cancer treatment center in Brazil. METHODS: A retrospective case-control study was developed with patients followed-up at the Brazilian National Cancer Institute, in which 243 DLBCL patients (91 HIV+ and 152 HIV-) were enrolled. HIV- controls were matched to HIV+ according to date of cancer diagnosis, clinical staging, primary cancer treatment and date of birth. Sociodemographic and cancer treatment data were extracted from medical charts. Kaplan-Meier analyses were carried out to estimate survival, while univariate and multiple Cox regression analyses were used to determine factors associated with mortality. RESULTS: A total of 98 deaths were observed in a 5-year period after cancer diagnosis. A negative association of HIV infection with both overall and disease-specific survival 1 year after cancer diagnosis was observed [hazard ratio (HR) = 1.98 and 1.96, respectively]. The negative association with HIV infection with disease-specific survival remained significant for a 5-year period after cancer diagnosis (HR = 1.53). HIV viral load above 1000 copies/ml at study entry was also associated with shorter overall and cancer-specific survival. CONCLUSIONS: HIV infection negatively impacted prognosis and mortality of DLBCL patients irrespective of cancer-related clinical factors.

Psychometric Evaluation of a Brazilian Version of the Lymphedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphedema in Patients After Cancer Treatment.

Background: The aim of this study was to evaluate psychometric properties of the Lymphedema Functioning, Disability and Health Questionnaire for lower limb lymphedema (Lymph-ICF-LL) in Brazilian patients with secondary lower limb lymphedema after cancer treatment. Methods and Results: A diagnostic test study was performed in 30 patients with lower limb lymphedema. To assess the reliability, the intraclass correlation coefficient (ICC) was analyzed through test-retest, Cronbach alpha coefficient, magnitude of intrasubject variability by standard error of measurement (SEM), and smallest real difference (SRD). To assess the face and content validity, a specific questionnaire was applied to assess the clarity of the scoring system and comprehensiveness of questions. To assess construct validity, correlations between the final Brazilian version of the Lymph ICF-LL and the quality of life questionnaire SF-36 (36-Item Short Form Health Survey Questionnaire) were analyzed. The ICCs and general internal consistency scores of Lymph-ICF-LL were high (ICCs >0.90 and the Cronbach alpha coefficient >0.90, respectively). Measurement variability between the tests was acceptable (SEM 5.9) with SRD of 16.4. Face and content validity were considered excellent by the patients as the scoring system was clear and questions were understandable for 97% and 90% of the patients, respectively. Construct validity was classified as good and all hypotheses for assessing convergent validity were accepted (medium to strong correlation, from -0.69 to -0.84). Conclusion: The Brazilian version of the Lymph-ICF-LL is a reliable and valuable instrument for assessing Brazilian patients with secondary lower limb lymphedema associated with cancer treatment.

HPV positive, wild type TP53, and p16 overexpression correlate with the absence of residual tumors after chemoradiotherapy in anal squamous cell carcinoma.

BACKGROUND: Anal residual tumors are consensually identified within six months of chemoradiotherapy and represent a persistent lesion that may have prognostic value for overall survival. The aim of this study was to evaluate the association of HPV and HIV status, p16 expression level and TP53 mutations with the absence of residual tumors (local response) in Squamous Cell Carcinoma (SCC) of the anal canal after chemoradiotherapy. METHODS: We performed a study on 78 patients with SCC of the anal canal who submitted to chemoradiotherapy and were followed for a six-month period to identify the absence or presence of residual tumors. HPV DNA was identified by polymerase chain reaction and direct sequencing, HIV RNA was detected by TaqMan amplification, p16 expression was detected by western blotting, and the mutational analysis of TP53 was performed by direct sequencing; additionally, samples carrying mutations underwent fluorescent in sit hybridization. The evaluation of the tumor response to treatment was conducted six months after the conclusion of chemoradiotherapy. The following classifications were used to evaluate the outcomes: a) no response (presence of residual tumor) and b) complete response (absence of residual tumor). RESULTS: The significant variables associated with the absence of residual tumors were HPV positive, p16 overexpressed, wild-type TP53, female gender, and stages I and II. Only the presence of HPV was independently correlated with the clinical response; this variable increased the chances of a response within six months by 31-fold. CONCLUSIONS: The presence of HPV in tumor cells was correlated with the absence of a residual tumor. This correlation is valuable and can direct future therapeutic approaches in the anal canal.

Factors associated with the lack of access to cervical cancer screening test results in the Brazilian unified health system network in the municipality of Rio de Janeiro.

Papanicolaou test screening remains an effective approach for the control of cervical cancer. However, for successful control of the disease, patients need to have access to the test results and complete the treatment. The aim of this study was to investigate the factors associated with lack of access to results from the most recent Papanicolaou test in women living in the municipality of Rio de Janeiro who used the Brazilian Unified Health System. Overall prevalence of lack of access to test results was 18.4%. Access to test results was lower for younger women of Black race/skin color origin, those who had difficulties in making an appointment, those who received no information about when to pick up the test results, and those who evaluated the assistance provided by the health professional who collected the Papanicolaou test. Issues related to the organization and infrastructure of the health unit were the most frequently reported cause by the interviewees. The Brazilian Unified Health Service should improve its knowledge of users and service conditions to prevent interruption of the screening flow.

Undernutrition as independent predictor of early mortality in elderly cancer patients.

OBJECTIVES: The aim of this study was to evaluate the 1-y survival of elderly patients with cancer and the association between undernutrition and mortality. METHODS: This was a cohort study with elderly patients ages ≥65 y admitted between September and October 2014. A nutritionist performed a Mini Nutritional Assessment-Short Form (MNA-SF) assessment during 48 h of hospital admission and collected data about potential confounding variables (comorbidities, stage of cancer, treatment in the previous 3 mo, and reason for hospitalization). Vital status was determined from the medical records or public records office. Overall survival was estimated using the Kaplan-Meier method. Cox regression was performed to estimate unadjusted hazard ratios. Variables with P < 0.20 by univariate analysis were selected for multivariate analysis. P < 0.05 was considered statistically significant. RESULTS: Of the 136 patients (mean age, 73.1 y; 52.2% men), 29.4%, 41.2%, and 29.4% were classified as normal, at risk for undernutrition, and undernutrition, respectively, according to the MNA-SF. The mortality rate was 31.6% after 12 mo. One-year mortality was higher among the undernourished patients, followed by patients at risk for undernutrition. After adjustment for confounding variables, the multivariate regression Cox model showed that being undernourished according to the MNA-SF increased the risk for death at 1 y (hazard ratio, 5.59; 95% confidence interval, 1.8-17.3; P < 0.001). CONCLUSION: The results showed that the MNA-SF can be a useful tool in identifying elderly patients at higher risk for 1-y mortality.

Predictors of postoperative complications, prolonged length of hospital stay, and short-term mortality in elderly patients with malignant head and neck neoplasm.

PURPOSE: To identify and assess predictors of short-term outcomes and a prolonged length of hospital stay after head and neck cancer surgery in older-old and oldest-old patients. PROCEDURES: Patients aged ≥75 years with head and neck cancer undergoing surgery at the Brazilian National Cancer Institute from January to December 2011 were assessed regarding postoperative complications, mortality, and length of hospital stay. RESULTS: Over the study period, 67 patients with head and neck cancer underwent surgery, 44.8% of whom developed complications within 30 days of surgery, surgical site and respiratory infections (29.9 and 20.9%, respectively) being the most common. The mean length of hospital stay was 7 days (range: 2-26). In multivariate analysis, previous radiotherapy, dependence in instrumental activities of daily living, and low serum hemoglobin (≤13.2 g/dl) were predictors of complications. In addition, the presence of at least 1 clinical or surgical complication, smoking, and an arm circumference ≤25 cm were independent predictors of a prolonged length of hospital stay. CONCLUSIONS: Complications after head and neck cancer surgery in the elderly are common and related to the prolonged length of hospital stay, both being influenced by previous radiotherapy, smoking, functional dependence in instrumental activities of daily living, and nutritional conditions. Such predictors should be considered in a preoperative assessment of elderly patients as these are modifiable risk factors.

Crises epilépticas no período neonatal: análise descritiva de uma população hospitalar / Neonatal epileptic seizures: descriptive analysis in a hospital population

OBJETIVO: Investigar a incidência e a letalidade de crises epilépticas neonatais e as condições associadas à sua presença. MÉTODOS: Estudo retrospectivo observacional de base hospitalar com crianças nascidas de janeiro de 1995 a dezembro de 2004 acompanhadas por quatro semanas após o parto. Analisaram-se os dados referentes aos períodos pré-natal, intraparto e neonatal. RESULTADOS: Foram identificados 6.600 nascidos vivos de 6.483 partos, encontrando-se 61 casos incidentes de crises epilépticas neonatais (0,9 por cento). A primeira crise ocorreu até 12 horas após o parto em 45,3 por cento dos neonatos. Das mães analisadas, 32,8 por cento apresentaram síndromes hipertensivas. Entre os 61 pacientes, 91,8 por cento eram conceptos únicos e 4,9 por cento eram primeiro e segundo gemelares. O peso foi menor que 2500g em 50,8 por cento e a restrição do crescimento intrauterino ocorreu em 25,9 por cento das gestações analisadas. Obervaram-se: hipoglicemia neonatal (56,5 por cento), icterícia neonatal (52,1 por cento) e asfixia perinatal (70,7 por cento). Desenvolveram sepse bacteriana 32 crianças e 17 apresentaram síndrome de aspiração meconial ao nascer. O desequilíbrio ácido-básico ocorreu em 68,1 por cento ao longo de 28 dias pós-parto. A letalidade foi de 47,4 por cento, sendo mais frequente no sexo masculino (65,6 por cento) e em filhos de mães afro-descendentes (67,2 por cento). CONCLUSÕES: A incidência de crises epilépticas no período neonatal identificada neste estudo foi três a quatro vezes superior à incidência relatada em hospitais de países desenvolvidos, embora as características dos casos fossem semelhantes. A letalidade foi de 47,4 por cento e a asfixia grave foi a condição patológica intraparto mais frequente.

OBJECTIVE:To investigate their incidence and lethality of neonatal epileptic seizures and their associated conditions. METHODS: A retrospective observational hospital-based study was carried out in infants born between January 1995 and December 2004. The infants were followed up for four weeks after birth. Data on the prenatal, intrapartum and neonatal periods were analyzed. RESULTS: Among 6,483 deliveries resulting in 6,600 liveborn infants, 61 cases of neonatal epileptic seizures were identified (0.92 percent). The first seizure occurred within 12 hours after birth in 45.3 percent of the newborn infants. Hypertensive syndromes were present in 32.8 percent of mothers and intrauterine growth restriction occurred in 25.9 percent of the pregnancies. Of the 61 newborn infants, 91.8 percent were single births and 4.9 percent were first or second twins. In 50.8 percent of the infants, birthweight was below 2500g. Associated conditions were: hypoglycemia in 56.5 percent, jaundice in 52.1 percent and perinatal asphyxia in 70.7 percent. Thirty-two infants developed bacterial sepsis and 17 had meconium aspiration syndrome. Acid-base imbalance occurred in 68.1 percent during the neonatal period. Lethality was 47.4 percent and occurred more often among boys (65.6 percent) and in neonates of Afro-descendent mothers (67.2 percent). CONCLUSIONS: The incidence of neonatal epileptic seizures identified here was three to four times higher than the incidence found in hospitals of developed countries, although the cases characteristics were similar. Lethality rate was 47.4 percent and severe asphyxia was the most common pathological condition during delivery.

Prevalência de depressão maior e sintomas depressivos em pacientes com infecção pelo HTLV -1 / Prevalence of major depression and symptoms of depression in patients with HTLV -1 infection

Introdução: depressão maior ocorre em 2 a 6,6% da população em geral e em 5 a 10% em pacientes ambulatoriais. Objetivo: avaliar a prevalência do episódio depressivo maior e dos sintomas depressivos em pacientes infectados com o vírus HTLV-1. Métodos: foram selecionados prospectivamente 36 pacientes infectados pelo vírus HTLV-1. O diagnóstico para depressão seguiu os critérios do DSM-IV (Diagnostic and Statistical Manual of Mental Disorders). Em todos os deprimidos aplicou-se a escala de Hamilton (HAM-D 21 itens) para quantificação da doença. Resultados: dez participantes (28%) apresentavam depressão maior, sendo nove mulheres e um homem. Sessenta e sete por cento (n = 22) apresentavam, pelo menos, um sintoma depressivo. Os sintomas depressivos mais prevalentes consistiram em alterações do sono, do apetite e anedonia. Conclusão: maior prevalência da depressão ocorre como possível forma de manifestação da infecção pelo HTLV-1. Os autores destacam a importância de investigação de sintomas depressivos como possível forma de manifestação da infecção pelo HTLV-1.

Introduction: major depression occurs at a rate of 2 to 6.6% in the population at large and 5 to 10% in hospitalized patients. Objective: to evaluate the prevalence of the major depression episode and of symptoms of depression in patients infected with the HTLV-1 virus. Methods: we prospectively selected 36 patients infected with the HTLV-1 virus. The diagnosis for depression was based on the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) criteria. In all of the depressed patients, we applied the Hamilton scale (HAM-D 21 items) in order to quantify the disease. Results: ten participants (28%) had major depression. Seventy-seven percent presented at least one symptom of depression. The most prevalent symptoms consisted of sleep disturbances, changes in appetite and anhedonia. Conclusion: we found a higher prevalence of depression among patients infected with the HTLV-1 virus. The authors emphasize the importance of investigating symptoms of depression in patients infected with HTLV-1.

Comparison of human papillomavirus DNA tests, liquid-based cytology and conventional cytology for the early detection of cervix uteri cancer.

To compare the performance of human papillomavirus DNA tests (samples collected by a healthcare professional and self-collected) and liquid-based cytology with conventional cytology in the detection of cervix uteri cancer and its precursor lesions. A cross-sectional study was carried out in 1777 women living in poor communities in Rio de Janeiro State, Brazil. Eligibility criteria included ages 25-59 years and not having had a Papanicolau test within at least 3 years prior to the study. Cytology (conventional or liquid-based) and human papillomavirus DNA (collected by a healthcare professional or self-collected) tests were performed using samples collected in a single visit. Women with abnormalities in at least one test and a systematic sample of 70 women with negative test results were referred to a colposcopic examination. Test readings were double-masked, and the outcome of interest was high-grade squamous intraepithelial lesion or worse. The pathology report was used as the gold standard. The prevalence of high-grade squamous intraepithelial lesion or worse was 2.0%. Human papillomavirus DNA test collected by a health professional alone or combined with conventional cytology had the highest sensitivity (91.4 and 97.1%, respectively). The highest specificity was found for conventional cytology (91.6%) and for a human papillomavirus DNA test collected by a healthcare professional (90.2%). On the basis of only test performance, the use of human papillomavirus DNA tests, alone or combined with cytology, would seem to be recommended. Its population-wide implementation, however, is conditional on a cost-effectiveness analysis.

A influência do silicone na gênese do câncer de mama / The influence of silicone implants on breast malignancies

Embora os implantes de silicone fossem usados nos Estados Unidos da América desde o início dos anos 60 para aumento ou reconstrução das mamas, sua ação carcinogênica foi mais intensamente questionada a partir dos resultados de um estudo experimental em cobaias, realizado em 1987, que os associou ao desenvolvimento de sarcomas. Em 1992, apoiado nas escassas descrições de casos isolados existentes na época, o Food and Drug Administration (FDA) decretou moratória ao uso dessas próteses. Neste artigo, os autores apresentam uma ampla revisão da literatura médica sobre a associação entre o uso de próteses mamárias de silicone e o desenvolvimento de câncer de mama com base em informações científicas consistentes e substanciais provenientes da experiência clínica, de relatos de casos, de estudos epidemiológicos e revisões sistemáticas de textos técnicos e científicos, e concluem que não há evidência científica de que exista associação causal entre implantes mamários de silicone e o risco de desenvolvimento subseqüente de câncer de mama.