Pulmonary Granuloma Is Not Always the Tuberculosis Hallmark: Pathology of Tuberculosis Stages in New World and Old World Monkeys Naturally Infected with the Mycobacterium tuberculosis Complex.

We present the pathology of monkeys naturally infected with Mycobacterium tuberculosis complex from five different colonies in Rio de Janeiro, Brazil. On the basis of gross and histopathological findings, the lesions were classified into chronic-active, extrapulmonary, early-activation or latent-reactivation stages. Typical granulomatous pneumonia was seen in 46.6% of cases (six rhesus monkeys [Macaca mulatta] and one Uta Hick's bearded saki [Chiropotes utahickae]). The absence of pulmonary granulomas did not preclude a diagnosis of tuberculosis (TB): classical granulomatous pneumonia was observed in the chronic-active and latent-reactivation stages but not in the extrapulmonary and early-activation stages. The early-activation stage was characterized by interstitial pneumonia with a predominance of foamy macrophages and molecular and immunohistochemical evidence of M. tuberculosis complex infection. TB should be considered as a cause of interstitial pneumonia in New World Monkeys. We recommend the use of immunohistochemistry and molecular analysis for diagnosis of TB, even when typical macroscopic or histological changes are not observed.

Predicting health-related social needs in Medicaid and Medicare populations using machine learning.

Providers currently rely on universal screening to identify health-related social needs (HRSNs). Predicting HRSNs using EHR and community-level data could be more efficient and less resource intensive. Using machine learning models, we evaluated the predictive performance of HRSN status from EHR and community-level social determinants of health (SDOH) data for Medicare and Medicaid beneficiaries participating in the Accountable Health Communities Model. We hypothesized that Medicaid insurance coverage would predict HRSN status. All models significantly outperformed the baseline Medicaid hypothesis. AUCs ranged from 0.59 to 0.68. The top performance (AUC = 0.68 CI 0.66-0.70) was achieved by the "any HRSNs" outcome, which is the most useful for screening prioritization. Community-level SDOH features had lower predictive performance than EHR features. Machine learning models can be used to prioritize patients for screening. However, screening only patients identified by our current model(s) would miss many patients. Future studies are warranted to optimize prediction of HRSNs.

Rapid tree carbon stock recovery in managed Amazonian forests.

While around 20% of the Amazonian forest has been cleared for pastures and agriculture, one fourth of the remaining forest is dedicated to wood production. Most of these production forests have been or will be selectively harvested for commercial timber, but recent studies show that even soon after logging, harvested stands retain much of their tree-biomass carbon and biodiversity. Comparing species richness of various animal taxa among logged and unlogged forests across the tropics, Burivalova et al. found that despite some variability among taxa, biodiversity loss was generally explained by logging intensity (the number of trees extracted). Here, we use a network of 79 permanent sample plots (376 ha total) located at 10 sites across the Amazon Basin to assess the main drivers of time-to-recovery of post-logging tree carbon (Table S1). Recovery time is of direct relevance to policies governing management practices (i.e., allowable volumes cut and cutting cycle lengths), and indirectly to forest-based climate change mitigation interventions.

Modificações da adiposidade em escolares de acordo com o estado nutricional: análise de 20 anos / Modifications of adiposity in school-age children according to nutritional status: a 20-year analysis

OBJETIVO: Analisar as modificações da adiposidade de escolares durante 20 anos, de acordo com o estado nutricional. MÉTODOS: O estudo faz parte do Projeto Misto Longitudinal de Crescimento, Desenvolvimento e Aptidão Física de Ilhabela. Uma amostra de 1.095 escolares de ambos os sexos, de 7 a 10 anos, atendiam aos seguintes critérios de inclusão: (a) pelo menos uma avaliação completa em um dos períodos analisados; (b) estar no estágio pré-púbere de maturação sexual; (c) ser aparentemente saudável. Os períodos analisados foram 1990/1991 (inicial), 2000/2001 (10 anos) e 2010/2011 (20 anos). As variáveis analisadas foram: massa corporal, estatura e adiposidade, pela análise individual de cada dobra cutânea. Os indivíduos foram classificados em eutróficos, com excesso de peso e obesos mediante as curvas propostas pela Organização Mundial da Saúde de índice de massa corporal para idade e sexo. Foi utilizada a Anova one-way, seguida do post-hoc de Scheffé, com p < 0,01. RESULTADOS: Nos meninos, o maior aumento ocorreu no grupo com excesso de peso, seguido pelos grupos obesos e eutróficos. Já nas meninas, os maiores aumentos ocorreram nos grupos com excesso de peso e eutróficas, seguidos pelo grupo obesas. CONCLUSÃO: Houve modificações da adiposidade, mesmo com o controle do estado nutricional, durante o período de 20 anos analisado, mostrando que os indivíduos que têm semelhantes índices de massa corporal podem variar em proporção e distribuição de tecido adiposo subcutâneo. Para ambos os sexos, o aumento foi maior nos grupos classificados como excesso de peso e, principalmente, nas dobras cutâneas centrais.

OBJECTIVE: To analyze adiposity changes in school-age children over a 20 year-period, according to nutritional status. METHODS: The study is part of the Ilhabela Longitudinal Mixed Project on Growth, Development and Physical Fitness. A sample of 1,095 school students of both sexes, from 7 to 10 years, met the following inclusion criteria: (a) at least one complete assessment in one of the analyzed periods; (b) to be in prepubertal stage of sexual maturation; (c) to be apparently healthy. The periods analyzed were 1990/1991 (initial), 2000/2001 (10 years) and 2010/2011 (20 years). The variables analyzed were: body weight, height and adiposity through individual analysis of each skinfold. Children were classified as eutrophic, overweight and obese, according to the curves of body mass index for age and sex proposed by the World Health Organization. The statistical analysis used was one-way ANOVA, followed by Scheffé's post-hoc test, with p < 0.01. RESULTS: In boys, the largest increase occurred in the overweight group, followed by the obese and eutrophic groups. In girls, the largest increases occurred in the groups with overweight and eutrophic children, followed by the obese group. CONCLUSION: in adiposity, even when the nutritional status was controlled, showing that individuals who have similar body mass indexes may vary in proportion and distribution of subcutaneous adipose tissue. In both sexes, the increase was higher in the overweight group, and mainly in central skinfolds.

Modifications of adiposity in school-age children according to nutritional status: a 20-year analysis.

OBJECTIVE: To analyze adiposity changes in school-age children over a 20 year-period, according to nutritional status. METHODS: The study is part of the Ilhabela Longitudinal Mixed Project on Growth, Development and Physical Fitness. A sample of 1,095 school students of both sexes, from 7 to 10 years, met the following inclusion criteria: (a) at least one complete assessment in one of the analyzed periods; (b) to be in prepubertal stage of sexual maturation; (c) to be apparently healthy. The periods analyzed were 1990/1991 (initial), 2000/2001 (10 years) and 2010/2011 (20 years). The variables analyzed were: body weight, height and adiposity through individual analysis of each skinfold. Children were classified as eutrophic, overweight and obese, according to the curves of body mass index for age and sex proposed by the World Health Organization. The statistical analysis used was one-way ANOVA, followed by Scheffé's post-hoc test, with p < 0.01. RESULTS: In boys, the largest increase occurred in the overweight group, followed by the obese and eutrophic groups. In girls, the largest increases occurred in the groups with overweight and eutrophic children, followed by the obese group. CONCLUSION: During the 20-year period analyzed, there were changes in adiposity, even when the nutritional status was controlled, showing that individuals who have similar body mass indexes may vary in proportion and distribution of subcutaneous adipose tissue. In both sexes, the increase was higher in the overweight group, and mainly in central skinfolds.

The beginning of the 21st century: a paradigm shift in the surgical management of renal cell carcinoma in South America.

PURPOSE: The incidence of renal cell carcinoma (RCC) has been rising by 2.3 to 4.3% every year over the past three decades. Previously, RCC has been known as the internist's tumor; however, it is now being called the radiologist's tumor because 2÷3 are now detected incidentally on abdominal imaging. We compared patients who were treated toward the end of the 20th century to those treated during the beginning of the 21st century with regard to RCC size and type of surgical treatment. MATERIALS AND METHODS: The study included 226 patients. For analysis of tumor size, we considered a cut point of <4 cm and>4 cm. For analysis of type of surgery performed, we considered radical and partial nephrectomy. RESULTS: After the turn of the century, there was a reduction of 1.57±0.48 cm in the size of the RCC that was operated on. Nephron sparing surgeries were performed in 17% of the cases until the year 2000, and 39% of the tumors were <4 cm. From 2001, 64% of the tumors measured<4 cm and 42% of the surgeries were performed using nephron sparing techniques. Mean tumor size was 5.95 cm (±3.58) for the cases diagnosed before year 2000, and cases treated after the beginning of 21st century had a mean tumor size of 4.38 cm (±3.27). CONCLUSIONS: Compared with the end of the 20th century, at the beginning of the 21st century due to a reduction in tumor size it was possible to increase the number of nephron sparing surgeries.

The beginning of the 21st century: a paradigm shift in the surgical management of renal cell carcinoma in South America

PURPOSE: The incidence of renal cell carcinoma (RCC) has been rising by 2.3 to 4.3 percent every year over the past three decades. Previously, RCC has been known as the internist’s tumor; however, it is now being called the radiologist’s tumor because 2/3 are now detected incidentally on abdominal imaging. We compared patients who were treated toward the end of the 20th century to those treated during the beginning of the 21st century with regard to RCC size and type of surgical treatment. MATERIALS AND METHODS: The study included 226 patients. For analysis of tumor size, we considered a cut point of < 4 cm and > 4 cm. For analysis of type of surgery performed, we considered radical and partial nephrectomy. RESULTS: After the turn of the century, there was a reduction of 1.57 ± 0.48 cm in the size of the RCC that was operated on. Nephron sparing surgeries were performed in 17 percent of the cases until the year 2000, and 39 percent of the tumors were < 4 cm. From 2001, 64 percent of the tumors measured < 4 cm and 42 percent of the surgeries were performed using nephron sparing techniques. Mean tumor size was 5.95 cm (± 3.58) for the cases diagnosed before year 2000, and cases treated after the beginning of 21st century had a mean tumor size of 4.38 cm (± 3.27). CONCLUSIONS: Compared with the end of the 20th century, at the beginning of the 21st century due to a reduction in tumor size it was possible to increase the number of nephron sparing surgeries.

Time trends in physical activity in the state of São Paulo, Brazil: 2002-2008.

PURPOSE: To document time trends in physical activity in the state of São Paulo, Brazil (2002-2008). In addition, we discuss the role of Agita São Paulo at explaining such trends. METHODS: Cross-sectional surveys were carried out in 2002, 2003, 2006, and 2008 in the state of São Paulo, Brazil, using comparable sampling approaches and similar sample sizes. In all surveys, physical activity was measured using the short version of the International Physical Activity Questionnaire. Separate weekly scores of walking and moderate- and vigorous-intensity physical activities were generated; cutoff points of 0 and 150 min·wk were used. Also, we created a total physical activity score by summing these three types of activity. We used logistic regression models for adjusting time trends for the different sociodemographic compositions of the samples. RESULTS: The prevalence of no physical activity decreased from 9.6% in 2002 to 2.7% in 2008, whereas the proportion of subjects below the 150-min threshold decreased from 43.7% in 2002 to 11.6% in 2008. These trends were mainly explained by increases in walking and moderate-intensity physical activity. Increases in physical activity were slightly greater among females than among males. Logistic regression models confirmed that these trends were not due to the different compositions of the samples. CONCLUSIONS: Physical activity levels are increasing in the state of São Paulo, Brazil. Considering that the few data available in Brazil using the same instrument indicate exactly the opposite trend and that Agita São Paulo primarily incentives the involvement in moderate-intensity physical activity and walking, it seems that at least part of the trends described here are explained by the Agita São Paulo program.

Prevalência de inatividade física e fatores associados em estudantes do ensino médio de escolas públicas estaduais / Prevalence of physical inactivity and associated factors among high school students from state's public schools

OBJETIVO: Descrever a prevalência de inatividade física e os fatores associados em estudantes do ensino médio de escolas públicas estaduais da cidade de São Paulo (SP). MÉTODOS: Foram selecionadas aleatoriamente 16 escolas públicas estaduais considerando as regiões geográficas da cidade de São Paulo (norte, sul, leste e oeste). A amostra foi de 3.845 estudantes do ensino médio no ano de 2006. Inatividade física foi mensurada com o Questionário Internacional de Atividade Física (IPAQ curto) e definida como praticar atividade física moderada e/ou vigorosa por um período menor que 300 minutos por semana. As variáveis independentes analisadas foram: gênero, idade, nível socioeconômico, região geográfica da cidade de São Paulo, conhecimento do programa Agita São Paulo, participação nas aulas de educação física escolar, uso de tabaco, ingestão de bebidas alcoólicas e tempo diário assistindo televisão. Foi utilizada a regressão de Poisson com três níveis para entrada de variáveis, com nível de significância de p < 0,05. RESULTADOS: A prevalência geral de inatividade física em adolescentes da cidade de São Paulo foi de 62,5 por cento (IC95 por cento 60,5-64,1). Os fatores associados à inatividade física foram o gênero, idade, nível socioeconômico, região geográfica da cidade de São Paulo, não conhecer o programa Agita São Paulo, não participar das aulas de educação física, uso de tabaco, ingestão de bebidas alcoólicas e tempo diário de televisão. CONCLUSÃO: A prevalência de inatividade física em adolescentes de São Paulo foi elevada em todas as regiões geográficas, além de fatores sociodemográficos e comportamentais contribuírem significativamente com a inatividade física.

OBJECTIVE: To describe the prevalence of physical inactivity and associated factors among high school students from state's public schools in the city of São Paulo, state of São Paulo, Brazil. METHODS: Sixteen state's public schools were randomly selected according to the geographic areas of the city (North, South, East, and West). The sample consisted of 3,845 high school students in 2006. Physical inactivity was measured using the International Physical Activity Questionnaire (short IPAQ) and was defined as practicing moderate and/or vigorous physical activity for a period of less than 300 minutes per week. The independent variables analyzed were: gender, age, socioeconomic level, geographic area of the city, awareness of the "Agita São Paulo" program, participation in physical education classes, smoking, alcohol intake and time spent per day watching television. Three-level Poisson regression was used for assessing the variables, with a significance level of p < 0.05. RESULTS: The general prevalence of physical inactivity among adolescents in São Paulo was 62.5 percent (95 percentCI 60.5-64.1). The factors associated with physical inactivity were gender, age, socioeconomic level, geographic area of the city, awareness of the "Agita São Paulo" program, non-participation in physical education classes, smoking, alcohol intake and time spent per day watching television. CONCLUSION: It was concluded that the prevalence of physical inactivity among adolescents in São Paulo was high in all the geographic areas evaluated, and that sociodemographic and behavioral factors contributed significantly to physical inactivity.

Prevalence of physical inactivity and associated factors among high school students from state's public schools.

OBJECTIVE: To describe the prevalence of physical inactivity and associated factors among high school students from state's public schools in the city of São Paulo, state of São Paulo, Brazil. METHODS: Sixteen state's public schools were randomly selected according to the geographic areas of the city (North, South, East, and West). The sample consisted of 3,845 high school students in 2006. Physical inactivity was measured using the International Physical Activity Questionnaire (short IPAQ) and was defined as practicing moderate and/or vigorous physical activity for a period of less than 300 minutes per week. The independent variables analyzed were: gender, age, socioeconomic level, geographic area of the city, awareness of the Agita São Paulo program, participation in physical education classes, smoking, alcohol intake and time spent per day watching television. Three-level Poisson regression was used for assessing the variables, with a significance level of p < 0.05. RESULTS: The general prevalence of physical inactivity among adolescents in São Paulo was 62.5% (95%CI 60.5-64.1). The factors associated with physical inactivity were gender, age, socioeconomic level, geographic area of the city, awareness of the Agita São Paulo program, non-participation in physical education classes, smoking, alcohol intake and time spent per day watching television. CONCLUSION: It was concluded that the prevalence of physical inactivity among adolescents in São Paulo was high in all the geographic areas evaluated, and that sociodemographic and behavioral factors contributed significantly to physical inactivity.

Influência da maturação sexual na aptidão física de escolares do município de Ilhabela: um estudo longitudinal / Influence of sexual maturation on physical fitness in male students of Ilhabela Brazil: a longitudinal study

Objetivo: Verificar a influência da maturação sexual sobre as variáveis de aptidão física de acordo com a faixa etária em escolares do sexo masculino do município de Ilhabela em uma abordagem longitudinal. Método: 27 escolares do sexo masculino foram acompanhados por um período de 4 anos consecutivos, entre 10 e 13 anos de idade. As variáveis avaliadas foram: massa corporal, estatura, adiposidade, impulsão vertical, shuttle run, corrida de 50 metros e a potência aeróbica (VO2máx l.min-1 e ml.kg-1.min-1), seguindo a padronização do CELAFISCS. A determinação do nível maturacional foi feita mediante a auto-avaliação dos pêlos púbicos proposta por Matsudo (1994). A análise estatística utilizada foi a análise de regressão univariada. O nível de significância adotado foi p<0,05. Resultados: A maturação sexual explicou de maneira significativa a adiposidade aos 10, 11 e 12 anos, a força aos 10 e 12 anos, a velocidade e a potência aeróbica (VO2máx l.min-1) apenas aos 10 anos. Conclusão: A maturação sexual explica principalmente a adiposidade, mas também a força, a velocidade e a potência aeróbica em termos absolutos (VO2máx l.min-1) do que as outras variáveis analisadas dos 10 aos 13 anos de idade no sexo masculino. A agilidade e o VO2máx (ml.kg-1.min-1) não foram explicadas pela maturação em qualquer das idades avaliadas.

Purpose: The aim of the present study was to verify through a longitudinal approach the influence of the sexual maturation on physical fitness according to age in peri-pubertal boys Methods: 27 male students from 10 to 13 years of age were followed during 4-year period. Variables analyzed were: body weight, height, adiposity, vertical jump, shuttle run, 50 meters run test and aerobic power (VO2máx - l.min-1 and ml.kg-1.min-1), according to CELAFISCS standard. Sexual maturation level was established through the self-assessment of Tanner (1991) stages, considering pubic hair, proposed by Matsudo (1994). Each student participated in, at least, one evaluation per year. Results were evaluated through univariate regression analysis. Level of significantly adapted was p<0.05. Results: Sexual maturation significantly accounted to adiposity values among 10, 11 and 12 years-old boys, to strength in the 10 and 12 years-old groups, and speed and aerobic power (VO2máx l.min-1) values only in the 10 years-old group. Conclusion: Based on this longitudinal study authors concluded that among peri-pubertal boys. Sexual maturation explained mainly adiposity values. Some strength, velocity, and aerobic power (absolute value). No influence was observed on agility and relative aerobic power.

Prediction of pathological stage in prostate cancer through the percentage of involved fragments upon biopsy.

INTRODUCTION: The need for defining the extension of disease in patients undergoing radical prostatectomy due to prostate adenocarcinoma is a relevant factor cure in such individuals. In order to identify a new independent preoperative factor for predicting the extension of prostate cancer, we assessed the role of the percentage of positive fragments upon biopsy. MATERIALS AND METHODS: A retrospective study compared the percentage of positive fragments on biopsy with the extension of disease as defined by the pathological examination of the surgical specimen from 898 patients undergoing radical prostatectomy due to clinically localized prostate cancer. RESULTS: On the univariate analysis, the percentage of positive fragments on biopsy showed a statistical significance for predicting confined disease (p < 0.001), which was found in 66.7% of the cases under study. Additionally, we observed that the total number of removed fragments exerts no influence on the extension of the disease (p = 0.567). CONCLUSION: the percentage of positive fragments is an independent factor for predicting the pathological stage of prostate adenocarcinoma, and the number of removed fragments is not related to the extension of the disease.

Prediction of pathological stage in prostate cancer through the percentage of involved fragments upon biopsy

INTRODUCTION: The need for defining the extension of disease in patients undergoing radical prostatectomy due to prostate adenocarcinoma is a relevant factor cure in such individuals. In order to identify a new independent preoperative factor for predicting the extension of prostate cancer, we assessed the role of the percentage of positive fragments upon biopsy. MATERIALS AND METHODS: A retrospective study compared the percentage of positive fragments on biopsy with the extension of disease as defined by the pathological examination of the surgical specimen from 898 patients undergoing radical prostatectomy due to clinically localized prostate cancer. RESULTS: On the univariate analysis, the percentage of positive fragments on biopsy showed a statistical significance for predicting confined disease (p < 0.001), which was found in 66.7 percent of the cases under study. Additionally, we observed that the total number of removed fragments exerts no influence on the extension of the disease (p = 0.567). CONCLUSION: the percentage of positive fragments is an independent factor for predicting the pathological stage of prostate adenocarcinoma, and the number of removed fragments is not related to the extension of the disease.