Prognostic factors for brain metastasis in women presenting cervical cancer.

PURPOSE: Although rare, brain metastases (BM) from cervical cancer (CC) are highly lethal. Adequate patient selection for specific treatments can improve survival rates in patients afflicted by this condition. This study aimed to describe the characteristics of CC patients who developed BM and overall survival-associated factors. Brain metastasis impact on the overall survival was assessed as a secondary objective. METHODS: This assessment comprises a retrospective cohort study on 3394 women presenting CC diagnosed between January 2010 and December 2017 at a single referral center. Incident BM cases were included. Descriptive statistics were calculated. Kaplan-Meier curves were used for the survival analysis and a Cox proportional hazards regression model was applied to explore the risk of death according to the analyzed independent variables. RESULTS: A total of 48 incident BM cases were identified. The median time between CC diagnosis and BM development was 1.5 years. Headaches (29.2%), dizziness/altered balance (29.2%), vertigo (29.2%) and motor disturbances (25.0%) were the most common signs and symptoms at presentation. Median overall survival after BM diagnosis was of 1.6 months (95% CI 0.9-2.3) while in the group of women without BM it was 5.5 years (95% CI 4.9-6.1). Concerning the Cox multivariate analysis, presenting one extracerebral metastases site (HR 2.8; 95% CI 1.3-6.2; p = 0.009) and receiving supportive treatment (HR 13.7; 95% CI 3.1-60.5; p 0.001) were independently associated with the risk of death. CONCLUSION: The median survival of women with BM following CC was poor. Women without extracerebral metastases and undergoing multimodal treatment displayed better overall survival rates.

Incidence and risk factors associated with the development of metastatic spinal cord compression due to bone metastasis in women with cervical cancer.

PURPOSE: The aim of this study was to determine the incidence and factors associated with the development of metastatic spinal cord compression (MSCC) after cervical cancer (CC). METHODS: This retrospective cohort of 3551 women with CC who underwent treatment at the Brazilian National Cancer Institute were included in the study. Clinical and sociodemographic variables were obtained from the Hospital Cancer Registry and from hospital records. A descriptive study of the population was carried out, using means and standard deviations or frequencies and percentages. The Kaplan-Meier curve was used to identify annual incidence rates. Associations between the independent variables and the outcome (MSCC) were evaluated by a univariate analysis, applying crude and adjusted odds ratios (aOR) assuming 95% confidence intervals. RESULTS: The MSCC incidence was of 1.5% (n = 51), associated to advanced staging (aOR = 2.65, 95% CI: 1.45-4.85, p = 0.001) and initial treatment with concomitant chemotherapy and radiotherapy (aOR = 4.40, 95% CI: 1.74-11.13, p = 0.002). CONCLUSIONS: Our findings revealed the incidence and factors associated with MSCC, indicating a subset of patients who may be potential targets for the prevention and early treatment of this condition, indicating unprecedented and relevant data for the Brazilian epidemiological scenario due to the high CC incidence rates.

Incidence and risk factors for the development of cerebral metastasis in cervical cancer patients.

OBJECTIVE: Cerebral metastasis (CM) in cervical cancer (CC) cases, although rare, results in high lethality rates. The present study aimed to assess CM incidence in a Brazilian reference CC center and evaluate the risk factors for CM development. Retrospective observational study of patients diagnosed with CC between 2010 and 2017. METHODS: Cumulative CM incidence and incidence density were evaluated. Characteristics associated to CM development risks were identified using crude (cOR) or adjusted (aOR) odds ratios. RESULTS: A total of 3,397 patients were included in this study. Patient age ranged from 18 to 101 years, with a mean age of 48.8±14.0. After a mean follow-up time of 3.2±2.1 years, 51 CM cases were identified, resulting in a cumulative incidence of 1.5% (95% confidence intervals [CI]=1.12-1.97) and an incidence density at the end of the 6th year of 27.4 per 1,000 women/year. Advanced clinical stage (aOR=3.15; 95% CI=1.16-8.58; p=0.025), the presence of previous lung metastasis (aOR=4.04; 95% CI=1.82-8.94; p=0.001) and the adenocarcinoma (aOR=2.90; 95% CI=1.46-5.76; p=0.002), adenosquamous carcinoma (aOR=7.33; 95% CI=2.87-18.73; p<0.001), undifferentiated carcinoma (aOR=14.37; 95% CI=3.77-54.76; p<0.001) and neuroendocrine carcinoma (aOR=21.31; 95% CI=6.65-68.37, p<0.001) histological types were associated with a higher risk for CM development. CM risk was higher in the first years of follow-up, with no cases observed after the 6th year. CONCLUSION: CC patients in advanced clinical stages, displaying previous lung metastasis and non-squamous histological types are at high risk of developing CM.

Priority conservation of medicinal woody plants from protected forests based on ecological and ethnobotanical data.

The combination of ethnobotanical and ecological knowledge is an important tool in indicating priority species for conservation. We sought to gather ethnobotanical knowledge on the diversity and use of woody medicinal plants in the Chapada Araripe region, assessing the real availability of woody medicinal resources in the Araripe Forests in the cerrado and carrasco areas, and indicate priority species for conservation. A total of 107 species were recorded in the ethnobotanical surveys, classified into 39 families and 83 genera, of which 92 species, 36 families and 70 genera for the cerrado areas, and 47 species, 25 families and 39 genera, for the carrasco areas. 59% were present in the phytosociological surveys for cerrado and 38% for carrascos. Species with high versatility of medicinal use did not necessarily have high local availability, and some were not recorded in the sampling. Thirteen species in cerrados and four in carrascos were indicated as conservation priorities. Use not aligned of species with the reality of the present time can indeed affect the vegetation landscape, and in a future scenario, not taking local measures to conserve protected forest resources, besides increasing the lists of local conservation priorities, can affect economic practices, increasing social and environmental conflicts.

Therapeutic indications, chemical composition and biological activity of native Brazilian species from Psidium genus (Myrtaceae): A review.

ETHNOPHARMACOLOGICAL IMPORTANCE: Brazilian medicinal species of the Psidium genus are rich in secondary metabolites such as terpenes and phenolic compounds and present biological activities for several human diseases. For the native Psidium species, there are no specific research reports for any member of the genus about ethnobotanical research, hindering the joint analysis of its therapeutic indications together with the scientific evidence already investigated. STUDY OBJECTIVE: Analyze the therapeutic indications, the main chemical constituents, and the biological activities of native species of the Psidium to Brazil. MATERIALS AND METHODS: Systematic research was carried out in the Scopus, ScienceDirect, PubMed, and Web of Science databases over a period of ten years. Articles in English, Portuguese and Spanish were used. The research was divided into three phases, seeking information on ethnobotany, chemical composition and biological activities. The words were combined to structure the descriptors used in the search. RESULTS: A total of 13 native species belonging to the Psidium genus were identified in this analysis, Psidium acutangulum DC., Psidium brownianum Mart. ex DC., Psidium cattleyanum Sabine, Psidium densicomum Mart. ex DC., Psidium grandifolium Mart. ex DC., Psidium guineense Sw., Psidium laruotteanum Cambess., Psidium myrsinites DC, Psidium myrtoides O. Berg, Psidium salutare (Kunth) O. Berg, Psidium schenckianum Kiaersk., Psidium sobralianum Proença & Landrum, Psidium striatulum Mart. ex DC. Of these, six were indicated in folk medicine, digestive system disorders being their main therapeutic indication. Most species presented an investigation of chemical composition and biological activity. They are rich in phenolic compounds, flavonoids, and terpenes and have antimicrobial, antioxidant, antiproliferative, and repellent activities. CONCLUSIONS: Native species of the Psidium genus are important sources of active ingredients in combating adversities that affect the human health, especially regarding the digestive system. They have a rich chemical composition, responsible for the biological activities demonstrated for the species.

Prevalence of Hepatitis C Virus Infection in Patients With Renal-Cell Carcinoma.

BACKGROUND: Some studies have demonstrated that the prevalence of chronic hepatitis C virus (HCV) infection is increased in patients with renal-cell carcinoma (RCC). Brazil is considered a low prevalence area for HCV (1.38%). The aim of this study was to evaluate the prevalence of HCV infection in patients with RCC. PATIENTS AND METHODS: A cross-sectional study with retrospective data collection was carried out. Patients more than 18 years old with a histopathologic diagnosis of RCC and who underwent HCV serology were included. Sociodemographic, pathologic, and clinical characteristics were evaluated at the time of patient admission. A descriptive analysis of the data was performed using means accompanied by their respective standard deviations for the continuous variables, and absolute number and frequency for the categorical variables. Comparisons between means were performed by analysis of variance. A chi-square test was used to compare the frequency of categorical variables. P < .05 was considered statistically significant. RESULTS: The prevalence of HCV infection was 4.1% (95% confidence interval, 1.7-8.3). No significant differences in age, sex, ethnicity, schooling, and alcohol or tobacco consumption among HCV- and HCV-negative patients with RCC were observed. CONCLUSIONS: A 3-fold higher prevalence of HCV infection was identified among patients with RCC than in the general Brazilian population. Further studies are required to confirm these data.

Uso de tablets por Agentes Comunitários de Saúde no Brasil

Objetivo: Refletir sobre o uso institucionalizado de tablets pelos Agentes Comunitários de Saúde (ACS) no seu processo de trabalho. Método: Pesquisa exploratória, com características quantitativa e qualitativa. Busca de reportagens realizada no Google notícias entre 2013 e 2019, utilizando os descritores "Agente Comunitário" e "Tablet". Elaborou-se um formulário eletrônico no Epi-info 7 com as principais informações de cada uma das notícias, gerando um respectivo banco de dados e clipping das matérias identificadas. Foi feita a análise temporal e geográfica das matérias. A abordagem qualitativa compreendeu a análise dos conteúdos das notícias, com base na análise de conteúdo de Laurence Bardin. Resultados e discussão: Foram encontradas vinte e sete (27) notícias de onze (11) estados de vinte e seis (26) municípios, sendo a maior parte da região Sul e Nordeste do Brasil. Na análise do conteúdo, percebeu-se que o tablet é compreendido como um instrumento que irá fazer com que o trabalho do ACS seja mais dinâmico e prático para eles e para a equipe de saúde da família como um todo, alguns dos termos que mais se destacaram foram: melhoria, facilidade e agilidade no processo de trabalho. O processo de qualificação dos ACS para o uso da nova tecnologia foi citado em 11 notícias (41%). Conclusão: É importante problematizar a introdução de tablets no processo de trabalho do ACS, levantando avanços e desafios, oferecendo também a qualificação apropriada para que estes profissionais possam fazer o melhor uso da ferramenta e não descartar totalmente os papéis, pois podem ser úteis.

Characterization of advanced glycation end products and their receptor (RAGE) in an animal model of myocardial infarction.

Circulating advanced glycation end products (AGE) and their receptor, RAGE, are increased after a myocardial infarction (MI) episode and seem to be associated with worse prognosis in patients. Despite the increasing importance of these molecules in the course of cardiac diseases, they have never been characterized in an animal model of MI. Thus, the aim of this study was to characterize AGE formation and RAGE expression in plasma and cardiac tissue during cardiac remodeling after MI in rats. Adult male Wistar rats were randomized to receive sham surgery (n = 15) or MI induction (n = 14) by left anterior descending coronary artery ligation. The MI group was stratified into two subgroups based on postoperative left ventricular ejection fraction: low (MIlowEF) and intermediate (MIintermEF). Echocardiography findings and plasma levels of AGEs, protein carbonyl, and free amines were assessed at baseline and 2, 30, and 120 days postoperatively. At the end of follow-up, the heart was harvested for AGE and RAGE evaluation. No differences were observed in AGE formation in plasma, except for a decrease in absorbance in MIlowEF at the end of follow-up. A decrease in yellowish-brown AGEs in heart homogenate was found, which was confirmed by immunodetection of N-ε-carboxymethyl-lysine. No differences could be seen in plasma RAGE levels among the groups, despite an increase in MI groups over the time. However, MI animals presented an increase of 50% in heart RAGE at the end of the follow-up. Despite the inflammatory and oxidative profile of experimental MI in rats, there was no increase in plasma AGE or RAGE levels. However, AGE levels in cardiac tissue declined. Thus, we suggest that the rat MI model should be employed with caution when studying the AGE-RAGE signaling axis or anti-AGE drugs for not reflecting previous clinical findings.

Prevalence of hepatitis C virus infection and its impact on the prognosis of head and neck cancer patients.

OBJECTIVE: Several studies have shown a higher prevalence of hepatitis C virus (HCV) infection among patients with head and neck cancer (HNC) compared to the general population. In Brazil, the prevalence of HCV infection is considered low (1.38%). The aim of this study was to determine HCV prevalence and how this can modify outcomes of patients with HNC. STUDY DESIGN: Retrospective cohort. METHODS: Patients with a diagnosis of malignant neoplasm in the head and neck (HN) region and who had serology performed for HCV were included. Patients were classified into two groups: head and neck squamous cell carcinoma (HNSCC) and other head and neck malignant neoplasms (OHNMN). Descriptive statistics were performed for all variables of interest. Means were compared using ANOVA and proportions using chi-square tests. Survival data were compared by Kaplan-Meier curves and log-rank test. RESULTS: Global HCV prevalence in patients with HNC was 7.8%, reaching 12.8% in HNSCC and 3.4% in OHNMN (p = 0.003). There was a higher risk of developing a second primary neoplasm in HNSCC compared to OHNMN patients (20.6% versus 4.6%; p = 0.001). The mean survival was not different between HCV-positive and HCV-negative patients (6.0 years versus 6.6 years, respectively, p = 0.516). CONCLUSION: The prevalence of HCV infection was higher in HNC patients compared to the general Brazilian population. It seems reasonable to consider that HCV infection is associated with an increased risk of HNC, but HCV infection does not worsens the prognosis of HNC patients.