Spatial dynamics and socioeconomic factors correlated with American cutaneous leishmaniasis in Pernambuco, Brazil from 2008 to 2017.

INTRODUCTION: American cutaneous leishmaniasis (ACL) is a public health problem and has been associated with country's territory. We aimed to analyze the spatial dynamics and socioeconomic factors correlated to the incidence of ACL in Pernambuco, Brazil from 2008 to 2017. METHODS: A cross-sectional, ecological study was conducted in the Brazilian municipalities. Patient data were obtained from the Health Hazard Notification System (SINAN); indicators and incidence for the total period and for quinquennium were obtained. Socioeconomic factors were analyzed to evaluate the association between the incidence of ACL and presence of bathroom and running water, garbage collection availability, inadequate water supply, sanitation, rural population, per capita income, and vulnerability to poverty. Spatial analysis considered the gross incidence; the Bayesian local empirical method and Moran spatial autocorrelation index were applied using Terra View and QGIS. RESULTS: The incidence of ACL reduced (0.29/100,000 inhabitants per year). Individuals with ACL were young adults (30.3%), men (60.2%), brown skinned (62.9%), rural residents (70.6%), and less educated (46.7%); had autochthonous transmission (78.8%); developed the cutaneous form (97.2%); had evolution to cure (82.7%); and were diagnosed using the clinical epidemiological criterion (70.5%). ACL occurred in the large part of the state and showed heterogeneous distribution, with persistence of two high priority intervention clusters covering Health Regions I, II, III, IV, and XII. CONCLUSIONS: Spatial analysis and epidemiological indicators complement each other. The combination of these methods can improve the understanding on ACL occurrence, which will help subsidize planning and enhance the quality and effectiveness of healthcare interventions.

[Assessment of the impact of prenatal, childbirth, and neonatal care on avoidable neonatal deaths in Pernambuco State, Brazil: an adequacy study]. / Avaliação do impacto de programas de assistência pré-natal, parto e ao recém-nascido nas mortes neonatais evitáveis em Pernambuco, Brasil: estudo de adequação.

This study aimed to assess the impact of programs for prenatal, childbirth, and neonatal care (Mother Owl and Stork Network) on avoidable neonatal mortality in Pernambuco State, Brazil, using the adequacy approach. We analyzed the trend in avoidable neonatal mortality and the impact of these programs on avoidable neonatal mortality in four health regions in the state from 2000 to 2016. The Mortality Information System (SIM) and the Information System on Live Births (SINASC) and official documents were used as the data sources. Deaths were classified according to the Brazilian List of Avoidable Causes of Deaths Via Interventions by the Unified National Health System. Linear regression and joinpoint methods were used to analyze tendencies and identifying turning points in the neonatal mortality curves. There was a sharp drop in avoidable neonatal mortality in the state, especially in early neonatal mortality. Except for the I-Recife region, where there was a downturn in the mortality curves after implementation of the Stork Network, there was no association between the turning points in the curves and the periods with the programs' implementation in the regions. Other factors appear to have led to the improvement of these indicators, such as the expansion of the high-risk network. Strengthening this network can thus help reduce avoidable neonatal deaths, especially early deaths.

Este estudo teve como objetivo avaliar o impacto de programas voltados à assistência pré-natal, parto e ao recém-nascido (Mãe Coruja Pernambucana e Rede Cegonha) na mortalidade neonatal evitável no Estado de Pernambuco, Brasil, utilizando a abordagem de adequação. Analisou-se a tendência dos coeficientes de mortalidade neonatal evitável, bem como o impacto desses programas na mortalidade neonatal evitável em quatro regiões de saúde do estado, de 2000 a 2016. Sistemas de Informações sobre Mortalidade (SIM) e de Nascidos Vivos (SINASC) e documentos oficiais foram usados como fonte de dados. Os óbitos foram classificados segundo a Lista Brasileira de Causas de Óbitos Evitáveis por Intervenções do SUS. Utilizaram-se métodos de regressão linear e joinpoint para análise das tendências e identificação de pontos de inflexão nas curvas de mortalidade neonatal. Houve acentuada queda da mortalidade neonatal evitável no estado, principalmente a precoce. Excetuando-se a Região I-Recife, onde observou-se inflexão negativa das curvas de mortalidade após a implantação da Rede Cegonha, não houve correspondência das inflexões nas curvas com os períodos de implantação dos programas nas demais regiões. Outros fatores parecem ter atuado na melhoria desses indicadores, como a ampliação da rede de alto risco. Portanto, o fortalecimento dessa rede pode contribuir na redução dos óbitos neonatais evitáveis, particularmente o precoce.

El objetivo de este estudio fue evaluar el impacto de programas dirigidos a la asistencia pre-natal, parto y cuidados al recién nacido (Madre-Búho y Red Cigüeña) en la mortalidad neonatal evitable en el estado de Pernambuco, Brasil, utilizando un abordaje de adecuación. Se analizó la tendencia de los coeficientes de mortalidad neonatal evitable, así como el impacto de estos programas en la mortalidad neonatal evitable en cuatro regiones de salud del estado, de 2000 a 2016. Se utilizaron como fuente de datos los Sistemas de Información sobre Mortalidad (SIM) y de Nacidos Vivos (SINASC), así como documentos oficiales. Los óbitos se clasificaron según la Lista Brasileña de Causas de Óbitos Evitables por Intervenciones del SUS. Se utilizaron métodos de regresión lineal y joinpoint para el análisis de las tendencias e identificación de puntos de inflexión en la curvas de mortalidad neonatal. Hubo una acentuada caída de la mortalidad neonatal evitable en el estado, principalmente la precoz. Exceptuándose la región I-Recife, donde se observó una inflexión negativa de las curvas de mortalidad tras la implantación de la Red Cigüeña, no hubo una correspondencia de las inflexiones en las curvas con los períodos de implantación de los programas en las demás regiones. Otros factores parecen haber actuado en la mejoría de estos indicadores, como la ampliación de la red de alto riesgo. Por tanto, el fortalecimiento de esta red puede contribuir a la reducción de los óbitos neonatales evitables, particularmente el precoz.

Avaliação do impacto de programas de assistência pré-natal, parto e ao recém-nascido nas mortes neonatais evitáveis em Pernambuco, Brasil: estudo de adequação / Assessment of the impact of prenatal, childbirth, and neonatal care on avoidable neonatal deaths in Pernambuco State, Brazil: an adequacy study / Evaluación del impacto de programas de asistencia pre-natal, parto y cuidados al recién-nacido en las muertes neonatales evitables en Pernambuco, Brasil: estudio de adecuación

Este estudo teve como objetivo avaliar o impacto de programas voltados à assistência pré-natal, parto e ao recém-nascido (Mãe Coruja Pernambucana e Rede Cegonha) na mortalidade neonatal evitável no Estado de Pernambuco, Brasil, utilizando a abordagem de adequação. Analisou-se a tendência dos coeficientes de mortalidade neonatal evitável, bem como o impacto desses programas na mortalidade neonatal evitável em quatro regiões de saúde do estado, de 2000 a 2016. Sistemas de Informações sobre Mortalidade (SIM) e de Nascidos Vivos (SINASC) e documentos oficiais foram usados como fonte de dados. Os óbitos foram classificados segundo a Lista Brasileira de Causas de Óbitos Evitáveis por Intervenções do SUS. Utilizaram-se métodos de regressão linear e joinpoint para análise das tendências e identificação de pontos de inflexão nas curvas de mortalidade neonatal. Houve acentuada queda da mortalidade neonatal evitável no estado, principalmente a precoce. Excetuando-se a Região I-Recife, onde observou-se inflexão negativa das curvas de mortalidade após a implantação da Rede Cegonha, não houve correspondência das inflexões nas curvas com os períodos de implantação dos programas nas demais regiões. Outros fatores parecem ter atuado na melhoria desses indicadores, como a ampliação da rede de alto risco. Portanto, o fortalecimento dessa rede pode contribuir na redução dos óbitos neonatais evitáveis, particularmente o precoce.

This study aimed to assess the impact of programs for prenatal, childbirth, and neonatal care (Mother Owl and Stork Network) on avoidable neonatal mortality in Pernambuco State, Brazil, using the adequacy approach. We analyzed the trend in avoidable neonatal mortality and the impact of these programs on avoidable neonatal mortality in four health regions in the state from 2000 to 2016. The Mortality Information System (SIM) and the Information System on Live Births (SINASC) and official documents were used as the data sources. Deaths were classified according to the Brazilian List of Avoidable Causes of Deaths Via Interventions by the Unified National Health System. Linear regression and joinpoint methods were used to analyze tendencies and identifying turning points in the neonatal mortality curves. There was a sharp drop in avoidable neonatal mortality in the state, especially in early neonatal mortality. Except for the I-Recife region, where there was a downturn in the mortality curves after implementation of the Stork Network, there was no association between the turning points in the curves and the periods with the programs' implementation in the regions. Other factors appear to have led to the improvement of these indicators, such as the expansion of the high-risk network. Strengthening this network can thus help reduce avoidable neonatal deaths, especially early deaths.

El objetivo de este estudio fue evaluar el impacto de programas dirigidos a la asistencia pre-natal, parto y cuidados al recién nacido (Madre-Búho y Red Cigüeña) en la mortalidad neonatal evitable en el estado de Pernambuco, Brasil, utilizando un abordaje de adecuación. Se analizó la tendencia de los coeficientes de mortalidad neonatal evitable, así como el impacto de estos programas en la mortalidad neonatal evitable en cuatro regiones de salud del estado, de 2000 a 2016. Se utilizaron como fuente de datos los Sistemas de Información sobre Mortalidad (SIM) y de Nacidos Vivos (SINASC), así como documentos oficiales. Los óbitos se clasificaron según la Lista Brasileña de Causas de Óbitos Evitables por Intervenciones del SUS. Se utilizaron métodos de regresión lineal y joinpoint para el análisis de las tendencias e identificación de puntos de inflexión en la curvas de mortalidad neonatal. Hubo una acentuada caída de la mortalidad neonatal evitable en el estado, principalmente la precoz. Exceptuándose la región I-Recife, donde se observó una inflexión negativa de las curvas de mortalidad tras la implantación de la Red Cigüeña, no hubo una correspondencia de las inflexiones en las curvas con los períodos de implantación de los programas en las demás regiones. Otros factores parecen haber actuado en la mejoría de estos indicadores, como la ampliación de la red de alto riesgo. Por tanto, el fortalecimiento de esta red puede contribuir a la reducción de los óbitos neonatales evitables, particularmente el precoz.

Spatial dynamics and socioeconomic factors correlated with American cutaneous leishmaniasis in Pernambuco, Brazil from 2008 to 2017

Abstract INTRODUCTION: American cutaneous leishmaniasis (ACL) is a public health problem and has been associated with country's territory. We aimed to analyze the spatial dynamics and socioeconomic factors correlated to the incidence of ACL in Pernambuco, Brazil from 2008 to 2017. METHODS: A cross-sectional, ecological study was conducted in the Brazilian municipalities. Patient data were obtained from the Health Hazard Notification System (SINAN); indicators and incidence for the total period and for quinquennium were obtained. Socioeconomic factors were analyzed to evaluate the association between the incidence of ACL and presence of bathroom and running water, garbage collection availability, inadequate water supply, sanitation, rural population, per capita income, and vulnerability to poverty. Spatial analysis considered the gross incidence; the Bayesian local empirical method and Moran spatial autocorrelation index were applied using Terra View and QGIS. RESULTS: The incidence of ACL reduced (0.29/100,000 inhabitants per year). Individuals with ACL were young adults (30.3%), men (60.2%), brown skinned (62.9%), rural residents (70.6%), and less educated (46.7%); had autochthonous transmission (78.8%); developed the cutaneous form (97.2%); had evolution to cure (82.7%); and were diagnosed using the clinical epidemiological criterion (70.5%). ACL occurred in the large part of the state and showed heterogeneous distribution, with persistence of two high priority intervention clusters covering Health Regions I, II, III, IV, and XII. CONCLUSIONS: Spatial analysis and epidemiological indicators complement each other. The combination of these methods can improve the understanding on ACL occurrence, which will help subsidize planning and enhance the quality and effectiveness of healthcare interventions.

Randomized comparison between indocyanine green fluorescence plus 99mtechnetium and 99mtechnetium alone methods for sentinel lymph node biopsy in breast cancer.

Use of both patent blue and a radioisotope to locate, and reduce the risk of sentinel lymph node (SLN) detection failure in breast cancer is recommended, but drawbacks commonly lead to using only a radioisotope. An alternative method would therefore be valuable. This randomized, controlled study in 99 patients compared SLN detection using 99mtechnetium (Tc) alone versus Tc combined with indocyanine green (ICG). The primary endpoint was the SLN identification rate. The primary outcome measure was the number of patients with <2 SLN detected. One SLN was detected in 44.0% of patients in the dual detection group and 40.8% in the 99mTc alone group (RR = 1.08 (95% CI 0.68; 1.72), p = 0.84). A mean (±SD) of 2.14 ± 1.23 SLN were identified in the dual detection group vs. 1.77 ± 0.85 using Tc alone (p = 0.09). Eight-five (78.7%) SLN were both ICG+ and TC+, 15 (13.9%) ICG+ and Tc-, and 7 (6.5%) ICG- and Tc+. SLN detected were ICG-positive in 92.6% of patients and 99mTc-positive in 85.2% with. No adverse event related to ICG injection was recorded. Dual detection of SLN using ICG and radioisotope is reliable and sensitive but was not superior to isotope alone in successfully locating SLN in our pilot randomized trial.

A strategy action from the Cievs/Pernambuco in response to the emergency on Congenital Syndrome associated to Zika virus infection: an integrative action / Estratégia de atuação do Cievs/Pernambuco na resposta à emergência da Síndrome Congênita associada à infecção pelo vírus Zika: uma ação integrativa

Abstract Objectives: to describe the strategy action from the Centro de Informações Estratégicas de Vigilância em Saúde (Cievs/PE) (Strategic Information on Health Surveillance Center) in response to the emergency on Congenital Syndrome associated to Zika virus infection (CSZ) in Pernambuco State between 2015 and 2016. Methods: description performed on the strategies and activities developed by Cievs/PE during the important international public health emergency related to CSZ. Results: participated in detecting suspected CSZ cases; participated in elaborating clinical epidemiological protocols; developed electronic forms to notify CSZ cases and pregnant women with exanthema rashes; prepared epidemiological reports; developed a website about the emergency on the Cievs/PE website; insert the occurrence in the Comitê de Avaliação e Monitoramento de Eventos (CAME) (Committee to Assess and Monitor Occurrence); resolution of demands during readiness; technical visits from National and International institutions. The actions developed by the Cievs/PE were fundamental in detecting and following-up on 2,073 CSZ cases. 390 cases were confirmed (18.1%) and 1,413 were discarded (65.6%), and 4,467 pregnant women had exanthema rash. Conclusions: the action from the Cievs/PE allowed to employ timely strategies on preparation and response in a qualified and cooperative way to face public health emergency on CSZ's

Resumo Objetivos: descrever a estratégia de atuação do Centro de Informações Estratégicas de Vigilância em Saúde (Cievs/PE) na resposta à emergência da Síndrome Congênita associada à infecção pelo vírus Zika (SCZ) no estado de Pernambuco, entre 2015 e 2016. Métodos: realizada descrição das estratégias e atividades desenvolvidas pelo Cievs/PE durante a emergência em saúde pública de importância internacional relacionada a SCZ. Resultados: participação na detecção dos casos suspeitos da SCZ; participação na elaboração dos protocolos clínico epidemiológicos; construção de formulários eletrônicos para notificação dos casos da SCZ e gestante com exantema; elaboração de informes epidemiológicos; construção de página eletrônica sobre a emergência no site do Cievs/PE; inserção do evento no Comitê de Avaliação e Monitoramento de Eventos (CAME); resolução de demandas durante a prontidão; visita técnica de instituições nacionais e internacionais. As ações desenvolvidas pelo Cievs/PE foram fundamentais para a detecção e acompanhamento de 2.073 casos da SCZ, com a confirmação 390 (18,1%) e descarte de 1.413 (65,6%) casos, e 4.467 gestantes com exantema. Conclusões: a atuação do Cievs/PE permitiu o emprego de estratégias de preparação e resposta em tempo oportuno, de forma qualificada e cooperativa no enfrentamento a emergência em saúde pública da SCZ.

[Place of indocyanine green coupled with fluorescence imaging in research of breast cancer sentinel node]. / Place du vert d'indocyanine couplée à l'imagerie par fluorescence dans la recherche du ganglion sentinelle du cancer du sein.

The sentinel node has a fundamental role in the management of early breast cancer. Currently, the double detection of blue and radioisotope is recommended. But in common practice, many centers use a single method. However, with a single detection, the risk of false negatives and the identification failure rate increase to a significant extent and the number of sentinel lymph node detected and removed is not enough. Furthermore, the tracers used until now show inconveniences. The purpose of this work is to present a new method of detection, using the green of indocyanine coupled with fluorescence imaging, and to compare it with the already existing methods. The method combined by fluorescence and isotopic is reliable, sure, of fast learning and could constitute a good strategy of detection. The major interest is to obtain a satisfactory number of sentinel nodes. The profit could be even more important for overweight patients. The fluorescence used alone is at the moment not possible. Wide ranging studies are necessary. The FLUOTECH, randomized study of 100 patients, comparing the isotopic method of double isotope technique and fluorescence, is underway to confirm these data.

Loss of heterozygosity in tumor tissue in hormonal receptor genes is associated with poor prognostic criteria in breast cancer.

The estrogen receptors (ESRα and ß) and the androgen receptor (AR) mediate genomic and non-genomic effects on breast tumor growth and proliferation. We analyzed 101 breast cancer patients for allelic loss in microsatellites located in regulatory regions of the ESRs and AR genes in breast cancer tumors. The loss of heterozygosity (LOH) at these loci was found in 36.2% of tumor tissues (ductal carcinoma cases), for 19% of cases at the ESRα locus, for 16% at the ESRß locus, and for 10% at the AR locus. The LOH in at least one of the two ESR loci was correlated to poor prognosis criteria: ESR-negative status (P = 0.007), PR-negative status (P = 0.003), high Scarff-Bloom-Richardson (SBR) grade (P = 0.0007), high MIB-1 proliferation index (P = 0.02), and diminished apoptosis potential (TP53-positive status, P = 0.018). When AR was also considered, the LOH in at least one of the three loci was associated with ESR-negative status (P = 0.036), PR-negative status (P = 0.027), high SBR grade (P = 0.005), high mitotic index (P = 0.0002), TP53-positive status (P = 0.029), and proliferating index (high MIB-1, P = 0.03). Allelic loss was observed in 26% of normal tissue adjacent to tumor with LOH at the ESRα locus and in 7.1% of tumors with LOH at the ESRß locus. The LOH in tumor tissue in the regulatory regions of ESRα, ESRß, and AR genes has potentially synergistic effects on tumor proliferation, histological aggressiveness, down-regulation of ESRα and progesterone receptor (PR) genes, and is an early genetic alteration in cancer that is possibly involved in passage to estrogen independence.

Morphological and immunohistochemical analysis in ovaries and fallopian tubes of tamoxifen, letrozole and clomiphene-treated rats.

PURPOSE: Ovarian and tubal dysplasia may be precursors to ovarian cancer. The goal of this study was to check whether these histopathological lesions would be found after ovulation induction using tamoxifen, clomiphene citrate and letrozole. METHODS: Seventy-two rats were divided into four groups. In the first group, 24 rats received normal saline. The second group (16 rats) received clomiphene citrate for six cycles. The third group, divided into two sub-groups of eight rats each, were stimulated with tamoxifen for six cycles, with a dosage, respectively, of 0.4 and 0.8 mg/kg/day. In the last group, eight rats received letrozole 0.1 mg/kg/day and eight other rats received letrozole 0.5 mg/kg/day, for six cycles. Once the six cycles had been completed the rats were killed in order to remove ovaries and tubes for histopathological analysis (morphological, p53 and Ki67 immunohistochemical assessment). RESULTS: Histopathological lesions were found in both ovaries and tubes. The mean ovarian dysplasia score was significantly higher in the tamoxifen group whatever the dosage (p = 0.006 and 0.0002) and in the letrozole group with 0.5 mg/kg/day (p = 0.0002) compared with the control group. The mean tubal dysplasia score was significantly higher in all groups that received drug treatment compared with the control group, whatever the dosage used. The proliferation index (Ki67) was significantly higher in the tamoxifen and letrozole groups while no significant difference was found for apoptosis marker p53. CONCLUSIONS: Ovulation induction may induce histopathological abnormalities in ovaries and tubes with a different immunohistochemical profile in comparison with salpingo-oophorectomies for genetic risk.

Tubo-ovarian dysplasia in relationship with ovulation induction in rats.

OBJECTIVE: To assess tubo-ovarian dysplasia via morphologic and immunohistochemical study of rats exposed to ovulation stimulation protocols. DESIGN: Animal experimental study. SETTING: Academic research hospital. ANIMAL(S): 72 female Wistar rats divided into three groups. INTERVENTION(S): Stimulation protocols using follicle-stimulating hormone (FSH) or clomiphene citrate for 3, 6, or 12 cycles, after which the animals were killed. MAIN OUTCOME MEASURE(S): Ovarian and tubal dysplasia score and immunohistochemical assessment using p53 and Ki67. RESULT(S): The ovarian dysplasia score was statistically significantly higher after 12 stimulation cycles in the groups receiving FSH (group B) or clomiphene citrate (group C) compared with control (group A). The tubal dysplasia score was statistically significantly increased after only three stimulation cycles in groups B and C. The Ki67 proliferation marker was statistically significantly expressed in the ovaries from group C, and in the fallopian tubes from groups B and C. P53 was constantly low in all three groups. CONCLUSION(S): Ovulation stimulation may induce tubal and ovarian histopathologic and immunohistochemical abnormalities with a dose effect. The role of the fallopian tubes and their interaction with the ovaries require further study.