The epidemiological profile of meningitis among adults in a South African district hospital.

Introduction: understanding the epidemiological profile of a disease in a particular region allows for proper planning of public health resources for prevention, early diagnosis and treatment. In this present study, we describe the epidemiological profile of viral, fungal, tuberculous and bacterial meningitis among adults at National District Hospital (NDH), Free State province, over three years period (January 2017 to December 2019). Methods: a retrospective, observational study of all adult meningitis cases, managed at the National District Hospital (NDH) Bloemfontein, Free State Province, South Africa between January 2017 and December 2019. Results: of the 236 case files reviewed, majority (93.2%; n=220) of the patients managed for meningitis were black, as well as males (55.5%; n = 131). Higher incidence was found between the ages 20 to 49 (81.7%). Of those who died, the majority (n = 14; 63.6%) were males, in the age group 40-49 (n = 7; 31.8%), had TB meningitis (n = 12; 54.5%), were HIV positive (n = 20; 90.9%), and had cell count <100 cells/mm3 (n = 10; 45.5%). Conclusion: our study suggests that combining information on patient demography, co-morbidities, clinical presentation, and examination findings can substantially contribute to raising clinical suspicion, leading to swift identification, diagnosis, and treatment of patients.

Cell Cycle Changes, DNA Ploidy, and PTTG1 Gene Expression in HTLV-1 Patients.

Human T-cell lymphotropic virus type-1 (HTLV-1) is a pathogenic retrovirus that is associated with adult T-cell leukemia/lymphoma (ATL). Genetic instability is the hallmark of ATL. Cell cycle progression is needed for virus particle reproduction. HTLV-1 encoded Tax protein ultimately disrupts the mitotic spindle checkpoint, leading to incorrect chromosome segregation, resulting in aneuploidy. Cell cycle abnormalities have been described in T cells transfected with HTLV-1 virus in vitro, but not in HTLV-1 asymptomatic carriers. PTTG1 and HTLV-1 viral protein Tax exhibit a cooperative transforming activity. Overexpressed PTTG1 results in chromosome instability and aneuploidy, which has been suggested as a mechanism underlying PTTG1 transforming activity. Here we aimed to investigate cell cycle, DNA ploidy and PTTG1 mRNA expression in CD4+ and CD8+ T cells in healthy subjects (HS), HTLV-1 asymptomatic carriers and ATL patients. We have identified that HTLV-1 asymptomatic carriers have shown DNA aneuploidy and cell cycle arrest at cell cycle phase G0/G1 in CD4+ T cells. CD8+ T cells of HTLV-1 asymptomatic carriers also demonstrated DNA aneuploidy but without alteration in cell cycle. In ATL, CD4+ and CD8+ T cells present a higher number of cells in cell cycle S-phase and PTTG1 overexpression. These studies provide insight into malignant transformation of HTLV-1 asymptomatic carriers to ATL patients.

Effect of TCF7L2 polymorphism on pancreatic hormones after exenatide in type 2 diabetes.

BACKGROUND: Glucagon-like peptide 1 (GLP-1) stimulates insulin secretion and reduces blood glucose in type 2 diabetes mellitus (T2DM). TCF7L2 rs7903146 polymorphism has been associated with decreased insulin secretion, reduced GLP-1 action, and possible impaired peripheral insulin sensitivity. OBJECTIVES: To evaluate the postprandial pancreatic hormone response in patients with T2DM carriers of the TCF7L2 variant rs7903146 (CT/TT) compared with noncarriers of this variant (CC) after treatment with the GLP-1 agonist exenatide. METHODS: Intervention study. Patients with T2DM (n = 162) were genotyped for the TCF7L2 rs7903146 single nucleotide polymorphism (SNP). Individuals with CT/TT and CC genotypes were compared regarding basal serum levels of glucose, glycosylated hemoglobin A1C (HbA1c), HDL, uric acid, insulin, and C-peptide. A subset of 56 individuals was evaluated during a 500-calorie mixed-meal test with measurements of glucose, insulin, proinsulin, C-peptide and glucagon before and after treatment with exenatide for 8 weeks. RESULTS: Patients with genotypes CC and CT/TT presented similar glucose area under the curve (AUC) 0-180 min before treatment and a similar decrease after treatment (p < 0.001). Before exenatide, insulin levels at 30-120 min were higher in CT/TT versus CC subjects (p < 0.05). After treatment with exenatide, only CT/TT individuals demonstrated insulin reduction at 30-180 min during the meal test (p < 0.05). Patients with the CC genotype presented no differences in insulin concentrations before and after treatment. The areas under the glucagon curve between 0 and 180 min were similar before treatment and reduced after treatment in both groups (p < 0.001). CONCLUSIONS: The presence of the TCF7L2 rs7903146 T allele in patients with T2DM was associated with increased secretion of insulin response to a mixed-meal test. Furthermore, after treatment with exenatide, only the carriers of the T allele showed significantly decreased postprandial plasma insulin peak levels comparing with non carriers.

TCF7L2 correlation in both insulin secretion and postprandial insulin sensitivity.

BACKGROUND: The TCF7L2 rs7903146 variant is strongly associated with type 2 diabetes mellitus (T2DM). However, the mechanisms involved in this association remain unknown and may include extrapancreatic effects. The aim of this study was to perform a metabolic characterization of T2DM patients with and without the TCF7L2 rs7903146 risk T allele and analyze some influences of the TCF7L2 genotype on glucose metabolism. METHODS: Patients with T2DM (n = 162) were genotyped for the TCF7L2 rs7903146 single nucleotide polymorphism. Individuals with CT/TT and CC genotypes were compared regarding basal serum levels of glucose, glycosylated hemoglobin A1C, HDL, uric acid, insulin, and C-peptide. A subset of 56 individuals was evaluated during a 500-calorie mixed-meal test with measurements of glucose, insulin, proinsulin, C-peptide and glucagon. Additional secondary assessments included determination of insulinogenic index (IGI30), and insulin sensitivity (%S) and resistance (IR) by Homeostatic model assessment (HOMA). RESULTS: Patients with the CT/TT genotype showed lower baseline plasma concentrations of C-peptide when compared with those with the CC genotype. Of the 56 individuals who participated in the mixed-meal test, 26 and 30 had the CC and CT/TT genotypes, respectively. CT/TT subjects, compared with CC individuals, had higher post prandial plasma levels of insulin and C-peptide at 30-120 min (p < 0.05) and proinsulin at 45-240 min (p < 0.05). Interestingly CT/TT individuals presented at baseline higher %S (p = 0.021), and lower IR (p = 0.020) than CC individuals. No significant differences in IGI30 values were observed between groups. CONCLUSIONS: The T2DM individuals carrying the rs7903146 T allele of the TCF7L2 gene presented higher IR pattern in response to a mix-meal test, different of beta cell function at baseline assessed by C-peptide levels which was lower, and Homa-IR was lower when comparing with non-carriers.

Percutaneous ethanol injection versus conservative treatment for benign cystic and mixed thyroid nodules

ABSTRACT Objective To evaluate the efficacy and safety of percutaneous ethanol injection (PEI) in reducing the volume of cystic and mixed thyroid nodules. Materials and methods A total of 36 patients with nodules treated with PEI and 13 individuals who declined PEI and were followed clinically or received other non surgical treatment (control group). Assessments were performed at baseline (immediately before treatment in the PEI group or evaluation of the nodule on ultrasonography in the control group) at short-term (on average 30 days after the last injection in the PEI group), and long-term (on average 14 months after baseline in the PEI group or 26 months after baseline in the control group). Results In the PEI group, the mean baseline volume of 10.4 ± 9.8 cm3 reduced at short-term follow-up to 2.9 ± 3.1 cm3 (67.7 ± 19.9%, p < 0.001) and at long-term follow-up to 2.0 ± 2.5 cm3 (78.2 ± 19.5%, p < 0.01 versus baseline and p = 0.009 versus short-term follow-up). Both types of nodules showed similar degrees of reduction. In the control group, mean volume was 5.8 ± 3.4 cm3 at baseline and 6.2 ± 3.0 cm3 at long-term follow-up (p = 0.507). Compared with the control group, the PEI group showed larger reduction (p < 0.001). Conclusions PEI is effective in reducing the volume of cystic and mixed benign thyroid nodules, with sustained long-term efficacy and better outcome when compared with conservative therapies. Treatment with PEI is a safe alternative, with minimal, transient and self-limited adverse events.

Percutaneous ethanol injection versus conservative treatment for benign cystic and mixed thyroid nodules.

OBJECTIVE: To evaluate the efficacy and safety of percutaneous ethanol injection (PEI) in reducing the volume of cystic and mixed thyroid nodules. MATERIALS AND METHODS: A total of 36 patients with nodules treated with PEI and 13 individuals who declined PEI and were followed clinically or received other non surgical treatment (control group). Assessments were performed at baseline (immediately before treatment in the PEI group or evaluation of the nodule on ultrasonography in the control group) at short-term (on average 30 days after the last injection in the PEI group), and long-term (on average 14 months after baseline in the PEI group or 26 months after baseline in the control group). RESULTS: In the PEI group, the mean baseline volume of 10.4 ± 9.8 cm3 reduced at short-term follow-up to 2.9 ± 3.1 cm3 (67.7 ± 19.9%, p < 0.001) and at long-term follow-up to 2.0 ± 2.5 cm3 (78.2 ± 19.5%, p < 0.01 versus baseline and p = 0.009 versus short-term follow-up). Both types of nodules showed similar degrees of reduction. In the control group, mean volume was 5.8 ± 3.4 cm3 at baseline and 6.2 ± 3.0 cm3 at long-term follow-up (p = 0.507). Compared with the control group, the PEI group showed larger reduction (p < 0.001). CONCLUSIONS: PEI is effective in reducing the volume of cystic and mixed benign thyroid nodules, with sustained long-term efficacy and better outcome when compared with conservative therapies. Treatment with PEI is a safe alternative, with minimal, transient and self-limited adverse events.

Clinical variables associated with depression in patients with type 2 diabetes.

BACKGROUND: the aim of the study was to evaluate the relationship between type 2 diabetes (T2DM), depression and depressive symptoms and their clinical impact on T2DM. METHODS: the authors evaluated 214 outpatients, 105 with diabetes (T2DM group) and 109 non-diabetics (control group), with ages ranging between 50 and 75 years (T2DM group 65.1 ± 5.6 years, control group 63.4 ± 5.8 years). Use of antidepressant treatment or score ≥ 16 on the Beck depression inventory (BDI) was considered depression. Complications of diabetes and total symptom score (TSS) for peripheral neuropathy were reported by patients. RESULTS: diabetes group had a higher frequency of depression (35.2%) compared to controls (21.1%) (p=0,021), with 2.4 times increased risk of depression. The presence of depressive symptoms was also higher in T2DM group (mean BDI 9.5 ± 8.8 versus 6.9 ± 6.2; p=0.039). Symptoms of diabetic neuropathy were higher in depressed subjects. The metabolic control and presence of complications in T2DM group were not associated with depression. CONCLUSION: T2DM led to an increased risk of depression, but this did not influence the metabolic control or the presence of other complications.

Clinical variables associated with depression in patients with type 2 diabetes / Características clínicas associadas à depressão em pacientes com diabetes tipo 2

SummaryBackground:the aim of the study was to evaluate the relationship between type 2 diabetes (T2DM), depression and depressive symptoms and their clinical impact on T2DM.Methods:the authors evaluated 214 outpatients, 105 with diabetes (T2DM group) and 109 non-diabetics (control group), with ages ranging between 50 and 75 years (T2DM group 65.1 ± 5.6 years, control group 63.4 ± 5.8 years). Use of antidepressant treatment or score ≥ 16 on the Beck depression inventory (BDI) was considered depression. Complications of diabetes and total symptom score (TSS) for peripheral neuropathy were reported by patients.Results:diabetes group had a higher frequency of depression (35.2%) compared to controls (21.1%) (p=0,021), with 2.4 times increased risk of depression. The presence of depressive symptoms was also higher in T2DM group (mean BDI 9.5 ± 8.8 versus 6.9 ± 6.2; p=0.039). Symptoms of diabetic neuropathy were higher in depressed subjects. The metabolic control and presence of complications in T2DM group were not associated with depression.Conclusion:T2DM led to an increased risk of depression, but this did not influence the metabolic control or the presence of other complications.

ResumoObjetivo:avaliar a relação entre diabetes mellitus tipo 2 (DM2), depressão e sintomas depressivos e seu impacto no controle clínico do DM2.Métodos:foram avaliados 214 pacientes ambulatoriais, 105 com DM2 e 109 não diabéticos, com idade entre 55 e 75 anos (grupo DM2 65,1±5,6 anos e grupo controle 63,4±5,8 anos). Considerou-se depressão o uso de tratamento antidepressivo ou escore ≥16 no inventário de Beck (BDI). Complicações do DM2 e escore total de sintomas (TSS) para neuropatia periférica foram questionados aos pacientes.Resultados:o grupo DM2 apresentou maior frequência de depressão (35,2%) em relação aos controles (21,1%) (p=0,021), com um risco 2,4 vezes maior de apresentar depressão. A presença de sintomas depressivos também foi superior no grupo DM2 (média BDI 9,5±8,8 versus 6,9±6,2; p=0,039). Os sintomas de neuropatia diabética foram superiores nos depressivos. O controle metabólico e a presença de complicações no grupo DM2 não foram associados à depressão.Conclusão:o DM2 determinou um maior risco de depressão; porém, essa associação não influenciou o controle metabólico e a presença de outras complicações da doença.

Redução da mobilidade funcional e da capacidade cognitiva no diabetes melito tipo 2 / Reduction of functional mobility and cognitive capacity in type 2 diabetes mellitus

Objetivos Avaliar a mobilidade funcional e sua relação com a capacidade cognitiva em pacientes com diabetes tipo 2 (DM2) entre 50 e 65 anos de idade, e com menos de 10 anos de diagnóstico. Materiais e métodos Estudo observacional, analítico e transversal envolvendo indivíduos não diabéticos e pacientes com DM2 com controle glicêmico inadequado, selecionados por amostra de conveniência. Em ambos os grupos, foram aplicados questionário estruturado, avaliação cognitiva com Miniexame do Estado Mental (MEEM) e teste do relógio (TDR), além da avaliação de mobilidade funcional pelo teste Timed Up & GO (TUG). Resultados No TUG os pacientes com DM2 apresentaram tempo médio de 11,27 segundos versus 9,52 segundos nos controles (p = 0,013). A associação entre declínio cognitivo e dismobilidade foi positiva nos indivíduos com DM2 (p = 0,037). No subgrupo que apresentou dismobilidade e declínio cognitivo associados, 18% eram portadores de DM2 e 1,6% era do grupo sem DM2 (p < 0,01). Conclusões Pacientes com DM2 apresentaram pior mobilidade funcional e desempenho cognitivo, favorecendo a hipótese de que o DM2 influencia a mobilidade funcional e capacidade cognitiva antes do aparecimento de complicações vasculares ou neuropáticas. Esses dados sugerem que a hiperglicemia é um fator agravante no desempenho de atividades que exijam funções mentais como atenção, orientação e memória de trabalho. Arq Bras Endocrinol Metab. 2014;58(9):946-52 .

Objectives The aim of the present study was to evaluate the functional mobility and its relationship to cognitive ability in patients with type 2 diabetes (T2DM), age between 50 and 65 years and under 10 years of diagnosis. Materials and methods An observational, analytical and cross-sectional study, involving no diabetic and type 2 diabetic individuals with inadequate glycemic control, selected by convenience sampling. In both groups, were administered structured questionnaire and cognitive assessment with Mini-Mental State Examination (MMSE) and the clock drawing test (CDT), besides assessment of functional mobility by the Timed Up & Go (TUG). Results In TUG, DM2 patients presented a mean time of 11.27 seconds versus 9.52 seconds (p = 0.013). The association between cognitive decline and decrease of mobility was positive in individuals with T2DM (p = 0.037). In the subgroup that showed decrease of mobility and associated cognitive decline, 18% were patients with DM2 and 1.6% were individuals without T2DM (p < 0.01). Conclusions Patients with T2DM presented worse functional mobility and cognitive performance, supporting the hypothesis that DM2 influence functional mobility and cognitive ability, regardless of neuropathic or vascular complications. These data suggest that hyperglycemia is an aggravating factor in the performance of activities requiring mental functions such as attention, working memory and orientation. Arq Bras Endocrinol Metab. 2014;58(9):946-52 .

[Reduction of functional mobility and cognitive capacity in type 2 diabetes mellitus]. / Redução da mobilidade funcional e da capacidade cognitiva no diabetes melito tipo 2.

OBJECTIVES: The aim of the present study was to evaluate the functional mobility and its relationship to cognitive ability in patients with type 2 diabetes (T2DM), age between 50 and 65 years and under 10 years of diagnosis. MATERIALS AND METHODS: An observational, analytical and cross-sectional study, involving no diabetic and type 2 diabetic individuals with inadequate glycemic control, selected by convenience sampling. In both groups, were administered structured questionnaire and cognitive assessment with Mini-Mental State Examination (MMSE) and the clock drawing test (CDT), besides assessment of functional mobility by the Timed Up & Go (TUG). RESULTS: In TUG, DM2 patients presented a mean time of 11.27 seconds versus 9.52 seconds (p = 0.013). The association between cognitive decline and decrease of mobility was positive in individuals with T2DM (p = 0.037). In the subgroup that showed decrease of mobility and associated cognitive decline, 18% were patients with DM2 and 1.6% were individuals without T2DM (p < 0.01). CONCLUSIONS: Patients with T2DM presented worse functional mobility and cognitive performance, supporting the hypothesis that DM2 influence functional mobility and cognitive ability, regardless of neuropathic or vascular complications. These data suggest that hyperglycemia is an aggravating factor in the performance of activities requiring mental functions such as attention, working memory and orientation.

Evaluation of the association between the JAK2 46/1 haplotype and chronic myeloproliferative neoplasms in a Brazilian population.

OBJECTIVE: The JAK2 46/1 haplotype has recently been described as a major contributing factor to the development of myeloproliferative neoplasm, whether positive or negative forthe JAK2 V617F mutation. The G allele, identified by a single-nucleotide polymorphism known as JAK2 rs10974944, is part of the JAK2 46/1 haplotype. The aim of this study was to verify the association between the presence of the G allele and the development of BCR-ABL-negative chronic myeloproliferative neoplasms in our population. METHODS: Blood and oral mucosa swab samples were obtained from 56 patients of two local Brazilian hospitals who had previously been diagnosed with BCR-ABL-negative chronic myeloproliferative neoplasms. Blood samples from 90 local blood donors were used as controls. The presence of the G allele was assessed using a PCR-RFLP assay after extracting DNA from the samples. RESULTS: The presence of the G allele was strongly associated with the presence of BCR-ABL-negative chronic myeloproliferative neoplasms (p = 0.0001; OR = 2.674; 95% CI = 1.630-4.385) in the studied population. CONCLUSION: In agreement with previous reports, the JAK2 46/1 haplotype, represented in this study by the presence of the G allele, is an important predisposing factor in the oncogenetic development of these neoplasms in our population.

Evaluation of the association between the JAK2 46/1 haplotype and chronic myeloproliferative neoplasms in a Brazilian population

OBJECTIVE: The JAK2 46/1 haplotype has recently been described as a major contributing factor to the development of myeloproliferative neoplasm, whether positive or negative forthe JAK2 V617F mutation. The G allele, identified by a single-nucleotide polymorphism known as JAK2 rs10974944, is part of the JAK2 46/1 haplotype. The aim of this study was to verify the association between the presence of the G allele and the development of BCR-ABL-negative chronic myeloproliferative neoplasms in our population. METHODS: Blood and oral mucosa swab samples were obtained from 56 patients of two local Brazilian hospitals who had previously been diagnosed with BCR-ABL-negative chronic myeloproliferative neoplasms. Blood samples from 90 local blood donors were used as controls. The presence of the G allele was assessed using a PCR-RFLP assay after extracting DNA from the samples. RESULTS: The presence of the G allele was strongly associated with the presence of BCR-ABL-negative chronic myeloproliferative neoplasms (p = 0.0001; OR = 2.674; 95% CI = 1.630-4.385) in the studied population. CONCLUSION: In agreement with previous reports, the JAK2 46/1 haplotype, represented in this study by the presence of the G allele, is an important predisposing factor in the oncogenetic development of these neoplasms in our population.

Comparative analysis of risk for falls in patients with and without type 2 diabetes mellitus.

OBJECTIVE: To compare frequency and risk of falls based on a functional mobility test in diabetic and non-diabetic individuals. METHODS: Cross-sectional study involving patients with and without type 2 diabetes mellitus (DM2) selected by convenience sampling. Men and women between the ages of 50 and 65 were included and divided as group 1 (G1) - with DM2 diagnosis for < 10 years fasting blood glucose at interview/test time, as well as prior > 200 mg/dL; and group 2 (G2) - no diabetes, same age group, and fasting blood glucose < 100 mg/dL. Both groups responded to a structured questionnaire about their health, fall risk, and underwent a physical exam and a mobility assessment test (Timed Up and Go - TUG). The results were analyzed by the software SPSS, with TUG being categorized in ranges of risk for fall. We considered that the risk was positive for all those who fit into medium- and high-risk range. RESULTS: Fifty patients with DM2 and 68 patients without DM2 were assessed. There were no statistical differences in the number of falls between the groups, however non-diabetic subjects obtained a higher performance in TUG test (p = 0.003) as the risk categories were observed. Reduced visual acuity and difficulty in getting up were more frequently reported in G1 (p < 0.05). CONCLUSION: There appears to be an association between hyperglycemic status and poorer mobility, with an increased fall risk even in younger patients and in those with shorter disease duration.

Análise comparativa do risco de quedas entre pacientes com e sem diabetes mellitus tipo 2 / Comparative analysis of risk for falls in patients with and without type 2 diabetes mellitus

OBJETIVO: Comparar a frequência e o risco de quedas baseado em teste de mobilidade funcional entre diabéticos e não diabéticos. MÉTODOS: Estudo transversal envolvendo pacientes com e sem diabetes mellitus tipo 2 (DM2) selecionados por amostra de conveniência. Foram incluídos homens e mulheres entre 50 e 65 anos, sendo divididos em: grupo 1 (G1) - com diagnóstico de DM2 < 10 anos, glicemia de jejum > 200 mg/dL no momento da inclusão e prévia; e grupo 2 (G2) - sem diabetes, de mesma faixa etária, e glicemia de jejum < 100 mg/dL. Ambos responderam a questionário estruturado sobre sua saúde, risco de quedas e se submeteram a exame físico e ao Timed Up & Go (TUG), teste de avaliação de mobilidade. Os resultados foram analisados pelo programa Statistical Package for the Social Sciences (SPSS), sendo que o TUG foi categorizado em faixas de risco para quedas. Consideramos risco positivo para todos os que se enquadraram em médio e alto risco. RESULTADOS: Foram avaliados 50 pacientes com DM2 e 68 sem a doença. Não houve diferença estatística entre o número de quedas para os grupos, entretanto os não diabéticos obtiveram melhor desempenho no teste TUG (p = 0,003) quando observadas as categorias de risco descritas. A redução da acuidade visual e a dificuldade para levantar foram mais referidas no G1 (p < 0,05). CONCLUSÃO: Parece haver uma associação entre estado hiperglicêmico e piora da mobilidade, com risco aumentado de quedas, mesmo em pacientes mais jovens e com menor tempo de doença.

OBJECTIVE: To compare frequency and risk of falls based on a functional mobility test in diabetic and non-diabetic individuals. METHODS: Cross-sectional study involving patients with and without type 2 diabetes mellitus (DM2) selected by convenience sampling. Men and women between the ages of 50 and 65 were included and divided as group 1 (G1) - with DM2 diagnosis for < 10 years fasting blood glucose at interview/test time, as well as prior > 200 mg/dL; and group 2 (G2) - no diabetes, same age group, and fasting blood glucose < 100 mg/dL. Both groups responded to a structured questionnaire about their health, fall risk, and underwent a physical exam and a mobility assessment test (Timed Up and Go - TUG). The results were analyzed by the software SPSS, with TUG being categorized in ranges of risk for fall. We considered that the risk was positive for all those who fit into medium- and high-risk range. RESULTS: Fifty patients with DM2 and 68 patients without DM2 were assessed. There were no statistical differences in the number of falls between the groups, however non-diabetic subjects obtained a higher performance in TUG test (p = 0.003) as the risk categories were observed. Reduced visual acuity and difficulty in getting up were more frequently reported in G1 (p < 0.05). CONCLUSION: There appears to be an association between hyperglycemic status and poorer mobility, with an increased fall risk even in younger patients and in those with shorter disease duration.

Colonização da muscosa oral por leveduras, em pacientes oncológicos, encaminhados para quimioterapia em Maringá - PR / Yeast colonization of oral mucosa in oncological patients refered to chemotherapy in Maringá – Pr (Brazil)

A quimioterapia antineoplásica é um recurso terapêutico utilizado, a cada ano, por mais de 10 milhões depessoas em todo o mundo. Entre suas complicações, destacam-se a mucosite e a neutropenia que predispõemestes pacientes a infecções oportunistas. A colonização prévia da boca por leveduras do gênero Candida está associada ao risco aumentado de infecções tanto localizadas como sistêmicas, estas últimas com elevadoíndice de mortalidade (30 a 40%). Este estudo, de caráter quantitativo e descritivo, teve como objetivo investigara microbiota de leveduras da boca de pacientes portadores de câncer, por meio de cultura quantitativa,contagem e identificação de colônias, no início da quimioterapia, no Hospital do Câncer de Maringá. Dos 26pacientes examinados, 20 (77%) apresentaram leveduras, 18 estavam colonizados por uma única espécie edois por duas espécies diferentes. Dos 22 isolados obtidos, 16 (73%) eram Candida albicans. Os resultadosquantitativos revelaram que 61,5% dos pacientes estavam significativamente colonizados, previamente aotratamento quimioterápico. Essa constatação desperta a atenção no sentido de se estabelecer cuidados visando evitar o desenvolvimento do processo infeccioso, tendo em conta a potencialização dos riscos após o início da quimioterapia.

Antineoplasic chemotherapy is a therapeutic resource used worldwide by more than 10 million people every year.Among its complications are mucositis and neutropenia, which predispose those patients to opportunisticinfections. Previous colonization of the mouth by Candida genus yeasts is associated with an increased risk ofboth localized and systemic infections, the latter of which have a high mortality index (30 to 40%). This study, ofquantitative and descriptive character, had as objective to investigate the mouth yeast microbiota of patients withcancer, through quantitative culture, colony count and identification, at the beginning of chemotherapy in theCancer Hospital of Maringá. From 26 patients examined, 20 (77%) presented yeast; 18 were colonized by onlyone species and two by two different species. From the 22 isolates obtained, 16 (73%) were Candida albicans.The quantitative results showed that 61.5% of patients had been significantly colonized prior to chemotherapy.This finding calls attention to the importance in establishing means to avoid the development of the infectiousprocess, having in mind the potential of risks after the start of chemotherapy.

La quimioterapia antineoplásica es un recurso terapéutico utilizado, a cada año, por más de 10 millones depersonas en todo el mundo. Entre sus complicaciones, se destacan la mucosite y la neutropenia que predisponea estos pacientes a las infecciones oportunistas. La colonización previa de la boca por levaduras del géneroCandida está asociada al riesgo aumentado de infecciones tanto localizadas, como sistémicas, estas últimascon elevado índice de mortalidad (30 a un 40%). Este estudio, de carácter cuantitativo, descriptivo, tuvo comoobjetivo estudiar la microbiota de levaduras de la boca de pacientes portadores de cáncer, a través de culturacuantitativa, contar e identificar colonias, en el inicio de la quimioterapia, en el Hospital del Cáncer de Maringá.De los 26 pacientes examinados, 20 (un 77%) presentaron levaduras, 18 estaban colonizados por una únicaespecie y dos por dos especies diferentes. De los 22 aislados obtenidos, 16 (un 73%) eran Candida albicans.Los resultados cuantitativos revelaron que un 61,5% de los pacientes se presentaban significativamentecolonizados antes del tratamiento quimioterápico. Ese hallazgo llama la atención en el sentido de establecersecuidados que pretenden evitar el desarrollo del proceso infeccioso, teniendo en cuenta potenciar los riesgosdespués del inicio de la quimioterapia.

Aleitamento materno e diabetes mellitus do tipo 1 / Breast feeding and type 1 diabetes mellitus

Objetivos: Considerando-se os recentes relatos de uma possível relação entre exposição precoce ao leite bovino e diabetes mellitus do tipo 1 (DM1), este estudo teve como objetivo pesquisar a idade de início de exposição alimentar ao leite bovino em indivíduos postadores de DM1, através de um estudo caso-controle; bem como correlacionar a idade de introdução do leite bovino na dieta com o desenvolvimento e a idade de aparecimento do DM1. Métodos: O estudo foi baseado em entrevistas dirigidas às mães de indivíduos dos seguintes grupos: a) grupo de pacientes diabéticos insulino-dependentes (GDM1), com diagnóstico realizado até os 30 anos, com média de idade ao diagnóstico de 9,2+5,4 anos; b) grupo controle (GC); estudantes não-diabéticos. A amostra constitui-se de 124 indivíduos (47 do GDM1 e 77 do GC), sem diferença estatística em relação a sexo e idade cronológica entre os dois grupos. Resultados: A média do tempo de aleitamento exclusivo foi significativamente menor para o GDM considerando o sexo feminino. Não houve diferença significante entre as médias dos grupos considerando o sexo masculino. Não houve correlação entre a idade de esposição ao leite bovino e a idade de início do DM1. Conclusões: indivíduos com DM1 do sexo feminino foram expostos mais precocemente ao leite bovino comparados aos indivíduos controles, sugerindo um possível papel deste alimento na etiopatogenia da doença. A retirada precoce do leite materno da dieta dos lactentes e, consequentemente, dos fatores de proteção por ele oferecidos, podem ser considerados elementos potencialmente relacionados com o desencadeamento do processo autoimune.