Severe dengue in the intensive care unit.

Dengue fever is considered the most prolific vector-borne disease in the world, with its transmission rate increasing more than eight times in the last two decades. While most cases present mild to moderate symptoms, 5% of patients can develop severe disease. Although the mechanisms are yet not fully comprehended, immune-mediated activation leading to excessive cytokine expression is suggested as a cause of the two main findings in critical patients: increased vascular permeability that may shock and thrombocytopenia, and coagulopathy that can induce hemorrhage. The risk factors of severe disease include previous infection by a different serotype, specific genotypes associated with more efficient replication, certain genetic polymorphisms, and comorbidities such as diabetes, obesity, and cardiovascular disease. The World Health Organization recommends careful monitoring and prompt hospitalization of patients with warning signs or propensity for severe disease to reduce mortality. This review aims to update the diagnosis and management of patients with severe dengue in the intensive care unit.

Maternal health during the COVID-19 pandemic: Experiences of health workers in three Brazilian municipalities.

OBJECTIVE: To analyze the experiences of maternal health workers in three Brazilian cities, located in the Northeast (São Luís), Southeast (Niterói), and South (Pelotas) regions during the first year of the COVID-19 pandemic. METHODS: Qualitative research carried out between December 2020 and February 2021. Interviews were conducted, in person or remotely, with 30 health workers, doctors and nurses, working in maternity hospitals of different degrees of complexity. RESULTS: Sociodemographic characteristics, employment relationships and professional qualification of the interviewees were described. Two thematic axes were identified: 1) changes in hospital organization and dynamics in the pandemic; 2) Illness and suffering of health workers. The majority of respondents were women. Most physicians had work relationships in the public and private sectors. In Niterói, health workers had better professional qualifications and more precarious work relationships (as temporary hires), compared to São Luís and Pelotas. In the context of the uncertainties resulting from the pandemic, this situation generated even more insecurity for those workers. The statements at the beginning of the pandemic covered topics such as changes in the organizational dynamics of services, healthcare, telemedicine, and interaction between health workers and users. In the health workers' perception, the initial period of the health emergency, which resulted in intense changes in the provision of services, was marked by an increase in preterm births, perinatal mortality, and fetal losses. Work overload, fear of contamination, concern for family members and uncertainties regarding the new disease caused intense suffering in health workers who had little institutional support in the cities studied. The suffering experienced by health workers went beyond the work dimension, reaching their private life. CONCLUSION: Changes caused by the pandemic required immediate adjustments in professional practices, generating insecurities in healthcare regardless of the location studied. The method of hiring health workers remained the same as the previously practiced one in each city. Due to the risk of disease transmission, measures contrary to humanization practices, and more restrictive in São Luís, were reported as harmful to obstetric care. The Covid-19 pandemic was a huge challenge for the Brazilian health system, aggravating the working conditions experienced by health workers. In addition to the work environment, it was possible to briefly glimpse its effects on private life.

Experiences of women in prenatal, childbirth, and postpartum care during the COVID-19 pandemic in selected cities in Brazil: The resignification of the experience of pregnancy and giving birth.

The COVID-19 pandemic has impacted public and private health systems around the world, impairing good practices in women's health care. However, little is known about the experiences, knowledge, and feelings of Brazilian women in this period. The objective was to analyze the experiences of women, seen at maternity hospitals accredited by the Brazilian Unified Health System (SUS, acronym in Portuguese), regarding health care during pregnancy, childbirth, and postpartum periods, their interpersonal relationships, and perceptions and feelings about the pandemic. This was a qualitative, exploratory research, carried out in three Brazilian municipalities with women hospitalized in 2020, during pregnancy, childbirth, or postpartum period, with COVID-19 or not. For data collection, semi-structured individual interviews (in person, by telephone, or by digital platform) were conducted, recorded and transcribed. The content analysis of thematic modalities was displayed as per the following axes: i) Knowledge about the disease; ii) Search for health care in prenatal, childbirth, and postpartum periods; iii) Experience of suffering from COVID-19; iv) Income and work; and v) Family dynamics and social support network. A total of 46 women were interviewed in São Luís-MA, Pelotas-RS, and Niterói-RJ. Use of media was important to convey information and fight fake news. The pandemic negatively impacted access to health care in the prenatal, childbirth, and postpartum periods, contributing to worsening of the population's social and economic vulnerabilities. Women experienced diverse manifestations of the disease, and psychic disorders were very frequent. Social isolation during the pandemic disrupted the support network of these women, who found social support strategies in communication technologies. Women-centered care-including qualified listening and mental health support-can reduce the severity of COVID-19 cases in pregnant, parturient, and postpartum women. Sustainable employment and income maintenance policies are essential to mitigate social vulnerabilities and reduce risks for these women.

Association of human papillomavirus (HPV), p16, p53 and p63 expression with non-bilharzia-associated squamous cell carcinoma of the bladder and algorithm construction for histopathological grading prediction.

OBJECTIVE: To investigate the expression of human papillomavirus (HPV), p16, p53, and p63 in non-schistosomiasis-related squamous cell carcinoma of the bladder and to develop an accurate and automated tool to predict histological classification based on clinicopathological features. METHODS: Twenty-eight patients with primary bladder pure squamous cell carcinoma who underwent cystectomy or transurethral resection of bladder tumor (TURBT) for bladder cancer between January 2011 and July 2017 were evaluated. Clinical data and follow-up information were obtained from medical records. Formalin-fixed, paraffin-embedded surgical specimens were used for immunohistochemical staining for p16, p53, and p63. Human papillomavirus detection was evaluated by PCR. Statistical analysis was performed, and statistical significance was set at p<0.05. Finally, decision trees were built to classify patients' prognostic features. Leave-one-out cross-validation was used to test the generalizability of the model. RESULTS: Neither direct HPV detection nor its indirect marker (p16 protein) was identified in most cases. The absence of p16 was correlated with less aggressive histological grading (p=0.040). The positive p16 staining detection found only in pT1 and pT2 cases in our sample suggests a possible role for this tumor suppressor protein in the initial stages of bladder squamous cell carcinoma. The decision trees constructed described the relationship between clinical features, such as hematuria/dysuria, the level of tumor invasion, HPV status, lymphovascular invasion, gender, age, compromised lymph nodes, and tumor degree differentiation, with high classification accuracy. CONCLUSION: The algorithm classifier approach established decision pathways for semi-automatic tumor histological classification, laying the foundation for tailored semi-automated decision support systems for pathologists.

Association of human papillomavirus (HPV), p16, p53 and p63 expression with non-bilharzia-associated squamous cell carcinoma of the bladder and algorithm construction for histopathological grading prediction

ABSTRACT Objective To investigate the expression of human papillomavirus (HPV), p16, p53, and p63 in non-schistosomiasis-related squamous cell carcinoma of the bladder and to develop an accurate and automated tool to predict histological classification based on clinicopathological features. Methods Twenty-eight patients with primary bladder pure squamous cell carcinoma who underwent cystectomy or transurethral resection of bladder tumor (TURBT) for bladder cancer between January 2011 and July 2017 were evaluated. Clinical data and follow-up information were obtained from medical records. Formalin-fixed, paraffin-embedded surgical specimens were used for immunohistochemical staining for p16, p53, and p63. Human papillomavirus detection was evaluated by PCR. Statistical analysis was performed, and statistical significance was set at p<0.05. Finally, decision trees were built to classify patients' prognostic features. Leave-one-out cross-validation was used to test the generalizability of the model. Results Neither direct HPV detection nor its indirect marker (p16 protein) was identified in most cases. The absence of p16 was correlated with less aggressive histological grading (p=0.040). The positive p16 staining detection found only in pT1 and pT2 cases in our sample suggests a possible role for this tumor suppressor protein in the initial stages of bladder squamous cell carcinoma. The decision trees constructed described the relationship between clinical features, such as hematuria/dysuria, the level of tumor invasion, HPV status, lymphovascular invasion, gender, age, compromised lymph nodes, and tumor degree differentiation, with high classification accuracy. Conclusion The algorithm classifier approach established decision pathways for semi-automatic tumor histological classification, laying the foundation for tailored semi-automated decision support systems for pathologists.

Mortalidade materna no Brasil: análise da associação de recursos financeiros federais de custeio / Maternal mortality in Brazil: analysis of association with federal financial resources of costing

Introdução: A razão de mortalidade materna é importante não somente para avaliar a saúde das mulheres, mas também é indicador de desenvolvimento econômico e de desigualdades sociais, sendo base para avaliar a eficiência dos sistemas de saúde de países. O financiamento desses sistemas é fundamental para caracterizá-los em sua dimensão de serviços e ações para as populações. Este trabalho teve o objetivo de avaliar a associação entre os gastos federais de custeio em Atenção Básica e de Média e Alta Complexidade, desde 2008 até 2017, e a mortalidade materna. Métodos: O estudo foi ecológico, quantitativo e utilizou dados secundários dos bancos do Ministério da Saúde, analisando correlação entre financiamento e mortalidade materna. Resultados e Conclusão: Entre os resultados, não foi encontrada associação significativa entre custeio federal de AB e MAC e mortalidade materna; o Brasil apresenta mortalidade materna ainda alta e praticamente sem modificações nos últimos dez anos, ainda que existam diferenças de até quatro vezes na taxa de mortalidade materna entre as regiões, porém sem significativa associação com o financiamento.

Introduction: Maternal mortality rates are important not only to assess women's health but also as an indicator of economic development and social inequalities, supporting the assessment of the efficacy of country's health systems. Financing of these systems is essential to characterize them as services and actions for populations. This study aimed to assess the association of federal funding expenses on Primary Health Care (PHC) and Medium and High Complexity Health Care (MHCHC) from 2008 to 2017 with maternal mortality. Method: This quantitative, ecological study used secondary data from databases of the Brazilian Ministry of Health to analyze the correlation between financing and maternal mortality. Results and Conclusion: The results did not show a significant association of federal financing of PHC and MHCHC with maternal mortality; in Brazil high maternal mortality rates are still high and have remained almost unchanged over the last ten years, although there are differences of up to four-fold in mortality rates among regions, but with no significant association with financing.

Wild-type Yellow fever virus in cerebrospinal fluid from fatal cases in Brazil, 2018.

Yellow fever virus (YFV) is the causative agent of yellow fever (YF), a hemorrhagic and viscerotropic acute disease. Severe YF has been described in approximately 15-25% of YF patients, with 20-50% of severe YF cases being fatal. Here we analyzed cerebrospinal fluid (CSF) samples collected during the YF outbreak in Brazil in 2018, aiming to investigate CNS neuroinvasion in fatal YFV cases. YFV RNA was screened by RT-qPCR targeting the 3'UTR region of the YFV genome in CSF. CSF samples were tested for the presence of anti-YFV IgM and neutralizing antibodies, coupled with routine laboratory examinations. Among the 13 patients studied, we detected anti-YFV IgM in CSF from eight patients and YFV RNA in CSF from five patients. YFV RNA genomic load in CSF samples ranged from 1.75×103 to 5.42×103 RNA copies/mL. We genotyped YFV from three CSF samples that grouped with other YFV samples from the 2018 outbreak in Brazil within the South-American I genotype. Even though descriptions of neurologic manifestations due to wild type YFV (WT-YFV) infection are rare, since the last YF outbreak in Brazil in 2017-2018, a few studies have demonstrated WT-YFV RNA in CSF samples from YF fatal cases. Serological tests indicated the presence of IgM and neutralizing antibodies against YFV in CSF samples from two patients. Although the presence of viral RNA, IgM and neutralizing antibodies in CSF samples could indicate neuroinvasiveness, further studies are needed to better elucidate the role of YFV neuroinvasion and possible impacts in disease pathogenesis.

Influenza vaccination coverage in elderly and high-risk adults: characterization of associated factors.

OBJECTIVE: To evaluate the prevalence and factors associated with non-vaccination against influenza in the risk group. METHODS: A cross-sectional, population-based study, carried out in the city of Rio Grande (RS). The outcome was defined as belonging to risk groups and not having been vaccinated in the last 12 months. Demographic, socioeconomic, behavioral variables, and access for health services were analyzed. RESULTS: In this study, 680 individuals participated. The prevalence was 46.0% (95%CI: 41.8-50.3), ranging from 27.9% (elderly) to 81.8% (pregnant women). Young adults, single, intermediate socioeconomic bracket, smoker, with depressive symptoms, who did not perform physical activity and did not consult a physician in the last year, had a higher prevalence of non-vaccination. CONCLUSION: Half of the sample was not vaccinated in the period. Due to the similarity of influenza-like illness and the coronavirus 2019 disease (COVID-19), increasing vaccination would minimize mortality and use of hospital beds due to influenza, optimizing the response of hospital capacity.

Occupational infection to Brucella abortus B19 vaccine despite antimicrobial prophylaxis / Infecção ocupacional pela cepa vacinal de Brucella abortus B19 apesar de profilaxia antimicrobiana

ABSTRACT: The authors report the case of a veterinarian who acquired brucellosis infection by accidental exposure to Brucella abortus vaccine (BRUCEL-VET B19) while performing animal vaccination. Antibiotic prophylaxis with doxycycline and rifampin for six weeks was indicated, but rifampin was discontinued after 10 days due to gastrointestinal in-tolerance. Despite prophylaxis, the patient seroconverted after 30 days, but was asymptomatic and did not require additional antibiotic therapy. Post-exposure prophylaxis of Brucella is not free from side effects and asymptomatic seroconversion can occur despite prophylaxis. (AU)

RESUMO: Os autores relatam o caso de um veterinário que adquiriu infecção por brucelose por exposição acidental à vacina Brucellaabortus (BRUCEL-VET B19) durante a vacinação animal. A profilaxia antibiótica com doxiciclina e rifampici-na por seis semanas foi indicada, mas a rifampicina foi descontinuada após 10 dias devido à intolerância gastroin-testinal. A profilaxia pós-exposição de Brucella não está isenta de efeitos colaterais e a soroconversãoassintomática pode ocorrer apesar da profilaxia. (AU)

Influenza vaccination coverage in elderly and high-risk adults: characterization of associated factors / Cobertura vacinal de influenza em idosos e adultos de alto risco: caracterização dos fatores associados

ABSTRACT Objective To evaluate the prevalence and factors associated with non-vaccination against influenza in the risk group. Methods A cross-sectional, population-based study, carried out in the city of Rio Grande (RS). The outcome was defined as belonging to risk groups and not having been vaccinated in the last 12 months. Demographic, socioeconomic, behavioral variables, and access for health services were analyzed. Results In this study, 680 individuals participated. The prevalence was 46.0% (95%CI: 41.8-50.3), ranging from 27.9% (elderly) to 81.8% (pregnant women). Young adults, single, intermediate socioeconomic bracket, smoker, with depressive symptoms, who did not perform physical activity and did not consult a physician in the last year, had a higher prevalence of non-vaccination. Conclusion Half of the sample was not vaccinated in the period. Due to the similarity of influenza-like illness and the coronavirus 2019 disease (COVID-19), increasing vaccination would minimize mortality and use of hospital beds due to influenza, optimizing the response of hospital capacity.

RESUMO Objetivo Avaliar a prevalência e os fatores associados à não vacinação contra influenza em grupos de risco. Métodos Estudo transversal, de base populacional, realizado em Rio Grande (RS). O desfecho foi definido como pertencer aos grupos de risco e não ter se vacinado nos últimos 12 meses. Foram analisadas variáveis demográficas, socioeconômicas, comportamentais e de acesso a serviços de saúde. Resultados Participaram 680 indivíduos. A prevalência foi de 46,0% (IC95%: 41,8-50,3), variando de 27,9% (idosos) a 81,8% (gestantes). Adultos jovens, solteiros, de nível econômico intermediário, tabagistas, com sintomas depressivos, que não praticavam atividade física e não consultaram um médico no último ano tiveram maior prevalência de não vacinação. Conclusão Metade da amostra não foi vacinada no período. Pela semelhança da síndrome gripal com a doença pelo coronavírus 2019 (COVID-19), aumentar a vacinação minimizaria a mortalidade e a utilização de leitos hospitalares devido à influenza, otimizando a resposta da capacidade hospitalar.

Chronic REM sleep restriction in young rats increases energy expenditure with no change in food intake.

NEW FINDINGS: What is the central question of this study? What are the effects of different periods of REM sleep restriction (7, 14 and 21 days) on metabolic parameters in young rats? What is the main finding and its importance? Animals submitted to each period of REM sleep deprivation showed a negative energy balance, with reduced body weight gain, body energy gain and gross food efficiency, less body fat content, and increased energy expenditure. There was no increase in food intake after any of the REM sleep restriction periods. In young rats, negative energy balance is not compensated by increased dietary intake as observed in adult rats. ABSTRACT: Reduced sleep is associated with metabolic alterations, not only in adults, but also in children and adolescents. Several studies have shown that sleep restricted (SR) adult rats exhibit metabolic changes, followed by increased food intake, but few have evaluated these functions in young animals. The aim of the present study was to establish the metabolic parameters of young rats subjected to different periods of REM sleep restriction and to propose a correction factor for the correct measurement of food intake. Young male Wistar rats were distributed in control and SR groups for 7, 14 or 21 days. Sleep restriction was performed by the single platform method for 18 h. Regardless of the length of sleep restriction, all SR rats had a negative energy balance, evidenced by reduction in body weight gain, body energy gain and gross food efficiency, accompanied by increased energy expenditure. In addition, sleep restriction reduced body fat content throughout the entire period. Discounting food spillage, there was no increase in food intake by SR rats. In conclusion, the present study revealed metabolic changes in SR young rats after different lengths of REM sleep restriction and that weight loss and increased energy expenditure were not compensated by increased dietary intake as occurs in adult rats, indicating that young rats use other mechanisms to cope with the negative energy balance caused by sleep restriction. In addition, we propose a correction factor for food intake, to prevent overestimation of this parameter, due to food spillage in the water containers.

Autoestima e aspectos socioemocionais em pacientes de cirurgia ortognática: propostas de análise psicológica / Self-esteem and socio-emotional aspects in orthognactic surgery patients: proposals for psychological analysis

A pesquisa objetivou investigar a autoestima e os aspectos socioemocionais de pacientes com deformidades dentofaciais submetidos à cirurgia ortognática. Disponibilizamos um questionário da plataforma Google Docs em um grupo de uma rede social composto por pessoas com interesses em comum no tema. Houve 120 respostas no total e, em geral, elas revelaram que houve aumento de autoestima nos pacientes (média geral subiu de 4,58 para 8,33) e melhora significativa em fatores funcionais, sociais e psicológicos. Contudo, existe a possibilidade de frustração para alguns sujeitos submetidos ao procedimento, oriundo das expectativas perante a cirurgia, especialmente no âmbito estético. A cirurgia ortognática é uma alternativa considerável no tratamento de deformidades dentofaciais e de seus agravos, porém, diante da pluralidade de resultados e reações, infere-se a importância de acompanhamento psicológico no pré e pós-cirúrgico, como forma de preparo para a cirurgia e de adaptação aos resultados do procedimento.

This study aimed to investigate the self-esteem and the socio-emotional aspects of patients with dentofacial deformities submitted to orthognathic surgery. We provide a Google Docs platform questionnaire in a social network group composed of people with common interests. There were 120 responses in total and, in general, there was an increase in self-esteem in the patients (general average increased from 4.58 to 8.33) and significant improvement in functional, social and psychological factors. There is, however, the possibility of that some subjects submitted to the procedure may experience frustration, arising from expectations before the surgery, especially aesthetic ones. Orthognathic surgery is a viable alternative in the treatment of dentofacial deformities and their aggravations. However, given the plurality of results and reactions, we infer the importance of psychological follow-up in preoperative and postoperative periods as preparation for surgery and adaptation to the results of the procedure.

Microbial Communities of the Gut and Nest of the Humus- and Litter-Feeding Termite Procornitermes araujoi (Syntermitinae).

The evolution of the symbiotic association with microbes allowed termites to decompose ingested lignocellulose from plant-derived substrates, including herbivore dung and soil humus. Representatives of the Syntermitinae (Termitidae) range in their feeding habits from wood and litter-feeding to humus-feeding species. However, only limited information is available about their feeding ecology and associated microbial communities. Here we conducted a study of the microbial communities associated to the termite Procornitermes araujoi using Illumina sequencing of the 16S and ITS rRNA genes. This species has been previously included in different feeding guilds. However, most aspects of its feeding ecology are unknown, especially those associated to its symbiotic microbiota. Our results showed that the microbial communities of termite guts and nest substrates of P. araujoi differed significantly for bacteria and fungi. Firmicutes dominated the bacterial gut community of both workers and soldiers, whereas Actinobacteria was found in higher prevalence in the nest walls. Sordariomycetes was the most abundant fungal class in both gut and nest samples and distinguish P. araujoi from the grass/litter feeding Cornitermes cumulans. Our results also showed that diversity of gut bacteria were higher in P. araujoi and Silvestritermes euamignathus than in the grass/litter feeders (C. cumulans and Syntermes dirus), that could indicate an adaptation of the microbial community of polyphagous termites to the higher complexity of their diets.

Food Storage by the Savanna Termite Cornitermes cumulans (Syntermitinae): a Strategy to Improve Hemicellulose Digestibility?

It has been suggested that food storage inside the nest may offer termites with a nutritional provision during low resource availability. Additionally, feces employed as construction material provide an excellent environment for colonization by microorganisms and, together with the storage of plant material inside the nest, could thus provide some advantage to the termites in terms of lignocellulose decomposition. Here, we conducted for the first time a comprehensive study of the microbial communities associated to a termite exhibiting food storage behavior using Illumina sequencing of the 16S and (ITS2) regions of rRNA genes, together with enzymatic assays and data collected in the field. Cornitermes cumulans (Syntermitinae) stored grass litter in nodules made from feces and saliva located in the nest core. The amount of nodules increased with nest size and isolation, and interestingly, the soluble fraction of extracts from nodules showed a higher activity against hemicellulosic substrates compared to termite guts. Actinobacteria and Sordariales dominated microbial communities of food nodules and nest walls, whereas Spirochetes and Pleosporales dominated gut samples of C. cumulans. Within Syntermitinae, however, gut bacterial assemblages were dissimilar. On the other hand, there is a remarkable convergence of the bacterial community structure of Termitidae nests. Our results suggest that the role of nodules could be related to food storage; however, the higher xylanolytic activity in the nodules and their associated microbiota could also provide C. cumulans with an external source of predigested polysaccharides, which might be advantageous in comparison with litter-feeding termites that do not display food storage behavior.

Entre a saúde e a repressão: políticas públicas na região da Cracolândia SP / Between health and repression: public policies in the region of Cracolândia SP

Um território, uma substância e três Políticas Públicas atuando sobre uma mesma população. O trabalho tem como objetivo oferecer uma análise das Políticas Públicas para usuários de Crack instaladas no território da "Cracolândia" paulista, localizado no Bairro da Luz (São Paulo-SP). A criação do Programa Crack É Possível Vencer em 2010, articulada à emergência de discursos que especulavam sobre uma possível epidemia e crescente interesse dos meios de comunicação sobre a população usuária, abriu a possibilidade de criação de espaços institucionais para que o Estado intervisse sobre os usuários de crack. Dentro desse contexto, e articuladas a esse Programa do Governo Federal, surgem duas Políticas Públicas: Programa Recomeço de gestão Estadual e Programa De Braços Abertos de gestão Municipal. As ações dessas duas políticas durante os anos 2014 e 2015 constituem o foco do recorte empírico do presente trabalho. O esforço de pesquisa foi no sentido de investigar como as novas Políticas Públicas que se propunham a operar no campo da Saúde Pública e do cuidado iriam se materializar no território, como o discurso institucional iria se traduzir enquanto práticas. Em especial, interessava observar se as novas ações iriam inibir o movimento histórico de higienização do território e expulsão dos usuários

One territory, one substance and three Public Policies acting on the same population. The work has as its goal to offer an analysis of the Pubic Policies for crack users installed in the São Paulos Cracôlandia territory, located in the Luz neighborhood ( São Paulo - SP). The creation of the program Crack é Possível Vencer, articulated on the emergence of speeches which speculated about a possible epidemic and growing interest on media about the users population, opened the possibility to the creation of institutional spaces to the State to intervene on crack users. Within this context, and within this context, and articulated to this program of the Federal Government, there are two Public Policies: Programa Recomeço of State management - and Programa De Braços Abertos- of Municipal management. The actions of these two policies during the years 2014 and 2015 are the focus of the empirical object of this work. The effort of the researching was in the sense of investigate with Public Policies which proposed to operate on the field of Public Health and care - they would materialize in the territory, as the institutional discourse would translate as practical

Expression of P16 in NUT carcinomas with no association with human papillomavirus (HPV).

NUT carcinoma (NC) is a rare malignant neoplasm usually located in the midline, including the upper aerodigestive tract. NC is an aggressive and highly lethal type of carcinoma. It is defined by the rearrangement of the nuclear protein in the testis (NUT) gene on chromosome 15q14. In most cases, the NUT is involved in a balanced translocation with the BRD4 gene on chromosome 19p13.1, an event that creates a BRD4-NUT fusion gene. The relationship between the human papillomavirus (HPV), p16, and upper aerodigestive tract cancer has been long postulated. In this study, we evaluated the relationship of the p16 expression in 4 cases of NCs and its eventual association with HPV. All 4 cases presented typical histopathologic findings with nuclear positivity of the NUT protein and strong expression for p16. None of these cases, however, showed an association with HPV evaluated by polymerase chain reaction. Despite the expression of p16, this negative result for HPV indicates that HPV infection probably does not play a role in the pathogenesis of NC.

Câncer de mama em mulheres jovens: análise de 12.689 casos / Breast Cancer in Young Women: Analysis of 12.689 Cases

Introdução: O câncer de mama em mulheres com idade inferior a 40 anos é incomum. Entretanto, nessa população,a doença cursa, em geral, com pior prognóstico. Objetivos: Descrever o perfil clínico e epidemiológico de mulheres jovens diagnosticadas com câncer de mama no Brasil e comparar as características clínicas entre mulheres com idade inferior a 34 anos e aquelas entre 35 e 39 anos. Método: Estudo transversal dos casos analíticos de câncer de mama em mulheres de 18 a 39 anos, inseridos no Módulo Integrador dos Registros Hospitalares de Câncer e no Registro Hospitalar de Câncer do Estado de São Paulo, entre 2000 a 2009. Foi realizada a análise descritiva das variáveis. Resultados: Foram incluídos 12.689 casos. A idade mediana foi de 36 anos, a maioria das mulheres possuía ensino médio (32,3%)e era proveniente do Sistema Único de Saúde (74,6%). O estadiamento avançado (≥IIB) foi registrado em 62,8% dos casos e, ao final do primeiro tratamento, 44,4% das pacientes encontravam-se sem evidência da doença. Mulheres muito jovens apresentaram mais frequentemente tamanho do tumor >2cm, status dos linfonodos positivo, presença demetástase, estadiamento clínico avançado (≥IIB) e ausência de resposta terapêutica ao primeiro tratamento. Conclusão: No Brasil, mulheres jovens com câncer de mama apresentam estadiamento avançado ao diagnóstico. Aquelas muitojovens (<35 anos) apresentam doença ainda mais avançada e pior resposta terapêutica que aquelas entre 35 e 39 anos

Introduction:Breast cancer in women under 40 years old is unusual. However, in this population the disease usually progresses with worse prognosis.Objectives:to describe the clinical and epidemiological profile of young women diagnosed with breast cancer in Brazil and to compare the clinical characteristics among women aged less than 34 years and those between 35 and 39 years...

[The impact of low birth weight related to gestational depression on federal funding of public health: a study in Pelotas, Rio Grande do Sul State, Brazil]. / O impacto do baixo peso ao nascer relacionado à depressão gestacional para o financiamento federal da saúde pública: uma análise do Município de Pelotas, Rio Grande do Sul, Brasil.

Low birth weight is related to morbidity and mortality and sequelae during infant development, thereby impacting health system costs. It is thus important to evaluate factors that influence low birth weight and to estimate their impact on the Brazilian Unified National Health System (SUS). This was a nested prospective study in a cohort of pregnant women who received prenatal care and gave birth in the National Health System in hospitals with ICUs in the city of Pelotas, Rio Grande do Sul State, Brazil. Gestational depression was associated with a fourfold risk of low birth weight (PR = 3.94; CI: 1.49-10.36). Based on the population-attributable fraction, in the overall population an estimated 36.17% of low birth weight infants are born to mothers with an episode of depression during pregnancy, with an estimated cost of more than R$76 million (U$38 million) in Brazil. The study recommends the expansion of preventive and therapeutic mental health care measures for pregnant women and the adequate use of resources in the Unified National Health System to improve neonatal outcomes.

O impacto do baixo peso ao nascer relacionado à depressão gestacional para o financiamento federal da saúde pública: uma análise do Município de Pelotas, Rio Grande do Sul, Brasil / The impact of low birth weight related to gestational depression on Federal funding of public health: a study in Pelotas, Rio Grande do Sul State, Brazil

O baixo peso ao nascer está relacionado com morbimortalidade e sequelas no desenvolvimento infantil, impactando nos custos dos sistemas de saúde, por isso é importante avaliar fatores que o influenciam, estimando seu impacto no Sistema Único de Saúde (SUS). Este é um estudo prospectivo aninhado a uma coorte de gestantes que realizaram pré-natal e parto exclusivamente pelo SUS nos hospitais com UTI da cidade de Pelotas, Rio Grande do Sul, Brasil. Entre os resultados, concluiu-se que mães com episódios de depressão gestacional apresentam quase quatro vezes mais chances de ter um filho com baixo peso ao nascer (RP = 3,94; IC: 1,49-10,36). Valendo-se do cálculo da fração atribuível na população, estima-se que, na população geral, 36,17% dos bebês com baixo peso ao nascer são filhos de mães que tiveram episódio depressivo, estimando-se um custo que pode chegar a mais de R$ 76 milhões no Brasil. Sugere-se que se ampliem as ações preventivas e curativas para as gestantes na área da saúde mental, possibilitando melhor desfecho de saúde dos recém-nascidos, e que se utilizem adequadamente os recursos do SUS.

Low birth weight is related to morbidity and mortality and sequelae during infant development, thereby impacting health system costs. It is thus important to evaluate factors that influence low birth weight and to estimate their impact on the Brazilian Unified National Health System (SUS). This was a nested prospective study in a cohort of pregnant women who received prenatal care and gave birth in the National Health System in hospitals with ICUs in the city of Pelotas, Rio Grande do Sul State, Brazil. Gestational depression was associated with a fourfold risk of low birth weight (PR = 3.94; CI: 1.49-10.36). Based on the population-attributable fraction, in the overall population an estimated 36.17% of low birth weight infants are born to mothers with an episode of depression during pregnancy, with an estimated cost of more than R$76 million (U$38 million) in Brazil. The study recommends the expansion of preventive and therapeutic mental health care measures for pregnant women and the adequate use of resources in the Unified National Health System to improve neonatal outcomes.

[Voice disorder clinic in the speech therapy outpatient unit at "Hospital das Clínicas da Universidade Federal de Minas Gerais"]. / Atendimento em voz no Ambulatório de Fonoaudiologia do Hospital das Clínicas da Universidade Federal de Minas Gerais.

This study set out to describe the profile of the patients with voice complaints and/or alterations who were attended between July 2003 and December 2006 at the speech therapy outpatient unit of "Hospital das Clínicas da Universidade Federal de Minas Gerais." This was analyzed according to age, sex, profession, schooling, origin, treatment performed and factors that interfere in medical care evolution. This was a retrospective study based on the analysis of the recorded data of the individuals according to a specifically prepared Protocol. The results showed that the individuals included in this study were predominantly young women, referred by a specialist from Belo Horizonte, who do not work and also have incomplete elementary school education. Attendance of those patients was on an individual basis, and almost half of them were discharged by the speech therapist. The elderly patients, who have functional or psychogenic dysphonia and a neutral or wheezy type of voice, showed a close correlation with the discharge rate by speech therapist. The younger individuals with organo-functional dysphonia bore a statistical correlation with abandoning treatment. The individuals who eventually abandoned treatment did not bear any correlation with the crossed variables.