Spending Estimates for Gastric Cancer in Central Brazil

Abstract Stomach cancer is the second leading cause of death by cancer worldwide and is even more pronounced in South America. In Brazil, it is estimated that an increase in the number of cases due to this cancer occurred in the biennium 2018-2019. In this study, we investigated the expenditures of the State Health Department of Goiás on hospitalizations and treatment of gastric cancer for the Unified Health System (SUS) from 2008-2016. This is a cross-sectional, descriptive, and analytical study based on secondary data from the Unified Health System computing department (DATASUS) and the System of Management of the Table of Procedures, Medications, Orthosis, Prosthesis, and Special Materials of SUS through CONECTA-SUS related to International Classification of Diseases-10/C16 (ICD-10/C16) procedures for gastric neoplasms. A total of I$ 5,697,958.20 was spent on gastric tumor in the last nine years in Goiás, I$ 4,492,916.67 (0.3%) on hospitalizations, and I$ 1,997,120.91 on treatment. This study presents a current and relevant estimate of the costs of gastric cancer patients in Goiás. Moreover, we provide information on the extent of the cancer issue to public health. Our analysis offers components for service management and studies that reduce resource allocation in more rational ways

Detection of resistance genes in pyometra isolated bacteria in bitches / Detecção de genes de resistência em bactérias isoladas de piometra em cadelas

Pyometra has several immunological and molecular changes that are responsible for uterine inflammation and the disease may or may not have infections. This study aimed to isolate and identify bacteria in the uterine content of bitches with pyometra, to analyze the susceptibility profile to antibiotics, detect ß-lactamase enzyme production by phenotypic tests, and resistance genes to ß-lactams. Eighteen samples of uterine content were collected by aspiration puncture. The samples were inoculated in bacteriological media and identified by biochemical tests. Subsequently, antibiogram tests, screening for detection of ß-lactamases, and Real-Time PCR for detection of resistance genes was performed. Escherichia coli, Klebsiella spp., Enterobacter aerogenes, Citrobacter spp., Staphylococcus spp., and Streptococcus spp. were identified in the analyzed samples of uterine content. In the antibiogram test, 90.5% of the isolates showed resistance to at least one antibiotic, and of these, 36.8% were considered MDR, with three Staphylococcus spp., three E. coli, and one Klebsiellaspp. Concerning bacterial resistance to the groups of antibiotics tested, 38.1% of the isolates were resistant to at least one type of ß-lactam, 33.3% to tetracycline, 19.0% to aminoglycosides, and 14.3% to fluoroquinolones, macrolides, and trimethoprim-sulfamethoxazole. In the phenotypic test to detect ß-lactamase production, E. coli samples were negative and Klebsiella spp. was positive for the production of AmpC, which presented the blaCMY, blaSPM, and blaSIM genes. Bacteria that are resistant to antibiotics represent a great challenge and laboratory support is therefore essential, without which therapeutic success decreases and death may be inevitable.(AU)

A piometra apresenta diversas alterações imunológicas e moleculares que são responsáveis pela inflamação uterina, e a doença pode ser infecciosa ou não. O objetivo deste estudo foi isolar e identificar bactérias no conteúdo uterino de cadelas com piometra, analisar o perfil de suscetibilidade aos antibióticos, detectar a produção de enzimas ß-lactamase por testes fenotípicos e genes de resistência aos ß-lactâmicos. Dezoito amostras de conteúdo uterino foram coletadas por punção aspirativa. As amostras foram inoculadas em meio bacteriológico e identificadas por testes bioquímicos. Posteriormente, foram realizados testes de antibiograma, triagem para detecção de ß-lactamases e PCR em tempo real para detecção de genes de resistência. Escherichia coli, Klebsiella spp., Enterobacter aerogenes, Citrobacter spp., Staphylococcus spp. e Streptococcus spp. foram identificados nas amostras de conteúdo uterino analisadas. No teste de antibiograma, 90,5% dos isolados apresentaram resistência a pelo menos um antibiótico, e destes, 36,8% foram considerados MR, sendo três Staphylococcus spp., três E. coli e uma Klebsiella spp. Sobre a resistência bacteriana aos grupos de antibióticos testados, 38,1% dos isolados foram resistentes a pelo menos um tipo de ß-lactâmico, 33,3% à tetraciclina, 19,0% aos aminoglicosídeos e 14,3% às fluorquinolonas, macrolídeos e trimetoprim-sulfametoxazol. No teste fenotípico para detecção da produção de ß-lactamase, as amostras de E. coli foram negativas, e Klebsiella spp. foi positiva para a produção de AmpC, que apresentou os genes blaCMY, blaSPM e blaSIM. As bactérias resistentes aos antibióticos representam um grande desafio e, portanto, o suporte laboratorial é essencial, sem o qual o sucesso terapêutico diminui e a morte pode ser inevitável.(AU)

[ARTICLE PARTIAL RETRACTION] PREVALENCE OF HELICOBACTER PYLORI INFECTION IN DYSPEPTIC PATIENTS AND ITS ASSOCIATION WITH CLINICAL RISK FACTORS FOR DEVELOPING GASTRIC ADENOCARCINOMA.

BACKGROUND: In Brazil, particularly in the underdeveloped localities, the prevalence of Helicobacter pylori (H. pylori) infections can range up to 90%. These rates are higher in older individuals and vary by country region. H. pylori infections are linked to the development of gastric pathologies, namely mild to moderate gastritis, gastroenteritis, peptic ulcer, intestinal metaplasia, and gastric cancer. In 1994, this organism was classified by the International Agency for Research on Cancer (IARC) as pertaining to the Group 1 carcinogen for gastric adenocarcinoma etiology. Gastric cancer represents a significant public health problem, being the fourth most common malignant tumor and the second largest cause of cancer-related deaths. OBJECTIVE: To investigate the prevalence of H. pylori infection in dyspeptic patients and determine the link between clinical risk factors and gastric adenocarcinoma diagnosis. METHODS: Polymerase chain reaction (PCR) analysis was employed for molecular diagnosis of gastric tissue biopsies collected from 113 dyspeptic patients at the University Hospital of Federal University of Goiás. Molecular analyses allowed the identification of H. pylori infections. Furthermore, histopathological examinations were performed to determine the clinical risks of developing gastric malignancies. RESULTS: The test results identified 69 individuals older than 44 years, from 75 (66.4%) positive H. pylori infection samples. The prevalence of gastric adenocarcinoma in this study was 1.3%. Among the infected patients, six (8.2%) had high risk, and 67 (91.8%) had a low risk of developing gastric cancer (P<0.05). CONCLUSION: This study shows a high prevalence of H. pylori infection and identifies its contribution to gastric inflammations, which in the long term are manifested in high-risk clinical factors for the development of gastric adenocarcinoma.

[Artigo Parcialmente Retratado] Prevalência da infecção por Helicobacter pylori em pacientes dispépticos e associação com fatores de riscos clínicos para o desenvolvimento de adenocarcinoma gástrico / [article partial retraction] prevalence of helicobacter pylori infection in dyspeptic patients and its association with clinical risk factors for developing gastric adenocarcinoma

ABSTRACT BACKGROUND: In Brazil, particularly in the underdeveloped localities, the prevalence of Helicobacter pylori (H. pylori) infections can range up to 90%. These rates are higher in older individuals and vary by country region. H. pylori infections are linked to the development of gastric pathologies, namely mild to moderate gastritis, gastroenteritis, peptic ulcer, intestinal metaplasia, and gastric cancer. In 1994, this organism was classified by the International Agency for Research on Cancer (IARC) as pertaining to the Group 1 carcinogen for gastric adenocarcinoma etiology. Gastric cancer represents a significant public health problem, being the fourth most common malignant tumor and the second largest cause of cancer-related deaths. OBJECTIVE: To investigate the prevalence of H. pylori infection in dyspeptic patients and determine the link between clinical risk factors and gastric adenocarcinoma diagnosis. METHODS: Polymerase chain reaction (PCR) analysis was employed for molecular diagnosis of gastric tissue biopsies collected from 113 dyspeptic patients at the University Hospital of Federal University of Goiás. Molecular analyses allowed the identification of H. pylori infections. Furthermore, histopathological examinations were performed to determine the clinical risks of developing gastric malignancies. RESULTS: The test results identified 69 individuals older than 44 years, from 75 (66.4%) positive H. pylori infection samples. The prevalence of gastric adenocarcinoma in this study was 1.3%. Among the infected patients, six (8.2%) had high risk, and 67 (91.8%) had a low risk of developing gastric cancer (P<0.05). CONCLUSION: This study shows a high prevalence of H. pylori infection and identifies its contribution to gastric inflammations, which in the long term are manifested in high-risk clinical factors for the development of gastric adenocarcinoma.

RESUMO CONTEXTO: No Brasil, particularmente nas áreas mais pobres, a prevalência da infecção por Helicobacter pylori pode variar até 90%. Esses índices aumentam com o envelhecimento da população e são distintos entre as diferentes regiões do país. Podendo manifestar diferentes sintomatologias, essa infecção está diretamente relacionada com o desenvolvimento de patologias gástricas como gastrite leve a moderada, gastroenterites, úlcera péptica, metaplasia intestinal e principalmente, o câncer gástrico. Em 1994 a bactéria foi categorizada pela International Agency for Research on Cancer (IARC) como carcinógeno do Grupo 1 para adenocarcinoma gástrico, tipo de câncer que representa um importante problema de saúde pública, sendo o quarto tumor maligno mais comum e a segunda maior causa de mortes por câncer no mundo. OBJETIVO: Analisar a prevalência da bactéria em pacientes dispépticos e avaliar a associação de fatores de risco clínicos para desenvolvimento de adenocarcinoma gástrico. MÉTODOS: Biópsias de tecido gástrico coletadas de 113 pacientes dispépticos, atendidos no Hospital das Clínicas da Universidade Federal de Goiás, foram submetidas a diagnóstico molecular por meio de Reação em Cadeia da Polimerase, para identificação da infecção por Helicobacter pylori, e exame histopatológico, para avaliar o risco clínico de desenvolvimento de adenocarcinoma gástrico. RESULTADOS: Foram diagnosticadas 75 (66,4%) amostras positivas para infecção por Helicobacter pylori, sendo 69 indivíduos maiores de 44 anos de idade. A prevalência do adenocarcinoma gástrico nesse estudo foi de 1,3% e dentre os pacientes positivos para a infecção bacteriana seis (8,2%) possuem alto risco e 67 (91,8%) baixo risco de desenvolver esse tipo de câncer (P<0,05). CONCLUSÃO: Esse estudo mostra uma alta prevalência da infecção por H. pylori na população estudada e identifica sua intrínseca contribuição para inflamações gástricas, que a longo prazo se manifestam em fatores clínicos de alto risco para o desenvolvimento de adenocarcinoma gástrico.

Validation of Comet assay in Oregon-R and Wild type strains of Drosophila melanogaster exposed to a natural radioactive environment in Brazilian semiarid region.

Natural radiation of geological origin is a common phenomenon in Brazil, a country where radioactive agents such as uranium may be often found. As an unstable atom, uranium undergoes radioactive decay with the generation of a series of decay by-products, including radon, which may be highly genotoxic and trigger several pathological processes, among which cancer. Because it is a gas, radon may move freely between cracks and gaps in the ground, seeping upwards into the buildings and in the environment. In this study, two Drosophila melanogaster Meigen (Diptera, Drosophilidae) strains called Oregon-R and Wild (collected in a non-radioactive environment) were exposed to atmospheric radiation in the Lajes Pintadas city, in the semiarid zone of northeastern Brazil. After six days of environmental exposure, the organisms presented genetic damage significantly higher than that of the negative control group. The genotoxic effects observed reinforce the findings of other studies carried out in the same region, which warn about the environmental risks related to natural radioactivity occurrence. The results also validate the use of the Comet assay in hemocytes of D. melanogaster as a sensitive test to detect genotoxicity caused by natural radiation, and the use of a recently collected D. melanogaster strain in the environmental of radon.

Genotoxic and Cytotoxic Effects of Antiretroviral Combinations in Mice Bone Marrow.

Commonly used guidelines for the management of human immunodeficiency virus (HIV) infection (highly active antiretroviral therapy, HAART) include drug combinations such as tenofovir disoproxil fumarate (TDF) + lamivudine (3TC) and combivir [zidovudine (AZT) + 3TC] + efavirenz (EFV). These combinations may enhance the genotoxic effects induced by such drugs individually, since the therapy requires lifelong adherence and the drugs have unknown effects during treatment. Thus, the evaluation of the benefits and risks of HAART is of great importance. In order to assess the cytotoxic and genotoxic potential of three concentrations of each of the antiretroviral combinations TDF + 3TC (800 + 400, 1600 + 800, and 3200 + 1600 mg/kg body weight, BW) and combivir + EFV (200 + 100 + 400, 400 + 200 + 800, and 800 + 400 + 1600 mg/kg BW) after two exposure periods (24 h and 48 h), in the present study the in vivo comet assay (single-cell gel electrophoresis) and the mouse bone marrow micronucleus test were used. Neither TDF + 3TC nor combivir + EFV induced DNA damage at any concentrations tested after 24 h or 48 h using the comet assay. After 24 h, both combinations increased the micronucleus frequency at all concentrations tested. After 48 h, combivir + EFV increased the micronucleated polychromatic erythrocyte (MNPCE) frequency at the two highest concentrations tested. Polychromatic erythrocytes (PCE)/normochromatic erythrocytes (NCE) ratio was high for both combinations, suggesting that they can be mitogenic. Since genotoxicity may be related to carcinogenesis, it is necessary to conduct further studies to verify the long-term mutagenic effects of these drugs.