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1.
Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer
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Tobias-Machado, Marcos
; Ornellas, Antonio A.
; Hidaka, Alexandre K.
; Medina, Luis G.
; Mattos, Pablo A. L.
; Besio, Ruben S.
; Abreu, Diego
; Castro, Pedro R.
; Nishimoto, Ricardo H.
; Astigueta, Juan
; Dourado, Aurus
; Machado, Roberto D.
; Magnabosco, Wesley J.
; Corona-Montes, Victor
; Villoldo, Gustavo M.
; Zampolli, Hamilton C.
; Taha, Anis
; Auad, Pericles R.
; Faria, Eliney F.
; Arantes, Paulo B. O.
; Tavares, Alessandro
; Nascimento, Francisco S. M. S.
; Brazão Jr., Eder S.
; Rocha, Maurício M.
; Costa, Walter H.
; Panico, Vinicius
; Reis, Leonardo O.
; Almeida-Carrera, Roberto J.
; Silva, Rafael C.
; Zequi, Stênio C.
; Calixto, José R. R.
; Sotelo, Rene
.
ABSTRACT Objective: To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). Materials and Methods: Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. Results: From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. Conclusion: VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of non-bulky lymph nodes in penile cancer.
2.
Genetic variability of Leishmania (Leishmania) infantum causing human visceral leishmaniasis in the Southeastern Brazil
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Lima, Vinicius Alves
; Silva, Renata Elen Costa
; Camargo, Luiz Henrique Moraes Caetano
; Hiramoto, Roberto Mitsuyoshi
; Leal, Elcio de Souza
; Braz, Lucia Maria Almeida
; Lindoso, José Angelo Lauletta
.
Revista do Instituto de Medicina Tropical de São Paulo
- Journal Metrics
ABSTRACT Leishmania infantum is a protozoan that causes visceral leishmaniasis (VL) in the Americas and some regions of Europe. The disease is mainly characterized by hepatosplenomegaly and fever, and can be fatal. Factors related to the host and parasite can contribute to the transmission of Leishmania and the clinical outcome. The intraspecific genetic variability of L. infantum strains may be one of these factors. In this study, we evaluated the genetic variability of L. infantum obtained from bone marrow smear slides from patients in the Sao Paulo State, Brazil. For this, the minicircle of the kDNA hypervariable region was used as target by Sanger sequencing. By analyzing the similarity of the nucleotides and the maximum likelihood tree (Fasttree), we observed a high similarity (98%) among samples. Moreover, we identified four different profiles of L. infantum. In conclusion, L. infantum strains from Sao Paulo State, Brazil, showed low diversity measured by minicircle of the kDNA hypervariable region.
3.
[SciELO Preprints] - Guideline of the Brazilian Society of Cardiology on Diagnosis and Treatment of Patients with Chagas Disease Cardiomyopathy
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Marin-Neto, José Antonio
Rassi Jr., Anis
Moraes Oliveira, Gláucia M.
Lemos Correia, Luís Claudio
Novaes Ramos Jr., Alberto
Hasslocher-Moreno, Alejandro Marcel
Luquetti Ostermayer, Alejandro
Sousa, Andréa Silvestre de
Amato Vincenzo de Paola, Angelo
Sobral de Sousa, Antonio Carlos
Pinho Ribeiro, Antonio Luiz
Correia Filho, Dalmo
Moraes de Souza, Dilma do Socorro
Cunha-Neto, Edecio
J. A. Ramires, Felix
Bacal, Fernando
Pereira Nunes, Maria do Carmo
Martinelli Filho, Martino
Ibrahim Scanavacca, Maurício
Magalhães Saraiva, Roberto
Alves de Oliveira Júnior, Wilson
M. Lorga-Filho, Adalberto
de Jesus Benevides de Almeida Guimarães, Adriana
Lopes Latado Braga, Adriana
Sarmento de Oliveira, Adriana
V. L. Sarabanda, Alvaro
Yecê das Neves Pinto, Ana
Assis Lopes do Carmo, André
Schmidt, André
Costa, Andréa Rodrigues da
Ianni, Barbara Maria
Markman Filho, Brivaldo
Eduardo Rochitte, Carlos
Thé Macedo, Carolina
Mady, Charles
Chevillard, Christophe
Bittencourt das Virgens, Cláudio Marcelo
Nery de Castro, Cleudson
De Paoli de Carvalho Britto, Constança Felícia
Pisani, Cristiano
do Carmo Rassi, Daniela
C. Sobral Filho, Dario
Rodrigues Almeida, Dirceu
A. Bocchi, Edimar
T. Mesquita, Evandro
de Souza Nogueira Sardinha Mendes, Fernanda
Pereira, Francisca Tatiana
Sperandio da Silva, Gilberto Marcelo
de Lima Peixoto, Giselle
Glotz de Lima, Gustavo
H. Veloso, Henrique
Turin Moreira, Henrique
Bellotti Lopes, Hugo
Masciarelli Francisco Pinto, Ibraim
Pinto Dias, João Carlos
Bemfica, João Marcos
Silva-Nunes, João Paulo
Soares Barreto-Filho, José Augusto
Kerr Saraiva, José Francisco
Lannes-Vieira, Joseli
Menezes Oliveira, Joselina Luzia
V. Armaganijan, Luciana
Martins, Luiz Cláudio
C. Sangenis, Luiz Henrique
Barbosa, Marco Paulo
Almeida-Santos, Marcos Antônio
Simões, Marcos Vinicius
Shikanai-Yasuda, Maria Aparecida
Vieira Moreira, Maria da Consolação
Higuchi, Maria de Lourdes
Costa Monteiro, Maria Rita de Cássia
Felix Mediano, Mauro Felippe
Maia Lima, Mayara
T. Oliveira, Maykon
Moreira Dias Romano , Minna
Nitz, Nadjar
de Tarso Jorge Medeiros, Paulo
Vieira Alves, Renato
Alkmim Teixeira, Ricardo
Coury Pedrosa, Roberto
Aras, Roque
Morais Torres, Rosália
dos Santos Povoa, Rui Manoel
Rassi, Sérgio Gabriel
Salles Xavier, Sérgio
Marinho Martins Alves , Silvia
B. N. Tavares, Suelene
Lima Palmeira, Swamy
da Silva Junior, Telêmaco Luiz
da Rocha Rodrigues, Thiago
Madrini Junior, Vagner
Maia da Costa , Veruska
Dutra, Walderez
This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.nbsp;
Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.
nbsp;
Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.nbsp;
The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.nbsp;
The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.nbsp; nbsp;nbsp;
Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.
Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou.
A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica.
Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas.
A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica.
A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.nbsp;nbsp;nbsp;
Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.nbsp;
4.
IMMUNOHISTOCHEMICAL DETECTION OF L CELLS IN GASTROINTESTINAL TRACT MUCOSA OF PATIENTS AFTER SURGICAL TREATMENT FOR CONTROL OF TYPE 2 DIABETES MELLITUS
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ESTABILE, Priscila Costa
; ALMEIDA, Mara Cristina de
; CAMPAGNOLI, Eduardo Bauml
; SANTO, Marco Aurelio
; RODRIGUES, Marcos Ricardo da Silva
; MILLÉO, Fábio Quirillo
; ARTONI, Roberto Ferreira
.
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)
- Journal Metrics
RESUMO - RACIONAL: O diabetes tipo 2 (DM2) é uma doença de impacto mundial que tem levado ao aumento de comorbidades e mortalidade em vários países. A imunoexpressão dos hormônios incretínicos glp-1 e pyy3-36, pode ser usada como marcador no trato gastrointestinal para analisar a atividade da célula L em resposta ao tratamento do DM2. OBJETIVO: O presente estudo teve como objetivo investigar a presença, localização e secreção de células L no intestino delgado de pacientes submetidos à forma de cirurgia bariátrica denominada gastroenteromentectomia adaptativa com bipartição parcial. MÉTODOS: Ensaios imunohistoquímicos, reação quantitativa em cadeia de polimerase em tempo real (qPCR) e análise de manchas ocidentais foram realizados em amostras de mucosa intestinal de pacientes com diabetes tipo 2 nos períodos pré- e pós-operatório. RESULTADOS: Todos os resultados foram consistentes e indicaram expressão basal e secreção de peptídeos glucagon-1 (GLP-1) e peptídeos YY (PYY3-36) incretinas por células L. Uma maior densidade de células foi demonstrada nas porções mais distais do intestino delgado. Não foi encontrada diferença significativa entre os níveis de expressão GLP-1 e PYY3-36 nos períodos pré-operatório e pós-operatório, provavelmente devido ao estado de jejum prolongado durante o qual as amostras foram coletadas CONCLUSÃO: O maior número de células L em atividade implica melhor sinalização de peptídeo, resposta e funcionamento do sistema neuroendócrino.
ABSTRACT - BACKGROUND: Type 2 diabetes mellitus (T2DM) is a disease of global impact that has led to an increase in comorbidities and mortality in several countries. Immunoexpression of the incretin hormones such as glucagon-like peptide-1 (GLP-1) and peptide YY (3-36) (PYY3-36) can be used as a scorer in the gastrointestinal tract to analyze L-cell activity in response to T2DM treatment. OBJECTIVE: This study aimed to investigate the presence, location, and secretion of L cells in the small intestine of patients undergoing the form of bariatric surgery denominated adaptive gastroenteromentectomy with partial bipartition. METHODS: Immunohistochemical assays, quantitative real-time polymerase chain reaction (qPCR), and Western blot analysis were performed on samples of intestinal mucosa from patients with T2DM in both the preoperative and postoperative periods. RESULTS: All results were consistent and indicated basal expression and secretion of GLP-1 and PYY3-36 incretins by L cells. A greater density of cells was demonstrated in the most distal portions of the small intestine. No significant difference was found between GLP-1 and PYY3-36 expression levels in the preoperative and postoperative periods because of prolonged fasting during which the samples were collected. CONCLUSION: The greater number of L cells in activity implies better peptide signaling, response, and functioning of the neuroendocrine system.
5.
[SciELO Preprints] - Strengthening the surveillance and information activities is urgent and essential to reduce the transmission force of SARS-CoV-2
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Teixeira, Maria Glória
Kerr, Ligia Regina Franco Sansigolo
Ximenes, Ricardo Arraes de Alencar
Almeida, Rosa Lívia Freitas de
Ichihara, Maria Yury
Albuquerque, Maria de Fátima Militão de
Aquino, Estela M L
Werneck, Guilherme
Carmo, Eduardo Hage
Medronho, Roberto Andrade
Oliveira, Wanderson Kleber de
Henriques, Claudio Maierovitch Pessanha
Kendall, Carl
Silva, Antônio Augusto Moura da
Almeida-Filho, Naomar M.
Souza, Wayner Vieira de
Veras , Maria Amelia de Sousa Mascena
Penna, Gerson Oliveira
Silva , Gulnar Azevedo e
Brandão Filho, Sinval Pinto
Barreto, Maurício L.
6.
Práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras: uma análise secundária do estudo Fluid-TRIPS
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Freitas, Flavio Geraldo Rezende de
; Hammond, Naomi
; Li, Yang
; Azevedo, Luciano Cesar Pontes de
; Cavalcanti, Alexandre Biasi
; Taniguchi, Leandro
; Gobatto, André
; Japiassú, André Miguel
; Bafi, Antonio Tonete
; Mazza, Bruno Franco
; Noritomi, Danilo Teixeira
; Dal-Pizzol, Felipe
; Bozza, Fernando
; Salluh, Jorge Ibrahin Figueira
; Westphal, Glauco Adrieno
; Soares, Márcio
; Assunção, Murillo Santucci César de
; Lisboa, Thiago
; Lobo, Suzana Margarete Ajeje
; Barbosa, Achilles Rohlfs
; Ventura, Adriana Fonseca
; Souza, Ailson Faria de
; Silva, Alexandre Francisco
; Toledo, Alexandre
; Reis, Aline
; Cembranel, Allan
; Rea Neto, Alvaro
; Gut, Ana Lúcia
; Justo, Ana Patricia Pierre
; Santos, Ana Paula
; Albuquerque, André Campos D. de
; Scazufka, André
; Rodrigues, Antonio Babo
; Fernandino, Bruno Bonaccorsi
; Silva, Bruno Goncalves
; Vidal, Bruno Sarno
; Pinheiro, Bruno Valle
; Pinto, Bruno Vilela Costa
; Feijo, Carlos Augusto Ramos
; Abreu Filho, Carlos de
; Bosso, Carlos Eduardo da Costa Nunes
; Moreira, Carlos Eduardo Nassif
; Ramos, Carlos Henrique Ferreira
; Tavares, Carmen
; Arantes, Cidamaiá
; Grion, Cintia
; Mendes, Ciro Leite
; Kmohan, Claudio
; Piras, Claudio
; Castro, Cristine Pilati Pileggi
; Lins, Cyntia
; Beraldo, Daniel
; Fontes, Daniel
; Boni, Daniela
; Castiglioni, Débora
; Paisani, Denise de Moraes
; Pedroso, Durval Ferreira Fonseca
; Mattos, Ederson Roberto
; Brito Sobrinho, Edgar de
; Troncoso, Edgar M. V.
; Rodrigues Filho, Edison Moraes
; Nogueira, Eduardo Enrico Ferrari
; Ferreira, Eduardo Leme
; Pacheco, Eduardo Souza
; Jodar, Euzebio
; Ferreira, Evandro L. A.
; Araujo, Fabiana Fernandes de
; Trevisol, Fabiana Schuelter
; Amorim, Fábio Ferreira
; Giannini, Fabio Poianas
; Santos, Fabrício Primitivo Matos
; Buarque, Fátima
; Lima, Felipe Gallego
; Costa, Fernando Antonio Alvares da
; Sad, Fernando Cesar dos Anjos
; Aranha, Fernando G.
; Ganem, Fernando
; Callil, Flavio
; Costa Filho, Francisco Flávio
; Dall´Arto, Frederico Toledo Campo
; Moreno, Geovani
; Friedman, Gilberto
; Moralez, Giulliana Martines
; Silva, Guilherme Abdalla da
; Costa, Guilherme
; Cavalcanti, Guilherme Silva
; Cavalcanti, Guilherme Silva
; Betônico, Gustavo Navarro
; Betônico, Gustavo Navarro
; Reis, Hélder
; Araujo, Helia Beatriz N.
; Hortiz Júnior, Helio Anjos
; Guimaraes, Helio Penna
; Urbano, Hugo
; Maia, Israel
; Santiago Filho, Ivan Lopes
; Farhat Júnior, Jamil
; Alvarez, Janu Rangel
; Passos, Joel Tavares
; Paranhos, Jorge Eduardo da Rocha
; Marques, José Aurelio
; Moreira Filho, José Gonçalves
; Andrade, Jose Neto
; Sobrinho, José Onofre de C
; Bezerra, Jose Terceiro de Paiva
; Alves, Juliana Apolônio
; Ferreira, Juliana
; Gomes, Jussara
; Sato, Karina Midori
; Gerent, Karine
; Teixeira, Kathia Margarida Costa
; Conde, Katia Aparecida Pessoa
; Martins, Laércia Ferreira
; Figueirêdo, Lanese
; Rezegue, Leila
; Tcherniacovsk, Leonardo
; Ferraz, Leone Oliveira
; Cavalcante, Liane
; Rabelo, Ligia
; Miilher, Lilian
; Garcia, Lisiane
; Tannous, Luana
; Hajjar, Ludhmila Abrahão
; Paciência, Luís Eduardo Miranda
; Cruz Neto, Luiz Monteiro da
; Bley, Macia Valeria
; Sousa, Marcelo Ferreira
; Puga, Marcelo Lourencini
; Romano, Marcelo Luz Pereira
; Nobrega, Marciano
; Arbex, Marcio
; Rodrigues, Márcio Leite
; Guerreiro, Márcio Osório
; Rocha, Marcone
; Alves, Maria Angela Pangoni
; Alves, Maria Angela Pangoni
; Rosa, Maria Doroti
; Dias, Mariza D’Agostino
; Martins, Miquéias
; Oliveira, Mirella de
; Moretti, Miriane Melo Silveira
; Matsui, Mirna
; Messender, Octavio
; Santarém, Orlando Luís de Andrade
; Silveira, Patricio Júnior Henrique da
; Vassallo, Paula Frizera
; Antoniazzi, Paulo
; Gottardo, Paulo César
; Correia, Paulo
; Ferreira, Paulo
; Torres, Paulo
; Silva, Pedro Gabrile M. de Barros e
; Foernges, Rafael
; Gomes, Rafael
; Moraes, Rafael
; Nonato filho, Raimundo
; Borba, Renato Luis
; Gomes, Renato V
; Cordioli, Ricardo
; Lima, Ricardo
; López, Ricardo Pérez
; Gargioni, Ricardo Rath de Oliveira
; Rosenblat, Richard
; Souza, Roberta Machado de
; Almeida, Roberto
; Narciso, Roberto Camargo
; Marco, Roberto
; waltrick, Roberto
; Biondi, Rodrigo
; Figueiredo, Rodrigo
; Dutra, Rodrigo Santana
; Batista, Roseane
; Felipe, Rouge
; Franco, Rubens Sergio da Silva
; Houly, Sandra
; Faria, Sara Socorro
; Pinto, Sergio Felix
; Luzzi, Sergio
; Sant’ana, Sergio
; Fernandes, Sergio Sonego
; Yamada, Sérgio
; Zajac, Sérgio
; Vaz, Sidiner Mesquita
; Bezerra, Silvia Aparecida Bezerra
; Farhat, Tatiana Bueno Tardivo
; Santos, Thiago Martins
; Smith, Tiago
; Silva, Ulysses V. A.
; Damasceno, Valnei Bento
; Nobre, Vandack
; Dantas, Vicente Cés de Souza
; Irineu, Vivian Menezes
; Bogado, Viviane
; Nedel, Wagner
; Campos Filho, Walther
; Dantas, Weidson
; Viana, William
; Oliveira Filho, Wilson de
; Delgadinho, Wilson Martins
; Finfer, Simon
; Machado, Flavia Ribeiro
.
RESUMO Objetivo: Descrever as práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras e compará-las com as de outros países participantes do estudo Fluid-TRIPS. Métodos: Este foi um estudo observacional transversal, prospectivo e internacional, de uma amostra de conveniência de unidades de terapia intensiva de 27 países (inclusive o Brasil), com utilização da base de dados Fluid-TRIPS compilada em 2014. Descrevemos os padrões de ressuscitação volêmica utilizados no Brasil em comparação com os de outros países e identificamos os fatores associados com a escolha dos fluidos. Resultados: No dia do estudo, foram incluídos 3.214 pacientes do Brasil e 3.493 pacientes de outros países, dos quais, respectivamente, 16,1% e 26,8% (p < 0,001) receberam fluidos. A principal indicação para ressuscitação volêmica foi comprometimento da perfusão e/ou baixo débito cardíaco (Brasil 71,7% versus outros países 56,4%; p < 0,001). No Brasil, a percentagem de pacientes que receberam soluções cristaloides foi mais elevada (97,7% versus 76,8%; p < 0,001), e solução de cloreto de sódio a 0,9% foi o cristaloide mais comumente utilizado (62,5% versus 27,1%; p < 0,001). A análise multivariada sugeriu que os níveis de albumina se associaram com o uso tanto de cristaloides quanto de coloides, enquanto o tipo de prescritor dos fluidos se associou apenas com o uso de cristaloides. Conclusão: Nossos resultados sugerem que cristaloides são usados mais frequentemente do que coloides para ressuscitação no Brasil, e essa discrepância, em termos de frequências, é mais elevada do que em outros países. A solução de cloreto de sódio 0,9% foi o cristaloide mais frequentemente prescrito. Os níveis de albumina sérica e o tipo de prescritor de fluidos foram os fatores associados com a escolha de cristaloides ou coloides para a prescrição de fluidos.
Abstract Objective: To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS. Methods: This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice. Results: On the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only. Conclusion: Our results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.
https://doi.org/10.5935/0103-507x.20210028
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7.
Validation of ELISA with recombinant antigens in serological diagnosis of canine Leishmania infantum infection
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Fujimori, Mahyumi
; de Almeida, Arleana do Bom Parto Ferreira
; Barrouin-Melo, Stella Maria
; Cortez, Luiz Ricardo Paes de Barros
; Duthie, Malcolm Scott
; Hiramoto, Roberto Mitsuyoshi
; de Pinho, Flaviane Alves
; Reed, Steven Gregory
; Sousa, Valéria Régia Franco
; Souza, Nazaré Fonseca
; Soares, Rodrigo Martins
; Tolezano, José Eduardo
; Sanchez, Maria Carmen Arroyo
; Goto, Hiro
.
BACKGROUND Dogs are the main peridomiciliary reservoir of Leishmania infantum thus the correct diagnosis of infection is essential for the control of the transmission and treatment as well. However, the diagnosis is based on serological assays that are not fully effective. OBJECTIVE We aimed to establish an effective serological assay for the diagnosis of L. infantum infected dogs using Leishmania-derived recombinant antigens. METHODS Leishmania derived rK39-, rK28-, rKR95-based enzyme-linked immunosorbent assay (ELISA) was standardized using symptomatic and asymptomatic L. infantum-infected dogs. Then 2,530 samples from inquiry in endemic areas for VL were evaluated and the results compared with recommended assays by the Brazilian Ministry of Health (MH algorithm). Further samples from a cohort of 30 dogs were searched. FINDINGS For rK39-, rK28- and rKR95-ELISA the sensitivity was around 97% and specificity 100%. The positivity of these three ELISA in the inquiry samples was 27-28%, around 10% higher than the assays currently in use. When cohort samples were searched, we observed likely false-negative results (> 65%) with supposedly negative samples that turned positive six months later with the assays in use (MH algorithm). MAIN CONCLUSIONS For the diagnosis of L. infantum-infected dogs, rK39-based ELISA showed better diagnostic performance than other assays in use in Brazil and worldwide.
https://doi.org/10.1590/0074-02760200428
516 downloads
8.
Hancornia speciosa serum fraction latex stimulates the angiogenesis and extracellular matrix remodeling processes
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D’ABADIA, PATRÍCIA L.
; BAILÃO, ELISA FLÁVIA LUIZ C.
; LINO JÚNIOR, RUY S.
; OLIVEIRA, MATHEUS GABRIEL
; SILVA, VINICIUS B.
; OLIVEIRA, LEANDRA A.R.
; CONCEIÇÃO, EDEMILSON C.
; MELO-REIS, PAULO ROBERTO
; BORGES, LEONARDO LUIZ
; GONÇALVES, PABLO JOSÉ
; ALMEIDA, LUCIANE M.
.
Abstract The Hancornia speciosa latex reveals angiogenic, osteogenic, and anti-inflammatory properties, which present its potential for developing of wound healing drugs; however, the latex compounds responsible for angiogenesis remain unknown. One strategy to screen these active compounds is evaluation of latex fractions. This study aimed to obtain different fractions of latex and evaluate its angiogenic activity separately using the chick chorioallantoic membrane (CAM) assay. The serum (SE) fraction was responsible for angiogenesis, which was subject to biochemical characterization and computational simulations in order to understand the contribution of H. speciosa latex in wound healing process. Our results revealed weak antioxidant potential and absence of antimicrobial activity in the SE fraction. Phytochemical analysis identified chlorogenic acids (CGA) as the main compound of SE fraction. CGA bioactivity predictions identify different molecules associated with extracellular matrix (ECM) remodeling, such as metalloproteinases, which also are overexpressed in our CAM assay experiment. Docking simulations revealed the interactions between CGA and matrix metalloproteinase 2. In conclusion, SE latex fraction stimulates angiogenesis and may influence ECM remodeling. These properties may contribute to the wound healing process, and also confirm the widespread use of this plant.
https://doi.org/10.1590/0001-3765202020190107
1041 downloads
9.
Clinical and functional correlations of the difference between slow vital capacity and FVC
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Fernandez, Jonathan Jerias
; Castellano, Maria Vera Cruz de Oliveira
; Vianna, Flavia de Almeida Filardo
; Nacif, Sérgio Roberto
; Rodrigues Junior, Roberto
; Rodrigues, Sílvia Carla Sousa
.
RESUMO Objetivo: Avaliar a relação da diferença entre a capacidade vital lenta (CVL) e CVF (ΔCVL-CVF) com dados demográficos, clínicos e de função pulmonar. Métodos: Estudo analítico, transversal, no qual os participantes responderam a um questionário de saúde respiratória e foram submetidos a espirometria e pletismografia. A amostra foi dividida em dois grupos: ΔCVL-CVF ≥ 200 mL e ΔCVL-CVF < 200 mL. Foram realizadas análises de correlações entre os grupos e de regressão logística binominal. Resultados: Foram selecionados 187 indivíduos. Na amostra total, a média da ΔCVL-CVF foi de 0,17 ± 0,14 L. Na amostra, 61 indivíduos (32,62%) apresentaram ΔCVL-CVF ≥ 200 mL. O uso da manobra expiratória lenta reduziu a prevalência de distúrbio ventilatório inespecífico e resultados espirométricos normais, ao revelar distúrbio ventilatório obstrutivo (DVO). DVO e achados de aprisionamento aéreo (capacidade residual funcional elevada e capacidade inspiratória/CPT reduzida) foram preditores de ΔCVL-CVF ≥ 200 mL no modelo final da regressão logística (ajustada para peso e índice de massa corpórea > 30 kg/m2). Foi observada maior chance de resposta ao broncodilatador no grupo ΔCVL-CVF ≥ 200 mL: VEF1 (OR = 4,38; IC95%: 1,45-13,26) e CVF (OR = 3,83; IC95%: 1,26-11,71). Conclusões: O uso da manobra expiratória lenta diminuiu a prevalência de distúrbio ventilatório inespecífico e de resultados espirométricos normais, podendo a ΔCVL-CVF ≥ 200 mL ser resultado de DVO e aprisionamento aéreo, tendo maior chance de resposta ao broncodilatador.
ABSTRACT Objective: To evaluate the relationship that the difference between slow vital capacity (SVC) and FVC (ΔSVC-FVC) has with demographic, clinical, and pulmonary function data. Methods: This was an analytical cross-sectional study in which participants completed a respiratory health questionnaire, as well as undergoing spirometry and plethysmography. The sample was divided into two groups: ΔSVC-FVC ≥ 200 mL and ΔSVC-FVC < 200 mL. The intergroup correlations were analyzed, and binomial logistic regression analysis was performed. Results: The sample comprised 187 individuals. In the sample as a whole, the mean ΔSVC-FVC was 0.17 ± 0.14 L, and 61 individuals (32.62%) had a ΔSVC-FVC ≥ 200 mL. The use of an SVC maneuver reduced the prevalence of nonspecific lung disease and of normal spirometry results by revealing obstructive lung disease (OLD). In the final logistic regression model (adjusted for weight and body mass index > 30 kg/m2), OLD and findings of air trapping (high functional residual capacity and a low inspiratory capacity/TLC ratio) were predictors of a ΔSVC-FVC ≥ 200 mL. The chance of a bronchodilator response was found to be greater in the ΔSVC-FVC ≥ 200 mL group: for FEV1 (OR = 4.38; 95% CI: 1.45-13.26); and for FVC (OR = 3.83; 95% CI: 1.26-11.71). Conclusions: The use of an SVC maneuver appears to decrease the prevalence of nonspecific lung disease and of normal spirometry results. Individuals with a ΔSVC-FVC ≥ 200 mL, which is probably the result of OLD and air trapping, are apparently more likely to respond to bronchodilator administration.
https://doi.org/10.1590/1806-3713/e20180328
1238 downloads
10.
Does the combination of resistance training and stretching increase cardiac overload?
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Silva, Gabriel Costa e.
; Simão, Roberto
; Conceição, Rodrigo Rodrigues da
; Costa, Pablo B.
; Miranda, Humberto
; Conceição, Rodolfo Rodrigues da
; Almeida, Roberto L.
; Sato, Mônica Akemi
.
OBJECTIVES: To compare the effects of combinations of resistance training (RT) and static stretching (SS) on heart rate (HR), systolic pressure (SBP), diastolic pressure (DBP), rate pressure product (RPP), oxygen saturation (SpO2), rating of perceived effort (RPE), and heart rate variability (HRV) in men. METHODS: Twelve normotensive healthy men participated in four protocols: a) SS+RT, b) RT+SS, c) RT, and d) SS. Variables were measured before, immediately after, and 15, 30, and 45 min after the sessions. RESULTS: The combination of SS and RT increased (p<0.001) HR when compared to the effects of the noncombined protocols (from 2.38 to 11.02%), and this result indicated metabolic compensation. Regarding DBP, there were differences (p<0.001) between the RT and SS groups (53.93±8.59 vs. 67.00±7.01 mmHg). SS has been shown to be able to reduce (p<0.001) SpO2 (4.67%) due to the occlusion caused by a reduction in the caliber of the blood vessels during SS compared to during rest. The increase in RPP (6.88% between RT and SS+RT) along with the HR results indicated higher metabolic stress than that reflected by the RPE (combined protocols increased RPE from 21.63 to 43.25%). The HRV analysis confirmed these results, showing increases (p<0.01) in the LF index between the combined and noncombined protocols. Compared to the effect of RT, the combination of SS and RT promoted a vagal suppression root mean square of the successive differences (RMSSD) index (from 9.51 to 21.52%) between the RT and SS+RT groups (p<0.01) and between the RT and RT+SS groups (p<0.001). CONCLUSION: Static stretching increases cardiac overload and RPE, reducing oxygen supply, especially when performed in combination with RT.
https://doi.org/10.6061/clinics/2019/e1066
684 downloads
11.
Anatomical terminology of the internal nose and paranasal sinuses: cross-cultural adaptation to Portuguese
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Bezerra, Thiago Freire Pinto
; Stamm, Aldo
; Anselmo-Lima, Wilma Teresinha
; Fornazieri, Marco Aurélio
; Melo, Nelson D’Ávila
; Balsalobre, Leonardo
; Jotz, Geraldo Pereira
; Leão, Henrique Zaquia
; Nunes, André Alencar Araripe
; Felippu, Alexandre
; Cedin, Antonio Carlos
; Pinheiro-Neto, Carlos D.
; Oliveira, Diego Lima
; Sakano, Eulalia
; Kosugi, Eduardo Macoto
; Araújo, Elizabeth
; Valera, Fabiana Cardoso Pereira
; Pinna, Fábio de Rezende
; Romano, Fabrizio Ricci
; Pádua, Francine Grecco de Melo
; Ramos, Henrique Faria
; Telles Jr., João
; Sá, Leonardo Conrado Barbosa de
; D'Assunção Filho, Leopoldo Marques
; Sennes, Luiz Ubirajara
; Gregório, Luis Carlos
; Sampaio, Marcelo H.
; Santos, Marco César Jorge dos
; Franca, Marco
; Mocellin, Marcos
; Lessa, Marcus Miranda
; Avelino, Melissa Ameloti G.
; Tepedino, Miguel
; Andrade, Nilvano Alves de
; Piltcher, Otavio B.
; Roithmann, Renato
; Pilan, Renata Mendonça
; Meireles, Roberto Campos
; Guimarães, Roberto Eustáquio
; Santos, Rodrigo de Paula
; Pezato, Rogério
; Pignatari, Shirley
; Abdo, Tatiana Telles
; Nakajima, Victor
; Almeida, Washington
; Nakanishi, Marcio
; Voegels, Richard L.
.
Resumo: Introdução: A cirurgia endoscópica funcional endonasal é um procedimento cirúrgico frequente entre os otorrinolaringologistas. Em 2014, a Sociedade Europeia de Rinologia publicou o "Documento Europeu para Posicionamento sobre a Terminologia Anatômica Interna do Nariz e das Cavidades Paranasais" com o objetivo de unificar os termos na língua inglesa. Ainda não dispomos de uma terminologia unificada na língua portuguesa. Objetivo: Adaptação transcultural dos termos anatômicos do nariz e das cavidades paranasais para o português da "European Anatomical Terminology of the Internal Nose and Paranasal Sinuses". Método: Um grupo de rinologistas de todo o Brasil, com experiência em cirurgia endoscópica endonasal, foi convidado a participar da elaboração desse posicionamento sobre os termos anatômicos do nariz e das cavidades paranasais para o português conforme metodologia adaptada da previamente descrita por Rudmik e Smith. Resultados: Os resultados desse documento foram gerados a partir da concordância da maioria dos participantes conforme as sugestões mais populares entre os rinologistas. Uma adaptação transcultural da terminologia anatômica nasossinusal foi consolidada. Sugerimos que se busque uniformizar termos como "concha inferior", "septo nasal", "porção (óssea/cartilaginosa) do septo nasal", "meato (médio/ inferior) nasal", "via da drenagem do seio frontal", "recesso frontal" e "processo uncinado". Conclusão: Consolidamos uma versão adaptada em português da "European Anatomical Terminology of the Internal Nose and Paranasal Sinuses" que auxiliará a publicação de comunicados técnicos, publicações científicas e o ensino dos termos anatômicos internos do nariz e das cavidades paranasais no Brasil.
Abstract Introduction: Functional endonasal endoscopic surgery is a frequent surgical procedure among otorhinolaryngologists. In 2014, the European Society of Rhinology published the "European Position Paper on the Anatomical Terminology of the Internal Nose and Paranasal Sinuses", aiming to unify the terms in the English language. We do not yet have a unified terminology in the Portuguese language. Objective: Transcultural adaptation of the anatomical terms of the nose and paranasal cavities of the "European Anatomical Terminology of the Internal Nose and Paranasal Sinuses" to Portuguese. Methods: A group of rhinologists from diverse parts of Brazil, all experienced in endoscopic endonasal surgery, was invited to participate in the creation of this position paper on the anatomical terms of the nose and paranasal sinuses in the Portuguese language according to the methodology adapted from that previously described by Rudmik and Smith. Results: The results of this document were generated based on the agreement of the majority of the participants according to the most popular suggestions among the rhinologists. A cross-cultural adaptation of the sinonasal anatomical terminology was consolidated. We suggest the terms "inferior turbinate", "nasal septum", "(bone/cartilaginous) part of the nasal septum", "(middle/inferior) nasal meatus", "frontal sinus drainage pathway", "frontal recess" and "uncinate process" be standardized. Conclusion: We have consolidated a Portuguese version of the European Anatomical Terminology of the Internal Nose and Paranasal Sinuses, which will help in the publication of technical announcements, scientific publications and the teaching of the internal anatomical terms of the nose and paranasal sinuses in Brazil.
https://doi.org/10.1016/j.bjorl.2018.08.003
1085 downloads
12.
Brazilian legislation on genetic heritage harms Biodiversity Convention goals and threatens basic biology research and education
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ALVES, RUY JOSÉ V.
; WEKSLER, MARCELO
; OLIVEIRA, JOÃO A.
; BUCKUP, PAULO A.
; POMBAL JR., JOSÉ P.
; SANTANA, HÉLCIO R.G.
; PERACCHI, ADRIANO LÚCIO
; KELLNER, ALEXANDER W.A.
; ALEIXO, ALEXANDRE
; LANGGUTH, ALFREDO
; ALMEIDA, ALZIRA MARIA P. DE
; ALBERNAZ, ANA LUISA
; RIBAS, CAMILA C.
; ZILBERBERG, CARLA
; GRELLE, CARLOS EDUARDO V.
; ROCHA, CARLOS F.D.
; LAMAS, CARLOS JOSÉ E.
; HADDAD, CÉLIO F.B.
; BONVICINO, CIBELE R.
; PRADO, CYNTHIA P.A.
; LIMA, DANIELA O. DE
; ROSSA-FERES, DENISE C.
; SANTOS, FABRÍCIO R. DOS
; SALIMENA, FÁTIMA REGINA G.
; PERINI, FERNANDO A.
; BOCKMANN, FLÁVIO A.
; FRANCO, FRANCISCO LUÍS
; GIUDICE, GISELE M.L. DEL
; COLLI, GUARINO R.
; VIEIRA, IMA CÉLIA G.
; MARINHO-FILHO, JADER
; WERNECK, JANE M.C.F.
; SANTOS, JORGE A.D. DOS
; NASCIMENTO, JORGE LUIZ DO
; NESSIMIAN, JORGE LUIZ
; CORDEIRO, JOSÉ LUIS P.
; CLARO, KLEBER DEL
; SALLES, LEANDRO O.
; CASATTI, LILIAN
; PY-DANIEL, LUCIA HELENA R.
; SILVEIRA, LUÍS FÁBIO
; TOLEDO, LUÍS FELIPE
; OLIVEIRA, LUIZ F. DE
; MALABARBA, LUIZ ROBERTO
; SILVA, MARCELO D. DA
; COURI, MÁRCIA S.
; MARTINS, MÁRCIO
; TAVARES, MARCOS D.S.
; SOBRAL, MARCOS EDUARDO G.
; VIEIRA, MARCUS VINÍCIUS
; OLIVEIRA, MARIA DE LOURDES A.
; PINNA, MÁRIO DE
; HOPKINS, MICHAEL J.G.
; SOLÉ, MIRCO
; MENEZES, NAÉRCIO A.
; PASSOS, PAULO
; D’ANDREA, PAULO SERGIO
; PINTO, PEDRO C.E.A.
; VIANA, PEDRO L.
; TOLEDO, PETER M.
; REIS, ROBERTO E.
; VILELA, ROBERTO
; BASTOS, ROGÉRIO P.
; COLLEVATTI, ROSANE G.
; CERQUEIRA, RUI
; CASTROVIEJO-FISHER, SANTIAGO
; CARAMASCHI, ULISSES
.
https://doi.org/10.1590/0001-3765201820180460
7311 downloads
13.
Efficacy of ozone in the microbiological disinfection of maize grains
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Brito Júnior, Joel Guimarães de
; Faroni, Lêda Rita D’Antonino
; Cecon, Paulo Roberto
; Benevenuto, Wellingta Cristina Almeida do Nascimento
; Benevenuto Júnior, Augusto Aloísio
; Heleno, Fernanda Fernandes
.
Resumo O objetivo deste trabalho foi determinar a eficácia do ozônio para a desinfecção microbiológica de grãos de milho. Utilizaram-se amostras de 2 kg de grãos de milho, com teor de água de 14,4% b.u., contendo 94% e 97% de infecção natural por Penicillium spp. e Aspergillus spp., respectivamente. Para determinação da concentração e do tempo de saturação dos grãos pelo ozônio, aplicou-se o gás na concentração de 2,14 mg L-1 ao fluxo de 5,8 L min-1 , à temperatura de 25 ºC ± 2°C. O experimento foi instalado segundo esquema de parcela subdividida, tendo, nas parcelas, dois tratamentos (ar atmosférico e gás ozônio), e, nas subparcelas, os tempos de exposição (0, 10, 20, 30 e 50 h), em delineamento inteiramente casualizado. Observou-se que a concentração e o tempo de saturação do ozônio na massa de grãos foram de 0,9874 mg L-1 e 138,56 min, respectivamente. O processo de ozonização foi eficaz no controle de fungos de armazenamento na massa de grãos, com 50 h de exposição ao gás, reduzindo o índice de ocorrência de Aspergillus spp. (78,5%) e Penicillium spp. (98,0%), confirmando, portanto, seu efeito fungicida, nas condições apresentadas.
Abstract This research aimed to determine the effectiveness of ozone in the microbiological disinfection of maize grains. Two kg samples of maize grains were used with moisture contents of 14.4% (w.b.), and 94% and 97% of natural infection by Penicillium spp and Aspergillus spp, respectively. The gas was applied at a concentration of 2.14 mg L-1 and flow rate of 5.8 L min-1 for 370 min at 25 ºC ± 2 ºC in order to determine the ozone concentration and saturation time of the maize grains. The experiment was installed according to a split plot design, with two treatments in the plots (atmospheric air and ozone gas) and exposure times of (0, 10, 20, 30 and 50 h) in the subplots, in a completely randomized design. It was shown that the ozone concentration and saturation time in the grain mass were 0.9874 mg L-1 and 138.56 min, respectively. Ozonation was effective in controlling storage fungi in the grain mass with 50 h of exposure to the gas, reducing the rate of incidence of Aspergillus spp (78.5%) and Penicillium spp (98.0%), thereby confirming its fungicidal effect under the conditions presented.
https://doi.org/10.1590/1981-6723.02217
1965 downloads
14.
3rd Guideline for Perioperative Cardiovascular Evaluation of the Brazilian Society of Cardiology
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Gualandro, Danielle Menosi
; Yu, Pai Ching
; Caramelli, Bruno
; Marques, André Coelho
; Calderaro, Daniela
; Fornari, Luciana Savoy
; Pinho, Claudio
; Feitosa, Alina Coutinho Rodrigues
; Polanczyk, Carisi Anne
; Rochitte, Carlos Eduardo
; Jardim, Carlos
; Vieira, Carolina L. Z.
; Nakamura, Debora Y. M.
; Iezzi, Denise
; Schreen, Dirk
; Adam, Eduardo Leal
; D’Amico, Elbio Antonio
; Lima, Emerson Q. de
; Burdmann, Emmanuel de Almeida
; Mateo, Enrique Indalecio Pachón
; Marcondes-Braga, Fabiana Goulart
; Machado, Fabio S.
; Paula, Flavio J. de
; Carmo, Gabriel Assis Lopes do
; Feitosa-Filho, Gilson Soares
; Prado, Gustavo Faibischew
; Lopes, Heno Ferreira
; Fernandes, João R. C.
; Lima, José J. G. de
; Sacilotto, Luciana
; Drager, Luciano Ferreira
; Vacanti, Luciano Janussi
; Rohde, Luis Eduardo Paim
; Prada, Luis F. L.
; Gowdak, Luis Henrique Wolff
; Vieira, Marcelo Luiz Campos
; Monachini, Maristela Camargo
; Macatrão-Costa, Milena Frota
; Paixão, Milena Ribeiro
; Oliveira Junior, Mucio Tavares de
; Cury, Patricia
; Villaça, Paula R.
; Farsky, Pedro Silvio
; Siciliano, Rinaldo F.
; Heinisch, Roberto Henrique
; Souza, Rogerio
; Gualandro, Sandra F.M.
; Accorsi, Tarso Augusto Duenhas
; Mathias Júnior, Wilson
.
https://doi.org/10.5935/abc.20170140
100302 downloads
15.
Practical Considerations of Real Life of Hepatocellular Carcinoma in a Tertiary Center of Brazil
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Carvalho, Sandra R. Almeida
; Ferraz, Maria L. Gomes
; Matos, Carla A. Loureiro
; Silva, Antônio E. Benedito
; Filho, Roberto J. Carvalho
; Perez, Rogério Renato
; Gonzalez, Adriano Miziara
; Salzedas-Netto, Alcides A.
; Szejnfeld, Denis
; D’Ippolito, Giuseppe
; Lanzoni, Valéria Pereira
; Silva, Ivonete S. Souza
.
ABSTRACT Background. Hepatocellular carcinoma (HCC) is the most common malignancy that develops in cirrhotic livers. Its clinical and epidemiological characteristics and mortality rates vary according to geographical region. The objective of this study was to evaluate the clinical profile, epidemiological characteristics, laboratory parameters, treatment and survival of patients with HCC. Material and methods. Patients with HCC seen between 2000 and 2012 were studied. The Kaplan-Meier method was used for survival analysis according to variables in question. Results. The study included 247 patients with a mean age of 60 ± 10 years. There was a predominance of males (74%). The main etiologies of HCC were HCV infection (55%), excessive alcohol consumption (12%), and HBV infection (8%). Liver cirrhosis was present in 92% of cases. The mean tumor number and diameter were 2 and 5 cm, respectively. Patients meeting the Milan criteria corresponded to 43% of the sample. Liver transplantation was performed in 22.4% of patients of the Milan subset and in 10% of the whole sample. The overall mean survival was 60 months, with a 1-, 3- and 5-year survival probability of 74%, 40% and 29%, respectively. Lower survival was observed among patients with alcoholic etiology. Survival was higher among patients submitted to liver transplantation (P < 0.001), TACE (P < 0.001), or any kind of treatment (P < 0.001). However, no difference was found for surgical resection (P = 0.1) or sorafenib (P = 0.1). Conclusion. Patients with HCC were mainly older men diagnosed at an advanced stage. Treatment was associated with better overall survival, but few patients survived to be treated.
https://doi.org/10.5604/16652681.1231584
596 downloads
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