Circunfer?ncia do pesco?o e risco cardiovascular em 10 anos : diferen?as por sexo. an?lise seccional da linha de base do Estudo Longitudinal de Sa?de do Adulto (ELSA-Brasil).

Programa de P?s-Gradua??o em Sa?de e Nutri??o. Escola de Nutri??o, Universidade Federal de Ouro Preto.INTRODU??O: A circunfer?ncia do pesco?o (CP) ? uma estimativa da gordura do pesco?o e da gordura subcut?nea da parte superior do corpo, cujo aumento parece conferir risco cardiovascular adicional ?quele conferido pela adiposidade geral e abdominal. O Framingham Global Risk Score (FGRS) fornece uma estimativa do risco de desenvolver DCV em 10 anos, utilizado para identificar indiv?duos sob maior risco de DCV, inclusive na pr?tica cl?nica. OBJETIVO: O objetivo da presente disserta??o foi verificar a associa??o entre a circunfer?ncia do pesco?o e o risco de evento cardiovascular em 10 anos em homens e mulheres participantes da linha de base do Estudo Longitudinal de Sa?de do Adulto (ELSA-Brasil). M?TODOS: Trata-se de estudo de corte transversal com participantes da linha de base do Estudo Longitudinal de Sa?de do Adulto (ELSABrasil) (2008-2010). O ELSA-Brasil ? uma coorte multic?ntrica com 15.105 servidores p?blicos, ativos e aposentados de institui??es de ensino e pesquisa de seis capitais de estados brasileiros. Para a presente an?lise, foram exclu?dos os indiv?duos com relato de DCV (n=738) e sem informa??es para DCV (n=26), CP (n=11), FGRS (n=28) e covari?veis (n=382), permanecendo 13.920 participantes. As caracter?sticas da popula??o do estudo e dos componentes do FGRS foram descritas por meio de frequ?ncias absolutas e relativas, m?dias e desvio padr?o (?DP) ou medianas (1? e 3? quartis) e utilizados testes compara??o dessas medidas. A associa??o entre a CP (utilizada como vari?vel cont?nua e agrupda em quartis) e o risco DCV em 10 anos, mensurado pelo FGRS, foi estimada por meio de Modelos Lineares Generalizados (MLG), com distribui??o gama e fun??o logar?tmica, cujo exponencial do coeficiente de regress?o fornece a Raz?o da M?dias Aritm?ticas com intervalo de 95% de confian?a (RMA, IC95%). Foram realizados ajustes por idade, escolaridade, ra?a/cor autorreferida, consumo de ?lcool, atividade f?sica no lazer, ?ndice de massa corporal (IMC) e circunfer?ncia da cintura (CC). RESULTADOS: A m?dia de idade dos participantes foi de 51,7 anos (DP?7,6), sendo 55% mulheres. A m?dia da CP aumentou com o incremento do risco de DCV em 10 anos agrupado em categorias de risco (risco baixo 20%) em ambos os sexos. Ap?s todos os ajustes, incluindo as demais medidas de adiposidade corporal, a CP permaneceu independentemente associada a um aumento de 3% na m?dia aritm?tica do risco DCV em 10 anos (RMA= 1,03; IC 95% 1,01-1,03) nos homens e de 5% (RMA= 1,05; IC 95% 1,04-1,06) nas mulheres. Nos modelos de regress?o utilizando a CP agrupada em quartis, ap?s todos os ajustes, observamos que comparados ao primeiro quartil todos os demais apresentaram aumento gradual na m?dia aritm?tica no risco de DCV em 10 anos, que chegou a um incremento de 18% entre os que estavam no ?ltimo quartil (IC95%: 1,13-1,24) entre os homens e a 35% (IC95%: 1,28-1,43) entre as mulheres. Foram realizadas an?lises de sensibilidade com a exclus?o de participantes em uso de hipolipemiantes, uso de corticoides, e de mulheres em uso de anticoncepcional ou em reposi??o hormonal e essas exclus?es n?o levaram a altera??o nos resultados observados. CONCLUS?O: Nossos resultados sugerem uma associa??o entre a circunfer?ncia do pesco?o e o risco DCV em 10 anos, mensurado pelo Framingham Global Risk Score em ambos os sexos, mas indicando maior for?a de associa??o entre as mulheres. Contudo, novos estudos em outras popula??es e an?lises longitudinais s?o necess?rios.INTRODUCTION: The effect of adipose tissue on the development of CVD varies between different fat deposits. Neck Circumference (NC) provides an estimate of neck fat and upper body subcutaneous fat that has been singled out as the sole body fat deposit that confers additional cardiovascular risk above and beyond general and central body fat. OBJECTIVE: The objective of this dissertation was to verify the association between neck circumference and cardiovascular risk in 10 years in men and women participants from the baseline of the Longitudinal Study of Adult Health (ELSA-Brazil). METHODS: A cross-sectional study was conducted with participants from the Study of the Longitudinal Study of Adult Health (ELSA-Brazil) baseline (2008-2010). ELSABrazil is a multicentre cohort composed of 15,105 civil serventes from institution of education and research institutions in six Brazilian state capitals. For the present analysis, individuals with a history of CVD (acute myocardial infarction, heart failure, stroke and coronary artery bypass grafting) (n = 738), missing information for CVD (n = 26), for NC = 11), for the Framingham Global Risk Score (n = 28) and for covariables (n = 382) were excluded. At the end the sample analytic was composed by 13,920 participants.The characteristics of the study population and the FGRS components were described by means of absolute and relative frequencies (categorical variables) and means and standard deviation (? SD) or medians (1st and 3rd quartiles) (continuous variables). Pearson's Chisquare test was used for comparison of frequencies, Student's t-test for comparison of means and Kruskal-Wallis test for comparison of medians. The association between NC (continous variable and agrouped in quartiles) and the10-years CDV risk, measured by the FGRS, was estimated using Generalized Linear Models (MLG), with gamma distribution and logarithmic function, whose exponential regression coefficient gives the Arithmetic Mean Ratio with 95% confidence interval (RMA, 95% CI). Potential confounding factors were age, schooling, self-reported race / color, alcohol consumption, leisure time physical activity, body mass index (BMI) and waist circumference (WC). RESULTS: The mean age of participants was 51.7 years (SD ? 7.6), being 55% female. The mean NC increased according to risk categories of the 10-year CVD risk (low risk 20%) in both sexes. In the crude analysis, it was observed that the increase of one centimeter in NC was associated with an increase of 5% (RMA = 1.05, 95% CI: 1.04-1.05) in the mean 10-year CVD risk in men and 11% (RMA = 1.11, 95% CI: 1.10-1.12) in women. After all the adjustments, including the other measures of body adiposity, NC remained independently associated with a 3% increase in the arithmetic mean of CVD risk in 10 years (RMA = 1.03, 95% CI, 1.01- 1.03) in men and 5% (RMA = 1.05, 95% CI 1.04-1.06) in women. In the regression models using NC grouped in quartiles, after all the adjustments, we observed that, compared to the first quartile, all the others presented a gradual increase in the arithmetic mean in the risk of the 10-years CVD risk, which reached an increase of 18% in men who were in the last quartile (95% CI: 1.13-1.24) and 35% (95% CI: 1.28-1.43) in women. Sensitivity analyzes were performed with the exclusion of participants taking lipidlowering drugs, corticosteroids, and women taking contraceptives or hormone replacement, and these exclusions did not lead to alteration in the observed results. CONCLUSION: Our results suggest an association between NC and 10-years CVD risk as measured by the Framingham Global Risk Score in both sexes, but indicating a greater strength of association among women

Brazilian gamma detection device for sentinel lymph node biopsy

OBJECTIVE: To test the effectiveness of an intra-operative gamma detection Brazilian device (IPEN) on sentinel lymph node biopsy (SLNB) procedures. METHODS: Forty melanoma or breast cancer patients with indication for undergoing SLNB were studied. Lymphoscintigraphy was done 2 to 24 hours prior to surgery. Lymphatic mapping with vital dye and gamma detection were performed intraoperatively. For gamma detection Neoprobe ® 1500 was used followed by IPEN (equipment under test) in the first 20 patients and for the remaining half IPEN was used first to verify its ability to locate the sentinel node (SN). Measurements were taken from the radiopharmaceutical product injection site, from SN (in vivo and ex vivo) and from background. It was recorded if the SN was stained or not and if it was found easily by surgeon. RESULTS: There were 33 (82.5%) breast cancer and 7 (17.5%) melanoma patients. Ages varied from 21 to 68 year-old (median age of 46). Sex distribution was 35 (87.5%) women and 5 (12.5%) men. Sentinel node was found in all but one patient. There was no statistical difference between the reasons ex vivo/ background obtained with the measures of both equipments (p=0, 2583-ns). The SN was easily found by the surgeon with both devices. CONCLUSION: The SLNB was successfully performed using either equipment. It was possible to do SLNB with the Brazilian device developed by IPEN without prejudice for the patient.OBJETIVO: Testar a eficácia de equipamento de detecção gama intra-operatória (DGI) desenvolvido pelo IPEN (Brasil), em procedimentos de biópsia de linfonodo sentinela (BLS) no melanoma e no câncer de mama. MÉTODOS: Foram estudados 40 pacientes portadores de melanoma ou câncer de mama com indicação para realização de BLS.Todos pacientes foram submetidos à linfocintilografia e a BLS ocorreu entre 2 a 24 horas após a mesma. Concomitantemente à DGI, realizou-se o mapeamento linfático com corante vital. Foram feitas leituras com o equipamento convencional Neoprobe® 1500 e com o equipamento em teste (IPEN) dos valores de captação do sítio de injeção do radiofármaco, do LS in vivo e ex vivo e da captação de fundo. Foi registrado se o LS estava corado e se o cirurgião teve facilidade para encontrá-lo. Nos primeiros 20 pacientes utilizou-se o equipamento convencional e depois o de teste; nos outros 20, utilizou-se primeiro o equipamento em teste, com objetivo de verificar se o mesmo identificava primariamente o LS. RESULTADOS: Dos quarenta pacientes, 33 eram portadores de tumor de mama e sete de melanoma cutâneo; variação da idade: 21 a 68 anos (mediana= 46 anos); 35 mulheres e 5 homens. Em apenas um paciente o LS não foi encontrado, nem pela DGI nem pelo corante vital. Não houve diferença estatística entre as razões ex vivo/fundo obtidas com os dois equipamentos (p=0, 2583-ns). CONCLUSÃO: É possível realizar o procedimento de BLS com o equipamento brasileiro desenvolvido pelo IPEN, com facilidade e sem prejuízo para o paciente.Hospital Israelita Albert EinsteinIPENUniversidade Federal de São Paulo (UNIFESP)Faculdade de Medicina Anhembi-MorumbiUNIFESPSciEL

Vulnerability of Brazilian municipalities to hantavirus infections based on multi‑criteria decision analysis

Background: Hantavirus infection is an emerging zoonosis transmitted by wild rodents. In Brazil, high case-fatality rates among humans infected with hantavirus are of serious concern to public health authorities. Appropriate preventive measures partly depend on reliable knowledge about the geographical distribution of this disease. Methods: Incidence of hantavirus infections in Brazil (1993–2013) was analyzed. Epidemiological, socioeconomic, and demographic indicators were also used to classify cities’ vulnerability to disease by means of multi-criteria decision analysis (MCDA). Results: From 1993 to 2013, 1752 cases of hantavirus were registered in 16 Brazilian states. The highest incidence of hantavirus was observed in the states of Mato Grosso (0.57/100,000) and Santa Catarina (0.13/100,000). Based on MCDA analysis, municipalities in the southern, southeastern, and midwestern regions of Brazil can be classified as highly vulnerable. Most municipalities in northern and northeastern Brazil were classified as having low vulnerability to hantavirus cardiopulmonary syndrome. Conclusions: Although most human infections by hantavirus registered in Brazil occurred in the southern region of the country, a greater vulnerability to hantavirus was found in the Brazilian Midwest. This result reflects the need to strengthen surveillance where the disease has thus far gone unreported

Exercise inhibits the effects of smoke-induced COPD involving modulation of STAT3

Purpose . Evaluate the participation of STAT3 in the e ff ects of aerobic exercise (AE) in a model of smoke-induced COPD. Methods . C57Bl/6 male mice were divided into control, Exe, COPD, and COPD+Exe groups. Smoke were administered during 90 days. Treadmill aerobic training begun on day 61 until day 90. Pulmonary in fl ammation, systemic in fl ammation, the level of lung emphysema, and the airway remodeling were evaluated. Analysis of integral and phosphorylated expression of STAT3 by airway epithelial cells, peribronchial leukocytes, and parenchymal leukocytes was performed. Results . AE inhibited smoke-induced accumulation of total cells ( p <0 001 ), lymphocytes ( p <0 001 ), and neutrophils ( p <0 001 ) in BAL, as well as BAL levels of IL- 1 β ( p <0 001 ), CXCL1 ( p <0 001 ), IL-17 ( p <0 001 ), and TNF- α ( p <0 05 ), while increased the levels of IL-10 ( p <0 001 ). AE also inhibited smoke-induced increases in total leukocytes ( p <0 001 ), neutrophils ( p <0 05 ), lymphocytes ( p <0 001 ), and monocytes ( p <0 01 ) in blood, as well as serum levels of IL-1 β ( p <0 01 ), CXCL1 ( p <0 01 ), IL-17 ( p <0 05 ), and TNF- α ( p <0 01 ), while increased the levels of IL-10 ( p <0 001 ). AE reduced smoke-induced emphysema ( p <0 001 ) and collagen fi ber accumulation in the airways ( p <0 001 ). AE reduced smoke-induced STAT3 and phospho-STAT3 expression in airway epithelial cells ( p <0 001 ), peribronchial leukocytes ( p <0 001 ), and parenchymal leukocytes ( p <0 001 ). Conclusions .AE reduces smoke-induced COPD phenotype involving STAT3