Neuropsychomotor development characteristics of the infants who born from women who abused drugs during pregnancy

Introduction: The use of street drugs during pregnancy, due to their deleterious effects on the health of the infant, may have clinical implications for neuropsychomotor development. Objective: The aim of this study was to analyse the characteristics of the neuropsychomotor development of infants born from women who used street drugs during pregnancy. Methods: A cross-sectional retrospective study was carried out. A total of 51 medical records of infants weighing less than 1.500 grams, who were born in the Hospital de Clínicas da Universidade Federal de Uberlândia (HC/UFU), Minas Gerais, Brazil, from January 2014 to December 2015 were analysed. Using the Development Screening test Denver II at 6 or 9 months of corrected age performed the neuropsychomotor development evaluation. Statistical analysis included quantitative variables that were described by means of average, medians and standard deviation. Groups were compared by the t test or Mann-Whitney test. The associations of the qualitative variables were evaluated by means of the likelihood ratio test. Results: Of the 51 records analysed, 39.2% belong to the group of children of mothers who used street drugs and 60.8% belong to the group of children of nonuser mothers. The neuropsychomotor development was predominantly abnormal and with a significant difference in the general performance classification (p<0.001) and, specifically, in the coarse motor area (p = 0.003) in the group of infants born to mothers who used street drugs. Conclusion: Infants of mothers who used street drugs had a greater delay in neuropsychomotor development

Survival differences between women and men in the non-reproductive cancers: Results from a matched analysis of the surveillance, epidemiology, and end-results program

BackgroundMen with non-reproductive cancers have a discrepant outcome compared to women. However, they differ significantly in the incidence of cancer type and characteristics.MethodsPatients with single primary cancer who were 18 years or older and whose data were gathered and made accessible by the Surveillance, Epidemiology, and End Results (SEER) program were included in this retrospective analysis. Kaplan-Meier curves and Cox regression before and after propensity score matching were performed to analyze the risk survival by sex.ResultsAmong the 1,274,118 patients included [median (range) age, 65 year (18–85+) years; 688,481 (54.9%) male]. The median follow-up was 21 months (0–191). Substantial improvements in survival were observed for both sexes during the years of inclusion analyzed, with no difference between them, reaching a reduction of almost 17% of deaths in 2010, and of almost 28% in 2015, compared to 2004. The women had a median survival of 74 months and overall mortality of 48.7%. Males had a median survival of 30 months (29.67–30.33) with an overall mortality of 56.2%. The PSM showed a reduced difference (6 months shorter median survival and 2.3% more death in men), but no change in hazards was observed compared to the unmatched analysis [adjusted HR: 0.888 (0.864–0.912) vs. 0.876 (0.866–0.886) in unmatched].ConclusionsThe discrepancy in survival between men and women is not explained only by the incidence of more aggressive and more advanced cancers in the former

Clinical and laboratory predictors of bronchopulmonary dysplasia in very low birth weight preterm infants

Background: Bronchopulmonary dysplasia (BPD) is a multifactorial disease that has specific clinical, radiological and histological features, defined as the oxygen dependence at concentrations above 21% for a period ≥ 28 days and / or at 36 weeks post- menstrual. Currently, there are no clinical parameters or biomarkers for its prediction. Objective: To identify clinical and laboratory biomarkers predictive of bronchopulmonary dysplasia in very low birth weight preterm infants. Methods: We analyzed a prospective cohort of 40 neonates with gestational age <34 weeks, weighing <1500 g, and who did not present congenital malformations. Preterm infants were divided into two groups: 19 without BPD and 21 with BPD. An analysis of the clinical variables, blood collection between 36 and 48 h of life, and quantification of two cytokines (GM-CSF and eotaxin) were performed through a multiplex system. Results: Maternal characteristics were homogeneous, and among neonatal characteristics, the time of mechanical ventilation was critical for development of the disease. The two cytokines were highly significant on the second day of life; GM-CSF levels presented a significantly higher values in the BPD group (p = 0.002), while eotaxin presented higher levels in the group without BPD (p = 0.02). The ratio between GM-CSF and eotaxin determined 100% sensitivity and 80% specificity for IMV (ROC area = 0.9013, CI = 0.7791–1.024, p< 0.0001). Conclusions: The IMV duration time performed in the first 48 hours of life in the low birth weight neonates is a significant clinical predictor of BPD. The use of continuous IMV is associated with increased ratios between GM-CSF and eotaxin, suggesting increased lung injury and consequently progression of the disease.Dissertação (Mestrado)Introdução: A displasia broncopulmonar (DBP) é uma doença multifatorial que possui características clínicas, radiológicas e histológicas específicas, definida como a dependência de oxigênio em concentrações acima de 21% por um período ≥ 28 dias e/ou nas 36 semanas de idade pós-menstrual. Atualmente, não existem parâmetros clínicos ou biomarcadores para a sua predição. Objetivo: Identificar biomarcadores clínicos e laboratoriais preditivos para displasia broncopulmonar em recém-nascidos pré-termo de muito baixo peso. Material e Métodos: Analisamos uma coorte prospectiva de 40 neonatos com idade gestacional <34 semanas, com peso <1.500 g e que não apresentavam malformações congênitas. Os prematuros foram divididos em dois grupos: 19 sem DBP e 21 com DBP. Uma análise das variáveis clínicas, coleta de sangue entre 36 e 48 horas de vida e quantificação de duas citocinas (GM-CSF e eotaxina) foram realizadas através de um sistema multiplex. Resultados: As características maternas foram homogêneas, e entre as características neonatais, o tempo de ventilação mecânica foi fundamental para o desenvolvimento da doença. As duas citocinas foram altamente significativas no segundo dia de vida. Os níveis de GM-CSF apresentaram valores significativamente maiores no grupo com DBP (p = 0,002), enquanto a eotaxina apresentou níveis mais elevados no grupo sem DBP (p = 0,02). A relação entre GM-CSF e eotaxina determinou 100% de sensibilidade e 80% de especificidade para VMI (área ROC = 0,9013, IC = 0,7791-1,024, p <0,0001). Conclusões: O tempo de duração da VMI realizado nas primeiras 48 horas de vida nos recém-nascidos com baixo peso ao nascer é um preditor clínico significativo da DBP. O uso de VMI contínua está associado ao aumento da razão entre GM-CSF e eotaxina, sugerindo aumento da lesão pulmonar e consequente progressão da doença

Analysis of the surgical approach in prostate cancer staging: results from the surveillance, epidemiology and end results program

Abstract Surgery is not used as a criterion for staging prostate cancer, although there is evidence that the number of analyzed and affected lymph nodes have prognosis value. The aim of this study was to determine whether there are significant differences in staging criteria in patients who underwent prostatectomy compared to those who did not, and whether the number of affected and analyzed lymph nodes (LN) plays a prognostic role. In this retrospective study, a test cohort consisting of 404,210 newly diagnosed men with prostate cancer, between 2004 and 2010, was obtained from the 17 registries (Nov 2021 submission); a validation consisting of 147,719 newly diagnosed men with prostate cancer between 2004 and 2019 was obtained from the 8 registries (Nov 2021 submission). Prostate cancer-specific survival was analyzed by Kaplan–Meier curves, survival tables and Cox regression; overall survival was analyzed only to compare Harrell's C-index between different staging criteria. In initial analyses, it was observed that the prognostic value of lymph node metastasis changes according to the type of staging (clinical or pathological), which is linked to the surgical approach (prostatectomy). Compared with T4/N0/M0 patients, which are also classified as stage IVA, N1/M0 patients had a shorter [adjusted HR: 1.767 (1429–2184), p  2 + LNs). This new (pathological) classification of N allowed the reclassification of patients based on T and Gleason grade groups, mainly those with T3 and T4 disease. In the validation group, this new staging criterion was proven to be superior [specific survival C-index: 0.908 (0.906–0.911); overall survival C-index: 0.788 (0.786–0.791)] compared to that currently used by the AJCC [8th edition; specific survival C-index: 0.892 (0.889–0.895); overall survival C-index: 0.744 (0.741–0.747)]. In addition, an adequate number of dissected lymph nodes results in a 39% reduction in death risk [adjusted HR: 0.610 (0.498–0.747), p < 0.0005]. As main conclusion, the surgery has a major impact on prostate cancer staging, mainly modifying the effect of N on survival, and enabling the stratification of pathological N according to the number of affected LN. Such a factor, when considered as staging criteria, improves the prognosis classification