Survival after Laparoscopic versus Abdominal Radical Hysterectomy in Early Cervical Cancer: A Randomized Controlled Trial

Previous studies have reported the safety of laparoscopic radical hysterectomy for treatment of early cervical cancer, as option to laparotomy. This study aims to compare overall survival between laparoscopic versus abdominal radical hysterectomy for early cervical cancer. Methods: A single-center randomized controlled trial enrolled 30 patients with clinically staged IA2 cervical cancer and lymphovascular invasion, IB and IIA, who underwent laparoscopic radical hysterectomy (16) or abdominal radical hysterectomy (14). Result: The mean overall survival time was 74.74 months (CI 95%: 54.15-95.33) for LRH 91.67 months (CI 95%: 74.97-108.37) for ARH (logrank test = 0.30). The mean disease-free survival time was 81.07 months (CI 95%: 60.95-101.19) for LRH and 95.82 months (CI 95%: 80.18-111.47) for ARH (log-rank test = 0.371). The overall survival hazard ratio was 2.05 (CI 95%: 0.51-8.24), and the disease-free hazard ratio was 2.13 (CI 95%: 0.39-11.7). Conclusion: Our study suggests a nonsignificant trend of worse outcomes for LRH. In light of recent controversy and need for prospective studies, further studies in different populations are required for definite conclusions and until then, patients should be aware of risks and benefits, survival data and quality of life outcomes related to both surgical techniques.info:eu-repo/semantics/publishedVersio

Necessidade de cuidados paliativos em pacientes com insuficiência cardíaca avançada internados em um hospital terciário

Objective: To evaluate the need for palliative care in patients with advanced Congestive Heart Failure (CHF) hospitalized in a cardiology ward. Method: Application of the World Health Organization Palliative Needs tool (NECPAL) with the assistant physician, patient and/or caregiver for evaluation of indication of Palliative Care (PC). Results: 82 patients with a diagnosis of class III/IV Heart Failure or ejection fraction less than or equal to 40% in echocardiography of the last 12 months were included: Mean age 68 ± 20 years, 51 male patients and 31 female patients. Forty-three patients (52.4%) were married or in consensual union and ten (12%) lived alone. The death of 46 patients (56.1%) in the subsequent 12 months would not surprise their physician, and forty-five patients (55%) had palliative care indication according to the NECPAL. Conclusion: About half of patients hospitalized for class III/IV Heart Failure would have an indication of Palliative Care for the relief of suffering caused by the disease

Videolaparoscopic Radical Hysterectomy Approach: a Ten-Year Experience

Videolaparoscopic radical hysterectomy was found to have comparable operative times, lymph node retrieval, and complications as those reported by others

Cell block sensitivity for immunohistochemical detection of cytokeratin 5, oestrogen and progesterone receptors in canine primary mammary carcinoma

Mammary carcinomas are relatively common ailments among female canines aged around 10 years old, presentingan important morbidity with an average survival of five years. The cytoinclusion technique is frequently employed in human medicine as the investigative method of choice as it quickly provides resources for the determination of the correct therapeutic response, however, the effectiveness of the technique in canines remains understudied in veterinary medicine. This study aims at evaluating the degree of correlation with immunohistochemical marking for cytokeratin 5 (CK5), oestrogen and progesterone receptors (ER and PR) between the cytoinclusion and the histopathology technique in mammary carcinomas. Twenty-five samples of mammary carcinoma, both for the cytoinclusion and histopathological techniques were submitted for histological processing; microscope slides were created for hematoxylin-eosin (HE) staining and the immunohistochemical technique (IHC) was assessed for the ER, PR and CK5 receptors. Through the HE staining, we reached a concordance rate of 100% between the cytoinclusion and the histopathological analysis in the diagnosis of carcinomas. The immunohistochemical assay presented sensitivity of 85.71%, 95.45% and 100% and Cohen’s kappa of 0.78, 0.84 and 0.95 for ER, PR and CK5, respectively, as well as 100% specificity and P<0.01 for all three markers. Therefore, cytoinclusion represents an accessible, fast and low-cost method, offering high sensitivity for the cytomorphological and immunohistochemical diagnosis of mammary carcinoma in female canines

Serum cytokine responses over the entire clinical-immunological spectrum of human leishmania (l.) infantum chagasi infection

The clinical-immunological spectrum of human Leishmania (L.) infantum chagasi infection in Amazonian Brazil was recently reviewed based on clinical, DTH, and IFAT (IgG) evaluations that identified five profiles: three asymptomatic (asymptomatic infection, AIsubclinical resistant infection, SRIand indeterminate initial infection, III) and two symptomatic (symptomatic infection, SIAmerican visceral leishmaniasis, AVLand subclinical oligosymptomatic infection, SOI). TNF-alpha, IL-4, IL-6, and IL-10 serum cytokines were analyzed using multiplexed Cytometric Bead Array in 161 samples from endemic areas in the Brazilian Amazon: SI [AVL] (21 cases), III (49), SRI (19), SOI (12), AI (36), and a control group [CG] (24). The highest IL-6 serumlevels were observed in the SI profile (AVL)higher IL-10 serum levels were observed in SI than in SOI or CG and in AI and III than in SOIhigher TNF-alpha serum levels were seen in SI than in CG. Positive correlations were found between IL-6 and IL-10 serum levels in the SI and III profiles and between IL-6 and TNF-alpha and between IL-4 and TNF-alpha in the III profile. These results provide strong evidence for associating IL-6 and IL-10 with the immunopathogenesis of AVL and help clarify the role of these cytokines in the infection spectrum.Instituto Evandro Chagas (Secretaria de Vigilancia em Saude, Ministerio da Saude, Brazil)Nucleo de Medicina Tropical (Universidade Federal do Para, Brazil)Laboratorio de Investigacao Medica (LIM)-50 (Hospital de Clinicas (HC)-Faculdade de Medicina (FM)-Universidade de Sao Paulo (USP), Brazil)Sao Paulo Research Foundation (FAPESP) [2006/56319-1]Parasitology Department, Evandro Chagas Institute, Surveillance Secretary of Health, Ministry of Health, Ananindeua, PA, BrazilAlbert Einstein Israelite Hospital, São Paulo, SP, BrazilDivision of Immunology, Federal University of São Paulo, São Paulo, SP, BrazilPathology Department, Medical School of São Paulo University, São Paulo, SP, BrazilTropical Medicine Nucleus, Federal University of Pará, Belém, PA, BrazilDivision of Immunology, Federal University of São Paulo, São Paulo, SP, BrazilFAPESP: 2006/56319-1Web of Scienc

Malignant tumor of the peripheral nerve sheath in a left Whippet canine kidney

Background: Malignant tumors of the peripheral nerve sheath (MTPNS`s) are considered rare tumors that can affect soft tissues. In dogs, the occurrence is more common in the nerves of the brachial plexus, but they can affect the lumbosacral plexus and cranial nerves. Rarely, they can affect spinal nerves and nerve roots and the urinary tract, especially in kidneys. The present report aims to describe a clinical case of a 10-year-old sterilized female whippet, who had a history of persistent hematuria for months, with subsequent diagnosis of MTPNS as the cause of hematuria.Case: The patient came for evaluation with a history of persistent hematuria. Evaluation of abnormal elements and sedimentation, showed the description of numerous red blood cells and the presence of proteinuria. The abdominal ultrasound revealed a left kidney with enlarged dimensions, irregular contour, loss of corticomedullary definition. The urinary vesicle showed an increase in cellularity. On physical examination, the patient had vital parameters within the normal range. A Snap 4DX® Plus exam was requested, which showed a reaction for Dirofilaria immitis. With this result, it was initially suspected that renal vasculitis. After starting the treatment, the patient started to present normal colored urine. However, after the end of this period, the patient returned to hematuria. After six months of treatment and without justification for the permanence of hematuria, urethrocystoscopy was indicated, which revealed a urinary vesicle with a hemorrhagic focus. A urinary bladder wall biopsy was performed, which showed no changes. Four months after the urethrocystoscopic exam, the patient had her first azotemic crisis. This time that the left renal neoformation observed on ultrasound examination. With the discovery of the origin of the problem, a therapeutic approach could be instituted, consisting of the left nephrectomy. The histopathological analysis showed malignant spindle cell neoplasia. Immunohistochemical analysis in peroxidase revealed positivity for the markers, concluding the diagnosis as a tumor of the peripheral nerve sheath. Seven months after surgery, a new ultrasound examination of the abdominal region, as well as tests for the assessment of renal function, all of which were within normal parameters.Discussion: Most of the MTPNS originate in the peripheral nerves and in the cranial nerve sheath, but it can rarely originate in the abdominal cavity, as in the case reported here, in which the origin was renal. Such neoplasms are not common in dogs, with an incidence of 0.5%. The age of the affected dogs is, on average, nine years for the appearance of the neoplasia, with females with the highest frequency of occurrence. Both data corroborate the patient's age at the time of diagnosis. This is a tumor that is considered to be highly malignant and progressive, which did not occur in the patient in question, since she had a history of persistent hematuria for a long period, with no manifestation of the presence of the tumor on imaging. Still regarding the clinical manifestation of the patient's persistent hematuria, the same occurrence can be observed in a human patient who also reported a history of persistent hematuria and, like the patient in the report, not associated with any other clinical signs. It is important to differentiate this type of neoplasia from the others, because in many cases, the histological patterns are similar, making the performance of immunohistochemistry essential for the diagnosis. Renal MTPNS is rare in humans, and in dogs it is no different. This fact makes it difficult to describe the prognosis. Thus, efforts should be considered for the early diagnosis of peripheral nerve neoplasms, in view of their low response to available halopathic treatments and taking into account the rare aspect and evolution of this disease

Serum Cytokine Responses over the Entire Clinical-Immunological Spectrum of Human Leishmania (L.) infantum chagasi

The clinical-immunological spectrum of human Leishmania (L.) infantum chagasi infection in Amazonian Brazil was recently reviewed based on clinical, DTH, and IFAT (IgG) evaluations that identified five profiles: three asymptomatic (asymptomatic infection, AI; subclinical resistant infection, SRI; and indeterminate initial infection, III) and two symptomatic (symptomatic infection, SI; American visceral leishmaniasis, AVL; and subclinical oligosymptomatic infection, SOI). TNF-α, IL-4, IL-6, and IL-10 serum cytokines were analyzed using multiplexed Cytometric Bead Array in 161 samples from endemic areas in the Brazilian Amazon: SI [AVL] (21 cases), III (49), SRI (19), SOI (12), AI (36), and a control group [CG] (24). The highest IL-6 serum levels were observed in the SI profile (AVL); higher IL-10 serum levels were observed in SI than in SOI or CG and in AI and III than in SOI; higher TNF-α serum levels were seen in SI than in CG. Positive correlations were found between IL-6 and IL-10 serum levels in the SI and III profiles and between IL-6 and TNF-α and between IL-4 and TNF-α in the III profile. These results provide strong evidence for associating IL-6 and IL-10 with the immunopathogenesis of AVL and help clarify the role of these cytokines in the infection spectrum

O impacto dos padrões alimentares sobre o excesso de peso e obesidade: uma visão hormonal e inflamatória

Padrões alimentares são os conjuntos ou grupos de alimentos que são consumidos por uma determinada população, os quais expressam efeitos combinados e sinérgicos na saúde pública. Os diferentes tipos de padrões alimentares podem ser associados ou não às doenças crônicas não transmissíveis (DCNT), entre elas a obesidade. A obesidade leva a um estado inflamatório subclínico que piora ainda mais o quadro e leva a outras comorbidades também associadas às DCNT. Este artigo tem o objetivo de relacionar os padrões alimentares inadequados e seus grupos de alimentos, os quais podem induzir e agravar a obesidade através da liberação de substâncias pró–inflamatórias. Este trabalho tem como metodologia a busca por artigos científicos nas principais bases de dados científicas, usando as palavras-chaves “padrões alimentares”, “obesidade”, “hábitos alimentares” e “inflamação”

Dispensação de medicamentos para pacientes idosos na rede pública de saúde de um município da região metropolitana do Vale do Paraíba - São Paulo / Dispensing medication for elderly patients in the public health network of a municipality in the metropolitan region of Vale do Paraíba - São Paulo

A despeito das lutas e conquistas nos últimos séculos para se obter um serviço de saúde de qualidade,  o aumento da longevidade pode trazer à tona vários problemas de saúde e com eles a polifarmácia que é utilizada em decorrencia das comorbidades que mais afetam essa faixa etária. Este estudo visou descrever e analisar a prevalência da utilização de 5 ou mais medicamentos prescritos por paciente e sua relação com o aumento da idade a partir dos 60 anos. Com este intuito foi realizado  um estudo retrospectivo em receitas dispensadas em uma  farmácia pública do município de Pindamonhangaba no estado de São Paulo. Neste estudo observou-se um predomínio do sexo feminino e um percentual considerável de interações medicamentosas por prescrições sendo a maioria destas de gravidade moderada