Fructosamine and glycated hemoglobin as biomarkers of glycemic control in people with type 2 diabetes mellitus and cancer (GlicoOnco study)

Introduction: Glycemic control is important to avoid diabetes complications in individuals with cancer. There is no evidence for HbA1c and fructosamine as reliable biomarkers in these conditions. There are particularities in caring for patients with diabetes and cancer that can alter these biomarkers. Objective: The aim of this study was to evaluate HbA1c and fructosamine as glycemic biomarkers in people with type 2 diabetes and cancer, undergoing clinical or surgical oncological treatment. Methods: The authors conducted a single-center, retrospective analysis with people who have cancer and diabetes. Comparison of glycemic biomarkers (HbA1c, fructosamine, and Self-Monitoring of Blood Glucose [SMBG]) was performed including evaluation in individuals undergoing chemotherapy, using glucocorticoids, with anemia, hypoproteinemia or with reduced estimated Glomerular Filtration Rate (eGFR). Results: There was a strong positive correlation between fructosamine and HbA1c (n = 318, r = 0.66, p < 0.001) in people with diabetes and cancer even in those under chemotherapy (n = 101, r = 0.61, p < 0.001) or using glucocorticoids (n = 96, r = 0.67, p<0.001). There was a strong correlation between HbA1c and fructosamine in subjects with anemia (n = 111, r = 0.66, p < 0.001), hypoproteinemia (n = 54, r = 0.67, p < 0.001), or with eGFR ≥ 60 mL/min/1.73 m2 (n = 189, r = 0.70, p < 0.001), and moderate correlation with hypoalbuminemia (n = 21, r = 0.54, p = 0.001) and with reduced eGFR (n = 67, r = 0.57, p < 0.001). The correlations between fructosamine and HbA1c with SMBG were moderate (n = 164, r = 0.49, p < 0.001; n = 111, r = 0.55, p < 0.001, respectively), strong in subjects undergoing chemotherapy, with hypoalbuminemia or hypoproteinemia, and at least moderate, if eGFR < 60 mL/min/1.73 m2 or with anemia. Conclusions: Fructosamine and HbA1c can be used as glycemic biomarkers in people with diabetes and cancer, even in those with anemia, hypoproteinemia, or undergoing chemotherapy

Spatiotemporal model fine for predicting fine particulate matter concentration in the Metropolitan Area of São Paulo

O padrão espaço-temporal das concentrações do material particulado no (MP2:5) é um importante fator para prever alguns desfechos de saúde dos habitantes de uma área urbana. As concentrações de MP2:5 podem ser obtidas por meio de redes de monitoramento da qualidade do ar, que no geral, possuem um número insuciente de estações para representar a exposição de toda uma população em uma determinada região. Nesse sentido, do ponto de vista epidemiológico, se faz necessário o desenvolvimento de metodologias que permitam estimar com alta resolução espacial e temporal as concentrações do MP2:5 em locais sem estações de monitoramento, de forma que seja possível estudar os desfechos de curto (dias/ semanas) e de longo prazo (anos). Nesta tese aplicamos uma metodologia proposta por pesquisadores da Faculdade de Saúde Pública de Harvard para predizer as concentrações de MP2:5 na Região Metropolitana de São Paulo (RMSP), entre janeiro de 2012 e dezembro de 2017. Além disso, propomos alterações nessa metodologia, com o intuito de considerar nos modelos de predição as duas fontes de correlação (espacial e temporal) inerente aos dados, já que a metodologia proposta por Harvard considera apenas fonte de correlação espacial. Também apresentamos os desvios-padrão dos erros de predição, uma medida da incerteza associada às estimativas obtidas nesses modelos. A metodologia de Harvard tem como base o Modelo Linear Misto (MLM) e a utilização de dados de Profundidade Óptica do Aerossol (POA) obtidos de satélites. A POA tem se mostrado como preditora das concentrações de MP2:5 e/ou MP10 medidos na superfície em diferentes regiões do mundo. Com o MLM é possível incorporar nas predições a variação diária da relação POA-MP2:5, ocasionada pelas condições meteorológicas. Pela primeira vez na RMSP, nós utilizamos os dados de POA com alta resolução espacial (1 km2) da versão 6 do algoritmo Multiangle Implementation of Atmospheric Correction (MAIAC). Os resultados mostraram que, diferente do que se observa em outras regiões onde essa metodologia já foi utilizada, os dados de POA do MAIAC não foram preditores das concentrações de MP2:5 e de MP10 na superfície da RMSP. Verificamos que o modelo de aerossol empregado pelo MAIAC na aquisição dos dados de POA não representa de forma adequada as propriedades do aerossol dessa região. Porém, os modelos de predição propostos que não consideraram esses dados foram capazes de explicar respectivamente, cerca de 60% e 70% da variabilidade das concentrações diurnas e diárias do MP2:5 na RMSP. O desempenho dos modelos de predição para as concentrações diárias de MP2:5 foi bastante satisfatório e comparável ao desempenho dos modelos de predição desenvolvidos na Suíça, Israel e Cidade do México, que utilizaram os dados de POA do MAIAC. Além disso, os modelos de predição que consideraram as duas fontes de correlação apresentaram poder de predição cerca de 5% maiores do que os modelos que consideram apenas a correlação espacial, além de gerarem estimativas mais precisas. Os mapas com a média anual das estimativas das concentrações diurnas e diárias de MP2:5 sobre a RMSP foram disponibilizados em um repositório de acesso livre. Essas estimativas podem ser utilizadas como uma aproxima ção para a exposição à poluição atmosférica dos habitantes da RMSP, contribuindo com os estudos epidemiológicos que visam entender seus impactos na saúde da populaçãoThe spatiotemporal pattern of ne particulate matter (PM2:5) concentrations is an important factor in predicting some health outcomes of inhabitants in urban areas. PM2:5 concentrations are measured in air quality monitoring networks, which, in general, are sparse and do not represent the exposure of an entire population in a given region. From an epidemiological point of view, it is necessary to develop methodologies that allow us to estimate PM2:5 concentrations with high spatial and temporal resolution in places without monitoring stations, so that it is possible to study the short-term (days/weeks) and long term (years) outcomes. In this thesis, we applied a methodology proposed by researchers from the Harvard School of Public Health to predict the concentrations of PM2:5 in the Metropolitan Area of São Paulo (MASP), in the 2012-2017 period. In addition, we proposed changes in that methodology, in order to consider in the prediction models the two sources of correlation (spatial and temporal) inherent to the data, since the methodology proposed by Harvard considers only the spatial correlation. We also presented the standard deviations of the prediction errors associated with the estimates obtained in those models. The Harvard methodology is based on the Linear Mixed Model (LMM) and on the use of Aerosol Optical Depth (AOD) data obtained from satellites. AOD data have been shown to be a predictor of surface PM2:5 and/or PM10 concentrations in dierent regions of the world. With LMM it is possible to incorporate in the predictions the daily variation of AOD-PM2:5 relationship, caused by the variation of meteorological conditions. For the rst time in the MASP, we used AOD data with high spatial resolution (1 km2) from version 6 of the Multiangle Implementation of Atmospheric Correction (MAIAC) algorithm. Our results showed that, unlike what was observed in other regions where Harvard methodology has already been applied, AOD data from MAIAC were not predictive of surface PM2:5 and PM10 concentrations over the MASP. We found that the aerosol model used by MAIAC in the AOD retrievals does not adequately represent the aerosol properties of that region. However, the proposed prediction models that did not consider AOD data were able to explain, respectively, about 60% and 70% of the variability of diunal and daily PM2:5 concentrations over the MASP. The performance of the prediction models for daily PM2:5 concentrations were quite satisfactory and comparable to the performance of the prediction models developed in Switzerland, Israel and Mexico City, which used AOD data from MAIAC. In addition, the prediction models that considered the two correlation sources had about 5% greater predictive power than the models that considered only the spatial correlation, and also generated more accurate estimates. The maps with the annual of the estimates of diurnal and daily PM2:5 concentrations over the MASP were made available in an open access repository. Those estimates can be used as an approximation for the exposure to air pollution of the inhabitants in the MASP, contributing to epidemiological studies that aim to understand their impacts on the population\'s healt

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Neste trabalho, utilizando o enfoque Bayesiano, ajustamos modelos lineares mistos a um conjunto de dados para o qual a suposição de que os efeitos aleatórios têm distribuição normal não é adequada considerando ditribuições t com diferentes graus de liberdade como distribuição para os efeitos aleatórios. Além disso, utilizamos uma estrutura de covariância autoregressiva de primeira ordem para a matriz de covariância intraunidades amostrais.not availabl

Impact of route choice and period of the day on cyclists' exposure to black carbon in London, Rotterdam and São Paulo

Cyclists are exposed to direct traffic emissions due to their proximity to on-road vehicles. Several studies associate black carbon (BC) exposure with both mortality and morbidity caused by cardiovascular and respiratory diseases. We did a comparative assessment of cyclists' exposure to BC in three cities: London, Rotterdam and São Paulo. We measured personal exposure to BC during the peak and off-peak hours in all three cities using the same instrument. Three origin-destination (O-D) pairs, each with two routes, for a total of six routes, were chosen in each city. The first route of each O-D pair was along busy major roads and the other perceived to be clean passing close to green/blue/quiet areas. This work brings together results from three different Latin American and European cities, with an aim to understand the BC exposure variabilities while cycling during peak and off-peak hours, identify main pollution hotspots resulting in enhanced exposure and associate the measured concentrations with proximity to green areas and waterways. BC concentrations were higher during the morning-peak hours compared with evening-peak hours in Rotterdam and São Paulo. London showed an opposite trend, with higher concentrations during evening hours. In most cases, the cyclists using the alternative route were found to be less exposed to BC in London and São Paulo. In Rotterdam, the differences in absolute concentrations between main and alternate routes were modest. Each city is different but the common features among all were that the exposure is related to route choice, a period of the day and proximity with the mobile sources. These findings have implications in terms of considering the pollutants exposure when establishing new cycle routes

Is DWI/ADC a useful tool in the characterization of focal hepatic lesions suspected of malignancy?

OBJECTIVE: Apparent diffusion coefficient (ADC) values calculated through magnetic resonance imaging have been proposed as a useful tool to distinguish benign from malignant liver lesions. Most studies however included simple cysts in their analysis. Liver cysts are easy to diagnose, have very high ADC values and their inclusion facilitates differentiation in the ADC values between benign and malignant liver lesions groups. We prospectively evaluated the ability of ADC values to differentiate metastatic liver lesions from all benign or only solid benign liver lesions. MATERIAL AND METHODS: Sixty-seven adult cancer patients with 188 liver lesions were evaluated. Lesions were categorized as metastatic or benign throughout imaging and clinical evaluation. One hundred and five (105) metastatic lesions and 83 benign lesions including hemangiomas (37), cysts (42), adenomas (2) and focal nodular hyperplasias (2) were evaluated. ADC values were calculated for each lesion utilizing two b values (0 and 600 sec/mm2). RESULTS: The average ADC value for cysts was 2.4×10(-3) mm2/sec (CI: 2.1-2.6), for solid benign lesions was 1.4×10(-3) mm2/sec (CI: 1.1-1.7) and for metastases was 1.0×10(-3) mm2/sec (CI: 0.8-1.3). There was a difference between the ADC values of metastases and benign solid lesions (p<0.0001). With the ADC value of 1.5×10(-3) mm2/sec as a cut off it is possible to distinguish metastatic from benign liver lesions, including cysts, with an accuracy of 78%. But to distinguish metastatic from benign solid liver lesions the best ADC cut off value was 1.2×10(-3) mm2/sec and the accuracy drops to 71%. CONCLUSIONS: ADC values proved to be helpful in the distinction between metastasis and benign solid hepatic lesions. But the exclusion of cysts in the analysis point out to a lower cut off value and lower accuracy than previously reported

Análise noticiosa do trabalho em enfermagem no contexto da pandemia da COVID-19

Resumo Objetivo Analisar as notícias veiculadas na imprensa brasileira sobre o trabalho em enfermagem no período da pandemia da COVID-19, compreendido entre fevereiro de 2020 a agosto de 2021. Métodos Estudo documental, descritivo, de abordagem qualitativa. Elaborado a partir de informações coletadas em sites de notícias, por meio de clipping, seguindo as etapas de monitoramento, coleta, análise e arquivamento de menções ao trabalho em enfermagem feitas pela mídia brasileira. A amostra totalizou 432 notícias. A análise dos dados se deu pela Análise de Conteúdo Temática proposta por Laurence Bardin. Resultados O ano de 2020 destacou-se dentre as notícias analisadas (59,96%), cujos personagens envolvidos foram profissionais da enfermagem, do sexo feminino (36,57%), de nível técnico (38,89%) e superior (38,43%). Houve predomínio de notícias nas regiões Sudeste (45,83%) e Centro-Oeste (17,36%). Foram identificadas seis categorias para análise dos dados: óbitos entre as trabalhadoras (40,74%), condições precárias de trabalho (28,94%), vacinação (8,56%), contaminação das trabalhadoras (8,33%), suspeita de infração ética (8,10%) e cura da COVID-19 (5,32%). Conclusão A pandemia da COVID-19 no Brasil trouxe o trabalho e as trabalhadoras da enfermagem para o centro de debate jornalístico. O óbito, as condições precárias de trabalho e a contaminação das trabalhadoras de enfermagem, veiculadas na imprensa, relacionam-se com a precarização do trabalho em enfermagem neste estudo. Conjectura-se que o debate jornalístico sobre o trabalho em enfermagem na pandemia da COVID-19 ajudou a fortalecer pautas políticas, como a que conduziu à promulgação da Lei n. 14.434/2022, que trata do piso salarial nacional para essas profissionais

Evaluation of reliability of FISH versus brightfield dual-probe in situ hybridization (BDISH) for frontline assessment of HER2 status in breast cancer samples in a community setting

Aims: To evaluate the reliability of novel brightfield microscopy–based dual in situ hybridization (BDISH) methods for frontline HER2 status analysis in selected suboptimally preserved breast cancer tissue samples reflecting of the worst scenario in a community. Methods and Results: A total of 320 morphologically poorly preserved breast invasive ductal carcinomas from the archives of 2 tertiary institutions in Brazil were selected for a tissue microarray–based analysis. 4B5 antibody was used for immunohistochemistry. Fluorescence in situ hybridization (FISH), DuoCISH, ZytoDot CISH, and silver in situ hybridization (SISH) were performed and compared. The highest agreement was observed between SISH and FISH. In addition, SISH was easier to assess in both amplified and nonamplified cases when compared with the other chromogenic methods, due to the sharpness of its dots. DuoCISH produced false-positive results, associated with thicker ill-defined dots, causing poor distinction between nonamplification and low amplification. ZytoDot CISH showed lower sensitivity, with increased frequency of false-positive results. Conclusions: SISH is the most reliable of the BDISH methods, with sensitivity and specificity highly comparable with FISH. It is also less deleterious than other BDISH methods, producing signals that were more distinct and therefore more readily analyzable even in poorly preserved tissue