Factors associated with death by tuberculosis in the eastern part of São Paulo city, 2001

OBJECTIVE: To identify factors associated with death from TB, evaluating TB cases reported for 2001 in the city of São Paulo (specifically in the neighborhoods of Cidade Tiradentes, Guaianazes, Itaquera and São Mateus) and comparing those evolving to death with those evolving to cure. METHODS: We investigated all deaths in which TB was given as the principal cause (n = 48), analyzing medical charts and conducting home visits to interview the caregiver(s). In parallel, we investigated 96 TB cases in which the patient had been discharged after a cure had been achieved. Patients with HIV were excluded from both groups. RESULTS: There were no differences between the two groups in terms of the clinical form of tuberculosis, laboratory test confirmation of the diagnosis and type of treatment. Death from TB was found to be associated, in a statistically significant manner, with being male, being over 50 years of age, having had less than 3 years of schooling, suffering from alcoholism and being unemployed. The logistic regression showed that the variables presenting the strongest associations with death from TB were suffering from alcoholism and being over 50, whereas being a new treatment and being employed were found to be protective. The combination of suffering from alcoholism, being unemployed and being over 50 increased the chance of evolving to death by 25 times (95%CI: 6.43-97.20). CONCLUSION: Ongoing education of health professionals, prompt epidemiological interventions and efficient patient referral systems could improve the indices related to this disease.OBJETIVO: Identificar os fatores mais associados à evolução para óbito por tuberculose (TB), comparando casos de TB que evoluíram para óbito com os que evoluíram para cura, entre os casos notificados em 2001, nas subprefeituras de Cidade Tiradentes, Guaianazes, Itaquera e São Mateus, na zona leste do município de São Paulo. MÉTODOS: Foram investigados todos os óbitos (n = 48) que tiveram como causa básica TB, com análise do prontuário hospitalar e posterior visita domiciliar com entrevista do(s) cuidador(es). Paralelamente, investigaram-se 96 casos de TB que tiveram alta cura. Em ambos os grupos, foram excluídos pacientes portadores de HIV. RESULTADOS: A distribuição dos casos curados e óbitos de TB foi igual em ambos os grupos para forma clínica da TB, confirmação laboratorial do diagnóstico e tipo de tratamento. Os casos de óbito tiveram associação estatisticamente significante com sexo masculino, idade maior que 50 anos, escolaridade menor que 3 anos, alcoolismo e desemprego. A regressão logística mostrou que as variáveis de maior significância para evolução para óbito foram: alcoolismo e idade maior que 50 anos, enquanto ser virgem de tratamento e ter ocupação foram fatores de proteção. A associação de alcoolismo, desemprego e idade superior a 50 anos em um mesmo paciente aumentou 25 vezes a chance de evoluir para óbito (IC95%: 6,4397,20). CONCLUSÃO: O treinamento continuado das equipes de saúde, também em nível hospitalar, com prontidão nas ações de vigilância epidemiológica e um adequado funcionamento do sistema de referência/contra-referência em muito melhorarão os indicadores da doença.Prefeitura do Município de São PauloUniversidade Federal de São Paulo (UNIFESP) Departamento de Medicina PreventivaUNIFESP, Depto. de Medicina PreventivaSciEL

Mammographic density is related to stroma and stromal proteoglycan expression

BACKGROUND: Mammographic density and certain histological changes in breast tissues are both risk factors for breast cancer. However, the relationship between these factors remains uncertain. Previous studies have focused on the histology of the epithelial changes, even though breast stroma is the major tissue compartment by volume. We have previously identified lumican and decorin as abundant small leucine-rich proteoglycans in breast stroma that show altered expression after breast tumorigenesis. In this study we have examined breast biopsies for a relationship between mammographic density and stromal alterations. METHODS: We reviewed mammograms from women aged 50–69 years who had enrolled in a provincial mammography screening program and had undergone an excision biopsy for an abnormality that was subsequently diagnosed as benign or pre-invasive breast disease. The overall mammographic density was classified into density categories. All biopsy tissue sections were reviewed and tissue blocks from excision margins distant from the diagnostic lesion were selected. Histological composition was assessed in sections stained with haematoxylin and eosin, and the expression of lumican and decorin was assessed by immunohistochemistry; both were quantified by semi-quantitative scoring. RESULTS: Tissue sections corresponding to regions of high in comparison with low mammographic density showed no significant difference in the density of ductal and lobular units but showed significantly higher collagen density and extent of fibrosis. Similarly, the expression of lumican and decorin was significantly increased. CONCLUSION: Alteration in stromal composition is correlated with increased mammographic density. Although epithelial changes define the eventual pathway for breast cancer development, mammographic density might correspond more directly to alterations in stromal composition

Open Applications developed in Brazil for Distant Learning in Dentistry: Valuable Educational Resources for Academic Professional Qualification

Technology Enabled Learning, distance learning that leverages Information and Communication Technologies (ICT), has enabled thousands of individuals to access educational content, , and encouraged many educational institutions to adopt this modality. In Brazil, in order to promote Permanent Education in Health  or continuing professional development (CPD) of professionals working in the public health sector, the government created the Open University of Brazilian National Health System (UNA-SUS), which  offers postgraduate, updating and improvement courses, focusing on public and community health. In addition, to improve quality in Primary Care service inside SUS, Brazil developed the Telehealth Networks Programme; a national program that integrates teaching and service through ICT, offering conditions to promote Telecare and Tele-education. A challenge in consolidating these initiatives is to service professionals working in remote areas, precisely those who need CPD the most. To address this problem, UNA-SUS collaborated with Federal University of Maranhão (UFMA) to develop applications for mobile devices available through the SAITE Store platform. This makes the educational content created by the institution available both online and offline, and using different types of devices.  Recognising Dentistry as a primary healthcare component, UNA-SUS/UFMA developed applications for this specific area. The content is multidisciplinary, presenting relevant information to the various professionals who provide primary care services in dental care within the healthcare network. This paper describes the history of the partnership between UNA-SUS/UFMA, the focus on dentistry and alignment with the Faculty of Dentistry of the University of São Paulo (FOUSP) Teledentistry programme,  the rationale and production process of mobile applications by UNA-SUS/UFMA, and their relevance  for academic and professional qualification of primary healthcare workers throughout Brazil

Efficacy of Papacarie¯ in reduction of residual bacteria in deciduous teeth: a randomized, controlled clinical trial

OBJECTIVES: The aim of the present study was to analyze the efficacy of Papacarie¯ gel compared with the traditional method (low-speed bur) in reducing the counts of total bacteria, Lactobacillus, total Streptococcus and Streptococcus mutans group. METHODS: A randomized, controlled clinical trial with a split-mouth design was performed. The sample comprised 40 deciduous teeth in 20 children (10 males and 10 females) aged four to seven years. The teeth were randomly allocated to two groups: G1, or chemomechanical caries removal with Papacarie Duo¯, and G2, or the removal of carious dentin tissue with a low-speed bur. Infected dentin was collected prior to the procedure, and the remaining dentin was collected immediately following the removal of the carious tissue. Initial and final counts of bacterial colonies were performed to determine whether there was a reduction in the number of colony-forming units (CFUs) of each microorganism studied. ClinicalTrials.gov: NCT01811420. RESULTS: Reductions were found in the numbers of total bacteria, total Streptococcus and Streptococcus mutans group following either of the caries removal methods (p;0.05). CONCLUSION: Papacarie¯ is an excellent option for the minimally invasive removal of carious tissue, achieving significant reductions in total bacteria, total Streptococcus and S. mutans with the same effectiveness as the traditional caries removal method

Randomized controlled clinical trial of long-term chemo-mechanical caries removal using PapacarieTM gel

Objectives: Compare the effectiveness of PapacarieTM gel for the chemo-mechanical removal of carious lesions on primary teeth to conventional caries removal with a low-speed bur with regard to execution time, clinical aspects and radiographic findings. Material and Methods: A randomized controlled clinical trial with a split-mouth design was carried out. The sample was composed of 20 children aged four to seven years, in whom 40 deciduous teeth were randomly divided into two groups: chemo-mechanical caries removal with PapacarieTM and removal of carious dentin with a low-speed bur. Each child underwent both procedures and served as his/her own control. Restorations were performed with glass ionomer cement. The time required to perform the procedure was also analyzed. The patients underwent longitudinal clinical and radiographic follow-up of the restorations. Results: No statistically significant difference between groups was found regarding the time required to perform the procedures and the radiographic follow up. Statistically significant differences between groups were found in the clinical evaluation at 6 and 18 months after treatment. Conclusion: PapacarieTM is as effective as the traditional method for the removal of carious dentin on deciduous teeth, but offers the advantages of the preservation of sound dental tissue as well as the avoidance of sharp rotary instruments and local anesthesia

Protection from inflammatory organ damage in a murine model of hemophagocytic lymphohistiocytosis using treatment with IL-18 binding protein

Hemophagocytic lymphohistiocytosis (HLH) is a life threatening condition due to the association of an infectious agent with lymphocyte cytotoxicity defects, either of congenital genetic origin in children or presumably acquired in adults. In HLH patients, an excess of lymphocyte or macrophage cytokines, such as IFN-gamma and TN Fu is present in serum. In animal models of the disease, IFN-gamma and INF-alpha have been shown to play a central pathogenic role. In humans, unusually high concentrations of IL-18, an inducer of IFN-gamma, and INF-alpha have been reported, and are associated with an imbalance between IL-18 and its natural inhibitor IL18 binding protein (IL18BP) resulting in an excess of free IL18 Here we studied whether IL-18B P could reduce disease severity in an animal model of HLH. Mouse cytomegalovirus infection in perforin-1 knock out mice induced a lethal condition similar to human HLH characterized by cytopenia with marked inflammatory lesions in the liver and spleen as well as the presence of hemophagocytosis in bone marrow. IL-18B P treatment decreased hemophagocytosis and reversed liver as well as spleen damage. IL-18BP treatment also reduced both IFN-gamma and TNF-alpha production by CD8+ T and NK cells, as well as Fas ligand expression on NK cell surface. These data suggest that IL-18B P is beneficial in an animal model of HLH and in combination with anti infectious therapy may be a promising strategy to treat HLH patients

PVLSI (Pioneer Valley Life Sciences Institute) Posters - 2019

PVLSI (Pioneer Valley Life Sciences Institute) Posters - 2019https://scholarlycommons.libraryinfo.bhs.org/research_education/1014/thumbnail.jp