Predictive models for mutations in mismatch repair genes: implication for genetic counseling in developing countries

<p>Abstract</p> <p>Background</p> <p>Lynch syndrome (LS) is the most common form of inherited predisposition to colorectal cancer (CRC), accounting for 2-5% of all CRC. LS is an autosomal dominant disease characterized by mutations in the mismatch repair genes mutL homolog 1 (MLH1), mutS homolog 2 (MSH2), postmeiotic segregation increased 1 (PMS1), post-meiotic segregation increased 2 (PMS2) and mutS homolog 6 (MSH6). Mutation risk prediction models can be incorporated into clinical practice, facilitating the decision-making process and identifying individuals for molecular investigation. This is extremely important in countries with limited economic resources. This study aims to evaluate sensitivity and specificity of five predictive models for germline mutations in repair genes in a sample of individuals with suspected Lynch syndrome.</p> <p>Methods</p> <p>Blood samples from 88 patients were analyzed through sequencing MLH1, MSH2 and MSH6 genes. The probability of detecting a mutation was calculated using the PREMM, Barnetson, MMRpro, Wijnen and Myriad models. To evaluate the sensitivity and specificity of the models, receiver operating characteristic curves were constructed.</p> <p>Results</p> <p>Of the 88 patients included in this analysis, 31 mutations were identified: 16 were found in the MSH2 gene, 15 in the MLH1 gene and no pathogenic mutations were identified in the MSH6 gene. It was observed that the AUC for the PREMM (0.846), Barnetson (0.850), MMRpro (0.821) and Wijnen (0.807) models did not present significant statistical difference. The Myriad model presented lower AUC (0.704) than the four other models evaluated. Considering thresholds of ≥ 5%, the models sensitivity varied between 1 (Myriad) and 0.87 (Wijnen) and specificity ranged from 0 (Myriad) to 0.38 (Barnetson).</p> <p>Conclusions</p> <p>The Barnetson, PREMM, MMRpro and Wijnen models present similar AUC. The AUC of the Myriad model is statistically inferior to the four other models.</p

Two new species of Odontostilbe historically hidden under O. microcephala (Characiformes: Cheirodontinae)

Specimens historically identified as Odontostilbe microcephala from the upper rio Paraná and Andean piedmont tributaries of the río Paraguay are reviewed and split in three species. We found that the distribution of O. microcephala is restricted to the Andean slope of the río Paraguay basin. The species is distinguished from congeners with subterminal mouth by the elongate body, usually 10-12 gill rakers on upper branch and smaller horizontal orbital diameter (24.6-32.8 % HL, mean 28.7%). Specimens from upper rio Paraná constitute two new species, diagnosed from other Cheirodontinae by the presence of mesopterygoid teeth, grouped on median portion and forming a continuous row. The new species are distinguished from each other by having premaxillary teeth with five cusps vs. nine cusps and by the number of lamellae in left and right sides of central median raphe of olfactory rosette with 20-21 vs. 11-12.Espécimes historicamente identificados com Odontostilbe microcephala do rio Paraná e tributários do río Paraguay, foram revisados e separados em três espécies. A distribuição de O. microcephala é restrita ao sopé andino da bacia do río Paraguay. A espécie é distinta das congêneres com boca subterminal pela forma alongada, geralmente 10-12 rastros branquiais no ramo superior e menor diâmetro horizontal da órbita (24,6-32,8 % CC, média 28,7%). Espécimes do alto rio Paraná constituem duas espécies novas diagnosticadas de outros Cheirodontinae pela presença de dentes no mesopterigoide, agrupados em sua porção média e formando uma fileira continua. As novas espécies distinguem-se por ter dentes premaxilares com cinco cúspides vs. nove cúspides e pelo número de lamelas nos lados esquerdo e direito da rafe central da roseta olfativa com 20-21 vs. 11-12

Socioeconomic inequalities in the use of outpatient services in Brazil according to health care need: evidence from the World Health Survey

<p>Abstract</p> <p>Background</p> <p>The Brazilian health system is founded on the principle of equity, meaning provision of equal care for equal needs. However, little is known about the impact of health policies in narrowing socioeconomic health inequalities. Using data from the Brazilian World Health Survey, this paper addresses socioeconomic inequalities in the use of outpatient services according to intensity of need.</p> <p>Methods</p> <p>A three-stage cluster sampling was used to select 5000 adults (18 years and over). The non-response rate was 24.7% and calibration of the natural expansion factors was necessary to obtain the demographic structure of the Brazilian population. Utilization was established by use of outpatient services in the 12 months prior to the interview. Socioeconomic inequalities were analyzed by logistic regression models using years of schooling and private health insurance as independent variables, and controlling by age and sex. Effects of the socioeconomic variables on health services utilization were further analyzed according to self-rated health (good, fair and poor), considered as an indicator of intensity of health care need.</p> <p>Results</p> <p>Among the 5000 respondents, 63.4% used an outpatient service in the year preceding the survey. The association of health services utilization and self-rated health was significant (p < 0.001). Regarding socioeconomic inequalities, the less educated used health services less frequently, despite presenting worse health conditions. Highly significant effects were found for both socioeconomic variables, years of schooling (p < 0.001) and private health insurance (p < 0.00), after controlling for age and sex. Stratifying by self-rated health, the effects of both socioeconomic variables were significant among those with good health status, but not statistically significant among those with poor self-rated health.</p> <p>Conclusions</p> <p>The analysis showed that the social gradient in outpatient services utilization decreases as the need is more intense. Among individuals with good self-rated health, possible explanations for the inequality are the lower use of preventive services and unequal supply of health services among the socially disadvantaged groups, or excessive use of health services by the wealthy. On the other hand, our results indicate an adequate performance of the Brazilian health system in narrowing socioeconomic inequalities in health in the most serious situations of need.</p