SITUACIÓN CLÍNICA Y EPIDEMIOLÓGICA DE LA SÍFILIS GESTACIONAL EN ANÁPOLIS-GO: UN ANÁLISIS RETROSPECTIVO

Objetivo: descrever a situação clínica e epidemiológica da sífilis gestacional em Anápolis, Goiás, Brasil, entre os anos de 2012 e 2018.Método: estudo epidemiológico, descritivo e transversal de natureza quantitativa. Como instrumento de coleta, foram utilizados dados da ficha de notificação da sífilis gestacional cadastradas no Departamento de Vigilância Epidemiológica. Para análise estatística, foi utilizado o teste quiquadrado com nível de significância 5% (p<0,05).Resultados: evidenciou-se aumento dos casos de sífilis gestacional. A assistência foi oferecida a 522 pacientes, entre 19 e 29 anos (58,1%), com etnia parda (69,1%) e com ensino médio incompleto (24,5%); predominou a sífilis primária (30,8%) e alto índice de não tratamento do parceiro (57,1%). Conclusão: dentro do período estudado, houve aumento dos casos de sífilis gestacional e não tratamento do parceiro. Este estudo poderá contribuir para o planejamento de ações de prevenção primária e secundária, visando diminuir a incidência da doença e suas consequências.Objective: to describe the clinical and epidemiological situation of gestational syphilis in Anápolis, Goiás, Brazil, between the years 2012 to 2018.Method: descriptive, cross-sectional study of a quantitative nature. As a collection instrument, data from the gestational syphilis notification form registered in the Epidemiological Surveillance Department were used. For statistical analysis, the chi-square test was used, with a 5% significance level (p<0.05).Results: an increase in gestational syphilis cases was evidenced. Care was offered to 522 women, aged between 19 and 29 years (58.1%), with brown ethnicity (69.1%) and incomplete high school education (24.5%); latent syphilis predominated (58.1%), followed by primary syphilis (30.8%) and a high rate of non-treatment of the partner (57.1%).Conclusion: within the period studied, there was an increase in cases of gestational syphilis and non-treatment of the partner. This study may contribute to the planning of primary and secondary prevention actions, aiming to decrease the incidence of the disease and its consequences.Objetivo: describir la situación clínica y epidemiológica de la sífilis gestacional en Anápolis, Goiás, Brasil, entre los años 2012 y 2018. Método: estudio descriptivo y transversal de carácter cuantitativo. Se utilizaron como instrumento de recogida los datos de la ficha de notificación de sífilis gestacional registrada en el Departamento de Vigilancia Epidemiológica. Para el análisis estadístico se utilizó la prueba de chi-cuadrado con un nivel de significación del 5% (p<0,05). Resultados: se evidenció un aumento de los casos de sífilis gestacional. La asistencia se ofreció a 522 mujeres, con edades comprendidas entre los 19 y los 29 años (58,1%), de etnia parda (69,1%) y con estudios secundarios incompletos (24,5%); predominó la sífilis latente (58,1%), seguida de la sífilis primaria (30,8%) y un alto índice de no tratamiento de la pareja (57,1%). Conclusión: dentro del período estudiado, hubo un aumento de los casos de sífilis gestacional y no tratamiento de la pareja. Este estudio puede contribuir a la planificación de acciones de prevención primaria y secundaria, con el objetivo de disminuir la incidencia de la enfermedad y sus consecuencias

Mecanismos de ação dos protetores solares na prevenção do câncer de pele

RESUMO: O câncer de pele é uma das neoplasias predominantes que acometem a população mundial, principalmente aquela residente nos países da zona tropical. O presente estudo consiste de um resumo expandido que tem como função demonstrar a importância do uso do protetor solar na prevenção dessa doença. Foram selecionados cinco artigos das bases de dados SciELO, PubMed e Google Acadêmico. Após a revisão dos artigos, nota-se que o protetor solar atua na prevenção de danos causados pelas radiações ultravioleta, dentre eles o fotoenvelhecimento, aumento de espécies reativas de oxigênio (ERO) e danos ao material genético. A abordagem ao assunto é de extrema importância, valorizando as relações entre o uso de filtros solares e a prevenção do câncer de pele, buscando implementações mais efetivas de controle da incidência de neoplasias de pele e mudanças no modelo de saúde em vigência.Palavras-chave:Protetor solar. Câncer de pele. Toxicidade

Repercussão da endometriose na gestação: uma revisão integrativa

INTRODUÇÃO: A endometriose acomete até 11% da população feminina em idade reprodutiva e já possui relação consolidada com casos de infertilidade. Seus reflexos negativos parecem se estender ao período gestacional. OBJETIVO: Avaliar como a endometriose está envolvida em riscos maternos e fetais durante a gestação. METODOLOGIA: Trata-se de uma revisão integrativa na base de dados PUBMED utilizando os descritores “endometriosis” AND “pregnancy’’ AND “complications” para artigos publicados entre 2018 e 2024. RESULTADOS: De 30 a 50% das mulheres com endometriose podem ter maiores dificuldades em engravidar. O risco de um parto prematuro é 16% maior em mulheres com endometriose as quais possuem 19,3% a mais de chances de sofrer um aborto espontâneo. São maiores os riscos para diabetes gestacional (DMG) e distúrbios hipertensivos na gravidez em mulheres com endometriose. A endometriose materna relaciona-se a maiores índices de morte neonatal (1,29 vezes) e de chances aumentadas de natimorto (1,78 vezes). CONCLUSÃO: A endometriose parece estar relacionada a maiores taxas de placenta prévia, retardo do crescimento intrauterino, hipertensão gestacional, risco de gravidez ectópica e abortamento em comparação com mulheres que não possuem a doença. A endometriose também está envolvida com resultados fetais negativos

Development of a bone-targeted pH-sensitive liposomal formulation containing doxorubicin: physicochemical characterization, cytotoxicity, and biodistribution evaluation in a mouse model of bone metastasis

Background: Despite recent advances in cancer therapy, the treatment of bone tumors remains a major challenge. A possible underlying hypothesis, limitation, and unmet need may be the inability of therapeutics to penetrate into dense bone mineral, which can lead to poor efficacy and high toxicity, due to drug uptake in healthy organs. The development of nanostructured formulations with high affinity for bone could be an interesting approach to overcome these challenges. Purpose To develop a liposomal formulation with high affinity for hydroxyapatite and the ability to release doxorubicin (DOX) in an acidic environment for future application as a tool for treatment of bone metastases. Materials and methods Liposomes were prepared by thin-film lipid hydration, followed by extrusion and the sulfate gradient-encapsulation method. Liposomes were characterized by average diameter, ζ-potential, encapsulation percentage, X-ray diffraction, and differential scanning calorimetry. Release studies in buffer (pH 7.4 or 5), plasma, and serum, as well as hydroxyapatite-affinity in vitro analysis were performed. Cytotoxicity was evaluated by MTT assay against the MDA-MB-231 cell line, and biodistribution was assessed in bone metastasis-bearing animals. Results: Liposomes presented suitable diameter (~170 nm), DOX encapsulation (~2 mg/mL), controlled release, and good plasma and serum stability. The existence of interactions between DOX and the lipid bilayer was proved through differential scanning calorimetry and small-angle X-ray scattering. DOX release was faster when the pH was in the range of a tumor than at physiological pH. The bone-targeted formulation showed a strong affinity for hydroxyapatite. The encapsulation of DOX did not interfere in its intrinsic cytotoxicity against the MDA-MB-231 cell line. Biodistribution studies demonstrated high affinity of this formulation for tumors and reduction of uptake in the heart. Conclusion: These results suggest that bone-targeted pH-sensitive liposomes containing DOX can be an interesting strategy for selectively delivering this drug into bone-tumor sites, increasing its activity, and reducing DOX-related toxicity

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used