Aspectos epidemiológicos atuais da tuberculose e o impacto da estratégia DOTS no controle da doença

This article aims to present the current situation of tuberculosis and how the DOTS (Directly Observed Treatment Short Course) strategy has impacted national tuberculosis control programs worldwide, in Latin America and in Brazil. Data reveal a tendency towards a slow decline in disease rates (1%) around the world in 2003. In Brazil, data indicate a constant downward tendency of approximately 3% a year in incidence levels. The DOTS strategy has been recommended to all countries. Brazil needs to improve its tuberculosis surveillance efforts, particularly in terms of confirming negative sputum smear results at the end of treatment.La finalidad de este artículo es dibujar la situación actual de la tuberculosis y el impacto de la estrategia DOTS (Directly Observed Treatment Short Course) en los Programas Nacionales de Control de la enfermedad en el mundo, en América Latina y en Brasil. Los datos evidencian una tendencia a la caída lenta de la enfermedad en el mundo (1%) en 2003. En Brasil, los datos indican una tendencia descendente constante en la incidencia, con caída aproximada de unos 3% al año. La estrategia DOTS ha sida recomendada a todos los países. El Brasil necesita mejorar la vigilancia de la enfermedad, principalmente con relación a la confirmación de la conversión de la baciloscopia al término del tratamiento.O artigo tem por objetivo apresentar a situação atual da tuberculose e o impacto da estratégia DOTS (Directly Observed Treatment Short Course) nos Programas Nacionais de Controle da doença no mundo, na América Latina e no Brasil. Os dados evidenciam tendência de declínio lento da doença no mundo (1%), em 2003. No Brasil, os dados indicam tendência descendente constante na incidência, com queda aproximada de 3% ao ano. A estratégia DOTS tem sido recomendada a todos os países. O Brasil necessita melhorar a vigilância da doença, principalmente em relação à confirmação da conversão da baciloscopia ao término do tratamento

Some interesting features of new massive gravity

A proof that new massive gravity - the massive 3D gravity model proposed by Bergshoeff, Hohm and Townsend (BHT) - is the only unitary system at the tree level that can be constructed by augmenting planar gravity through the curvature-squared terms, is presented. Two interesting gravitational properties of the BHT model, namely, time dilation and time delay, which have no counterpart in the usual Einstein 3D gravity, are analyzed as well.Comment: Submitted to Classical and Quantum Gravit

Clinical profiles and quality of care of subjects with type 2 diabetes according to their cardiovascular risk: an observational, retrospective study

Background: The European Society of Cardiology (ESC) recently defined cardiovascular risk classes for subjects with diabetes. Aim of this study was to explore the distribution of subjects with type 2 diabetes (T2D) by cardiovascular risk groups according to the ESC classification and to describe the quality indicators of care, with particular regard to cardiovascular risk factors. Methods: The study is based on data extracted from electronic medical records of patients treated at the 258 Italian diabetes centers participating in the AMD Annals initiative. Patients with T2D were stratified by cardiovascular risk. General descriptive indicators, measures of intermediate outcomes, intensity/appropriateness of pharmacological treatment for diabetes and cardiovascular risk factors, presence of other complications and overall quality of care were evaluated. Results: Overall, 473,740 subjects with type 2 diabetes (78.5% at very high cardiovascular risk, 20.9% at high risk and 0.6% at moderate risk) were evaluated. Among people with T2D at very high risk: 26.4% had retinopathy, 39.5% had albuminuria, 18.7% had a previous major cardiovascular event, 39.0% had organ damage, 89.1% had three or more risk factors. The use of DPP4-i markedly increased as cardiovascular risk increased. The prescription of secretagogues also increased and that of GLP1-RAs tended to increase. The use of SGLT2-i was still limited, and only slightly higher in subjects with very high cardiovascular risk. The overall quality of care, as summarized by the Q score, tended to be lower as the level of cardiovascular risk increased. Conclusions: A large proportion of subjects with T2D is at high or very high risk. Glucose-lowering drug therapies seem not to be adequately used with respect to their potential advantages in terms of cardiovascular risk reduction. Several actions are necessary to improve the quality of care

Trends in stream nitrogen concentrations for forested reference catchments across the USA

To examine whether stream nitrogen concentrations in forested reference catchments have changed over time and if patterns were consistent across the USA, we synthesized up to 44 yr of data collected from 22 catchments at seven USDA Forest Service Experimental Forests. Trends in stream nitrogen presented high spatial variability both among catchments at a site and among sites across the USA. We found both increasing and decreasing trends in monthly flow-weighted stream nitrate and ammonium concentrations. At a subset of the catchments, we found that the length and period of analysis influenced whether trends were positive, negative or non-significant. Trends also differed among neighboring catchments within several Experimental Forests, suggesting the importance of catchment-specific factors in determining nutrient exports. Over the longest time periods, trends were more consistent among catchments within sites, although there are fewer long-term records for analysis. These findings highlight the critical value of long-term, uninterrupted stream chemistry monitoring at a network of sites across the USA to elucidate patterns of change in nutrient concentrations at minimally disturbed forested sites

The quality of life of Hansen’s disease patients in a medium-sized city

Study model: cross-sectional study. Objectives: describe the epidemiological profile of HD patients in Uberaba, Minas Gerais, assess their quality of life and verify the association of quality of life with epidemiological and sociodemographic variables. Methods: In order to evaluate the quality of life, we applied the instrument proposed by the World Health Organization (WHOQOL-bref) and a questionnaire of the epidemiological profile built by the authors. The descriptive statistical analysis and the T-Student and Mann-Whitney tests were used. Participation consisted of 29 HD patients. Results: There was a predominance of married male patients with low education and income. The highest quality of life scores were found in social and psychological relationships; the environmental and physical factors obtained the lowest scores. We observed better quality of life in individuals over the age of 60, in social (p=0.0267) and environmental (p=0.0359) relationships; married, in the physical aspect (p=0.0495); and with low education, in the physical (p=0.03) and psychological (p=0.0084) aspects. Conclusions: The study demonstrated the aspects of vulnerability and support to HD patients, presenting better quality of life in elderly, married individuals with low educationModelo do estudo: estudo do tipo transversal. Objetivos: descrever o perfil epidemiológico dos portadores de hanseníase de Uberaba-MG, avaliar a qualidade de vida e verificar a associação dos domínios da qualidade de vida com variáveis epidemiológicas e sociodemográficas. Métodos: Para a avaliação da qualidade de vida, foram aplicados o instrumento proposto pela Organização Mundial de Saúde (WHOQOL-bref) e um questionário do perfil epidemiológico construído pelos autores. Utilizaram-se a análise estatística descritiva e os testes T-Student e Mann-Whitney. Participaram da pesquisa 29 portadores de hanseníase. Resultados: Houve predomínio do sexo masculino, casados, com baixas escolaridade e renda. Encontraram-se os maiores escores de qualidade de vida nos domínios relações sociais e psicológicas; os fatores ambiental e físico obtiveram os menores escores. Foi observada melhor qualidade de vida em indivíduos com mais de 60 anos, nos domínios relações sociais (p=0,0267) e ambiental (p=0,0359); casados, no domínio físico (p=0,0495); e com baixa escolaridade, nos domínios físico (p=0,03) e psicológico (p=0,0084). Conclusões: O estudo permitiu verificar os aspectos de vulnerabilidade e de suporte dos portadores de hanseníase, apresentando-se melhor qualidade de vida em indivíduos idosos, casados e com baixa escolaridad

Aboveground Biomass Accumulation in a Tropical Wet Forest in Nicaragua Following a Catastrophic Hurricane Disturbance 1

Among their effects on forest structure and carbon dynamics, hurricanes frequently create large-scale canopy gaps that promote secondary growth. To measure the accumulation of aboveground biomass (AGBM) in a hurricane damaged forest, we established permanent plots 4 mo after the landfall of Hurricane Joan on the Atlantic coast of Nicaragua in October 1988. We quantified AGBM accumulation in these plots by correlating diameter measurements to AGBM values using a published allometric regression equation for tropical wet forests. In the first measurement year following the storm, AGBM in hurricane-affected plots was quite variable, ranging from 26 to 153 Mg/ha, with a mean of 78 (±15) Mg/ha. AGBM was substantially lower than in two control plots several kilometers outside the hurricane's path (331 ±15 Mg/ha). Biomass accumulation was slow (5.36 ± 0.74 Mg/ha/yr), relative to previous studies of forest regeneration following another hurricane (Hugo) and agricultural activity. We suggest that large-scale, homogenous canopy damage caused by Hurricane Joan impeded the dispersal and establishment of pioneer trees and led to a secondary forest dominated by late successional species that resprouted and survived the disturbance. With the relatively slow rate of biomass accumulation, any tightening in disturbance interval could reduce the maximum capacity of the living biomass to store carbon.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73646/1/j.1744-7429.2005.00077.x.pd

Human glioblastoma multiforme: p53 reactivation by a novel MDM2 inhibitor

Cancer development and chemo-resistance are often due to impaired functioning of the p53 tumor suppressor through genetic mutation or sequestration by other proteins. In glioblastoma multiforme (GBM), p53 availability is frequently reduced because it binds to the Murine Double Minute-2 (MDM2) oncoprotein, which accumulates at high concentrations in tumor cells. The use of MDM2 inhibitors that interfere with the binding of p53 and MDM2 has become a valid approach to inhibit cell growth in a number of cancers; however little is known about the efficacy of these inhibitors in GBM. We report that a new small-molecule inhibitor of MDM2 with a spirooxoindolepyrrolidine core structure, named ISA27, effectively reactivated p53 function and inhibited human GBM cell growth in vitro by inducing cell cycle arrest and apoptosis. In immunoincompetent BALB/c nude mice bearing a human GBM xenograft, the administration of ISA27 in vivo activated p53, inhibited cell proliferation and induced apoptosis in tumor tissue. Significantly, ISA27 was non-toxic in an in vitro normal human cell model and an in vivo mouse model. ISA27 administration in combination with temozolomide (TMZ) produced a synergistic inhibitory effect on GBM cell viability in vitro, suggesting the possibility of lowering the dose of TMZ used in the treatment of GBM. In conclusion, our data show that ISA27 releases the powerful antitumor capacities of p53 in GBM cells. The use of this MDM2 inhibitor could become a novel therapy for the treatment of GBM patients

Pre-operative management of Pleomorphic and florid lobular carcinoma in situ of the breast: Report of a large multi-institutional series and review of the literature

Background: Pleomorphic and Florid Lobular carcinoma in situ (P/F LCIS) are rare variants of LCIS, the exact nature of which is still debated. Aim: To collect a large series of P/F LCIS diagnosed on preoperative biopsies and evaluate their association with invasive carcinoma and high grade duct carcinoma in situ (DCIS). Data obtained were compared with those reported in the literature. Methods: A multi-institutional series of P/F LCIS was retrieved. All cases were diagnosed on pre-operative biopsies, which was followed by an open surgical excision. Data on post-operative histopathology were available. A literature review was performed. Results: A total of 117 cases were collected; invasive carcinoma and/or DCIS was present in 78/117 cases (66.7%). Seventy cases of P/F LCIS were pure on biopsy and 31 of these showed pathological upgrade in post-surgical specimens. Pre-operative biopsy accuracy was 47/78 (60.3%); pre-operative biopsy underestimation of cancer was 31/78 (39,7.%). In the literature review papers, invasive carcinoma or DCIS was associated with 274 of 418 (65.5%) cases of P/F LCIS. Pre-operative biopsy accuracy was 66% (181/274) whereas pre-operative biopsy underestimation of cancer was 33.9% (93/274). Conclusions: The data presented here indicate that P/F LCIS is frequently associated with invasive carcinoma or high grade DCIS and that pre-operative biopsy is associated with an underestimation of malignancy. Open surgery is indicated when P/F LCIS is diagnosed pre-operatively