The importance of superficial basal cell carcinoma in a retrospective study of 139 patients who underwent Mohs micrographic surgery in a Brazilian university hospital

OBJECTIVE: Mohs micrographic surgery is a specialized surgical procedure used to treat skin cancer. The purpose of this study was to better understand the profile of the patients who underwent the procedure and to determine how histology might be related to complications and the number of stages required for complete removal. METHODS: The records of patients who underwent Mohs micrographic surgery from October 2008 to November 2013 at the Dermatology Division of the Hospital of the Campinas University were assessed. The variables included were gender, age, anatomical location, histology, number of stages required and complications. RESULTS: Contingency tables were used to compare the number of stages with the histological diagnosis. The analysis showed that patients with superficial basal cell carcinoma were 9.03 times more likely to require more than one stage. A comparison between complications and histological diagnosis showed that patients with superficial basal cell carcinoma were 6.5 times more likely to experience complications. CONCLUSION: Although superficial basal cell carcinoma is typically thought to represent a less-aggressive variant of these tumors, its propensity for demonstrating “skip areas” and clinically indistinct borders make it a challenge to treat. Its particular nature may result in the higher number of surgery stages required, which may, as a consequence, result in more complications, including recurrence. Recurrence likely occurs due to the inadequate excision of the tumors despite their clear margins. Further research on this subtype of basal cell carcinoma is needed to optimize treatments and decrease morbidity

The importance of superficial basal cell carcinoma in a retrospective study of 139 patients who underwent mohs micrographic surgery in a Brazilian university hospital

OBJECTIVE: Mohs micrographic surgery is a specialized surgical procedure used to treat skin cancer. The purpose of this study was to better understand the profile of the patients who underwent the procedure and to determine how histology might be related to complications and the number of stages required for complete removal. METHODS: The records of patients who underwent Mohs micrographic surgery from October 2008 to November 2013 at the Dermatology Division of the Hospital of the Campinas University were assessed. The variables included were gender, age, anatomical location, histology, number of stages required and complications. RESULTS: Contingency tables were used to compare the number of stages with the histological diagnosis. The analysis showed that patients with superficial basal cell carcinoma were 9.03 times more likely to require more than one stage. A comparison between complications and histological diagnosis showed that patients with superficial basal cell carcinoma were 6.5 times more likely to experience complications. CONCLUSION: Although superficial basal cell carcinoma is typically thought to represent a less-aggressive variant of these tumors, its propensity for demonstrating "skip areas'' and clinically indistinct borders make it a challenge to treat. Its particular nature may result in the higher number of surgery stages required, which may, as a consequence, result in more complications, including recurrence. Recurrence likely occurs due to the inadequate excision of the tumors despite their clear margins. Further research on this subtype of basal cell carcinoma is needed to optimize treatments and decrease morbidity.Mohs micrographic surgery is a specialized surgical procedure used to treat skin cancer. The purpose of this study was to better understand the profile of the patients who underwent the procedure and to determine how histology might be related to complica7011721725sem informaçãosem informaçã

Propagação de figueira com estacas de diferentes diâmetros

Este trabalho objetivou estudar o efeito do diâmetro de estacas de figueira (Fícus carica L.) no seu enraizamento e formação inicial de mudas. O experimento foi conduzido de setembro a novembro de 2011, sendo o delineamento em blocos casualizados, com três diâmetros de estacas: T1= 0,7 a 0,9 cm; T2= 1,3 a 1,6 cm e T3= 1,6 a 2,0 cm, em sete repetições de dezoito estacas. Após 60 dias foram avaliados o número de estacas com raízes, comprimento da maior raiz, porcentagem de enraizamento, número de estacas brotadas, número de brotos, número de folhas, massa fresca da parte aérea, massa seca da parte aérea, porcentagem de brotação e massa fresca de raízes. Os resultados mostraram que os diferentes diâmetros de estacas de figueira não tiveram efeito sobre o enraizamento, contudo, a formação da parte aérea das mudas foi mais favorável em estacas com maior diâmetro

Fatores prognósticos da doença meningocócica: estudo relativo a 254 casos

Two hundred and fifty-four cases of acute meningococcic meningitis at the hospital of the University of Londrina, Paraná (Brazil), between 1972 and 1976, were analyzed to determine the lethality of nine prognostic factors, which, according to literature, are said to aggravate the prognosis, namely: age, the period of time the patient has had the disease before admission, petechial and purpuric lesions of the skin, shock, coma, reduced number of leucocytes in peripherical blood, normal cerebrospinal fluid (c.s.f.) on admission, leucocyte number in c.s.f. lower than 100/mm³, protein concentration in c.s.f. higher than 300 mg/dl and glucose concentration in c.s.f. lower than 10 mg/dl (all in c.s.f. obtained upon admission). The following prognostic factors significantly influenced the mortality rate for this disease: 1) extreme ages - greater lethality in children under one year of age and in adults older than 40; 2) if the patient showed signs of the disease less than 48 hours before admission; 3) patient in coma upon admission, or; 4) in a state of shock; 5) leucocytes numbering 10,000/mm³ or lower in peripherical blood obtained upon admission. The combination of these factors showed that the greater the number of associated factors, the higher the mortality rate.Analisa-se, em relação a 254 casos de doença meningocócica, a variação da letalidade sob a influência dos seguintes fatores que, segundo a literatura, agravam-lhe o prognóstico: grupos de idade extrema, tempo curto de história antes da admissão, presença de púrpuras e/ou petéquias na admissão, ocorrência de choque ou de coma, número de leucócitos normal ou diminuído no sangue periférico na admissão, líquido cefalorraquidiano normal na admissão, número de leucócitos normal ou diminuído no sangue periférico na admissão, número de leucócitos menor que 100/mm³, proteinorraquia maior que 300 mg/dl, ou glicorraquia menor que 10 mg/dl, no líquido cefalorraquidiano colhido na admissão. Dentre esses fatores, aqueles para os quais se demonstrou influência estatisticamente significativa sobre a letalidade foram: 1) idades extremas: maior letalidade em crianças com menos de um ano de idade e em adultos com mais de 40 anos; 2) tempo de história, antes da admissão hospitalar, menor que 48 horas; 3) presença de coma ou 4) choque na admissão; 5) número de leucócitos, no sangue periférico colhido na admissão, igual ou menor que 10.000/mm³. A combinação desses fatores evidenciou que, quanto maior o número deles associados, mais alto o índice de letalidade

Ocorrência da doença meningocócica em japoneses e descendentes no município de Londrina, Paraná, Brasil (1965-1975)

In the case of Japanese and their descendants living in the municipality of Londrina, State of Paraná, the morbidity of meningococcic disease was about seven times lower than for the rest of the population, the death rate having been nil during both endemic and epidemic phases. A review of medical and hospital records, covering registered cases, showed no diagnoses of meningococcic disease in 75% of patients of Japanese origin or in 20% of samplings of non-Japanese patients. The possible relationship of socioeconomic and cultural (nutritional) factors, as regards above observations is discussed.Foi feito estudo visando a determinação das taxas de medida da doença meningocócica em japoneses e seus descendentes, do município de Londrina, Paraná, Brasil. A morbidade por doença meningocócica (DM) foi cerca de 7 meses mais baixa que no restante da população, tendo sido nula entre os mesmos a ocorrência de óbitos, tanto em fase endêmica, como epidêmica, A revisão dos prontuários médicos hospitalares correspondentes aos casos notificados exclui o diagnóstico de DM em 75% dos pacientes de origem japonesa e em 20% da amostra de pacientes não japoneses. É discutida a eventual relação de fatores sócio-econômicos e cultural (alimentar) às observações

Combination of Pneumococcal Surface Protein A (PspA) with Whole Cell Pertussis Vaccine Increases Protection Against Pneumococcal Challenge in Mice

Streptococcus pneumoniae is the leading cause of respiratory acute infections around the world. In Latin America, approximately 20,000 children under 5 years of age die of pneumococcal diseases annually. Pneumococcal surface protein A (PspA) is among the best-characterized pneumococcal antigens that confer protection in animal models of pneumococcal infections and, as such, is a good alternative for the currently available conjugated vaccines. Efficient immune responses directed to PspA in animal models have already been described. Nevertheless, few low cost adjuvants for a subunit pneumococcal vaccine have been proposed to date. Here, we have tested the adjuvant properties of the whole cell Bordetella pertussis vaccine (wP) that is currently part of the DTP (diphtheria-tetanus-pertussis) vaccine administrated to children in several countries, as an adjuvant to PspA. Nasal immunization of BALB/c mice with a combination of PspA5 and wP or wPlow – a new generation vaccine that contains low levels of B. pertussis LPS – conferred protection against a respiratory lethal challenge with S. pneumoniae. Both PspA5-wP and PspA5-wPlow vaccines induced high levels of systemic and mucosal antibodies against PspA5, with similar profile, indicating no essential requirement for B. pertussis LPS in the adjuvant properties of wP. Accordingly, nasal immunization of C3H/HeJ mice with PspA5-wP conferred protection against the pneumococcal challenge, thus ruling out a role for TLR4 responses in the adjuvant activity and the protection mechanisms triggered by the vaccines. The high levels of anti-PspA5 antibodies correlated with increased cross-reactivity against PspAs from different clades and also reflected in cross-protection. In addition, passive immunization experiments indicated that antibodies played an important role in protection in this model. Finally, subcutaneous immunization with a combination of PspA5 with DTPlow protected mice against challenge with two different pneumococcal strains, opening the possibility for the development of a combined infant vaccine composed of DTP and PspA

Desnutrição e aproveitamento escolar: estudo entre escolares da primeira série do primeiro grau da zona urbana periférica de Londrina, PR, Brasil

Four hundred and fifty first graders from the peripheric urban area of Londrina were studied with the objective of demonstrating a possible association between malnutrition and school failure. In this series of 450 children, 227 were male and 223 were female. The incidence of malnutrition was 34,89%. Of the undernourished children, only 56,69% had a satisfactory outcome in comparison with 73,88% of the eutrophic children, thus demonstrating a significant relation between malnutrition and school failure. The undernourished children belonged to families with a low per capita gross monthly income, in a greater proportion than the eutrophic ones. School failure was shown to be more closely related to per capita month expenditures in food rather than with the per capita gross monthly income itself.Estudaram-se 450 escolares da periferia de Londrina, PR, Brasil, com o objetivo de demonstrar uma possível associação entre desnutrição e aproveitamento escolar. Destes 450 escolares, 227 eram do sexo masculino e 223 do feminino. A incidência de desnutrição foi de 34,89%. Das crianças desnutridas, apenas 56,69% obtiveram rendimento satisfatório, em comparação aos 73,88% das crianças eutróficas, demonstrando uma relação significativa entre desnuirição e aproveitamento escolar. As crianças desnutridas provinham de famílias com baixa renda mensal bruta per capita em maior proporção que as eutróficas. O aproveitamento escolar mostrou estar mais relacionado ao gasto mensal per capita em alimentação do que a renda mensal bruta per capita

EDUCAÇÃO AMBIENTAL ALIADA AO MÉTODO DE RECUPERAÇÃO POR PLANTIO EM UMA NASCENTE LOCALIZADA NA ÁREA URBANA DO MUNICIPIO DE ITAPIRA – SP

Currently, concern for the environment is present in the lives of most of the population. Studies on the state of conservation of water sources and the structure of its riparian show is extremely important to support programs of restoration of these ecosystems. This article discusses the importance of restoring vegetation by tillage in a permanent preservation area located around two springs found in the urban perimeter of Itapira – SP through environmental education programs developed by the Department of Agriculture and Environment with the members of the Intermunicipal Consortium of Sanitation Water Circuit and surrounding residents. These vegetation belts exert barrier function and protection of watercourses, serving as ecological corridors, linking forest fragments, allowing the transit of animals and removing them from isolation and fixation of atmospheric carbon, thereby contributing to the reduction of greenhouse effect. The study seeks to further subsidize the authorities and society to raise awareness and preservation of the natural environment, since there is a lack of information and concern about the possible threat of water scarcity that is both trumpets around the world..Atualmente, a preocupação com o ambiente está presente na vida de grande parte da população. Estudos sobre o estado de conservação de nascentes e a estrutura de suas matas ciliares se mostram de extrema importância para embasar programas de recomposição desses ecossistemas.  Neste artigo discute-se a importância da recomposição vegetal por plantio direto em uma área de preservação permanente localizada ao redor de duas nascentes encontradas no perímetro urbano do município de Itapira – SP através de ações de educação ambiental desenvolvidas pela Secretaria de Agricultura e Meio Ambiente junto aos integrantes do Consorcio Intermunicipal de Saneamento Básico do Circuito das Águas e moradores do entorno. Essas faixas de vegetação exercem a função de barreira e proteção dos cursos d’água, servindo como corredores ecológicos, unindo fragmentos de matas, permitindo o trânsito de animais e retirando-os do isolamento e a fixação do carbono atmosférico, contribuindo assim para a redução do efeito-estufa. O estudo procura ainda, subsidiar as autoridades e a sociedade para a conscientização e preservação do meio natural, uma vez que há carência de informações e a preocupação com a possível ameaça de escassez hídrica que tanto se alardeia pelo mundo todo

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation