Associação de pneumocistose e criptococose em pacientes imunocomprometidos : estudo em serviço especializado

O objetivo deste trabalho foi o de avaliar a associação da pneumocistose e criptococose a relacionando a características clínicas e epidemiológicas em pacientes infectados pelo HIV. Encontramos dez pacientes com casos confirmados de infecção por P. jirocecii, dentre eles, sete com infecção simultânea de C. neoformans e três com infecção por C. gattii (todos os pacientes infectados com o HIV e com valores de CD4+ inferiores a 200 cel/µL). Estes casos correspondem a um terço das coinfecções da casuística de pneumocistose e 1% da casuística de criptococose da nossa instituição. Esta população teve o diagnóstico simultâneo das doenças durante a internação (desconhecia o diagnóstico de HIV previamente). Dois pacientes com meningite por C. neoformans não apresentavam sintomatologia prévia ou durante a internação. A mortalidade alcançou a 30% dos casos, sendo todos os pacientes diagnosticados com infecção por C. gattii. Dessa forma, recomendamos que aqueles pacientes com diagnóstico de HIV na internação hospitalar (prévia ou diagnosticada recentemente) com valores de CD4+ inferiores a 200 cel/µL achados de imagéticos com infiltrados pulmonares difusos, independentemente de sua apresentação clínica (mesmo que assintomáticos) prossigam a investigação para infecções fúngicas por pesquisa de fungos pela prata, cultivo, pesquisa de testes de aglutinação em latex ou imunocromatográfico (padronizado), microscopia e imunodifusão.The aim of this paper is to identify the double infection by Pneumocystis jirovecii and Cryptococcus neoformans / Cryptococcus gattii in a human immunodeficiency virus (HIV) disease-endemic region. We included data from all patients diagnosed with P. jirovecii and Cryptococcus infection from January 1985 to December 2014 by patient medical records. We found 10 patients of double infection by P. jirovecii and C. neoformans / C. gattii in a hospital in a HIV disease-endemic region. Some cases of our sample had asymptomatic infections and all of C. gattii-infected patients died during the hospitalization. This paper calls the attention to the correct and rapid diagnoses in suspected PcP with HIV, CD4 levels less than 200 cel/µL and bilateral fibronodular infiltrates independent of clinical presentation. In this way, it is recommended to perform extensive investigation for fungal infections by rapid methenamine silver stain, culture, immunochromatography or latex agglutination tests, microscopy and immunodiffusion in order to provide an efficient clinical benefit

Overexpression of PIK3CA impacts global survival of patients with HER2 subtype breast carcinoma

Purpose: To investigate the expression of proteins fosfatidilinositol-4,5-bifosfate 3-quinase (PIK3CA) and phosphatase and tensin homolog (PTEN) in HER2-positive breast cancer and verify their associations with clinical and pathological variables. Methods: We assessed PTEN and PIK3CA status using immunohistochemistry (IHC), which was performed in formalin-fixed paraffin-embedded biopsies from 50 patients with HER2-positive breast cancer. Medical records were studied for collection of clinical-pathological information, including overall survival (OS). The HIC markers PTEN and PIK3CA were analyzed semi-quantitatively by two blinded independent researchers. The relationship between the variables were evaluated using the chi-square test and Kaplan-Meier curves plus log-rank test for survival. Results: In IHC, the expression level of PIK3CA was 86%, and loss of PTEN expression was observed in 46% of the cases. The expression of the markers showed no significant correlation with each other or with the clinical and pathological parameters studied: tumor grade, staging, ER, PR, Ki67 and recurrence. The highest expression of PIK3CA was associated with lower number of deaths (p=0.016) and longer OS of patients (p=0.001). The PTEN marker showed no significant effect on OS. Conclusions: The PIK3CA expression showed a protective effect in relation to the OS of patients with HER2-positive breast cancer

The Loss of Heterozygosity of FHIT Gene in Sporadic Breast Cancer

The loss of heterozygosity (LOH) is a genetic event that can change gene function. FHIT is a potential tumor suppressor gene.  Although the precise FHIT molecular mechanism of action is not well understood, evidences suggest that Fhit protein reduced levels are involved in mammary carcinogenesis.  The aim of this study was to investigate if FHIT LOH could influence on sporadic breast cancer (BC) biological behavior, through its association with prognostic factors for sporadic BC.Tumor tissue and peripheral blood samples were analyzed using the microsatellite marker D3S1300. The findings were associated with clinicopathological parameters including overall survival. LOH was detected in 31.1%(52/167) of the informative BC’ cases. Considering clinical and pathological characteristics we have found no significant association with FHIT LOH status. The mean follow-up time was 80 months. After the Cox regression analysis two parameters remained associated with BC’s risk of death: TNM stage III and IV - HR = 3.74(95% CI, 1.16-12.1) P=0.027 and disease relapse HR = 3.14(CI 95% 1.26-7.80) P =0.014. This study shows that FHIT LOH by itself is not a prognostic factor for sporadic BC.  Further researches are required to elucidate the functional role of FHIT LOH concerning to BC.

Predictors of noncompliance to pulmonary tuberculosis treatment : an insight from South America

To investigate the factors associated with a higher risk of noncompliance to tuberculosis (TB) treatment in Porto Alegre, Brazil. Methods We identified 478 adult patients for this case-control study undergoing treatment for confirmed pulmonary TB. Cases (noncompliance) were defined as patients who stopped treatment for more than 30 consecutive days (n = 118). Controls were defined as all patients who completed treatment and were cured (n = 360). Factors associated with noncompliance were calculated with unadjusted and adjusted odds ratio (OR). Results The rate of noncompliance in our study was 25%. The factors of noncompliance after adjustments in the overall population were, in order of magnitude, living in an area of lower income (OR = 4.35, 95%CI: 2.50±7.58), abuse of drugs (OR = 2.73, 95%CI: 1.47±5.09), nonadherence to a previous treatment regimen (OR = 2.1, 95%CI: 1.28±3.45), and history of smoking (OR = 1.72, 95%CI: 1.00±3.00). Age, race, gender, level of education, HIV infection or diabetes status were not associated with a higher risk of noncompliance. In the subgroup of retreatment cases, poverty (OR = 2.65; 95%CI = 1.06±6.66), smoking history (OR = 2.94; 95%CI = 1.09±7.92), male gender (OR = 3.25; 95%CI = 1.32±8.0), and younger age (OR = 4.3; 95%CI = 1.15±16.07) were also associated with a higher risk of dropout. Conclusion Predictors of poor compliance to TB treatment were low income, abuse of drugs, re-treatment cases and history of smoking

Vaccination coverage against human papillomavirus (HPV) and associated factors in female academics from a university in southwestern Goiás, Brazil

OBJECTIVE To check the coverage of the HPV vaccine in women enrolled in health courses at a university in southwest Goiás, Brazil, and the factors associated with vaccination. METHODS This is a cross-sectional study, including female university students of health courses, aged 18 years or more. A standardized and self-applying questionnaire was used. Participants who received two or more doses of the vaccine were considered immunized. Multiple analysis was performed using multinomial logistic regression. RESULT We observed that, of the 1510 participants, 473 (31.3%) had two or more doses of HPV vaccine, 167 (11.0%) one dose and 870 (57.6%) were unvaccinated. Participants under 21 years of age and in socioeconomic stratum A were 2 times more likely to have received two or more doses of the vaccine (Prevalence Ratio = 1.95; 95%CI 1.40–2.70 and Prevalence Ratio = 2.09; 95%CI 1.39–3.13, respectively). CONCLUSIONS The research revealed extensive possibility for interventions with the aim of achieving greater vaccination coverage among female university students. Even women with more knowledge and high economic stratum showed low vaccination coverage, suggesting that results of higher vaccine coverage can be obtained with vaccination carried out in a school environment.OBJETIVO Verificar a cobertura da vacina contra o HPV em mulheres matriculadas em cursos da área de saúde de uma universidade do sudoeste do Estado de Goiás e os fatores associados à vacinação. MÉTODOS Trata-se de estudo transversal, incluindo universitárias dos cursos da área de saúde, com 18 anos ou mais. Foi utilizado questionário padronizado e autoaplicável. As participantes que receberam duas ou mais doses da vacina foram consideradas como imunizadas. A análise múltipla foi realizada por meio de regressão logística multinomial. RESULTADOS Observou-se que, das 1510 participantes, 473 (31,3%) com duas ou mais doses de vacina contra o HPV, 167 (11,0%) com uma dose e 870 (57,6%) não vacinadas. As participantes com menos de 21 anos e inseridas no estrato socioeconômico A tinham 2 vezes mais chance de terem recebido duas doses ou mais da vacina (Razão de Prevalência = 1,95; IC95% 1,40–2,70 e Razão de Prevalência = 2,09; IC95% 1.39–3,13, respectivamente). CONCLUSÕES A pesquisa revelou extensa possibilidade para intervenções com o objetivo de atingir maior cobertura vacinal entre as universitárias. Mesmo mulheres com mais conhecimento e de estrato econômico elevado apresentaram baixa cobertura vacinal, sugerindo que resultados de cobertura vacinal maior podem ser obtidos com a vacinação realizada em ambiente escolar

Effects of blood glucose level on 18F fluorodeoxyglucose (18F-FDG) uptake for PET/CT in normal organs: an analysis on 5623 patients

Abstract Our purpose was to evaluate the effect of glycemia on 18F-FDG uptake in normal organs of interest. The influences of other confounding factors, such as body mass index (BMI), diabetes, age, and sex, on the relationships between glycemia and organ-specific standardized uptake values (SUVs) were also investigated. We retrospectively identified 5623 consecutive patients who had undergone clinical PET/CT for oncological indications. Patients were stratified into groups based on glucose levels, measured immediately before 18F-FDG injection. Differences in mean SUVmax values among glycemic ranges were clinically significant only when >10% variation was observed. The brain was the only organ that presented a significant inverse relationship between SUVmax and glycemia (p < 0.001), even after controlling for diabetic status. No such difference was observed for the liver or lung. After adjustment for sex, age, and BMI, the association of glycemia with SUVmax was significant for the brain and liver, but not for the lung. In conclusion, the brain was the only organ analyzed showing a clinically significant relationship to glycemia after adjustment for potentially confounding variables. The lung was least affected by the variables in our model, and may serve as an alternative background tissue to the liver

CT densitovolumetry in children with obliterative bronchiolitis: correlation with clinical scores and pulmonary function test results

OBJECTIVE: To determine whether air trapping (expressed as the percentage of air trapping relative to total lung volume [AT%]) correlates with clinical and functional parameters in children with obliterative bronchiolitis (OB).METHODS: CT scans of 19 children with OB were post-processed for AT% quantification with the use of a fixed threshold of −950 HU (AT%950) and of thresholds selected with the aid of density masks (AT%DM). Patients were divided into three groups by AT% severity. We examined AT% correlations with oxygen saturation (SO2) at rest, six-minute walk distance (6MWD), minimum SO2 during the six-minute walk test (6MWT_SO2), FVC, FEV1, FEV1/FVC, and clinical parameters.RESULTS: The 6MWD was longer in the patients with larger normal lung volumes (r = 0.53). We found that AT%950 showed significant correlations (before and after the exclusion of outliers, respectively) with the clinical score (r = 0.72; 0.80), FVC (r = 0.24; 0.59), FEV1 (r = −0.58; −0.67), and FEV1/FVC (r = −0.53; r = −0.62), as did AT%DM with the clinical score (r = 0.58; r = 0.63), SO2 at rest (r = −0.40; r = −0.61), 6MWT_SO2 (r = −0.24; r = −0.55), FVC (r = −0.44; r = −0.80), FEV1 (r = −0.65; r = −0.71), and FEV1/FVC (r = −0.41; r = −0.52).CONCLUSIONS: Our results show that AT% correlates significantly with clinical scores and pulmonary function test results in children with OB