Relationship between race and clinical characteristics, extent of disease, and response to chemotherapy in patients with low-risk gestational trophoblastic neoplasia

Objective. To evaluate the potential effects of race on clinical characteristics, extent of disease, and response to chemotherapy in women with postmolar low-risk gestational trophoblastic neoplasia (GTN).Methods. This non-concurrent cohort study was undertaken including patients with FIGO-defined postmolar low-risk GTN treated with comparable doses and schedules of chemotherapy at the New England Trophoblastic Disease Center (NETDC) between 1973 and 2012. Racial groups investigated included whites, African American and Asians. Information on patient characteristics and response to chemotherapy (need for second line chemotherapy, reason for changing to an alternative chemotherapy, number of cycles/regimens, need for combination chemotherapy, and time to hCG remission) was obtained.Results. Of 316 women, 274 (86.7%) were white, 19 (6%) African American, and 23 (7.3%) Asian. African Americans were significantly younger than white and Asian women (p = 0.008). Disease presentation, and extent of disease, including antecedent molar histology, median time to persistence, median hCG level at persistence, rate of D&C at persistence, presence of metastatic disease, and FIGO stage and risk score were similar among races. Need for second line chemotherapy (p = 0.023), and median number of regimens (p = 0.035) were greater in Asian women than in other races.Conclusions. Low-risk GTN was more aggressive in Asian women, who were significantly more likely to need second line chemotherapy and a higher number of chemotherapy regimens to achieve complete remission than women of African American and Asian descent. Further studies involving racial differences related to clinical, biological and environmental characteristics are needed. (C) 2015 Published by Elsevier Inc.

Glucose-6-phosphate dehydrogenase and glutathione reductase activity in methemoglobin reduction by methylene blue and cyst amine: study on glucose-6-phosphate dehydrogenase-deficient individuals, on normal subjects and on riboflavin-treated subjects

Os autores padronizaram métodos para a avaliação da atividade da glicose-6-fosfato desidrogenase e glutationa redutase. O princípio geral do primeiro método baseou-se na formação de metahemoglobina pelo nitrito de sódio, seguido da estimulação da via das pentoses pelo azul de metileno. Foram estudados 46 indivíduos adultos, sendo 23 do sexo masculino e 23 do feminino, não deficientes em glicose-6-fosfato desidrogenase (G6PD), com idades variando entre 20 e 30 anos. Os resultados revelaram que a redução da metahemoglobina pelo azul de metileno para sangue total, foram de 154.50 e 139.90 mg/min (p<0.05) respectivamente para o sexo masculino e feminino. Para hemácias lavadas os valores foram de 221.10 e 207.85 mg/min (n.s.) respectivamente. Estas observações permitiram concluir que ao se empregar hemácias lavadas e 0.7 g% de concentração de nitrito de sódio, por um lado não houve diferença entre os sexos e por outro, abreviou o tempo de leitura da quantidade residual de metahemoglobina para 90 minutos. A avaliação da atividade da glutationa redutase foi feita baseado no fato de que a cistamina (agente tiol) liga-se aos grupos SH da hemoglobina formando complexos. Estes complexos são revertidos pela ação da glutationa redutase, ocorrendo conjuntamente nesta reação a redução da metahemoglobina. Foram estudados 32 indivíduos adultos, sendo 16 do sexo masculino e 16 do feminino, não deficientes em G6PD, com idades variando entre 20 e 30 anos. Os resultados revelaram valores de redução da metahemoglobina pela cistamina de 81.27 e 91.13 mg/min (p<0.01) respectivamente para o sexo masculino e feminino. Estas observações permitiram concluir que o emprego de hemácias lavadas e 0.1 molar de concentração de cistamina torna possível a leitura da quantidade residual de metahemoglobina aos 180 minutos de incubação. A atividade da glutationa redutase avaliada por meio da redução da metahemoglobina pela cistamina, foi estudada em 14 indivíduos do sexo feminino antes e após o tratamento com 10 mg por dia de riboflavina durante 8 dias. Os resultados foram de 73.69 e 94.26 mg/min (p<0.01) antes e após o tratamento. Estas observações permitiram concluir que a oferta de riboflavina, mesmo para indivíduos normais, aumenta a atividade da glutationa redutase. Foram ainda avaliados 3 indivíduos da raça negra e deficientes em G6PD, sendo 2 do sexo masculino e 1 do feminino. Houve ativação parcial da G6PD e glutationa redutase, sendo estas alterações mais intensas nos indivíduos do sexo masculino. Considerando-se a raça e as características laboratoriais observadas, foi possível sugerir que a deficiência em G6PD verificada é do tipo Africano, bem como, permitiu considerar os indivíduos do sexo feminino coin o sendo heterozigoto para esta deficiência. Por fim, a análise dos resultados em seu conjunto permitiu concluir que os métodos propostos se mostraram eficientes para avaliar a atividade da G6PD e glutationa redutase. Esta última é dependente da via das pentoses, geradora de NADPH e da riboflavina, vitamina precursora de FAD.

Incidence and prevalence rates of inflammatory bowel diseases, in midwestern of São Paulo State, Brazil

CONTEXTO: No Brasil, a incidência e prevalência populacionais das doenças inflamatórias intestinais são desconhecidas. OBJETIVO: Neste trabalho, estimou-se esses parâmetros na área que abrange a antiga região de saúde DIR 11, no centro-oeste do Estado de São Paulo. MÉTODOS: Usou-se um registro sequencial de 115 pacientes (>15 anos de idade) com doenças inflamatórias intestinais, residindo na área de estudo, atendidos durante período de 20 anos (1986-2005) em hospital de referência. Estimou-se, para quatro períodos consecutivos de 5 anos, as incidências e prevalências de acordo com os tipos de doença e do sexo de doentes. As suas inter-relações foram analisadas utilizando o modelo de regressão linear de Poisson. RESULTADOS: Na região, as doenças inflamatórias intestinais foram predominantes em mulheres jovens, da raça branca, residindo na zona urbana.A incidência da retocolite foi maior que a da doença de Crohn e das colites não classificadas, e diferentemente dessas duas ultimas, mostrou decréscimo no último período (2001-2005). Neste mesmo período, a taxa da incidência para a retocolite foi de 4,48 casos/100.000 habitantes, para a doença de Crohn atingiu 3,50 casos/100.000 habitantes e a das colites não classificadas foi de 1,75 casos/100.000 habitantes. As prevalências atingiram os valores de 14,81 casos/100.000 habitantes para a retocolite, 5,65 casos/100.000 habitantes para a doenças de Crohn e 2,14 casos/100.000 habitantes. Considerando todas as doenças inflamatórias a prevalência atingiu o valor de 22,61 casos/100.000 habitantes. CONCLUSÃO:A incidência dessas doenças inflamatórias intestinais nessa região é baixa, igualando-se aos países da América Latina e do sul da Europa e sua crescente prevalência justifica políticas de saúde para as suas abordagens.

Geographic and Educational Factors and Risk of the First Peritonitis Episode in Brazilian Peritoneal Dialysis Study (BRAZPD) Patients

Background and objectives Peritonitis remains as the most frequent cause of peritoneal dialysis (PD) failure, impairing patient's outcome. No large multicenter study has addressed socioeconomic, educational, and geographic issues as peritonitis risk factors in countries with a large geographic area and diverse socioeconomic conditions, such as Brazil.Design, setting, participants, & measurements Incident PD patients recruited from 114 dialysis centers and reporting to BRAZPD, a multicenter observational study, from December 2004 through October 2007 were included. Clinical, dialysis-related, demographic, and socioeconomic variables were analyzed. Patients were followed up until their first peritonitis. Cox proportional model was used to determine independent factors associated with peritonitis.Results In a cumulative follow-up of 2032 patients during 22.026 patient-months, 474 (23.3%) presented a first peritonitis episode. In contrast to earlier findings, PD modality, previous hemodialysis, diabetes, gender, age, and family income were not risk predictors. Factors independently associated with increased hazard risk were lower educational level, non-white race, region where patients live, shorter distance from dialysis center, and lower number of patients per center.Conclusions Educational level and geographic factors as well as race and center size are associated with risk for the first peritonitis, independent of socioeconomic status, PD modality, and comorbidities. Clin J Am Soc Nephrol 6: 1944-1951, 2011. doi: 10.2215/CJN.11431210

Genetic and environmental factors that affect the best time of Thoroughbred horses in Brazil

On the basis of information provided by the Brazilian Association of Race Horse Breeders, we analysed the racing performance of 947 Thoroughbred horses in races held from 1985 to 1992. The performance was evaluated using the best, time of the animals. The variance component was obtained by the derivative-free restricted maximum likelihood method, and the model used contained fixed effects of the racing month and year, sex, race track, track condition, animal age, number of competitors in race, and distance, and the random animal effect. The low heritability estimate obtained (0.12) indicates that selection based on animal phenotypic value must induce small genetic changes in this trail.

Actinic cheilitis: Clinical and histological features

Purpose: The purpose of this study was to analyze the clinical and histological features of actinic cheilitis (AC).Patients and Methods: A total of 29 patients with AC were clinically evaluated, and incisional biopsies were performed to confirm the clinical diagnosis. Histological features were analyzed, and dysplasia was classified as mild, moderate, or severe. The chi(2) test was used for the following variables: gender, age, race, and smoking habits. The degree of dysplasia was related to these variables (Fisher's test) to test for independence between them (P <.05).Results: of the patient group, 72.41% were male, 75.86% were overage 40 years, 93.10% were white, and 72.41% were nonsmokers. Clinically, all patients presented with multifocal lesions. The following manifestations were seen: dryness, atrophy, scaly lesions, swelling of the lip, erythema, ulceration, blurred demarcation between the lip vermilion border and the skin, marked folds along the lip vermilion, white spots or plaques, crusts, blotchy areas, and areas of pallor. Keratosis, granulosis, hyperplasia, acanthosis, or atrophy and dysplasia were found in the epithelial tissue; elastosis, inflammatory infiltrate, and vasodilatation were found in the connective tissue. Dysplasia was mild in 10.34% of the patients, moderate in 27.59%, and severe in 62.07%. Absence of sample homogeneity was observed in regard to gender, age, race, and smoking habits. It was not possible to reject the hypothesis of independence between mild, moderate, or severe dysplasia and gender, age, race, and smoking habits.Conclusions: Dryness, atrophy, and scaly lesions were the most common clinical findings observed. Dysplasia, inflammatory infiltrate, and vasodilatation, as well as elastosis, were the most common histological findings observed. Gender, age, race, or smoking habits were not related to the degree of dysplasia in the sample. (c) 2008 American Association of Oral and Maxillofacial Surgeons.

Mucus extravasation and retention phenomena: a 24-year study

Background: Mucoceles are benign lesions related to the minor salivary glands and their respective ducts frequently affecting oral structures which are generally asymptomatic. Mucoceles are generally characterized by swollen nodular lesions preferentially located on the lower lip and differ from the so-called ranulas, which are lesions located on the floor of the mouth and related to the sublingual or submandibular glands.Methods: The objective of the present study was to analyze data such as age, gender, race and site of the lesion of 173 mucocele cases diagnosed at the Discipline of Stomatology, Sao Jose dos Campos Dental School, UNESP, over a period of 24 years (April 1980 to February 2003).Results: of the 173 cases analyzed, 104 (60.12%) were females and 69 (39.88%) were males. Age ranged from 4 to 70 years (mean +/- SD: 17 +/- 9.53) and most patients were in the second decade of life (n = 86, 49.42%); white (n = 124, 71.68%). The lower lip was the site most frequently affected by the lesions (n = 135, 78.03%), whereas the lowest prevalence was observed for the soft palate, buccal mucosa, and lingual frenum.Conclusion: In this study, mucoceles predominated in white female subjects in the second decade of life, with the lower lip being the most frequently affected site.

A second mutation in the methylenetetrahydrofolate reductase gene and the risk of venous thrombotic disease

We assessed the effect of a recently described mutation in the MTHFR gene (1298 A --> C) on the risk of deep venous thrombosis (DVT) by determining its prevalence in 190 patients with verified DVT and in age-, race- and gender-matched controls. MTHFR 1298 A --> C was found in 42.1% of patients and in 41.1% of controls. The OR for venous thrombosis was 1.07 (95% CI 0.70-1.65) for heterozygotes and 0.83 (95% CI 0.33-2.08) for homozygotes. The OR for the factor V Leiden (FVL) mutation was 3.40 (95% CI 1.22-9.48), for FII 20210 G --> A was 5.22 (95% CI 1.12-24.2) and for MTHFR 677 C --> T, 1.24 (95% CI 0.82-1.87). No significant increased risk for venous thrombosis was found when MTHFR 1298 A --> C was coinherited with FVL (OR 2.85, 95% CI 0.88-9.23), FIT 20210 G --> A (OR 7.19, 95% CT 0.87-59.4) or MTHFR 677 C --> T (OR 1.44, 95% CT 0.71-2.92). These data do not support a critical role of MTHFR 1298 A --> C in the predisposition to DVT.

Television violence and young adults in Brazil: a content analysis of the popular telenovella, Malhação = Violência na televisão brasileira e jovens : uma análise de conteúdo da telenovela popular, Malahção

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)