Prevalence of BRCA1 and BRCA2 gene mutations in families with medium and high risk of breast and ovarian cancer in Brazil

Of all malignant neoplasias affecting women, breast cancer has the highest incidence rate in Brazil. The objective of the present study was to determine the frequency of genetic modifications in families with medium and high risk for breast and ovarian cancer from different regions of Brazil. An exploratory, descriptive study was carried out on the prevalence of the BRCA1 and BRCA2 mutations in case series of high-risk families for breast and/or ovarian cancer. After heredogram construction, a blood sample was taken and DNA extraction was performed in all index cases. The protein truncation test was used to screen for truncated mutations in exon 11 of the BRCA1 gene and in exons 10 and 11 of the BRCA2 gene. Of the 612 individuals submitted to genetic testing, 21 (3.4%), 19 women and 2 men, had mutations in the BRCA1 or BRCA2 genes. Of the 19 BRCA1 mutations found in the 18 participants, 7 consisted of ins6kb mutations, 4 were 5382insC, 3 were 2156delGinsCC, 2 were 185delAG, 1 was C1201G, 1 was C3522T, and 1 was 3450del4. With respect to the BRCA2 gene, 3 mutations were found: 5878del10, 5036delA and 4232insA (one case each). The prevalence of germline mutations in the BRCA1 and BRCA2 genes found in the present study was lower than reported by other studies on high-risk Brazilian populations. The inclusion of individuals with medium risk may have contributed to the lower prevalence observed.

Use of the caffeine-halothane contracture test for the diagnosis of malignant hyperthermia in Brazil

Malignant hyperthermia (MH) is a pharmacogenetic disease triggered by volatile anesthetics and succinylcholine. Deaths due to MH have been reported in Brazil. The first Malignant Hyperthermia Diagnostic and Research Center in Latin America was inaugurated in 1993 at the Federal University of Rio de Janeiro, Brazil. The center followed the diagnostic protocols of the North America MH Group, in which the contractures of biopsies from the vastus lateralis muscle are analyzed after exposure to caffeine and halothane (CHCT). CHCT was performed in individuals who survived, their relatives and those with signs/symptoms somewhat related to MH susceptibility (MHS). Here, we report data from 194 patients collected over 16 years. The Southeast (N = 110) and South (N = 71) represented the majority of patients. Median age was 25 (4-70) years, with similar numbers of males (104) and females (90). MHS was found in 90 patients and 104 patients were normal. Abnormal responses to both caffeine and halothane were observed in 59 patients and to caffeine or halothane in 20 and 11 patients, respectively. The contracture of biopsies from MHS exposed to caffeine and halothane was 1.027 ± 0.075 g (N = 285) and 4.021 ± 0.255 g (N = 226), respectively. MHS was found in patients with either low or high blood creatine kinase and also, with a low score on the clinical grading scale. Thus, these parameters cannot be used with certainty to predict MHS. We conclude that the CHCT protocol described by the North America MH Group contributed to identification of MHS in suspected individuals at an MH center in Brazil with 100% sensitivity and 65.7% specificity.

Vancomycin-dependent Enterococcus faecium vanA: characterization of the first case isolated in a university hospital in Brazil

In this study, we report the characterization of a strain of Enterococcus faecium vanA, which grows only in the presence of vancomycin (VDEfm-UEL). The bacterium was isolated from the feces of a female patient who had undergone surgical treatment of Reinke’s edema and was receiving intravenous vancomycin therapy for infection with methicillin/oxacillin-resistant Staphylococcus aureus, a postoperative complication. Antimicrobial dependence was further confirmed by the vancomycin E-test. VDEfm-UEL was also shown to be resistant to ampicillin, ciprofloxacin, chloramphenicol, erythromycin, levofloxacin, penicillin, rifampicin, and teicoplanin. The putative virulence genes efaA, gelE and esp were detected by PCR. The ddl gene from VDEfm-UEL was cloned and sequenced. Vancomycin dependence seems to be associated with the insertion of a nucleotide in that sequence, which results in a frame-shift mutation, introducing a premature stop codon. This is the first report of vancomycin-dependent E. faecium isolation in a university hospital in Brazil.

An MD-PhD program in Brazil: students’ concepts of science and of common sense

In 1995, a pioneering MD-PhD program was initiated in Brazil for the training of medical scientists in experimental sciences at the Federal University of Rio de Janeiro. The program’s aim was achieved with respect to publication of theses in the form of papers with international visibility and also in terms of fostering the scientific careers of the graduates. The expansion of this type of program is one of the strategies for improving the preparation of biomedical researchers in Brazil. A noteworthy absence of interest in carrying out clinical research limits the ability of young Brazilian physicians to solve biomedical problems. To understand the students’ views of science, we used qualitative and quantitative triangulation methods, as well as participant observation to evaluate the students’ concepts of science and common sense. Subjective aspects were clearly less evident in their concepts of science. There was a strong concern about "methodology", "truth" and "usefulness". "Intuition", "creativity" and "curiosity" were the least mentioned thematic categories. Students recognized the value of intuition when it appeared as an explicit option but they did not refer to it spontaneously. Common sense was associated with "consensus", "opinion" and ideas that "require scientific validation". Such observations indicate that MD-PhD students share with their senior academic colleagues the same reluctance to consider common sense as a valid adjunct for the solution of scientific problems. Overcoming this difficulty may be an important step toward stimulating the interest of physicians in pursuing experimental research.

Antiretroviral therapy-associated dyslipidemia in patients from a reference center in Brazil

The aim of this study was to determine the impact of antiretroviral therapy on the lipid profile of human immunodeficiency virus (HIV) patients before and after the initiation of highly active antiretroviral therapy (HAART). This was a cross-sectional analysis of patients receiving HAART at a reference center in Belo Horizonte, Brazil, on the basis of medical records from 2002 to 2006. Patients were included if they had at least one lipid test or a clinical or laboratory diagnosis of dyslipidemia/lipodystrophy. Among the 692 patients, 620 met the eligibility criteria. The majority were males (66.5%), middle age (average 39 years), had a low educational level (60.4%), and low income (51.0%). HAART duration ranged from 11 days to 4.6 years, with a mean of 28.6 months (SD = ± 470.19 days). The prevalence of dyslipidemia/lipodystrophy nearly tripled (11.3% pre- and 32.4% post-HAART). Dyslipidemia was associated with older age (P = 0.007), nucleoside reverse transcriptase inhibitor (NRTI) + protease inhibitor (PI) regimens (P = 0.04), NRTI + non-NRTI (NNRTI) regimens (P = 0.026), the use of stavudine (d4T) in any regimen (P = 0.002) or in NRTI-based regimens (P = 0.006), and longer exposure to HAART (P < 0.000). In addition, there was no correlation between dyslipidemia and gender (P = 0.084). Only 2.0% of the patients received treatment for dyslipidemia during the trial. These results show a need for continuous monitoring of patients under antiretroviral therapy, particularly those using NRTI-based regimens, especially when combined with d4T and PIs. Secondly, interventions should be developed to correct metabolic changes.

Evaluation of renal function in sickle cell disease patients in Brazil

The objective of this study was to investigate renal function in a cohort of 98 patients with sickle cell disease (SCD) followed up at a tertiary hospital in Brazil. Clinical and laboratory characteristics at the time of the most recent medical examination were analyzed. Renal function was evaluated by the estimation of glomerular filtration rate (GFR) by the criteria of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). We compared patients with normal GFR to patients with decreased GFR (<60 mL·min-1·(1.73 m²)-1) and hyperfiltration (>120 mL·min-1·(1.73 m²)-1). Comparison between patients according to the use of hydroxyurea and comparison of clinical and laboratory parameters according to GFR were also carried out. Average patient age was 33.8 ± 13.3 years (range 19-67 years), and 57 (58.1%) patients were females. The comparison of patients according to GFR showed that patients with decreased GFR (<60 mL·min-1·(1.73 m²)-1) were older, had lower levels of hematocrit, hemoglobin and platelets and higher levels of urea and creatinine. Independent risk factors for decreased GFR were advanced age (OR = 21.6, P < 0.0001) and anemia (OR = 39.6, P < 0.0001). Patients with glomerular hyperfiltration tended to be younger, had higher levels of hematocrit, hemoglobin and platelets and lower levels of urea and creatinine, with less frequent urinary abnormalities. Hydroxyurea, at the dosage of 500-1000 mg/day, was being administered to 28.5% of the patients, and there was no significant difference regarding renal function between the two groups. Further studies are required to establish the best therapeutic approach to renal abnormalities in SCD.

Association of sulfur dioxide exposure with circulatory system deaths in a medium-sized city in Brazil

There is a demonstrable association between exposure to air pollutants and deaths due to cardiovascular diseases. The objective of this study was to estimate the effects of exposure to sulfur dioxide on mortality due to circulatory diseases in individuals 50 years of age or older residing in São José dos Campos, SP. This was a time-series ecological study for the years 2003 to 2007 using information on deaths due to circulatory disease obtained from Datasus reports. Data on daily levels of pollutants, particulate matter, sulfur dioxide (SO2), ozone, temperature, and humidity were obtained from the São Paulo State Environmental Agency. Moving average models for 2 to 7 days were calculated by Poisson regression using the R software. Exposure to SO2 was analyzed using a unipollutant, bipollutant or multipollutant model adjusted for mean temperature and humidity. The relative risks with 95%CI were obtained and the percent decrease in risk was calculated. There were 1928 deaths with a daily mean (± SD) of 1.05 ± 1.03 (range: 0-6). Exposure to SO2 was significantly associated with mortality due to circulatory disease: RR = 1.04 (95%CI = 1.01 to 1.06) in the 7-day moving average, after adjusting for ozone. There was an 8.5% decrease in risk in the multipollutant model, proportional to a decrease of SO2 concentrations. The results of this study suggest that residents of medium-sized Brazilian cities with characteristics similar to those of São José dos Campos probably have health problems due to exposure to air pollutants.

Practices and ethical concerns regarding preimplantation diagnosis. Who regulates preimplantation genetic diagnosis in Brazil?

Preimplantation genetic diagnosis (PGD) was originally developed to diagnose embryo-related genetic abnormalities for couples who present a high risk of a specific inherited disorder. Because this technology involves embryo selection, the medical, bioethical, and legal implications of the technique have been debated, particularly when it is used to select features that are not related to serious diseases. Although several initiatives have attempted to achieve regulatory harmonization, the diversity of healthcare services available and the presence of cultural differences have hampered attempts to achieve this goal. Thus, in different countries, the provision of PGD and regulatory frameworks reflect the perceptions of scientific groups, legislators, and society regarding this technology. In Brazil, several texts have been analyzed by the National Congress to regulate the use of assisted reproduction technologies. Legislative debates, however, are not conclusive, and limited information has been published on how PGD is specifically regulated. The country requires the development of new regulatory standards to ensure adequate access to this technology and to guarantee its safe practice. This study examined official documents published on PGD regulation in Brazil and demonstrated how little direct oversight of PGD currently exists. It provides relevant information to encourage reflection on a particular regulation model in a Brazilian context, and should serve as part of the basis to enable further reform of the clinical practice of PGD in the country.

Cancer research in Brazil - stuck in second gear?

This article describes the main issues regarding clinical cancer research in Brazil, including both the opportunities and the hurdles. Scientists and clinicians in this field had the opportunity to talk to regulatory agencies and to the Health Ministry representative at a meeting held in the State of Rio de Janeiro, Brazil, in April 2014. Our conclusions are that we do indeed have opportunities; however, we need to move forward regarding partnerships between academia and industry, increase the availability of funding, and provide easier navigation through the regulatory processes.

Effect of blanching time on selective mineral elements extraction from the spinach substitute (Tetragonia expansa) commonly used in Brazil

The true spinach (Spinacia oleracea) does not grow well in warm climates and for that reason is not commercialized in Brazil. Instead, a spinach substitute (Tetragonia expansa), originally from New Zealand, is widely used in the country. There is scant information on the mineral profile and none on the soluble mineral fraction of this vegetable. The solubility of a mineral is one of the important factors for its absorption. For this reason, the calcium, magnesium, iron, manganese, copper, zinc, potassium, and sodium soluble fractions in the raw spinach substitute were determined and the effect of blanching times on the solubility of these minerals was investigated. Blanching times of 1, 5, and 15 minutes were employed. The magnesium, manganese, potassium, and sodium soluble fractions increased sizably with shorter blanching time. Longer blanching time (15 minutes) caused large losses of minerals. The soluble mineral fractions can contribute poorly to diet in terms of potassium, magnesium, manganese, and zinc. The spinach substitute cannot be considered a dietary source of calcium, iron and copper due to the insolubility of these minerals in the vegetable, possibly caused by the large oxalate content.

Fumonisin B1 and ochratoxin A in beers made in Brazil

Samples of beer made in Brazil were analyzed for the presence of fumonisin B1 (FB1) and ochratoxin A (OTA). FB1 was searched for in 58 beer samples from 30 plants located in nine states. The samples were concentrated and cleaned up with strong ion exchange column, derivatized with OPA and analyzed by HPLC with fluorescence detection. The limit of detection was 0.26 ng.mL-1 and the average recovery was 98%. Twenty-five samples contained FB1 ranging from 1 to 40 ng.mL-1. Beer (123 samples) from 36 plants located in 5 states were analyzed for OTA by means of immunoaffinity column cleanup followed by liquid chromatography associated with fluorescence. The detection limit was 0.1 ng.mL-1 and the average recovery was 92%. Five samples contained OTA in concentrations from 1 to 18 ng.mL-1. The results indicate that FB1 and OTA contamination in Brazilian beer is not geographically limited and that beer does not contribute significantly to FB1 intake by consumers. In the case of regular high ingestion, beer could contribute sizably to OTA, intake although still below the maximum considered tolerable for the toxin.

Physico-chemical characterization and bioactive compounds of blackberry fruits (Rubus sp.) grown in Brazil

Five blackberry cultivars (Rubus sp.) were evaluated for antioxidant capacity, bioactive compounds and composition. Ascorbic acid levels, consisting of dehydro-ascorbic acid, ranged from 9.8 to 21.4 mg.100 g-1 fresh weight. Cyanidin (66 to 80% of total flavonoids), epicatechin, quercetin and traces of kaempferol were the main flavonoids found in all cultivars. The five cultivars presented high antioxidant capacity in the β-carotene/linoleic acid system, with inhibition similar to the synthetic antioxidant BHT, at a 50 µM concentration. Caingangue cultivar presented high vitamin C and total phenolics content, while Guarani had the highest cyanidin, total anthocyanin and total flavonoids levels and also the highest antioxidant capacity. These cultivars also presented good TSS/TA ratios. From the data, at a quantitative level, blackberry can be considered a good source of bioactive compounds, as well as potentially beneficial to human health.

Association between aflatoxin and aflatoxigenic fungi in Brazil nut (Bertholletia excelsa H.B.K.)

Brazil nut has a high nutritional content and is a very important trade commodity to some Latin American countries. In order to evaluate its safety, 120 samples from different stages of the productive chain were analyzed in terms of: moisture content (mc), aflatoxigenic fungi and aflatoxin (LOQ = 1.95 μg.kg-1 total aflatoxin) using TLC. Among all samples, 4 (6.7%) from the receiving area, and 5 (16.7%), from retail presented aflatoxins above the LOQ, but the amount of aflatoxins was below the LOQ after the samples were dried in the plant. The positive samples were above the limit of total aflatoxin permitted by the European Union (4.0 μg.kg-1) and Brazil (30 μg.kg-1). The mc mean was 22.43% in the receiving area, which is higher than that in the other stages samples. All the A. flavus strains were aflatoxigenic, and there was statistic association between the presence of aflatoxin and flavus strains. The aflatoxigenic fungi strains associated to the aflatoxins levels in the samples show that an effective control is necessary for the food safety in the Brazil nut production chain.

Chemical composition of five loquat cultivars planted in Brazil

Loquat is a fruit with high market value cultivated in Southeast Brazil. Despite of this, there are little details about its quality characteristics. Fruits from five loquat cultivars, developed using genetic breeding, were analyzed to assess their compositional traits. The cultivars Centenária, Mizuho, Mizumo, Néctar de Cristal and Mizauto were selected based on their high productivity and resistance to diseases. Soluble sugars, organic acids, and carotenoids were quantified using liquid chromatography. The cultivar (cv.) with the highest total sugar concentration was Mizumo and the lowest concentration was found in Centenária. The main sugar detected was sucrose, and the malic acid was the major organic acid. Ascorbic acid was detected in small amounts. The total dietary fiber contents were almost the same in all cultivars. The major carotenoids detected were β-carotene and β-cryptoxanthin, except for the cultivar Nectar de Cristal, a white pulp loquat. These results contribute to the knowledge about de physiology of loquat fruit, an interesting raw material due to its nutritional and sensorial characteristics. Furthermore, the results obtained could help to identify the most appropriate use of the loquats with different attributes either for consumption in natura or for industrial processing.

Phenolic compounds and antioxidant activity of blueberry cultivars grown in Brazil

The aim of this study was to evaluate the content of the phenolic compounds and anthocyanins and the antioxidant activity of blueberry (Vaccinium sp.) cultivars grown in Brazil. The Folin-Ciocalteau method was applied in order to quantify the phenolic compounds and ABTS, DPPH, FRAP, and β-carotene/linoleic acid methods were applied in order to evaluated antioxidant activity. The phenolic compounds content ranged from 274.48 to 694.60 mg GAE.100 g-1 of fresh weight (FW). Anthocyanins content ranged from 40.62 to 378.31 mg.100 g-1 FW for Bluecrop and Tifblue cultivars, respectively. Antioxidant activities assessed by ABTS, DPPH and FRAP methods presented significant differences among the studied cultivars ranging from 1238.48 to 2445.96, 1014.24 to 2055.06 and 699.78 to 1740.25 µmol TEAC.100 g-1 FW, respectively. The results confirm the blueberry as a source of phenolic compounds with high antioxidant activity and also show that there are different levels of concentrations of phenolic compounds and antioxidant activity according to the cultivar and production location.