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OBJECTIVES: The COVID-19 pandemic has differentially impacted cardiovascular disease (CVD) mortality worldwide. Causes of death misclassification may be one of the reasons. We evaluated the impact of the pandemic on CVD mortality in Brazil, comparing underlying causes (UCs) and multiple causes (MCs) of death. STUDY DESIGN: Ecological time-series study. METHODS: An ecological, time-series study was conducted analysing age-standardised death rates for CVD, from epidemiological week (EW) 10/2020 to 39/2021, using data from the Mortality Information System, Brazil. CVD was defined using the International Classification of Diseases (ICD-10) coding, if reported as UC or MC of death. Observed and expected data (mean for the same EW, 2017-2019) were compared. Risk ratios (RiRs) were analysed, and 95% confidence intervals (CIs) were calculated. RESULTS: Age-standardised mortality rate for CVD as UC of death was 165.8 (95%CI: 165.4-166.3) per 100,000 inhabitants, similar to what was expected (165.6/100,000, 95%CI: 165.2-166.1, RiR = 1.00). There was increased out-of-hospital mortality (RiR = 1.18; 95%CI: 1.17-1.19) and deaths of ill-defined causes (RiR = 1.43; 95%CI: 1.42-1.44). The increase in out-of-hospital deaths was more pronounced in the North (RiR = 1.33; 95%CI 1.30-1.36) region, with a less resilient health system. Conversely, as MCs of death, there was a 10% increase in CVD mortality (observed: 243.2 [95%CI: 242.7-243.7], expected: 221.6 [95%CI: 221.1-222.1] per 100,000). An increase also occurred in the North and Central West regions (RiR = 1.16; 95%CI: 1.15-1.18), among men (RiR = 1.11; 95%CI: 1.11-1.12) and individuals aged ≥60 years (RiR = 1.11; 95%CI: 1.10-1.11). CONCLUSIONS: During the pandemic, mortality rates for CVD as MCs of death increased in Brazil, whereas as UC mortality rates did not change. Higher out-of-hospital mortality, misclassification, and competing causes of death may explain this pattern.
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BACKGROUND: Early childhood caries (ECC) has a profound impact on a child's quality of life, and its management remains a challenge for the paediatric dentist, mainly because it depends on radical changes in the child/carers' daily behaviour and any dental treatment must be provided to very young child. CASE REPORT: This case report describes the on-going care of a 2-year-old child presenting with ECC and management until permanent dentition is complete. All patient-focused, teamdelivered care was delivered using the minimum intervention oral care framework, implementing non-invasive and minimally invasive preventive procedures. Throughout the care provided, oral and dental health education was reinforced in all visits. The child's mother was trained to perform effective biofilm control and dietary habits were adjusted, especially baby-bottle removal during sleep. The child was initially anxious and resistant towards any dental examination and clinical procedures. However, with effort from the oral healthcare team members, the patient became compliant, allowing the mother to perform suitable oral hygiene measures, as well as accepting the clinical procedures carried out by the paediatric dentist. The clinical procedures consisted of atraumatic restorations and fluoride varnish applications. During the subsequent years after the baseline treatment, follow-up visits included continued dietary and oral hygiene instruction with positive behavior reinforcement, fluoride topical applications and tooth-restoration complex maintenance with glass-ionomer cement where needed. Currently, the patient is 19 years old and has a stable, healthy permanent dentition. CONCLUSION: Understanding of the causes of oral diseases by the patients' caregivers, alongside with pragmatic practical guidance to maintain good oral health, can reduce the risk for acquiring future disease, since caries activity control is the basis for successful caries management.
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Suscetibilidade à Cárie Dentária , Cárie Dentária , Pré-Escolar , Lactente , Criança , Humanos , Adulto Jovem , Adulto , Seguimentos , Qualidade de Vida , Cárie Dentária/prevenção & controle , Saúde BucalRESUMO
PURPOSE: This aim of this study was to use ovarian cancer cells shed in ascitic fluid to establish primary cultures and subsequently use it to detect drug resistance to paclitaxel. Survivin siRNA was used to down regulate survivin expression and effect on paclitaxel resistance was also evaluated. METHODOLOGY: Ascitic fluid along with corresponding primary tumor tissue was collected from twenty untreated epithelial ovarian cancer patients. Ten primary cultures were established from ascites obtained from untreated ovarian cancer patients in MCDB 105 and M199 medium (ratio 1:1). Knockdown of survivin was done using siRNA and sensitivity to paclitaxel was evaluated by MTT assay. RESULTS: Grape-like clusters of ovarian cancer cells present in ascites attached and gave a characteristic cobble stone appearance. Treatment with survivin siRNA resulted in a fivefold decrease in survivin expression in primary cultures. Survivin siRNA treatment significantly increased the sensitivity of the primary ovarian cancer cell cultures to paclitaxel. CONCLUSION: Ascitic cancer cells reflect the molecular profile of tumor and can be used to diagnose resistance to chemotherapy. This study also establishes that high survivin expression is also responsible for resistance to paclitaxel.
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Resistencia a Medicamentos Antineoplásicos/genética , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Proteínas Inibidoras de Apoptose/antagonistas & inibidores , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/patologia , Paclitaxel/farmacologia , RNA Interferente Pequeno/genética , Antineoplásicos Fitogênicos/farmacologia , Apoptose/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Feminino , Humanos , Proteínas Inibidoras de Apoptose/genética , Neoplasias Ovarianas/genética , RNA Mensageiro/genética , Reação em Cadeia da Polimerase em Tempo Real , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Survivina , Células Tumorais CultivadasRESUMO
BACKGROUND: The prevalence of occult HBV, defined by the presence of HBV DNA in individuals with antibodies to HBV core antigen and with absence of HBV surface antigen, but its clinical significance and virological features in HIV-infected patients is still unclear. AIM: To investigate the prevalence, clinical significance and molecular characterization of occult hepatitis B virus infection in ART-Naive HIV-positive individuals. MATERIAL AND METHODS: Among the 1077 HIV-infected patients with different risk factors for HIV infection, 297 were HBsAg-ve ART-naive, of them 112 was randomly selected for the study. HBV DNA was tested by in-house PCR and quantified by qPCR. Molecular characterization was performed by sequencing the envelope and overlapping polymerase genes. RESULTS: We found the prevalence of occult HBV to be 10.7% among a randomly selected group of HBsAg-ve/antiHBc+ve HIV-infected patients. Overall 33.9% (38 of 112) of the patients were antiHBc positive indicating exposure to HBV infection. HBV DNA was detected in 12/38 (31.5%) antiHBc positive samples and 50% of them had CD4 T cell count < 200 cells/mm(3). HCV coinfection was low (2.7%). No surrogate marker for OBI could be identified. Presence of antiHBs antibodies did not rule out OBI. Liver biopsy in six cases showed varying stages of chronic hepatitis. Several mutations were detected but not the common immune escape mutant G145R. CONCLUSION: In conclusion the prevalence of OBI was significantly high among HIV coinfected patients, which highlights the importance of HBV DNA testing in these patients and indicates need for further prospective studies in larger cohorts to assess its clinical significance.
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Coinfecção , Infecções por HIV/epidemiologia , Antígenos do Núcleo do Vírus da Hepatite B/sangue , Vírus da Hepatite B/imunologia , Hepatite B/epidemiologia , Encaminhamento e Consulta , Adolescente , Adulto , Biomarcadores/sangue , Biópsia , Contagem de Linfócito CD4 , Distribuição de Qui-Quadrado , DNA Viral/sangue , Ensaio de Imunoadsorção Enzimática , Feminino , Infecções por HIV/diagnóstico , Hepatite B/diagnóstico , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/genética , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Mutação , Reação em Cadeia da Polimerase , Valor Preditivo dos Testes , Prevalência , RNA Viral/sangue , Análise de Sequência de DNA , Adulto JovemRESUMO
OBJECTIVE: Bacterial translocation from the gut has been invoked as a common inciting event for postinjury multiple organ failure. We previously showed that gut ischemia/reperfusion induces remote organ injury. The purpose of this study was to ascertain if endotoxin has a pivotal mechanistic role in this process. DESIGN: Prospective, randomized study. SETTING: Animal laboratory. SUBJECTS: Sprague-Dawley rats weighing 300 to 350 g. INTERVENTIONS: Anesthetized animals underwent 45 mins of superior mesenteric artery occlusion and 2 hrs of reperfusion; sham laparotomy served as controls. Endotoxin was eliminated with the murine immunoglobulin (Ig) M antibody E5, 3 mg/kg i.v. before the study. MEASUREMENTS AND MAIN RESULTS: Plasma endotoxin was measured by the limulus amebocyte lysate assay. At 2 hrs of reperfusion, circulating neutrophil priming was determined by the difference in superoxide generation with and without the activating stimulus, N-formyl-Met-Leu-Phe. Neutrophil sequestration in the lung was quantitated by myeloperoxidase activity, and by lung endothelial permeability by 125I albumin lung/blood ratio. Endotoxin concentrations were not significantly (significance determined as p < .05) different between the gut ischemia/reperfusion and laparotomy groups (n = > or = 5) during ischemia or reperfusion. Circulating neutrophil priming, neutrophil accumulation in the lung, and lung injury were provoked by gut ischemia/reperfusion, but not altered by endotoxin elimination. CONCLUSION: Gut ischemia/reperfusion primes circulating neutrophils and produces lung injury by a mechanism independent of endotoxin.
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Intestino Delgado/irrigação sanguínea , Pulmão/fisiopatologia , Oclusão Vascular Mesentérica/complicações , Traumatismo por Reperfusão/fisiopatologia , Animais , Endotoxinas/sangue , Artéria Mesentérica Superior , Neutrófilos/fisiologia , Estudos Prospectivos , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Traumatismo por Reperfusão/etiologiaRESUMO
Chronic hypobaric hypoxia induces a mild degree of pulmonary arterial hypertension with structural alterations in the peripheral portions of the pulmonary arterial tree of the native Andean highlanders. On the other hand, animals indigenous to high altitude do not show these changes and are adapted to hypobaric hypoxia. The small pulmonary arteries of seven native Himalayan highlanders were examined at autopsy and found to be thin-walled with no medial hypertrophy of the muscular pulmonary arteries or muscularization of the arterioles. These findings suggest that the Himalayan highlanders may be adapted to hypobaric hypoxia.