RESUMO
BACKGROUND: Vitamin D deficiency is associated with higher risk of cancer, possibly due to its antiproliferative, antiangiogenic, proapoptotic, cell-differentiating and anti-invasive effects. The anticarcinogenic role of vitamin D in melanoma is still a matter of debate. Loss of nuclear and cytoplasmic vitamin D receptor (VDR) expression in melanoma cells has been reported. OBJECTIVES: To analyse VDR immunohistochemical expression in benign dermal naevi (DN) and malignant melanoma (MM). METHODS: A case-control study evaluated nuclear and cytoplasmic VDR immunohistochemical staining in 54 DN and 55 MM tissue samples. RESULTS: There was significantly higher cytoplasmic VDR positivity in DN compared with MM (59% vs. 16%, P < 0·001). The mean VDR cytoplasmic expression was also higher in DN vs. MM (P < 0·001). No differences in nuclear VDR positivity were observed between groups, but mean nuclear VDR expression was significantly lower in DN vs. MM (P = 0·02). The loss of cytoplasmic VDR in MM was associated with Clark level, tumour staging and American Joint Committee on Cancer pTNM staging (P=0·004, 0·009 and 0·02, respectively). CONCLUSIONS: Alterations in VDR expression and localization are found in MM compared with DN. Loss of cytoplasmic VDR was associated with melanoma tumour size, suggesting that loss of cytoplasmic VDR may be a prognostic factor.
Assuntos
Melanoma/patologia , Nevo Pigmentado/patologia , Receptores de Calcitriol/metabolismo , Neoplasias Cutâneas/patologia , Biomarcadores Tumorais/metabolismo , Estudos de Casos e Controles , Núcleo Celular/química , Citoplasma/química , Extremidades , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Tronco , Carga TumoralRESUMO
Vitamin D (VD) deficiency has been linked to increased incidence and morbidity of tuberculosis (TB). Chile has large variations in solar radiation (SR; a proxy of VD status) and high prevalence of VD deficiency in its southernmost regions with low SR. We investigated the correlation between regional SR and rates of TB incidence, admissions and deaths in Chile by reviewing national records on prospectively collected mandatory disease notifications, admissions and mortality between 2001 and 2011. Over the study period, 26 691 new TB notifications were registered. The TB incidence rate was 14·77 (95% confidence intervals (CIs) 14·60-14·95), admission rate was 12·12 (95% CI 11·96-12·28) and mortality rate was 1·61 (95% CI 1·55-1·67) per 100 000 population per year. Multivariable linear regressions adjusting for significant demographic TB risk factors in Chile (regional prevalence of HIV infection, rates of migration from TB-endemic countries and rates of imprisonment) revealed an independent and highly statistically significant inverse association between SR and TB incidence rate (ß -1·05, 95% CI -1·73 to -0·36, P = 0·007), admission rate (ß -1·58, 95% CI -2·23 to -0·93, P < 0·001), and mortality rate (ß -0·15, 95% CI -0·23 to -0·07, P = 0·002). These findings support a potential pathogenic role of VD deficiency in TB incidence and severity.
Assuntos
Luz Solar , Tuberculose/epidemiologia , Deficiência de Vitamina D/epidemiologia , Adulto , Idoso , Chile/epidemiologia , Feminino , Geografia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Tuberculose/microbiologia , Tuberculose/mortalidade , Deficiência de Vitamina D/etiologiaRESUMO
AIMS: Liver transplant is the primary therapy for patients with end-stage liver disease. Its high success rates have lead to a broadening of the indications for liver transplantation, resulting in an increasing shortage of donors. Living donor liver transplantation has become an option to overcome waiting list mortality. We describe our experience with hepatectomy for living donor liver transplantation and report a case of death. METHODS: Patients (n = 132) underwent hepatectomy for living donor liver transplantation from June 2000 through June 2004. A 4-phase preoperative evaluation was performed on all patients, whose ages ranged from 13 to 54 years (mean = 29.7 +/- 8.1 years). Of the 132 patients, 76 patients (57.5%) underwent left lateral segmentectomy, 33 patients (25%) underwent left lobectomy, and 23 patients (16%) underwent right hepatectomy. In 2 other patients (1.5%), a monosegment (segment II) was obtained after left lateral segmentectomy. RESULTS: Twenty patients (15%) experienced a complication, the most common being incisional hernia, pneumonia, and biliary fistulae. On the seventh postoperative day, 1 patient developed a fatal cerebral hemorrhage while recovering from mild liver dysfunction. CONCLUSIONS: Although living donor liver transplantation is generally safe, serious and fatal complications may occur.
Assuntos
Hepatectomia/métodos , Transplante de Fígado , Doadores Vivos , Adolescente , Idoso , Hemorragia Cerebral/epidemiologia , Lateralidade Funcional , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Coleta de Tecidos e Órgãos/métodosRESUMO
Several technical improvements have been made to increase donor pool for pediatric liver transplantation, including reduced-size grafts, split-liver, and recently living donors. The objective of the present study is to report our single-center experience with 60 hepatectomies for living donor liver transplantation in pediatric recipients between June 2000 and December 2002. Donor workup consisted of a complete history and physical examination followed by laboratory test and liver function tests. Graft size was estimated using computed tomography scan or abdominal ultrasound. Liver biopsy was performed in all donors. Arteriogram was performed to evaluate hepatic arterial anatomy. All donors survived the procedure. Only seven patients experienced complications (10.2%), most of which were short term. We conclude that liver living donation for pediatric population is a safe procedure.
Assuntos
Hepatectomia/métodos , Transplante de Fígado/estatística & dados numéricos , Doadores Vivos , Coleta de Tecidos e Órgãos/métodos , Adolescente , Adulto , Peso Corporal , Criança , Humanos , Testes de Função Hepática , Doadores Vivos/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Several recent studies have demonstrated a positive association between obesity and asthma among women but not men. The present study examines the effect of misclassification of body mass index (BMI) in the association between obesity and asthma by gender. This cross-sectional analysis included a total sample of 961 Mexican adults. Use of measured BMI revealed that obesity (BMI >30 kg/m(2)) was a risk factor for asthma diagnosis in both men (OR, 2.5; 95% CI, 1.1-5.9) and women (OR, 2.3; 95% CI, 1.5-3.8). In contrast, use of self-reported BMI showed that only women (OR, 1.7; 95% CI, 1.1-2.7) and not men (OR, 1.3; 95% CI, 0.6-2.9) were at increased risk of asthma diagnosis. Use of self-reported BMI substantially underestimated the prevalence of obesity; this bias was not related to asthma per se but was mainly due to obesity. Therefore, misclassification of BMI obscured the relationship between obesity and asthma to a greater extent among men than among women since obesity prevalence in the general population was higher among men. Measurement bias merits greater attention in future research on obesity and asthma.
Assuntos
Asma/etiologia , Índice de Massa Corporal , Obesidade/complicações , Adulto , Estatura , Peso Corporal , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , México , Pessoa de Meia-Idade , Obesidade/diagnóstico , Fatores de Risco , Autorrevelação , Fatores SexuaisRESUMO
OBJECTIVE: Single-center studies have reported varying relapse rates after treatment of patients with acute asthma. We determined the relapse rate after emergency department (ED) treatment in a cohort of children. DESIGN: This was a prospective inception cohort study performed during 1997-1998. SETTING: The study was performed in 44 EDs including both general and pediatric centers. PATIENTS: Children (n = 1184) aged 2 to 17 years who had been admitted to EDs, with acute asthma restricted to 881 patients discharged from the ED. MAIN RESULTS: Two weeks after discharge, families were telephoned to determine relapse. Follow-up data were available for 762 (86%) of the children with a 10% incidence of relapse. On univariate analysis several factors were associated with relapse including current medications and markers of asthma severity. On multivariate analysis the factors associated with relapse were age (OR 1.4 per 5-year increase), use of second-line asthma medications (OR 3.7), exposure to cigarette smoke (OR 0.5), and ED visits within the past year (OR 1.2 per 5 ED visits). CONCLUSIONS: The incidence of relapse among children is lower than that observed among adults and varies with age. Other risk factors such as frequent ED visits are likely markers of chronic asthma severity. Further research should focus on ways to decrease the relapse rate among patients at high risk.
Assuntos
Asma/prevenção & controle , Asma/epidemiologia , Canadá/epidemiologia , Criança , Doença Crônica , Emergências , Feminino , Humanos , Masculino , Análise Multivariada , Razão de Chances , Estudos Prospectivos , Risco , Prevenção Secundária , Estatísticas não Paramétricas , Estados Unidos/epidemiologiaRESUMO
The reproductive performance of 28 sows seropositive to Leptospira interrogans serovar icterohaemorrhagiae was compared with that of 87 Leptospira sp. seronegative dams belonging to the same herd. Sows were sampled during 1988 to 1993. During this period the herd was not submitted to any kind of intervention (antibiotic therapy, immunoprophylaxis or rodent control). Relative risks (RR) of return to heat, mummified fetuses, stillbirth, and weak newborn piglets for infected sows were assessed and the differences in means of total piglets born per litter, piglets born alive, piglets effectively housed, weaned piglets, stillbirths, mummified fetuses, weak newborn piglets, weight at birth of the piglets effectively housed, weight at 21 days of life and weight at weaning were evaluated. Seropositive dams had a greater risk of having weak newborn piglets (RR = 1.67, 1.02 < or = CI 95% < or = 2.72) and also of having more weak newborn piglets per litter (P = 0.01). Other variables examined were not different (P > 0.05).
Assuntos
Anticorpos Antibacterianos/sangue , Leptospira interrogans/imunologia , Reprodução/fisiologia , Doenças dos Suínos/fisiopatologia , Doença de Weil/veterinária , Envelhecimento/imunologia , Envelhecimento/fisiologia , Animais , Animais Recém-Nascidos , Antibacterianos/uso terapêutico , Peso Corporal/fisiologia , Brasil/epidemiologia , Cruzamento , Feminino , Morte Fetal/epidemiologia , Morte Fetal/veterinária , Imunoterapia/métodos , Imunoterapia/veterinária , Masculino , Gravidez , Estudos Retrospectivos , Fatores de Risco , Controle de Roedores , Suínos , Doenças dos Suínos/epidemiologia , Doenças dos Suínos/terapia , Doença de Weil/fisiopatologia , Doença de Weil/terapiaRESUMO
Em ecotopos naturais de varios municipios dos Estados de Sao Paulo e Minas Gerais foram capturados gambas do genero Didelphis, naturalmente infectados, dos quais foram selecionados 25 exemplares de cada subespecie, D. albiventris e D. aurita.Nestes animais foram feitos 4 hemoculturas (5 tubos de cada vez) e 4 xenodiagnosticos seriados (5 insetos de cada especie), sendo utilizado o meio de Warren e as especies de triatomineos Panstrongylus megistus Triatoma sordida e Rhodnius neglectus, com intervalo de uma semana entre cada repeticao. Os resultados foram submetidos a analise de varianca e ao teste de Duncan, o qual demonstrou que houve um aumento de eficiencia dos dois metodos, a medida em que sao repetidos os exames e que os xenodiagnosticos sempre foram superiores as hemoculturas