Raymundo Soares de Azevedo Neto

Hepatitis B (HBV), Hepatitis C (HCV) and Hepatitis Delta (HDV) Viruses in the Colombian Population—How Is the Epidemiological Situation?

Background Viral hepatitis B, C and delta still remain a serious problem worldwide. In Colombia, data from 1980s described that HBV and HDV infection are important causes of hepatitis, but little is known about HCV infection. The aim of this study was to determine the currently frequency of HBV, HCV and HDV in four different Colombian regions. Methodology/Principal Findings This study was conducted in 697 habitants from 4 Colombian departments: Amazonas, Chocó, Magdalena and San Andres Islands. Epidemiological data were obtained from an interview applied to each individual aiming to evaluate risk factors related to HBV, HCV or HDV infections. All samples were tested for HBsAg, anti-HBc, anti-HBs and anti-HCV markers. Samples that were positive to HBsAg and/or anti-HBc were tested to anti-HDV. Concerning the geographical origin of the samples, the three HBV markers showed a statistically significant difference: HBsAg (p = 0.033) and anti-HBc (p<0.001) were more frequent in Amazonas and Magdalena departments. Isolated anti-HBs (a marker of previous vaccination) frequencies were: Chocó (53.26%), Amazonas (32.88%), Magdalena (17.0%) and San Andrés (15.33%) - p<0.001. Prevalence of anti-HBc increased with age; HBsAg varied from 1.97 to 8.39% (p = 0.033). Amazonas department showed the highest frequency for anti-HCV marker (5.68%), while the lowest frequency was found in San Andrés Island (0.66%). Anti-HDV was found in 9 (5.20%) out of 173 anti-HBc and/or HBsAg positive samples, 8 of them from the Amazonas region and 1 from them Magdalena department. Conclusions/Significance In conclusion, HBV, HCV and HDV infections are detected throughout Colombia in frequency levels that would place some areas as hyperendemic for HBV, especially those found in Amazonas and Magdalena departments. Novel strategies to increase HBV immunization in the rural population and to strengthen HCV surveillance are reinforced by these results.

Synovial sarcoma of the extremities: prognostic factors for 20 nonmetastatic cases and a new histologic grading system with prognostic significance

PURPOSE To evaluate 20 cases of nonmetastatic synovial sarcoma of the extremities regarding prognostic factors, and to propose a histologic grading system with prognostic significance. METHODS The cases of 20 patients (14 females and 6 males) with nonmetastatic synovial sarcomas of the extremities treated between 1985 and 1998, were retrospectively evaluated regarding prognostic factors. A histologic grading system with prognostic significance is proposed. RESULTS The mean follow-up period was 48.4 months (range, 16-116 months). There was local recurrence in 3 cases (15%), microscopic surgical margin being the only prognostic factor identified. Seven patients (35%) died of the disease in a mean postoperative period of 31.7 months (range, 16-53 months), all with pulmonary or brain metastasis. The survival rate was 65% in 48.4 months of follow-up. CONCLUSION The unfavorable prognostic factors identified regarding survival were high histologic grade, tumors proximal to the knee or elbow, and spontaneous tumor necrosis over 25%. Local recurrence did not have influence on survival in this study. The presence of mast cells appears to have a positive influence on survival, although statistical significance was not reached (P = 0.07). The oncologic and functional result was good in 6 cases (30%), regular in 7 (35%), and poor in 7 cases (35%).

Sorologia positiva para sífilis, toxoplasmose e doença de Chagas em gestantes de primeira consulta em centros de saúde de área metropolitana, Brasil

Alguns testes sorologicos tem sido utilizados para detectar, indiretamente, a presenca de possiveis agentes etiologicos infecciosos durante a gestacao, que sendo transmitidos ao feto, por via placentaria, causam infeccoes congenitas com sequelas leves ou graves e ate morte fetal. Foram estudadas 481 gestantes, com idade media de 24,5 anos (de 14 a 46 anos), atendidas em primeira consulta nos Centros de Saude, na Cidade de Sao Paulo, SP (Brasil) no periodo de abril a outubro de 1988. Segundo o trimestre gestacional, 230 pacientes (47,8%) estavam no primeiro trimestre; 203 (42,2%) no 2o e 48 (10,0%) no 3o. Das 474 pacientes que declararam algum tipo de renda mensal, 309 (65,2%) pertenciam a familias com renda ate 1 SMPC (salario minimo per capita) e somente 15 (3,2%) pertenciam a familias com renda superior a 3 SMPC, caracterizando o baixo nivel economico das gestantes. Das 481 pacientes 159 (33,1%) eram nascidas no Estado de Sao Paulo e as 322 (66,9%) restantes eram imigrantes procedentes de outros Estados, destacando-se Bahia (23,1%); Minas Gerais (11,4%); Parana (7,5%); Paraiba (5,4%) e Pernambuco(5,4%). Foram realizados testes imunodiagnosticos para sifilis, toxoplasmose e doenca de Chagas. Foram observados resultados positivos para sifilis em 25 gestantes (5,2%). Para toxoplasmose, 157 (32,4%) nao tinham anticorpos em nivel detectavel e 67 (13,9%) apresentaram titulos elevados, indicativos de infeccao ativa, das quais em 6 (10,3%) foram detectados anticorpos da classe IgM. Para doenca de Chagas foram encontrados anticorpos especificos em 14 (2,9%) gestantes, sendo que destas, 10 (71,4%) eram procedentes da Bahia e Minas Gerais.

Correlation between the expression of vegf and survival in osteosarcoma

Objective: To present a series of 50 consecutive patients with non-metastatic extremity osteosarcoma, and attempt to correlate expression of the vascular endothelial growth factor (VEGF) protein in biopsy tissue to their prognosis regarding overall survival, disease-free survival and local recurrence. Methods: Fifty cases of non-metastatic osteosarcoma of the extremities treated between 1986 and 2006 at Instituto de Ortopedia e Traumatologia da Universidade de São Paulo, São Paulo, Brasil, were evaluated regarding expression of the VEGF protein. There were 19 females and 31 males. The mean age was 16 years old (range 5-28 years old) and the mean follow-up was 60.6 months (range 25-167 months). The variables studied were age, gender, anatomic location, type of surgery, surgical margins, tumor size, post chemotherapy necrosis, local recurrence, pulmonary metastasis and death. Results: Thirty-six patients showed VEGF expression on 30% or less cells (low), and the remaining 14 cases had VEGF expression above 30% (high). Among the 36 patients with low VEGF expression, nine developed pulmonary metastasis and four died (11.1%). Among the 14 patients with high VEGF expression, six developed pulmonary metastasis and three died (21.4%). Conclusion: There was no statistically significant correlation between the expression of VEGF and any of the variables studied. Level of Evidence IV, Therapeutic Study.

Karyotypic and fluorescent in situ hybridization study of the centromere of chromosome 7 in secondary myeloid neoplasms

Background Secondary myeloid neoplasms comprise a group of secondary diseases following exposure to myelotoxic agents or due to congenital diseases. The improvement of anticancer agents and immunosuppressive drugs seem to be associated with an increased incidence of secondary myeloid neoplasms. Karyotyping of bone marrow is essential for diagnosis and prognosis. Previous use of alkylating agents and radiation are associated with clonal abnormalities such as recurrent unbalanced -5/5q-, -7/7q- and complex karyotypes, whereas topoisomerase-II inhibitors lead to changes such as the balanced 11q23 rearrangement, t(8;21), t(15;17) and inv(16). Objective To study the clinical and cytogenetic data of patients with secondary myeloid neoplasms who took antineoplastic and/or immunosuppressive drugs or progressed from aplastic anemia. Methods The clinical and cytogenetic characteristics of 42 patients diagnosed with secondary myeloid neoplasms in one institution were retrospectively evaluated. Of these, 25, 11 and 6 patients had had oncological diseases, aplastic anemia and other diseases, respectively. Conventional cytogenetic and FISH analyses were performed for monosomy 7. Results The cytogenetic study was conclusive in 32 cases with 84.4% of clonal abnormalities. Monosomy 7 and complex karyotypes were present in 44.4% and 37%, respectively. A high prevalence of unbalanced abnormalities (96.3%) was observed. Monosomy 7 was more prevalent in patients with myelodysplastic syndromes/myeloid neoplasms after aplastic anemia (66.6%). The median survival after diagnosis of myeloid neoplasms was only 5.7 months. Normal cytogenetics was associated to better survival (p-value = 0.03). There was a slightly worse trend of survival for patients with complex karyotypes (p-value = 0.057). Abnormal karyotype was an independent risk factor for poor survival (p-value = 0.012). Conclusion This study enhances the importance of cytogenetic analysis of patients at the time of diagnosis of secondary myeloid neoplasms.

Perfil do médico residente atendido no Grupo de Assistência Psicológica ao Aluno (GRAPAL) da Faculdade de Medicina da Universidade de São Paulo

OBJECTIVES: To define the profile of medical residents assisted by a mental health care service, aiming to contribute to the understanding of this groups needs. Methods: Observational study, retrospective cohort design. Data were collected from the medical records of a series of residents assisted by the group of psychological care for students of the Sao Paulo University School of Medicine , during the period 1998-2002; and from the institutions general register of residents. Proportions of residents assisted according to time, year of residency, gender , age, specialty, graduation school and distance from family home are described and differences between proportions of these variables categories are analyzed. RESULTS: The total of residents included was 2,131 with a follow-up time of 4,727 resident-years. Among them, computing first episode of care only, there were 104 residents assisted (4.9% residents assisted, or 2.2 residents assisted per 100 resident-years of follow-up). Their most frequent characteristics were: first year of residency (4.5%), age under 26 years (6.1%), female (6.9%), graduates from other schools (5.9%), and residents of cognitive specialties (6.7%).Psychiatric assistance in this sample shows an association with gender and factors related to a crisis of adaptation. The proportion of residents assisted has not increased during the period analyzed.

Are CYP1A1, CYP17 and CYP1B1 mutation genes involved on girls with precocious puberty? A pilot study

OBJECTIVES To investigate three genes associated with puberty timing in girls with central precocious puberty by evaluating the association between polymorphism in the gene sequence codifying the enzymes participating in steroidogenesis, CYP1A1, CYP17, and CYP1B1 and central precocious puberty. STUDY DESIGN A total of 177 patients was included and divided into two groups: Case group with 73 girls diagnosed with central precocious puberty; Control group with 104 girls with puberty onset after 8 years of age who were followed at the Sector of Gynecology of Childhood and Adolescence, Division of Gynecology Clinic, HC-FMUSP. Polymorphism presence was assessed in the genes involved in estrogen metabolism (CYP1A1, CYP17, and CYP1B1) by the restriction fragment length polymorphism (RFLP) technique using DNA from peripheral blood. RESULTS No significant difference in the distribution of the CYP1A1 Mspl (p=0.86) and CYP17 (p=0.12) genotypes was detected between the two study groups. As for CYP1B1 Eco571, the mutated C/C genotype was found to be more frequent in the control group than in the case group (p=0.03). CONCLUSION Our data suggest the CYP1B1 Eco571 gene variant is associated with puberty timing.

Development of a Model to Predict Invasiveness in Ductal Carcinoma In Situ Diagnosed by Percutaneous Biopsy—Original Study and Critical Evaluation of the Literature

Background Approximately 30% of ductal carcinoma in situ (DCIS) cases have an invasive component discovered on the final analysis that could affect surgical management. The aims of the present study were to determine the risk factors associated with the underestimation of DCIS and to develop a model to predict the probability of invasiveness. Materials and Methods A retrospective analysis was performed on the data for all patients with a diagnosis of DCIS found by percutaneous biopsy from January 2008 to February 2016. Thirteen potential predictors of invasiveness were examined. The statistical analysis of the present study was improved using Nagelkerke’s R2, the area under the receiving operating characteristic (AUC) curve, and the Hosmer‐Lemeshow goodness‐of‐fit test. Results Of 354 biopsy specimens deemed to be DCIS on initial biopsy, 100 (28.2%) were recategorized as invasive carcinoma after surgery. On multivariate analysis, the strongest predictors of invasiveness were comedonecrosis, size on mammography, suspected microinvasion, histologic grade, and younger patient age. The model had a good discriminative ability, with an AUC of 0.764. The overall performance of the model was fair, with a Nagelkerke’s R2 of 40.9%. A separate analysis performed on 274 specimens obtained through vacuum‐assisted biopsy revealed different variables were associated with underestimation; however, a similar AUC (0.743) and Nagelkerke’s R2 (45.7%) were obtained. Conclusion Our model had the best AUC for predicting DCIS invasiveness reported to date. However, further statistical analysis showed only a fair overall performance. The currently known clinical, radiographic, and pathologic features might be insufficient to identify which patients with DCIS have underestimated disease. Micro‐Abstract Our aim was to develop a model to predict invasiveness in patients with a diagnosis of ductal carcinoma in situ found at percutaneous biopsy. The calculated sample size was 296 patients. We used Nagelkerke’s R2 and Hosmer‐Lemeshow goodness‐of‐fit tests to improve statistical analysis. We evaluated 354 patients and developed 2 models that have the best discrimination reported to date.