Background
Colorectal cancer (CRC) is the third most common malignancy and the second leading cause of cancer-related death in the world. The aim of this study was to investigate the geographic ...distribution and time trends of CRC in Brazil.
Methods
Data were retrospectively retrieved from January 2005 to December 2018 from the Brazilian Public Health System. The incidence and lethality rates of CRC per 100,000 inhabitants in each municipality were estimated from hospitalizations and in-hospital deaths and were classified by age, sex, and demographic features.
Results
During the study period, the mean incidence of CRC estimated from hospitalizations and adjusted to available hospital beds more than tripled from 14.6 to 51.4 per 100,000 inhabitants (352%). Increases in CRC incidence were detected in all age ranges, particularly among people aged 50–69 years (266%). Incidence rates increased in all 5 macroregions, with a clear South to North gradient. The greatest changes in incidence and lethality rates were registered in small-sized municipalities. CRC lethality estimated from in-hospital deaths decreased similarly in both sexes, from 12 to 8% for males and females, from 2005 to 2018. The decline in lethality rates was seen in all age ranges, mainly in people aged 50 to 69 years (− 38%).
Conclusions
CRC incidence is increasing, predominantly above fifty years of age, and also in areas previously considered as having low incidence, but the increase is not paralleled by lethality rates. This suggests recent improvements in CRC screening programs and treatment, but also supports the spread of environmental risk factors throughout the country.
To evaluate the short term safety and potential therapeutic effect of allogenic adipose tissue-derived stromal/stem cells (ASCs) + cholecalciferol in patients with recent-onset T1D.
Prospective, ...phase II, open trial, pilot study in which patients with recent onset T1D received ASCs (1 × 10
cells/kg) and cholecalciferol 2000 UI/day for 3 months (group 1) and were compared to controls with standard insulin therapy (group 2). Adverse events, C-peptide (CP), insulin dose, HbA1c, time in range (TIR), glucose variability (continuous glucose monitoring) and frequency of CD4
FoxP3+ T-cells (flow cytometry) were evaluated at baseline (T0) and after 3 months (T3).
13 patients were included (8: group 1; 5: group 2). Their mean age and disease duration were 26.7 ± 6.1 years and 2.9 ± 1.05 months. Adverse events were transient headache (
= 8), mild local reactions (
= 7), tachycardia (
= 4), abdominal cramps (
= 1), thrombophlebitis (
= 4), mild floaters (
= 2), central retinal vein occlusion (
= 1, complete resolution). At T3, group 1 had lower insulin requirement (0.22 ± 0.17 vs. 0.61±0.26IU/Kg;
= 0.01) and HbA1c (6.47 ± 0.86 vs. 7.48 ± 0.52%;
= 0.03) than group 2. In group 1, 2 patients became insulin free (for 4 and 8 weeks) and all were in honeymoon at T3 (vs. none in group 2;
= 0.01). CP variations did not differ between groups (-4.6 ± 29.1% vs. +2.3 ± 59.65%;
= 0.83).
Allogenic ASCs + cholecalciferol without immunosuppression was associated with stability of CP and unanticipated mild transient adverse events in patients with recent onset T1D.
NCT03920397.
Abstract Objective Pathogens related to systemic infections have been detected in the periodontal microbiota. The relationship amongst these pathogens, periodontal bacteria and periodontal clinical ...status is poorly understood. This study evaluated the association amongst red complex, A. actinomycetemcomitans ( A.a ) and non-oral pathogenic bacteria in subjects with good periodontal health (PH), gingivitis (G), chronic (CP) and aggressive (AP) periodontitis. Methods Subgingival biofilm samples were obtained from 51 PH, 42 G, 219 CP and 90 AP subjects. The presence and levels of A.a , red complex ( Porphyromonas gingivalis , Tannerella forsythia , Treponema denticola ), Acinetobacter baumannii , Escherichia coli , Enterococcus faecalis , Pseudomonas aeruginosa , and Staphylococcus aureus were determined by DNA probes and DNA–DNA hybridization technique. Results CP and AP subjects presented significantly higher prevalence and levels of A.a , red complex and A. baumannii than G and PH individuals ( p < 0.01), whereas S. aureus was detected in lower frequency and counts in AP as compared to the other groups ( p < 0.001). The predictor variables age, prevalence of red complex, and the presence of A. baumannii and P. aeruginosa were strongly associated with the frequency of sites with PD and CAL ≥5 mm. Increasing age (OR 1.08), high frequency of red complex (OR 6.10), and the presence of A.a with P. aeruginosa (OR 1.90) were associated with periodontal disease ( p < 0.001). Subjects harbouring a high prevalence of A.a , A. baumannii , and red complex with P. aeruginosa were more likely to have AP than CP ( p < 0.001). Conclusion Putative periodontal pathogens and non-oral bacteria alone or in association were strongly associated with periodontitis.
Abstract
Background
Oral isotretinoin (ISO) is the drug of choice for the treatment of severe acne. For photoaging treatment, ISO has been proved to be effective in some controlled and noncontrolled ...trials and is an alternative to topical retinoic acid (RA) therapy, which causes an expected skin irritation.
Objective
To evaluate and compare the skin remodeling in patients taking ISO 20 mg 3 times a week for 12 weeks and 12 weeks after the end of the treatment to quantify collagen I and collagen III augmentation.
Material and methods
Immunohistochemical studies were performed to evaluate the expression of collagen I and collagen III, metalloproteinases (MMPs) ‐1, ‐3, ‐7, ‐9, ‐12, and the tissue inhibitor of MMP type‐1 (TIMP‐1) of the skin of 20 45 to 50‐year‐old women through morphometry in a semiquantitative method. The inclusion criteria were facial aging 2 and 3 of Glogau's classification, with phototypes between II and V who had not entered menopause. Biopsies of the skin of the left preauricular region were performed at three different times: pre‐treatment (T0), end of 12‐week treatment (T1), and 12 weeks posttreatment (T2).
Results
Collagen fibers I and III increased with statistical significance in T1 (50.7%;
P
= 0.012) but not in T2 (49.7%), which in turn was higher than in T0 (47.2%) for collagen I and T1 (33.3%;
P
= 0.002) but not in T2 (32.7%), and also was higher than T0 (32.0%) for collagen III. MMP‐9 presented a decreased activity with statistical significance in T1 (
P
= 0.047) and T2 (
P
= 0.058). MMP‐1 showed a reduction in T2 only (
P
= 0.015). MMPs ‐3, ‐7, ‐12, and TIMP‐1 did not present significant modification in their expressions during or after the treatment.
Conclusions
Low‐dose ISO is effective in remodeling the extracellular matrix (ECM). This study found that the increase of collagen occurs through the augmentation of both collagen I and collagen III fibers. With originality, it was possible to verify the durability of these fibers for at least 12 weeks. This may be related to the decrease in MMP‐9 expression verified at the end of the treatment and 12 weeks posttreatment.
Objective
Combination antiretroviral treatment (cART) allows for longer survival for people living with HIV and hence long‐term complications of both disease and treatment are common. Our purpose was ...to evaluate bone alterations in men living with HIV (MLWH) and receiving cART and to identify associated factors that can be corrected or mitigated.
Patients and Design
Thirty MLWH and 36 healthy controls (≥50 years) were studied for areal bone mineral density (aBMD) and body composition (dual‐energy X‐ray absorptiometry), volumetric bone mineral density (vBMD) and bone microstructure (high‐resolution peripheral quantitative computed tomography HR‐pQCT), serum calcium, phosphate, parathyroid hormone, 25(OH)D, testosterone (T), estradiol (E2), glucose, creatinine, and albumin levels.
Results
The proportion of patients classified as osteoporosis (according to the lowest aBMD T‐score) was higher among MLWH as compared to controls (17.9% vs. 5.9%, p = .011). The MLWH showed significant alterations in cortical and trabecular bone on HR‐pQCT, which were not associated with the duration of HIV infection or cART. These differences in vBMD and bone microstructure seen in HR‐pQCT persisted in the nonosteoporotic MLWH as compared to nonosteoporotic control subjects. Body mass index (BMI) and fat mass were lower in MLWH and positively associated with total vBMD, cortical bone area, and thickness. E2 and E2/T ratios were lower in MLWH than in controls and significantly correlated with several cortical and trabecular bone parameters. Multivariate regression analysis entering simultaneously age, BMI, and E2 defined that E2 is an independent influence on bone parameters evaluated by HR‐pQCT.
Conclusion
MLWH have alterations in bone volumetric density and microstructure when compared with controls, irrespective of aBMD, which are associated with lower E2 and BMI.
Comorbidities such as obesity, hypertension, and diabetes are associated with COVID-19 development and severity, probably due to immune dysregulation; however, the mechanisms underlying these ...associations are not clear. The immune signatures of hypertensive patients with obesity with COVID-19 may provide new insight into the mechanisms of immune dysregulation and progression to severe disease in these patients.
Hypertensive patients were selected prospectively from a multicenter registry of adults hospitalized with COVID-19 and stratified according to obesity (BMI ≥ 30 kg/m²). Clinical data including baseline characteristics, complications, treatment, and 46 immune markers were compared between groups. Logistic regression was performed to identify variables associated with the risk of COVID-19 progression in each group.
The sample comprised 213 patients (89 with and 124 without obesity). The clinical profiles of patients with and without obesity differed, suggesting potential interactions with COVID-19 severity. Relative to patients without obesity, patients with obesity were younger and fewer had cardiac disease and myocardial injury. Patients with obesity had higher EGF, GCSF, GMCSF, interleukin (IL)-1ra, IL-5, IL-7, IL-8, IL-15, IL-1β, MCP 1, and VEGF levels, total lymphocyte counts, and CD8
CD38
mean fluorescence intensity (MFI), and lower NK-NKG2A MFI and percentage of CD8
CD38
T cells. Significant correlations between cytokine and immune cell expression were observed in both groups. Five variables best predicted progression to severe COVID-19 in patients with obesity: diabetes, the EGF, IL-10, and IL-13 levels, and the percentage of CD8
HLA-DR
CD38
cells. Three variables were predictive for patients without obesity: myocardial injury and the percentages of B lymphocytes and HLA-DR
CD38
cells.
Our findings suggest that clinical and immune variables and obesity interact synergistically to increase the COVID-19 progression risk. The immune signatures of hypertensive patients with and without obesity severe COVID-19 highlight differences in immune dysregulation mechanisms, with potential therapeutic applications.
Background and Aims
Crohn’s disease (CD) can lead to work disability with social and economic impacts worldwide. In Brazil, where its prevalence is increasing, we assessed the indirect costs, ...prevalence, and risk factors for work disability in the state of Rio de Janeiro and in a tertiary care referral center of the state.
Methods
Data were retrieved from the database of the Single System of Social Security Benefits Information, with a cross-check for aid pension and disability retirement. A subanalysis was performed with CD patients followed up at the tertiary care referral center using a prospective CD database, including clinical variables assessed as possible risk factors for work disability.
Results
From 2010 to 2018, the estimated prevalence of CD was 26.05 per 100,000 inhabitants, while the associated work disability was 16.6%, with indirect costs of US$ 8,562,195.86. Permanent disability occurred more frequently in those aged 40 to 49 years. In the referral center, the prevalence of work disability was 16.7%, with a mean interval of 3 years between diagnosis and the first benefit. Risk factors for absence from work were predominantly abdominal surgery, anovaginal fistulas, disease duration, and the A2 profile of the Montreal classification.
Conclusions
In Rio de Janeiro, work disability affects one-sixth of CD patients, and risk factors are associated with disease duration and complications. In the context of increasing prevalence, as this disability compromises young patients after a relatively short period of disease, the socioeconomic burden of CD is expected to increase in the future.
This study aims to assess interrelationships between serum lead (Pb), cadmium (Cd), arsenic (As), and mercury (Hg) concentrations in pregnant women in their third trimester and umbilical cord blood, ...while inter-metal correlations were also determined. This study is part of the PIPA project (Childhood and Environmental Pollutant Project), whose pilot study was carried out from October 2017 to August 2018 and will be presented here. Blood samples were obtained from 117 mother-umbilical cord pairs and analyzed concerning metal concentrations. A positive correlation was found between metal concentrations in mother and cord blood (
R
> 0.7,
p
< 0.001). The results indicate that mother metal concentrations are able to determine child metal concentrations (
p
< 0.001). The correlations between maternal blood metal concentrations were positive for all assessed metals except for As and Hg. The strongest correlations in this matrix were observed between Cd and Pb (
R
= 0.471
p
= 0.000), Cd and Hg (
R
= 0.425
p
= 0.000), and Pb and Hg (
R
= 0.427
p
= 0.000). Umbilical cord correlations were lower compared to mother blood correlations. In general, the four analyzed metals displayed significant correlations to serum concentrations in both maternal and cord blood.
This study compared prevalence and risk factors of dental anxiety between men and women. The sample consisted of 244 participants (n = 122 men) aged 18 years or older who sought dental care at a ...public Dental Education Institution from March 2018 to November 2019. The Modified Dental Anxiety Scale was used to determine presence of dental anxiety. The following risk factors were recorded: age, years of schooling, preoperative pain, and type of dental treatment. Bivariate analysis was used to assess the difference in dental anxiety between the sexes. Multivariate logistic regression was used to analyze the association between dental anxiety and gender, regardless of the influence of other variables. Total prevalence of dental anxiety was 18% (n = 44), 22.9% (28/122) in women and 13.1% (16/122) in men (p = 0.04). Gender (odds ratio: 1.83, 95% confidence interval: 0.92-3.62) and preoperative pain (odds ratio: 2.095, 95% confidence interval: 0.97-4.49) were associated with dental anxiety. We concluded that women had a higher prevalence of dental anxiety. Preoperative pain was associated with dental anxiety regardless of gender.
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