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Adaptação transcultural do Skin Cancer Index para o português e avaliação da qualidade de vida em pacientes com câncer de pele não melanoma cervicofacial

Sun, 01 Jan 2023 00:00:00 GMT

Título: Adaptação transcultural do Skin Cancer Index para o português e avaliação da qualidade de vida em pacientes com câncer de pele não melanoma cervicofacial Autor(es): Hora, Evânia Curvelo Abstract: Non-melanoma skin cancer (NMSC) is the most frequent malignant neoplasm in Brazil. NMSCs occur mostly in the cervicofacial region, are associated with high morbidity, and often require surgical management. This causes functional, aesthetic, and emotional sequelae impacting the patient's quality of life (QoL). The Skin Cancer Index (SCI) was created to measure the QoL of NMSC patients. This study aimed to perform a cross-cultural adaptation of the SCI to the Portuguese language and the culture of northeastern Brazil, and measure its psychometric properties of reliability, validity, and responsiveness in assessing the QoL of patients with cervicofacial NMSC. This way, a specific instrument was developed to measure the QoL of this population. This study was performed in two stages. The first stage consisted of methodological research on the cross-cultural adaptation of the SCI through five steps: initial translation, synthesis of translations, back-translation, expert committee approval, and testing of the pre-final version (n=40). The second stage was a cross-sectional study on the clinical validation and assessment of the QoL of these patients (n= 182). The first stage resulted in an adapted version of the SCI. This version reached a Content Validity Index level significantly higher than 80% (p<0.05), evaluated through the Exact Binomial test. Temporal stability of the SCI during the test and retest periods was observed. Moreover, the Pearson’s correlations, as well as the Intraclass Correlation Coefficient, showed coefficients higher than 0.9, indicating excellent reliability. In the second stage, the adapted version was administered together with the Brazilian version of the Dermatology Life Quality Index (DLQI), during the pre-and post- operative periods (4 months postoperatively). Reliability in the subscales, and the total instrument, guaranteed by McDonald's ω, were considered ideal (>0.8) in all sub- dimensions. Moreover, α was considered ideal in the “emotional” and “social” sub-dimensions.Construct validity was obtained in all sub-dimensions and on the scale using the criteria (χ2) p-value > 0.05, RMSEA < 0.08, CFI ≥ 0.9, and SRMR ≤ 0.08. QoL and responsiveness were assessed by the student’s t-test in a paired sample at T0 (preoperatively) and T1 (4 monthspostoperatively). Significant results were observed with an increase in the SCI scale scores in all its dimensions and the total instrument (p < 0.001), and a decrease in the DLQI scale (p = 0.001). This showed that the adapted scale demonstrated a better postoperative QoL. The variables that presented significant results in the total scale, which indicated better QoL, were “men” (p = 0.002), “without children” (p = 0.019), “income above 4 minimun wages (p < 0.001), “from the private sector” (p < 0.001), “did not report itching” (p = 0.021), and “no scalp lesions” (p=0.012). The QoL measurement indicated a change from the baseline and postoperative improvement in all subscales and in the total instrument. The final version of the SCI adapted to the Portuguese language was called “SCI-versão brasileira” and proved to be a valid, reliable, and responsive instrument that allows health professionals to identify changes in the QoL of patients with NMSC.

Perfil fenotípico e funcional de neutrófilos em paciente COVID-19 após vacinação

Mon, 01 Jan 2024 00:00:00 GMT

Título: Perfil fenotípico e funcional de neutrófilos em paciente COVID-19 após vacinação Autor(es): Oliveira, Yrna Lorena Matos de Abstract: Introduction: A dysregulation in the innate immune response against the SARS-CoV-2 coronavirus may contribute to a worse prognosis in COVID-19. Serum biomarkers released by neutrophils such as the TREM-1 receptor and IL-6 are associated with the severity of inflammatory diseases. Different functional profiles of neutrophils have been described with an important role in antiviral defense and also in the inflammatory process triggered by the virus. With the advance of vaccination, it is important to understand how neutrophils are contributing to the pathogenesis of the disease. Aim: To evaluate the neutrophil profile in COVID1-9 after vaccination. Methods: This study was divided into two chapters, the first referring to a meta- analysis and the second to an experimental study. The meta-analysis was carried out in order to evaluate serum levels of the soluble form of TREM-1 (sTREM-1) in humans with viral pneumonia compared to healthy controls, according to the PRISMA guideline, and seven studies were included, four studies analyzed patients with COVID-19 and three studies evaluated other viruses. The cross-sectional study was carried out with severe COVID-19 patients, 17 unvaccinated and 12 vaccinated, admitted to intensive care units. The phenotypic and functional profile of neutrophils and the dosage of serum proteins and cytokines were evaluated. The neutrophil phenotype was determined by flow cytometry using the following surface markers: CD11b (cell adhesion), CD16 (phagocytic capacity), CD182 (chemotaxis), TREM-1 (activation), HLA-DR (antigen presentation) and CD274 (suppressive activity), together with the dosage of serum proteins, IL-6 and sTREM-1 assessed using specific immunoassays and, the dosage of cytokines : GM-CSF; IFN-γ; IL-1β; IL-2; IL-4; IL-5; IL-12 p70; IL-13; IL-18; and TNF-α by the LUMINEX method. Results: The meta-analysis found increased sTREM-1 levels in COVID-19 patients compared to healthy controls (SMD 1.53; 95% CI 0.53-2.52). In addition, higher sTREM-1 levels were found in vaccinated severe COVID-19 patients compared to healthy patients. There was no significant difference between severe and non-severe COVID-19 patients. The cross-sectional study found that serum IL-6 levels were significantly higher in unvaccinated severe COVID-19 patients compared to the vaccinated group. In vaccinated patients, neutrophils expressed more surface markers TREM- 1, CD182, HLA-DR, MFI of HLA-DR and PD-L1, as well as an increase in the CD16+CD182+TREM-1+ population (p=0.0009) and the HLA-DR+PDL-1+ population (p<0.0001). Correspondingly, vaccinated patients showed significant correlations mainly related to the number of PD-L1+ neutrophils and inflammatory cytokines, while in unvaccinated patients, inflammatory cytokines were negatively correlated with TREM-1 on the surface of neutrophils. Conclusion: From these data we can conclude that the TREM-1 molecule participates in the pathogenesis of COVID-19 and that vaccination has favored a more activated state or a more prepared immune system, in terms of regulation, antigen presentation, chemotaxis, inflammatory response and immune activation in the face of SARS-CoV-2 infection.

Tendência secular de mortalidade e morbidade por câncer do colo do útero nas regiões do Brasil

Mon, 01 Jan 2024 00:00:00 GMT

Título: Tendência secular de mortalidade e morbidade por câncer do colo do útero nas regiões do Brasil Autor(es): Ferrari, Yasmim Anayr Costa Abstract: Cervical cancer continues to be a significant public health challenge worldwide. Despite well-established prevention and screening methods, the disease still exhibits high rates of incidence, morbidity, and mortality among women. The objective of this research is to analyze the long-term trends in mortality and morbidity caused by cervical cancer in Brazil and its regions. This study utilizes a population and ecological approach with time series analysis, examining cases of cervical cancer-related deaths and hospitalizations across all age groups in the five Brazilian regions: Midwest, Northeast, North, Southeast, and South. The data used for analysis were obtained from the Department of Informatics of the Unified Health System. Information on deaths came from the Mortality Information System (SIM) and hospitalizations from the Hospital Information System (SIH). The specific codes employed to retrieve the data were 180 (Malignant neoplasm of the cervix) according to the International Classification of Diseases (ICD) 9 and C53 (Malignant neoplasm of the cervix) according to ICD-10. Crude rates, age-specific rates, and age-standardized rates were calculated for each year and age group, using both the Brazilian population and the world population as references. The age groups were categorized into 20 to 44 years, 45 to 64 years, and 65 years or older, excluding women below 19 years of age due to their low representation (less than 0.5%). The mortality trend was calculated using the Joinpoint Regression Program, version 4.9.1.0, National Cancer Institute, USA. The statistical significance adopted was 5.0%, identified through the Monte Carlo Permutation test, and the Confidence Interval (CI) was 95.0%. There were 171,793 thousand deaths recorded from 1980 to 2021 and 736,491 thousand hospitalizations from 1992 to 2021. Mortality rates from cervical cancer increased in the North and Northeast and decreased in other places. Hospitalization rates have reduced in Brazil and in all regions. Regarding mortality trends, there was a reduction in the Central- West (AAPC -1,3; CI -1,5; -1,1) and Southeast (AAPC -0,9; CI -1,4; -0,5), stability in Brazil (AAPC -0,3; CI -1,0; 0,4), North (AAPC 0,6; CI -0,1; 1,3) and South (AAPC 0,0; CI -0,5; 0,5) and an increase in the Northeast (AAPC 0,6; CI 0,3; 0,8). For hospitalizations, Brazil (AAPC -2,5; CI -3,9; -1,0), Northeast (AAPC -3,2; CI -4,5; -1,9) and Southeast (AAPC -2,9; CI -4,7; -1,2) showed decreasing trends and the Central- West (AAPC -2,6; CI -5,6; 0,4), North (AAPC -1,2; CI -5,0; 2,8) and South (AAPC -1,7; CI -3,6; 0,2) regions-maintained stability. Regional disparities were evident in this study, where the North and Northeast had the highest mortality rates. Despite decreasing and stationary trends, cervical cancer still represents an important cause of illness and death in Brazilian women.

Presença de polimorfismos genéticos no receptor de vitamina D e padrão da reserva corporal de micronutrientes e suas relações com os marcadores do controle glicêmico, perfis lipídico e inflamatório de indivíduos com diabetes mellitus tipo 2

Mon, 01 Jan 2024 00:00:00 GMT

Título: Presença de polimorfismos genéticos no receptor de vitamina D e padrão da reserva corporal de micronutrientes e suas relações com os marcadores do controle glicêmico, perfis lipídico e inflamatório de indivíduos com diabetes mellitus tipo 2 Autor(es): Santos, Ramara Kadija Fonseca Abstract: Genetic single nucleotide polymorphisms (SNPs) and haplotypes in the vitamin D receptor (VDR), and deficiencies in vitamin D, magnesium (Mg), zinc (Zn), calcium (Ca) and potassium (K) are factors that alone contribute to inadequate metabolic control in individuals with type 2 diabetes mellitus (DM2). Thus, the aim of this study is to associate the presence of SNPs in the VDR, haplotypes and patterns of micronutrient body reserves with markers of glycemic control, lipid levels and inflammatory profile in individuals with DM2. To this end, a meta-analysis evaluated the association between the presence of SNPs in the VDR and markers of glycemic control, lipid levels and inflammatory profile in individuals with DM2, following the MOOSE guidelines and registered with PROSPERO (nºCRD42021268152). A systematic search of the data was carried out in the PubMed, EMBASE and SCOPUS databases. Studies comparing the values of markers of glycemic control, lipid profile and inflammation between the identified genotypes were included. The quality of the studies was assessed using the Newcastle-Ottawa scale. Effect sizes were tested using a random-effects model and reported as standardized mean difference (SMD) and 95% confidence interval (95%CI). In parallel, an observational, cross-sectional study was carried out with 160 adults with DM2, both sexes, living in Sergipe. Sociodemographic information was collected, anthropometric and body composition assessments were carried out, and blood was drawn to identify SNPs and assess biochemical markers of glycemic and lipid control. The frequency of SNPs, linkage disequilibrium and the Hardy-Weinberg test were calculated and SNPs with a frequency greater than 1% were inserted into the haplotype model. The SNPs and haplotypes, and the micronutrient body reserve patterns established by principal component analysis and stratified into quartiles, were entered into the binary logistic regression model tests (dependent variables therapeutic target values for fasting glycemia, percent of glycated hemoglobin (%HbA1c) and Homeostasis Model Assessment - Insulin Resistance (HOMA-IR) adjusted for gender, age, time of diagnosis and BMI, significance p<0.05. The meta-analysis identified four SNPs: Fokl (rs2228570); BsmI (rs1544410); Taql (rs731236) and Apal (rs7975232). The Fokl and BsmI SNPs were associated with higher %HbA1c (SMD=0.409, p=0.002) and triacylglycerol (SMD=0.206, p=0.023), respectively. In the observational study, the Bsml SNP was associated with increased %HbA1c (OR=2.071, p=0.045), but the haplotypes did not contribute to inadequate glycemic control. Two patterns of body micronutrient reserve were established. The lowest quartile of Pattern 1 (Mg, Zn, Ca and K) and Pattern 2 (25(OH)D and Zn) were 4.319 (p=0.019) and 3.970 (p=0.038) times more likely to increase HOMA-IR and %HbA1c values, respectively. It is concluded that SNPs in the VDR and the pattern of micronutrient body reserves explained by the lower concentration of 25(OH)D, Zn, Mg, Ca and K contribute to poor metabolic control in individuals with DM2.