Análise exploratória dos padrões alimentares de pacientes com adenocarcinoma gástrico: um estudo de caso-controle na Região Brasil Central / Exploratory analysis of dietary patterns of patients with gastric adenocarcinoma: a case-control study in central brazil

ABSTRACT Background: Diet is one of the most important modifiable risk factors for the incidence of gastric cancer. Objective: To carry out an exploratory analysis on the dietary patterns of individuals with gastric adenocarcinoma (AdG) in the Central Brazil region. Methods: This is a case-control study carried out from April 2019 to July 2022, in three reference centers for cancer treatment in Goiânia-GO. The cases were patients diagnosed with AdG, the control 1 dyspeptic patients submitted to upper digestive endoscopy and the control 2 patients without gastric complaints. In the three groups, patients aged 18 to 75 years and of both sexes were recruited. To assess food consumption, a Food Frequency Questionnaire validated for the Brazilian population was used. Dietary patterns were identified by Exploratory Factor Analysis (EFA), using principal component analysis as the extraction method, followed by Varimax rotation. Results: The commonality values in the EFA for the foods/food groups consumed by the cases and controls were above 0.30 for all variables. The variance explained by the model was 66.7% for cases, 60.3% for control 1 and 59.7% for control 2. Three eating patterns were identified in cases, control 1 and control 2 that explained 34, 87%, 35.41% and 33.25% respectively of the total variance. The first pattern ("healthy") was characterized by the consumption of vegetables, fruits, meat and cheese; the second ("unhealthy") for sausages, pizzas, snacks, ketchup, sweet drinks and instant noodles and the third ("prudent") rice, beans, meat and fried fish and pasta. Conclusion: This study identified three dietary patterns among patients with AdG and controls in the Central Brazil region. According to the identified patterns, it will be possible to establish a relationship between diet and other epidemiological measures aimed at the prevention of gastric cancer.

RESUMO Contexto: A dieta é um dos fatores de risco modificáveis mais importante para a incidência de câncer gástrico. Objetivo: Realizar uma análise exploratória sobre os padrões alimentares de indivíduos com adenocarcinoma gástrico (AdG) na região Brasil central. Métodos: Este é um estudo de caso-controle realizado no período de abril de 2019 a julho de 2022, em três centros de referência para o tratamento para câncer em Goiânia-GO. Os casos foram pacientes diagnosticados com AdG, o controle 1 pacientes dispépticos submetidos a endoscopia digestiva alta e o controle 2 pacientes sem queixas gástricas. Nos três grupos foram recrutados pacientes de 18 a 75 anos e de ambos os sexos. Para avaliar o consumo alimentar foi utilizado um Questionário de Frequência Alimentar validado para a população brasileira. Os padrões alimentares foram identificados por Análise Fatorial Exploratória (AFE), utilizando a análise de componentes principais como método de extração, seguida pela rotação Varimax. Resultados: Os valores de comunalidade na AFE para os alimentos/grupos alimentares consumidos pelos casos e controles ficaram acima de 0,30 para todas as variáveis. A variância explicada pelo modelo foi de 66,7%, para casos, 60,3% para o controle 1 e 59,7% para o controle 2. Foram identificados três padrões alimentares nos casos, controle 1 e controle 2 que explicaram 34,87%, 35,41% e 33,25% respectivamente da variância total. O primeiro padrão ("saudável") foi caracterizado pelo consumo de vegetais, frutas, carne e queijos; o segundo ("não saudável") por embutidos, pizzas, snacks, ketchup, bebidas doces e macarrão instantâneo e o terceiro ("prudente") arroz, feijão, carnes e peixes fritos e massas. Conclusão: Esse estudo identificou três padrões alimentares entre os pacientes com AdG e os controles na região Brasil central. De acordo com os padrões identificados, será possível estabelecer uma relação entre a dieta e outras medidas epidemiológicas destinadas à prevenção do câncer gástrico.

Predictores clínicos de tuberculosis multidrogorresistente en pacientes con tuberculosis pulmonar en Huánuco, Perú. 2010-2015 / Predictor Factors For Multidrug-Resistant Tuberculosis Among Patients With Pulmonary Tuberculosis In Huánuco, Peru. 2010-2015

Introducción: En la ciudad de Huánuco se observa un crecimiento progresivo de casos de tuberculosis y cada vez más frecuente la tuberculosis multidrogorresistente, por esta razón fue necesario identificar factores predictores para desarrollar tuberculosis multidrogorresistente. Objetivo: Determinar si la fiebre persistente, el patrón radiográfico cavitario y la baciloscopía positiva al primer mes de tratamiento son predictores de tuberculosis multidrogorresistente en pacientes con tuberculosis Pulmonar en cuatro establecimientos de salud de la ciudad de Huánuco, entre enero 2010 y diciembre 2015. Métodos:Estudio observacional, casos y controles. Se consideraron 37 casos y 111 controles. Los datos se recolectaron de las historias clínicas. Resultados: Los factores predictores encontrados en el análisis bivariado fueron la persistencia de la fiebre a las dos semanas (p=0,001; OR 0,05; IC 0,01-0,5), el patrón radiográfico cavitario (p=0,000; OR 11,6; IC 4,6­26,5), y la positividad de la baciloscopía al primer mes de tratamiento (p=0,00; OR 13,5; IC 4,1-44,6 al 95%). Estas fueron confirmadas con el análisis multivariado (p=0,08; p=0,002; p=0,00 respectivamente). Conclusión: La persistencia de la fiebre a las dos semanas, el patrón radiográfico cavitario y la baciloscopía positiva al primer mes de tratamiento mostraron asociación predictiva en forma independiente para el diagnóstico de tuberculosis multidrogorresistente.

Introduction: In the city of Huánuco and around the world, there is a progressive increase in cases of tuberculosis and multidrug-resistant tuberculosis, for this reason it was necessary to identify predictors to develop multidrug-resistant tuberculosis. Objective: To determine if persistent fever, cavitary radiographic pattern and positive smear microscopy at the first month of treatment, are predictors of multidrug-resistant tuberculosis in patients with pulmonary tuberculosis, in four health facilities in the city of Huánuco, between January 2010 and December 2015. Methods: Case and control study. We considered 37 cases and 111 controls. Data were collected from medical records. Results: The predictive factors found in the bivariate analysis were persistence of fever at 2 weeks (p = 0.001, OR 0.05, CI 0.01-0.5), cavitary radiographic pattern (p = 0.000, OR 11.6, 95%IC 4.6-26.5), and smear microscopy positivity at the first month of treatment (p = 0.00, OR 13.5, 95%CI 4.1-44.6). These were confirmed by multivariate analysis (p = 0.012, p = 0.00, p = 0.00 respectively). Conclusion: The persistence of fever at two weeks, cavitary radiographic pattern and positive smear microscopy at the first month of treatment were predictive factors associated independently for the diagnosis of multidrug-resistant Tuberculosis.

Atenção pré-natal e fatores de risco associados à prematuridade e baixo peso ao nascer em capital do nordeste brasileiro / Prenatal care and risk factors associated with premature birth and low birth weight in the a capital in the Brazilian Northeast

Resumo Os principais determinantes do risco de morrer no período neonatal são o baixo peso ao nascer e a prematuridade. O estudo teve como objetivo analisar a adequação do pré-natal e fatores de risco associados à prematuridade e ao baixo peso ao nascerem uma capital do nordeste brasileiro. Trata-se de um estudo caso-controle. Foi construído um modelo de adequação do pré-natal composto por quatro indicadores. Utilizou-se estatística descritiva para análise univariada; testes de Wald, de tendência linear, t de Student e qui-quadrado para a análise bivariada e regressão logística múltipla para análise multivariada com p<0,05. A análise multivariada mostrou que baixa escolaridade, não realizar atividade remunerada, parto cesáreo, oligodrâmnio, descolamento prematuro da placenta e pré-eclâmpsia são fatores independentes associados com a prematuridade e/ou baixo peso ao nascer. Para adequação do pré-natal, a variável Indicador III permaneceu significativa, mostrando que as mães que apresentaram inadequação da atenção pré-natal tiveram chance aumentada para a ocorrência do desfecho, evidenciando a necessidade de adequação de políticas públicas de saúde de atenção às gestantes no município estudado.

Abstract The main determinants of the risk of mortality in the neonatal period are low birth weight and premature birth. The study sought to analyze the adequacy of prenatal care and risk factors associated with premature birth and low birth weight in a northeastern Brazilian capital. This is a case-control study. A model for adequacy of prenatal conditions composed of four indicators was created. Descriptive statistics for univariate analysis were used; as well as Wald linear trend tests, Student’s t and chi-square test for bivariate analysis and multiple logistic regression for multivariate analysis with p <0.05. Multivariate analysis showed that poor education, not performing gainful activity, caesarean section, oligohydramnios, placental abruption and pre-eclampsia are independent factors associated with premature birth and/or low birth weight. For adequacy of prenatal care, variable indicator III remained significant, showing that mothers who had inadequate prenatal care had an increased chance for the occurrence of the outcome, highlighting the need for adequate public health policies of care for pregnant women in the municipality under scrutiny.

Brote de enfermedad alimentaria en la localidad de El Huecú, provincia de Neuquén / Foodborne disease outbreak in El Huecú community, province of Neuquén

En febrero de 2006 ocurrió un brote epidémico de gastroenteritis aguda de origen alimentario, en ocasión de un festejo popular en una pequeña localidad de la provincia de Neuquén, Argentina. Aproximadamente 800 personas participaron de un almuerzo en las instalaciones del Gimnasio Municipal, y unas tres horas después de finalizado, cerca de 150 asistentes consultaron al hospital local, afectados por síndrome gastroentérico agudo. Se realizó una investigación epidemiológica caso-control a través de un muestreo representativo no probabilístico. Los resultados epidemiológicos establecieron un brote de ETA a fuente común, con una relación caso-control de 1:1,8. Los principales síntomas fueron cólicos abdominales (88%), vómitos (73,5%) y diarrea (60%). La torta que se sirvió en ese evento fue identificada como el alimento causal (OR 9,79; IC 95%; 2,66-36,00; valor p = 0,0001), sujeto a condiciones higiénico-sanitarias insatisfactorias en los diferentes procesos de elaboración, conservación y manipulación. De una porción de la torta se aisló una cepa de Staphylococcus aureus subespecie aureus, coagulasa positiva, enterotoxigénica, con un recuento de 2,4x10(6) UFC/g, y también se aisló este microorganismo de tres muestras de manos y narinas de personas involucradas en la preparación y el servicio. Las cepas aisladas de un operador y de la torta portaron el gen sea y presentaron el mismo patrón de SmaI-PFGE. Se atribuyó el brote de ETA a la contaminación durante el proceso de preparación de la torta consumida durante ese almuerzo popular, lo que podría estar relacionado con deficiencias en aspectos higiénicos y con la falta de refrigeración y de mantenimiento de la cadena de frío.

In the summer of 2006, an epidemic outbreak of acute gastrointestinal illness related to food consumption occurred in a small town in the province of Neuquén, Argentina. During a popular feast, approximately 800 local residents attended lunch held in the facilities of the Municipal Gymnasium. About three hours later, nearly 150 attendees sought medical assistance at the local hospital due to acute gastroenteritis. A case-control epidemiological investigation was conducted using representative non-probability sampling. The epidemiological investigation showed a common-source foodborne disease outbreak with a case-control ratio of 1:1.8. The main symptoms were abdominal cramps (88%), vomiting (73.5%) and diarrhea (60%). The cake was identified as the source of infection (OR 9.79; IC 95%, 2.66-36.00; p = 0.0001), and unsatisfactory hygienic conditions in food production, conservation and handling steps were identified. Coagulase positive, enterotoxigenic Staphylococcus aureus, subspecies aureus was detected in a piece of cake, with a count of 2.4x10(6) CFU/g, and in samples from the hands and nostrils of three people involved in food preparation and service. The strains isolated from both the cake and one of the food handlers carried the sea gene, and presented the same SmaI-PFGE pattern. The foodborne disease outbreak was considered to be due to contamination in the preparation process of the cake consumed at the feast, which was related to inadequate hygienic conditions, lack of refrigeration and cold chain disruption.

Factores de riesgo de mortalidad en el hijo de madre toxémica / Mortality Risk Factors in the Child of a Toxemic Mother

Objetivo. Determinar los factores de riesgo de mortalidad en el hijo de madre toxémica. Material y métodos. Estudio de casos y controles en hijos de toxémicas, de producto único, de 28 a 42 semanas de gestación; los casos fueron los fallecidos y los controles los sobrevivientes. Resultados. Fueron 57 casos y 114 controles. Los factores de riesgo significativos: eclampsia (RM= 4.25, IC95% 1.76-10.39, p= 0.0002), desprendimiento placentario (RM= 8.13, IC95% 2.29-31.4, p= 0.00007), anestesia general (RM= 5.32, IC95% 1.74-16.51 p= 0.0005), síndrome de dificultad respiratoria (RM= 23.68, IC95% 3.31-478 p= 0.00004), ventilación mecánica (RM= 334, IC95% 42.63-7084, p=0.000000001), hemorragia peri-intraventricular (RM= 64.57, IC95% 8.36-1361, p = 0.0000001), insuficiencia renal aguda (RM= 26.13, IC95% 5.21-177, p= 0.0000002 ) y hemorragia pulmonar (RM= 8.40, IC95% 2.71-27.11, p= 0.000006). Se detectaron como factores protectores: alta escolaridad materna (RM= 0.110, IC95% 0.01-0.66, p= 0.02), desnutrición in útero (RM= 0.39, IC95% 0.18-0.84, p= 0.008) y taquipnea transitoria del recién nacido (RM= 0.021, IC95% 0.00-0.15, p= 0.00000001 Conclusiones. Los factores de riesgo maternos fueron: eclampsia, desprendimiento placentario, anestesia general y muerte materna; en el producto: síndrome de dificultad respiratoria, ventilación mecánica y hemorragia peri-intraventricular. Es interesante el hallazgo de los factores de protección.

Objective. To determine risk factors of mortality in the infant of a toxemic mother. Material and Methods. A case-controls study, single products only, of 28-42 weeks of gestation; cases were either stillborn and neonatal deaths. Where controls were survivors. Results. There were 57 cases and 114 controls. Significant risk factors were: eclampsia (OR= 4.25, 95%CI 1.76-10.39, p =0.0002), placental detachment (OR = 8.13,95%CL 2.29-31.4, p= 0.00007), general anesthesia (OR= 5.32, 95%CI 1.74-16.51, p=0.0005), respiratory distress syndrome (OR= 23.68, 95%CI 3.31-478 p= 0.00004), mechanic ventilation (OR= 334, 95%CI 42.63-7084, p= 0.000000001), peri-intraventricular hemorrhage (OR = 64.57, 95%CI 8.36-1361, p= 0.0000001), acute renal failure (OR=2613, 95%CI 5.21-177, p=0.0000002) and pulmonary hemorrhage (OR= 8.40, 95%CL 2.71-27.11, p= 0.000006). We observed as protective factors: high maternal educational level (OR=0.110, 95%CI 0.01-0.66, p= 0.02), intrauterine malnutrition (OR= 0.39, 95%CL 0.18-0.84, p= 0.008) and transient tachypnea of the newborn (OR= 0.021, 95%CI0.00-0.15,p= 0.00000001). Conclusions. We found as maternal risk factors: eclampsia; premature placental detachment; general anesthesia, and maternal death, in the newborns they were respiratory distress syndrome, mechanical ventilation and peri-intraventricular hemorrhage. The finding of protection factorsis unteresting.