Pharmaceutical Care Practice and Consequences on Quality of Life and Satisfaction of Diabetic Patients: A Randomized Clinical Trial

Abstract The pursuit of quality of life, which has become marked in recent years, has translated into important population health benefits. This study assessed the quality of life of patients with type 2 diabetes (T2DM) who received pharmaceutical care, and their satisfaction with the service provided in community pharmacies. This single blind, randomized controlled clinical trial included 100 patients. The intervention group (N=47) received pharmaceutical care by a clinical pharmacist and the control group (N=42) received standard care. The Quality of Life Diabetes Questionnaire (DQOL) was used to measure all participants´ quality of life at study enrollment and six months later. Satisfaction of the participants in the intervention group was measured using a validated 14-items questionnaire. At the end of the study, participants in the intervention group had a statistically significant improvement in DQOL scores ( -0.62 x 1.57, p < 0.001) and were highly satisfied with the intervention (96% excellent satisfaction scores). Pharmaceutical care practice was associated with high satisfaction and increased quality of life scores in T2DM patients. These results underscore the important role of pharmacists to improve the health of diabetic patients.

Food safety in Brazilian popular public restaurants: Food handlers' knowledge and practices.

This study aims to assess food safety knowledge and practices of food handlers in popular public restaurants in Brazil. A questionnaire has been applied with 70 food handlers in different municipalities, with questions related to food safety knowledge and food safety self-reported practices, and observed practices. To check hygienic-sanitary conditions of restaurants, a checklist has been applied. Regarding food safety knowledge, an average of 72.64% of correct answers has been observed. Food safety self-reported practices presented 80.71% of adequacy, while observed practices were 75.40%. A positive correlation has been observed between food safety knowledge and self-reported practices of handlers. The observed food safety practice of handlers presented no correlation with food safety knowledge and self-reported practices. The average adequacy of hygienic-sanitary conditions was 68.08%, classifying the units as "regular." Despite satisfactory results related to the handlers' food safety knowledge and practices, the hygienic-sanitary conditions of the restaurants are of concern. PRACTICAL APPLICATIONS: The Popular Restaurant Program in Brazil aims to provide proper food from a nutritional and hygienic-sanitary aspect at affordable prices. The assessment of food handlers' food safety knowledge and practices and the assessment of hygienic-sanitary conditions of these units are key in supporting actions aimed at improving the quality of the meals served, as food handlers are the essential agents in the production of meals and can become a source for food contamination if necessary care is not taken. Therefore, conducting this assessment can be an important tool for quality management in these units and can provide improvements in the process of food handling, in addition to ensuring compliance with the objectives proposed by the Popular Restaurant Program.

A manometry classification to assess pelvic floor muscle function in women.

OBJECTIVE: To develop a classification scale for manometry of pelvic floor muscles (PFM) in Brazilian women, according to the modified Oxford scale. METHODS: A cross sectional study, with 288 women enrolled in the Maternity, Natal, Brazil. Manometry and PFM strength data were collected and classified according to the modified Oxford scale. A simple linear regression was performed to determine the classification scale of manometry using the modified Oxford scale as the explanatory variable and the arithmetic mean of the manometry measurements as the response variable. RESULTS: The average age was 52.80 (±8.78; CI: 51.67-53.93) years. Manometry showed an average of 35.1 (±22.7; CI: 32.1-38.0) cmH2O and most women (29.7%) scored grade 3 on the modified Oxford scale. According to the proposed scale, values between 7.5 to 14.5 cmH2O correspond to very weak pressure; 14.6 to 26.5 cmH2O represent weak pressure; 26.6 to 41.5 cmH2O represent moderate pressure; 41.6 to 60.5 cmH2O represent good pressure, and values above 60.6 cmH2O correspond to strong pressure. CONCLUSION: Manometry values were rated on a five-point scale. It is possible to rank the pressure levels performed by voluntary contraction of PFM with this new scale.

Characteristics of Triatomine infestation and natural Trypanosoma cruzi infection in the State of Rio Grande do Norte, Brazil.

INTRODUCTION Natural and artificial ecotope infestation by the kissing bug triatomines and their colonization and infection by Trypanosoma cruzi , the Chagas disease agent, were evaluated in nine municipalities of the State of Rio Grande do Norte, Brazil. METHODS Following identification, triatomine intestinal contents were analyzed by direct microscopic examination, xenoculture, and polymerase chain reaction (PCR) for parasite detection. Trypanosoma cruzi isolates were genotyped using three different markers. RESULTS Of 842 triatomines captured, 65% were Triatoma brasiliensis , 17.8% Triatoma pseudomaculata , 12.5% Panstrongylus lutzi , and 4.7% Rhodnius nasutus . Triatoma brasiliensis and P. lutzi adults were found in the intradomicile. T. brasiliensis, T. pseudomaculata , and R. nasutus nymphs and adults were found in the peridomicile and wild environment. Intradomiciliary and peridomiciliary infestation indexes were 5.6% and 33.7%, respectively. In the peridomicile, chicken coops were the most infested ecotope. The T. cruzi triatomine infection rate was 30.2%, of which PCR detected 29%. P . lutzi (78.1%), T . brasiliensis (24.5%), and T . pseudomaculata (22.7%) were the most infected species. TcII and III genotypes were detected in T. brasiliensis and TcIII in P. lutzi . CONCLUSIONS T. brasiliensis was found in all environments and most ecotopes with high T. cruzi infection rates. High infection rates were also detected in T . pseudomaculata and P. lutzi , suggesting their role in the interchange between the wild and peridomestic transmission cycles. The combination of PCR, microscopic examination, and xenoculture contributed to improving T. cruzi infection evaluation in triatomine bugs. The TcII and TcIII genotypes were predominant in the study area.

Characteristics of Triatomine infestation and natural Trypanosoma cruzi infection in the State of Rio Grande do Norte, Brazil

Abstract: INTRODUCTION Natural and artificial ecotope infestation by the kissing bug triatomines and their colonization and infection by Trypanosoma cruzi , the Chagas disease agent, were evaluated in nine municipalities of the State of Rio Grande do Norte, Brazil. METHODS Following identification, triatomine intestinal contents were analyzed by direct microscopic examination, xenoculture, and polymerase chain reaction (PCR) for parasite detection. Trypanosoma cruzi isolates were genotyped using three different markers. RESULTS Of 842 triatomines captured, 65% were Triatoma brasiliensis , 17.8% Triatoma pseudomaculata , 12.5% Panstrongylus lutzi , and 4.7% Rhodnius nasutus . Triatoma brasiliensis and P. lutzi adults were found in the intradomicile. T. brasiliensis, T. pseudomaculata , and R. nasutus nymphs and adults were found in the peridomicile and wild environment. Intradomiciliary and peridomiciliary infestation indexes were 5.6% and 33.7%, respectively. In the peridomicile, chicken coops were the most infested ecotope. The T. cruzi triatomine infection rate was 30.2%, of which PCR detected 29%. P . lutzi (78.1%), T . brasiliensis (24.5%), and T . pseudomaculata (22.7%) were the most infected species. TcII and III genotypes were detected in T. brasiliensis and TcIII in P. lutzi . CONCLUSIONS T. brasiliensis was found in all environments and most ecotopes with high T. cruzi infection rates. High infection rates were also detected in T . pseudomaculata and P. lutzi , suggesting their role in the interchange between the wild and peridomestic transmission cycles. The combination of PCR, microscopic examination, and xenoculture contributed to improving T. cruzi infection evaluation in triatomine bugs. The TcII and TcIII genotypes were predominant in the study area.

Genital tract infection with Chlamydia trachomatis in women attended at a cervical cancer screening program in Northeastern from Brazil.

PURPOSE: This cross-sectional study aimed to estimate the prevalence of Chlamydia trachomatis (CT) infection alone and in combination with human papillomavirus (HPV). Furthermore, the study investigates whether the CT infection increases the risk of contracting HPV and whether the presence of both pathogens is associated with a higher prevalence of cervical lesions. METHODS: Cervical samples of 1,134 asymptomatic women enrolled in a screening program for cervical cancer were analyzed. Two cervical specimens were collected from each patient, one for cytologic examination and the other for detection of CT by polymerase chain reaction (PCR), using a primer pair which amplifies a specific sequence of the DNA plasmid. RESULTS: The overall prevalence rate infection was 10.9%, being 10% in the women with normal cytology, 13.8% in those with atypical squamous cells of undetermined significance (ASC-US), and 25% with low-grade squamous intraepithelial lesion (LSIL). The infection by CT did not increase the risk of acquiring HPV infection. The higher prevalence of LSIL in women co-infected with HPV and CT is possibly due to HPV. CONCLUSION: CT infection was more prevalent in younger women aged up to 32 years, who had an early onset of reproductive activity and a history of having had multiple sexual partners lifelong may be at a greater risk of acquiring infection of the genital tract by C. trachomatis.

Immunoexpression of transforming growth factor beta and interferon gamma in radicular and dentigerous cysts.

INTRODUCTION: The aim of this study was to evaluate and compare the immunohistochemical expression of transforming growing factor beta (TGF-ß) and interferon gamma (IFN-γ) between radicular cysts (RCs) and dentigerous cysts (DCs). METHODS: Twenty RCs and DCs were selected for analysis of the immunoexpression of TGF-ß and IFN-γ in the epithelium and capsule. RESULTS: The cell reactivity of TGF-ß and IFN-γ in the lining epithelium and capsule of RCs showed no significant differences when compared with DCs (P > .05). There was a tendency of a higher expression of TGF-ß in the capsule of DCs. CONCLUSIONS: Our results showed the presence of TGF-ß and IFN-γ in RCs and DCs, supporting the hypothesis that both participate in the development of these lesions, where IFN-γ usually plays a role in bone resorption, which is counterbalanced by the osteoprotective activity performed by TGF-ß.

Genital infection with herpes simplex virus types 1 and 2 in women from natal, Brazil.

Objective. To evaluate the prevalence of HSV-1 and HSV-2 in pregnant and nonpregnant women, testing the correlation between DNA of the viruses with colposcopic and/or cytological changes, and evaluate association with sociodemographic characteristics and sexual activity. Methods. Included in this study were 106 pregnant and 130 nonpregnant women treated at primary health care units of Natal, Brazil, in the period 2010-2011. The patients were examined by colposcopy, and two cervical specimens were collected: one for cytology examination and another for analysis by PCR for detection of HSV-1 and HSV-2. Results. HSV-1 alone was detected in 16.0% of pregnant and 30.0% of nonpregnant women. For HSV-2, these rates were 12.3% and 15.5%, respectively. HSV-2 had a higher correlation with cytology and/or colposcopy changes than HSV-1 did. Genital HSV-1 infection was not associated with any of the variables tested, whereas HSV-2 infection was associated with ethnicity, marital status, and number of sexual partners. Conclusions. The prevalence of HSV-1 was higher than that observed for HSV-2 in both pregnant and nonpregnant women. The genital infection by HSV-2 was higher in women with changed colposcopy and/or cytology, and it was associated with ethnicity, marital status, and number of sexual partners.

Knowledge, attitudes and practices regarding the Pap test among women in Northeastern Brazil.

CONTEXT AND OBJECTIVE: The Papanicolaou (Pap) test has been shown to be effective in preventing cervical cancer. However, both the national and international literature shows that Pap testing has not reached the level of coverage desired. The objective of this study was to assess women's knowledge, attitudes and practices regarding the Pap test and to investigate whether there are any associations between these three factors and the women's sociodemographic characteristics. DESIGN AND SETTING: Cross-sectional descriptive study conducted in Floriano, Piauí. METHODS: The study was conducted among 493 women between November 2009 and December 2010. A questionnaire with precoded questions was sed, and the responses were analyzed in terms of appropriateness in relation to the Pap test. RESULTS: The degrees of adequacy of knowledge, attitudes and practices regarding the Pap test were 36.7%, 67.2% and 69.6%, respectively. Among the main barriers against testing, absence of symptoms and a sense of embarrassment were the most notable. CONCLUSIONS: Women who visit doctors periodically had the most appropriate practices regarding the Pap test, but their knowledge of the procedure was poor. This suggests that these women were not receiving adequate information about the benefits of periodic testing.

Knowledge, attitudes and practices regarding the Pap test among women in northeastern Brazil / Conhecimentos, atitudes e praticas sobre o exame de Papanicolaou em mulheres do nordeste brasileiro

CONTEXT AND OBJECTIVE: The Papanicolaou (Pap) test has been shown to be effective in preventing cervical cancer. However, both the national and international literature shows that Pap testing has not reached the level of coverage desired. The objective of this study was to assess women's knowledge, attitudes and practices regarding the Pap test and to investigate whether there are any associations between these three factors and the women's sociodemographic characteristics. DESIGN AND SETTING: Cross-sectional descriptive study conducted in Floriano, Piauí. METHODS : The study was conducted among 493 women between November 2009 and December 2010. A questionnaire with precoded questions was sed, and the responses were analyzed in terms of appropriateness in relation to the Pap test. RESULTS : The degrees of adequacy of knowledge, attitudes and practices regarding the Pap test were 36.7%, 67.2% and 69.6%, respectively. Among the main barriers against testing, absence of symptoms and a sense of embarrassment were the most notable. CONCLUSIONS: Women who visit doctors periodically had the most appropriate practices regarding the Pap test, but their knowledge of the procedure was poor. This suggests that these women were not receiving adequate information about the benefits of periodic testing. .

CONTEXTO E OBJETIVO: O exame de Papanicolaou já mostrou efetividade na prevenção de câncer do colo do útero. A literatura nacional e internacional tem mostrado que o exame de Papanicolaou não tem alcançado o índice de cobertura desejado. O objetivo deste estudo foi avaliar os conhecimentos, atitudes e práticas entre mulheres em relação ao exame de Papanicolaou e verificar se existe associação entre esses comportamentos e as características sociodemográficas. TIPO DE ESTUDO E LOCAL: Estudo descritivo e transversal realizado em Floriano, Piauí. MÉTODOS: O estudo foi conduzido com 493 mulheres no período de novembro de 2009 a dezembro de 2010. Utilizou-se m questionário com perguntas precodificadas, cujas respostas foram analisadas quanto à adequação dos comportamentos em relação ao exame. RESULTADOS: Os graus de adequação dos conhecimentos, atitudes e práticas em relação ao exame foram de 36,7%, 67,2% e 69,6%, respectivamente. Dentre as principais barreiras para a sua realização, destacaram-se a ausência de sintomas e a vergonha. CONCLUSÃO: As mulheres que realizam consultas periodicamente apresentam prática mais adequada, porém com baixa adequação de conhecimentos frente ao procedimento, sugerindo que não estejam recebendo as informações adequadas sobre os benefícios da realização periódica do exame de Papanicolaou. .

Knowledge about HPV and Screening of Cervical Cancer among Women from the Metropolitan Region of Natal, Brazil.

Objective. The purpose of this study was to assess the knowledge level about HPV and screening of cervical cancer in women from the metropolitan region of Natal, Brazil. Materials and Methods. A descriptive cross-sectional study involving sexually active women was conducted. The participants were submitted to a face-to-face interview, using a structured questionnaire that permitted the quantification of data and opinions of the respondents. Results. Most participants (70.9%) had poor knowledge about HPV and also the Pap test (53.0%). The high level of knowledge about HPV was associated with age, education, marital status, household income, and pregnancy, while the high level of knowledge about the Pap test proved to be associated only with education and household income. Conclusion. The results highlight the need for performing educational campaigns emphasizing the role of HPV in the etiology of cervical lesions of different degrees, including cervical cancer, as well as the importance of having a Pap test regularly to prevent these diseases.

Ecological interactions among phlebotomines (Diptera: Psychodidae) in an agroforestry environment of northeast Brazil.

Phlebotomine vectors transmit parasites and can cause visceral leishmaniasis (VL) or cutaneous leishmaniasis (TL). Phlebotomine females are hematophagous but need to ingest carbohydrates, possibly promoting the development of protozoan parasites in their digestive tract. The present study evaluated the species composition and abundance across several habitats in a metropolitan landscape, as well as associations among phlebotomines, plants, and local climatic parameters. Three consecutive monthly collections were carried out in an Atlantic Forest fragment, using CDC light traps in peridomestic areas and cashew, coconut, and mango tree. plantations. Eight species of phlebotomine were captured: Evandromyia evandroi, Lutzomyia longipalpis, Psathyromyia shannoni, Sciopemyia sordellii, Evandromyia walkeri, Psychodopygus wellcomei, Nyssomyia whitmani, and Nyssomyia intermedia, primarily from the forest environment. L. longipalpis was confirmed as a species adapted to anthropic environments, while P. wellcomei was shown to be predominately forest-dwelling. Phlebotomines exhibited diversified food consumption patterns in relation to carbohydrate sources. They fed on both native and exotic species of arboreal and shrubby vegetables and gramineous plants.

Seroepidemiology of Trypanosoma cruzi infection in the semiarid rural zone of the State of Rio Grande do Norte, Brazil.

INTRODUCTION: A seroepidemiological survey was carried out to evaluate Trypanosoma cruzi infection in an endemic area of the State of Rio Grande do Norte, Brazil, involving rural residents. METHODS: Sixteen municipalities were randomly selected, 15 from the west mesoregion and one from the central, with an estimated population of 83,852 individuals. A total of 1,950 blood samples were collected in the west mesoregion and 390 in Caicó. Anti-T. cruzi antibodies were detected using the Chagatest® ELISA HAI-hemagglutination kits and indirect immunofluorescence. As sera presented indeterminate results, TESAcruzi® western blot was performed to confirm reactivity. RESULTS: An estimated seroprevalence of 6.5% was determined for the west mesoregion and 3.3% for Caicó. Seropositivity rises progressively with the age of individuals, up to 40 years in Caicó and up to 50 years in the west mesoregion. Only educational level and knowledge regarding the triatomine were associated with seropositivity. No seroreactive individuals under 18 years of age were identified. CONCLUSIONS: Infection by T. cruzi remains high and is concentrated in municipalities in the central western area of the west mesoregion; however, evidence suggests a decline in vector transmission in this mesoregion and in Caicó. Epidemiological variables appear not to influence seropositivity, with the exception of education and knowledge concerning the triatomine, among seroreactive individuals from the west mesoregion.

Seroepidemiology of Trypanosoma cruzi infection in the semiarid rural zone of the State of Rio Grande do Norte, Brazil / Soroepidemiologia da infecção pelo Trypanosoma cruzi na zona rural do semiárido do Estado do Rio Grande do Norte, Brasil

INTRODUCTION: A seroepidemiological survey was carried out to evaluate Trypanosoma cruzi infection in an endemic area of the State of Rio Grande do Norte, Brazil, involving rural residents. METHODS: Sixteen municipalities were randomly selected, 15 from the west mesoregion and one from the central, with an estimated population of 83,852 individuals. A total of 1,950 blood samples were collected in the west mesoregion and 390 in Caicó. Anti-T. cruzi antibodies were detected using the Chagatest® ELISA HAI-hemagglutination kits and indirect immunofluorescence. As sera presented indeterminate results, TESAcruzi® western blot was performed to confirm reactivity. RESULTS: An estimated seroprevalence of 6.5% was determined for the west mesoregion and 3.3% for Caicó. Seropositivity rises progressively with the age of individuals, up to 40 years in Caicó and up to 50 years in the west mesoregion. Only educational level and knowledge regarding the triatomine were associated with seropositivity. No seroreactive individuals under 18 years of age were identified. CONCLUSIONS: Infection by T. cruzi remains high and is concentrated in municipalities in the central western area of the west mesoregion; however, evidence suggests a decline in vector transmission in this mesoregion and in Caicó. Epidemiological variables appear not to influence seropositivity, with the exception of education and knowledge concerning the triatomine, among seroreactive individuals from the west mesoregion.

INTRODUÇÃO: A infecção pelo Trypanosoma cruzi foi avaliada em uma área endêmica do Estado do Rio Grande do Norte, Brasil, por inquérito soroepidemiológico amostral em moradores da zona rural. MÉTODOS: Dezesseis municípios foram sorteados, 15 da mesorregião oeste e um da central, com população estimada em 83.852 indivíduos. Foram coletadas 1.950 amostras de sangue no oeste e 390 em Caicó. A detecção de anticorpos anti-T. cruzi foi realizada usando os kits Chagatest® ELISA, HAI-hemaglutinação e a reação de imunofluorescência indireta. Nos soros com resultados indeterminados foi realizado o western blot TESAcruzi® para confirmação da reatividade. RESULTADOS: A estimativa da soroprevalência revelou 6,5% para a mesorregião oeste e 3,3% em Caicó. A soropositividade eleva-se progressivamente com a idade dos indivíduos até a quinta década de vida em Caicó e na sexta década na mesorregião oeste. Apenas o grau de escolaridade e o conhecimento do triatomíneo evidenciaram associação à soropositividade. Não foram identificados indivíduos sororreativos com idade inferior a 18 anos. CONCLUSÕES: A infecção pelo T. cruzi persiste mais elevada e concentrada em municípios da área central da mesorregião oeste, mas evidências sugerem o declínio da transmissão vetorial nessa mesorregião e em Caicó. As variáveis epidemiológicas parecem não exercer influência na soropositividade, à exceção da escolaridade e conhecimento do triatomíneo entre indivíduos sororreativos da mesorregião oeste.

Frequência e perfil de resistência de Klebsiella spp. em um hospital universitário de Natal/RN durante 10 anos / Frequence and resistance profile of Klebsiella spp. isolates in a university hospital in Natal/RN during a ten-year period

INTRODUÇÃO: As espécies de Klebsiella spp. podem causar vários tipos de infecções, principalmente hospitalares, e têm merecido destaque pelos seus variados e emergentes mecanismos de resistência. OBJETIVOS: Determinar a frequência de isolamento e a caracterização do perfil de resistência de Klebsiella spp. em um hospital universitário durante um período de 10 anos e, ainda, avaliar a tendência para o crescimento dessa resistência. Material e método: Fez-se um estudo descritivo e retrospectivo a partir de dados coletados nos livros de registro do Laboratório de Microbiologia Clínica do hospital investigado, correspondentes ao período de janeiro de 1999 a dezembro de 2008. RESULTADO: A frequência de isolamento de Klebsiella spp. foi de 13,4 por cento com predominância em uroculturas (56,4 por cento). Houve aumento significativo na resistência para a maioria dos antimicrobianos testados ao longo do período analisado com tendência para o crescimento da mesma. Nesse período, isolou-se 23 por cento de Klebsiella spp. com fenótipo produtor de betalactamases de amplo espectro (ESBL). DISCUSSÃO: O isolamento de Klebsiella spp. resistente a antimicrobianos em amostras de origem clínica e a detecção da tendência do crescimento da resistência, inclusive às drogas de reserva terapêutica, são motivos de grande preocupação. Nesse hospital, a implantação de métodos de triagem e de confirmatórios para os mecanismos de resistência de Klebsiella spp. poderiam auxiliar no diagnóstico e no tratamento das infecções causadas por esse microrganismo. CONCLUSÃO: A tendência de crescimento na resistência aos antibióticos detectada neste estudo reforça a importância de monitoramentos contínuos. Estes elucidam características locais, orientando para melhores medidas de controle.

INTRODUCTION: Klebsiella spp. species can cause several infections, particularly nosocomial ones. Furthermore, its multiple emerging resistance mechanisms have been widely described. OBJECTIVES: To determine the isolation frequency and resistance profile of Klebsiella spp. at a university hospital during a ten-year period as well as to assess the increase in its resistance. Material and method: A retrospective and descriptive study was carried out based on data collected from the record books of the Laboratory of Clinical Microbiology of the investigated Hospital from January 1999 to December 2008. RESULTS: The isolation frequency of Klebsiella spp. was 13.4 percent, predominantly in urine cultures (56.4 percent). There was a significant increase in resistance to most antimicrobials tested over the analyzed period; 23 percent of Klebsiella spp. with ESBL phenotype was isolated over this period. DISCUSSION: Multi-resistant Klebsiella spp. isolates from clinical samples as well as its growing trend in resistance mechanisms, including to reserve drugs, are cause for great concern. The implementation of screening and confirmatory methods of bacterial resistance could aid in the diagnosis and treatment of infections caused by this microorganism. CONCLUSION: The increase in resistance to antibiotics reinforces the importance of continuous monitoring, which elucidates local characteristics and allows more suitable control measures.

Human papillomavirus prevalence in women with normal cytology and with cervical cancer in Natal, Brazil.

This study analyzed the prevalence of human papillomavirus (HPV) in cervical specimens obtained from women with normal cytology and with cervical cancer, in order to evaluate their correlation with health status and demographic characteristics, as well as sexual and reproductive activity in women treated at a cancer reference hospital in Natal, Northeast Brazil. A total of 158 women were divided into 2 groups according to their health status: group I comprised 110 women with normal cytology, and group II comprised 48 women with cervical cancer. Cervical smears were analyzed by cytological or histopathological examination for the detection of cytological alterations, and by PCR for HPV DNA detection using MY09/11 primers, followed by HPV genotyping by dot blot hybridization. Results showed overall HPV prevalence to be 24.5% in group I, with 19.1% of patients having single infection and 5.4% double infection. The HPV prevalence in group II was 85.4%, with 79.2% of patients having single and 6.2% double infection. We identified 10 different HPV genotypes, most with high oncogenic potential. HPV 16 was the most prevalent genotype in the two studied groups, followed by HPV 58 and HPV 18. High-risk HPV genital infection, chronological age, ethnicity, early onset of sexual and reproductive activities, multiple sexual partners and smoking increased the risk for cervical cancer.

Comparative immunohistochemical expression of RANK, RANKL and OPG in radicular and dentigerous cysts.

OBJECTIVE: Receptor activator of nuclear factor-κB (RANK), RANK ligand (RANKL) and osteoprotegerin (OPG) are members of the superfamily of ligands and receptors of tumour necrosis factor family involved in bone metabolism. The formation, differentiation and activity of osteoclasts are regulated by these proteins. To clarify the roles of osteoclast regulatory factors in cystic expansion of odontogenic cysts, expression of these proteins were analysed in radicular and dentigerous cysts. DESIGN: The immunohistochemistry expression of these biomarkers were evaluated and measured in lining epithelium and fibrous capsule of the radicular (n=20) and dentigerous cysts (n=20). RESULTS: A similar expression in lining epithelium was observed in the lesions. The fibrous capsule of dentigerous cyst showed a higher content of RANK-positive and RANKL-positive cells than fibrous capsule of radicular cyst. In the lining epithelium the RANKL/OPG ratio showed higher numbers of OPG-positive than RANKL-positive cells, whereas fibrous capsule of the cysts had a tendency to present a similar expression (OPG=RANKL). CONCLUSION: Ours findings indicate the presence of RANK, RANKL and OPG in cysts. Moreover, increased expression of OPG compared to RANKL in the lining epithelium could contribute to the differential bone resorption activity in theses lesions.

Câncer de boca e orofaringe: tendências e análise de sobrevida em Natal (RN) / Oral and oropharyngeal cancer: trends and analysis of survival in Natal (RN)

Introdução: O câncer de boca é classificado como uma das dez maiores incidências de câncer no mundo. No Brasil, as taxas de incidência e de mortalidade por esse câncer encontram-se entre as mais elevadas do mundo. Para o câncer intraoral (língua, gengiva, base da boca e outras e não especificadas partes da boca), a taxa acumulada de sobrevida após 5 anos é menor que 50%. Objetivo: Estimar a probabilidade acumulada de sobrevida após 5 anos, ajustar o modelo de regressão de Cox para os cânceres de boca e de orofaringe, segundo faixa etária, sexo, morfologia e localização, para a cidade de Natal, Brasil. Descrever os coeficientes de mortalidade e de incidência dos cânceres de boca e de orofaringe e as tendências desses coeficientes para a cidade de Natal, nos períodos de 1980 a 2001 e de 1997 a 2001, respectivamente. Metodologia: Foi obtida a sobrevida de pacientes registrados entre 1997 e 2001 no Registro de Câncer de Base populacional de Natal. Foram testadas as diferenças entre as curvas de sobrevida através do teste log-rank. O modelo de riscos proporcionais de Cox foi utilizado para estimativas das razões de riscos. O modelo de regressão linear simples foi utilizado para as análises de tendência dos coeficientes de incidência e de mortalidade. Resultados: A probabilidade acumulada após 5 anos para todos os casos foi de 22,9%. Os pacientes com neoplasia maligna indiferenciada têm 4,7 vezes mais risco de morrer do que aqueles com carcinoma epidermóide, enquanto que os pacientes com câncer de orofaringe têm 2,0 vezes mais risco de morrer do que aqueles com câncer de boca. Os coeficientes padronizados de mortalidade e de incidência do câncer de boca em Natal foram, respectivamente, 2,9 e 4,3 por 100 mil habitantes. Para o câncer de orofaringe10 os coeficientes obtidos de mortalidade e de incidência foram, respectivamente, 1,1 e 0,7 por 100 mil habitantes. Conclusão: Identifica-se uma baixa taxa de sobrevida após 5 anos. Pacientes com câncer de boca...

Purpose Estimate the accumulated survival probability after five years and adjust the Cox regression model for mouth and oropharyngeal cancers, according to age range, sex, morphology, and location, for the city of Natal, Brazil. Methods Survival data of patients registered between 1997 and 2001 was obtained from the Population-based Cancer Record of Natal. Differences between the survival curves were tested using the log-rank test. The Cox proportional risk model was used to estimate risk ratios. Results The median survival time obtained for all the cases was 9.5 months, with accumulated probability after five years of 22.9%. The patients with undifferentiated malignant neoplasia were 4.7 times more at risk of dying than those with epidermoid carcinoma, whereas the patients with oropharyngeal cancer had 2.0 times more at risk of dying than those with mouth cancer. Conclusions A low survival rate after five years was identified and no improvement in prognosis was observed over time. Patients with oropharyngeal cancer had a greater risk of dying, independent of the factors considered in this study. Also independent of other factors, undifferentiated malignant neoplasia posed a greater risk of death.

Conhecimentos, atitudes e prática do exame de Papanicolaou por mulheres, Nordeste do Brasil / Knowledge, attitudes, and practices related to Pap test by women, Northeastern Brazil

OBJETIVO: Analisar conhecimentos, atitudes e práticas das mulheres em relação ao exame citológico de Papanicolaou e a associação entre esses comportamentos e características sociodemográficas MÉTODOS: Inquérito domiciliar com abordagem quantitativa. Foram entrevistadas 267 mulheres com idade de 15 a 69 anos, selecionadas de forma estratificada aleatória, residentes no município de São José do Mipibu, RN, em 2007. Utilizou-se questionário com perguntas pré-codificadas e abertas, cujas respostas foram descritas e analisadas quanto à adequação dos conhecimentos, atitudes e prática das mulheres em relação ao exame preventivo de Papanicolaou. Foram realizados testes de associação entre as características sociodemográficas e os comportamentos estudados, com nível de significância de 5%. RESULTADOS: Apesar de 46,1% das mulheres entrevistadas terem mostrado conhecimento adequado, proporções de adequação significativamente maiores foram observadas em relação às atitudes e prática quanto ao exame: 63,3% e 64,4%, respectivamente. O maior grau de escolaridade apresentou associação com adequação dos conhecimentos, atitudes e prática, enquanto as principais barreiras para a realização do exame relatadas foram descuido, falta de solicitação do exame pelo médico e vergonha. CONCLUSÕES: O médico é a principal fonte de informação sobre o exame de Papanicolau. Entretanto, mulheres que vão a consultas com maior freqüência, embora apresentem prática mais adequada do exame, possuem baixa adequação de conhecimento e atitude frente ao procedimento, sugerindo que não estejam recebendo as informações adequadas sobre o objetivo do exame, suas vantagens e benefícios para sua saúde.

OBJECTIVE: To assess the knowledge, attitudes and practices of women related to the Pap test and the association between these behaviors and sociodemographic characteristics. METHODS: A household survey with quantitative approach was conducted. A total of 267 women aged 15 to 69 years, randomly selected in a stratified manner, living in the city of São José de Mipibu, Northeastern Brazil, were interviewed in 2007. A questionnaire consisting of pre-coded open questions was administered and answers were described and analyzed, as for adequacy of knowledge, attitudes, and practices of women regarding the Pap test. Tests of association were carried out between sociodemographic characteristics and behaviors studied at a 5% significance level. RESULTS: Although 46.1% of the women interviewed showed adequate knowledge about the Pap test, a significantly higher proportion of adequacy was seen regarding attitudes and practices, 63.3% and 64.4%, respectively. Higher schooling was associated with adequacy of knowledge, attitudes, and practices. The main barriers to the Pap test were negligence, non-requesting by their physicians, and shame. CONCLUSIONS: The physician is the main source of information about the Pap test. However, women who more often attend medical visits, despite their good practice, show low adequacy of knowledge and attitudes related to the Pap test, which indicates that they are not receiving appropriate information on the test's purpose, advantages and benefits to women's health.

Knowledge, attitudes, and practices related to Pap test by women, Northeastern Brazil.

OBJECTIVE: To assess the knowledge, attitudes and practices of women related to the Pap test and the association between these behaviors and sociodemographic characteristics. METHODS: A household survey with quantitative approach was conducted. A total of 267 women aged 15 to 69 years, randomly selected in a stratified manner, living in the city of São José de Mipibu, Northeastern Brazil, were interviewed in 2007. A questionnaire consisting of pre-coded open questions was administered and answers were described and analyzed, as for adequacy of knowledge, attitudes, and practices of women regarding the Pap test. Tests of association were carried out between sociodemographic characteristics and behaviors studied at a 5% significance level. RESULTS: Although 46.1% of the women interviewed showed adequate knowledge about the Pap test, a significantly higher proportion of adequacy was seen regarding attitudes and practices, 63.3% and 64.4%, respectively. Higher schooling was associated with adequacy of knowledge, attitudes, and practices. The main barriers to the Pap test were negligence, non-requesting by their physicians, and shame. CONCLUSIONS: The physician is the main source of information about the Pap test. However, women who more often attend medical visits, despite their good practice, show low adequacy of knowledge and attitudes related to the Pap test, which indicates that they are not receiving appropriate information on the test's purpose, advantages and benefits to women's health.