Association of donor hepatectomy time with liver transplantation outcomes: A multicenter retrospective study.

BACKGROUND: Prolonged donor hepatectomy time may be implicated in early and late complications of liver transplantation. AIM: To evaluate the impact of donor hepatectomy time on outcomes of liver transplant recipients, mainly early allograft dysfunction. METHODS: This multicenter retrospective study included brain-dead donors and adult liver graft recipients. Donor-recipient matching was obtained through a crossover list. Clinical and laboratory data were recorded for both donors and recipients. Donor hepatectomy, cold ischemia, and warm ischemia times were recorded. Primary outcome was early allograft dysfunction. Secondary outcomes included need for retransplantation, length of intensive care unit and hospital stay, and patient and graft survival at 12 months. RESULTS: From January 2019 to December 2021, a total of 243 patients underwent a liver transplant from a brain-dead donor. Of these, 57 (25%) developed early allograft dysfunction. The median donor hepatectomy time was 29 (23-40) min. Patients with early allograft dysfunction had a median hepatectomy time of 25 (22-38) min, whereas those without it had a median time of 30 (24-40) min (P = 0.126). CONCLUSION: Donor hepatectomy time was not associated with early allograft dysfunction, graft survival, or patient survival following liver transplantation.

Does liraglutide alleviate inflammation in brain-dead donors? A randomized clinical trial.

Brain death triggers an inflammatory cascade that damages organs before procurement, adversely affecting the quality of grafts. This randomized clinical trial aimed to compare the efficacy of liraglutide compared to placebo in attenuating brain death-induced inflammation, endoplasmic reticulum stress, and oxidative stress. We conducted a double-blinded, placebo-controlled, randomized clinical trial with brain-dead donors. Fifty brain-dead donors were randomized to receive subcutaneous liraglutide or placebo. The primary outcome was the reduction in IL-6 plasma levels. Secondary outcomes were changes in other plasma pro-inflammatory (IL-1ß, interferon-γ, TNF) and anti-inflammatory cytokines (IL-10), expression of antiapoptotic ( BCL2 ), endoplasmic reticulum stress markers ( DDIT3/CHOP , HSPA5/BIP ), and antioxidant ( superoxide dismutase 2 , uncoupling protein 2 ) genes, and expression TNF, DDIT3, and superoxide dismutase 2 proteins in liver biopsies. The liraglutide group showed lower cytokine levels compared to the placebo group during follow-up: Δ IL-6 (-28 [-182, 135] vs. 32 [-10.6, 70.7] pg/mL; p = 0.041) and Δ IL-10 (-0.01 [-2.2, 1.5] vs. 1.9 [-0.2, 6.1] pg/mL; p = 0.042), respectively. The administration of liraglutide did not significantly alter the expression of inflammatory, antiapoptotic, endoplasmic reticulum stress, or antioxidant genes in the liver tissue. Similar to gene expression, expressions of proteins in the liver were not affected by the administration of liraglutide. Treatment with liraglutide did not increase the organ recovery rate [OR = 1.2 (95% CI: 0.2-8.6), p = 0.82]. Liraglutide administration reduced IL-6 and prevented the increase of IL-10 plasma levels in brain-dead donors without affecting the expression of genes and proteins related to inflammation, apoptosis, endoplasmic reticulum stress, or oxidative stress.

Brain death-induced cytokine release is not associated with primary graft dysfunction: a cohort study. / A liberação de citocinas induzida pela morte cerebral não está associada à disfunção primária do enxerto: um estudo de coorte.

OBJECTIVE: To examine the association between donor plasma cytokine levels and the development of primary graft dysfunction of organs transplanted from deceased donors. METHODS: Seventeen deceased donors and the respective 47 transplant recipients were prospectively included in the study. Recipients were divided into two groups: group 1, patients who developed primary graft dysfunction; and group 2, patients who did not develop primary graft dysfunction. Donor plasma levels of TNF, IL-6, IL-1ß, and IFN-γ assessed by ELISA were compared between groups. RESULTS: Sixty-nine organs were retrieved, and 48 transplants were performed. Donor plasma cytokine levels did not differ between groups (in pg/mL): TNF, group 1: 10.8 (4.3 - 30.8) versus group 2: 8.7 (4.1 - 33.1), p = 0.63; IL-6, group 1: 1617.8 (106.7 - 5361.7) versus group 2: 922.9 (161.7 - 5361.7), p = 0.56; IL-1ß, group 1: 0.1 (0.1 - 126.1) versus group 2: 0.1 (0.1 - 243.6), p = 0.60; and IFN-γ, group 1: 0.03 (0.02 - 0.2) versus group 2: 0.03 (0.02 - 0.1), p = 0.93). Similar findings were obtained when kidney transplants were analyzed separately. CONCLUSION: In this sample of transplant recipients, deceased donor plasma cytokines TNF, IL-6, IL-1ß, and IFN-γ were not associated with the development of primary graft dysfunction.

OBJETIVO: Examinar a associação entre os níveis de citocinas no plasma do doador e o desenvolvimento de disfunção primária do enxerto de órgãos transplantados a partir de doadores falecidos. MÉTODOS: Foram incluídos no estudo de forma prospectiva 17 doadores falecidos e os respectivos 47 pacientes receptores de transplante. Os receptores foram divididos em dois grupos: grupo 1, de pacientes que desenvolveram disfunção primária do enxerto, e grupo 2, de pacientes que não desenvolveram disfunção primária do enxerto. Os níveis de TNF, IL-6, IL-1ß, e IFN-γ, avaliados por meio de ELISA, foram comparados entre os grupos. RESULTADOS: Obtiveram-se 69 órgãos, sendo realizados 48 transplantes. Os níveis plasmáticos de citocinas nos doadores não diferiram entre os grupos (em pg/mL): TNF no grupo 1, com 10,8 (4,3 - 30,8) versus no grupo 2, com 8,7 (4,1 - 33,1), com valor de p = 0,63; IL-6 no grupo 1: 1.617,8 (106,7 - 5.361,7) versus no grupo 2: 922,9 (161,7 - 5.361,7), com p = 0,56; IL-1ß, no grupo 1: 0,1 (0,1 - 126,1) versus no grupo 2: 0,1 (0,1 - 243,6), com p = 0,60; e IFN-γ, no grupo 1: 0,03 (0,02 - 0,2) versus no grupo 2: 0,03 (0,02 - 0,1), p = 0,93). Obtivemos resultados similares ao examinar separadamente os casos de transplante renal. CONCLUSÃO: Nesta amostra de receptores de transplante, os níveis plasmáticos das citocinas TNF, IL-6, IL-1ß e IFN-γ nos doadores não se associaram com o desenvolvimento de disfunção primária do enxerto.

A liberação de citocinas induzida pela morte cerebral não está associada à disfunção primária do enxerto: um estudo de coorte / Brain death-induced cytokine release is not associated with primary graft dysfunction: a cohort study

RESUMO Objetivo: Examinar a associação entre os níveis de citocinas no plasma do doador e o desenvolvimento de disfunção primária do enxerto de órgãos transplantados a partir de doadores falecidos. Métodos: Foram incluídos no estudo de forma prospectiva 17 doadores falecidos e os respectivos 47 pacientes receptores de transplante. Os receptores foram divididos em dois grupos: grupo 1, de pacientes que desenvolveram disfunção primária do enxerto, e grupo 2, de pacientes que não desenvolveram disfunção primária do enxerto. Os níveis de TNF, IL-6, IL-1β, e IFN-γ, avaliados por meio de ELISA, foram comparados entre os grupos. Resultados: Obtiveram-se 69 órgãos, sendo realizados 48 transplantes. Os níveis plasmáticos de citocinas nos doadores não diferiram entre os grupos (em pg/mL): TNF no grupo 1, com 10,8 (4,3 - 30,8) versus no grupo 2, com 8,7 (4,1 - 33,1), com valor de p = 0,63; IL-6 no grupo 1: 1.617,8 (106,7 - 5.361,7) versus no grupo 2: 922,9 (161,7 - 5.361,7), com p = 0,56; IL-1β, no grupo 1: 0,1 (0,1 - 126,1) versus no grupo 2: 0,1 (0,1 - 243,6), com p = 0,60; e IFN-γ, no grupo 1: 0,03 (0,02 - 0,2) versus no grupo 2: 0,03 (0,02 - 0,1), p = 0,93). Obtivemos resultados similares ao examinar separadamente os casos de transplante renal. Conclusão: Nesta amostra de receptores de transplante, os níveis plasmáticos das citocinas TNF, IL-6, IL-1β e IFN-γ nos doadores não se associaram com o desenvolvimento de disfunção primária do enxerto.

ABSTRACT Objective: To examine the association between donor plasma cytokine levels and the development of primary graft dysfunction of organs transplanted from deceased donors. Methods: Seventeen deceased donors and the respective 47 transplant recipients were prospectively included in the study. Recipients were divided into two groups: group 1, patients who developed primary graft dysfunction; and group 2, patients who did not develop primary graft dysfunction. Donor plasma levels of TNF, IL-6, IL-1β, and IFN-γ assessed by ELISA were compared between groups. Results: Sixty-nine organs were retrieved, and 48 transplants were performed. Donor plasma cytokine levels did not differ between groups (in pg/mL): TNF, group 1: 10.8 (4.3 - 30.8) versus group 2: 8.7 (4.1 - 33.1), p = 0.63; IL-6, group 1: 1617.8 (106.7 - 5361.7) versus group 2: 922.9 (161.7 - 5361.7), p = 0.56; IL-1β, group 1: 0.1 (0.1 - 126.1) versus group 2: 0.1 (0.1 - 243.6), p = 0.60; and IFN-γ, group 1: 0.03 (0.02 - 0.2) versus group 2: 0.03 (0.02 - 0.1), p = 0.93). Similar findings were obtained when kidney transplants were analyzed separately. Conclusion: In this sample of transplant recipients, deceased donor plasma cytokines TNF, IL-6, IL-1β, and IFN-γ were not associated with the development of primary graft dysfunction.

Brain Death-Induced Inflammatory Activity is Similar to Sepsis-Induced Cytokine Release.

Brain death (BD) is associated with a systemic inflammation leading to worse graft outcomes. This study aimed to compare plasma cytokine values between brain-dead and critically ill patients, including septic and non-septic controls, and evaluate cytokine release kinetics in BD. Sixteen brain-dead and 32 control patients (16 with and 16 without sepsis) were included. Plasma cytokines were measured by magnetic bead assay after the first clinical exam consistent with BD and every 6 hours thereafter, and at the time of study entry in the control group. The values for IL-8 and IFN-γ were higher in brain-dead and septic patients than in non-septic patients [IL-8: 80.3 (18.7-169.6) vs. 68.2 (22.4-359.4) vs. 16.4 (9.2-42.7) pg/mL; P = 0.006; IFN-γ: 2.8 (1.6-6.1) vs. 3.4 (1.2-9.0) vs. 0.5 (0.5-1.8) pg/mL; P = 0.012]. TNF showed a clear tendency to increase in brain-dead patients [2.7 (1.0-4.8) vs. 1.0 (1.0-5.6) vs. 1.0 (1.0-1.0) pg/mL; P = 0.051], and IL-6 values were higher in brain-dead patients than in non-septic controls [174.5 (104.9-692.5) vs. 13.2 (7.3-38.6) pg/mL; P = 0.002]. These differences remained even after excluding brain-dead patients who also had sepsis ( n = 3). IL-1ß and IL-10 values increased from baseline to time point 2 (∼6 hours later) [IL-1ß: 5.39 (1.93-16.89) vs. 7.11 (1.93-29.13) pg/mL; P = 0.012; IL-10: 8.78 (3.62-16.49) vs. 15.73 (5.49-23.98) pg/mL; P = 0.009]. BD-induced and sepsis-induced plasma cytokine values were similarly high, and both were higher than the observed in non-septic critically ill patients.

Association between vitamin D levels and inflammatory activity in brain death: A prospective study.

BACKGROUND: Vitamin D insufficiency is linked to several common inflammatory disorders. Brain death (BD) causes a massive catecholamine release, leading to intense inflammatory activity. We aimed to evaluate vitamin D serum levels in brain-dead individuals in comparison to critically ill patients without BD to assess the correlation between vitamin D and cytokine levels. METHODS: Sixteen brain-dead patients and 32 critically ill controls were prospectively enrolled. Blood samples from 25 brain-dead patients from a previous study were also used for vitamin D quantification. Plasma TNF, IL-1ß, IL-6, IL-8, IL-10, IFN-γ and serum vitamin D levels were compared using Student's t-test or one-way ANOVA. Spearman's test was used to assess the correlation between vitamin D and cytokine levels. RESULTS: Mean vitamin D levels were 16.4 ±â€¯7.9 ng/mL, with 52 patients (71.2%) classified as vitamin D deficient (serum levels < 20 ng/mL). Vitamin D levels were similar in 41 brain-dead patients as compared to control subjects (15.6 ±â€¯6.9 ng/mL vs 17.4 ±â€¯9.0 ng/mL; p = 0.383). Moderate direct correlations were observed between vitamin D and IL-8, IL-10, and IFN-γ in the prospective group of 16 brain-dead patients (IL-8: r = 0.5, p = 0.049; IL-10 r = 0.67, p = 0.005; IFN-γ r = 0.6, p = 0.015). Vitamin D was inversely correlated with IL-6 (r = -0.36, p = 0.044) in critically ill controls. CONCLUSIONS: Vitamin D serum levels were similarly low in brain-dead and critically ill patients. In brain-dead patients, vitamin D serum levels correlated with plasma IL-8, IL-10 and IFN-γ.

HIV, hepatitis B and C, and syphilis prevalence and coinfection among sex workers in Southern Brazil.

INTRODUCTION: Sex workers (SWs) are vulnerable to HIV, hepatitis, and syphilis coinfection. METHODS: A cross-sectional study was conducted in Tubarão, Laguna, and Imbituba, Southern Brazil. We surveyed 147 SWs using face-to-face interviews and blood sampling for serological evaluation. RESULTS: Prevalence of hepatitis B (HBV) was 23.1%, syphilis 19.7%, hepatitis C (HCV) 8.8%, and HIV 8.8%. Of 13 HIV-infected patients, 3 were co-infected with HCV, 4 with syphilis, and 5 with HBV. CONCLUSIONS: SWs had high HIV infection rates, and coinfection with viral hepatitis and syphilis.

Epidemiology of squamous cell carcinomas among the population attended in the city of Tubarão, Brazil, between 1999 and 2009.

BACKGROUND: Skin cancer is the most common neoplasm in Brazil, with increasing incidence in recent decades. Data on the incidence of squamous cell carcinoma are scarce in southern Santa Catarina. OBJECTIVE: To establish epidemiological data on squamous cell carcinoma in Tubarão, State of Santa Catarina. METHODS: A cross-sectional review was conducted on anatomical pathology reports, positive for squamous cell carcinoma of the skin, found in the local laboratories. A convenience sampling method was used for data collection, since all the pathology reports from the local laboratories between 1999 and 2009 were included. The collected variables included year of diagnosis, age, gender, city of origin, tumor site, histological type and subtype, lesion size, margin involvement and relapse. RESULTS: In total, 1,437 case reports were identified, most frequently in individuals between 70 and 79 years old. Patient morbidity was 69.5 per 100,000 population for the year 1999, and 136.7 per 100,000 population for the year 2009, which represents a 50 percent increase. The face was the most affected area and the most common histological subtype was the well-differentiated tumor. CONCLUSION: There were 1,437 reports of squamous cell carcinoma of the skin between 1999 and 2009, with a significant increase in patient morbidity. There was an association between male gender and location on the lip and ear, and between females and the occurrence of squamous cell carcinoma of the skin on the nose, and upper and lower limbs. There was a prevalence of margin involvement after resection in 18% of lesions.

Epidemiology of squamous cell carcinomas among the population attended in the city of Tubarão, Brazil, between 1999 and 2009 / Epidemiologia dos carcinomas espinocelulares na população atendida em Tubarão (SC), entre 1999 e 2009

BACKGROUND: Skin cancer is the most common neoplasm in Brazil, with increasing incidence in recent decades. Data on the incidence of squamous cell carcinoma are scarce in southern Santa Catarina. OBJECTIVE: To establish epidemiological data on squamous cell carcinoma in Tubarão, State of Santa Catarina. METHODS: A cross-sectional review was conducted on anatomical pathology reports, positive for squamous cell carcinoma of the skin, found in the local laboratories. A convenience sampling method was used for data collection, since all the pathology reports from the local laboratories between 1999 and 2009 were included. The collected variables included year of diagnosis, age, gender, city of origin, tumor site, histological type and subtype, lesion size, margin involvement and relapse. RESULTS: In total, 1,437 case reports were identified, most frequently in individuals between 70 and 79 years old. Patient morbidity was 69.5 per 100,000 population for the year 1999, and 136.7 per 100,000 population for the year 2009, which represents a 50 percent increase. The face was the most affected area and the most common histological subtype was the well-differentiated tumor. CONCLUSION: There were 1,437 reports of squamous cell carcinoma of the skin between 1999 and 2009, with a significant increase in patient morbidity. There was an association between male gender and location on the lip and ear, and between females and the occurrence of squamous cell carcinoma of the skin on the nose, and upper and lower limbs. There was a prevalence of margin involvement after resection in 18% of lesions.

FUNDAMENTOS: O câncer da pele é a neoplasia mais frequente no Brasil, com incidência crescente nas últimas décadas. Na Região Sul de Santa Catarina os dados sobre a incidência de carcinoma espinocelular são escassos. OBJETIVO: Estabelecer dados epidemiológicos do carcinoma espinocelular em Tubarão (SC). MÉTODOS: Foi realizado estudo transversal com revisão dos laudos anatomopatológicos positivos para o carcinoma espinocelular dos laboratórios de Tubarão, SC amostragem por conveniência, e as variáveis coletadas foram: ano do diagnóstico, idade, sexo, cidade de origem, local da lesão, grau de diferenciação, diâmetro da lesão, comprometimento de margem e ocorrência de recidiva. RESULTADOS: Identificaram-se 1.437 laudos com diagnóstico de carcinoma espinocelular, com maior frequência na faixa etária entre 70 e 79 anos. Foi calculado o coeficiente de morbidade para carcinoma espinocelular de 69,5 em 1999 e 136,7/100.000 habitantes para 2009, acarretando aumento de 50%. A região de face foi a mais acometida e o subtipo histológico mais comum foi o bem diferenciado. CONCLUSÃO: Ocorreram 1.437 laudos de carcinoma espinocelular entre 1999 e 2009, com aumento significativo da morbidade. Houve associação entre sexo masculino e a localização em lábio e orelha, e entre sexo feminino e ocorrência de carcinoma espinocelular no nariz, membros superiores e inferiores. Houve prevalência de margens comprometidas após ressecção em 18% das lesões.

Avaliação das mortes por causas externas na cidade de Tubarão (SC) no ano de 2009 / Mortality by external causes in Tubarão (SC), 2009

Introdução: Os acidentes e a violência no Brasil configuram problema de saúde pública de grande magnitude e transcendência, que tem provocado forte impacto na morbi-mortalidade da população. O objetivo deste estudo foi avaliar a mortalidade por causas externas em Tubarão (SC) no ano de 2009. Métodos: Trata-se de um estudo epidemiológico com delineamento transversal. Os casos foram compostos por 100% dos óbitos registrados por causas externas no Instituto Médico Legal (IML) do Município de Tubarão (SC) no ano de 2009. Resultados: Ocorreram 213 óbitos por causas externas, correspondendo a 20% do número de óbitos no ano de 2009. A maior prevalência é decorrente dos acidentes de trânsito. Houve associação estatisticamente significativa entre acidente de trânsito e morte por trauma cranioencefálico (p<0,001). A BR-101 e a Rodovia SC-438 foram os locais com maior número de vítimas por acidentes de trânsito, com 70% e 21%, respectivamente. Por estar situado entre a BR-101, uma das rodovias mais movimentadas do Estado de Santa Catarina e do Brasil, o Município de Tubarão apresenta elevado índice de morte por acidente de trânsito, sendo responsável por 46,7% dos acidentes por causas externas. Quanto às vítimas, mais de 80% eram do gênero masculino, jovens e de baixa escolaridade. Em relação ao suicídio, 74% ocorreram entre os homens, sendo que 44,4% por enforcamento. Conclusões: O perfil das vítimas foi de homens jovens, residentes em municípios vizinhos, sendo a principal causa os acidentes de trânsito (46,7%) cuja principal lesão é o trauma cranioencefálio.

Introduction: Accidents and violence in Brazil constitute a public health problem of great magnitude and importance, as they have had a strong impact on morbidity and mortality rates. The aim of this study was to assess mortality from external causes in the city of Tubarão, SC in 2009. Methods: This is a cross-sectional epidemiological study. The cases were composed of all (100%) of the deaths from external causes registered in the Legal Medical Institute of Tubarão in 2009. Results: There were 213 deaths from external causes, accounting for 20% of the number of deaths in 2009. The highest prevalence is a result of traffic accidents. There were significant associations between traffic accidents and death from head injury (p <0.001). The BR-101 and SC-438 highways are the places with the highest number of fatalities from traffic accidents, with 70% and 21%, respectively. As it is located around the BR-101, one of the busiest highways in the state of Santa Catarina and Brazil, Tubarão has a high death rate from traffic accidents, accounting for 46.7% of accidents due to external causes. Over 80% of the victims were poorly educated young males. In relation to suicide, 74% occurred among men and 44.4% by hanging. Conclusions: The profile of the victims was young men, living in neighboring cities, the main cause being traffic accidents (46.7%) whose primary injury is head trauma.

Epidemiologia dos carcinomas basocelulares em Tubarão, Santa Catarina (SC), Brasil, entre 1999 e 2008 / Epidemiology of basal cell carcinomas in Tubarão, Santa Catarina (SC), Brazil between 1999 and 2008

FUNDAMENTOS: O câncer da pele é frequente no Brasil, com incidência crescente. Na Região Sul de Santa Catarina não existem dados da incidência de carcinoma basocelular. OBJETIVO: Estabelecer dados do carcinoma basocelular em Tubarão (SC) entre 1999 e 2008. MÉTODOS: Estudo transversal com revisão dos laudos anatomopatológicos de carcinoma basocelular dos laboratórios de Tubarão (SC), com coleta das variáveis de interesse: ano do diagnóstico, idade, gênero, cidade de origem, local da lesão, subtipo histológico, diâmetro da lesão, comprometimento de margem e ocorrência de recidiva. RESULTADOS: Identificaram-se 3.253 laudos de carcinoma basocelular, com maior frequência na faixa etária entre 61 e 80 anos. Calculou-se o coeficiente de incidência para carcinoma basocelular de 164,5 em 1999 e 295,2 em 2008 para cada 100 mil habitantes, acarretando aumento de 80 por cento. A região cefálica foi a mais acometida e o subtipo histológico mais comum foi o nodular. Houve associação entre gênero masculino e a localização em tronco e orelha, e entre gênero feminino e ocorrência de carcinoma basocelular no nariz. O subtipo esclerodermiforme foi o mais agressivo em relação ao comprometimento de margens. CONCLUSÃO: Do total de casos de carcinoma basocelular, houve prevalência de margens comprometidas após ressecção em 27 por cento das lesões. Após análise multivariada, as lesões de 2cm ou mais apresentaram probabilidade 5,5 vezes maior de comprometimento de margens, ao passo que a localização em face indicou probabilidade 1,8 vez maior (p<0,0001).

BACKGROUND: Skin cancer is the most frequent type of neoplasm in Brazil. There are no data on the incidence of basal cell carcinoma in the Southern region of Santa Catarina. OBJECTIVE: To establish epidemiological data on basal cell carcinoma in Tubarão, Santa Catarina, between 1999 and 2008. METHODS: A crosssectional study was conducted in which anatomopathological reports of basal cell carcinoma from the laboratories of Tubarão, Santa Catarina, were analyzed. We considered the following variables: year of diagnosis, age, gender, city of origin, tumor site, histological subtype, lesion diameter, margin involvement, and relapse. RESULTS: Reports of 3,253 subjects most frequently between the ages of 61 and 80 years diagnosed with basal cell carcinoma were obtained. The incidence of basal cell carcinoma was 164.5 cases per 100,000 inhabitants in 1999 and 295.2 per 100,000 in 2008, showing an increase of 80 percent. Most lesions occurred in the cephalic region and nodular was the most common histological subtype. There was an association between males and basal cell carcinoma of the torso and ear, and between females and basal cell carcinoma of the nose. The sclerodermiform subtype was the most aggressive in relation to margin involvement. CONCLUSION: There was a prevalence of involved margins following resection in 27 percent of lesions. Based on multivariate analysis, lesions ? 2 cm in diameter were 5.5 times more likely to present margin involvement, and basal cell carcinoma of the face was 1.8 times more likely to occur (p <0.0001).

Epidemiology of basal cell carcinomas in Tubarão, Santa Catarina (SC), Brazil between 1999 and 2008.

BACKGROUND: Skin cancer is the most frequent type of neoplasm in Brazil. There are no data on the incidence of basal cell carcinoma in the Southern region of Santa Catarina. OBJECTIVE: To establish epidemiological data on basal cell carcinoma in Tubarão, Santa Catarina, between 1999 and 2008. METHODS: A cross-sectional study was conducted in which anatomopathological reports of basal cell carcinoma from the laboratories of Tubarão, Santa Catarina, were analyzed. We considered the following variables: year of diagnosis, age, gender, city of origin, tumor site, histological subtype, lesion diameter, margin involvement, and relapse. RESULTS: Reports of 3,253 subjects most frequently between the ages of 61 and 80 years diagnosed with basal cell carcinoma were obtained. The incidence of basal cell carcinoma was 164.5 cases per 100,000 inhabitants in 1999 and 295.2 per 100,000 in 2008, showing an increase of 80%. Most lesions occurred in the cephalic region and nodular was the most common histological subtype. There was an association between males and basal cell carcinoma of the torso and ear, and between females and basal cell carcinoma of the nose. The sclerodermiform subtype was the most aggressive in relation to margin involvement. CONCLUSION: There was a prevalence of involved margins following resection in 27% of lesions. Based on multivariate analysis, lesions of 2 cm in diameter were 5.5 times more likely to present margin involvement, and basal cell carcinoma of the face was 1.8 times more likely to occur (p <0.0001).

Uso de analgésicos no pós-operatóro para tratamento da dor em hospital no sul do Brasil / Use of analgesics in postoperative to pain relief in a hospital in south of Brazil

Justificativa e objetivo: O tratamento inadequado da dor pós-operatória resulta em aumento da morbimortalidade. A morfina é o analgésico opióide de primeira escolha no tratamento da dor aguda de grande intensidade, como é a dor pós-operatória. No Brasil, tem ocorridoa subutilização da morfina, que é substituída por analgésicos mais fracos ou com menor eficácia comprovada.Este estudo teve como objetivo avaliar a freqüência da utilização de analgésicos em pacientes submetidos a procedimentos cirúrgicos em um hospital do sul de Santa Catarina, analisando o grau de satisfação dos pacientes em relação à analgesia no manejo da dor pós-operatória. Métodos: Foi realizado um estudo epidemiológicodescritivo e transversal com 98 pacientes entrevistados no pós-operatório, após submeterem-se a cirurgias ortopédicas, cesarianas ou histerectomias no referido hospital,no período de março a agosto de 2006.Resultados: A média de idade dos entrevistados foi de 41,5 anos ± 21,7 anos. Dos pacientes selecionados,56,1% realizaram cirurgia ortopédica, 40,8% cesariana e 3,1% histerectomia. O medicamento prescrito com maiorfreqüência foi o cetoprofeno e a principal associação utilizadafoi tramadol e fármaco não-opióide em 28% dos casos. Nenhum paciente utilizou morfina. Na escala numéricade dor, a média constatada foi de 4,4 ± 2,6, sendo esta considerada dor de moderada intensidade. Conclusões: Para o tratamento da dor pós-operatória têm sido empregados analgésicos não-opióides, primordialmente antiinflamatórios não-esteroidais, queeventualmente são associados a opióides fracos como o tramadol. No entanto, o relato de dor de moderada intensidade e o surgimento de reações adversas indicam escolha inadequada e não racional dos analgésicos utilizadosno tratamento da dor pós-operatória.

Background and objective: The inadequate treatment of postoperative pain results in the increase of patientmorbimortality. Morphine is the first choice of opioid analgesics in the treatment of acute pain of greatintensity, such as postoperative pain. In Brazil morphine has been underutilized, being substituted by weaker or less effective analgesics. The objective of this study was to evaluate the frequency use of analgesics by patients submitted to surgical procedures in a hospital in South of Brazil, analyzing their degree of satisfaction with analgesia in handling postoperative pain. Methods: A descriptive, prospective and transversalepidemiological study was conducted with 98 patients interviewed in the postoperative phase, after beingsubmitted to orthopedic surgery, caesarean section or hysterectomy in the hospital, between March and August,2006. Results: The median age was 41.5 and standard deviation was ± 21.7. Of the selected patients, 56.1%had been submitted to orthopedic surgery, 40.8% to caesarian section and 3.1% to hysterectomy. The most frequently prescribed medicine was cetoprofen and tramadol was the main association used with non-opioid agentin 28% of the cases. In the numerical pain scale, the mean found was 4.4, standard deviation was 2.6, whichis considered moderate-intensity pain.Conclusions: Non-opioid analgesics, primarily nonsteroidal anti-inflammatory drugs, which are eventually associated with weak opioids such as tramadol, have been used for the treatment of postoperative pain. However, reports of moderate intensity pain and the emergence of adverse reactions indicate inappropriate choice and non-rational use of analgesics for the treatmentof postoperative pain.

Comportamento sexual e fatores de risco para a ocorrência de gravidez, DST e HIV em estudantes do município de Ascurra (SC) / Sexual behavior and risk factors for unwanted pregnancy, std and HIV among students in Ascurra, Santa Catarina

Objetivo: Verificar o comportamento sexual, gravidez e fatores de risco para DST/HIV em estudantes de Ascurra (SC). Métodos: Estudo transversal que incluiu adolescentes após anuência do termo de consentimento. O questionárioauto-aplicável em sala de aula, elaborado pelos autores, abordava questões sobre comportamento sexual,uso de drogas, gravidez atual ou pregressa e sintomas na esfera genital. Os dados foram analisados no SPSS 15.0, aplicando teste de qui-quadrado para associação entre variáveis categóricas. O nível de significânciaestatística foi de 95%. Resultados: Dos 259 alunos, 36,7% eram meninose 63,3% meninas. A idade variou entre 12 e 19 anos, média de 14,72±1,45. A média de idade da primeira relaçãofoi 14,2±1,7 anos, variando entre 8 e 16 anos. A prática sexual vaginal foi predominante, sendo que 21,2%alunos relataram já ter tido relações sexuais. O uso consistente de preservativo foi relatado por 77%, a maioria teve apenas 1 parceiro, sendo que 61,8% utilizavam método contraceptivo. Nenhum citou ocorrência de gravidez ou aborto. Entre os com vida sexualmente ativa 21,8% utilizaram pílula de emergência, 12,7% referirammanifestações genitais e 5,4% fizeram teste anti-HIV. Entre os pesquisados 8,9% afirmaram utilizar algum tipode droga. Conclusões: Os estudantes apresentaram fatores de risco para DST/HIV e gravidez indesejada, já que ouso de preservativo não é consistente em todas as relações sexuais. O uso de pílula de emergência e manifestaçõesgenitais apontam para a desinformação sobre sexo seguro e não utilização correta de preservativo.

Objective: To verify sexual behavior, unwanted pregnancy and risk factors for STD/HIV among students in Ascurra, Santa Catarina. Methods: A cross-sectional study interviewed adolescentswho were asked for consent. The self-administered questionnaire in the classroom, prepared by the authors, addressed questions about sexual behavior, drug use, current or previous pregnancy, and symptoms in the genital area. SPSS 15.0 was engaged in data analysis, using chi-square tests for association between categoricalvariables. Statistical significance level was set at 95%. Results: Out of 259 students, 36.7% were boys and63.3% girls. Age range was 12-19 years, with a mean of 14.73 ± 1.450. The mean age at their first sexual intercourse was 14.2 ± 1.7 years, ranging between 8-16 years. Vaginal intercourse was predominant as reportedby 21.2% of students who had had sexual activity. Consistent use of condoms was reported by 77%, most had only one partner, and 61.8% used contraceptive methods consistently. There was no report of unwanted pregnancy or abortion. Among those who had an active sex life, 21.8% reported the use of emergency contraceptive pills, 12.7% reported genital manifestations, and 5.4%were submitted to anti-HIV tests. The use of drugs was reported by 8.9% of the interviewees. Conclusions: Students face risk factors for DTS/HIV and undesired pregnancy, since the use of condoms is not consistent. The use of emergency contraceptive pills and genital manifestations indicate misinformation about safe sex and correct use of condoms.

Comportamento sexual de risco para DST e gravidez em adolescentes / Sexual behavion and risk for STD and pregnancy among teenagers

Introdução: o comportamento sexual de risco entre adolescentes pode ter consequências como gravidez indesejada e ocorrência de DST, tornando-se grave problema de saúde pública.Objetivo: verificar o comportamento sexual e fatores de risco para gravidez e DST entre adolescentes matriculados no ensino médio em escolas do Município de Tubarão (SC). Métodos: foram estudados adolescentes matriculados em quatro escolas escolhidas por sorteio. Foi utilizado questionário autoaplicável, após a anuência. Utilizou-se teste de qui-quadrado para associação entre as variáveis e teste de t de Student para comparação entre médias. Resultados: Dos 379 entrevistados, 41,7% estudavam em escolas privadas e 39,6% relataram ter tido relação sexual. A média deidade da sexarca foi de 15 ± 1,54 anos, variando entre 9 e 19 anos. Destes apenas 55,3% faziam uso consistente de preservativo, 46% usaram contracepção de emergência e 90,7% utilizavam contracepção. Houve relato de quatro gestações pregressas, e 44% afi rmaram a ocorrência de sintomas em esfera genital, havendo associação estatística com o não uso de preservativo (p = 0,004). O uso de drogas foi relatado por 42,5% adolescentes. A sexarca e a contracepção de emergência foram estatisticamente significativas em relação ao aluno estudar em escola pública. A prática sexual predominante foi a vaginal (50,7%) e94% tinham comportamento heterossexual. Conclusão: a ocorrência de gravidez, baixa adesão ao uso de preservativo em todas as relações sexuais, o uso de drogas e histórico de sintomas genitais permitem concluir que os adolescentes apresentaram comportamentos de risco que podem aumentar a incidência de DST, HIV e gravidez indesejada.

Introduction: the sexual risk behavior among adolescents may have consequences such as unwanted pregnancy and STDs, becoming a serious public health problem. Objective: to analyze sexual behavior and risk factors for unwanted pregnancy and STDs among adolescents enrolled in secondary education in schools of the municipality of Tubarão, Santa Catarina. Methods: the sample consisted of adolescents enrolled in four schools chosen through raffl e. A self-administered questionnaire was used after consent. Chi-square test was used to analyze association between variables and Student?s t test for comparison of means. Results: Out of 379 respondents, 41.7% studied in private schools and 39.6% reported having had sexual intercourse. The mean age at fi rst sexual intercourse was 15±1.54 years, ranging between 9 and 19 years. Of those, only 55.3% reported consistent use of condoms, 46% used emergency contraception and 90.7% used contraceptive methods. There were four reports of past pregnancies, and 44% said they had experienced symptoms in the genital area, which was statistically associated with the lack of condom use (p = 0.004). The use of drugs was reported by 42.5%. Age at fi rst sexual intercourse and emergency contraception were statistically signifi cant in relation to students studying in state schools. Conclusion: vaginal intercourse was the predominant sexual practice as reported by 50.7% of participants; 94% had heterosexual behavior. The occurrence of pregnancy, poor use of condoms and unprotected sex practices, drug use and history of genital symptoms show that adolescents have risk behaviors which may increase the incidence of STDs, HIV and unplanned pregnancy.