Malignant Neoplasms Arising in the Cardiac Pacemaker Cavity: A Systematic Review.

Cancer is the abnormal proliferation of physiologically inadequate cells. Studies have identified the cardiac pacemaker pocket as a site of rare neoplasms. To evaluate the clinical outcomes, treatment, prognosis, and individualized management of tumors originating in the cardiac pacemaker pocket, a systematic review was conducted using case reports and case series available in the PubMed/Medline, Science Direct, Cochrane Central, LILACS, and Scientific Electronic Library Online (Scielo) databases. Pacemaker pocket tumors affected patients with a mean age of 72.9 years, with a higher incidence in males (76.9%, n = 10). The average time for neoplasm development was 4.4 years (54.07 months). The most prevalent model was Medtronic (38.4%, n = 5), with titanium (83.3%) being the most common metal composition. Chemotherapy was the most performed procedure among patients (38.4%), followed by radiation therapy (38.4%) and surgical tumor resection (30.7%). Six analyzed cases (46.1%) resulted in death, and four patients (30.7%) achieved a cure. Patients with pacemakers should be routinely evaluated for the occurrence of malignant tumors at the site of device implantation.

Análise da tendência espaço-temporal da hepatite B no estado do Pará, 2006 a 2018 / Analysis of the Spatio-temporal trend of hepatitis B in the state of Pará, 2006 to 2018

Objetivo: o presente estudo tem por objetivo realizar uma análise do perfil espaço-temporal da hepatite B no estado do Pará, entre os anos de 2006 e 2018. Métodos: trata-se de um trabalho epidemiológico, ecológico e descritivo, realizado no estado do Pará por meio de seus municípios e regiões de saúde. A base de dados foi levantada perante consulta ao Departamento de Informática do SUS (DATASUS). Foram calculadas as variações percentuais anuais (APC) nas taxas de incidência de hepatite B, mediante a modelagem pelo método Jointpoint, usando o ano calendário como variável de regressão. Resultados: no estado do Pará, foram notificados, no período do estudo, 3,228 casos, sendo, 48,3% em homens e 51,7% em mulheres, com média de 248,3 casos por ano (61,8 de desvio padrão). A taxa de incidência média entre os anos de 2006 a 2018, nos 144 municípios no estado do Pará, obteve uma grande variação de 0 a 21,54 casos por 100.000 mil habitantes. Conclusão: apesar da dispersão nas taxas de incidência, obteve-se uma tendência crescente da ocorrência de casos de hepatite B no período estudado, sugerindo a necessidade de medidas de saúde pública mais eficazes no combate ao HBV.

Objective: this study aims to analyze the spatiotemporal profile of hepatitis B in the State of Pará from 2006 to 2018. Methods: this is an ecological and descriptive epidemiological study carried out in the State of Pará through its municipalities and health regions. The database was collected from the consultation with the SUS Computer Department (DATASUS). The annual percentage changes (APC) in the hepatitis B incidence rates were calculated through modeling by the Jointpoint method, using the calendar year as a regressive variable. Results: in the state of Pará, 3,228 cases were reported, of which 48.3% were men and 51.7% were women, with an average of 248.3 cases per year (61.8 standard deviations). The average incidence rate between the years 2006 to 2018 in the 144 municipalities in the state of Pará obtained a wide variation from 0 to 21.54 cases per 100,000 inhabitants. Conclusions: despite the dispersion in incidence rates, there was an incre

Uptake of lipid core nanoparticles by fragments of tissues collected during cerebral tumor excision surgeries: hypotheses for use in drug targeting therapy.

PURPOSE: Malignant cerebral tumors have poor prognosis and the blood-brain barrier is a major hindrance for most drugs to reach those tumors. Lipid nanoparticles (LDE) that bind to lipoprotein receptors may carry anticancer drugs and penetrate the cells through those receptors that are overexpressed in gliomas. The aim was to investigate the in vivo uptake of LDE by human cerebral tumors. METHODS: Twelve consecutive patients (4 with glioblastomas, 1 meduloblastoma, 1 primary lymphoma, 2 with non-cerebral metastases and 4 with benign tumors) scheduled for tumor excision surgery were injected intravenously, 12 h before surgery, with LDE labeled 14C-cholesterol oleate. Fragments of tumors and of normal head tissues (muscle, periosteum, dura mater) discarded by the surgeon were submitted to lipid extraction and radioactive counting. RESULTS: Tumor LDE uptake (range: 10-283 d.p.m./g of tissue) was not lower than that of normal tissues (range: 20-263 d.p.m./g). Malignant tumor uptake was threefold greater than benign tumor uptake (140 ± 93 vs 46 ± 18 d.p.m./g, p < 0.05). Results show that LDE can concentrate in brain malignant tumors and may be used to carry drugs directed against those tumors. CONCLUSION: As LDE was previously shown to markedly decrease drug toxicity this new therapeutic strategy should be tested in future trials.

A importância dos fatores associados a não adesão ao exame preventivo do câncer de colo uterino por mulheres brasileiras ­ revisão sistemática / The importance of factors associated with non-adherence to preventive screening for cervical cancer by Brazilian women ­ systematic review

Objetivo: O presente estudo busca avaliar a importância da adesão ao exame de Papanicolaou no diagnóstico do Papilomavírus humano, bem como relatar as dificuldades e os fatores da não realização do mesmo por mulheres brasileiras. Métodos: revisão sistemática da literatura mediante busca de artigos indexados nas plataformas eletrônicas de dados PubMed, BVS-Brasil e SciELO, entre os anos de 2008 a 2018. Resultados: No total foram encontrados 1.458 artigos nas bases de dados selecionadas, foram excluídos 1.411 artigos, os quais se enquadraram nos critérios de exclusão, e 38 duplicatas. Ao final do total de artigos analisados foram incluídos 10 para a realização da síntese quali-quantitativa. Considerações finais: A partir dos artigos analisados pode-se observar que as diferenças entre raça, classe econômica, nível de escolaridade e estado civil mostram-se como fatores determinantes quando comparamos a diferença na adesão e acesso do exame de Papanicolaou entre as mulheres brasileiras. Faz-se necessária a utilização de ações, campanhas e estratégias para a melhoria na realização do exame, enfatizando a sua importância.

Objective: The present study aims to evaluate the importance of the adhesion of the Pap smear technique to the diagnosis of the human papillomavirus, as well as to report the difficulties and factors of noncompletion by Brazilian women. Methods: systematic review of the literature by searching articles indexed in the electronic platforms of data PubMed, BVS-Brazil and Scielo, between the years of 2008 to 2018. Results: In total, 1,458 articles were found in the selected databases, 1,411 articles were excluded, as these were included in the exclusion criteria and 38 duplicates. At the end of the total of analyzed articles, 10 were included for the accomplishment of the qualitative-quantitative synthesis. Final considerations: From the analyzed articles, it can be observed that the differences between race, economic class, schooling level and marital status are determining factors when comparing the difference in the adhesion and access of the Pap test among Brazilian women. It is necessary to use actions, campaigns and strategies for improving the exam, emphasizing the importance of taking the exam.

PD-L1 Expression Associated with Epstein-Barr Virus Status and Patients' Survival in a Large Cohort of Gastric Cancer Patients in Northern Brazil.

Gastric cancer (GC) is a worldwide health problem, making it one of the most common types of cancer, in fifth place of all tumor types, and the third highest cause of cancer deaths in the world. There is a subgroup of GC that consists of tumors infected with the Epstein-Barr virus (EBV) and is characterized mainly by the overexpression of programmed cell death protein-ligand-1 (PD-L1). In the present study, we present histopathological and survival data of a thousand GC patients, associated with EBV status and PD-L1 expression. Of the thousand tumors analyzed, 190 were EBV-positive and the vast majority (86.8%) had a high relative expression of mRNA and PD-L1 protein (p < 0.0001) in relation to non-neoplastic control. On the other hand, in EBV-negative samples, the majority had a low PD-L1 expression of RNA and protein (p < 0.0001). In the Kaplan-Meier analysis, the probability of survival and increased overall survival of EBV-positive GC patients was impacted by the PD-L1 overexpression (p < 0.0001 and p = 0.004, respectively). However, the PD-L1 low expression was correlated with low overall survival in those patients. Patients with GC positive for EBV, presenting PD-L1 overexpression can benefit from immunotherapy treatments and performing the quantification of PD-L1 in gastric neoplasms should be adopted as routine.

Parasitic contamination in the soil of beaches from Mosqueiro Island, Pará State, Brazil / Contaminação parasitária no solo de praias da Ilha do Mosqueiro, Estado do Pará, Brasil

Objective: We aimed to evaluate the prevalence of intestinal parasitic in the soil of three beaches of Mosqueiro Island, located in the State of Pará, Brazil, as well as to compare the frequency of helminths and protozoa, pathogenic and non-pathogenic parasites according to the beaches analyzed. Methods: This is a cross-sectional analytical study conducted during August and September 2019, in which 155 soil samples were analyzed by Hoffman's method. Results: The results showed that 16.1% of samples were contaminated from 61.3% of collection points. Murubira beach and Farol beach presented the highest prevalence of parasites, however, there was no significant difference between beaches. Also, it was observed a predominance of protozoa (63%) and non-pathogenic parasites (55.6%) in analyzed samples, but there was no statistically significant difference according to the investigated location. Endolimax nana 25.9% (7/27) and hookworms 18.5% (5/27) were the most detected parasites on the beaches. Conclusion: Thus, this study showed parasitic contamination on the beaches from Mosqueiro Island, which may be associated with a lack of sanitation infrastructure and personal hygiene in these places. Therefore, these results reinforce the need to adopt educational and preventive measures to reduce parasitic agents.

Objetivo: Avaliar a prevalência de parasitos intestinais no solo de três praias da Ilha de Mosqueiro, localizada no estado do Pará, Brasil, além de comparar a frequência de helmintos e protozoários, parasitos patogênicos e não patogênicos de acordo com as praias analisadas. Metdodos: Este é um estudo transversal, analítico, realizado durante agosto e setembro de 2019, no qual 155 amostras do solo foram analisadas pelo método de Hoffman. Resultados: Os resultados revelaram que 16,1% das amostras estavam contaminadas em 61,3% dos pontos de coleta. As praias do Murubira e do Farol apresentaram a maior prevalência de parasitos, porém não houve diferença significativa entre os diferentes locais de coleta. Além disso, foi observada a predominância de protozoários (63%) e parasitas não patogênicos (55.6%) nas amostras analisadas, mas não houve diferença estatística significativa entre os locais investigados. Endolimax nana 25,9% (7/27) e Ancilostomídeos 18,5% (5/27) foram os parasitas mais detectados nas praias. Conclusao: Desse modo, este estudo mostrou contaminação parasitária nas praias da Ilha de Mosqueiro, o que pode estar associada à falta de infraestrutura de saneamento e higiene pessoal nesses locais. Além disso, esses resultados reforçam a necessidade de se adotar medidas educacionais e preventivas para a redução desses agentes parasitários.

Uso de biomarcadores sanguíneos no diagnóstico da doença de Alzheimer: um futuro próximo? / Use of blood biomarkers in the diagnosis of Alzheimer's disease: a near future?

A doença de Alzheimer (DA) é uma das formas mais comuns de demência, sendo ela uma patologia neurodegenerativa que acomete pessoas idosas de maneira irreversível. O diagnóstico precoce possibilitaria a realização de tratamentos que apresentassem melhores resultados sobre a redução da severidade dos sintomas. Entretanto, isto é um grande problema, pois os métodos já consolidados de diagnóstico são invasivos, como a análise do líquido cefalorraquidiano e a biópsia do cérebro. Este estudo buscou analisar biomarcadores sanguíneos capazes de identificar a DA ainda em seu estágio inicial. Realizou-se uma revisão integrativa da literatura mediante busca de artigos indexados nas plataformas eletrônicas de dados PubMed e SciELO com o descritor em inglês e português "Biomarker, blood, alzheimer": Foram analisados artigos de 2013 a 2019, onde os principais tipos de biomarcadores foram os que realizaram a análise de proteínas específicas, microRNAs e autoanticorpos, proporcionando assim bons resultados não só no diagnóstico como também no custo benefício, pois a eles confere a diferenciação das demais patologias para o estado inicial da doença de Alzheimer. Conclui-se que apesar dos resultados obtidos terem sido positivos, ainda são necessários mais estudos a fim de aumentar a sensibilidade e especificidade na diferenciação da DA de outros tipos de demência.

Alzheimer's disease (AD) is one of the most common forms of dementia, being a neurodegenerative disorder that irreversibly affects older people. Early diagnosis would enable the realization of treatments presenting better results on reducing the severity of symptoms. However, this is a major problem, since the already consolidated methods of diagnosis are invasive, such as CSF analysis and brain biopsy. This study aimed to analyze blood biomarkers capable of identifying AD even in its initial stage. An integrative review of the literature was carried out by searching indexed articles in electronic data platforms PubMed and SciELO with the descriptor in English and Portuguese "Biomarker, blood, alzheimer": Articles from 2013 to 2019 were analyzed, where the main types of biomarkers were the ones that carried out the analysis of specific proteins, microRNAs and autoantibodies. Thus providing good results not only in the diagnosis, but also in the cost benefit, since they confer the differentiation of the other pathologies to the initial state of Alzheimer's disease. It has concluded that although the results obtained were positive, further studies are needed in order to increase sensitivity and specificity in the differentiation of AD from other types of dementia.

Epidemiological and TNFα polymorphism evaluation in patients with cryptococcal meningitis treated at a referral hospital in North Brazil.

INTRODUCTION: The present study evaluated the epidemiology of cryptococcal meningitis and TNFα gene polymorphisms in patients at a reference hospital in northern Brazil. METHODS: Samples from 25 patients infected with Cryptococcus spp. were collected to confirm the infection and to analyze the TNFα gene polymorphisms. RESULTS: Cryptococcus neoformans was detected as the predominant etiological agent (100%) in HIV-positive patients. No genetic polymorphic changes were found. CONCLUSIONS: No correlation was observed between the analyzed TNFα polymorphisms and cryptococcal meningitis.

Epidemiological and TNFα polymorphism evaluation in patients with cryptococcal meningitis treated at a referral hospital in North Brazil

Abstract INTRODUCTION: The present study evaluated the epidemiology of cryptococcal meningitis and TNFα gene polymorphisms in patients at a reference hospital in northern Brazil. METHODS: Samples from 25 patients infected with Cryptococcus spp. were collected to confirm the infection and to analyze the TNFα gene polymorphisms. RESULTS: Cryptococcus neoformans was detected as the predominant etiological agent (100%) in HIV-positive patients. No genetic polymorphic changes were found. CONCLUSIONS: No correlation was observed between the analyzed TNFα polymorphisms and cryptococcal meningitis.

Avaliação comparativa entre os novos métodos e os métodos tradicionais de diagnósticos laboratoriais para as hemofilias: revisão integrativa / Comparative evaluation between the new methods and the current methods of laboratory diagnosis for hemophilia: integrative literature review

A hemofilia é uma coagulopatia hereditária ligada ao cromossomo X, causada pela deficiên- cia dos fatores VIII (hemofilia A) e IX (hemofilia B). Essa doença acomete cerca de 1:10.000 nascidos vivos do sexo masculino na hemofilia A e de 1:40.000 na hemofilia B no mundo. Este estudo buscou avaliar os métodos atuais e os novos métodos de diagnóstico laboratoriais em fase de testes para detecção e acompanhamento dos pacientes com hemofilia. Reali- zou-se um estudo de revisão integrativa da literatura mediante busca de artigos indexados, utilizando as plataformas de dados PubMed e SciELO. A partir da pesquisa realizada foram selecionados oito artigos, categorizados em: Técnica Inovadora; Diagnóstico molecular; Método modificado e Potencialização de sensibilidade. Com essas novas técnicas será possível, com maior especificidade, a quantificação do fator VIII, identificação e diferencia- ção de anticorpos inibidores de anticorpos não inibidores; análise dos genes FVIII, FIX e outros genes da hemostasia, por técnicas de Citometria de Fluxo e o Biossensor de Resso- nância de Plasmon de Superfície; detecção de deleções, inserções e mutações conhecidas ou novas através do Sequenciamento de Nova Geração, podendo esses resultados serem correlacionados com outros testes para melhor definição dos fenótipos clínicos da doença.

Organic effects of associating paclitaxel with a lipid-based nanoparticle system on a nonhuman primate, Cebus apella.

Lipid-based nanoparticle systems have been used as vehicles for chemotherapeutic agents in experimental cancer treatments. Those systems have generally been credited with attenuating the severe toxicity of chemotherapeutic agents. This study aimed to investigate the effects of associating paclitaxel (PTX) with a lipid-based nanoparticle system on a nonhuman primate, Cebus apella, documenting the toxicity as measured by serum biochemistry, which is a detailed analysis of blood and tissue. Eighteen C. apella were studied: three animals were treated with cholesterol-rich nanoemulsion (LDE) only, without PTX, administered intravenously every 3 weeks, during six treatment cycles; six animals were treated with PTX associated with LDE at the same administration scheme, three with lower (175 mg/m2) and three with higher (250 mg/m2) PTX doses; and six animals were treated with commercial PTX, three with the lower and three with the higher doses. In the LDE-PTX group, no clinical toxicity appeared, and the weight-food consumption curve was similar to that of the controls. Two animals treated with commercial PTX presented weight loss, nausea and vomiting, diarrhea, skin flaking, 70% loss of body hair, and decreased physical activity. The use of LDE as a carrier at both lower and higher doses reduced the toxicity of the drug in this species, which is closely related to human subjects. This was observed not only by clinical, biochemical, and hematological profiles but also by the histopathological analysis. The results of this study support the assumption that lipid-based nanoparticle systems used as drug carriers can serve as valuable tools to decrease the toxicity and increase the safety of chemotherapeutic agents.

Evaluation of in vivo and in vitro toxicological and genotoxic potential of aluminum chloride.

Aluminum and its compounds are common contaminants of water and food, as well as medications and cosmetics. The wide distribution of the element facilitates the demand for detailed studies of its biological and toxicological effects. This work aimed to evaluate the possible genotoxic and toxic activity resulting from in vivo and in vitro exposure to Al. For in vivo analysis, 40 Swiss mice were used, various concentrations of hydrated aluminum chloride were administered orally. They were analyzed for possible genic activity and metal cytotoxicity using a micronucleus test (MN), and for toxicity through histopathological evaluation of the extracted organs. For in vitro analysis, lymphocytes from the peripheral blood of 3 healthy donors were used. These cells were exposed to the same chemical agent in various concentrations. In vivo study revealed a significant increase in the number of MN in all Al concentrations. Furthermore, significant alterations in all the organs evaluated were verified by the presence of irreversible lesions (such as necrosis). Corroborating these findings, a significant increase in the quantity of MN in all concentrations with lymphocytes in vitro. In light of this, we suggest that this metal presents genotoxic potential and is potentially a cause of pathological disorders.

Evaluation of the immunological cellular response of Cebus apella exposed to the carcinogen N-methyl-N-nitrosourea and treated with CANOVA®.

The immune response modifier Canova® is a homeopathic remedy indicated for patients with depressed immune system, since this drug appears to increase adaptive immunity and induce an immune response against multiple and severe pathological conditions, including cancer. We evaluated the pattern of immune cellular response in non-human primates of the species Cebus apella exposed to N-methyl-N-nitrosourea (MNU) with and without Canova®. Twelve animals were divided into four groups, with three animals each: negative control and three experimental groups, MNU-alone (35 days); MNU (35 days)-plus-Canova® (3 days) and Canova®-alone (3 days). The animals received MNU orally and Canova® by three intravenous injections. Evaluation of the cellular immune response was performed by immunophenotyping of T-lymphocytes (CD4(+), CD8(+)), B-lymphocytes and natural killer cells. Analysis was also performed of the cell cycle. Our results suggest an increase of T-lymphocytes (CD4(+)CD3(+)) only in the Canova® group, while in the MNU-plus-Canova® group only B-lymphocytes increased.

Diagnóstico de imunofenótipos de síndromes linfoproliferativas crônicas por citometria de fluxo na Fundação HEMOPA / Diagnosis of immunophenotyping of chronic lymphoproliferative syndromes by flow cytometry at HEMOPA blood center

INTRODUÇÃO: As síndromes linfoproliferativas formam um grupo heterogêneo de neoplasias malignas com diferentes comportamentos clínicos, fatores patológicos e características epidemiológicas e podem ter seu diagnóstico geral com base na morfologia das células linfoides observadas no sangue periférico. OBJETIVO: Testar a factibilidade diagnóstica do método de imunofenotipagem por citometria de fluxo para síndromes linfoproliferativas a partir da definição de um painel mínimo de anticorpos. MATERIAL E MÉTODOS: Participaram 47 pacientes para diagnóstico diferencial dos subtipos de síndromes linfoproliferativas por citometria de fluxo, no período de julho de 2008 a julho de 2010, atendidos na Fundação HEMOPA. RESULTADOS: A mediana de idade dos pacientes foi de 68 anos, não houve diferença estatística entre os sexos e o subtipo de síndromes linfoproliferativas mais frequente foi a leucemia linfoide crônica/linfoma linfocítico de pequenas células B. CONCLUSÃO: O método de imunofenotipagem por citometria de fluxo, ao lado da morfologia, de amostras de sangue periférico mostrou-se uma metodologia auxiliar, segura, rápida, factível e não invasiva para o diagnóstico de síndromes linfoproliferativas crônicas a partir do painel de anticorpos sugerido.

INTRODUCTION: Lymphoproliferative syndromes comprise a heterogeneous group of malignant neoplasias with different clinical behaviors, pathological factors and epidemiological characteristics, whose diagnosis may be based on lymphoid cell morphology observed in peripheral blood. OBJECTIVE: To test the diagnostic feasibility of immunophenotyping by flow cytometry for lymphoproliferative syndromes through the definition of minimal antibody panel. MATERIAL AND METHODS: During the period of July 2008 to July 2010, 47 patients from HEMOPA blood center participated in this study for differential diagnosis of lymphoproliferative syndromes subtypes by flow cytometry. RESULTS: The mean age was 68 years old. There was no statistical difference between genders, and the most frequent subtype of lymphoproliferative syndromes was chronic lymphoid leukemia/small B-cell lymphocytic lymphoma. CONCLUSION: Based on the antibody panel recommended in this investigation, the immunophenotyping method by flow cytometry associated with morphological characterization of peripheral blood samples is a reliable, rapid, feasible, and non-invasive procedure for the diagnosis of chronic lymphoproliferative syndromes.