Prevalence of HPV genotypes and assessment of their clinical relevance in laryngeal squamous cell carcinoma in a northeastern state of Brazil-a retrospective study.

Background: A high prevalence and incidence of head and neck tumors make Brazil the country with the third-highest number of cases of these malignant neoplasms. The main risk factors are smoking and alcohol consumption; however, cases related to the human papillomavirus (HPV) have tripled in number, demonstrating a changing disease profile. Studies have reported the prevalence of HPV in laryngeal squamous cell carcinoma (LSCC) to vary between 8% and 83%. The role of HPV as an important causative factor in LSCC remains unclear. Methods: This retrospective study included 82 patients with LSCC diagnosed between 2014 and 2019 at two oncology hospitals in São Luís, Brazil. Sociodemographic and clinical data, and the histopathologic characteristics of the tumors, were collected directly from medical records. Genetic material was extracted from paraffin-embedded samples using nested polymerase chain reaction (PCR) and automated sequencing for HPV detection and genotyping. The results by social and clinicopathologic variables were then compared using the chi-squared test and multivariate analysis. Results: Sociodemographic analysesdemonstrated that most patients were men (87.8%), brown-skinned (75.6%), and resident in the state capital (53.7%). They generally had a poor education status (53.7%), having only an elementary school education (completed/incomplete), and 51.2% were self-employed in occupations such as farming or fishing. Smoking and alcohol consumption habits were observed in approximately half the patients. With respect to clinical characteristics, 39% of patients exhibited T1/T2 staging, 51.2% had no distant metastasis, and 30.5% had lymph node invasion. HPV DNA was detected in half the samples (50%), with the high oncogenic type 16 being the most prevalent. There was no significant relationship observed between the economic, educational, occupational with the HPV LSCC in the presented data, although multivariate analysis demonstrated that HPV DNA was more likely to be present in T3-T4 tumors (p = 0.002).

Sebaceous breast carcinoma.

Breast sebaceous carcinoma is one of the rarest breast neoplasms, with less than 30 cases reported worldwide. Due to the rarity, the new WHO classification of breast tumors grouped these tumors among the ductal carcinoma. A detailed description of these cases is relevant due to the insufficient knowledge about the prognosis of this neoplasm. We report the clinical, histological, and immunohistochemical characteristics of a case of sebaceous carcinoma of the breast in an 81-year-old woman with a right breast nodule. The tumor was composed of nests of a varying mixture of sebaceous cells with abundant slightly vacuolated cytoplasm, surrounded by smaller oval-to-fusiform cells with eosinophilic cytoplasm without vacuolization. No lymph node metastases were present. The immunohistochemical reactions were positive for GATA3, EMA, CD15, and GCDFP15 (focal staining), and negative for RE, RP, and HER-2. The tumor was classified as triple-negative. Morphologically, the differential diagnoses included skin sebaceous carcinoma, lipid-rich carcinoma, apocrine carcinoma, and glycogen-rich clear cell carcinoma. Most of the previously reported cases were positive for RE and RP, which generally was associated with a better prognosis. However, some cases presented a more aggressive behavior with distant and lymph node metastases.

Sebaceous breast carcinoma

ABSTRACT Breast sebaceous carcinoma is one of the rarest breast neoplasms, with less than 30 cases reported worldwide. Due to the rarity, the new WHO classification of breast tumors grouped these tumors among the ductal carcinoma. A detailed description of these cases is relevant due to the insufficient knowledge about the prognosis of this neoplasm. We report the clinical, histological, and immunohistochemical characteristics of a case of sebaceous carcinoma of the breast in an 81-year-old woman with a right breast nodule. The tumor was composed of nests of a varying mixture of sebaceous cells with abundant slightly vacuolated cytoplasm, surrounded by smaller oval-to-fusiform cells with eosinophilic cytoplasm without vacuolization. No lymph node metastases were present. The immunohistochemical reactions were positive for GATA3, EMA, CD15, and GCDFP15 (focal staining), and negative for RE, RP, and HER-2. The tumor was classified as triple-negative. Morphologically, the differential diagnoses included skin sebaceous carcinoma, lipid-rich carcinoma, apocrine carcinoma, and glycogen-rich clear cell carcinoma. Most of the previously reported cases were positive for RE and RP, which generally was associated with a better prognosis. However, some cases presented a more aggressive behavior with distant and lymph node metastases.

The Prevalence of Nondiabetic Renal Diseases in Patients with Diabetes Mellitus in the University Hospital of Ribeirão Preto, São Paulo.

OBJECTIVE: To evaluate the prevalence of nondiabetic renal diseases (NDRDs) in renal biopsies of patients with diabetes mellitus (DM) in the University Hospital of Ribeirão Preto, São Paulo. Research Design and Methods. We conducted a retrospective study including kidney biopsies performed in diabetic patients between 1987 and 2013. We evaluated 79 biopsies during this period. The primary variable was the prevalence of NDRD in patients with DM. The secondary variables were the presence of systemic arterial hypertension (SAH), hematuria, time since diagnosis of DM, serum creatinine, and proteinuria levels. The cases were divided into the following groups: isolated diabetic nephropathy (DN-group I), isolated nondiabetic renal diseases (NDRD-group II), associated NDRD/DN (group III), and associated NDRD+NDRD/DN (group IV). RESULTS: Most of the patients (58.22%) presented only alterations arising from DN. NDRDs were present in 41.77% of the patients. Membranous glomerulonephritis (30.3%) and IgA nephropathy (24.24%) were the most prevalent NDRDs. We found no differences between female and male patients with NDRD when assessing the secondary variables. A time since diagnosis of five years or less revealed a statistical difference (p = 0.0005) in the comparison between the isolated DN (group I) and the NDRD+NDRD/DN (group IV). The other secondary variables were not significant in the comparison of the groups. CONCLUSIONS: We concluded that the prevalence of NDRD is 41.77%. Membranous glomerulonephritis was the most prevalent NDRD in our study. We also conclude that the probability of the presence of NDRD with or without concomitant DN is greater for patients who had biopsies with a time since diagnosis of five years or less. A time since diagnosis of ten years or more does not allow the exclusion of the presence of NDRD.

Expression of HLA-E molecules in the placental tissue of women infected with HIV-1 and uninfected women.

INTRODUCTION: Expression of HLA-E molecule in the placental extravillous trophoblast is associated with immune system cell inhibition, resulting in immune tolerance to fetus during pregnancy. HIV-1 can infect trophoblast cells and modify the expression of HLA-E, which may inhibit the cytotoxic activity of the immune system. AIM: The aim of this study was to evaluate HLA-E expression in third trimester placental tissue of women infected with HIV-1 and uninfected women. METHODS: We performed an immunohistochemistry assay to evaluate HLA-E staining in the placental tissue of 99 HIV-1 infected and 85 uninfected women. A pathologist analyzed and classified the HLA-E expression in the placental cells. RESULTS: Irrespective of the HIV status, HLA-E staining was observed in the extravillous trophoblast cells, endothelial cells and Hofbauer cells, but not in the syncytiotrophoblast. HLA-E staining showed no significant difference between the placental tissue of women infected with HIV-1 and uninfected women (P = 0.76). Considering HIV-1 infected women, HLA-E staining was not influenced by HIV-1 viral load (P = 0.48), CD4+ T-cell count (P = 0.10) and antiretroviral therapy used during pregnancy (P = 0.54). DISCUSSION: Despite the presence of HIV-1 infection, the expression of HLA-E molecules in the placental tissue was not modified when the infection was under antiretroviral therapy control.

Critical evaluation of justifications for the transfusion of red blood cells: the reality of a government emergency hospital.

BACKGROUND: Blood products and derivatives are indispensable resources in medical therapies. However, it is important to note that the number of donations is far from ideal. Despite constant campaign efforts, a deficit of 1 million units is expected by 2030. OBJECTIVES: To determine the adequacy of the indications for red blood cell transfusion in an emergency hospital in Alagoas. METHODS: This was a cross-sectional observational study conducted at the Alagoas Blood Center. Of a total of 2936 red blood cell transfusion requests in 2009, 334 were randomized and compared with transfusion parameters described in the literature (primary variable). After analysis, the transfusion requests were categorized as adequate, inadequate or inconclusive. This last group included all red blood cell transfusion requests with insufficient clinical information, rendering their classification as adequate or inadequate impossible. The secondary variable involved the reasons for red blood cell transfusion. A 95% confidence interval was used in the statistical analysis. RESULTS: Forty-seven (14.07%) requests were adequate and 30 (8.98%) were inadequate. Most of the requests were classified as inconclusive (76.94%). The main indications for transfusion were upper gastrointestinal bleeding (26.95%), anemia (46.71%), hypovolemia/hypovolemic shock (10.78%) and sepsis/septic shock (3.29%). CONCLUSION: It was not possible to reach a conclusion on the adequacy of the indication for transfusion in most of the cases. Therefore, it is important to adopt a transfusion protocol, rigorously analyze blood bank requests, to provide awareness campaigns on the rational use of blood and to implement strategies to use blood products more effectively.

Critical evaluation of justifications for the transfusion of red blood cells: the reality of a government emergency hospital

BACKGROUND:Blood products and derivatives are indispensable resources in medical therapies. However, it is important to note that the number of donations is far from ideal. Despite constant campaign efforts, a deficit of 1 million units is expected by 2030. OBJECTIVES: To determine the adequacy of the indications for red blood cell transfusion in an emergency hospital in Alagoas. METHODS: This was a cross-sectional observational study conducted at the Alagoas Blood Center. Of a total of 2936 red blood cell transfusion requests in 2009, 334 were randomized and compared with transfusion parameters described in the literature (primary variable). After analysis, the transfusion requests were categorized as adequate, inadequate or inconclusive. This last group included all red blood cell transfusion requests with insufficient clinical information, rendering their classification as adequate or inadequate impossible. The secondary variable involved the reasons for red blood cell transfusion. A 95% confidence interval was used in the statistical analysis. RESULTS: Forty-seven (14.07%) requests were adequate and 30 (8.98%) were inadequate. Most of the requests were classified as inconclusive (76.94%). The main indications for transfusion were upper gastrointestinal bleeding (26.95%), anemia (46.71%), hypovolemia/hypovolemic shock (10.78%) and sepsis/septic shock (3.29%). CONCLUSION: It was not possible to reach a conclusion ...

Aumento no material fibrinoide perivilositário nas placentas de gestações com pré-eclâmpsia / Increase in perivillous fibrinoid material in placentas from pregnancies with preeclampsia

INTRODUÇÃO: A pré-eclâmpsia responde por alta morbimortalidade no Brasil e no mundo. A sua etiologia ainda não foi totalmente esclarecida. Entre as alterações placentárias na pré-eclâmpsia citam-se: infartos, aumento de nós sinciciais, hipotrofia vilositária, espessamento da membrana basal trofoblástica e deposição de material fibrinoide. OBJETIVO: Analisar quantitativamente imagens do material fibrinoide perivilositário presente em placentas de gestações com e sem pré-eclâmpsia. MATERIAL E MÉTODOS: Foi realizado estudo de caso-controle no Serviço de Anatomia Patológica do Hospital Universitário Professor Alberto Antunes (HUPAA). Realizou-se análise histomorfométrica de 840 imagens provenientes de 14 placentas de gestações com pré-eclâmpsia (casos) e 14 placentas de gestações sem pré-eclâmpsia (controles). RESULTADOS: A média da área do material fibrinoide no grupo pré-eclâmpsia foi de 168,46 pixels, e no grupo sem pré-eclâmpsia, de 89,63 pixels. Foi observada uma quantidade menor da área total dos núcleos na pré-eclâmpsia, 89,51 pixels, do que no grupo controle, 113,34 pixels. CONCLUSÃO: Nas placentas de gestações com pré-eclâmpsia a área ocupada pelo material fibrinoide está aumentada em 1,8 vez em comparação com as placentas de gestações normais. As áreas dos núcleos e citoplasmas foram maiores no grupo controle. Não houve diferença estatisticamente significativa quanto à área do estroma. Observou-se também redução do espaço ocupado pelas vilosidades na pré-eclâmpsia, sendo este fato compatível com hipotrofia vilositária.

INTRODUCTION: Preeclampsia is responsible for high maternal mortality in Brazil and worldwide. Its etiology has not been fully elucidated. Placental changes in preeclampsia include: infarcts, increase in syncytial knots, villous hypotrophy, thickening of trophoblastic basement membrane and fibrin deposition. OBJECTIVE: To analyze quantitatively images of perivillous fibrinoid material present in placentas from pregnancies with and without preeclampsia. MATERIAL AND METHODS: A case-control study was carried out at the Anatomical Pathological Service of Professor Alberto Antunes University Hospital. It was performed the histomorphometric analysis of 840 images comprising 14 placenta samples from pregnancies with preeclampsia (cases) and 14 placenta samples from pregnancies without preeclampsia (controls). RESULTS: In the preeclampsia group the mean area of fibrinoid material was 168.46 pixels and in the group without preeclampsia it was 89.63 pixels. The nuclei total area was smaller in preeclampsia (89.51 pixels) in comparison with the control group (113.34 pixels). CONCLUSION: In placentas from preeclampsia pregnancies the fibrinoid material area is larger (1.8x) compared to normal pregnancies. Nuclei and cytoplasm areas were larger in the control group. There was no statistical difference regarding the stromal area. There was also a reduction in villous space in preeclampsia, which is consistent with villous hypotrophy.

Frequência do uso adequado dos testes estatísticos nos artigos originais publicados na Revista Brasileira de Anestesiologia entre janeiro de 2008 e dezembro de 2009 / Frequency of the adequate use of statistical tests of hypothesis in original articles published in the Revista Brasileira de Anestesiologia between January 2008 and December 2009 / Frecuencia del uso adecuado de los test estadísticos en los artículos originales publicados en la Revista Brasileña de Anestesiología entre enero de 2008 y diciembre de 2009

JUSTIFICATIVA E OBJETIVOS: A realização de uma análise estatística é necessária para uma avaliação adequada do artigo original por parte do leitor, possibilitando-lhe melhor visualização e compreensão dos resultados. O objetivo desta pesquisa foi determinar a frequência do uso adequado dos testes estatísticos de hipóteses presentes nos artigos originais publicados na Revista Brasileira de Anestesiologia no período entre janeiro de 2008 e dezembro de 2009. MÉTODOS: Foram selecionados artigos originais publicados na Revista Brasileira de Anestesiologia entre janeiro de 2008 a dezembro de 2009. O uso dos testes estatísticos foi avaliado como apropriado quando a seleção dos testes foi adequada para variáveis contínuas e categóricas e para testes paramétricos e não paramétricos; houve descrição do fator de correção quando se relatou o uso de múltiplas comparações; foi mencionado o uso específico de um teste estatístico para a análise de uma variável. RESULTADOS: Foram selecionados 76 artigos originais, com um total de 179 testes estatísticos de hipóteses. A frequência dos testes estatísticos mais utilizados foi: 20,11 por cento para o qui-quadrado, 19,55 por cento para o teste t de student, 10,05 por cento para o teste de ANOVA e 9,49 por cento para o teste exato de Fisher. A frequência de uso adequado dos testes estatísticos de hipóteses foi de 56,42 por cento (IC 95 por cento 49,16 por cento a 63,68 por cento), de uso inadequado 13,41 por cento (IC 95 por cento 8,42 por cento a 18,40 por cento), ocorrendo resultado inconclusivo em 30,16 por cento (IC 95 por cento 23,44 por cento a 36,88 por cento). CONCLUSÕES: A frequência do uso adequado dos testes estatísticos utilizados nos artigos originais publicados na Revista Brasileira de Anestesiologia entre janeiro de 2008 e dezembro de 2009 foi de 56,42 por cento.

BACKGROUND AND OBJECTIVES: Statistical analysis is necessary for adequate evaluation of the original article by the reader allowing him/her to better visualize and comprehend the results. The objective of the present study was to determine the frequency of the adequate use of statistical tests in original articles published in the Revista Brasileira de Anestesiologia from January 2008 to December 2009. METHODS: Original articles published in the Revista Brasileira de Anestesiologia between January 2008 and December 2009 were selected. The use of statistical tests was deemed appropriate when the selection of the tests was adequate for continuous and categorical variables and for parametric and non-parametric tests, the correction factor was described when the use of multiple comparisons was reported, and the specific use of a statistical test for analysis of one variable was mentioned. RESULTS: Seventy-six original articles from a total of 179 statistical tests were selected. The frequency of the statistical tests used more often was: Chi-square 20.11 percent, Student t test 19.55 percent, ANOVA 10.05 percent, and Fisher exact test 9.49 percent. The frequency of the adequate use of statistical tests was 56.42 percent (95 percent CI 49.16 percent to 63.68 percent), erroneous use in 13.41 percent (95 percent CI 8.42 percent to 18.40 percent), and an inconclusive result in 30.16 percent (95 percent CI 23.44 percent to 36.88 percent). CONCLUSIONS: The frequency of inadequate use of statistical tests in the articles published by the Revista Brasileira de Anestesiologia between January 2008 and December 2009 was 56.42 percent.

JUSTIFICATIVA Y OBJETIVOS: La realización de un análisis estadístico se hace necesario para una evaluación pertinente del artículo original por parte del lector, ayudándolo a obtener una mejor visualización y comprensión de los resultados. El objetivo de esta investigación fue determinar la frecuencia del uso adecuado de los test estadísticos de hipótesis presentes en los artículos originales publicados en la Revista Brasileña de Anestesiología, entre enero de 2008 y diciembre de 2009. MÉTODOS: Se seleccionaron artículos originales publicados en la Revista Brasileña de Anestesiología entre enero de 2008 a diciembre de 2009. El uso de los test estadísticos se evaluó como apropiado cuando: la selección de los test fue satisfactoria para las variables continuas y categóricas y para el test paramétrico y no paramétrico; hubo una descripción del factor de corrección cuando se relató el uso de múltiples comparaciones; fue mencionado el uso específico de un test estadístico para el análisis de una variable. RESULTADOS: Se seleccionaron 76 artículos originales, con un total de 179 test estadísticos de hipótesis. La frecuencia de los test estadísticos más utilizados fue: 20,11 por ciento para el Chi-Cuadrado, 19,55 por ciento, para el test t de Student, 10,05 por ciento para el test de ANOVA y 9,49 por ciento para el test exacto de Fisher. La frecuencia de uso adecuado de los test estadísticos de hipótesis fue de un 56,42 por ciento (IC 95 por ciento 49,16 por ciento a 63,68 por ciento), de uso inadecuado, 13,41 por ciento (IC 95 por ciento 8,42 por ciento a 18,40 por ciento), con un resultado sin conclusiones en un 30,16 por ciento (IC 95 por ciento 23,44 por ciento a 36,88 por ciento). CONCLUSIONES: La frecuencia del uso adecuado de los test estadísticos utilizados en los artículos originales publicados en la Revista Brasileña de Anestesiología entre enero de 2008 y diciembre de 2009, fue de un 56,42 por ciento.

Frequency of the adequate use of statistical tests of hypothesis in original articles published in the Revista Brasileira de Anestesiologia between January 2008 and December 2009.

BACKGROUND AND OBJECTIVES: Statistical analysis is necessary for adequate evaluation of the original article by the reader allowing him/her to better visualize and comprehend the results. The objective of the present study was to determine the frequency of the adequate use of statistical tests in original articles published in the Revista Brasileira de Anestesiologia from January 2008 to December 2009. METHODS: Original articles published in the Revista Brasileira de Anestesiologia between January 2008 and December 2009 were selected. The use of statistical tests was deemed appropriate when the selection of the tests was adequate for continuous and categorical variables and for parametric and non-parametric tests, the correction factor was described when the use of multiple comparisons was reported, and the specific use of a statistical test for analysis of one variable was mentioned. RESULTS: Seventy-six original articles from a total of 179 statistical tests were selected. The frequency of the statistical tests used more often was: Chi-square 20.11%, Student t test 19.55%, ANOVA 10.05%, and Fisher exact test 9.49%. The frequency of the adequate use of statistical tests was 56.42% (95% CI 49.16% to 63.68%), erroneous use in 13.41% (95% CI 8.42% to 18.40%), and an inconclusive result in 30.16% (95% CI 23.44% to 36.88%). CONCLUSIONS: The frequency of inadequate use of statistical tests in the articles published by the Revista Brasileira de Anestesiologia between January 2008 and December 2009 was 56.42%.

Uso do sulfato de magnésio por via venosa e nebulização para o tratamento da asma aguda na emergência: [revisão] / Use of the intravenous and nebulized magnesium sulfate for the treatment of the acute asthma in the emergence: [review]

JUSTIFICATIVA E OBJETIVOS: Tem sido mostrado que o sulfato de magnésio apresenta benefícios em adultos e crianças asmáticos, com fraca resposta aos agentes beta-agonistas e corticóides sistêmicos no departamento de emergência. O objetivo deste estudo foi realizar uma revisão não sistemática acerca do tratamento da asma aguda com sulfato de magnésio por via venosa e nebulização na emergência. CONTEÚDO: As primeiras investigações que demonstraram benefício no uso do sulfato de magnésio na asma são de 1938. Os efeitos do sulfato de magnésio podem ser mediados através da ação antagonista do cálcio ou através da função de co-fator em sistemas enzimáticos envolvendo o fluxo iônico através da membrana celular. Foi realizada uma revisão de literatura através da base de dados MedLine nos últimos seis anos (2000 a 2006) e incluídos os artigos publicados na língua inglesa, através do cruzamento dos unitermos asma e sulfato de magnésio. CONCLUSÕES: A administração de rotina do sulfato de magnésio por via venosa e nebulização em pacientes com asma aguda grave que se apresentam no serviço de emergência não é recomendado; entretanto, como um tratamento adjuvante obtém-se algum benefício.

BACKGROUND AND OBJECTIVES: Magnesium sulfate has been shown to benefit asthmatic children and adults with poor responses to initial beta-agonist therapy and systemic corticoids in the emergency department. The aim of this study was to realize a no systematic review about the treatment of the acute asthma with intravenous and nebulized magnesium sulfate in the emergence. CONTENTS: The first investigations that demonstrate the benefit in the use of the magnesium sulfate in asthma date to 1938. The effects of magnesium sulfate may be mediated through its action as a calcium antagonist or through its function as a cofactor in enzyme systems involving ion flux across cell membranes. We realized a literature review using MedLine database of the last six years (2000 to 2006). Articles published in English were included by the crossing of keywords asthma and magnesium sulfate. CONCLUSIONS: The routine administration of intravenous and nebulized magnesium sulfate to severely ill patients with acute asthma presents in the emergence department is not recommended, however as an adjunct therapy brings some benefit.

[Use of the intravenous and nebulized magnesium sulfate for the treatment of the acute asthma in the emergence]. / Uso do sulfato de magnésio por via venosa e nebulização para o tratamento da asma aguda na emergência.

BACKGROUND AND OBJECTIVES: Magnesium sulfate has been shown to benefit asthmatic children and adults with poor responses to initial beta-agonist therapy and systemic corticoids in the emergency department. The aim of this study was to realize a no systematic review about the treatment of the acute asthma with intravenous and nebulized magnesium sulfate in the emergence. CONTENTS: The first investigations that demonstrate the benefit in the use of the magnesium sulfate in asthma date to 1938. The effects of magnesium sulfate may be mediated through its action as a calcium antagonist or through its function as a cofactor in enzyme systems involving ion flux across cell membranes. We realized a literature review using MedLine database of the last six years (2000 to 2006). Articles published in English were included by the crossing of keywords asthma and magnesium sulfate. CONCLUSIONS: The routine administration of intravenous and nebulized magnesium sulfate to severely ill patients with acute asthma presents in the emergence department is not recommended, however as an adjunct therapy brings some benefit.