Effectiveness of the prevention of mother-to-child HIV transmission in Bahia, Brazil.

INTRODUCTION: Antiretroviral therapy and prophylaxis during the antepartum, intrapartum and postpartum periods, cesarean delivery and avoidance of breast milk significantly reduce vertical transmission of HIV. OBJECTIVE: To evaluate the effectiveness prevention of mother-to-child transmission of HIV and determine the rate of vertical transmission in a public sexually transmitted infection and HIV referral center in Salvador, Bahia, in the period immediately prior to the initiation of universal antiretroviral therapy in pregnant women. METHODS: Cross-sectional study using data collected from medical records of children born to HIV infected mothers in Bahia from 2005 to 2008 who were referred to the Reference Center for Diagnosis and Research of Sexually Transmitted Diseases and HIV/AIDS for care. RESULTS: Of 232 HIV-exposed infants, 19 (8.2%) had confirmed HIV infection. One hundred eighty-eight (81%) mothers received antenatal care, 120 (52%) antepartum antiretroviral therapy or prophylaxis, and 168 (72%) intrapartum zidovudine. Two hundred twenty-three (96%) infants received zidovudine. In multivariable models, the combination of intrapartum and postpartum antiretroviral prophylaxis was associated with decreased adjusted odds of mother-to-child transmission. CONCLUSIONS: Low levels of antenatal screening and access to prevention of mother-to-child transmission were significant limitations in the cascade of prevention of mother-to-child transmission at our center in this period.

Osteosarcoma in patients younger than 12 years old without metastases have similar prognosis as adolescent and young adults.

BACKGROUND: Childhood cancer is relatively rare and tends to present specific age distribution, as a prognostic factor for some of these diseases. Information on how young age affects prognosis, response to chemotherapy, and local control options in children versus AYA with osteosarcoma (OST) is minimal. METHODS: In order to identify the main differences in clinical pathologic features, surgical approaches and survival rates of primary high grade OST of the extremity between children (n = 156; <12 years old) and AYA (n = 397; 12-30 years old), the institutional database with 553 patients treated by BOTG studies over 15 years were reviewed. RESULTS: There were no differences in metastases at diagnosis, tumor size, and grade of necrosis between the two age groups. The rate of amputation was 30% higher in the children group (P = 0.018). The rate of limb salvage surgery using reconstruction with allograft or autograft was 70% higher in the children group (P = 0.018) while endoprosthesis rate was 40% higher in the AYA group (P = 0.018). The log rank test revealed that survival is similar between the two age groups for non-metastatic patients (P = 0.424 for OS and P = 0.393 for EFS). Metastatic patients of both ages group had higher risk of dying compared to non-metastatic (HR 3.283 95% CI 2.581-4.177; P < 0.001). Children with metastases at diagnosis had less OS time (P = 0.049) and EFS time (P = 0.032) than adolescents. CONCLUSION: Non-metastatic OST in preadolescent patients does not appear to be significantly different from those seen in AYA patients, but has local control challenges. Children presenting with metastases should be considered an ultra-high-risk group.

Fifteen Years' Experience of the Brazilian Osteosarcoma Treatment Group (BOTG): A Contribution from an Emerging Country.

PURPOSE: Little information is available regarding the tumor features, prognostic factors, and treatment results in children and adolescents and young adults (AYAs) with osteosarcoma diagnosed in developing countries. We reviewed the results of three observational cohorts of osteosarcoma patients treated in an emerging country. METHODS: A total of 604 patients below the age of 30 years with high-grade osteosarcoma were prospectively enrolled in the Brazilian Osteosarcoma Treatment Group (BOTG) studies III, IV, and V. Gender, age, time from onset of symptoms to diagnosis, primary tumor site, presence or absence of metastases at diagnosis, tumor size, type of surgery (limb-sparing or amputation), treatment protocol, and histological response were correlated with survival. RESULTS: The estimated 5-year overall survival and event-free survival (EFS) rates for the 553 eligible patients were 49% and 39% respectively; of the 390 non-metastatic patients included in the total, overall- and event-free survival were 59% and 48% respectively. Metastases at diagnosis, primary tumor site, type of surgery, and histological response were significant predictors of overall survival and EFS in univariate and multivariate analysis, whereas tumor size and treatment protocol lost prognostic significance in multivariate analysis. CONCLUSION: We report on the outcome of three consecutive studies for the treatment of osteosarcoma carried out in Brazil over 15 years. Although the survival rates presented are below those reported in current literature, it represents the result of a favorable experience gathered from the national collaborative work.

[Gastrinoma has an infrequent prevalence in pediatric age: a case report]. / Gastrinoma tem ocorrência incomum na faixa etária pediátrica. Relato de um caso.

The authors present the clinical, laboratory and radiological findings suggestive ofgastrinoma in a patient 1 year and 9 months old. Laboratory tests obtained after fasting revealed elevated serum gastrin, supporting the suspected diagnosis of gastrinoma. In the endoscopy an elevated lesion with central depression was observed. The immunohistochemical examination revealed the benign nature of the tumor and the hyperplasia of argentaffin cells. Gastrinoma is a rare disease that predominantly affects young adults, but it must be considered in the pediatric group when clinical and laboratorial features of this disease are observed.

Diferenças raciais e a sua relação com a saúde / Racial differences related to health

Neste artigo são abordadas as diferenças raciais e sua relação com a saúde. Apesar do longo uso da categoria raça em pesquisas clínicas e epidemiológicas, sua caracterização é pouco clara, principalmente naquelas comunidades cuja formação é, sabidamente, multirracial. Discordância a respeito do conceito de raça e a grande miscigenação dificultam a classificação e avaliação do surgimento e do comportamento de determinadas doenças, apartir do momento em que se perde o parâmetro do conceito biológico de "raça pura". Isto nos faz pensar sobre questões sociais como educação, economia, cultura, política, religião, etnia e racismo, entre outros. Realizou-se revisão de literatura e trabalhou-se sobre várias referências acerca do tema e comentado sobre sua importância. Alguns estudos mostram que a influência da raça sobre as diversas patologias é pouco elucidativa. Em outros, estabelece-se estreita relação entre a doença e fatores raciais. A influência de fatores socioeconômicos e culturais atua conjuntamente com aqueles de cunho biológico, o que torna difícil se estabelecer a real participação da raça em relação à saúde. Alguns comentários sobre o câncer, em especial, o câncer infantil, são feitos em separado, dada a sua importância no mundo atual.

Estudo de sobrevida em criancas portadoras de leucemia linfoblastica aguda / Survival study in with childhood lymphoblastic leukemia

Analisou-se o tempo de sobrevida livre de doenca apos remissão (SLD) em criancas portadoras de leucemia linfoblastica agua (LLA), acompanhadas em um Servico de Referencia para o Diagnoostico e Tratamento do Cancer Infantil, em Salvado, Bahia, no periodo de janeiro de 1985 a dezembro de 2000. Foram avaliados os dados de 497 pacientes com diagnostico de LLA, confirmando por mielograma e tratados segundo os protocolos terapeuticos do Grupo Brasileiro para o Tratamento da Leucemia na Infancia (GBTLI-LLA) sendo que 468 foram elegiveis para o estudo. Desses, 258 eram pertencentes ao ensaio GBTLI-LLA 85 e 210, ao GBTLI-LLA 93...