Assuntos
Antineoplásicos/administração & dosagem , Neoplasias da Mama/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Quimioterapia Adjuvante/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Resultado do TratamentoRESUMO
BACKGROUND: The aim of this study was to evaluate the efficacy of the ultrasonography with Power Doppler, by quantifying the vascular density by Vascularity Index (VI), to predict the pathologic response to neoadjuvant chemotherapy (NAC) for breast cancer (BC). METHODS: For this prospective observational study, 20 patients were recruited with a histological diagnosis of infiltrating breast carcinoma and indication for NAC. Patients were submitted to ultrasonography with Power Doppler. Tumor vascular density was evaluated by computer software SysArea©1, before treatment, after 2 or 3 cycles of chemotherapy and at the end of treatment. The pathologic response was analyzed. The sensitivity, specificity and positive and negative predictive values for the histological response were also calculated and P-values <0.05. RESULTS: VI showed a sensitivity of 88.88%, specificity of 100%, positive predictive value of 100% and negative predictive value of 91.66% for the pathologic response, as well as being strongly associated with it. The variation of VI, in terms of either an increase or decrease after 2 or 3 cycles of chemotherapy, significantly predicted the final histological response. CONCLUSIONS: The analysis of VI was predictive and showed a strong correlation with histological response to neoadjuvant chemotherapy for BC.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Group B Streptococcus (GBS) remains a major cause of neonatal sepsis and is also associated with invasive and noninvasive infections in pregnant women and non-pregnant adults, elderly and patients with underlying medical conditions. Ten capsular serotypes have been recognized, and determination of their distribution within a specific population or geographical region is important as they are major targets for the development of vaccine strategies. We have evaluated the characteristics of GBS isolates recovered from individuals with infections or colonization by this microorganism, living in different geographic regions of Brazil. METHODS: A total of 434 isolates were identified and serotyped by conventional phenotypic tests. The determination of antimicrobial susceptibility was performed by the disk diffusion method. Genes associated with resistance to erythromycin (ermA, ermB, mefA) and tetracycline (tetK, tetL, tetM, tetO) as well as virulence-associated genes (bac, bca, lmb, scpB) were investigated using PCR. Pulsed-field gel electrophoresis (PFGE) was used to examine the genetic diversity of macrolide-resistant and of a number of selected macrolide-susceptible isolates. RESULTS: Overall, serotypes Ia (27.6%), II (19.1%), Ib (18.7%) and V (13.6%) were the most predominant, followed by serotypes IV (8.1%) and III (6.7%). All the isolates were susceptible to the beta-lactam antimicrobials tested and 97% were resistant to tetracycline. Resistance to erythromycin and clindamycin were found in 4.1% and 3% of the isolates, respectively. Among the resistance genes investigated, tetM (99.3%) and tetO (1.8%) were detected among tetracycline-resistant isolates and ermA (39%) and ermB (27.6%) were found among macrolide-resistant isolates. The lmb and scpB virulence genes were detected in all isolates, while bac and bca were detected in 57 (13.1%) and 237 (54.6%) isolates, respectively. Molecular typing by PFGE showed that resistance to erythromycin was associated with a variety of clones. CONCLUSION: These findings indicate that GBS isolates circulating in Brazil have a variety of phenotypic and genotypic characteristics, and suggest that macrolide-resistant isolates may arise by both clonal spread and independent acquisition of resistance genes.
Assuntos
Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/efeitos dos fármacos , Streptococcus agalactiae/isolamento & purificação , Fatores de Virulência/genética , Adulto , Idoso , Brasil/epidemiologia , Clindamicina/farmacologia , Farmacorresistência Bacteriana Múltipla , Eritromicina/farmacologia , Feminino , Variação Genética , Genótipo , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Dados de Sequência Molecular , Filogenia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/microbiologia , Sorotipagem , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae/classificação , Streptococcus agalactiae/fisiologia , Tetraciclina/farmacologia , VirulênciaRESUMO
A punçäo com agulha fina (PAF) da mama é um importante meio diagnóstico de nódulos mamários. Sendo dependente de treinamento do profissional, seja para obter o material, seja para interpretá-lo, a técnica deve ser testada em cada instituiçäo para que se calcule os riscos de falsos diagnósticos positivos e negativos. Analisando 1.321 pacientes determinamos a acuidade diagnóstica deste exame através da comparaçäo de 496 citologias com as respectivas histologias. Obtivemos sensibilidade de 94 por cento, especificidade de 99,3 por cento, VPP de 98 por cento e VPN de 96, 7 por cento. Partindo do pressuposto de que a PAF da mama tem seu valor já estabelecido na literatura, optamos por discutir, neste trabalho, suas dificuldades principalmente falsos-positivos, falsos-negativos e materiais insatisfatórios
