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Peres HA, Leira Pereira LR, Martinez EZ, Viana CM, Foss-Freitas MC. Heart failure is associated with non-adherence to pharmacotherapy in elderly with type 2 diabetes mellitus in public health system Brazilians. Diabetes Metab Syndr 2019; 13:939-946. [PMID: 31336548 DOI: 10.1016/j.dsx.2018.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 12/19/2018] [Indexed: 11/19/2022]
Abstract
UNLABELLED The rising prevalence of T2DM poses a serious threat to human health and the viability of many health care systems around the world. Non-adherence to therapeutic in the T2DM is high, and Brazilian studies of public heath for to identify new variables are scares. The present study explored cardiovascular consequences associated with compliance and non-adherence among T2DM in Brazilian patients seeking medical care in Brazilian basic health unit clinics. METHODS This is a cross-sectional study carried out in a city the interior of Sao Paulo state, with patients with T2DM, being municipal PHS users. Data were collected from the computerized system of the municipality for a one single researcher and patient records, and analyzed using the IBM SPSS v.18 statistical package. The response variables was categorized in adherent MGT (>80) and non-adherent MGT (≤80). RESULTS The mean age of patients was 63.6 ± 9.5 with predominance for the sex male 66.4% and 42% of patients with T2DM do not adherence to treatment. We found an associated odds ratio (OR) = 2.3 (1.1-5.1) between heart failure and non-adherence in patients with T2DM. CONCLUSION Heart failure is a factor associated with non-adherence to treatment in patients with T2DM and in the practice clinical, the screening for heart failure and interventions may improve adherence to pharmacotherapy.
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Affiliation(s)
- Heverton Alves Peres
- Department of Internal Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Sao Paulo, Brazil.
| | - Leonardo Régis Leira Pereira
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Edson Zangiacomini Martinez
- Department of Social Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | | | - Maria Cristina Foss-Freitas
- Department of Internal Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Sao Paulo, Brazil
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2
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Silva GCM, Jabor VAP, Bonato PS, Martinez EZ, Faria-E-Sousa SJ. Penetration of 0.3% ciprofloxacin, 0.3% ofloxacin, and 0.5% moxifloxacin into the cornea and aqueous humor of enucleated human eyes. ACTA ACUST UNITED AC 2017; 50:e5901. [PMID: 28678917 PMCID: PMC5496154 DOI: 10.1590/1414-431x20175901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 04/18/2017] [Indexed: 11/21/2022]
Abstract
We aimed to quantify the penetration of ciprofloxacin, ofloxacin, and moxifloxacin into the cornea and aqueous humor of cadaver eyes. A total of 60 enucleated eyes, not eligible for corneal transplantation, were divided into three groups and immersed in commercial solutions of 0.3% ciprofloxacin, 0.3% ofloxacin, or 0.5% moxifloxacin for 10 min. Whole corneas and samples of aqueous humor were then harvested and frozen, and drug concentrations analyzed by liquid chromatography tandem mass spectrometry. The mean corneal concentration of moxifloxacin was twice as high as ofloxacin, and the latter was twice as high as ciprofloxacin. The mean concentration of moxifloxacin in the aqueous humor was four times higher than the other antibiotics, and the mean concentrations of ciprofloxacin and ofloxacin were statistically similar. The amount of drug that penetrated the anterior chamber after a 10-min immersion was far below the safe limit of endothelial toxicity of each preparation. Moxifloxacin demonstrated far superior penetration into the cornea and anterior chamber of cadaver eyes compared to ciprofloxacin and ofloxacin. One should not expect endothelial toxicity with the commercial eye drops of ciprofloxacin, ofloxacin, and moxifloxacin that reach the anterior chamber through the cornea.
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Affiliation(s)
- G C M Silva
- Departamento de Oftalmologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - V A P Jabor
- Departamento de Física e Química, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - P S Bonato
- Departamento de Física e Química, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - E Z Martinez
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - S J Faria-E-Sousa
- Departamento de Oftalmologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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3
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Basile-Filho A, Menegueti MG, Nicolini EA, Lago AF, Martinez EZ, Auxiliadora-Martins M. The apache ii and serum sodium levels as predictors of mortality in the surgical critically ill patients. Intensive Care Med Exp 2015. [PMCID: PMC4797876 DOI: 10.1186/2197-425x-3-s1-a757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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4
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Franco LJ, Dal Fabbro AL, Martinez EZ, Sartorelli DS, Silva AS, Soares LP, Franco LF, Kuhn PC, Vieira-Filho JPB, Moisés RS. Performance of glycated haemoglobin (HbA1c) as a screening test for diabetes and impaired glucose tolerance (IGT) in a high risk population--the Brazilian Xavante Indians. Diabetes Res Clin Pract 2014; 106:337-42. [PMID: 25271115 DOI: 10.1016/j.diabres.2014.08.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 08/06/2014] [Accepted: 08/30/2014] [Indexed: 10/24/2022]
Abstract
AIMS To examine the properties of HbA1c to detect diabetes and IGT in adult Brazilian Xavante Indians, a high risk population for diabetes. METHODS The survey was carried out between October 2010 and January 2012 and based on a 75 g oral glucose tolerance test (OGTT). Basal and 2h capillary glycaemia were measured by HemoCue Glucose 201+; HbA1c using an automated high-performance liquid chromatography analyzer (Tosoh G7). RESULTS 630 individuals aged ≥ 20 years were examined and 80 had a previous diagnosis of diabetes. Sensitivity, specificity and accuracy for HbA1c ≥ 6.5% (≥ 48 mmol/mol) were 71.3%, 90.5% and 87.2%. The areas under the ROC curve (AUC) was 0.88 (95%CI: 0.83-0.93). To identify IGT, HbA1c values between 5.7% and 6.4% (39-47 mmol/mol) presented sensitivity, specificity and accuracy of 87.2%, 24.7% and 51.4%, with an AUC of 0.62 (95%CI: 0.57-0.67). CONCLUSIONS The ADA/WHO proposed cut-off of 6.5% (48 mmol/mol) for HbA1c was adequate to detect diabetes among the Xavante. However, the performance of the ADA proposed cut-off points for pre-diabetes, when used to detect IGT was inadequate and should not be recommended.
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Affiliation(s)
- L J Franco
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, CEP: 14049-900 Ribeirão Preto, SP, Brazil.
| | - A L Dal Fabbro
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, CEP: 14049-900 Ribeirão Preto, SP, Brazil
| | - E Z Martinez
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, CEP: 14049-900 Ribeirão Preto, SP, Brazil
| | - D S Sartorelli
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, CEP: 14049-900 Ribeirão Preto, SP, Brazil
| | - A S Silva
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, CEP: 14049-900 Ribeirão Preto, SP, Brazil
| | - L P Soares
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, CEP: 14049-900 Ribeirão Preto, SP, Brazil
| | - L F Franco
- Division of Endocrinology, Escola Paulista de Medicina, Federal University of São Paulo. Rua Pedro de Toledo, 781-12 floor, CEP: 04039-001 São Paulo, SP, Brazil
| | - P C Kuhn
- Division of Endocrinology, Escola Paulista de Medicina, Federal University of São Paulo. Rua Pedro de Toledo, 781-12 floor, CEP: 04039-001 São Paulo, SP, Brazil
| | - J P B Vieira-Filho
- Division of Endocrinology, Escola Paulista de Medicina, Federal University of São Paulo. Rua Pedro de Toledo, 781-12 floor, CEP: 04039-001 São Paulo, SP, Brazil
| | - R S Moisés
- Division of Endocrinology, Escola Paulista de Medicina, Federal University of São Paulo. Rua Pedro de Toledo, 781-12 floor, CEP: 04039-001 São Paulo, SP, Brazil
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Basile-Filho A, Nicolini EA, Auxiliadora-Martins M, Alkmim-Teixeira GC, Martinez EZ, Martins-Filho OA, de Castro e Silva O. Comparison of acute physiology and chronic health evaluation II death risk, Child-Pugh, Charlson, and model for end-stage liver disease indexes to predict early mortality after liver transplantation. Transplant Proc 2011; 43:1660-4. [PMID: 21693253 DOI: 10.1016/j.transproceed.2010.11.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 10/28/2010] [Accepted: 11/03/2010] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study sought to determine which prognostic index was the most efficient to predict early (1-month) mortality of patients undergoing orthotopic liver transplantation (OLT). MATERIALS AND METHODS This retrospective study included 63 patients including 49 males and 14 females of overall median age 51.6 ± 9.7 years who were admitted to the intensive care unit (ICU) of a tertiary hospital. The Acute Physiology and Chronic Health Evaluation II (APACHE II) death risk, Child-Pugh, Charlson, and Model for End-stage Liver Disease (MELD) indices pre-OLT and post-OLT were analyzed by generation of receiver operating characteristic (ROC) curves to determine the area under the ROC curve (AUC), as a predictive factor for each index. The level of significance was set at P < .05. RESULTS The general 1-month posttransplantation mortality rate of OLT patients was 19% (n = 12 p). The AUC was 0.81 (confidence interval [CI] = 0.66-0.96; sensitivity = 72.5; specificity = 83.3) for APACHE II death risk; 0.74 (CI = 0.57-0.92; sensitivity = 76.5; specificity = 66.7) for MELD post-OLT; 0.70 (CI = 0.54-0.85; sensitivity = 64.7; specificity = 66.7) for Child-Pugh; 0.57 (CI = 0.36-0.78; sensitivity = 74.5; specificity = 50.0) for Charlson; and 0.50 (CI = 0.32-0.69; sensitivity = 98.0; specificity = 16.7) for MELD Pre-OLT. CONCLUSION Among the studied indices, the APACHE II death risk scoring system was the most effective to predict early mortality after OLT.
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Affiliation(s)
- A Basile-Filho
- Intensive Care Division, Department of Surgery and Anatomy, Ribeirão Preto University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Giacobbe M, Mendes Pinto-Neto A, Simões Costa-Paiva LH, Martinez EZ. The usefulness of ovarian volume, antral follicle count and age as predictors of menopausal status. Climacteric 2010; 7:255-60. [PMID: 15669549 DOI: 10.1080/13697130410001713715] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To compare the accuracy of ovarian volume, antral follicle count and age in predicting menopausal status in healthy women. METHODS The cross-sectional study was set in the Gynecology Division at the Leonor Mendes de Barros Maternity Hospital, São Paulo, Brazil. The subjects of this study were premenopausal (n = 121) and postmenopausal (n = 71) healthy women aged between 40 and 55 years. They were submitted to a medical interview and transvaginal ultrasound examination. The ovarian volume (cm3), antral follicle count and chronological age were recorded in both groups and the accuracies of these parameters in predicting menopausal status were compared. RESULTS Premenopausal women presented larger ovaries than postmenopausal women (p < 0.01). Premenopausal women had a higher number of antral follicles than postmenopausal women (p < 0.01). The receiver operating characteristic curves showed that ovarian volume, age and antral follicle count had similar sensitivities and specificities in predicting menopausal status. The best cut-off points were observed when ovarian volume was <4 cm3, age was > or =48 years and antral follicle count was < or = two follicles. CONCLUSIONS Ovarian volume, antral follicle count and chronological age are all individually predictive of menopausal status, with similar accuracies.
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Affiliation(s)
- M Giacobbe
- Leonor Mendes de Barros Maternity Hospital, São Paulo, Brazil
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7
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Nascimento CCF, Padula N, Milani JGPO, Shimano AC, Martinez EZ, Mattiello-Sverzut AC. Histomorphometric analysis of the response of rat skeletal muscle to swimming, immobilization and rehabilitation. Braz J Med Biol Res 2009; 41:818-24. [PMID: 18820773 DOI: 10.1590/s0100-879x2008000900013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Accepted: 07/31/2008] [Indexed: 11/22/2022] Open
Abstract
The objective of the present study was to determine to what extent, if any, swimming training applied before immobilization in a cast interferes with the rehabilitation process in rat muscles. Female Wistar rats, mean weight 260.52 +/- 16.26 g, were divided into 4 groups of 6 rats each: control, 6 weeks under baseline conditions; trained, swimming training for 6 weeks; trained-immobilized, swimming training for 6 weeks and then immobilized for 1 week; trained-immobilized-rehabilitated, swimming training for 6 weeks, immobilized for 1 week and then remobilized with swimming for 2 weeks. The animals were then sacrificed and the soleus and tibialis anterior muscles were dissected, frozen in liquid nitrogen and processed histochemically (H&E and mATPase). Data were analyzed statistically by the mixed effects linear model (P < 0.05). Cytoarchitectural changes such as degenerative characteristics in the immobilized group and regenerative characteristics such as centralized nucleus, fiber size variation and cell fragmentation in the groups submitted to swimming were more significant in the soleus muscle. The diameters of the lesser soleus type 1 and type 2A fibers were significantly reduced in the trained-immobilized group compared to the trained group (P < 0.001). In the tibialis anterior, there was an increase in the number of type 2B fibers and a reduction in type 2A fibers when trained-immobilized rats were compared to trained rats (P < 0.001). In trained-immobilized-rehabilitated rats, there was a reduction in type 2B fibers and an increase in type 2A fibers compared to trained-immobilized rats (P < 0.009). We concluded that swimming training did not minimize the deleterious effects of immobilization on the muscles studied and that remobilization did not favor tissue re-adaptation.
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Affiliation(s)
- C C F Nascimento
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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8
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Cornachione A, Cação-Benedini LO, Shimano MM, Volpon JB, Martinez EZ, Mattiello-Sverzut AC. Morphological comparison of different protocols of skeletal muscle remobilization in rats after hindlimb suspension. Scand J Med Sci Sports 2007; 18:453-61. [PMID: 18067520 DOI: 10.1111/j.1600-0838.2007.00720.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to evaluate and compare the efficacy of different remobilization protocols in different skeletal muscles considering the changes induced by hindlimb suspension of the tail. Thirty-six female Wistar rats were divided into six groups: control I, control II, suspended, suspended free, suspended trained on a declined treadmill and suspended trained on a flat treadmill. Fragments of soleus and tibialis anterior (TA) muscle were frozen and processed by different histochemical methods. The suspended soleus showed a significant increase in the proportional number of intermediate/hybrid fibers and a decrease in the number of type I fibers. Some of these changes proved to be reversible after remobilization. The three remobilization programs led to the recovery of both the proportional number of fibers and their size. The TA muscle presented a significant increase in the number and size of type I fibers and a cell size reduction of type IIB fibers, which were recovered after training on a declined treadmill and free movement. Especially regarding the soleus, the present findings indicate that, among the protocols, training on a declined treadmill was found to induce changes of a more regenerative nature, seemingly indicating a better tissue restructuring after the suspension procedure.
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Affiliation(s)
- A Cornachione
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, Brazil
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Guedes AC, Brenna SMF, Coelho SAS, Martinez EZ, Syrjänen KJ, Zeferino LC. p16INK4a Expression does not predict the outcome of cervical intraepithelial neoplasia grade 2. Int J Gynecol Cancer 2007; 17:1099-103. [PMID: 17367324 DOI: 10.1111/j.1525-1438.2007.00899.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Spontaneous regression of cervical intraepithelial neoplasia grade 2 (CIN2) lesions has been recognized since 1955, but predictors of this are poorly understood. Among the predictive markers studied, p16INK4a has been suggested to be of some value in monitoring the diagnosis of CIN2. In this clinical trial, 90 Brazilian women, diagnosed to CIN2 and high-risk human papillomavirus infection, were randomized into two groups of equal size: 45 women whose lesions were excised and 45 women subjected to prospective follow-up at 3-month intervals at least for 1 year (mean 6.8 months). p16INK4a expression was analyzed in paraffin-embedded sections using immunohistochemical staining. Among the 45 women in the follow-up group, 42% experienced spontaneous regression, 11% showed persistence, 22% progressed to CIN3, and 20% had partial regression to CIN1 or ASCUS (atypical squamous cell undetermined signifiance). p16INK4a expression was detected in 68.9% of the patients. In univariate survival (Cox) analysis, no significant difference in regression was obtained between p16INK4a-negative and -positive CIN2 lesions (adjusted HR = 1.1; 95% CI 0.6–2.0). In conclusion, p16INK4a expression could be useful in the diagnosis of CIN2. However, it failed to predict the outcome of CIN2. Because of its high spontaneous regression rate, follow-up could be considered as a management option of CIN2 in young and compliant women.
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Affiliation(s)
- A C Guedes
- Department of Gynecology, Leonor Mendes de Barros Maternity Hospital, Health State Secretariat, São Paulo, Brazil
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10
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Brenna SMF, Silva IDCG, Zeferino LC, Pereira JS, Martinez EZ, Syrjänen KJ. Prognostic value of P53 codon 72 polymorphism in invasive cervical cancer in Brazil. Gynecol Oncol 2004; 93:374-80. [PMID: 15099948 DOI: 10.1016/j.ygyno.2004.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The prognostic value of p53 codon72 polymorphism was analyzed in Brazilian women with cervical cancer. METHODS The present study consists of 148 women diagnosed and treated for invasive cervical carcinoma (FIGO stages Ib-IIIb) between 1992 and 2002. Demonstration of p53 polymorphism was performed in DNA extracted from paraffin-embedded sections using the polymerase chain reaction (PCR). RESULTS Among the 148 women, arg/arg was found in 99 (67%) and, arg/pro in 49 (33%). The overall survival (OS) curves (univariate) were different between arg/arg and arg/pro patients (P = 0.01). There was slightly increased risk of death for arg/arg patients (crude HR 2.2 CI 95% 1.2-4.0), which was not confounded by FIGO stages (adjusted HR 2.4 CI 95% 1.3-4.3). For disease-free survival (DFS), two situations were considered: (1) 124 women who received any treatment, and (2) 118 who received FIGO-recommended treatment. In the first group, 59% of arg/arg patients presented recurrence as compared to 32% in the arg/pro group (P = 0.02), whereas in the second group, 61% of the arg/arg and 34% arg/pro showed recurrence (P = 0.04). The risk of recurrence adjusted by FIGO stage for the 124 patients was 2.4 (CI 95% 1.0-3.7) and for the 118 it was 1.9 (CI 95% 1.0-3.4). These adjusted models showed no confounding and no interaction. CONCLUSIONS Despite the prognostic significance of p53 polymorphism in univariate survival analysis, there was no or only marginal evidence on the independent prognostic value of p53arg/arg in multivariate analysis. The more ominous prognosis of the homozygous (arg/arg) patients was explained by the primary treatment, independent on the FIGO stage.
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Affiliation(s)
- S M F Brenna
- Gynecology-Oncology, Health State Department, Maternity Hospital Leonor Mendes de Barros, São Paulo, Brazil.
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11
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Sagarra RAM, Andrade LALA, Martinez EZ, Pinto GA, Syrjänen KJ, Derchain SFM. P53 and Bcl-2 as prognostic predictors in epithelial ovarian cancer. Int J Gynecol Cancer 2002; 12:720-7. [PMID: 12445249 DOI: 10.1046/j.1525-1438.2002.01135.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The study was designed to evaluate the prognostic importance of clinical and pathologic variables with p53 and Bcl-2 in epithelial ovarian cancer using multivariate analysis. Tumor tissues from 90 patients were analyzed immunohistochemically for p53 and Bcl-2 expression. Hazard ratios were calculated in univariate and multivariate survival analyses. Forty-two (47%) were considered positive for p53 expression and 18 (20%) were positive for Bcl-2. Positive expression for p53 was less frequent in patients in FIGO stage I (22%). Positive staining for Bcl-2 correlated significantly with the histologic type (P < 0.01). No direct correlations could be demonstrated between p53 and Bcl-2 expression and age or histologic grade. In univariate analysis, p53 and Bcl-2 expression were not significantly correlated with overall survival, disease-free survival, or progression time. FIGO stage III and IV and residual disease > or =2 cm3 after first surgery were significantly correlated with poor outcome in univariate analysis. FIGO stage retained their independent prognostic value in multivariate analysis. Neither p53 nor Bcl-2 had any significant influence on outcome in multivariate survival analysis. FIGO stage proved to be the only significant independent prognostic factor in epithelial ovarian cancer, although residual disease remains correlated with disease-free survival.
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MESH Headings
- Adenocarcinoma, Mucinous/genetics
- Adenocarcinoma, Mucinous/mortality
- Adenocarcinoma, Mucinous/pathology
- Adult
- Aged
- Biomarkers, Tumor/blood
- Biomarkers, Tumor/genetics
- Brazil
- Carcinoma, Endometrioid/genetics
- Carcinoma, Endometrioid/mortality
- Carcinoma, Endometrioid/pathology
- Cystadenocarcinoma, Papillary/genetics
- Cystadenocarcinoma, Papillary/mortality
- Cystadenocarcinoma, Papillary/pathology
- Disease-Free Survival
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Immunohistochemistry
- Middle Aged
- Multivariate Analysis
- Neoplasm Staging
- Ovarian Neoplasms/genetics
- Ovarian Neoplasms/mortality
- Ovarian Neoplasms/pathology
- Predictive Value of Tests
- Prognosis
- Proto-Oncogene Proteins c-bcl-2/genetics
- Survival Analysis
- Tumor Suppressor Protein p53/genetics
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Affiliation(s)
- R A M Sagarra
- Department of Medical Clinic (Clinical Oncology), Universidade Estadual de Campinas, São Paulo, Brazil
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12
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Brenna SMF, Zeferino LC, Pinto GA, Souza RA, Andrade LAL, Vassalo J, Martinez EZ, Syrjänen KJ. P53 expression as a predictor of recurrence in cervical squamous cell carcinoma. Int J Gynecol Cancer 2002; 12:299-303. [PMID: 12060452 DOI: 10.1046/j.1525-1438.2002.01097.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
P53 protein function is frequently down-regulated in cervical cancer by complexing with human papillomavirus (HPV) E6 protein, leading to degradation of p53, genomic instability, and mutations. Results are controversial, however, on the prognostic value of p53 protein expression in cervical cancer. In this study, a cohort of 220 Brazilian women with FIGO stage IB-III cervical squamous cell carcinoma (SCC), followed for 5 years, was analyzed for p53 protein expression using immunohistochemistry. The disease-free survival (DFS) and relapse rate were analyzed using univariate (Kaplan-Meier) and multivariable (Cox's proportional hazards model) survival analyses. P53 protein expression was detected in 35% of the patients, including 21% in stage I, 28% in stage II and 51% in stage III of disease. Of 220 women, only 116 completed one of the treatment options standardized by FIGO within 120 days. There was a higher risk of relapse in stage II and III disease, that was not modified by p53 positivity; HR 3.0 (1.3-6.5) to stage II and HR 4.0 (1.9-8.5) to stage III. The multivariate analysis evidenced that p53 expression is not an independent factor exceeding the power of FIGO stage as the single most important determinant of the hazards for disease relapse.
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Affiliation(s)
- Sylvia M F Brenna
- Gynecologic Oncology Group, Maternity Hospital Leonor Mendes de Barros, The Health State Secretariat, Avenue Celso Garcia 2477, 03015-000 São Paulo, Brazil.
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Brenna SMF, Zeferino LC, Pinto GA, Souza RA, Andrade LAL, Vassalo J, Martinez EZ, Syrjanen KJ. c-Myc protein expression is not an independent prognostic predictor in cervical squamous cell carcinoma. Braz J Med Biol Res 2002; 35:425-30. [PMID: 11960190 DOI: 10.1590/s0100-879x2002000400003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The c-myc protein is known to regulate the cell cycle, and its down-regulation can lead to cell death by apoptosis. The role of c-myc protein as an independent prognostic determinant in cervical cancer is controversial. In the present study, a cohort of 220 Brazilian women (mean age 53.4 years) with FIGO stage I, II and III (21, 28 and 51%, respectively) cervical squamous cell carcinomas was analyzed for c-myc protein expression using immunohistochemistry. The disease-free survival and relapse-rate were analyzed using univariate (Kaplan-Meier) survival analysis for 116 women who completed the standard FIGO treatment and were followed up for 5 years. Positive c-myc staining was detected in 40% of carcinomas, 29% being grade 1, 9% grade 2, and 2% grade 3. The distribution of positive c-myc according to FIGO stage was 19% (17 women) in stage I, 33% (29) in stage II, and 48% (43) in stage III of disease. During the 60-month follow-up, disease-free survival in univariate (Kaplan-Meier) survival analysis (116 women) was lower for women with c-myc-positive tumors, i.e., 60.5, 47.5 and 36.6% at 12, 36, and 60 months, respectively (not significant). The present data suggest that immunohistochemical demonstration of c-myc does not possess any prognostic value independent of FIGO stage, and as such is unlikely to be a useful prognostic marker in cervical squamous cell carcinoma.
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Affiliation(s)
- S M F Brenna
- Grupo de Oncologia Ginecológica, Hospital Maternidade Leonor Mendes de Barros, Secretaria da Saúde do Estado de São Paulo, São Paulo, SP, Brasil. brenna@
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Roteli-Martins CM, Alves VA, Santos RT, Martinez EZ, Syrjänen KJ, Derchain SF. Value of morphological criteria in diagnosing cervical HPV lesions confirmed by in situ hybridization and hybrid capture assay. Pathol Res Pract 2002; 197:677-82. [PMID: 11700889 DOI: 10.1078/0344-0338-00145] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The present study evaluated the value of morphological criteria (binucleation, multinucleation, koilocytosis, spindle koilocytes, abnormal mitosis and dyskeratosis) in the diagnosis of cervical human papillomavirus (HPV) lesions confirmed by in situ hybridization (ISH) and hybrid capture (HC) assay. Colposcopic punch biopsies from a series of 138 women with abnormal Pap smears were examined on light microscopy and in situ hybridization (DAKO widespectrum cocktail probe) for HPV-induced morphological changes and HPV DNA, respectively. Cervical swabs were analyzed for HPV DNA of the oncogenic types using Hybrid Capture. CIN 2 and CIN 3 were found in 44 biopsies, CIN 1 in 62, and no evidence of HPV in 32 cases. HPV was detected by ISH in 51/138 (37%) cases and by HC in 66/138 (48%) lesions. With both tests, HPV DNA detection increased parallel with lesion severity, up to 70% and 59% in CIN 2/3 by HC and ISH, respectively OR 4.6 (1.7-12.1) and 10.1 (3.0-33.8). Among the histological criteria, multinucleation, binucleation and abnormal mitoses were significantly associated with HPV DNA detection. Multinucleation proved to be the strongest predictor of HPV DNA-positivity. Binucleation, abnormal mitosis, koilocytosis and spindle koilocytes were also reliable criteria of HPV lesions. Minor nuclear atypia, and "mild koilocytosis" were of no value in making this diagnosis.
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Roteli-Martins CM, Derchain SF, Martinez EZ, Siqueira SA, Alves VA, Syrjänen KJ. Morphological diagnosis of HPV lesions and cervical intraepithelial neoplasia (CIN) is highly reproducible. CLIN EXP OBSTET GYN 2002; 28:78-80. [PMID: 11491378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
PURPOSE to assess the value of individual histological criteria in the diagnosis of cervical HPV lesions. METHODS 138 women referred for colposcopic evaluation (due to abnormal PAP smears) were subjected to cervical punch biopsy. The biopsies were classified as no HPV lesion, CIN 1, or CIN 2-3 by two observers independently. Kappa tests were used for interobserver agreement of the diagnosis. The presence of binucleation, multinucleation, abnormal mitosis. koilocytosis, spindle koilocytosis and dyskeratosis was similarly assessed. RESULTS the Kappa statistic was 0.638 (CI 95% 0.533-0.743), showing substantial inter-observer agreement. Abnormal mitosis and multi-nucleation were the two most powerful discriminators between CIN 2-3 and CIN 1. Koilocytosis proved to be the single most powerful discriminator between CIN 1 lesions and non-HPV lesions. CONCLUSION the results advocate the use of histology as the gold standard in diagnosing cervical precancerous lesions. The classical criteria can be also used to differentiate low-grade lesions, which has practical implications by avoiding the unnecessary treatment of minor abnormalities.
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Vassallo J, Derchain SF, Pinto GA, Martinez EZ, Syrjänen KJ, Andrade LA. High risk HPV and p53 protein expression in cervical intraepithelial neoplasia. Int J Gynaecol Obstet 2000; 71:45-8. [PMID: 11044541 DOI: 10.1016/s0020-7292(00)00248-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Cervical intraepithelial lesions due to HPV infection are common in Brazil. An understanding of the mechanisms of the interaction between HPV and host factors is still incomplete. In spite of the high incidence of cervical cancer in Brazil, such studies with Brazilian patients are scarce. The purpose of this study was to correlate the presence of high-risk types of HPV and expression of p53 protein, grade of cervical lesion, age, high-risk sexual behaviors and smoking. It was also intended to establish whether p53 expression might be useful as a marker for CIN progression. METHODS HPV detection was performed on paraffin sections using biotin-labeled probes by in situ hybridization. p53 protein expression was evaluated by immunohistochemistry. RESULTS Seventy-eight patients with cervical dysplasia were included in the study. CIN 1 was diagnosed in 38 cases, and CIN 2+3 in 40 cases. High-risk HPV was detected in 42 patients. No correlation was found between the grade of cervical lesion or the presence of HPV and smoking, and high-risk sexual behavior. Expression of p53 was significantly higher in CIN 1, as compared with CIN 2+3, but did not correlate with HPV status. CONCLUSION Higher expression of p53 protein in early lesions supports the hypothesis of a partially protective role of the wild-type p53 in early stages of cervical lesions.
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Affiliation(s)
- J Vassallo
- Department of Anatomic Pathology, State University of Campinas (UNICAMP), São Paulo, Brazil.
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Derchain SF, Roteli-Martins CM, Syrjänen KJ, de Abreu HJ, Martinez EZ, Alves VA. Association of oncogenic human papillomavirus DNA with high grade cervical intraepithelial neoplasia: the role of cigarette smoking. Sex Transm Infect 1999; 75:406-8. [PMID: 10754946 PMCID: PMC1758258 DOI: 10.1136/sti.75.6.406] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- S F Derchain
- Department of Gynecology, UNICAMP, Campinas, Brazil
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