COVID-19 and HIV/AIDS in a cohort study in Sao Paulo, Brazil: outcomes and disparities by race and schooling

Studies describing characteristics and outcomes of COVID-19 among people living with HIV are currently limited, lacking detailed evaluation of the interplay among demographics, HIV-related variables, and comorbidities on COVID-19 outcomes. This retrospective cohort study describes mortality rates overall and according to demographic characteristics and explores predictors of admission to intensive care unit and death among 255 persons living with HIV with severe acute respiratory syndrome and confirmed SARS-CoV-2 infection in the State of Sao Paulo, Brazil. We found that the overall mortality rate was 4.1/1,000 person-days, with a case-fatality of 34%. Higher rates occurred among older adults, Black/Mixed skin color/race patients, and those with lower schooling. In a multivariable analysis adjusted for age, sex, CD4 count, viral load and number of comorbidities, skin color/race, and schooling remained significantly associated with higher mortality. Although tenofovir use was more frequent among survivors in the univariable analysis, we failed to find a statistically significant association between tenofovir use and survival in the multivariable analysis. Our findings suggest that social vulnerabilities related to both HIV and COVID-19 significantly impact the risk of death, overtaking traditional risk factors such as age, sex, CD4 count, and comorbidities.

Survival and prognostic factors of patients with breast cancer in the state of São Paulo

Introduction

Breast cancer is a public health problem worldwide, being the most common malignant neoplasm in the female population.

Objectives

To estimate 5- and 10-year breast cancer-specific survival probabilities of patients included in the hospital-based cancer registry (HBCR) of the Fundação Oncocentro de São Paulo (FOSP, in Portuguese) and to assess the prognostic factors for this neoplasm.

Methods

Historical cohort study that included women with breast cancer included in HBCR-FOSP and diagnosed between 2002 and 2012. The event of interest was breast cancer-specific mortality. Living cases at the end of follow-up (December 31, 2017), loss to follow-up and death other than that due to breast cancer were considered censored on the date of the last contact or date of death. Descriptive analysis and survival analysis were performed using the Kaplan-Meyer method. Survival curves were compared using the log-rank test. Hazard ratios (HR) and their 95%CI were estimated using Cox's proportional hazards model. The study was approved by the Human Research Ethics Committee of the Botucatu Medical School, São Paulo State University, Brazil.

Results

53,146 cases of invasive breast cancer were registered at HBCR-FOSP between 2002-2012. The median age at diagnosis was 55.9 years. By the end of the follow-up, 20,683 patients died, and 71.4% were due to breast cancer. The 5- and 10-year breast cancer-specific survival for the entire cohort was 76.1% (95%CI 75.7-76.5%) and 64.8% (95% CI 64.2-65.3%), respectively. In the multivariate analysis, the factors associated with prognosis were age at diagnosis, year of diagnosis, educational level, clinical stage, and histological type.

Conclusions

These findings may contribute to the development of policies for the identification of breast tumors at earlier stages.

Key messages

Breast cancer is an important public health problem in Brazil and worldwide. The findings of this study may contribute to the development of public policies for the control of breast cancer in the state of São Paulo.

Effects of aging on characteristics of breast meat from free-range broiler hens at 12 or 70 weeks of age

We evaluated the effect of broiler age and aging process on the meat characteristics of breast fillets from female free-range broilers slaughtered at 12 weeks of age (Wk12) and 70 weeks of age (Wk70). We used breast meat from female ISA Label (n = 60) broilers. Ten samples of each broiler age were aged in an incubator (2°C ± 0.5°C) for 3 and 7 days. Ten samples for each broiler age were analysed 4 h post-slaughter (Control group). Compared with breast meat from Wk12, breast meat from Wk70 showed higher shear force (30.52 N vs 27.19; P = 0.0322) and total collagen (4.33 g/kg vs 3.77 g/kg; P = 0.0149), which were reduced during aging to 15.49 N and 3.92 mg/100 g, respectively. The aging process did not affect the lipid oxidation of breast meat from Wk70. After aging for 3 days, breast meat from Wk70 had similar protein and fat contents to those of meat from Wk12 (21.29% and 1.04%, on average, respectively). Breast meat from Wk70 also showed lower concentrations of docosahexaenoic (0.32% vs 0.65%; P < 0.0001) and eicosapentaenoic (0.01% vs 0.12%; P < 0.0001) fatty acids than meat from Wk12. The use of free-range hen meat is beneficial to the industry because of the lower storage and cooking losses, which may influence the final yield, besides its lower polyunsaturated fatty acid concentration, which makes it less vulnerable to rancidification. Aging for at least 3 days at 2°C is satisfactory to promote the tenderisation of meat from free-range broiler hens.

Characteristics of carcasses and meat from feedlot-finished buffalo and Bos indicus (Nellore) bulls

The trade of buffalo meat is very limited in Brazil, where it is still considered exotic, and ~90% of it is marketed as cattle meat. The present study compared qualitative characteristics of the longissimus muscle from buffalo and cattle. Eighty uncastrated male bovids (40 Mediterranean × Murrah crossbred buffaloes and 40 Nellore cattle) with an average age of 21 months and initial average bodyweight of 350 kg and 305 kg respectively, were confined for 102 days. Buffalo carcass had lower dressing-out percentage (P < 0.0001; 52.1% vs 57.2%) than did cattle carcass; buffalo meat had greater fat cover (P < 0.0001; 13.8 vs 8.1 mm) and, consequently, lower cooling loss (P < 0.0001; 1.3% vs 1.8%) than did cattle meat; also had lower cooking loss (P = 0.0120; 29.42% vs 31.31%), lower collagen content (P < 0.0001; 4.81% vs 5.73%), higher moisture (P = 0.0027; 75.13% vs 74.55%), and lower atherogenicity index (P = 0.0008; 0.61 vs 0.70) than did cattle meat. There was no difference (P = 0.13) between buffalo and cattle regarding cold carcass weight (251 kg and 244.8 kg respectively). Tenderness, fat, and omega-6 : omega-3 fatty acid ratio were also similar in both meats. The buffalo carcass provides higher yield of cuts of high commercial value than does the cattle carcass; it has similar or better physical and chemical properties than beef and a lower percentage of polyunsaturated fatty acids, making it less susceptible to rancidity. Cattle meat has higher concentrations of C12:0 and C14:0 fatty acids, which are related to increased serum low-density lipoprotein and cholesterol concentrations, while buffalo meat is a rich source of C18:0 and C18:1n9c fatty acids, which help in the prevention of cardiovascular diseases.

Effect of freezing on the quality of meat from broilers raised in different rearing systems

We evaluated the effect of freezing (−18°C) for 12 months on the qualitative characteristics of breast, thigh and drumstick meat. Samples from male Cobb 500 broilers raised in antibiotic-free (n = 125), conventional (n = 125) and organic (n = 125) rearing systems and samples from male Hubbard ISA broilers raised in a free-range (n = 125) rearing system were used. Among the studied systems, up to the ninth month of freezing, the organic chicken breast meat showed lower (P < 0.001) water activity (aw) (0.966, on average). After 12 months of freezing, samples of antibiotic-free and organic poultry showed a pH value similar to that of fresh meat (5.94 and 5.86, respectively). Freezing for 12 months preserved the redness of drumstick meat from conventional broilers (a* = 4.86, on average) and the rearing system did not influence the aw of drumstick meat during the entire experimental period. Freezing preserved the aw of conventional and organic chicken meat samples until the ninth month of evaluation (0.978 and 0.974, respectively). Lipid oxidation in the breast, thigh and drumstick samples from the four rearing systems increased (P < 0.001) from the third month of freezing onwards. There were variations in colour, pH, aw and lipid oxidation of chicken meat among birds raised in different rearing systems. Freezing chicken meat did not prevent colour and pH changes or occurrence of lipid oxidation and did not promote a reduction of aw to levels unfavourable to microbiological development.

A comparison of the effects of post-mortem aging on breast meat from Cobb 500 and Hubbard ISA broilers

We compared the physical and chemical characteristics of the pectoralis major muscle from Cobb 500 and Hubbard ISA broilers and evaluated the effect of aging process for up to 7 days on meat quality. We used breast samples from male Cobb 500 (42 days of age; n = 60) and Hubbard ISA (85 days of age; n = 60) broilers. Twenty samples of each genotype were analysed 4 h post-slaughter (Control group). Another 20 samples of each genotype were aged in an incubator (2 ± 0.5°C) for 3 and for 7 days. Breast fillets were 23% heavier in the Cobb 500 group (306 g vs 248 g; P = 0.0009). Before aging, meat from Hubbard ISA broilers had higher (P < 0.001) water-holding capacity, which promotes the production of less exudate and possibly reduces nutritional losses during storage, which may be beneficial to the poultry industry. Despite being initially less tender, breast meat from Hubbard ISA broilers showed, during the aging process, a reduction (P < 0.05) of shear force (48.46–15.04 N), total collagen amount (6.0–4.8 g/kg) and myofibrillar fragmentation index (150.17–97.42) and had the same (P = 0.134) fat concentration (0.87 g/100 g) as that of breast meat from Cobb 500 broilers (0.93 g/100 g, respectively). Breast meat from Hubbard ISA broilers had a higher (P < 0.001) polyunsaturated fatty acid concentration, especially docosahexaenoic acid, which is beneficial to human health. Aging breast fillets for 3 days at 2°C is sufficient to tenderise the meat without reducing its juiciness, which suggests that the aging process can add value to free-range meat.

Circulating levels of adiponectin and extent of coronary artery disease in patients undergoing elective coronary angiography

Adiponectin (APN), an adipose tissue-released adipokine with demonstrated anti-inflammatory and anti-atherogenic properties, is encoded by a gene whose polymorphisms are associated with presence of coronary artery disease (CAD). Serum APN levels are inversely related with presence and complexity of CAD. Within this context, we sought to compare levels of total APN and its high molecular weight form (HMW APN) according to clinical presentation and extent of CAD in patients undergoing elective cardiac catheterization. From March 2008 to June 2010, clinical data and blood samples for APN and HMW APN measurements were collected from 415 subjects undergoing cardiac catheterization at two tertiary centers. CAD extent was estimated by the number of coronary arteries with significant stenosis (≥70% obstruction in a major coronary artery) and by Duke Jeopardy Score (DJS). Serum APN levels were similar between groups with stable or unstable CAD (APN 9.20±5.88 vs 9.47±6.23 μg/mL, P=0.738, and HMW APN 5.31±3.72 vs 5.91±4.16 μg/mL, P=0.255), even after stratification by the number of arteries involved (single-vessel vs multivessel disease: APN 9.39±5.76 vs 9.26±6.27 μg/mL, P=0.871; HMW APN 5.29±3.79 vs 5.83±4.04 μg/mL, P=0.306) and DJS score (APN, P=0.718; HMW APN, P=0.276). We conclude that APN and HMW APN serum levels are similar across clinical presentations and different extents of CAD, despite being significantly lower in the presence of obstructive CAD.

Physical and chemical characteristics of spent hen breast meat aged for 7 days

Consumption of poultry meat is increasing worldwide. However, little is known about the consumption and acceptability of meat from older hens and about the physical and chemical characteristics of this type of meat. This study evaluated the effect of broiler age and aging time on the physical properties, tenderness, chemical composition, and lipid profile of breast meat from broilers slaughtered at 6 (commercial age) and 70 weeks of age (broiler hens). The variables analysed were: colour, pH, water-holding capacity, cooking weight loss, shear force, total collagen, myofibrillar fragmentation index, chemical composition, total cholesterol, lipid oxidation, and fatty acid profile. Compared with commercial broilers, meat from broiler hens had higher shear force (from 33.45 N to 14.91 N after 3 days of aging), higher fat content, and lower cholesterol concentration. Additionally, it had more monounsaturated fatty acids and less polyunsaturated fatty acids than meat from commercial broilers. Collagen, fat, cholesterol levels and myofibrillar fragmentation index decreased with aging. The use of broiler hen meat as a raw material may be beneficial to the poultry industry because it has more fat and less cholesterol, higher intracellular water-holding capacity, and lower cooking loss than meat from commercial broilers. Moreover, because of the lower concentration of polyunsaturated fatty acids, broiler hen meat is less susceptible to lipid oxidation. Aging breast fillets for 3 days at 2°C is sufficient to tenderise the meat and reduce the amount of fat and cholesterol, suggesting that aging can be used as a technique to add value to poultry meat products.

Períodos de estresse térmico durante o crescimento afetam negativamente o desempenho e o rendimento de carcaça de frango de corte

O objetivo deste estudo foi avaliar o efeito da exposição de frangos de corte por até 72 horas a estresse térmico agudo, em diferentes fases do crescimento, sobre o desempenho e rendimento de carcaça. Quinhentos frangos de corte Cobb machos foram criados por até 42 dias em duas câmaras climáticas equipadas com sistemas de aquecimento e refrigeração. Duzentas e cinquenta aves foram submetidas ao estresse térmico (32°C±0,5°C), com duração de até 72 horas, com início aos 21 e 35 dias de idade. As demais 250 aves foram mantidas em conforto térmico durante todo o experimento. O calor do ambiente influenciou negativamente o peso corporal (1,595 kg) e a conversão alimentar (1,81) de frangos de corte submetidos ao estresse por calor a partir dos 21 dias de idade. Após dois períodos de estresse térmico, os frangos apresentaram menor consumo de ração (3,914 kg) e, consequentemente, menor peso (1,958 kg), quando comparados ao grupo controle (4,182 kg e 2,097 kg, respectivamente). Aves submetidas ao estresse térmico aos 21 dias de idade apresentaram redução do rendimento de peito. O peso ao abate de frangos de corte submetidos ao estresse térmico diminuiu após duas exposições ao calor. Frangos de corte submetidos ao estresse térmico agudo após 35 dias de idade apresentam pior desempenho do que frangos de corte criados em conforto térmico. Não há influência do estresse térmico sobre o rendimento de cortes comerciais da carcaça.

Molecular typing of Yersinia pseudotuberculosis strains isolated from livestock in Brazil

Yersinia pseudotuberculosis can infect a broad range of animals. In Brazil, this bacterium has been isolated from healthy and sick animals from sporadic cases and outbreaks of hemorrhagic gastroenteritis among livestock. However, the molecular diversity of these isolates is little understood. In this study, we used multilocus sequence typing, enterobacterial repetitive intergenic consensus PCR and pulsed-field gel electrophoresis to genotype 40 Y. pseudotuberculosis strains belonging to bio-serogroups 1/O:1a and 2/O:3 isolated between 1982 and 1990 in the southern region of Brazil. All three methodologies clustered the strains into two main clusters according to their bio-serogroups. Good correlations were observed between the clusters and the pathogenic potential of the strains. No correlation among the strains was observed according to geographical origin, host, place, or year of isolation. The grouping of the Y. pseudotuberculosis isolated in Brazil determined by these assays leads us to suggest that Brazilian livestock harbor two subpopulations of Y. pseudotuberculosis.

Reduction of aflatoxin B1 in stored peanuts (Arachis hypogaea L.) using Saccharomyces cerevisiae

Aflatoxin B(1) is a toxigenic and carcinogenic compound produced by Aspergillus flavus and Aspergillus parasiticus. To inhibit aflatoxin contamination of peanuts, seeds of two peanut breeds, IAC Caiapó and IAC Runner 886, were inoculated with A. parasiticus (1.0 × 10(6) spores per ml) and the yeast Saccharomyces cerevisiae (3.2 × 10(7) cells per ml) and incubated at 25°C for 7 and 15 days. Two experiments were conducted for each incubation period separately. The treatments were completely randomized, with three replications per treatment. Treatments included the two cultivars and three types of inoculation (pathogen alone, yeast and pathogen, and yeast 3 h before pathogen). Aflatoxin B(1) was quantified with a densitometer at 366 nm after thin layer chromatography. Aflatoxin B(1) contamination in peanuts was reduced after the addition of S. cerevisiae. The concentration of aflatoxin B(1) decreased by 74.4 and 55.9% after 7 and 15 days, respectively. The greatest aflatoxin reduction was observed when S. cerevisiae was inoculated 3 h before the pathogen in IAC Caiapó seeds and incubated for 7 days at 25°C. The use of S. cerevisiae is a promising strategy for biological control of aflatoxin contamination in peanuts.

P53 expression as a predictor of recurrence in cervical squamous cell carcinoma

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.

c-Myc protein expression is not an independent prognostic predictor in cervical squamous cell carcinoma

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.

Randomized, double-blind trial comparing indinavir alone, zidovudine alone and indinavir plus zidovudine in antiretroviral therapy-naive HIV-infected individuals with CD4 cell counts between 50 and 250/mm3

Treatment with indinavir has been shown to result in marked decreases in viral load and increases in CD4 cell counts in HIV-infected individuals. A randomized double-blind study to evaluate the efficacy of indinavir alone (800 mg q8h), zidovidine alone (200 mg q8h) or the combination was performed to evaluate progression to AIDS. 996 antiretroviral therapy-naive patients with CD4 cell counts of 50-250/mm3 were allocated to treatment. During the trial the protocol was amended to add lamivudine to the zidovudine-containing arms. The primary endpoint was time to development of an AIDS-defining illness or death. The study was terminated after a protocol-defined interim analysis demonstrated highly significant reductions in progression to a clinical event in the indinavir-containing arms, compared to the zidovudine arm (p<0. 0001). Over a median follow-up of 52 weeks (up to 99 weeks), percent reductions in hazards for the indinavir plus zidovudine and indinavir groups compared to the zidovudine group were 70% and 61%, respectively. Significant reductions in HIV RNA and increases in CD4 cell counts were also seen in the indinavir-containing groups compared to the zidovudine group. Improvement in both CD4 cell count and HIV RNA were associated with reduced risk of disease progression. All three regimens were generally well tolerated.