Publications by authors named "Renata Margarida Etchebehere"

36 Publications

CHRONIC USE OF PROTON PUMP INHIBITORS AND THE QUANTITY OF G, D, AND ECL CELLS IN THE STOMACH.

Arq Bras Cir Dig 2020 24;33(2):e1506. Epub 2020 Aug 24.

Surgical Pathology Subunity, Clinical Hospital, Triângulo Mineiro Federal University, Uberaba, MG, Brazil.

Background: Acid inhibition from chronic proton pump inhibitor use and a possible increase in gastrin can lead to changes in the regulation of hydrochloric acid production. However, it has not known whether such chronic use changes the presence of gastrin, delta, and enterochromaffin-like cells in the stomach or the relationship between gastrin and delta cells.

Aim: To analyze the number of gastrin-producing gastrin cells, somatostatin-producing cells, and histamine-producing cells in patients who were chronic users of proton pump inhibitor, with or without related Helicobacter pylori infection.

Methods: Biopsies from 105 patients, including 81 chronic proton pump inhibitor users (experimental group) and 24 controls, were processed immunohistochemically and subjected to counting of gastrin, delta, and enterochromaffin-like cells in high-magnification microscopic fields and in 10 glands.

Results: Gastrin cell, delta cell, and enterochromaffin-like cells counts were similar across the groups and appeared to be unaffected by Helicobacter pylori infection. The ratio between gastrin cells and delta cells was higher in the chronic users of proton pump inhibitor group than in controls.

Conclusion: Chronic users of proton pump inhibitor does not affect gastrin cell, delta cell, and enterochromaffin-like cell counts significantly, but may alter the ratio between gastrin cells and delta cells.
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http://dx.doi.org/10.1590/0102-672020190001e1506DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7448853PMC
September 2020

Overexpression of HIF-1α and Morphological Alterations in the Tongue of Rats Exposed To Secondhand Smoke.

Braz Dent J 2020 Jun 13;31(3):281-289. Epub 2020 Jul 13.

Cefores, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil.

Smoking is a risk factor for serious health problems and is associated with several changes in the tissues of the oral cavity. The aim of this study was to evaluate the collagen percentage, mast cells density, intensity of immunolabeled cells by anti-HIF-1α in the musculature lingual of rats exposed to secondhand smoke. Twenty-seven female Wistar albino rats were divided into three groups: rats not exposed to tobacco smoke inhalation (Control group) (n=7); rats exposed to smoke inhalation for 30 days (TAB 30) (n=10); and rats exposed to smoke inhalation for 45 days (TAB 45) (n=10). Subsequently, the animals were submitted to euthanasia and removal of the tongue for histological and immunohistochemistry processing and analysis. In the groups TAB 30 and TAB 45 there were a lower percentage of collagen, a higher density of mast cells and a greater intensity of anti-HIF-1α immunolabeled cells compared to Control group. There was also a positive and significant correlation between the percentage of collagen and mast cell density. There was not significative difference between TAB 30 e TAB 45 in any of the parameters evaluated. Therefore, the exposure of rats to secondhand smoke for 45 days causes decrease in perimysial collagen fibers, increase in the number of mast cells and increase in the immunolabeling for HIF-1α in lingual muscle cells. The present study was the first to evaluate the percentage of collagen, mast cell density and immunostaining for HIF-1α in rat tongues exposed to tobacco smoke.
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http://dx.doi.org/10.1590/0103-6440202002898DOI Listing
June 2020

Histoplasmosis in HIV-Infected Patients: Epidemiological, Clinical and Necropsy Data from a Brazilian Teaching Hospital.

Mycopathologia 2020 Apr 20;185(2):339-346. Epub 2020 Feb 20.

Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Mailbox 118, Uberaba, Minas Gerais, 38001-170, Brazil.

Histoplasmosis occurs in 5-10% of HIV-infected patients in endemic areas and evolves to severe and disseminated infection with mortality rates over 50% in some regions. This report presents epidemiological, clinical and outcome data from HIV-infected patients with histoplasmosis confirmed by culture and/or at necropsy who were admitted to a Brazilian teaching hospital. Data from 65 patients were obtained from their respective medical and necropsy records. From 2005 to 2018, 36 HIV-infected patients were diagnosed with histoplasmosis confirmed by culture. At admission, most of these patients presented disseminated fungal infection, whereas 15 (41.7%) were simultaneously diagnosed with both HIV infection and histoplasmosis. Fever, weight loss, hepatosplenomegaly, respiratory and digestive symptoms were present in 86.2%, 50%, 44.4% and 41.7% of the patients, respectively. At admission, 24 patients had low CD4 T-cell count and high viral load values. Among the 30 patients who received antifungals, 16 (53.3%) were cured, 13 (43.3%) died, and one was lost to follow-up. Six patients died prior to therapy. From 1990 to 2018, 63 necropsies of patients with Histoplasma capsulatum infection were performed. Of these patients, 29 (46.0%) were HIV-infected individuals, including 21 (72.4%) who presented disseminated histoplasmosis and 21 (72.4%) who were diagnosed with histoplasmosis at necropsy. The epidemiological, clinical and outcome profiles presented herein are similar to those described elsewhere and reinforce the difficulties that are still present in limited-resource settings where advanced immunodeficiency, combined with severe fungal infection and late patient admissions, is related to poor outcomes.
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http://dx.doi.org/10.1007/s11046-020-00435-yDOI Listing
April 2020

Lingual salivary gland hypertrophy and decreased acinar density in chagasic patients without megaesophagus.

Rev Inst Med Trop Sao Paulo 2019 20;61:e67. Epub 2019 Dec 20.

Universidade Federal do Triângulo Mineiro, Programa de Pós-Graduação em Ciências da Saúde, Uberaba, Minas Gerais, Brazil.

Although the salivary glands present several functions, there are few studies evaluating these glands in Chagas disease (CD). This study aimed to compare the percentage of collagen, the presence of inflammation, the density of chimase and tryptase mast cells, the area and density of lingual salivary gland acini in autopsied individuals with and without (CD). We analyzed 400 autopsy reports performed in a tertiary public hospital from 1999 to 2015 and selected all the cases in which tongue fragments were collected (27 cases), 12 with chronic CD without megaesophagus (CH) and 15 without CD (non-chagasic - NC). The histological sections of the tongue were stained by Picrosirius red for collagen evaluation and Hematoxylin-eosin for morphometric evaluation of salivary gland acini and inflammation. Anti-chimase and anti-tryptase antibodies were used for the immunohistochemical evaluation of mast cells. The chagasic patients presented higher volume and lower density of salivary glands acini. There was no difference in the collagen percentage, inflammation and density of mast cell chymase and tryptase between the groups. Although we did not observe a significant difference between the groups regarding the collagen percentage, inflammatory process and mast cell density, our results suggest that even without megaesophagus, chagasic patients present hypertrophy of the lingual salivary glands and lower acinar density probably due to mechanisms independent of the esophagus-glandular stimulus.
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http://dx.doi.org/10.1590/S1678-9946201961067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6907416PMC
February 2020

Lymphocytes in Peritumoral Stroma: Evaluation in Epithelial Ovarian Neoplasms.

Immunol Invest 2020 May 12;49(4):397-405. Epub 2019 Jul 12.

Department of Gynecology and Obstetrics, Research Institute of Oncology (IPON), Uberaba, Brazil.

: Ovarian cancer is a heterogeneous disease, where chronic inflammation is one of the central mechanisms of its pathogenesis. The objectives of the study were to evaluate the expression of CD3, CD4, CD8 and CD20 in the peritumoral stroma of benign and malignant ovarian epithelial neoplasms and to relate them to prognostic factors in ovarian cancer.: We evaluated 77 patients (40 benign epithelial ovarian neoplasms and 37 malignant epithelial ovarian neoplasms). Immunohistochemistry study for cytokines (CD3, CD4, CD8 and CD20) was performed. The evaluation of prognostic factors was performed using the Fisher's exact test. The significance level was less than 0.05.: A higher CD3 expression was found in the stroma of ovarian malignancies compared benign neoplasms, and greater expression of CD4 cells in the stroma of benign neoplasms compared to ovarian cancer. There was a greater expression of CD8 cells in the stromal ovarian malignancies with molecular type II compared to type I. In the evaluation of lymph node metastases, the absence of immuno-labelling of CD20 cells was associated with the absence of lymph node metastases.: The immune system plays a multifaceted role and can promote or inhibit tumor growth in different contexts.
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http://dx.doi.org/10.1080/08820139.2019.1637435DOI Listing
May 2020

Tonsillar hyperplasia and recurrent acute tonsillitis in children: Immunohistochemical evaluation of the lymphatic tissue.

Int J Pediatr Otorhinolaryngol 2019 06 23;121:15-19. Epub 2019 Feb 23.

Surgical Pathology Service, Triângulo Mineiro Federal University, Uberaba, Minas Gerais, Brazil. Electronic address:

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http://dx.doi.org/10.1016/j.ijporl.2019.02.032DOI Listing
June 2019

Increased serum gastrin in patients with different clinical forms of Chagas disease coinfected with Helicobacter pylori.

Rev Inst Med Trop Sao Paulo 2019 Feb 14;61:e7. Epub 2019 Feb 14.

Universidade Federal do Triângulo Mineiro, Instituto de Ciências Biológicas e Naturais, Uberaba, Minas Gerais, Brazil.

Trypanosoma cruzi and Helicobacter pylori (HP) are pathogens that cause chronic diseases and have been associated with hypergastrinemia. The aim of this study was to evaluate the fasting gastrin levels in patients with different clinical forms of Chagas disease (CD), coinfected or not by HP. The enrolled individuals were outpatients attending at the university hospital. HP infection was assessed by serology and 13 C-urea breath test. Fasting serum gastrin concentration was measured by chemiluminescence assay. Gastric endoscopic and histological features were also evaluated. Associations between CD and serum gastrin level were evaluated in a logistical model, adjusting for age, gender and HP status. A total of 113 patients were evaluated (45 with Chagas disease and 68 controls). In the multivariate analysis, increasing serum gastrin levels (OR= 1.02; 95% CI= 1.01-1.12), increasing age (OR= 1.05; 95% CI= 1.02 - 1.09) and HP-positive status (OR = 2.88; 95% CI = 1.10 - 7.51) remained independently associated with CD. The serum gastrin levels were significantly higher in the group of patients with the cardiodigestive form ( P = 0.03) as well as with digestive form ( P = <0.001) of Chagas disease than in the controls. In conclusion, patients with cardiodigestive and digestive clinical forms of CD have increased basal serum gastrin levels in comparison with controls. Moreover, we also demonstrated that H. pylori coinfection contributes to the hypergastrinemia shown in CD.
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http://dx.doi.org/10.1590/S1678-9946201961007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6376922PMC
February 2019

Melatonin treatment in fetal and neonatal diseases.

Pathol Res Pract 2018 Dec 23;214(12):1940-1951. Epub 2018 Oct 23.

Discipline of General Pathology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil. Electronic address:

This literature review aims to address the main scientific findings on oxidative stress activity in different gestational disorders, as well as the function and application of melatonin in the treatment of fetal and neonatal changes. Oxidative stress has been associated with the etiopathogenesis of recurrent miscarriages, preeclampsia, intrauterine growth restriction, and stillbirth. Both, the exacerbated consumption of the antioxidant enzymes superoxide dismutase, catalase and glutathione peroxidase, and the increased synthesis of reactive oxygen species, such as superoxide, peroxynitrite, and hydrogen peroxide, induce phospholipid peroxidation and endothelial dysfunction, impaired invasion and death of trophoblast cells, impaired decidualization, and remodeling of maternal spiral arteries. It has been postulated that melatonin induces specific biochemical responses that regulate cell proliferation in fetuses, and that its antioxidant action promotes bioavailability of nitric oxide and, thus, placental perfusion and also fetal nutrition and oxygenation. Therefore, the therapeutic action of melatonin has been the subject of major studies that aim to minimize or prevent different injuries affecting this pediatric age group, such as intrauterine growth restriction, encephalopathy, chronic lung diseases, retinopathy of prematurity Conclusion: the results antioxidant and indicate that melatonin is an important therapy for the clinical treatment of these diseases.
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http://dx.doi.org/10.1016/j.prp.2018.10.016DOI Listing
December 2018

Role of Alpha-Smooth Muscle Actin and Fibroblast Activation Protein Alpha in Ovarian Neoplasms.

Gynecol Obstet Invest 2018 5;83(4):381-387. Epub 2018 Apr 5.

Research Institute of Oncology (IPON)/Discipline of Gynecology and Obstetrics, Uberaba, Brazil.

Background/aims: Studies show that tumor growth is not just determined by the presence of malignant cells, since interactions between cancer cells and stromal microenvironment have important impacts on the cancer growth and progression. Cancer-associated fibroblasts play a prominent role in this process. The aims of the study were to investigate 2 cancer-associated fibroblasts markers, alpha-smooth muscle actin (α-SMA), and fibroblast activation protein alpha (FAP) in the stromal microenvironment of benign and malignant ovarian epithelial neoplasms, and to relate their tissue expression with prognostic factors in ovarian cancer.

Methods: α-SMA and FAP were evaluated by immunohistochemistry in malignant (n = 28) and benign (n = 28) ovarian neoplasms. Fisher's exact test was used with a significance level lower than 0.05.

Results: FAP immunostaining was stronger in ovarian cancer when compared to benign neoplasms (p = 0.0366). There was no significant difference in relation to α-SMA expression between malignant and benign ovarian neoplasms as well as prognostic factors. In ovarian cancer, FAP stainings 2/3 was significantly related to histological grades 2 and 3 (p = 0.0183).

Conclusion: FAP immunostaining is more intense in malignant neoplasms than in benign ovarian neoplasms, as well as in moderately differentiated and undifferentiated ovarian carcinomas compared to well-differentiated neoplasms, thus indicating that it can be used as a marker of worse prognosis.
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http://dx.doi.org/10.1159/000488088DOI Listing
October 2018

Angiogenic and antiangiogenic factors in preeclampsia.

Pathol Res Pract 2018 Jan 31;214(1):7-14. Epub 2017 Oct 31.

Discipline of General Pathology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil. Electronic address:

Background: Pre-eclampsia is a multifactorial hypertensive disorder that is triggered by placental insufficiency and that accounts for up to 15% of maternal deaths. In normal pregnancies, this process depends on the balance between the expression of angiogenic factors and antiangiogenic factors, which are responsible for remodeling the spiral arteries, as well as for neoangiogenesis and fetal development.

Purpose: The aim of this review is to discuss the main scientific findings regarding the role of angiogenic and antiangiogenic factors in the etiopathogenesis of preeclampsia.

Methods: An extensive research was conducted in the Pubmed database in search of scientific manuscripts discussing potential associations between angiogenic and antiangiogenic factors and preeclampsia. Ninety-one papers were included in this review.

Results: There is an increased expression of soluble fms-like tyrosine kinase receptor and soluble endoglin in pre-eclampsia, as well as reduced placental expression of vascular endothelial growth factor and placental growth factor. Systemic hypertension, proteinuria and kidney injury - such as enlargement and glomerular fibrin deposit, capillary occlusion due to edema, and hypertrophy of endocapillary cells - are some of these changes. The complex etiopathogenesis of preeclampsia instigates research of different biomarkers that allow for the early diagnosis of this entity, such as vascular endothelial growth factor, placental growth factor, soluble fms-like tyrosine kinase receptor, soluble endoglin, placental glycoprotein pregnancy-associated plasma protein-A and protein 13.

Conclusion: Even though it is possible to establish an efficient and effective diagnostic tool, three key principles must be observed in the management of preeclampsia: prevention, early screening and treatment.
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http://dx.doi.org/10.1016/j.prp.2017.10.021DOI Listing
January 2018

Analysis of CD15, CD57 and HIF-1α in biopsies of patients with peri-implantitis.

Pathol Res Pract 2017 Sep 23;213(9):1097-1101. Epub 2017 Jul 23.

Laboratory of Biopathology and Molecular Biology, University of Uberaba (UNIUBE), Uberaba, MG, Brazil; Cefores, Federal University of Triangulo Mineiro (UFTM), Uberaba, MG, Brazil. Electronic address:

Peri-implantitis is an infectious disease characterized by inflammation of the tissues surrounding the implant, bleeding on probing with or without suppuration, and bone loss. Peri-implant lesions contain a leukocyte infiltrate of plasma cells, lymphocytes, macrophages and neutrophils. A survey of the literature did not show any studies reporting an association between hypoxia and peri-implantitis. The aim of the present cross-sectional study was to evaluate histological changes and immunostaining for CD15, CD57 and HIF-1α in the peri-implant mucosa of patients with and without peri-implantitis. Mucosal biopsies were obtained from 18 patients with peri-implantitis and 10 control subjects without peri-implantitis at a private health care center between 2010 and 2012. The sections were fixed in 10% buffered formalin, processed and embedded in paraffin for histopathological and immunohistochemical study. Acanthosis, spongiosis and exocytosis were observed in both groups, with no significant difference between them. The peri-implantitis group showed increased immunostaining for CD15, a neutrophil marker, and HIF-1α, a tissue hypoxia marker, but no significant difference in immunostaining for CD57, a Natural Killer cell marker. The increase in neutrophil (CD15) and hypoxia (HIF-1α) markers in patients with peri-implantitis suggests an active participation of neutrophils and hypoxia in the pathogenesis of this disease. Since the present study was the first to evaluate the expression of CD15, CD57 and HIF-1α in peri-implant tissues, further studies should be performed to better understand the role of these molecules in peri-implantitis.
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http://dx.doi.org/10.1016/j.prp.2017.07.020DOI Listing
September 2017

Sarcomatous transformation of a hemosiderotic fibrohistiocytic lipomatous tumor: a case report.

Rev Bras Ortop 2017 May-Jun;52(3):366-369. Epub 2016 Nov 16.

Universidade Federal do Triângulo Mineiro (UFTM), Hospital de Clínicas, Serviço de Patologia Cirúrgica, Uberaba, MG, Brazil.

Hemosiderotic fibrohistiocytic lipomatous tumors are rare neoplasms that were first described in 2000. Initially considered a benign lipotamous lesion of the soft tissues, nowadays they are considered to be a locally aggressive tumor. They occur mainly in the foot and ankle of women in their fifth and sixth decades, although they may be found in any place in the lower limbs and, more rarely, in other parts of the body. Histologically, hemosiderotic fibrohistiocytic lipomatous tumors consist of a mixture of mature adipose tissue, fusiform cell fascicles, macrophages that often contain cytoplasmic hemosiderin, mononuclear inflammatory infiltrate, and stroma that may be focally myxoid. Local recurrence is observed in nearly one-third of all cases. There is no consensus in the literature whether this tumor is a part of a spectrum that comprises pleomorphic hyalinizing angiectatic tumors and myxoinflammatory fibroblastic malignant tumors, or if it is an independent entity. The authors report a case of a neoplasia after a diagnosis of a hemosiderotic fibrohistiocytic lipomatous tumor in a 38-year-old woman, with two recurrences and later sarcomatous transformation. An immunohistochemical study indicated myofibroblastic differentiation of a malignant neoplasm. To the best of the authors' knowledge, there are only few reported cases of malignant transformation in hemosiderotic fibrohistiocytic lipomatous tumors.
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http://dx.doi.org/10.1016/j.rboe.2016.11.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497010PMC
November 2016

Evaluation of the immunohistochemical expression of Gal-1, Gal-3 and Gal-9 in the colon of chronic chagasic patients.

Pathol Res Pract 2017 Sep 20;213(9):1207-1214. Epub 2017 Apr 20.

Laboratory of Biopathology and Molecular Biology, University of Uberaba (UNIUBE), Uberaba, MG, Brazil; Cefores, Federal University of Triangulo Mineiro (UFTM), Uberaba, MG, Brazil. Electronic address:

Objective And Design: The aim of the present study was to evaluate the immunohistochemical expression of Gal-1, Gal-3 and Gal-9 in the colon of chronic chagasic patients compared to biopsied non-chagasic patients.

Material Or Subjects: Thirty-two colon fragments were selected from chagasic patients with megacolon (n=25) and nonchagasic patients without megacolon (n=7).

Methods: Immunohistochemistry for Gal-1, Gal-3 and Gal-9 was performed using a common light microscope and the results were scored 0-3 according to labeling intensity. Data were analyzed statistically by the chi-square test.

Results: Higher Gal-1, Gal-3 and Gal-9 expression was observed in the myenteric plexus ganglia of chagasic patients compared to non-chagasic patients, p=0.0487, p=0.0019 and p=0.0325, respectively, whereas no significant differences were observed between groups regarding the expression of Gal-1, Gal-3 and Gal-9 in the muscle layer.

Conclusion: Since Gal-1, Gal-3 and Gal-9 galectin expression was higher in the myenteric plexus ganglia of chagasic patients, we believe that these lectins may be associated with ganglionitis in the chagasic megacolon. However, since the present study was the first to report the participation of Gal-9 in Chagas disease, further investigations are needed to elucidate the role of galectin 9 in this disease.
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http://dx.doi.org/10.1016/j.prp.2017.04.014DOI Listing
September 2017

Abdominopelvic Tuberculosis with a Frozen Section Analysis Consistent with Ovarian Cancer.

Case Rep Infect Dis 2017 9;2017:6401694. Epub 2017 Apr 9.

Oncological Research Institute (IPON), Discipline of Gynecology and Obstetrics, Federal University of the Triângulo Mineiro, Uberaba, MG, Brazil.

Pelvic tuberculosis is a type of extrapulmonary tuberculosis. The disease is accompanied by clinical and laboratory findings which may be unspecific and present aspects of other diseases, including gynecological malignancies. In this report, the authors presented a case of pelvic tuberculosis associated with peritoneal tuberculosis in a young woman exhibiting imaging and tumor markers consistent with ovarian neoplasm. An intraoperative frozen section analysis detected atypical cells that were suggestive of ovarian borderline or malignant epithelial neoplasia. The pathological analysis showed granulomatous inflammation in the right ovary and fallopian tube with a pattern of mycobacteriosis that was consistent with the presence of mycobacteria morphologically compatible with . The patient had a complete remission after the use of antituberculosis drugs.
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http://dx.doi.org/10.1155/2017/6401694DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5401731PMC
April 2017

Intrauterine infection, immune system and premature birth.

J Matern Fetal Neonatal Med 2018 May 20;31(9):1227-1233. Epub 2017 Apr 20.

a Department of General Pathology , Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro , Minas Gerais , Brazil.

Preterm birth accounts for nearly one million deaths among children under five years of age, and although its etiopathogenesis is not fully elucidated, ascending intrauterine infection and fetal inflammatory response seem to be the main triggers. The intense inflammatory response mediated by IL-1β, TNF-α, PAF, IFN-γ and IL-6, PGE and MMP-1 and MMP-9 causes fetal membrane damage and rupture, increased uterine contractions and biochemical and structural changes in the cervix. Furthermore, preterm neonates have deficient innate and adaptive immune responses characterized by reduced levels of IgG, opsonization and phagocytosis, as well as increased activation of Th1 cells in relation to Th2 cells. Therefore, this triad is favors the occurrence of neonatal complications, such as respiratory distress syndrome, necrotizing enterocolitis, retinopathy of prematurity and bronchopulmonary dysplasia. Due to serious maternal and child health complications of intrauterine infection, several studies have tried to identify biomarkers for the early diagnosis of this entity. This literature review aims to discuss the main scientific findings regarding the association between ascending intrauterine infection, immune system and preterm birth.
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http://dx.doi.org/10.1080/14767058.2017.1311318DOI Listing
May 2018

Gastric and jejunal histopathological changes in patients undergoing bariatric surgery.

Arq Gastroenterol 2017 Jan-Mar;54(1):75-78

Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brasil.

Background: - Morbid obesity is a multifactorial disease that is increasingly treated by surgery.

Objective: - To evaluate gastric histopathological changes in obese, and to compare with patients who underwent gastrojejunal bypass and the jejunal mucosa after the surgery.

Methods: - This is an observational study performed at a tertiary public hospital, evaluating endoscopic biopsies from 36 preoperative patients and 35 postoperative.

Results: - In the preoperative group, 80.6% had chronic gastritis, which was active in 38.9% (77.1% and 20.1%, respectively, in the postoperative). The postoperative group had a significant reduction in Helicobacter pylori infection (P=0.0001). A longer length of the gastric stump and a time since surgery of more than two years were associated with Helicobacter pylori infection. The jejunal mucosa was normal in 91.4% and showed slight nonspecific chronic inflammation in 8.6%.

Conclusion: - There was a reduction in the incidence of Helicobacter pylori infection in the postoperative group. A longer length of the gastric stump and longer time elapsed since surgery were associated with Helicobacter pylori infection. The jejunal mucosa was considered normal in an absolute majority of patients.
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http://dx.doi.org/10.1590/S0004-2803.2017v54n1-15DOI Listing
April 2017

GASTRIC AND JEJUNAL HISTOPATHOLOGICAL CHANGES IN PATIENTS UNDERGOING BARIATRIC SURGERY.

Arq Bras Cir Dig 2016 ;29Suppl 1(Suppl 1):35-38

Universidade Federal do Triângulo Mineiro (Triângulo Mineiro Federal University - UFTM), Uberaba, MG, Brazil.

Background: Morbid obesity is a multifactorial disease that increasingly is being treated by surgery.

Aim: To evaluate gastric histopathological changes in obese, and to compare with patients who underwent gastrojejunal bypass and the jejunal mucosa after the surgery.

Methods: This is an observational study performed at a tertiary public hospital, evaluating endoscopic biopsies from 36 preoperative patients and 35 postoperative.

Results: In the preoperative group, 80.6% had chronic gastritis, which was active in 38.9% (77.1% and 20.1%, respectively, in the postoperative). The postoperative group had a significant reduction in H. pylori infection (p=0.0001). A longer length of the gastric stump and a time since surgery of more than two years were associated with Helicobacter pylori infection. The jejunal mucosa was normal in 91.4% and showed slight nonspecific chronic inflammation in 8.6%.

Conclusion: There was a reduction in the incidence of Helicobacter pylori infection in the postoperative group. A longer length of the gastric stump and longer time elapsed since surgery were associated with Helicobacter pylori infection. The jejunal mucosa was considered normal in an absolute majority of patients.
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http://dx.doi.org/10.1590/0102-6720201600S10010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5064251PMC
January 2016

Cryptococcosis in Acquired Immunodeficiency Syndrome Patients Clinically Confirmed and/or Diagnosed at Necropsy in a Teaching Hospital in Brazil.

Am J Trop Med Hyg 2016 10 25;95(4):781-785. Epub 2016 Jul 25.

Infectious Diseases Unit, Triângulo Mineiro Federal University, Minas Gerais, Brazil.

Cryptococcosis occurs in acquired immunodeficiency syndrome (AIDS) patients with poor compliance to antiretroviral therapy or unaware of their human immunodeficiency virus status who present severe immunosuppression at admission. Consequently, high mortality rates are observed due to disseminated fungal infection. This report presents clinical and postmortem data of AIDS patients with cryptococcosis in a teaching hospital in Brazil. Retrospectively, medical and necropsy records of AIDS patients with cryptococcosis clinically confirmed and/or postmortem verified were reviewed. Clinical data were compared with those of patients presenting a good outcome to evaluate disseminated fungal infection and the agreement between clinical and postmortem diagnosis. At admission, most of the 45 patients with cryptococcal meningitis who died, presented more altered consciousness (P = 0.0047), intracranial increased pressure (P = 0.047), and severe malnutrition (P = 0.0006) than the survivors. Of 29 (64.4%) patients with cryptococcal meningitis, 23 died before week 2 on antifungal therapy, and the other six during the next 3 months. The remaining 16 (35.6%) cases had other diagnoses and died soon after. At necropsy, 31 (68.9%) presented disseminated infection involving two or more organs, whereas 14 (31.1%) cases had meningeal or pulmonary localized infection. The agreement of 64.4% between clinical and postmortem diagnosis was similar to some studies. However, other reports have shown figures ranging from 34% to 95%. Currently, a progressive worldwide decrease of autopsies is worrying because the role of postmortem examination is pivotal to verify or identify the death causes, which contributes to improve the quality of clinical diagnosis and medical training.
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http://dx.doi.org/10.4269/ajtmh.16-0148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5062772PMC
October 2016

Comparison of Classical and Secondary Cytologic Criteria Relative to Hybrid Capture for Diagnosing Cervical-vaginal Infection by Human Papillomavirus.

Rev Bras Ginecol Obstet 2016 Jan;38(1):41-6

UFTM, Uberaba, Minas Gerais, Brazil.

Objective: To compare the diagnostic accuracy of the classic Meisels cytologic criteria and the Schneider secondary criteria relative to the hybrid capture method for diagnosing HPV infection.

Methods: This was a retrospective study performed at a public university hospital. A total of 41 patients with a cytologic diagnosis of HPV infection and 40 HPV-negative patients were selected for review of the cervical-vaginal smears seeking to classical and secondary criteria. A single pathologist reviewed the slides in search of the criteria. The classical and secondary cytologic criteria were compared with the hybrid capture for diagnosing HPV infection. Bartleti test was applied for the age analysis, and Fisher's exact test was used to compare proportions. The tests were considered significant when the probability of rejecting the null hypothesis was less than 5% (p < 0.05).

Results: The Meisels criteria were less sensitive (34.0%) than the secondary Schneider criteria (57.5%) when compared with the hybrid capture (p < 0.0001), although the specificity of the former criteria was non-significantly higher (91.2% and 67.7%, respectively). In cases of moderate or intense inflammation, the sensitivity and specificity of the Schneider criteria were decreased, 33.3% and 50.0% respectively (p = 0.0115).

Conclusions: Compared with hybrid capture for diagnosis of HPV infection, the sensitivity of the secondary Schneider criteria was higher than the classical Meisels criteria.Moderate or intense inflammation reduces the sensitivity and specificity of the secondary Schneider criteria for diagnosing HPV infection using the hybrid capture as the gold standard.
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http://dx.doi.org/10.1055/s-0035-1570105DOI Listing
January 2016

Endoscopic and histopathologic gastric changes in chronic users of proton-pump inhibitors.

Arq Gastroenterol 2015 Jan-Mar;52(1):59-64

Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil.

Background: Proton-pump inhibitors have been used for at least two decades. They are among the most commonly sold drugs in the world. However, some controversy remains about the indications for their use and the consequences of their prolonged use.

Objectives: To evaluate and compare the endoscopic and histopathologic gastric changes in chronic users of proton-pump inhibitors to changes in non-users.

Methods: A prospective study performed at a tertiary Public Hospital involving 105 patients undergoing upper-gastrointestinal endoscopy. Subjects included 81 proton-pump inhibitor users and 24 non-users (control group). Biopsies of the antral-type mucosa, the antral-fundic transition, and the fundus were evaluated by the Sydney System. The presence of erosion or ulceration, lymphatic follicles, reactive gastropathy, and polypoid or epithelial hyperplasia was also determined. Serum levels of gastrin were measured.

Results: We found two polyps, one in each group, both of which were negative for Helicobacter pylori. There were two cases of parietal cell hyperplasia in users of proton-pump inhibitors. Gastrin was elevated in 28 users of proton-pump inhibitors and in four members of the control group. We did not find statistically significant differences in the endoscopic or histopathologic findings between the two groups.

Conclusions: Chronic use of proton-pump inhibitors for the duration examined was not associated with significant gastric changes. An interesting finding was that the 4 chronic users of proton-pump inhibitors who had serum gastrin levels above 500 pg/mL also had positive serology for Chagas disease.
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http://dx.doi.org/10.1590/S0004-28032015000100013DOI Listing
October 2015

Histological and endoscopic features of the stomachs of patients with Chagas disease in the era of Helicobacter pylori.

Rev Soc Bras Med Trop 2014 Nov-Dec;47(6):739-46

Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil.

Introduction: Most studies that have evaluated the stomachs of patients with Chagas disease were performed before the discovery of Helicobacter pylori and used no control groups. This study compared the gastric features of chagasic and non-chagasic patients and assessed whether gastritis could be associated with Chagas disease.

Methods: Gastric biopsy samples were taken from patients who underwent endoscopy for histological analysis according to the Updated Sydney System. H. pylori infection was assessed by histology, 16S ribosomal ribonucleic acid (rRNA) polymerase chain reaction (PCR), serology and the 13C-urea breath test. Patients were considered H. pylori-negative when all of these diagnostic tests were negative. Clinical and socio-demographic data were obtained by reviewing medical records and using a questionnaire.

Results: The prevalence of H. pylori infection (70.3% versus 71.7%) and chronic gastritis (92.2% versus 85%) was similar in the chagasic and non-chagasic groups, respectively; such as peptic ulcer, atrophy and intestinal metaplasia. Gastritis was associated with H. pylori infection independent of Chagas disease in a log-binomial regression model. However, the chagasic H. pylori-negative patients showed a significantly higher grade of mononuclear (in the corpus) and polymorphonuclear (PMN) (in the antrum) cell infiltration. Additionally, the patients with the digestive form of Chagas disease showed a significantly lower prevalence of corpus atrophy than those with other clinical forms.

Conclusions: The prevalence of H. pylori infection and of gastric histological and endoscopic features was similar among the chagasic and non-chagasic patients. Additionally, this is the first controlled study to demonstrate that H. pylori is the major cause of gastritis in patients with Chagas disease.
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http://dx.doi.org/10.1590/0037-8682-0180-2014DOI Listing
July 2015

Neonatal sepsis and inflammatory mediators.

Mediators Inflamm 2014 30;2014:269681. Epub 2014 Dec 30.

Department of Pathology, Institute of Tropical Pathology and Public Health, Federal University of Goias, 74605-050 Goiania, GO, Brazil ; Department of Pathology, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, 14049-900 Ribeirao Preto, SP, Brazil.

Neonatal sepsis is a major cause of morbidity and mortality and its signs and symptoms are nonspecific, which makes the diagnosis difficult. The routinely used laboratory tests are not effective methods of analysis, as they are extremely nonspecific and often cause inappropriate use of antibiotics. Sepsis is the result of an infection associated with a systemic inflammatory response with production and release of a wide range of inflammatory mediators. Cytokines are potent inflammatory mediators and their serum levels are increased during infections, so changes from other inflammatory effector molecules may occur. Although proinflammatory and anti-inflammatory cytokines have been identified as probable markers of neonatal infection, in order to characterize the inflammatory response during sepsis, it is necessary to analyze a panel of cytokines and not only the measurement of individual cytokines. Measurements of inflammatory mediators bring new options for diagnosing and following up neonatal sepsis, thus enabling early treatment and, as a result, increased neonatal survival. By taking into account the magnitude of neonatal sepsis, the aim of this review is to address the role of cytokines in the pathogenesis of neonatal sepsis and its value as a diagnostic criterion.
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http://dx.doi.org/10.1155/2014/269681DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295603PMC
September 2015

Blood vessels in ganglia in human esophagus might explain the higher frequency of megaesophagus compared with megacolon.

Rev Inst Med Trop Sao Paulo 2014 Nov-Dec;56(6):529-32

Resident, Universidade Federal do Triangulo Mineiro, Uberaba, MG, Brazil.

This study aimed to determine the existence of blood vessels within ganglia of the myenteric plexus of the human esophagus and colon. At necropsy, 15 stillborns, newborns and children up to two years of age, with no gastrointestinal disorders, were examined. Rings of the esophagus and colon were analyzed and then fixed in formalin and processed for paraffin. Histological sections were stained by hematoxylin-eosin, Giemsa and immunohistochemistry for the characterization of endothelial cells, using antibodies for anti-factor VIII and CD31. Blood vessels were identified within the ganglia of the myenteric plexus of the esophagus, and no blood vessels were found in any ganglia of the colon. It was concluded that the ganglia of the myenteric plexus of the esophagus are vascularized, while the ganglia of the colon are avascular. Vascularization within the esophageal ganglia could facilitate the entrance of infectious agents, as well as the development of inflammatory responses (ganglionitis) and denervation, as found in Chagas disease and idiopathic achalasia. This could explain the higher frequency of megaesophagus compared with megacolon.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296875PMC
http://dx.doi.org/10.1590/s0036-46652014000600013DOI Listing
April 2015

A retrospective study on cervical intraepithelial lesions of low-grade and undetermined significance: evolution, associated factors and cytohistological correlation.

Sao Paulo Med J 2014 ;132(2):92-6

Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil.

Context And Objectives: Cervical cancer is an important cause of morbidity and mortality throughout the world. There is some controversy about the factors that may be associated with infection by the human papillomavirus (HPV) that may favor or protect against evolution from a low-grade intraepithelial lesion to a high-grade intraepithelial lesion or invasive neoplasia. The objective here was to evaluate the evolution of low-grade intraepithelial lesions and squamous or glandular lesions of undetermined significance, the associated factors and cytohistological correlations.

Design And Setting: Retrospective study conducted in a public tertiary-level university hospital.

Methods: Information was obtained by reviewing patient records and/or colposcopy reports. A statistical analysis was performed using logistic regression, calculating the odds ratio and applying chi-square tests.

Results: Of the 3390 patients, 409 evolved to high-grade intraepithelial lesions, of which 354 had an initial diagnosis of HPV infection, 27 of squamous atypia of undetermined significance, 22 of low-grade intraepithelial lesions with or without cytological diagnosis of infection by associated HPV and six of glandular cell atypia of undetermined significance.

Conclusions: Lactobacillus sp and bacterial vaginosis on the smears, smoking and immunodepression were factors associated with evolution. A single partner, use of hormonal contraceptives, lower parity, age and a cytological diagnosis of cytolytic vaginosis, T. vaginalis, Candida sp or cocci were factors associated with protection. With regard to cytohistological correlation, there was a 74.08% agreement among patients with high-grade lesions and a biopsy obtained during the same period.
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http://dx.doi.org/10.1590/1516-3180.2014.1322579DOI Listing
October 2014

Tonsillar hyperplasia and recurrent tonsillitis: clinical-histological correlation.

Braz J Otorhinolaryngol 2013 Sep-Oct;79(5):603-8

Universidade Federal do Triângulo Mineiro, UberabaMG.

Unlabelled: Hypertrophy and recurrent tonsillitis are common indications of tonsillectomy. However, the pathological reports are similar, regardless of clinical aspects.

Objective: Search for histopathological changes that differentiate palatine tonsils operated because of hypertrophy vis-à-vis those operated because of recurrent tonsillitis.

Method: A prospective cross-sectional descriptive study involving 46 children divided into group I - 22 with hypertrophy; and group II - 24 with recurrent tonsillitis, in the period between 2010 and 2012, in a public hospital. We evaluated clinical and histopathological features (lymph follicles, germinal centers, fibrosis, necrosis, reticulation, infiltration by plasma cells and neutrophils).

Results: The patients' ages ranged between 2 and 11 years (5.17 ± 2.28). In group I, half of the patients had had the latest infection at seven months or more, and all with obstruction degree greater than 3 (> 50%). In group II, all had had the latest infection at less than seven months, and most with obstruction degree below 4 (< 75%). There was a statistically significant difference in the degree of obstruction (p = 0.0021) and number of germinal centers (p = 0.002) was higher in group I.

Conclusion: This study suggests that the number of germinal centers is the only histopathological criterion that can be used to differentiate the two groups.
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http://dx.doi.org/10.5935/1808-8694.20130108DOI Listing
February 2014

Testicular myeloid sarcoma: case report.

Rev Bras Hematol Hemoter 2013 ;35(1):68-70

Hospital Dr. Amaral Carvalho, Jaú, SP, Brazil.

Myeloid sarcomas are extramedullary solid tumors composed of immature granulocytic precursor cells. In association with acute myeloid leukemia and other myeloproliferative disorders, they may arise concurrently with compromised bone marrow related to acute myeloid leukemia, as a relapsed presentation, or occur as the first manifestation. The testicles are considered to be an uncommon site for myeloid sarcomas. No therapeutic strategy has been defined as best but may include chemotherapy, radiotherapy and/or hematopoietic stem cell transplantation. This study reports the evolution of a patient with testicular myeloid sarcoma as the first manifestation of acute myeloid leukemia. The patient initially refused medical treatment and died five months after the clinical condition started.
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http://dx.doi.org/10.5581/1516-8484.20130018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3621639PMC
April 2013

Invasive thymoma in a child: a rare case report.

J Pediatr Surg 2012 Feb;47(2):e23-5

Surgery Department, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil.

Thymomas are neoplasms of the anterior mediastinum and generally occur between the fourth and sixth decades of life. In children, they are rare, with few reported cases. We describe a 9-year-old boy with invasive thymoma treated successfully by surgery alone. The patient was previously healthy and under treatment for a community-acquired pneumonia. A chest radiograph showed an opacity at the left lung base, and thoracic computed tomographic scan showed a mass with thick walls and liquid content situated in the lingula with no cleavage plane with the mediastinum. The patient underwent a left anterolateral thoracotomy, which showed a mass extending from the anterior mediastinum, infiltrating the left upper lobe of lung, phrenic nerve, and pericardium. A left upper lobectomy and resection of the mediastinal mass and lymph nodes were carried out. The pathologic analysis showed it to be a type B3 fusiform-cell thymoma, infiltrating the left upper lobe and 1 peribronchial lymph node. A multidisciplined tumor group decided to observe the patient and followed with thoracic computed tomographic scans every 3 months. After 2 years of follow-up, the patient has no evidence of recurrent disease.
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http://dx.doi.org/10.1016/j.jpedsurg.2011.11.006DOI Listing
February 2012

Local lymphocytes and nitric oxide synthase in the uterine cervical stroma of patients with grade III cervical intraepithelial neoplasia.

Clinics (Sao Paulo) 2010 Jun;65(6):575-81

Federal University of Triângulo Mineiro, Research Institute of Oncology, Uberaba/MG, Brazil.

Objectives: Precancerous and cancerous cells can trigger an immune response that may limit tumor development and can be used as a prognostic marker. The aims of the present study were to quantify the presence of B and T lymphocytes, macrophages and cells expressing inducible nitric oxide synthase (iNOS) in the cervical stroma of women with grade III cervical intraepithelial neoplasia (CIN III) or in the intratumoral and peritumoral tissue of women with stage I invasive carcinoma.

Methods: Cervical tissue specimens were obtained from 60 women (20 each from control tissues, CIN III and invasive carcinomas). The average ages in the control, CIN III and invasive groups were 43.9 (+/- 4.3), 35.5 (+/- 9.5), and 50 (+/- 11.2) years, respectively. The specimens were immunohistochemically labeled with antibodies to identify T lymphocytes (CD3), cytotoxic lymphocytes (CD8), B lymphocytes (CD20), macrophages (CD68) and iNOS. We evaluated the markers in the stroma above the squamocolumnar junction (control), at the intraepithelial lesion (CIN cases), and in the infiltrating tumor. Two independent observers performed the immunohistochemical analysis.

Results: T lymphocytes, B lymphocytes, macrophages and iNOS were present more frequently (P<0.05) in the stroma of peritumoral invasive tumors compared to the controls and intratumoral invasive cancer samples. CD3+ and CD20+ lymphocytes were present more frequently in CIN III patients compared to samples from patients with intratumoral invasive cancer (P<0.05).

Conclusion: High numbers of T and B lymphocytes, macrophages and iNOS-expressing cells in the peritumoral stroma of the invasive tumors were observed. Cell migration appeared to be proportional to the progression of the lesion.
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http://dx.doi.org/10.1590/S1807-59322010000600003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2898547PMC
June 2010