Search

To determine the prevalence and possible variables associated with anal intraepithelial neoplasia and anal cancer in immunocompetent women with high-grade cervical intraepithelial neoplasia. A cross-sectional study involving immunocompetent women with a histological diagnosis of high-grade cervical intraepithelial neoplasia and cervical cancer, conducted between January 2016 and September 2020. All women underwent anal cytology and answered a questionnaire on characterization and potential risk factors. Women with altered cytology were submitted to anoscopy and biopsy. A total of 69 women were included in the study. Of these, 7 (10.1%) had abnormal anal cytology results: (high-grade lesion, atypical squamous cells of undetermined significance, and atypical squamous cells, cannot exclude high-grade lesions: 28,5% each; low grade lesion: 14,3%). Of the anoscopies, 3 (42.8%) showed alterations. Of the 2 (28,5% of all abnormal cytology results) biopsies performed, only 1 showed low-grade anal intraepithelial neoplasia. The average number of pregnancies, vaginal deliveries, and abortions was associated with abnormal anal cytology. However, the highest mean regarding the cesarean sections was associated with normal cytology. The prevalence of anal intraepithelial neoplasia was compatible with data from recent studies, especially those conducted in Brazil. Opportunistic screening for anal intraepithelial neoplasia in this high-risk population should be considered. Anal cytology is suitable for this purpose, due to its low cost and feasibility in public health services. Determinar a prevalência e as possíveis variáveis associadas à neoplasia intraepitelial anal e ao câncer anal em mulheres imunocompetentes com neoplasia intraepitelial cervical de alto grau. MéTODOS: Estudo transversal em mulheres imunocompetentes com diagnóstico histológico de neoplasia intraepitelial cervical de alto grau e câncer cervical, feito entre janeiro de 2016 e setembro de 2020. Todas as mulheres foram submetidas a citologia anal e responderam a um questionário de caracterização e potenciais fatores de risco. Mulheres com citologia alterada foram submetidas a anuscopia e biópsia. No total, 69 mulheres foram incluídas no estudo. Destas, 7 (10,1%) tiveram resultados anormais de citologia anal (lesão de alto grau, células escamosas atípicas de significado indeterminado, e células escamosas atípicas, não se pode excluir lesões de alto grau: 28,5% cada; lesão de baixo grau: 14,3%). Das anuscopias, 3 (42,8%) demonstraram alterações. Das 2 biópsias realizadas, apenas 1 apresentou neoplasia intraepitelial anal de baixo grau. O número médio de gestações, partos vaginais e abortos estava associado à citologia anal anormal. No entanto, a maior média de partos cesáreos estava associada à citologia normal. CONCLUSãO: A prevalência de neoplasia intraepitelial anal foi compatível com dados de estudos recentes, principalmente daqueles feitos no Brasil. O rastreamento oportunista para neoplasia intraepitelial anal nesta população de alto risco deve ser considerado. A citologia anal é adequada para esse fim, devido ao seu baixo custo e viabilidade nos serviços públicos de saúde.

Prior studies have demonstrated prolonged presence of yellow fever virus (YFV) RNA in saliva and urine as an alternative to serum. To investigate the presence of YFV RNA in urine, we used RT-PCR for YFV screening in 60 urine samples collected from a large cohort of naturally infected yellow fever (YF) patients during acute and convalescent phases of YF infection from recent YF outbreaks in Brazil (2017 to 2018). Fifteen urine samples from acute phase infection (up to 15 days post-symptom onset) and four urine samples from convalescent phase infection (up to 69 days post-symptom onset), were YFV PCR-positive. We genotyped YFV detected in seven urine samples (five collected during the acute phase and two collected during the YF convalescent phase). Genotyping indicated the presence of YFV South American I genotype in these samples. To our knowledge, this is the first report of wild-type YFV RNA detection in the urine this far out from symptom onset (up to 69 DPS), including YFV RNA detection during the convalescent phase of YF infection. The detection of YFV RNA in urine is an indicative of YFV infection; however, the results of RT-PCR using urine as sample should be interpreted with care, since a negative result does not exclude the possibility of YFV infection. With a possible prolonged period of detection beyond the viremic phase, the use of urine samples coupled with serological tests, epidemiologic inquiry, and clinical assessment could provide a longer diagnostic window for laboratory YF diagnosis.

The Itapemirim River is considered one of the most important water resources in the state of Espírito Santo, Brazil. However, environmental problems due to continuous anthropogenic contamination are threatening its potential use. This study assessed water quality by analyzing abiotic and toxicogenetic aspects of the water from four stations along the river. Samples were collected in both dry and rainy seasons. Most of the abiotic variables were below the threshold established by CONAMA Resolution No. 357/2005, and so were most of the metals. However, Al and Cu contents were above those allowed by legislation, ranging from 0.2 to 0.9 mg/L. Regarding toxicogenetic aspects, genotoxic effects were observed in meristematic cells of Allium cepa, in micronucleus test and comet assay of Oreochromis niloticus, and CHO-K1 cells. Mutagenic effects were significant at RI 02 (0.34), RI 03 (0.46), and RI 04 (0.12) stations on the first campaign in A. cepa F1 cells, compared to the negative control (0.0). The second campaign revealed the same results, but with the addition of samples from RI 01 (0.17) and RI 03 (0.18) showing mutagenicity in the micronucleus test with fish erythrocytes when compared to the negative control (0.3). Essentially, all the samples evaluated in both campaigns showed damage in A. cepa, O. niloticus, and CHO-K1 cells, thus demonstrating that the water quality of the Itapemirim River is compromised and requires action plans for its recovery.

OBJECTIVES To conduct the Brazilian translation, cross-cultural adaptation, validation, and reliability testing of the EMpowerment of PArents in THe Intensive Care (EMPATHIC-30). DESIGN Prospective study. SETTING PICU of a tertiary-care teaching hospital. PATIENTS Parents (n = 141) completed the translated EMPATHIC-30 questionnaire 72 hours after their child's PICU discharge. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The translation and cultural adaptation were performed in accordance with the principles of good practice for the translation and cultural adaptation process for patient-reported outcomes measures. Sentences were adapted according to the Brazilian syntax. Total content validity coefficient was above the established average (> 0.8). Reliability was evaluated with the coefficients McDonald omega and Cronbach alpha. The lowest Cronbach alpha found was 0.47 (CI 95%, 0.35-0.59) in the organization domain, where the lowest response rate was also concentrated. The values of the other domains were as follows: 0.64 (95% CI, 0.55-0.73) for information, 0.77 (95% CI, 0.71-0.83) for care and treatment, 0.72 (95% CI, 0.66-0.78) for parent participation, and 0.72 (95% CI, 0.65-0.79) for professional attitudes. The total internal consistency independent of the domain was 0.90 (CI 95%, 0.88-0.92). With regard to McDonald Omega, values were identified: 0.68 (95% CI, 0.49-0.88) for information, 0.73 (95% CI, 0.61-0.85) for care and treatment, 0.85 (95% CI, 0.47-0.80) for parent participation, 0.85 (95% CI, 0.76-0.93), and 0.72 (95% CI, 0.58-0.86) for professional attitudes. CONCLUSIONS EMPATHIC-30 has been translated and culturally adapted for the Brazilian population. Validation demonstrated an above-average total content validity coefficient, confirming the instrument content validity. A sufficient reliability was observed in both analyzed coefficients. The results support the use of the Brazilian version of EMPATHIC-30 for the evaluation of parents' satisfaction of children admitted to the PICU.

Yellow Fever (YF) is an acute febrile illness caused by yellow fever virus (YFV), a mosquito-borne flavivirus transmitted to humans and non-human primates. In Brazil, YF is a public health threat and may cause recurrent epidemics, even with the availability of a vaccine. We evaluated the sero-status for YFV in 581 individuals living in a risk area for YF in Brazil. The area presents history of cases and is located in the southeast region of country where outbreaks of YF have been reported since 2016. Through, a PRNT assay, we found 25.8% of individuals lacking YF-neutralizing antibodies. Furthermore, neutralizing antibodies were not detected in 10 individuals with proven vaccination. Our findings reinforce the importance of surveillance systems and the need of an urgent intensification of immunization programs in regions with YFV circulation. Monitoring susceptible individuals that could act as potential disseminators for YFV in risk areas should also be considered.

The present study aims to evaluate the knowledge of dental students and dentists who work in Primary Health Care (PHC). These are professionals who work in the public basic health units regarding oral cancer prevention, diagnosis, and treatment.A cross-sectional and observational Brazilian study was conducted. A survey with 27 questions was carried out regarding the (i) demographic, academic, and professional data of the participants, (ii) attitudes, practices, and self-perception about their training, and (iii) knowledge about oral cancer. With the exception of one question regarding the clinical characteristics of oral cancer, all knowledge answers were graded as correct or incorrect. Grades were assigned to each participant according to their level of knowledge, and scores for each participant were calculated ranging from 1 to 10. Mann-Whitney and Kruskal-Wallis tests were used to examine the difference in the knowledge score of oral cancer according to explanatory variables. The level of significance adopted was 5%.The sample comprised 541 dental students and 82 PHC dentists. Most participants did not consider it appropriate or had not received training for palpation of lymph nodes or for identifying lymphadenopathies associated with oral cancer. Less than 20% of the participants had some kind of practice before and felt safe performing biopsy surgery. The average student score was 7.01 ± 2.15, and the average dentist score was 7.81 ± 1.467.Although the scores were satisfactory, most of the participants did not show adequate knowledge about biopsy and palpation of cervical lymph nodes.

The COVID-19 pandemic caused unprecedented pressure over health care systems worldwide. Hospital-level data that may influence the prognosis in COVID-19 patients still needs to be better investigated. Therefore, this study analyzed regional socioeconomic, hospital, and intensive care units (ICU) characteristics associated with in-hospital mortality in COVID-19 patients admitted to Brazilian institutions. This multicenter retrospective cohort study is part of the Brazilian COVID-19 Registry. We enrolled patients ≥ 18 years old with laboratory-confirmed COVID-19 admitted to the participating hospitals from March to September 2020. Patients' data were obtained through hospital records. Hospitals' data were collected through forms filled in loco and through open national databases. Generalized linear mixed models with logit link function were used for pooling mortality and to assess the association between hospital characteristics and mortality estimates. We built two models, one tested general hospital characteristics while the other tested ICU characteristics. All analyses were adjusted for the proportion of high-risk patients at admission. Thirty-one hospitals were included. The mean number of beds was 320.4 ± 186.6. These hospitals had eligible 6556 COVID-19 admissions during the study period. Estimated in-hospital mortality ranged from 9.0 to 48.0%. The first model included all 31 hospitals and showed that a private source of funding (β = - 0.37; 95% CI - 0.71 to - 0.04; p = 0.029) and location in areas with a high gross domestic product (GDP) per capita (β = - 0.40; 95% CI - 0.72 to - 0.08; p = 0.014) were independently associated with a lower mortality. The second model included 23 hospitals and showed that hospitals with an ICU work shift composed of more than 50% of intensivists (β = - 0.59; 95% CI - 0.98 to - 0.20; p = 0.003) had lower mortality while hospitals with a higher proportion of less experienced medical professionals had higher mortality (β = 0.40; 95% CI 0.11-0.68; p = 0.006). The impact of those association increased according to the proportion of high-risk patients at admission. In-hospital mortality varied significantly among Brazilian hospitals. Private-funded hospitals and those located in municipalities with a high GDP had a lower mortality. When analyzing ICU-specific characteristics, hospitals with more experienced ICU teams had a reduced mortality.

Yellow fever (YF), caused by the yellow fever virus (YFV), is an emerging viral zoonosis that affects humans and non-human primates (NHP). In South America, YF is naturally maintained through enzootic/sylvatic cycles involving NHPs and mosquitoes (Haemagogus and Sabethes). In this study, we retrospectively analyzed wildlife rodents to better understand their role in a potential alternative YF sylvatic cycle. The plaque reduction neutralization test was performed to detect anti-YFV antibodies, while qPCR targeting the NS5 region of flaviviruses and standard PCR targeting the CprM region were applied to detect YFV RNA in tissue and blood samples. YFV was not evidenced in any of the tested samples. These findings provide additional information regarding sylvatic YFV and emphasize the importance of YFV surveillance in wild animals as potential reservoirs/hosts given the well-established enzootic cycle in the studied areas, mainly in the Atlantic Forest.

Invasive species can reach high abundances and dominate native environments. One of the most impressive examples of ecological invasions is the spread of the African subspecies of the honey bee throughout the Americas, starting from its introduction in a single locality in Brazil. The invasive honey bee is expected to more negatively impact bee community abundance and diversity than native dominant species, but this has not been tested previously. We developed a comprehensive and systematic bee sampling scheme, using a protocol deploying 11,520 pan traps across regions and crops for three years in Brazil. We found that invasive honey bees are now the single most dominant bee species. Such dominance has not only negative consequences for abundance and species richness of native bees but also for overall bee abundance (i.e., strong “numerical” effects of honey bees). Contrary to expectations, honey bees did not have stronger negative impacts than other native bees achieving similar levels of dominance (i.e., lack of negative “identity” effects of honey bees). These effects were markedly consistent across crop species, seasons and years, and were independent from land-use effects. Dominance could be a proxy of bee community degradation and more generally of the severity of ecological invasions.

The São Francisco River Basin (SFRB) is one of the main watersheds in Brazil, standing out for generating energy and consumption, among other ecosystem services. Hence, it is important to identify hydrological drought events and the anomalous climate patterns associated with dry conditions. The Standard Precipitation Index (SPI) for 12 months was used to identify hydrological drought episodes over SFRB 1979 and 2020. For these episodes, the severity, duration, intensity, and peak were obtained, and SPI-1 was applied for the longest and most severe episode to identify months with wet and dry conditions within the rainy season (Nov–Mar). Anomalous atmospheric and oceanic patterns associated with this episode were also analyzed. The results revealed the longest and most severe hydrological drought episode over the basin occurred between 2012 and 2020. The episode over the Upper portion of the basin lasted 103 months. The results showed a deficit of monthly precipitation up to 250 mm in the southeast and northeast regions of the country during the anomalous dry months identified through SPI-1. The dry conditions observed during the rainy season of this episode were associated with an anomalous high-pressure system acting close to the coast of Southeast Brazil, hindering the formation of precipitating systems.

The aim of the present study was to investigate the prevalence of oral health-related shame and the associated factors among 8-to-10-year-old Brazilian schoolchildren. A cross-sectional study was conducted with 388 children randomly selected from public and private schools of Diamantina, southeastern Brazil. In order to identify the feeling of shame, self-reports were collected through a single question, “In the last month, did you feel ashamed because of your teeth or mouth? Two calibrated examiners performed the clinical examination for dental caries (DMFT/dmft index), traumatic dental injuries (O’ Brien), and malocclusion (Dental Aesthetic Index). Sociodemographic indicators were obtained through a questionnaire answered by the children’s caregivers. Descriptive analysis, chi-square test, and hierarchical Poisson regression models were performed (95%CI; p < 0.05). The prevalence of shame was 38.1% (n = 148). The adjusted regression analysis demonstrated a significant association between shame and untreated dental caries (PR: 1.34; 95%CI: 1.04–1.74; p = 0.02), age of 10 years (PR: 1.36; 95%CI: 1.05–1.76; p = 0.01), and with parents with less than eight years of schooling (PR: 1.30; 95%CI: 1.00–1.68; p = 0.04). Older children with untreated dental caries and whose parents had lower education level presented a higher prevalence of oral health-related shame.

Background Chronic back pain is prevalent in Brazil, leading to enormous healthcare costs and social burdens. It also disproportionately affects low-income and less-healthy people. Objectives This study examines the associations of chronic back pain with biological, psychological, and social factors; how it limits usual activities; and how chronic back pain influences the use of treatment services. Methods Using Brazil’s National Health Survey (PNS-2019), multivariate logistic regressions were conducted to examine how biological, psychological, and social factors correlate with chronic back pain, limitations on usual activities, and pain treatment. Results PNS-2019 data showed that 23.4% (95% CI 22.8–24.0) of Brazilian adults aged over 20 reported back pain. A higher prevalence of chronic back pain was associated with biological factors (older age, being female, overweight or obese, current smoking, and having more chronic conditions), lower social conditions (low education, low per capita household income, non-married, and living in rural areas), and poor psychological health (more depressive symptoms). Chronic back pain is more likely to limit usual activities among those with low social conditions (lower education, lower income), poor physical and behavioral health (obese, current smokers, and those with a greater number of chronic conditions), and worse psychological health (more depressive symptoms). However, married people and those who do not consume alcohol were also more likely to report limited activities. Among those with back pain, 68% received at least one form of treatment. Those with intense limitations on their usual activities were 2.2 times as likely to report treatment. People with higher social conditions (higher income, college education, and private health insurance) were more likely to receive treatment. Conclusion The results show significant biological, psychological, and social disparities in the prevalence of chronic back pain in Brazil. The findings point to the need for tailored policies and prevention programs with attention to vulnerable groups. Even though Brazil has universal health care, those with better socioeconomic conditions are more likely to receive treatment.

This study aimed to investigate the environmental impacts generated by the hydroelectric complex in the Madeira River, Brazilian Amazon, based on the perceptions of local fishers and fishery database, it focus attention on three main impacts: (i) on local fishery stocks; (ii) in fish fauna and (iii) on the aquatic ecosystems. The local fishers were selected through the “snowball” approach for the application of semi-structured interviews. All the local fishers confirmed having perceived a decline in fishery productivity following the impounding of the Madeira River. Changes in the condition of the fish were also perceived by the local fishers, including exophthalmia (82%), a reduction in the weight or length of the fish (25%), and irregular breeding patterns (14%). In the case of impacts on the river, changes in the hydrological cycle were the process remembered most frequently (75%). The results elucidated a range of environmental impacts caused by the hydroelectric dams of the Madeira River. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s13280-020-01316-w) contains supplementary material, which is available to authorized users.

In addition to its valuable utility in forensic investigations, mitochondrial DNA (mtDNA) analysis is a reliable tool to uncover the origins of admixed populations, such as Brazilians. The state of Espirito Santo (ES), similar to other coastal Brazilian states, has a population shaped by 3 main ancestral roots: Amerindian, African and European. Among the latter, the Pomeranian descendants stand out due to the preservation of the traditional aspects of their culture, especially the Pomeranian language. Despite the genetic data already available, there is no mtDNA database that adequately reflects the diversity, the geographic distribution, and the origins of the maternal lineages from ES. To increase the knowledge of maternal ancestry and to investigate the population's genetic stratification, a total of 291 samples were collected in the 4 macroregions (Metropolitan, South, Central and North) of ES and in the Pomeranian communities. Complete control region data were produced for the general (N=214) and Pomeranian (N=77) groups. Regarding the general population, the high values of haplotype diversity (H=99.9%) and pairwise differences (MNPD=16.9) found are in agreement with those reported for other populations in the southeast region of the country. Regarding maternal inheritance, the ES populations stood out due to the predominance of European haplogroups (49.5%), although the North macroregion had a higher African ancestry (47.1%). Among the Pomeranians, the lowest MNPD value (11.2) and the high percentage of shared haplotypes (15%) were indicative of founder events. The FST analysis showed that the Pomeranians (98.7% of European lineages) are genetically isolated from the other admixed populations in Brazil. This study demonstrated that the ES state contains singularities regarding the intrapopulational and interpopulational diversity of mtDNA. Even after 5 centuries of interethnic admixture, the present-day population of Espirito Santo harbors genetic marks that trace back to the historical aspects of its formation.

Background Brazil is among the countries hit hardest by COVID-19, and older adults are among the vulnerable groups. Intergenerational coresidence and interdependence among family members, both prevalent in Brazil, likely increase social and physical contact and thus potential infection. Methods Using nationally representative data from the COVID-19 module of the Brazilian National Household Sample Survey (Pesquisa Nacional por Amostra de Domicílios), collected between July and November of 2020, we examined the association between living arrangements and exposure to and testing for COVID-19 among 63,816 Brazilians aged 60 years and older. We examine whether living arrangements influence self-reported COVID-19 symptoms as an indicator of subjective health assessment, testing as an indicator of health care service use, and a positive COVID-19 test result as an objective indicator of exposure to the disease. Results Living arrangements shape older adults’ vulnerabilities to COVID-19 exposure and testing. Specifically, those living alone were more likely to report having symptoms and having had a test for COVID-19. However, older adults in multigenerational and skipped generation households were more likely than solo-dwellers to test positive for COVID-19. Those with symptoms were more likely to test, regardless of their living arrangement. Among older adults without symptoms, those living alone had a higher probability of testing than those living in multigenerational or skipped-generation households. Conclusions Overall, our findings suggest that coresidence with younger family members puts older adults’ health at risk in the context of COVID-19. As younger Brazilians are increasingly vulnerable to COVID-19 and experiencing severe outcomes, policy makers need to be more attentive to the health needs of households that comprise older and younger cohorts, which are also more prevalent in poor and marginalized segments of the population.

Objective To evaluate the prognostic performance of the Pediatric Index of Mortality 2 (PIM2), ferritin, lactate, C-reactive protein (CRP), and leukocytes, alone and in combination, in pediatric patients with sepsis admitted to the pediatric intensive care unit (PICU). Methods A retrospective study was conducted in a PICU in Brazil. All patients aged 6 months to 18 years admitted with a diagnosis of sepsis were eligible for inclusion. Those with ferritin and C-reactive protein measured within 48 h and lactate and leukocytes within 24 h of admission were included in the prognostic performance analysis. Results Of 350 eligible patients with sepsis, 294 had undergone all measurements required for analysis and were included in the study. PIM2, ferritin, lactate, and CRP had good discriminatory power for mortality, with PIM2 and ferritin being superior to CRP. The cutoff values for PIM2 (> 14%), ferritin (> 135 ng/mL), lactate (> 1.7 mmol/L), and CRP (> 6.7 mg/mL) were associated with mortality. The combination of ferritin, lactate, and CRP had a positive predictive value of 43% for mortality, similar to that of PIM2 alone (38.6%). The combined use of the three biomarkers plus PIM2 increased the positive predictive value to 76% and accuracy to 0.945. Conclusions PIM2, ferritin, lactate, and CRP alone showed good prognostic performance for mortality in pediatric patients older than 6 months with sepsis. When combined, they were able to predict death in three-fourths of the patients with sepsis. Total leukocyte count was not useful as a prognostic marker.

Objective To identify reasons among Brazilian women for never having a Pap test. Design We designed a cross-sectional study that used data from the National Health Survey. Sample Two thousand four hundred and two women 25-64 years old who never had a pap test. Measures Variables were age, race, education, marital status, housing condition, primary health care access, health insurance, self-perceived health, and social support network. We calculated the prevalence of different reasons and odds ratios for each. Results The most frequent reason for never having a test were linked to women thinking the test was unnecessary (42.3%) which had a significant association with marital status (OR = 1.52; 95% CI = 1.07-1.91), age (OR = 1.56; 95% CI = 1.21-1.99), area of residence (OR = 1.15; 95% CI = 1.02-1.39), having a health insurance (OR = 1.18; 95% CI = 1.01-1.36), and self-perceived health (OR = 1.42; 95% CI = 1.28-1.56). The second most frequent reason was not knowing they needed a test (22.9%) which was associated with age (OR = 1.95; 95% CI = 1.74-2.16) and self-perceived health (OR = 1.56; 95% CI = 1.33-1.80). Conclusions The findings suggest lack of knowledge about cervical cancer and its prevention among Brazilian women. We consider it essential that the health service can provide the test, as well as the necessary guidelines for raising the awareness of the target audience.

Background and objectives FSGS recurrence after kidney transplantation is a major risk factor for graft loss. However, the natural history, clinical predictors, and response to treatment remain unclear because of small sample sizes and poor generalizability of single-center studies, and disease misclassification in registry-based studies. We therefore aimed to determine the incidence, predictors, and treatment response of recurrent FSGS in a large cohort of kidney transplant recipients. Design, setting, participants, & measurements The Post-Transplant Glomerular Disease (TANGO) project is an observational, multicenter, international cohort study that aims to investigate glomerular disease recurrence post-transplantation. Transplant recipients were screened for the diagnosis of idiopathic FSGS between 2005 and 2015 and details were recorded about the transplant, clinical outcomes, treatments, and other risk factors. Results Among 11,742 kidney transplant recipients screened for FSGS, 176 had a diagnosis of idiopathic FSGS and were included. FSGS recurred in 57 patients (32%; 95% confidence interval [95% CI], 25% to 39%) and 39% of them lost their graft over a median of 5 (interquartile range, 3.0–8.1) years. Multivariable Cox regression revealed a higher risk for recurrence with older age at native kidney disease onset (hazard ratio [HR], 1.37 per decade; 95% CI, 1.09 to 1.56). Other predictors were white race (HR, 2.14; 95% CI, 1.08 to 4.22), body mass index at transplant (HR, 0.89 per kg/m2; 95% CI, 0.83 to 0.95), and native kidney nephrectomies (HR, 2.76; 95% CI, 1.16 to 6.57). Plasmapheresis and rituximab were the most frequent treatments (81%). Partial or complete remission occurred in 57% of patients and was associated with better graft survival. Conclusions Idiopathic FSGS recurs post-transplant in one third of cases and is associated with a five-fold higher risk of graft loss. Response to treatment is associated with significantly better outcomes but is achieved in only half of the cases.

This study aims to estimate the prevalence of the primary occupational exposures, considered risk factors for Cancer in Brazil. We elaborated two exposure scenarios considering the agents' classification and the intensity of exposure, stratified by Brazilian regions and sex. Two pairs of specialists performed the classification of economic activities and occupations due to exposure. There was an excellent overall agreement (94%) and acceptable overall reliability (kappa 0.92, 95% CI 0.89-0.95). There is a notable difference (595%) in occupational exposure between the north (with a higher concentration of rural areas and extractivism) and southeast (with a higher level of industrial activities). There is a difference in prevalence from 833% for solvents to 1170% for inorganic dust between the two scenarios. There is a heterogeneity of exposures according to location, sex, circumstance, and sensitiveness of classification.

Introduction This study compared the intensity of postobturation pain after unintentional apical extrusion of calcium silicate–based root canal sealers (EndoSequence BC Sealer [Brasseler USA, Savannah, GA] and Bio-C Sealer [Angelus, Londrina, PR, Brazil]) with a resin-based sealer (AH Plus; Dentsply Sirona, York, PA). Methods A total of 330 patients referred for root canal treatment on molar teeth with asymptomatic irreversible pulpitis were recruited. Root canals were prepared using WaveOne Gold instruments (Dentsply Sirona) in a crown-down technique and irrigated with 2% chlorhexidine gel and saline solution. Next, patients were randomly distributed into 3 groups according to the root canal sealer used (n = 110): AH Plus, BC Sealer, and Bio-C Sealer. Root canal filling was then accomplished with a vertical compaction technique. Patients presenting with an unintentional extrusion of sealers (n = 13/group) were assessed for postobturation pain experience using a visual descriptor scale ranging from 0–10 at 6-, 12-, 24-, and 48-hour and 1-week intervals after treatment. Mixed analysis of variance repeated measures were used to assess the results (α = 0.05). Results The extrusion rate was similar for all sealers (~12%). There was no significant difference in the postobturation pain results between the root canal sealers evaluated (P > .05). However, after the time interval of 12 hours, AH Plus (P = .04073) and Bio-C Sealer (P = .04327) demonstrated a significant reduction in pain, whereas BC Sealer did not show differences in pain intensity, even in the maximum period evaluated of 1 week (P > .05). Conclusions The occurrence of unintentional apical extrusion of calcium silicate–based root canal sealers presents similar postoperative pain results compared with resin-based sealers with low-intensity pain.