The Complete Nucleotide Sequence of the Carbapenem Resistance-Conferring Conjugative Plasmid pLD209 from a Pseudomonas putida Clinical Strain Reveals a Chimeric Design Formed by Modules Derived from Both Environmental and Clinical Bacteria

The complete sequence of the carbapenem-resistance-conferring conjugative plasmid pLD209 from a Pseudomonas putida clinical strain is presented. pLD209 is formed by 3 well-defined regions: an adaptability module encompassing a Tn402-like class 1 integron of clinical origin containing bla_VIM-2 and aacA4 gene cassettes, partitioning and transfer modules, and a replication module derived from plasmids of environmental bacteria. pLD209 is thus a mosaic of modules originating in both the clinical and environmental (nonclinical) microbiota.     

Twins prematurity – the influence of prenatal surveillance

Objective: To evaluate the influence of the local prenatal surveillance of twin pregnancies in the obstetrical results.

Methods: A prospective cohort study of multiple pregnancies delivered over a period of 16 years in a tertiary centre was conducted. In this study 861 twin pregnancies were included. They were compared for obstetric complications, gestational age at delivery, mode of delivery and birthweight, according to the place of the surveillance.

Results: Of the 861 cases examined, the following obstetric complications were significantly different: metrorrhagia (p?=?0.039), infections (p?p?=?0.007), PROMPT (p?p?=?0.024). The mode of delivery was similar but occurred mostly ≤32 weeks (p?p?Conclusion: Our results demonstrate the crucial importance of prenatal surveillance be carried in a differentiated referral centers with specific/strict protocols or the urgent implementation of same protocols in all other places of surveillance, since this straight surveillance greatly reduces the occurrence of prenatal complications, mainly PROMPT, PTD.     

Time to diagnosis of retinoblastoma in Latin America: A systematic review

Retinoblastoma (RB) is the most common intraocular tumor of childhood. In low income countries, Time to diagnosis (TTD: interval between first symptom and diagnosis) has been associated with extraocular disease, metastasis and mortality. However, the relationship between TTD and prognosis is complex and not simply a linear correlation, particularly if TTD is <6?months. This systematic review aims to identify studies reporting TTD of retinoblastoma in Latin America, highlighting factors affecting TTD, alongside proposals and initiatives to obtain shorter intervals. The review also aims to discuss the methodology linked to cancer pathways studies. The study respected PRISMA recommendations, was registered on Prospero, an international database for systematic review registries under number CRD42017076777. MEDLINE/PUBMED, LILACS and SCIELO databases were searched. Studies from Latin America and the Caribbean, published between 1997 and 2017, reporting TTD and age at diagnosis of patients with retinoblastoma were selected. Nine studies were selected, concerning 1560 patients from Argentina, Brazil, Chile, Honduras, Mexico and Peru. The median TTD ranged from 3 to 5?months and the median age at diagnosis ranged from 16.5 to 22.2?months. A prolonged TTD was observed and was associated to damaging results on retinoblastoma outcomes, particularly increasing extraocular disease, and mortality rates. Methodological heterogeneity was observed and reiterates the importance of standardization of TTD studies, allowing more reliable comparisons and greater knowledge about retinoblastoma pathways before diagnosis. Reports on successful initiatives against delayed diagnosis were scarce, emphasizing a need for further studies.     

Association between oral conditions and functional limitations in childhood

The aim of this study was to evaluate the impact of oral conditions on functional limitations among preschoolers. A preschool‐based, cross‐sectional study was carried out with 843 preschoolers in Campina Grande, Brazil. Parents/caregivers answered a questionnaire addressing socio‐demographic characteristics and perceptions regarding the general/oral health of their children as well as the Brazilian version of the Early Childhood Oral Health Impact Scale. The nonparametric Kruskal–Wallis test followed by Mann–Whitney test (α = 5%) was used to compare mean children's quality‐of‐life scores for each independent variable. Poisson regression analysis was used to test associations between the independent and dependent variables (difficulties eating, drinking and speaking) (α = 5%). The multivariate regression model involved a hierarchical approach with four levels (distal to proximal determinants): (i) socio‐demographic aspects; (ii) health perceptions; (iii) oral conditions; and (iv) pain conditions. The prevalence of negative impact on function was 24·7% for eating/drinking and 8·0% for speaking. Significant associations were found between toothache and negative impact on eating/drinking (PR = 5·38; 95%CI: 3·20–9·02) as well as between high severity dental caries and negative impact on speaking (PR = 14·91; 95%CI: 1·98–112·32). Dental caries, traumatic dental injury and malocclusion were not significantly associated with a negative impact on eating or drinking. However, toothache was an indicator of negative impact on eating/drinking and dental caries severity was an indicator of negative impact on speaking.     

Nuclear fractal dimension in oral squamous cell carcinoma: a novel method for the evaluation of grading,staging, and survival

Fractal dimension (FD) in tissue specimens from patients with oral squamous cell carcinoma (OSCC) was evaluated. FD values in different stages of OSCC, and the correlations with clinicopathological variables and patient survival were investigated. Histological sections from OSCC and control non‐neoplastic mucosa specimens were stained with hematoxylin–eosin for pathological analysis and with Feulgen for nuclear evaluation. FD in OSCC groups vs. controls revealed statistically significant differences (P < 0.001). In addition, a progressive increase of FD from stage I and II lesions and stage III and IV lesions was observed, with statistically significant differences (P = 0.003). Moreover, different degrees of tumor differentiation showed a significant difference in the average nuclear FD values (P = 0.001). A relationship between FD and patients' survival was also detected with lower FD values associated to longer survival time and higher FD values with shorter survival time (P = 0.034). These data showed that FD significantly increased during OSCC progression. Thus, FD could represent a novel prognostic tool for OSCC, as FD values significantly correlated with patient survival. Fractal geometry could give insights into tumor morphology and could become an useful tool for analyzing irregular tumor growth patterns.     

Longitudinal evaluation of the impact of dental caries treatment on oral health‐related quality of life among schoolchildren

This study aimed to evaluate the impact of dental caries treatment on oral health‐related quality of life (OHRQoL) among schoolchildren and the responsiveness of the Child Perceptions Questionnaire (CPQ_8‐10) instrument. Brazilian schoolchildren, 8–10 yr of age, were randomly selected and assigned to two groups – dental caries treatment (DCT) and caries‐free (CF) – according to their caries experience [decayed, missing, or filled primary teeth (dmft) and decayed, missing or filled secondary teeth (DMFT) values of ≥0]. The CPQ_8‐10 instrument was administered at baseline and at 4 wk of follow‐up (i.e. 4 wk after completion of dental treatment). In the DCT group, increases in CPQ_8‐10 scores were observed between the baseline and follow‐up results. However, longitudinal evaluation of the CF group demonstrated no statistically significant difference in CPQ_8‐10 scores. Responsiveness of the CPQ_8‐10 instrument (magnitude of change in CPQ_8‐10 scores) in the DCT group was greater (effect size >0.7) than in the CF group. The findings of this study show that dental caries treatment has an important impact on OHRQoL of children. The CPQ_8‐10 was considered an acceptable instrument for longitudinal measurement of changes in OHRQoL.     

Occurrence of two autochthonous cases of American cutaneous leishmaniasis in the neighborhood of Caju,city of Rio de Janeiro,Brazil

American cutaneous leishmaniasis is in full geographic expansion in Brazil and it is considered among the infectious and parasitic diseases of utmost importance worldwide, not only by its frequency, but mainly by therapeutic difficulties, deformities and sequelae that may result. In the state of Rio de Janeiro, the first autochthonous case of American cutaneous leishmaniasis was registered by Rabello in 1913. The authors report two cases of the disease in the region around the Cemetery São Francisco Xavier, in the Caju neighborhood, Rio de Janeiro city, and emphasize the need for actions that aim to early diagnosis and treatment of American cutaneous leishmaniasis cases.