Impact of the COVID-19 Pandemic on Cancer Staging: An Analysis of Patients With Breast Cancer From a Community Practice in Brazil.

PURPOSE: A nationwide lockdown was enforced in Brazil starting in March 2020 because of the COVID-19 pandemic when cancer screening activities were reduced. In this study, we evaluated the impact of the COVID-19 pandemic on breast cancer (BC) diagnosis. METHODS: We extracted data from the medical records of patients age older than 18 years who were diagnosed with BC and started treatment or follow-up in private oncology institutions in Brazil between 2018 and 2021. The primary objective was to compare the stage distribution during the COVID-19 pandemic (2020-2021) with a historical prepandemic control cohort (2018-2019). Early BC was defined as stage I-II and advanced disease as stage IV. RESULTS: We collected data for 11,753 patients with an initial diagnosis of BC, with 6,493 patients in the pandemic (2020-2021) and 5,260 patients in the prepandemic period (2018-2019). We observed a lower prevalence of early-stage BC (63.6% v 68.4%) and a higher prevalence of advanced-stage BC (16.9 v 12.7%), after the onset of the pandemic (both P < .01). This pattern was similar for both estrogen receptor-positive/human epidermal growth factor receptor 2-negative and human epidermal growth factor receptor 2-positive tumors: significantly decreased in the early stage from 69% to 67% and 68% to 58%, respectively, and a considerable increase in advanced-stage disease from 13% to 15% and 13% to 20%, respectively. For triple-negative BC, there was a significantly higher percentage of patients with advanced-stage disease during the pandemic (17% v 11%). Overall, age 50 years or older and postmenopausal status were associated with a greater risk of advanced stage at diagnosis during the pandemic period. CONCLUSION: We observed a substantial increase in the number of cases of advanced-stage BC in Brazil during the COVID-19 pandemic.

Quedas em idosos com dor crônica: prevalência e fatores associados / Falls in chronic pain elderly patients: prevalence and associated factors

JUSTIFICATIVA E OBJETIVOS: A prevalência de queda e dor crônica é elevada em idosos com importantes consequências para a qualidade de vida. Verificar associação entre estes dois agravos pode ajudar a prevenir incapacidades e sofrimentos. O objetivo deste estudo foi identificar a prevalência de quedas entre idosos com dor há mais de um ano e avaliar a associação entre a ocorrênciade quedas e a localização, intensidade e frequência da dor.MÉTODO: Estudo transversal utilizando dados do projeto Saúde, Bem Estar e Envelhecimento. As variáveis dependentes foram: ocorrência e número de queda nos últimos 12 meses. As variáveis independentes foram: alocalização, intensidade e frequência da dor que "mais incomoda" com duração de mais de um ano. Para verificação de associação, realizou-se o teste de associação de Rao Scott, indicado para amostra populacional.RESULTADOS: Foram analisados 213 idosos acima de 60 anos com dor há mais de um ano e que responderam sobre ocorrência de quedas no último ano. A sua prevalência foi 56,29%. Resultados apontaram que idosos com dor há mais de um ano, intensa ou moderada, relataram maior número de quedas do que os idosos com dores leves. Não foram encontradas associações entre local e frequência dos episódios de dor e relato de quedas no último ano.CONCLUSÃO: Melhor controle da dor pode diminuir risco de quedas em idosos com dores crônicas, estes dois agravos precisam ser adequadamente avaliados e controlados pelos profissionais de saúde.

BACKGROUND AND OBJECTIVES: The prevalence of falls and chronic pain is high among the elderly with major consequences for quality of life. Checking the association between these two problems may help preventing incapacities and distress. This study aimed at identifying the prevalence of falls among the elderly with pain lasting more than one year and at evaluating the association of falls and pain location, intensity and frequency.METHOD: This was a transversal study using data from the Health, Wellbeing and Ageing project. Dependent variables were: occurrence and number of falls in the last 12 months. Independent variables were: location, intensityand frequency of the "most uncomfortable" pain lasting more than one year. Rao Scott test, indicated for population sampling, was used to check the association.RESULTS: We evaluated 213 elderly people above 60 years of age with pain lasting more than one year and who answered about falls in the last year. Its prevalence was 56.29%. Results have shown that elderly people with severe or moderate pain lasting more than one year have reported a higher number of falls as compared to elderly people with mild pain. No association was found between site and frequency of pain episodes and falls in the last year.CONCLUSION: Better pain control may decrease the risk of falls in the elderly population with chronic pain; these two problems have to be adequately evaluated and controlled by health professionals.

Interactions with apoptotic but not with necrotic neutrophils increase parasite burden in human macrophages infected with Leishmania amazonensis.

Neutrophils are involved in the initial steps of most responses to pathogens. In the present study, we evaluated the effects of the interaction of apoptotic vs. necrotic human neutrophils on macrophage infection by Leishmania amazonensis. Phagocytosis of apoptotic, but not viable, neutrophils by Leishmania-infected macrophages led to an increase in parasite burden via a mechanism dependent on TGF-beta1 and PGE2. Conversely, infected macrophages' uptake of necrotic neutrophils induced killing of L. amazonensis. Leishmanicidal activity was dependent on TNF-alpha and neutrophilic elastase. Nitric oxide was not involved in the killing of parasites, but the interaction of necrotic neutrophils with infected macrophages resulted in high superoxide production, a process reversed by catalase, an inhibitor of reactive oxygen intermediate production. Initial events after Leishmania infection involve interactions with neutrophils; we demonstrate that phagocytosis of these cells in an apoptotic or necrotic stage can influence the outcome of infection, driving either parasite survival or destruction.