Predictors of cancer in patients with acute pulmonary embolism.

BACKGROUND: Acute pulmonary embolism (PE) can occur as a manifestation of an underlying cancer and be of paraneoplastic aetiology. A previously unknown cancer is sometimes diagnosed after the acute PE diagnosis. The identification of a group of patients with elevated probability of having an occult cancer underlying PE was never performed. We aimed to determine predictors of occult cancer in acute PE. Our hypothesis was that the D-dimer levels would be a predictor of cancer. PATIENTS AND METHODS: We retrospectively analysed a cohort of patients hospitalized with acute PE. EXCLUSION CRITERIA: <18 years, venous embolism only of veins other than pulmonary territory or when the embolism was considered chronic, and no image confirmation of acute PE. Patients were grouped according to the timing of cancer diagnosis: 1) known concomitant active cancer, 2) cancer diagnosed during acute PE admission or in the following 2 years and, 3) no known cancer during the 2-year follow-up since PE diagnosis. Predictors of concomitant cancer were determined using a logistic regression analysis. Multivariate models were built. RESULTS: We studied 562 patients; median age was 72 years and 219 (39.0 %) were men. In 223 (39.7 %) of the patients the PE was of central arteries and 61.4 % presented with bilateral PE. PE was considered unprovoked at time of discharge in 47.7 %. Median (interquartile range) D-dimer level was 7.98 (3.30-14.99) µg/mL. A total of 126 (22.4 %) patients were in group 1, 47 in group 2 (cancer diagnosed after the diagnosis of acute PE and up to 2 years) and 389 patients were in group 3. Elevated D-dimer levels were independently associated with already known cancer. D-dimer were independent predictors of future cancer diagnosis: OR = 1.07 ((95 % CI: 1.01-1.14) per each 5 ng/mL increase; for patients with D-dimer >15.0 µg/mL the OR of future cancer was 2.10 (1.05-4.18). If only patients with unprovoked PE upon admission (n = 307) were to be considered results were similar considering D-dimer; anaemia also predicted unknown cancer [OR = 2.13 (1.08-4.16)]. CONCLUSIONS: Patients with D-dimer >15 µg/mL presented a >2-fold higher risk of being diagnosed with a cancer condition in the upcoming 2 years. D-dimer may help clinicians in identifying which patients are at higher risk of occult cancer.

360 Health Analysis (H360)-A Comparison of Key Performance Indicators in Breast Cancer Management across Health Institution Settings in Portugal.

BACKGROUND: The increased focus on quality indicators (QIs) and the use of clinical registries in real-world cancer studies have increased compliance with therapeutic standards and patient survival. The European Society of Breast Cancer Specialists (EUSOMA) established QIs to assess compliance with current standards in breast cancer care. METHODS: This retrospective study is part of H360 Health Analysis and aims to describe compliance with EUSOMA QIs in breast cancer management in different hospital settings (public vs. private; general hospitals vs. oncology centers). A set of key performance indicators (KPIs) was selected based on EUSOMA and previously identified QIs. Secondary data were retrieved from patients' clinical records. Compliance with target KPIs in different disease stages was compared with minimum and target EUSOMA standards. RESULTS: A total of 259 patient records were assessed. In stages I, II, and III, 18 KPIs met target EUSOMA standards, 5 met minimum standards, and 8 failed to meet minimum standards. Compliance with KPIs varied according to the type of hospital (particularly regarding diagnosis) and disease stage. Although small differences were found in KPI compliance among institutions, several statistical differences were found among treatment KPIs according to disease stage, particularly in stage III. CONCLUSIONS: This study represents the first assessment of the quality of breast cancer care in different hospital settings in Portugal and shows that, although most QIs meet EUSOMA standards, there is room for improvement. Differences have been found across institutions, particularly between oncology centers and general hospitals, in diagnosis and compliance with KPIs among disease stages. Stage III showed the greatest variability in compliance with treatment KPIs, probably related to the lower specificity of the guidelines in this disease stage.

Acute organ failure and risk of admission to intensive medical care in cancer patients: a single center prospective cohort study. / Falência aguda de órgão e risco de admissão em unidade de terapia intensiva nos pacientes oncológicos: estudo de coorte prospectivo unicêntrico.

OBJECTIVE: To ascertain the cumulative incidence of acute organ failure and intensive care unit admission in cancer patients. METHODS: This was a single-center prospective cohort study of adult cancer patients admitted for unscheduled inpatient care while on systemic cancer treatment. RESULTS: Between August 2018 and February 2019, 10,392 patients were on systemic treatment, 358 had unscheduled inpatient care and were eligible for inclusion, and 285 were included. The mean age was 60.9 years, 50.9% were male, and 17.9% of patients had hematologic cancers. The cumulative risk of acute organ failure was 39.6% (95%CI: 35 - 44), and that of intensive care unit admission among patients with acute organ failure was 15.0% (95%CI: 12 - 18). On admission, 62.1% of patients were considered not eligible for artificial organ replacement therapy. The median follow-up time was 9.5 months. Inpatient mortality was 17.5%, with an intensive care unit mortality rate of 58.8% and a median cohort survival of 134 days (95%CI: 106 - 162). In multivariate analysis, acute organ failure was associated with 6-month postdischarge mortality (HR 1.6; 95%CI: 1.2 - 2.2). CONCLUSION: The risk of acute organ failure in cancer patients admitted for unscheduled inpatient care while on systemic treatment was 39.6%, and the risk of intensive care unit admission was 15.0%. Acute organ failure in cancer patients was an independent poor prognostic factor for inpatient hospital mortality and 6-month survival.

OBJETIVO: Determinar a incidência cumulativa de falência aguda de órgão e internamento em unidade de terapia intensiva em pacientes oncológicos. MÉTODOS: Estudo de coorte prospectivo de pacientes oncológicos adultos em tratamento sistêmico antineoplásico, internados de forma não programada. RESULTADOS: Entre agosto de 2018 e fevereiro de 2019, 10.392 pacientes foram submetidos a tratamento sistêmico antineoplásico, sendo que 358 necessitaram de internamento hospitalar não programado e foram elegíveis para inclusão; por fim, 258 desses pacientes foram incluídos. A média de idade foi de 60,9 anos, e 50,9% eram do sexo masculino; 17,9% dos pacientes tinham câncer hematológico. O risco acumulado de falência de órgãos foi de 39,6% (IC95% 35 - 44) e o risco de internamento na unidade de terapia intensiva em pacientes com falência aguda de órgão foi de 15,0% (IC95% 12 - 18). À admissão em internamento, 62,1% dos pacientes foram considerados não elegíveis para terapia de substituição artificial de órgãos. O tempo mediano de seguimento foi de 9,5 meses. A mortalidade hospitalar foi de 17,5%, na unidade de terapia intensiva de 58,8%. A mediana de sobrevivência da coorte foi de 134 dias (IC95% 106 - 162). Na análise multivariada, a falência aguda de órgão se associou com a mortalidade aos 6 meses após a alta (hazard ratio: 1,6; IC95% 1,2 - 2,2). CONCLUSÃO: O risco de falência aguda de órgão em pacientes oncológicos admitidos para tratamento hospitalar não programado durante o tratamento sistémico foi de 39,6% e o risco de internamento em unidade de terapia intensiva foi de 15,0%. A falência aguda de órgão em pacientes oncológicos foi um fator de prognóstico independente para maior mortalidade intra-hospitalar e menor sobrevivência aos 6 meses após a alta.

Pancreatic neuroendocrine neoplasms: survival trend analysis of a comprehensive center.

Objectives: Therapeutic options for pancreatic neuroendocrine neoplasia (Pan-NEN) have increased over the last decade. We aim to understand the evolution of the prognosis of patients with diagnosis of Pan-NEN within a 12-year period, considering the implementation of new treatments. Methods: This study is a retrospective cohort study of patients diagnosed with Pan-NENs between 2006 and 2017. Survival outcome estimates were calculated by Kaplan-Meier method. The impact of baseline clinicopathological characteristics on survival was explored with the use of Cox proportional hazard model. Results: Of the 97 patients, 77 (79.9%) had well-differentiated neuroendocrine tumor (NET) according to WHO 2010 classification, and 52 (53.6%) had localized or locoregional disease. There were no differences between clinicopathological characteristics and survival outcomes when comparing patients diagnosed between 2006-2011 and 2012-2017. Neuroendocrine carcinoma - HR 2.76, 95% CI 1.17-6.55 - and stages III and IV at diagnosis were independent poor prognostic factors - HR 6.02, 95% CI 2.22-16.33 and HR 6.93, 95% CI 2.94-16.32, respectively. Conclusions: The new therapeutic approaches did not induce better survival outcomes on Pan-NEN in recent years. This is possibly due to the indolent nature of NET grades 1 and 2, even metastatic, allowing patients to be submitted to new target therapies along their disease course.

Homicídios femininos no Maranhão, Brasil, 2000-2019: estudo ecológico / Homicidios de mujeres en el estado de Maranhão, Brasil, 2000-2019: estudio ecológico / Female homicides in the state of Maranhão, Brazil, 2000-2019: an ecological study

Objetivo: Analisar o perfil e tendência temporal dos homicídios femininos no Maranhão, Brasil, em 2000-2019. Métodos: Estudo ecológico, com dados do Sistema de Informações sobre Mortalidade. Foram avaliados o perfil dos óbitos, tendência das taxas de mortalidade (método joinpoint) e correlação com indicadores socioeconômicos e de saúde (correlação de Pearson). Resultados: Foram notificados 1.915 homicídios femininos, predominando a idade de 20-29 anos (29,9%), solteiras (62,0%), 4-7 anos de estudo (29,7%), raça/cor da pele parda (71,3%), no domicílio (31,9%), por arma de fogo (41,1%). A tendência das taxas de mortalidade foi crescente (VPA = +8,21; IC95% 5,18;10,28). Observou-se correlação negativa dos homicídios com renda per capita (p-valor = 0,031), e positiva com proporção de famílias chefiadas por mulheres (p-valor = 0,001) e taxa de mortalidade masculina por agressão (p-valor = 0,001). Conclusão: Houve crescimento dos homicídios femininos, relacionados com violência estrutural na sociedade, pobreza e mulheres com maior autoridade familiar.

Objetivo: Analizar el perfil y la tendencia temporal de los homicidios de mujeres en Maranhão entre 2000-2019. Métodos: Estudio ecológico, con datos del Sistema de Información de Mortalidad. Se evaluó el perfil de muertes, la tendencia de las tasas de mortalidad (método joinpoint) y la correlación con indicadores socioeconómicos y de salud (correlación de Pearson). Resultados: Ocurrieron 1.915 homicidios de mujeres, con predominio entre los 20-29 años (29,9%), solteras (62,0%), con 4-7 años de estudio (29,7%), raza/color de piel parda (71,3%), en casa (31,9%) y por arma de fuego (41,1%). La tendencia de las tasas de mortalidad fue creciente (VPA = +8,21; IC95% 5,18;10,28). Hubo correlación negativa entre homicidios e ingreso per capita (p-valor = 0,031) y correlación positiva con proporción de familias encabezadas por mujeres (p-valor = 0,001) y tasa de mortalidad masculina por agresión (p-valor = 0,001). Conclusión: Hubo aumento de los homicidios de mujeres, relacionado con violencia estructural en la sociedad, pobreza y mujeres con mayor autoridad familiar.

Objective: To analyze the profile and temporal trends of female homicides in Maranhão, Brazil, between 2000 and 2019. Methods: This was an ecological study using data from the Mortality Information System. The profile of the deaths, mortality rate trends (joinpoint method) and correlation with socioeconomic and health indicators (Pearson correlation) were evaluated. Results: 1,915 female homicides were reported, with predominance among those between 20-29 years old (29.9%), single (62.0%), with 4-7 years schooling (29.7%), mixed race (71.3%), homicides at home (31.9%) and by firearms (41.1%). The mortality rate showed a rising trend (APC = +8.21; 95%CI 5.18;10.28). There was negative correlation between homicides and per capita income (p-value = 0.031) and positive correlation with the proportion of families headed by women (p-value = 0.001) and with the rate of male mortality due to assault (p-value = 0.001). Conclusion: There was an increase in female homicides, related to structural violence in society, poverty and women with greater family authority.

Falência aguda de órgão e risco de admissão em unidade de terapia intensiva nos pacientes oncológicos: estudo de coorte prospectivo unicêntrico / Acute organ failure and risk of admission to intensive medical care in cancer patients: a single center prospective cohort study

RESUMO Objetivo: Determinar a incidência cumulativa de falência aguda de órgão e internamento em unidade de terapia intensiva em pacientes oncológicos. Métodos: Estudo de coorte prospectivo de pacientes oncológicos adultos em tratamento sistêmico antineoplásico, internados de forma não programada. Resultados: Entre agosto de 2018 e fevereiro de 2019, 10.392 pacientes foram submetidos a tratamento sistêmico antineoplásico, sendo que 358 necessitaram de internamento hospitalar não programado e foram elegíveis para inclusão; por fim, 258 desses pacientes foram incluídos. A média de idade foi de 60,9 anos, e 50,9% eram do sexo masculino; 17,9% dos pacientes tinham câncer hematológico. O risco acumulado de falência de órgãos foi de 39,6% (IC95% 35 - 44) e o risco de internamento na unidade de terapia intensiva em pacientes com falência aguda de órgão foi de 15,0% (IC95% 12 - 18). À admissão em internamento, 62,1% dos pacientes foram considerados não elegíveis para terapia de substituição artificial de órgãos. O tempo mediano de seguimento foi de 9,5 meses. A mortalidade hospitalar foi de 17,5%, na unidade de terapia intensiva de 58,8%. A mediana de sobrevivência da coorte foi de 134 dias (IC95% 106 - 162). Na análise multivariada, a falência aguda de órgão se associou com a mortalidade aos 6 meses após a alta (hazard ratio: 1,6; IC95% 1,2 - 2,2). Conclusão: O risco de falência aguda de órgão em pacientes oncológicos admitidos para tratamento hospitalar não programado durante o tratamento sistémico foi de 39,6% e o risco de internamento em unidade de terapia intensiva foi de 15,0%. A falência aguda de órgão em pacientes oncológicos foi um fator de prognóstico independente para maior mortalidade intra-hospitalar e menor sobrevivência aos 6 meses após a alta.

ABSTRACT Objective: To ascertain the cumulative incidence of acute organ failure and intensive care unit admission in cancer patients. Methods: This was a single-center prospective cohort study of adult cancer patients admitted for unscheduled inpatient care while on systemic cancer treatment. Results: Between August 2018 and February 2019, 10,392 patients were on systemic treatment, 358 had unscheduled inpatient care and were eligible for inclusion, and 285 were included. The mean age was 60.9 years, 50.9% were male, and 17.9% of patients had hematologic cancers. The cumulative risk of acute organ failure was 39.6% (95%CI: 35 - 44), and that of intensive care unit admission among patients with acute organ failure was 15.0% (95%CI: 12 - 18). On admission, 62.1% of patients were considered not eligible for artificial organ replacement therapy. The median follow-up time was 9.5 months. Inpatient mortality was 17.5%, with an intensive care unit mortality rate of 58.8% and a median cohort survival of 134 days (95%CI: 106 - 162). In multivariate analysis, acute organ failure was associated with 6-month postdischarge mortality (HR 1.6; 95%CI: 1.2 - 2.2). Conclusion: The risk of acute organ failure in cancer patients admitted for unscheduled inpatient care while on systemic treatment was 39.6%, and the risk of intensive care unit admission was 15.0%. Acute organ failure in cancer patients was an independent poor prognostic factor for inpatient hospital mortality and 6-month survival.

Disseminated Saprochaete capitata fungal infection in a patient with acute myeloid leukemia.

The case highlights the importance of actively obtaining informative samples at an early stage and of prompt initiation of combination therapy with antifungal drugs.

Urachal carcinoma: A case of a rare neoplasm.

INTRODUCTION: Urachal carcinoma is a rare type of non-urothelial malignancy that arises from the urachal ligament, a remnant of fetal development. It frequently involves the dome of the bladder or its midline, with adenocarcinoma being the most common histological type. This malignancy is generally diagnosed in advanced stages and is associated with poor prognosis. CASE REPORT: A 40-year-old woman was referred to hospital due to recurrent urinary tract infections. Imaging studies showed the presence of a 3.7 cm tumor in the bladder dome that extended to the posterior region of the umbilicus. A biopsy through cystoscopy confirmed the diagnosis of urachal carcinoma. Since there were no metastases, the patient underwent partial cystectomy and resection of the urachal ligament and the umbilicus. Surgical margins were negative and it was considered a complete resection. Nine months later, disease progression occurred, with peritoneal carcinomatosis, multiple adenopathies and a 4 cm mass in the pelvic cavity with invasion of the vagina, rectum, and sigmoid colon. She began palliative chemotherapy with cisplatine and 5-fluorouracil. After 7 cycles, progression was again observed, with an increase of the pelvic mass, vaginal and rectal hemorrhage, multiple intramuscular implants, bilateral axillary adenopathies, as well as lesion in the right breast, which was compatible with metastasis from urachal carcinoma. She underwent hemostatic radiotherapy to the pelvic mass and second line palliative chemotherapy with gemcitabine and paclitaxel. After 4 cycles, the patient clinically deteriorated and eventually died. CONCLUSION: Urachal carcinoma is an aggressive malignancy. Although systemic treatment may be effective in disease control, a standard chemotherapy regimen is yet to be determined. Multicenter trials are needed to clarify the best treatment approach in these patients.

Implications of venous thromboembolism GWAS reported genetic makeup in the clinical outcome of ovarian cancer patients.

Ovarian cancer (OC) represents the most lethal gynaecological neoplasia. Conversely, venous thromboembolism (VTE) and OC are intricately connected, with many haemostatic components favouring OC progression. In light of this bilateral relationship, genome-wide association studies (GWAS) have reported several single-nucleotide polymorphisms (SNPs) associated with VTE risk that could be used as predictors of OC clinical outcome for better therapeutic management strategies. Thus, the present study aimed to analyse the impact of VTE GWAS-identified SNPs on the clinical outcome of 336 epithelial ovarian cancer (EOC) patients. Polymorphism genotyping was performed using the TaqMan® Allelic Discrimination methodology. Carriers with the ZFPM2 rs4734879 G allele presented a significantly higher 5-year OS, 10-year OS and disease-free survival (DFS) compared to AA genotype patients with FIGO I/II stages (P = 0.009, P = 0.001 and P = 0.003, respectively). Regarding SLC19A2 rs2038024 polymorphism, carriers with the CC genotype presented a significantly lower 5-year OS, 10-year OS and DFS compared to A allele carriers in the same FIGO subgroup (P < 0.001, P = 0.004 and P = 0.005, respectively). As for CNTN6 rs6764623 polymorphism, carriers with the CC genotype presented a significantly lower 5-year OS compared to A allele carriers with FIGO I/II stages (P = 0.015). As for OTUD7A rs7164569, F11 rs4253417 and PROCR rs10747514, no significant impact on EOC patients' survival was observed. However, future studies are required to validate these results and uncover the biological mechanisms underlying our results.

Prevalência e fatores associados à violência por parceiro íntimo na gestação em Caxias, Maranhão, 2019-2020 / Prevalencia y factores asociados con la violencia por la pareja durante el embarazo en Caxias, en el estado de Maranhão, Brasil, 2019-2020 / Prevalence and factors associated with intimate partner violence during pregnancy in Caxias, state of Maranhão, Brazil, 2019-2020

Objetivo: Analisar a prevalência e fatores associados à violência por parceiro íntimo na gestação. Métodos: Estudo transversal, com dados obtidos de entrevistas com grávidas de 10 a 49 anos de idade, no terceiro trimestre gestacional, residentes em Caxias, Maranhão, Brasil (2019-2020). Utilizou-se o instrumento World Health Organization Violence Against Women Study para identificação da forma de violência. Realizou-se análise hierarquizada por regressão logística múltipla. Resultados: Foram entrevistadas 233 gestantes. A violência na gestação apresentou prevalência de 33,0%, com predomínio da violência psicológica (18,9%). No modelo hierarquizado final, a faixa etária da mulher <20 anos (ORaj=2,09 - IC95% 1,17;3,54) e o consumo de drogas ilícitas pelo parceiro (ORaj=8,78 - IC95% 2,13;28,92) mantiveram-se associados ao desfecho de violência. Conclusão: A violência na gestação apresentou elevada prevalência, sendo a idade jovem da mulher e o uso de substâncias ilícitas pelo parceiro fatores associados a sua ocorrência.

Objetivo: Analizar la prevalencia y los factores asociados de la violencia de pareja durante el embarazo. Métodos: Estudio transversal, con datos obtenidos mediante entrevistas a mujeres embarazadas de 10 a 49 años en el tercer trimestre de gestación, residentes en Caxias, Maranhão, Brasil (2019-2020). Para identificar la violencia se utilizó el instrumento del Estudio sobre la Violencia contra la Mujer de la Organización Mundial de la Salud. Se realizó análisis jerárquico mediante mediante regresión logística múltiple. Resultados: Se entrevistaron 233 mujeres. La violencia durante la gestación tuvo prevalencia de 33,0%, con predominio de violencia psicológica (18,9%). En el modelo jerárquico final, la edad de la mujer <20 años (ORaj=2,09 - IC95% 1,17;3,54) y el consumo de drogas ilícitas por la pareja (ORaj=8,78 - IC95% 2,13;28,92) se mantuvieron asociadas al desenlace violento. Conclusión: La violencia durante el embarazo tuvo alta prevalencia, siendo la baja edad de la mujer y el consumo de sustancias ilegales por la pareja, factores asociados con su ocurrencia.

Objective: To analyze prevalence and factors associated with intimate partner violence during pregnancy. Methods: This was a cross-sectional study, with data obtained through interviews conducted with pregnant women aged 10 to 49 years during the third trimester of pregnancy, living in Caxias, state of Maranhão, Brazil (2019-2020). The instrument of the World Health Organization Violence Against Women Study was used to identify violence. A hierarchical analysis was performed using multiple logistic regression. Results: foram entrevistadas 233 gestantes. A prevalência de violência na gestação foi de 33,0%, com predomínio da violência psicológica (18,9%). No modelo hierárquico final, mulheres com idade <20 anos (ORadj=2,09 - IC95% 1,17;3,54) e uso de drogas ilícitas por parceiro íntimo (ORadj=8,78 - IC95% 2,13;28,92) permaneceram como fatores associados ao desfecho .Conclusion: Prevalence of violence during pregnancy was high, with illegal drug use by young women and their partners being factors associated with its occurrence.

Tendência da mortalidade feminina por agressão no nordeste brasileiro / Tendencia de la mortalidad femenina por agresión en el nordeste de brasil / Trend of female mortality by aggression in brazilian northeast

RESUMO Objetivo: analisar a tendência da mortalidade feminina por agressão na região Nordeste do Brasil entre 2000-2017. Métodos: trata-se de estudo ecológico, de série temporal, sobre a mortalidade feminina por agressão, com dados do Sistema de Informação sobre Mortalidade. Avaliaram-se todos os óbitos femininos codificados como X85-Y09 da Classificação Internacional de Doenças (versão 10). Empregou-se o método Joinpoint para a análise da tendência dos coeficientes de mortalidade por estado, com cálculo da variação percentual anual (VPA) e intervalos de confiança de 95% (IC95%). Resultados: registraram-se 21.350 óbitos, com aumento de 130% entre 2000 e 2017. Observou-se tendência de aumento no coeficiente de mortalidade em toda a região Nordeste (VPA= +4,3; IC95% 3,6; 5,0). Houve tendência de queda apenas em Pernambuco (VPA=-1,7; IC95% -2,6; -0,8) e aumento nos demais estados. Conclusão: houve tendência de aumento da mortalidade feminina por agressão, evidenciando que a violência contra a mulher permanece como grave problema de saúde pública na região.

RESUMEN Objetivo: analizar la tendencia de la mortalidad femenina por agresión en la región Nordeste de Brasil entre 2000-2017. Métodos: se trata de un estudio ecológico, de serie temporal, sobre la mortalidad femenina por agresión, con datos del Sistema de Información sobre Mortalidad. Se evaluaron todos los óbitos femeninos codificados como X85-Y09 de la Clasificación Internacional de Enfermedades (versión 10). Se empleó el método Joinpoint para el análisis de la tendencia de los coeficientes de mortalidad por estado, con cálculo de la variación porcentual anual (VPA) e intervalos de confianza del 95% (IC95%). Resultados: se registraron 21.350 óbitos, con aumento de 130% entre 2000 y 2017. Se observó tendencia de aumento en el coeficiente de mortalidad en toda la región Nordeste (VPA= +4,3; IC95% 3,6; 5,0). Hubo tendencia de caída solo en Pernambuco (VPA=-1,7; IC95% -2,6; -0,8) y aumento en los demás estados. Conclusión: hubo tendencia de aumento de la mortalidad femenina por agresión, evidenciando que la violencia contra la mujer permanece como grave problema de salud pública en la región.

ABSTRACT Objective: to analyze the trend of female mortality due to aggression in the Northeast region of Brazil between 2000-2017. Methods: this is an ecological, time-series study on female mortality due to aggression, with data from the Mortality Information System. All-female deaths coded as X85-Y09 of the International Classification of Diseases (version 10) were evaluated. The Joinpoint method was used to analyze the trend of mortality coefficients by state, with calculation of the annual percentage change (APV) and 95% confidence intervals (95%CI). Results: 21,350 deaths were registered, with an increase of 130% between 2000 and 2017. There was a trend towards an increase in the mortality rate throughout the Northeast region (APV= +4.3; 95%CI 3.6; 5.0). There was a downward trend only in Pernambuco (VPA=-1.7; 95%CI -2.6; -0.8) and an increase in the other states. Conclusion: there was an increasing trend in female mortality due to aggression, showing that violence against women remains a serious public health problem in the region.

Contribuições da disciplina didática para a formação em saúde coletiva: relato de experiência / Contribuciones de la disciplina didáctica para la formación en salud colectiva: informe de experiencia / Contributions of the didactics subject for the training in collective health: experience report

Objetivo descrever as contribuições da disciplina Didática para a formação em saúde coletiva. Método trata-se de um relato de experiência, do tipo descritivo, detalhado, no contexto da disciplina Didática, ministrada no segundo semestre de 2019, no Programa de Pós-Graduação em Saúde e Comunidade da Universidade Federal do Piauí. Para discussão, o relato possui duas partes: vivência e experiência com a disciplina Didática na pós-graduação e desafios da Didática para os profissionais da saúde. Resultados a disciplina Didática permitiu a compreensão do processo pedagógico como multidimensional, proporcionando a ruptura da concepção da disciplina apenas como um conjunto de métodos instrumentais para a prática docente. Conclusão a disciplina possibilitou o entendimento do complexo campo da Didática como um desafio para os profissionais de saúde coletiva e constituiu-se em componente importante na matriz curricular de formação desses profissionais.

Objetivo describir las contribuciones de la disciplina didáctica a la formación en salud pública. Método se trata de un informe de experiencia, descriptivo, detallado, en el contexto de la didáctica, impartido en el segundo semestre de 2019, en el Programa de Posgrado en Salud y Comunidad de la Universidad Federal de Piauí. Para la discusión, el informe consta de dos partes: experiencia y experiencia con la disciplina didáctica en estudios de posgrado y retos didácticos para los profesionales de la salud. Resultados la disciplina didáctica permitió la comprensión del proceso pedagógico como multidimensional, proporcionando la ruptura de la concepción de la disciplina sólo como un conjunto de métodos instrumentales para la práctica docente. Conclusión la disciplina permitió la comprensión del complejo campo de la Didáctica como un reto para los profesionales de la salud pública y constituyó un componente importante en la matriz curricular de formación de estos profesionales.

Objective to describe the contributions of Didactics discipline to the formation in public health. Method this is an experience report, descriptive, detailed, in the context of didactics, taught in the second semester of 2019, in the Graduate Program in Health and Community of the Federal University of Piauí. For discussion, the report has two parts: experience and experience with the didactics discipline in graduate studies and didactic challenges for health professionals. Results the didactics subject allowed the understanding of the pedagogical process as multidimensional, providing the rupture of the conception of the discipline only as a set of instrumental methods for teaching practice. Conclusion the discipline enabled the understanding of the complex field of Didactics as a challenge for public health professionals and constituted an important component in the curricular matrix of training of these professionals.

Tendência das internações hospitalares por complicações de aborto no Maranhão / Trend of hospital admissions due to abortion-related complications in Maranhão

A prática abortiva insegura coloca em risco a saúde da mulher, sendo importante causa de morbimortalidade materna. Assim, pesquisas sobre o aborto são relevantes para subsidiar a articulação de aspectos relacionados à saúde reprodutiva da mulher e à redução da mortalidade materna relacionada a esta causa. O objetivo desse estudo foi avaliar a tendência das internações hospitalares por complicações de aborto no Maranhão. Realizou-se estudo ecológico, de série temporal, utilizando dados de internações por complicações de aborto de mulheres de 10 a 49 anos no período de 2000 a 2014, no Maranhão. Os dados foram coletados do Sistema de Informações Hospitalares do Sistema Único de Saúde. Empregou-se o método Joinpoint para a análise das tendências por regiões de saúde. Foram analisadas 103.825 internações por complicações de aborto, com aumento de 105% entre 2000 e 2014. A taxa de internação média em todo o período foi de 3,4 abortos por 1.000 mulheres. Observou-se tendência de aumento da taxa de internações em todo o estado, com exceção apenas da região de saúde São Luís que apresentou tendência de queda da taxa de internação. Investigações futuras, especialmente fora do ambiente hospitalar, devem ser realizadas para melhor conhecer a prática abortiva no estado.

The practice of unsafe abortion puts women's health at risk and is an important cause of maternal morbidity and mortality. Therefore, research on abortion is relevant for describing aspects related to women's reproductive health and the reduction of maternal mortality related to this cause. The aim of this study was to assess the trend in hospital admissions due to abortion-related complications in Maranhão. This ecological, time-series study was carried out using data from hospitalizations due to abortion complications in women aged 10 to 49 years from 2000 to 2014, in Maranhão. Data were collected from the Hospital Information System of the Unified Health System. The Joinpoint method was used to analyze trends according to health regions. A total of 103,825 hospitalizations for complications of abortion were analyzed, with an increase of 105% between 2000 and 2014. The average hospitalization rate for the entire period was 3.4 abortions per 1,000 women. There was a trend towards an increase in the rate of hospitalizations throughout the state, except for the São Luís health region, which showed a downward trend in the rate of hospitalization. Future investigations, especially outside the hospital environment, should be carried out to better understand the abortion practices in the state.

The Influence of Gender in The Prognostic Impact of Diabetes mellitus in acute Pulmonary Embolism.

Diabetes mellitus (DM) predicts ominous outcomes in acute pulmonary embolism (PE). The influence of gender on the prognostic impact of DM in PE is unknown. We did a retrospective analysis of a cohort of patients hospitalized with PE between 2006 and 2013. The exclusion criteria were age <18, non-pulmonary veins thromboembolism, recurrent PE, chronic thromboembolic pulmonary hypertension, no radiologic confirmation of PE, and active neoplasia. The primary endpoint was all-cause mortality. The follow-up was from diagnosis until October 2017. We assessed the prognostic impact of DM using a multivariate Cox regression analysis. The analysis was stratified according to gender. The interaction between gender and DM in the outcome of patients with PE was tested. We studied 577 PE patients (median age 65 years, 36.9% men, 19.8% diabetic). The genders were similar regarding the prevalence of DM, the extension and location of PE, and the thrombolytic therapy or brain natriuretic peptide (BNP) value. Diabetics presented higher all-cause mortality (Hazard ratio (HR) = 2.33 (95% confidence Interval (CI) 1.513.61)) when compared with non-diabetics. However, when analysis was stratified according to gender, DM was independently associated with a worse prognosis only in women (HR = 2.31 (95% CI 1.453.65)), while in men the HR was 1.10 (95% CI 0.592.04). The interaction between gender and DM was significant (p = 0.04). Gender influences the prognostic impact of DM in acute PE. Diabetic women with PE have twice the long-term mortality risk, while DM is not mortality-associated in men.

YB-1 variant and androgen receptor axis-targeted agents in metastatic castration-resistant prostate cancer patients.

Aim: To evaluate the influence of YB-1 rs10493112 variant as a genetic marker for response to second-generation androgen receptor axis-target agents. Methods: A hospital-based cohort study of 78 patients with metastatic castration-resistant prostate cancer was conducted. Genotyping was performed by TaqMan® allelic discrimination technology. Main results: In abiraterone-treated and high-risk patients, YB-1 rs10493112 AA genotype carriers showed lower progression-free survival than C allele genotype patients (4 vs 17 months; p = 0.009). For carriers of AA genotype, multivariate Cox regression analysis revealed a fivefold increased risk of progression (p = 0.035). Conclusion: The study findings suggest that, for metastatic and castration-resistant prostate cancer patients, this polymorphism might be a putative marker for the clinical outcome.

360 Health Analysis (H360) - A Proposal for an Integrated Vision of Breast Cancer in Portugal.

H360 aims to provide a comprehensive picture of breast cancer management in Portugal by retrieving real-world data from 10 Portuguese hospitals and deriving a snapshot from the medical interpretation of evidence-based data to patient perspective on the quality and effectiveness of medical care provided. This article reviews evidence on breast cancer clinical practice and quality of care and disease management in Portugal. A review of evidence on breast cancer clinical practice and quality of care over the last 10 years was performed in PubMed using the query "Organization and Administration"[Mesh] AND "breast cancer"[All Fields] NOT "Review" [ptyp]. National cancer initiatives relevant for quality of care and national and international guidelines and consensus were analyzed. Retrieved results showed that breast cancer incidence is still increasing, including in Portugal. Studies investigating disease outcomes seek to derive improvements to clinical practice and better financial resource allocation. Setting performance measures (KPIs) in institutions treating cancer is not a reality in Portugal yet, but has potential to leverage the quality of clinical performance. A multidisciplinary approach within one health structure is also desirable. More investment in clinical (including academic) research is key to optimize the quality of care. Implementation of clinical practice guidelines (largely based on ESMO guidelines in Portugal) is crucial to improve patient outcomes. Not less importantly, quality of life is a treatment goal on its own in breast cancer care. Breast cancer remains a health challenge and a multidimensional, 360-degree appraisal, beyond the exclusively clinical perspective, may provide new insights towards an optimal patient-centered approach.

Palladium Catalyst with Task-Specific Ionic Liquid Ligands: Intracellular Reactions and Mitochondrial Imaging with Benzothiadiazole Derivatives.

A water-soluble and charge-tagged palladium complex (PdMAI) was found to function inside breast cancer live cells of the MCF-7 lineage as an efficient catalyst for cross-coupling reaction. PdMAI, bearing two ionophilic task-specific ionic liquids as ligands, efficiently catalyzed both in cellulo Suzuki and Buchwald-Hartwig amination reactions. For the first time, therefore, the Buchwald-Hartwig amination is described to occur inside the highly complex cellular environment. The 2,1,3-benzothiadiazole (BTD) core was used as the base for the syntheses, and two π-extended fluorescent derivatives (BTD-2APy) and (BTD-1AN), which were found to emit in the green and red channels, had impressive mitochondrial affinity. These chromophores allowed for selective mitochondrial imaging and tracking.

Athletic Training and Arrhythmogenic Right Ventricular Cardiomyopathy.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy characterized by ventricular arrhythmias and sudden death in the young and in competitive athletes. The deleterious role of exercise in the natural history of ARVC is clear. Even in the absence of a demonstrated arrhythmogenic substrate, family history or mutations of ARVC, intense physical exercise may in some individuals lead to the development of right ventricular dysfunction and arrhythmogenicity. This led to question the benignity of some adaptive features of the athlete's heart. In fact, there is an overlap between typical aspects of the athlete's heart and pathological changes described in ARVC, being challenging to distinguish the two conditions. The aim of this review is to highlight the aspects that help to distinguish between athlete's heart and ARVC, to review the major findings on exams helping in the differential diagnosis and to determine the implications on eligibility for leisure and competitive sports.

Pharmacogenomics in epithelial ovarian cancer first-line treatment outcome: validation of GWAS-associated NRG3 rs1649942 and BRE rs7572644 variants in an independent cohort.

The identification of predictive biomarkers for the first-line treatment of epithelial ovarian cancer (EOC) remains a challenge. Although genome-wide association studies (GWAS) have identified several genetic polymorphisms as predictors of EOC clinical outcome, the subsequent validation has not yet been performed. This study aims to validate the influence of Neuregulin 3 (NRG3) rs1649942 and Brain and reproductive organ-expressed (TNFRSF1A modulator) (BRE) rs7572644 GWAS-identified variants in an independent cohort of EOC patients from the North region of Portugal (n = 339) submitted to first-line treatment. Polymorphism genotypes were determined by real-time PCR using validated assays. Patients carrying the NRG3 rs1649942 A allele presented a significantly longer overall survival (OS) when compared to GG-genotype patients (log-rank test, P = 0.011) in the FIGO IV stage subgroup. No impact was observed for early-stage patients or considering disease-free survival (DFS) as an outcome. For FIGO I/II stage patients, BRE rs7572644 C allele carriers exhibit a decreased OS (P = 0.014) and DFS (P = 0.032) when compared to TT-homozygous patients. Furthermore, a Multivariate Cox regression analysis revealed a three-fold increase in the risk of death (HR, 3.09; P = 0.015) and recurrence (HR, 3.33; P = 0.009) for FIGO I/II C allele carriers. No significant impact was observed for late-stage patients. The BRE rs7572644 and NRG3 rs1649942 genetic variants were validated in an independent cohort of EOC Portuguese patients, particularly in specific subgroups considering FIGO staging. Further functional post-GWAS analyses are indispensable to understand the biological mechanisms underlying the observed results.

Bladder leiomyoma.

Leiomyomas of the bladder constitute <0.5% of all bladder tumors, with about 250 cases reported. Most patients present with urinary frequency or obstructive urinary symptoms. There are rare cases with other presentations, such as dyspareunia. We report a 22-year-old female who presented with complaints of pelvic discomfort, dysuria, and dyspareunia. Imaging and cystoscopy showed a protruding bladder lesion, which was excised through a transurethral resection. The pathologic diagnosis was bladder leiomyoma. Although being a benign condition, they can cause several different symptoms and should be early diagnosed and treated.