Emotional Distress in Portuguese Cancer Patients: The Use of the Emotion Thermometers (ET) Screening Tool.

Cancer patients may experience significant distress. The "Emotion Thermometers" (ETs) are a short visual analogue scale used to screen patients for psychosocial risk. This study aimed to assess emotional distress in a large sample of cancer patients attending psychological services at an non-governmental organization (NGO), and to explore factors that may contribute to it. The ETs were answered by 899 cancer patients. They were, on average, 59.9 years old, the majority were female, had breast cancer, were under treatment or were disease-free survivors, and reported high levels of emotional distress, above the cut-off (≥5). A Generalized Linear Model was used to measure the association between the level of distress, age, gender, disease phase and 33 items of the problem list. Four items-sadness, depression, sleep and breathing-were found to be significantly related to a higher level of distress. Additionally, women and patients who were in the palliative phase also had significantly higher levels of distress. The results confirm the need for early emotional screening in cancer patients, as well as attending to the characteristics of each patient. Additionally, they highlight the utility of the ETs for the clinical practice, allowing to optimize the referral to specialized psychosocial services.

Da despedida para o viver na ausência: considerações sobre o luto e rituais de despedida a partir de vivências na pandemia / From parting to living in absence: considerations on grief and rites of passage based on experiences during the pandemic / De la despedida para el vivir en la ausencia: consideraciones sobre el luto y rituales de despedida a partir de vivencias en la pandemia

Este artigo consiste em um estudo de três casos de luto vivenciados na pandemia de covid 19. Os dois primeiros são provenientes de pesquisa de mestrado, já o terceiro é um caso clínico de uma viúva em seu primeiro ano de luto. Identificamos e discutimos, conforme as perspectivas de Jung e de autores junguianos, que o fenômeno da morte desorganiza e constela o Caos. Contudo, rituais de despedida disseminados pela cultura e pelas religiões, ou mesmo criados pelo enlutado, podem auxiliar no processo de luto, possibilitando a criação de novos sentidos para a perda vivenciada. Constatamos que, quando não é possível a vivência destes rituais, pode haver risco e impacto na saúde mental dos enlutados.

This article consists of three case studys of grief experienced during the covid-19 pandemic. The first two cases originate from a master's research, while the third is a clinical case of a widow in her first year of mourning. We identified and discussed, according to Jung's perspectives and those of Jungian authors, that the phenomenon of death disorganizes and constellates Chaos. However, rites of passage disseminated by culture and religions, or even created by the bereaved, can assist in the mourning process, enabling the creation of new meanings for the experienced loss. We found that, when the experience of these rituals is not possible, there may be risks and impact on the mental health of the bereaved.

Este artículo consiste en un estudio de tres casos de luto experimentado en la pandemia de covid-19. Los dos primeros provienen de la investigación de maestría, mientras que el tercero es un caso clínico de una viuda en su primer año de luto. Identificamos y discutimos, conforme las perspectivas de Jung y de autores junguianos, que el fenómeno de la muerte desorganiza y constela el Caos. Sin embargo, rituales de despedida diseminados por la cultura y las religiones, o incluso creados por el enlutado, pueden ayudar en el proceso de luto, posibilitando la creación de nuevos sentidos para la pérdida vivenciada. Constatamos que, cuando no es posible la vivencia de estos rituales, puede haber riesgo e impacto en la salud mental de los enlutados.

Gasdermin-D activation by SARS-CoV-2 triggers NET and mediate COVID-19 immunopathology.

BACKGROUND: The release of neutrophil extracellular traps (NETs) is associated with inflammation, coagulopathy, and organ damage found in severe cases of COVID-19. However, the molecular mechanisms underlying the release of NETs in COVID-19 remain unclear. OBJECTIVES: We aim to investigate the role of the Gasdermin-D (GSDMD) pathway on NETs release and the development of organ damage during COVID-19. METHODS: We performed a single-cell transcriptome analysis in public data of bronchoalveolar lavage. Then, we enrolled 63 hospitalized patients with moderate and severe COVID-19. We analyze in blood and lung tissue samples the expression of GSDMD, presence of NETs, and signaling pathways upstreaming. Furthermore, we analyzed the treatment with disulfiram in a mouse model of SARS-CoV-2 infection. RESULTS: We found that the SARS-CoV-2 virus directly activates the pore-forming protein GSDMD that triggers NET production and organ damage in COVID-19. Single-cell transcriptome analysis revealed that the expression of GSDMD and inflammasome-related genes were increased in COVID-19 patients. High expression of active GSDMD associated with NETs structures was found in the lung tissue of COVID-19 patients. Furthermore, we showed that activation of GSDMD in neutrophils requires active caspase1/4 and live SARS-CoV-2, which infects neutrophils. In a mouse model of SARS-CoV-2 infection, the treatment with disulfiram inhibited NETs release and reduced organ damage. CONCLUSION: These results demonstrated that GSDMD-dependent NETosis plays a critical role in COVID-19 immunopathology and suggests GSDMD as a novel potential target for improving the COVID-19 therapeutic strategy.

Efferocytosis of SARS-CoV-2-infected dying cells impairs macrophage anti-inflammatory functions and clearance of apoptotic cells.

COVID-19 is a disease of dysfunctional immune responses, but the mechanisms triggering immunopathogenesis are not established. The functional plasticity of macrophages allows this cell type to promote pathogen elimination and inflammation or suppress inflammation and promote tissue remodeling and injury repair. During an infection, the clearance of dead and dying cells, a process named efferocytosis, can modulate the interplay between these contrasting functions. Here, we show that engulfment of SARS-CoV-2-infected apoptotic cells exacerbates inflammatory cytokine production, inhibits the expression of efferocytic receptors, and impairs continual efferocytosis by macrophages. We also provide evidence supporting that lung monocytes and macrophages from severe COVID-19 patients have compromised efferocytic capacity. Our findings reveal that dysfunctional efferocytosis of SARS-CoV-2-infected cell corpses suppresses macrophage anti-inflammation and efficient tissue repair programs and provides mechanistic insights for the excessive production of pro-inflammatory cytokines and accumulation of tissue damage associated with COVID-19 immunopathogenesis.

Avaliação dos bancos de alimentos: uma revisão integrativa da literatura nacional / Evaluation of food banks: an integrative review of national literature

Esta é uma revisão de literatura que teve por objetivo sistematizar a produção científica e bibliográfica especializada acerca da avaliação de bancos de alimentos públicos, de acordo com os aspectos relativos ao seu funcionamento. As buscas foram realizadas a partir de bases e repositórios científicos e de sites governamentais, de instituições públicas e da sociedade civil, cujas agendas estão relacionadas à Segurança Alimentar e Nutricional, no período de 2010 a 2020. Foram localizadas 240 publicações e, após exclusão dos estudos que não atendiam aos critérios de inclusão, seis estudos permaneceram na seleção. Foram identificados oito aspectos avaliados: gestão; público atendido e entidades beneficiadas; articulações; doadores; infraestrutura; alimentos; controle higiênico-sanitário; ações complementares. Os resultados dos estudos apontaram: baixa institucionalidade dos bancos de alimentos junto ao poder público; recursos humanos insuficientes, insustentáveis e com alta rotatividade; relação com entidades beneficiadas limitada à doação de alimentos; ações educativas principalmente de capacitação para manipuladores de alimentos; fragilidade na relação com doadores; necessidade de melhorias na infraestrutura; inadequações às regulamentações higiênico-sanitárias; e forte relação com o Programa de Aquisição de Alimentos. Os estudos de avaliação contribuíram com a identificação de pontos críticos para o avanço e sustentabilidade dos bancos de alimentos no país.

We need to talk about the use of methylphenidate by medical students - review of the literature / Precisamos falar sobre uso de Metilfenidato por estudantes de medicina - revisão da literatura

Abstract: Introduction: Studies methylphenidate (MPH) has been used by medical students to increase their mental activity and improve the performance required during undergraduate school, generating concern regarding the risks to their physical and mental health. This scenario indicates the need for specifically aimed measures in medical schools. Objective: To review the literature about the use of MPH without medical indication amongst medical students. Method: A thorough review of the literature published in English, Spanish, and Portuguese, between 2013 and 2019, based on data made available by Pubmed and Scielo, utilizing keywords in the three above languages, along the four stages of the selection process. Results and Discussion: Altogether, 224 articles were found, of which 25 were selected after reading, dealing with the use of MPH or 'cognition enhancer' by undergraduate medical students without a doctor's prescription. The research indicated significant variability in the frequency of consumption, related to the investigated pattern of use, use with or without indication, before or after entering University and country where the study was carried out. The most frequent justification for the use without medical indication was to attain improvement in academic performance. A lack of research with a fair appraisal of the cognition, behavioral and psychic risks involved, among them addiction and the approach of the topic in medical schools, was noted. Conclusion: The high rates of usage of MPH by medical students aiming at cognitive enhancement strengthens the importance of preventative actions in medical schools. The strategies must consider information concerning the risks of use (of MPH) without medical indication; non-pharmacological interventions for performance improvement; sleep hygiene measures organization for adequate study activities; broad discussions about ethical aspects and curricular structure.

Resumo: Introdução: Estudos mostram que o metilfenidato (MPH) tem sido utilizado por estudantes de medicina para aumentar sua atividade mental e melhorar o desempenho exigido durante a graduação, gerando preocupações quanto aos riscos à sua saúde física e mental. Esse cenário indica a necessidade de medidas especificamente direcionadas nas escolas médicas. Objetivo: Revisar a literatura sobre o uso de MPH sem indicação médica entre estudantes de medicina. Método: Revisão minuciosa da literatura publicada em inglês, espanhol e português, entre 2013 e 2019, com base em dados disponibilizados pelo PUBMED e SCIELO, utilizando palavras-chave nos três idiomas acima, ao longo das quatro etapas do processo de seleção. Resultados e Discussão: Ao todo, foram encontrados 224 artigos, dos quais 25 foram selecionados após leitura, tratando do uso de MPH ou 'potencializador da cognição' por graduandos de medicina sem prescrição médica. A pesquisa indicou variabilidade significativa na frequência de consumo, relacionada ao padrão de uso investigado, uso com ou sem indicação, antes ou após a entrada na Universidade e país onde o estudo foi realizado. A justificativa mais frequente para o uso sem indicação médica foi a de obter melhora no desempenho acadêmico. Notou-se a carência de pesquisas com uma avaliação adequada dos riscos cognitivos, comportamentais e psíquicos envolvidos, entre eles o risco de adição e a abordagem do tópico nas escolas médicas. Conclusão: As altas taxas de uso do MPH por estudantes de medicina visando o aprimoramento cognitivo reforça a importância de ações preventivas nas escolas médicas. As estratégias devem considerar informações sobre os riscos do uso (do MPH) sem indicação médica; intervenções não farmacológicas para melhoria do desempenho cognitivo; medidas de higiene do sono; organização para atividades de estudo adequadas; amplas discussões sobre aspectos éticos e estrutura curricular.

Beneficial effects of colchicine for moderate to severe COVID-19: a randomised, double-blinded, placebo-controlled clinical trial.

OBJECTIVE: To evaluate whether the addition of colchicine to standard treatment for COVID-19 results in better outcomes. DESIGN: We present the results of a randomised, double-blinded, placebo-controlled clinical trial of colchicine for the treatment of moderate to severe COVID-19, with 75 patients allocated 1:1 from 11 April to 30 August 2020. Colchicine regimen was 0.5 mg thrice daily for 5 days, then 0.5 mg twice daily for 5 days. The primary endpoints were the need for supplemental oxygen, time of hospitalisation, need for admission and length of stay in intensive care unit and death rate. RESULTS: Seventy-two patients (36 for placebo and 36 for colchicine) completed the study. Median (and IQR) time of need for supplemental oxygen was 4.0 (2.0-6.0) days for the colchicine group and 6.5 (4.0-9.0) days for the placebo group (p<0.001). Median (IQR) time of hospitalisation was 7.0 (5.0-9.0) days for the colchicine group and 9.0 (7.0-12.0) days for the placebo group (p=0.003). At day 2, 67% versus 86% of patients maintained the need for supplemental oxygen, while at day 7, the values were 9% versus 42%, in the colchicine and the placebo groups, respectively (log rank; p=0.001). Two patients died, both in placebo group. Diarrhoea was more frequent in the colchicine group (p=0.26). CONCLUSION: Colchicine reduced the length of both, supplemental oxygen therapy and hospitalisation. The drug was safe and well tolerated. Once death was an uncommon event, it is not possible to ensure that colchicine reduced mortality of COVID-19. TRIAL REGISTRATION NUMBER: RBR-8jyhxh.

Inflammasomes are activated in response to SARS-CoV-2 infection and are associated with COVID-19 severity in patients.

Severe cases of COVID-19 are characterized by a strong inflammatory process that may ultimately lead to organ failure and patient death. The NLRP3 inflammasome is a molecular platform that promotes inflammation via cleavage and activation of key inflammatory molecules including active caspase-1 (Casp1p20), IL-1ß, and IL-18. Although participation of the inflammasome in COVID-19 has been highly speculated, the inflammasome activation and participation in the outcome of the disease are unknown. Here we demonstrate that the NLRP3 inflammasome is activated in response to SARS-CoV-2 infection and is active in COVID-19 patients. Studying moderate and severe COVID-19 patients, we found active NLRP3 inflammasome in PBMCs and tissues of postmortem patients upon autopsy. Inflammasome-derived products such as Casp1p20 and IL-18 in the sera correlated with the markers of COVID-19 severity, including IL-6 and LDH. Moreover, higher levels of IL-18 and Casp1p20 are associated with disease severity and poor clinical outcome. Our results suggest that inflammasomes participate in the pathophysiology of the disease, indicating that these platforms might be a marker of disease severity and a potential therapeutic target for COVID-19.

A dor que não pode calar: reflexões sobre o luto em tempos de Covid-19 / The pain that cannot remain silent: reflections on grief in Covid-19 times / La douleur qui ne peut pas rester silencieuse: réflexions sur le deuil dans le cadre de Covid-19 / Dolor que no puede permanecer en silencio: reflexiones sobre el duelo en tiempos de Covid-19

Resumo A Covid-19 provocou número elevado de perdas e mudanças nos processos de cuidado e despedida, fatores que podem dificultar a elaboração do luto. Objetivamos, assim, compreender as particularidades do luto no âmbito da Covid-19, ressaltando a importância da adaptação e da criação de estratégias voltadas ao cuidado da saúde mental nos processos de luto. O ensaio realiza um panorama teórico, indicando elementos presentes na pandemia com potencial para interferir no luto, e apresenta um levantamento de iniciativas adaptadas a tal contexto. A pandemia trouxe mudanças na forma de experienciar o morrer. Evidenciam-se iniciativas na tentativa de mitigar os efeitos emocionais, cognitivos e comportamentais. O momento convoca a repensar conceitos e (re)criar compreensões acerca da morte e do luto, ressaltando-se a importância da Rede de Saúde Mental, com o fortalecimento de ações de base sociocomunitária, reconhecimento de diferentes níveis de complexidade das demandas e acesso organizado à atenção especializada.

Abstract Covid-19 caused a high number of losses and changes in the end-of-life care and farewell processes, factors that can add difficulty to the mourning process. Thus, we aim to understand the particularities of grief within the scope of Covid-19, emphasizing the importance of adaptation and creation of strategies to address mental health care in mourning processes. The essay provides a theoretical overview, indicating elements present in the pandemic with the potential to interfere in mourning and presents a survey of initiatives adapted to this context. The pandemic brought changes in the way of experiencing dying. Attempts to mitigate emotional, cognitive and behavioral effects are identified. The moment calls for rethinking concepts and (re)creating understandings about death and grief, emphasizing the importance of a mental health network, with the strengthening of community based actions, recognition of different levels of complexity of demands and organized access to specialized attention.

Résumé Le Covid-19 a causé un grand nombre de pertes et de changements dans les processus de soin et d'adieu, facteurs qui peuvent rendre le deuil plus compliqué. Ainsi, nous visons à comprendre les particularités du deuil dans le cadre de Covid-19, en soulignant l'importance de l'adaptation et de la création de stratégies pour les soins dans le domaine de la santé mentale dans les processus de deuil. L'essai fournit un aperçu théorique, indiquant les éléments présents dans la pandémie susceptibles d'interférer dans le deuil et présente des initiatives adaptées à ce contexte. La pandémie a entraîné des changements dans la appréhension la mort. Des initiatives visant à atténuer les effets émotionnels, cognitifs et comportementaux sont mis en évidence. Le moment appelle à repenser les concepts et à (re)créer des compréhensions sur la mort et le deuil, en soulignant l'importance du réseau de santé mentale, avec le renforcement des actions sociocommunautaires, la reconnaissance des différents niveaux de complexité des demandes et l'accès organisé à l'attention spécialisée.

Resumen Covid-19 causó una gran cantidad de muertes y cambios en los procesos de atención y despedida, factores que pueden dificultar el duelo. Por lo tanto, nuestro objetivo es comprender las particularidades del duelo el contexto de Covid-19, enfatizando la importancia de la adaptación y de la creación de estrategias dirigidas a la atención a la salud mental en los procesos de duelo. El ensayo proporciona un panorama teórico, indicando los elementos presentes en la pandemia con potencial de interferir en el duelo y presenta iniciativas adaptadas a este contexto. La pandemia trajo cambios en la forma de experimentar la muerte. Iniciativas que objetivan mitigar los efectos emocionales, cognitivos y conductuales son evidenciadas. El momento requiere repensar conceptos y crear comprensiones sobre la muerte y el duelo, enfatizando la importancia de una red de salud mental, con fortalecimiento de acciones basadas en la comunidad, reconocimiento de diferentes niveles de complejidad de las demandas y el acceso organizado a la atención especializada.

Programa de educação em saúde melhora indicadores de autocuidado em diabetes e hipertensão / El programa de educación en salud mejora los indicadores de autocuidado en diabetes e hipertensión / Health education program improves self-care indicators in diabetes and hypertension

Dentre as doenças crônicas não transmissíveis, a hipertensão arterial sistêmica (HAS) e o diabetes mellitus (DM) são as mais frequentes e constituem um problema de saúde mundial. Diante da necessidade de implantação de programas de autocuidado voltados para essas doenças, o trabalho tem como objetivo validar um programa de autocuidado para pacientes diabéticos e hipertensos. Trata-se de um estudo de coorte prospectivo de uma população de 100 indivíduos que estavam em sala de espera. A coleta dos dados foi realizada por meio de questionários sobre diferentes temas, aplicados nos encontros, para avaliar o conhecimento dos pacientes no pré e no pós-teste. Somente algumas questões específicas de cada tema não apresentaram diferença significativa entre o pré e o pós-teste. No entanto, todos os temas abordados apresentaram incremento de conhecimento no pós-teste. Sendo assim, pode-se validar este programa de cuidado para pacientes diabéticos e hipertensos, pois promove incremento de conhecimento para os pacientes.

Among chronic non-transmissible diseases, systemic arterial hypertension (SAH) and diabetes mellitus (DM) are the most frequent and constitute a global health problem. In view of the need to implement self-care programs about these diseases, the objective of this study is to validate a self-care program for diabetic and hypertensive patients. It is a prospective cohort study of a population of 100 individuals who were in the waiting room. The data collection was done through questionnaires about different topics, that were applied in the meetings, to evaluate the knowledge of patients in the pretest and posttest. Only a few specific questions of each theme did not present a significant difference between the pretest and posttest. However, all the themes addressed presented posttest knowledge increment. Therefore, this self-care program can be validated for diabetic and hypertensive patients, because it promotes an increase of knowledge for these patients.

Entre las enfermedades crónicas no transmisibles, hipertensión arterial sistémica (HAS) y la diabetes mellitus (DM) son las más frecuentes y constituyen un problema de salud mundial. Ante la necesidad de implantación de programas de autocuidado orientados a estas enfermedades, el trabajo tiene como objetivo validar un programa de autocuidado para pacientes diabéticos e hipertensos. Se trata de un estudio de cohorte prospectiva de una población de 100 individuos que estaban en la sala de espera. La recolección de los datos se realizó a través de cuestionarios sobre diferentes temas, aplicados en los encuentros, para evaluar el conocimiento de los pacientes en el pre-teste y en el post-test. Sólo algunas cuestiones específicas de cada tema no presentaron diferencia significativa entre el pre-test y el post-test. Sin embargo, todos los temas abordados presentaron incremento de conocimiento en el post-test. Por lo tanto, se puede validar este programa de autocuidado para pacientes diabéticos e hipertensos, pues promueve incremento de conocimiento para los pacientes.

A case of endometrial stromal sarcoma with synchronous bilateral adenocarcinoma of ovary.

Endometrial stromal tumor is a rare mesenchymal uterine tumor. We report the case of a patient with endometrial stromal sarcoma and concomitant bilateral endometrioid adenocarcinoma of the ovary in the context of pelvic endometriosis. The patient underwent a complete cytoreduction including total hysterectomy and bilateral adnexectomy, pelvic lymphadenectomy, appendicectomy, infracolic omentectomy, and pelvic peritonectomy. This is the first report to our knowledge that describes a synchronous endometrial stromal sarcoma and bilateral endometrioid adenocarcinoma of the ovary.

Neoadjuvant chemotherapy in advanced vulvar cancer.

INTRODUCTION: Locally advanced tumors of the vulva represent approximately one third of all vulvar cancers. Therapeutic options include chemoradiation, radiotherapy, and neoadjuvant chemotherapy (NACT). MATERIALS AND METHODS: Analysis of 3 NACT schemes, bleomicine, paclitaxel, and 5-fluorouracil/cisplatin, used in patients with locally advanced vulvar tumors in a 12-year period. The following parameters were evaluated and compared between regimens: age, initial tumor size, inguinal involvement, histological type, toxicities, response to treatment, surgery performed after NACT, and overall survival. RESULTS: Of the 25 patients included, 10 underwent an NACT regimen with bleomicine (Group A); 5, with paclitaxel (Group B); and 10, with a combination of 5-fluorouracil/cisplatin (Group C). In Group A, there was a 60% response rate. Mortality was 70%, with an overall survival rate of 70%, 40%, and 30% at 12, 24, and 60 months, respectively. The mean (SD) survival was 46.7 (15.4) months. In Group B, the response rate was 40%, with an 80% mortality rate and a survival rate of 60% and 20% at 12 and 24 months, respectively. The mean (SD) survival was 17.0 (3.8) months. In Group C, 20% of the responses were observed and the mortality was 90%, with an overall survival rate of 10% at 12 and 24 months and a mean (SD) survival of 7.6 (2.0) months. CONCLUSION: The best response and overall survival rates were achieved in Group A with the NACT scheme of bleomicine.

Turning subjective into objective: the BCCT.core software for evaluation of cosmetic results in breast cancer conservative treatment.

Twelve expert observers from nine different countries convened in a workshop to evaluate the validity of the Breast Cancer Conservative Treatment. Cosmetic results (BCCT.core) software, an objective method for the aesthetic evaluation of breast cancer conservative treatment. Experts were initially asked to subjectively classify the aesthetic results of 30 photographed cases submitted to breast cancer conservative treatment according to the four-point Harris scale. It was pre-established that if at least two-thirds [Cardoso MJ, Cardoso J, Santos AC, Barros H, Oliveira MC. Interobserver agreement and consensus over the esthetic evaluation of conservative treatment for breast cancer. Breast 2005] of participants provided the same classification this would be considered a consensual evaluation for that case. For cases where such agreement was not reached, consensus was obtained using a nominal group technique. Experts then individually performed objective evaluation of the same set of photographs using the BCCT.core software. This provides an automatic rating of aesthetic results, once scale and reference points in the photograph have been chosen. Agreement between observers, between each observer and the consensus, for computer evaluation obtained by the different participants and between software and consensus was calculated using multiple kappa (k) and weighted kappa (wk) statistics. In the subjective assessment, first-round consensus was achieved in 17 (57%) cases. Overall interobserver agreement was fair to moderate (k=0.40, wk=0.57). In the objective assessment there was a higher level of concordance between participants (k=0.86, wk=0.90). Agreement between software and consensus classification was fair (k=0.34, wk=0.53), but was higher in the 17 cases that reached first-round consensus (k=0.60, wk=0.73). Merging the two middle classes of the Harris scale, to form a three-point scale, led to an improvement of all non-weighted measures of agreement. These results show that the BCCT.core software provides consistent evaluation of cosmesis. It has the potential to become a gold standard method for assessment of breast cosmesis in clinical trials, as it can be used simultaneously by a panel of observers from different parts of the world to provide more reliable assessments than has been possible previously.

Factors determining esthetic outcome after breast cancer conservative treatment.

The aim of this study was to evaluate the factors that determine esthetic outcome after breast cancer conservative treatment, based on a consensual classification obtained with an international consensus panel. Photographs were taken from 120 women submitted to conservative unilateral breast cancer surgery (with or without axillary surgery) and radiotherapy. The images were sent to a panel of observers from 13 different countries and consensus on the classification of esthetic result (recorded as excellent, good, fair or poor) was obtained in 113 cases by means of a Delphi method. For each patient, data were collected retrospectively regarding patient characteristics, tumor, and treatment factors. Univariate and multivariate analysis were used to evaluate the correlation between these factors and overall cosmetic results. On univariate analysis, younger and thinner patients as well as patients with lower body mass index (BMI) and premenopausal status obtained better cosmetic results. In the group of tumor- and treatment-related factors, larger removed specimens, clearly visible scars, the use of chemotherapy and longer follow-up period were associated with less satisfactory results. On multivariate analysis, only BMI and scar visibility maintained a significant association with cosmesis. BMI and scar visibility are the only factors significantly associated with cosmetic results of breast cancer conservative treatment, as evaluated by an international consensus panel.

[Prognostic value of c-erb-2 immunohistochemistry expression in patients with primary breast cancer and adjuvant treatment with tamoxifen]. / Valor prognóstico da expressão por imuno-histoquímica do c-erb-2. Em doentes sob terapêutica adjuvante com Tamoxifeno por carcinoma primário da mama.

INTRODUCTION: The c-erb2 proto-oncogene is a member of the epidermal growth factor receptor family and has been associated with a more aggressive breast tumour biology and resistance to some types of treatments. AIMS: To evaluate the prognostic value of c-erb-2 receptor, from primary breast cancer on tamoxifen therapy. METHODS: We examined 66 paraffin-embedded sections from primary breast cancers. Patients were treated with surgery plus adjuvant treatment with tamoxifen; 58% had also received chemotherapy and/or radiotherapy. Membrane staining for c-erb-2 was evaluated by immunohistochemistry and overall survival and relapse-free survival were compared between positives and negatives for c-erb-2. RESULTS: 43,9% of tumours over expressed c-erb-2 receptor, but this was not associated with a worse prognosis on overall survival either on relapse free-survival, with a p value of 0,15 and 0,2 respectively. CONCLUSIONS: There is not any advantage to determine c-erb-2 as a prognostic factor on overall survival either on relapse free-survival. Attending the homogenous characteristics between both groups with any statistical differences according age.

[Atypical glandular cells of undetermined significance (agus) which entity?]. / Atipias glandulares de significado indeterminado (agus) que entidade?

OBJECTIVE: The aim of this study was to determine the incidence and evolution of the atypical glandular cells of undetermined significance (AGUS) without associated lesions identified on cervical Pap smear. MATERIAL AND METHODS: Retrospective study concerning 33.923 cervicovaginal smears performed in the Cytopathology Department of the Coimbra University Hospital (H.U.C.) between January 1995 an December 1997. AGUS diagnosis, isolated or associated with other lesions, was made in 716 cases. Four hundred fourty-four of them were refered to patiens of the H.U.C. Ginecology Department. One hundred seventy-seven cases were classified as AGUS alone; 62 related to the Ginecology Department where follow-up was performed within a period from 3 to 36 months. This study concerns exclusively AGUS patients without associated lesions (N=62). RESULTS: Sixty two cases of isolated AGUS were studied; the incidence was 0,52% and the average age 44,7 ±11,7 [19-75] years old. Follow-up, performed between 3 and 36 months, revealed: isolated cervical smears (N=9), cervical smears and endocervical curettage (N=15), cervical smears with colposcopy and directed biopsy and/or endocervical curettage (N=11), cervical smears and colposcopy (N=19). Total histerectomy was performed in 8 cases by other reasons. Cervical smears were normal in 91,2 % of the cases (N=62). Histologic examination of surgical samples refering to total histerectomy, cervix biopsies was normal in 14 cases (38,9%), revealed cronic cervicitis in 14 cases, LSIL in 7 cases and endocervical polyps in one case. CONCLUSION: In spite of the reduced data of the study, the results point to no need to an agressive therapeutical approach at AGUS diagnosis in Pap smears.