Sociodemographic and clinical variables as determinants of mortality and survival in patients with acute ST-elevation myocardial infarction in the Eastern Amazon.

Background: The aim of this study was to analyze the influence of sociodemographic and clinical variables as determinants of mortality and survival in patients with ST-segment elevation acute myocardial infarction in the Eastern Amazon. Design and methods: This observational, longitudinal, and retrospective study was conducted at the Gaspar Vianna Clinical Hospital Foundation in patients hospitalized from January 2017 to June 2020. Patients were divided into two groups: those who survived (G1) (n = 646) and those who died (G2) (n = 37). Sociodemographic and clinical variables associated with mortality and survival in these two groups were analyzed. Results: Patients with STEMI who had the highest risk of death were often the oldest (G1: 61.58 ± 10.74 years; G2: 69.57 ± 9.02 years; t = -4.492; p = 0.001), with Killip III-IV classifications (OR = 0.13; 95% CI = 0.02-0.71; p = 0.03), and with diseases such as heart failure (OR = 0.07; 95% CI = 0.004-1.50; p = 0.168) or renal failure (OR = 0.03; 95% CI = 0.006-0.16; p = 0.0001). In addition, female sex (hazard ratio = 2.073; 95% CI = 1.413-5.170), Killip III-IV classifications (hazard ratio = 4.041; 95% CI = 1.703-18.883) and the presence of heart failure (hazard ratio = 34.102; 95% CI = 4.410-263.684) or renal failure (hazard ratio = 14.278; 95% CI = 3.275-62.248) shortened in-hospital survival. Conclusions: Specific sociodemographic and clinical aspects influenced mortality and survival in patients with acute ST -elevation myocardial infarction.

Predictors of Testicular Cancer Mortality in Brazil: A 20-Year Ecological Study.

Testicular cancer is common in young men, and early detection and multimodality treatment can lead to successful outcomes. This study aims to identify sociodemographic and risk factors associated with higher testicular cancer mortality and poorer survival rates, while examining the impact of diagnostic and treatment procedures on reducing mortality. The retrospective ecological study analyzed mortality data from testicular cancer in Brazil from 2001 to 2020. Sociodemographic variables such as marital status, age, birth period, year of death (cohort), race, and geographic region were assessed. Risk factors included cryptorchidism and pesticide exposure. Data were subjected to statistical analysis, which revealed an increasing trend in mortality after 2011 among persons born after 1976 in the 15-40 age group. Individuals in the South Region, whites, and singles had higher age-standardized mortality rates (ASMRs), while singles had lower survival rates. The Northeast region had a higher survival rate. Fungicides and insecticides increase ASMR in Brazil. Herbicides increase ASMR in the Northeast and Midwest regions and insecticides increase ASMR in the Northeast, Southeast, and Midwest regions. High rates of implementation of diagnostic procedures in the Midwest were not sufficient to reduce ASMR. No treatment procedure was associated with mortality at the national or regional level.

Strength and Bioelectrical Activity of the Pelvic Floor Muscles and Sexual Function in Women with and without Stress Urinary Incontinence: An Observational Cross-Sectional Study.

Stress urinary incontinence (SUI) results from an increase in intravesical pressure, which exceeds the pressure at which the urethra remains closed. Symptoms cause social and sexual intercourse discomfort directly or indirectly, which affect health-related quality of life and are associated with pelvic floor muscle (PFM) dysfunction. We aimed to verify the variation in strength and PFM bioelectrical activity and sexual function in women with SUI. Additionally, we analyzed the impact of this dysfunction on quality of life. This was an observational cross-sectional study. Women aged 25−55 years with frequent sexual intercourse were included. Women with SUI were included in a study group (G2, n = 17), and those without any type of incontinence were included in a control group (G1, n = 16). Primary outcomes were level of strength and PFM bioelectrical activity and sexual function as determinants of worse SUI in the control group. Secondary outcomes were associated between the primary outcomes and severity of urinary loss, impact on daily life, and quality of life in women with SUI. In the domains evaluated in the Female Sexual Function Index (FSFI), only sexual desire was lower in women with SUI (G2) than in the controls (p = 0.033). During analysis of G1 variables, a positive and moderate correlation was observed between power/myoeletric activation and maximum voluntary contraction (MVC) (p < 0.01), peak (p < 0.01), and mean amplitudes (p = 0.017). There was a high positive correlation between sexual arousal and other variables, including vaginal lubrication, sexual orgasm, and total FSFI value (p < 0.001 for all analyses). During evaluation of G2 variables, the MVC was positively correlated with the peak and mean amplitudes (p < 0.0001). Additionally, there was a high and positive correlation between the mean amplitudes (%MVC) and personal relationships (KHQ) (p = 0.001); the same was observed between the total (ICIQ) and activities of daily living (ICIQ) (p < 0.0001). Therefore, women with SUI presented with lower sexual desire and bioelectric activity but were not related to PFM strength. Additionally, the domains of sexual function and certain variables of quality of life are aggravated by SUI.

Imbalance of Peripheral Temperature, Sympathovagal, and Cytokine Profile in Long COVID.

A persistent state of inflammation has been reported during the COVID-19 pandemic. This study aimed to assess short-term heart rate variability (HRV), peripheral body temperature, and serum cytokine levels in patients with long COVID. We evaluated 202 patients with long COVID symptoms categorized them according to the duration of their COVID symptoms (≤120 days, n = 81; >120 days, n = 121), in addition to 95 healthy individuals selected as controls. All HRV variables differed significantly between the control group and patients with long COVID in the ≤120 days group (p < 0.05), and participants in the long COVID ≤120 days group had higher temperatures than those in the long COVID >120 days group in all regions analysed (p < 0.05). Cytokine analysis showed higher levels of interleukin 17 (IL-17) and interleukin 2 (IL-2), and lower levels of interleukin 4 (IL-4) (p < 0.05). Our results suggest a reduction in parasympathetic activation during long COVID and an increase in body temperature due to possible endothelial damage caused by the maintenance of elevated levels of inflammatory mediators. Furthermore, high serum levels of IL-17 and IL-2 and low levels of IL-4 appear to constitute a long-term profile of COVID-19 cytokines, and these markers are potential targets for long COVID-treatment and prevention strategies.

Impact of sociodemographic factors and screening, diagnosis, and treatment strategies on colorectal cancer mortality in Brazil: A 20-year ecological study.

Colorectal cancer (CRC) caused 261,060 deaths in Brazil over a 20-year period, with a tendency to increase over time. This study aimed to verify the sociodemographic factors predicting higher mortality caused by CRC and survival rates. Moreover, we aimed to verify whether the performance of screening, diagnostic and treatment procedures had an impact on mortality. Ecological observational study of mortality due to CRC was conducted in Brazil from 2000-2019. The adjustment variable was age, which was used to calculate the age-standardized mortality rate (ASMR). The exposure variables were number of deaths and ASMR. Outcome variables were age-period-cohort, race classification, marital status, geographic region, and screening, diagnostic, and treatment procedures. Age-period-cohort analysis was performed. ANOVA and Kruskal-Wallis test with post hoc tests were used to assess differences in race classification, marital status, and geographic region. Multinomial logistic regression was used to test for interaction among sociodemographic factors. Survival analysis included Kaplan-Meier plot and Cox regression analysis were performed. Multivariate linear regression was used to test prediction using screening, diagnosis, and treatment procedures. In Brazil, mortality from CRC increased after age 45 years. The highest adjusted mortality rates were found among white individuals and in the South of the country (p < 0.05). Single, married, and widowed northern and northeastern persons had a higher risk of death than legally separated southern persons (p < 0.05). Lower survival rates were observed in brown and legally separated individuals and residents from the North (p < 0.05). An increase in first-line chemotherapy and a decrease in second-line chemotherapy were associated with high mortality in the north (p<0.05). In the south, second-line chemotherapy and abdominoperineal rectal resection were associated with high mortality (p < 0.05). Regional differences in sociodemographic factors and clinical procedures can serve as guidelines for adjusting public health policies.