The impact of sociodemographic factors and health insurance coverage in the diagnosis and clinicopathological characteristics of breast cancer in Brazil: AMAZONA III study (GBECAM 0115).

PURPOSE: In Brazil, the available cancer registries are deficient in number and quality and, hence, little information is known regarding sociodemographic, clinicopathological characteristics, treatment patterns, and outcomes of breast cancer (BC) patients. We performed the AMAZONA III/ GBECAM 0115 study and in this analysis, we describe patients' characteristics at diagnosis and their association with health insurance type. METHODS: This is a prospective cohort study developed in 23 sites in Brazil including women with newly diagnosed invasive BC from January 2016 to March 2018. In order to compare healthcare insurance type, we considered patients who were treated under the Brazilian public health system as publicly insured, and women who had private insurance or paid for their treatment as privately insured. RESULTS: A total of 2950 patients were included in the study. Median age at diagnosis was 53.9 years; 63.1% were publicly insured. The majority of patients (68.6%) had stage II-III breast cancer and ductal carcinoma histology (80.9%). The most common breast cancer subtype was luminal A-like (48.0%) followed by luminal B-HER2 positive-like (17.0%) and triple-negative (15.6%). Luminal A was more frequent in private (53.7% vs. 44.2%, p < .0001) than public, whereas Luminal B HER2-positive (19.2% vs. 14.2%, p = 0.0012) and HER2-positive (8.8% vs. 5.1%, p = 0.0009) were more common in patients with public health system coverage. Only 34% of patients were diagnosed by screening exams. Privately insured patients were more frequently diagnosed with stage I disease when compared to publicly insured patients; publicly insured patients had more stage III (33.5% vs. 14.7%; p-value < 0.0001) disease than privately insured ones. Breast cancer was detected by symptoms more frequently in publicly than in privately insured patients (74.2% vs 25.8%, respectively; p-value < 0.0001). CONCLUSIONS: Patients with public health coverage were diagnosed with symptomatic disease, later stages and more aggressive subtypes when compared to privately insured patients.

Análise crítica das indicações de transfusões sangüíneas em cirurgias / Critical analysis of the indications for blood transfusions in surgery

Os vários fatores que precipitam uma tranfusão sanguínea nos hospitais são chamados de "gatilho da transfusão. O objetivo da reposição de sangue no perioperatório é manter níveis satisfatórios de hemoglobina de volume sanguíneo para uma adequada oxigenação tecidual. Os fatores de coagulação são importantes nas disfunções de coagulação. O ideal é evitar-se ou promover-se uma melhor transfusão em pequenas quantidades e com menor risco. Trabalhos recentes questionam os padrões previamente considerados aceitáveis para a transfusão sanguínea. Produtos substitutivos para o tratamento do choque hemorrágico, bioprodutos do sangue e as indicações baseadas em parâmetros laboratoriais e clínicos såo analisadas e discutidas nesta revisão.

Alternativas ao uso de transfusöes de sangue alogênico em cirurgia ginecológica / Alternative use of allogenic blood transfusion in gynecologic surgery

Os autores realizaram estudo prospectivo de 154 pacientes submetidas a cirurgias ginecológicas provenientes de clínica privada e da Clínica Ginecológica do Hospital Universitário do Norte do Paraná, da Universidade Estadual de Londrina, durante os anos de 1998 e 1999, avaliando-se o tipo de cirurgia, cuidados perioperatórios, índices hematimétricos e necessidades transfusionais. Nas pacientes cujo teor de hemoglobina era inferior a 10g/dl no pré-operatório e 8g/dl no pós-operatório, administrou-se eritropoetina recombinante humana (Hu-Epo) na dose diária de 150-300UI/Kg, via subcutânea; hidróxido de ferro 100 mg, via endovenosa; ácido folínico 3mg, via intramuscular; Vitamina B12 5.000UI, via intramuscular. Houve rigoroso controle hemostático e hemodinâmico no intra-operatório, através de rigorosa hemostasia mecânica, da utilização de drogas e de produtos hemostáticos, além da utilização de expansores cristalóides e colóides. A média de perda de sangue operatória foi 2,13g/dl, fato que dispensou o uso de hemotransfusões em todos os casos. Concluem os autores que as cirurgias ginecológicas são possíveis sem o uso de transfusões de sangue alogênico, todavia a fim de que possa utilizar, adequadamente, alternativas pertinentes, práticas e viáveis