Three years of COVID-19 pandemic: comparative analysis of incidence, lethality and mortality among the States of the south region of Brazil / Três anos de pandemia da COVID-19: análise comparativa da incidência, letalidade e mortalidade entre os Estados da região sul do Brasi

Introduction: the first COVID-19 case in Brazil was confirmed on February 26, 2020. As of March 17, 2023, the Ministry of Health reported 699,634 deaths from COVID-19, with a case fatality rate of 1.9%. The impact of the COVID-19 pandemic in Brazil extends to socioeconomic and healthcare systems, reflecting significant regional disparities. Objective: To analyze mortality, incidence, and case fatality rates for COVID-19 in the states of Paraná and Santa Catarina, in the southern region of Brazil. Methods: This is an ecological time-series study using official Brazilian secondary data for COVID-19 cases and deaths. Data were extracted from the dashboard of the State Health Department of Santa Catarina and Paraná. Temporal series were developed for trend analysis using the Prais-Winsten regression model. Statistical analyses were performed using STATA 14.0 software (College Station, TX, USA, 2013). Results: In the analysis of rates over the entire period, trends for mortality, case fatality, and incidence in the state of Santa Catarina are decreasing, decreasing, and stationary, respectively. In Paraná, rates over the entire period showed a stationary trend for mortality, decreasing for case fatality, and increasing for incidence. Conclusion: COVID-19 had a devastating effect on the states of Santa Catarina and Paraná. Both states experienced the progression of the COVID-19 pandemic, with higher case fatality and mortality rates observed in Paraná, while Santa Catarina had a higher incidence rate over the three years of the COVID-19 pandemic.

An Overview of Psychological Interventions on Breast Cancer Patients: Systematic Review of Randomized Controlled Trials

Introduction: Psychological morbidities are common in breast cancer patients. Clinical conditions like depression, cognitive alterations, anxiety, distress, fear of cancer, sleep disorders, and fatigue may persist in cancer survivors. Therefore, psychological interventions are an essential treatment for breast cancer. Objective: To identify psychological interventions and psychological outcomes for women with breast cancer. Methods: Five databases were searched: EMBASE, ScienceDirect, MEDLINE (Ovid), CENTRAL (Ovid) y PsycINFO (APA PsyNET), from Jan 2014 to Jun 4th, 2018. Two authors reviewed all title articles and abstracts in databases and selected potentially eligible studies. A narrative synthesis of results was used due to the heterogeneity in randomized controlled trials, population characteristics, psychotherapies applied, outcomes, and timing of assessments. Results: This overview included 14 randomized controlled trials which comprise 1914 participants (included non-metastatic and metastatic), across 21 articles. The most common psychological interventions were cognitive-behavioral based. The principal psychological outcomes assessed were depression, quality of life, fatigue, and anxiety. Conclusion: Results from this review are useful to clarify an overview of intervention in psychological morbidities in breast cancer. Comorbidities vary, contribute costs to patients, and there is insufficient empirical evidence about psychotherapies to resolve all psychological morbidities in breast cancer patients.

Introducción: Las morbilidades psicológicas son comunes en pacientes con cáncer de mama. Condiciones clínicas como depresión, alteraciones cognitivas, ansiedad, angustia, miedo al cáncer, trastornos del sueño y fatiga pueden persistir en sobrevivientes de cáncer. Por ello, las intervenciones psicológicas son relevantes durante el tratamiento en el cáncer de mama. Objetivo: Identificar intervenciones y resultados psicológicos para mujeres con cáncer de mama. Métodos: Se buscaron en cinco bases de datos: EMBASE, ScienceDirect, MEDLINE (Ovid), CENTRAL (Ovid) y PsycINFO (APA PsyNET), de enero de 2014 al 4 de junio de 2018. Dos autores revisaron todos los artículos en bases de datos y seleccionaron estudios potencialmente elegibles. Se utilizó una síntesis narrativa de los resultados debido a la heterogeneidad en ensayos controlados aleatorios, características de la población, psicoterapias aplicadas, resultados y tiempo de las evaluaciones. Resultados: Este resumen incluyó 14 ensayos controlados aleatorios que comprometen a 1914 participantes (incluidos no metastásicos y metastásicos) en 21 artículos. Las intervenciones psicológicas más comunes fueron basadas en el comportamiento cognitivo. Los principales resultados psicológicos evaluados fueron la depresión, la calidad de vida, la fatiga y la ansiedad. Conclusión: Los resultados de esta revisión son útiles para aclarar una visión general de la intervención en morbilidades psicológicas en el cáncer de mama. Las comorbilidades varían, contribuyen con costos a los pacientes y no hay suficiente evidencia empírica sobre psicoterapias para resolver todas las morbilidades psicológicas en la mujer con cáncer de mama.

Tecnologias para o Diagnóstico da Radiodermite: uma Revisão Sistemática / Technologies for the Diagnosis of Radiodermatitis: a Systematic Review

Objetivo: a radiodermite ou radiodermatite é uma reação celular inflamatória desencadeada pela radioterapia, que é uma das alternativas para tratamento de vários tipos de cânceres. O objetivo deste trabalho foi analisar os principais métodos de diagnóstico de radiodermite com uso de ferramentas tecnológicas, quanto a equipamentos utilizados, forma de análise clínica, parâmetros desenvolvidos e produto final. Materiais e métodos: optou-se pela revisão sistemática de caráter exploratório e abordagem qualitativa. A busca por estudos em periódicos internacionais foi realizada no mês de julho de 2019, nas bases de dados MEDLINE e SCOPUS. Foram utilizados os descritores "radiodermatitis" e "acute radiation dermatitis", para a busca. Os critérios de inclusão foram: artigo, escrita em inglês, publicação nos últimos dez anos (01/2009 a 07/2019), e conteúdo relacionado ao diagnóstico de radiodermite causada por radioterapia de aplicação exclusiva. Resultados: esta revisão encontrou estudos sobre as seguintes ferramentas tecnológicas: avaliação citológica, avaliação de fluxo sanguíneo, machine learning, escala fotográfica, imagem térmica, dose de irradiação e espectrofotometria. O uso de imagens fotográficas e térmicas tem se consolidado como ferramenta de diagnóstico importante na área médica. Essas ferramentas tecnológicas têm se mostrado aplicáveis ao diagnóstico da radiodermite, com seu efeito potencializado por processamento digital de imagens e algoritmos de inteligência artificial. Conclusões: a análise aqui descrita demonstra a necessidade de desenvolvimento tecnológico para delineamento e padronização do processo de diagnóstico da radiodermite, o que permitiria tratamento precoce e manutenção do engajamento do indivíduo na terapia antineoplásica..Au

Objective: radiodermatitis or radiodermatitis is an inflammatory cell reaction triggered by radiotherapy, which is one of the alternatives for the treatment of various types of cancers. The objective of this work was to analyze the main diagnostic methods of radiodermatitis with the use of technological tools, regarding the equipment used, the form of clinical analysis, parameters developed and the final product. Materials and methods: a systematic review with an exploratory nature and a qualitative approach was performed. The search for studies in international journals was carried out in July 2019, in the MEDLINE and SCOPUS databases. The descriptors "radiodermatitis" and "acute radiation dermatitis" were used for the search. The inclusion criteria were: article, written in English, published in the last ten years (01/2009 to 07/2019), and content related to the diagnosis of radiodermatitis caused by radiotherapy of exclusive application. Results: This review found studies on the following technological tools:cytological assessment, blood flow assessment, machine learning, photographic scale, thermal image, irradiation dose, and spectrophotometry. The use of photographic and thermal images has been consolidated as an important diagnostic tool in the medical field. These technological tools have been shown to be applicable to the diagnosis of radiodermatitis, with its effect enhanced by digital image processing and artificial intelligence algorithms.Conclusions: The analysis described here demonstrates the need for technological development to outline and standardize the radiodermatitis diagnostic process, which would allow early treatment and maintenance of the individual's engagement in antineoplastic therapy..Au

The impact of the HPV vaccine on the world: initial outcomes and challenges / O impacto da vacina contra o HPV no mundo: resultados iniciais e desafios

Introduction: Human papillomavirus (HPV) infection can be considered an epidemic in the world and in Brazil. This infection accounts for virtually all cases of cervical cancer, most malignant anal, vaginal and oropharyngeal tumors, and a large number of cases of cancer of the penis and vulva. The most effective way to prevent this infection is through vaccination. Several countries, including Brazil, have already introduced this vaccine into the public vaccination programs and are observing the real-life results of decreasing HPV-associated diseases. Objective: To evaluate the effectiveness of HPV vaccination in preventing virus-induced diseases in countries that have adopted it for a longer time, in a different scenario from clinical studies. Methods: This is a bibliographic review study in journal databases PubMed, LILACS, SciELO and Scopus, with publications dated from 2000 to 2019. The research was restricted to articles in English and Portuguese and studies conducted in humans. Ten studies that were considered relevant were selected. Furthermore, additional articles found by free search were selected. After this phase, the chosen publications were obtained in full for reassessment of their methodology and results. Results: The HPV vaccine demonstrated its effectiveness in reducing the incidence of HPV infection and/or anogenital warts and/or precancerous lesions in the seven countries analyzed by the study: Australia, Brazil, Denmark, United States of America, New Zealand, Czech Republic and Sweden. The impact was bigger in countries that introduced it earlier, such as Australia, where the vaccine virtually eliminated the incidence of genital warts in women aged under 21 years. Although Brazil implemented the vaccine a few years ago, a preliminary study was conducted in Campos dos Goytacazes, RJ, where the vaccine was implemented in 2010, showing a 55% reduction in the incidence of genital warts for women aged under 21 years old, between 2007 and 2012. Conclusion: The HPV vaccine is highly effective in protecting against HPV infection and disease in the countries where it has been implemented, with better results than those seen in clinical trials

Introdução: A infecção pelo papilomavírus humano (HPV) pode ser considerada uma epidemia no mundo e no Brasil. Essa infecção responde por virtualmente todos os casos de câncer de colo de útero, pela maioria dos tumores malignos anais, vaginais e orofaríngeos e por um grande número dos casos de câncer de pênis e vulva. A forma mais eficaz de prevenção dessa infecção é por meio da vacinação. Vários países, entre eles o Brasil, já introduziram essa vacina na rede pública e começaram a observar os resultados na vida real de diminuição das doenças HPV induzidas. Objetivo: Avaliar a eficácia da vacinação contra o HPV na prevenção de doenças induzidas pelo vírus em países que a adotaram há mais tempo, em um cenário diferente dos estudos clínicos. Métodos: Estudo de revisão bibliográfica em bases de dados de periódicos PubMed, LILACS, SciELO e Scopus, com publicações no período de 2000 a 2019. A pesquisa restringiu-se a artigos de língua inglesa e portuguesa e com estudos realizados em seres humanos. Foram selecionados dez trabalhos considerados relevantes. Além disso, foram escolhidos artigos adicionais pesquisados por busca livre. Após essa fase, as publicações selecionadas foram obtidas na íntegra para reavaliação da metodologia e dos resultados. Resultados: A vacina contra o HPV demonstrou sua eficácia na redução da incidência de infecção pelo HPV e/ou verrugas anogenitais e/ou lesões pré-cancerosas nos sete países analisados pelo estudo: Austrália, Brasil, Dinamarca, Estados Unidos da América, Nova Zelândia, República Tcheca e Suécia. O impacto foi maior em países que introduziram a vacina mais precocemente, como na Austrália, onde ela virtualmente eliminou a incidência de verrugas genitais em mulheres abaixo de 21 anos. Ainda que o Brasil tenha implementado a vacina há poucos anos, um estudo preliminar foi realizado no município de Campos dos Goytacazes (RJ), onde a vacina foi introduzida em 2010, demonstrando redução na incidência de verrugas genitais em 55% para mulheres abaixo de 21 anos de idade, no período entre 2007 e 2012. Conclusão: A vacina contra o HPV é muito eficaz na proteção contra a infecção e as doenças induzidas pelo HPV nos países em que foi implementada, com resultados melhores que os observados nos ensaios clínicos.

Efficacy and Safety of Aerosolized Colistin in the Treatment of Ventilator-Associated Pneumonia: A Systematic Review and Meta-analysis

BACKGROUND: It is recommended to use aerosolized (AS) colistin in patients undergoing mechanical ventilation therapy as an adjunctive in the latest guidelines, in spite of high nephrotoxicity and limited studies. In this study, systematic reviews and metaanalyzes were conducted to evaluate the safety and efficacy of AS colistin in patients with ventilator-associated pneumonia. METHODS: Two authors independently searched related literature published from Pubmed and EMBASE until July 2016 and included a study comparing adjunctive AS colistin with intravenous (IV) colistin monotherapy. The primary outcome was the clinical response rate, the secondary outcome was the overall mortality, and nephrotoxicity. The publication bias was evaluated using the Egger's test. RESULTS: Of the total 279 articles, nine were finally included in the final analysis. There was a significant difference between the adjunctive AS colistin group and the IV colistin monotherapy group for the treatment-response rate (odds ratio (OR), 1.56; 95% CI, 1.14–2.14; p = 0.005; I² = 36%), although there was no significant difference in overall mortality (OR, 0.77; 95% CI, 0.57–1.04; p = 0.09; I² = 20%). However, there was no significant difference between the two groups in nephrotoxicity (OR, 1.13; 95% CI, 0.74–1.74; p = 0.57; I² = 4%). CONCLUSION: The addition of aerosolized colistin to IV colistin monotherapy showed better results in terms of efficacy than IV colistin monotherapy and did not show any significant difference in terms of total mortality and nephrotoxicity. Additional large-scale studies of this need to be verified.

When should we order preoperative chest radiography: A systematic review and clinical practice guidelines.

Routine preoperative investigation consumes much resource while Thailand suffers severe financial crisis. Objectives of the study were to apply a systematic review to answer the question whether routine preoperative investigation affected health outcomes; and to construct clinical practice guidelines for preoperative chest radiography (CXR). The guidelines were prepared for elective, non-cardiothoracic surgery in adult patients. Methods of the study were Medline search (1980-1998) and search from studies published in Thailand. Criteria for high validity and reliability were applied to paper selection. The results of the systematic review were discussed among anesthesiologists and other specialists and the guidelines were drawn by consensus. Results from the systematic review, there were no randomized controlled trials to answer the question and no studies reported health outcomes. Routine preoperative investigations yielded few positive results and were not very useful for patient care. From this review and the consensus, we proposed the guidelines, which consisted of a history questionnaire, physical examination and indication for investigation. For the preoperative CXR the indications were: age > 45 years, history of cardiovascular and respiratory diseases, autoimmune deficiency syndrome (AIDS), heavy smoking, chronic cough or fever, malignancy and findings of abnormal breath sounds on examination. This study recommends and prefers preoperative CXR as indicated by history and physical examination to routine.