Peritumoral infiltration of local anesthetic before surgery in early breast cancer: a comment

This is a comment on a study recently published about peritumoral infiltration of local anesthetic before surgery in early breast cancer. Previously, animal models and a randomized study for stage IV breast cancer patients inferred that the removal of the primary tumor resulted in increased growth factors and worse distant disease control. Therefore, breast cancer surgery might not be a strictly local intervention. In this new randomized study, the intervention was a peritumoral infiltration of local anesthetic ­ lidocaine 0.5% in the six tumor margins, as an attempt to limit the systemic repercussions of surgery. Although the adjuvant treatment available for the study seems outdated, leading us to question the external validation, limited resources may have increased the power of surgery. Unknown mechanisms during surgery can change the patient's journey, and it is our duty to look at surgical studies with due seriousness

An update on the status of breast cancer screening in Brazil after the covid-19 pandemic

ABSTRACT We have previously reported the impact of covid-19 pandemic on breast cancer screening, in Brazil: among women aged 50-69 years, mammography attendance decreased by 42% in public healthcare (SUS), comparing 2019 and 2020. In this short communication, we wish to present: a) an update of the number of mammograms performed, in 2021; b) an exploratory analysis of the characteristics of the screened population between 2019 and 2021. A total of 1.675.307 mammograms were performed in 2021, nearly 15% lower than pre-pandemic levels. Almost a third, 29.5% of them, had intervals greater than three years. In accordance with our previous study, the number of patients with palpable lumps on physical exam increased. The consequences of postponing breast cancer screening during the pandemic are still uncertain. Unfortunately, as of December 2021, screening attendance has not resumed. On the contrary, our results show an increase in the fraction of women with mammography delayed beyond three years.

Breast imaging hindered during covid-19 pandemic, in Brazil

ABSTRACT OBJECTIVE: To report the decrease in breast imaging after covid-19 pandemic, obtaining the number of mammograms performed in 2019 and 2020. Additionally, to investigate if there was an increase in the proportion of women undergoing mammography for diagnostic purposes, with palpable lesions. METHOD: This is a cross-sectional study, based on the number of mammograms performed by the Brazilian public health services, provided by DATASUS, an open access database. Mammograms from private institutions were not included. This study compares the number of mammograms performed in 2019 and 2020, in women aged 50-69 years, stratified by month, in each federal state, and the presence of palpable lumps (physician-reported). RESULTS: In total, 1,948,471 mammograms were performed in 2019 and 1,126,688 in 2020, for the population studied. These values represent a 42% decline. Monthly, a significant decreased is observed after April 2020. The results varied slightly according to federal state; yet the entire country was affected. Rondônia was the most affected state, with 67% decline. The proportion of women presenting palpable lumps increased from 7.06% on average in 2019 to 7.94% in 2020 (OR = 1.135, 95%CI 1.125-1.145, p = 0,001). DISCUSSION: The number of mammograms performed in 2020 declined considerably. Out of the women who presented for mammogram, the proportion of palpable lumps was significantly higher in 2020. Considering the detection rate of digital mammography, the loss of 800,000 exams means 4,000 undiagnosed breast cancer cases, by the end of 2020.

Apgar scoring system in Brazil's live births records: differences between home and hospital births / Escala de Apgar nos registros de nascidos vivos do Brasil: discordância entre parto normal hospitalar e parto domiciliar

Abstract Objective To promote informed choice for women and to compare home andhospital births in relation to the Apgar score. Methods Mother's profile and Apgar score of naturally born infants (without forceps assistance) in Brazil between 2011 and 2015, in both settings-hospital or home-were collected from live birth records provided by the Informatics Department of the Unified Health System (DATASUS, in the Portuguese acronym). For the analysis, were included only data fromlow-riskdeliveries, including gestational time between 37 and 41weeks, singleton pregnancy, at least four visits of prenatal care, infants weighing between 2,500 g, and 4,000 g, mother age between 20-40 years old, and absence of congenital anomalies. Results Home birth infants presented significantly higher risk of 0-5 Apgar scores, both in 1 minute (6.4% versus 3%, odds ratio [OR] = 2.2, confidence interval [CI] IC 2-2.4) and in 5 minutes (4.8% versus0.4%,OR = 11.5,CI 10.5-12.7). Another findingis related to recovery estimateswhen from an initially bad 1-minute Apgar (<6) to a subsequently better 5-minute Apgar (> 6). In this scenario, home infants had poorer recovery, Apgar scorewas persistently < 6 throughout the fifth minute in most cases (71% versus 10.7%, OR 20.4, CI 17-24.6). Conclusion The results show worse Apgar scores for babies born at home, compared with those born at the hospital setting. This is a pioneer and preliminary study that brings attention concerning differences in Apgar score related to home versus hospital place of birth in Brazil.

Resumo Objetivo Promover a escolha informada para asmulheres, comparando os resultados de partos domiciliares e hospitalares em relação à escala de Apgar. Métodos Foramcoletadas as informaçõesmaternas e a pontuação Apgar de nascidos de parto normal (pela definição, sem auxílio de fórcipe) no Brasil, de 2011 a 2015, a partir de registros de nascidos vivos disponibilizados pela plataforma do Departamento de Informática do Sistema Único de Saúde (DATASUS). Para a análise, incluímos somente dados de partos de baixo risco ocorridos em hospitais ou residências, incluindo tempo de gestação entre 37 e 41 semanas, gestação única, pelo menos quatro consultas de pré-natal, crianças com peso entre 2.500 g e 4.000 g, e idade materna entre 20 anos e 40 anos e ausência de anomalias congênitas. Resultados Em comparação ao nascido em ambiente hospitalar, o nascido em domicílio apresentou risco significativamente maior de pontuação 0 a 5, tanto no primeiro minuto (6,4% versus 3%, razão de chance [RC] = 2,2, intervalo de confiança [IC] 2-2,4) como no quinto minuto (4,8% versus 0,4%; RC = 11,5; IC 10,5-12,7). Outro achado que merece destaque é em relação às estimativas de recuperação quando de um Apgar inicialmente ruimao primeirominuto (< 6) para um subsequentemelhor (> 6) no quinto minuto. Neste cenário, os nascidos em domicílio apresentaram menor recuperação até o quinto minuto, persistindo em Apgar < 6 na maior parte dos casos (71% versus 10,7%; OR 20,4; IC 17-24,6). Conclusão Os resultados indicam piores escalas de Apgar para bebês nascidos em ambiente domiciliar, em comparação àqueles nascidos em ambiente hospitalar. Este é um estudo pioneiro e preliminar que atenta para as diferenças na escala de Apgar em relação ao local de nascimento domiciliar versus hospitalar no Brasil.

Comparação dos padrões da frequência cardíaca fetal no segundo e terceiro trimestres da gestação / Comparison of fetal heart rate patterns in the second and third trimesters of pregnancy

OBJETIVO: comparar os padrões da frequência cardíaca fetal (FCF) do segundo e terceiro trimestres da gestação. MÉTODOS: estudo prospectivo, comparativo, realizado no período de Janeiro de 2008 e Julho de 2009 com os seguintes critérios de inclusão: gestação única, feto vivo, ausência de intercorrências clínicas ou obstétricas, ausência de malformação fetal, com idade gestacional entre 24 e 27 semanas (segundo trimestre - 2ºT) ou entre 36 e 40 semanas (terceiro trimestre - 3ºT). Foram realizados os exames de cardiotocografia computadorizada (Sistema 8002 - Sonicaid) por período de 30 minutos e o perfil biofísico fetal. O Sistema 8002 analisa o traçado da FCF em períodos de 3,75 segundos (1/16 de minuto). Em cada período, a duração média dos intervalos de tempo entre sucessivos batimentos cardíacos fetais foi avaliada e mensurada em milisegundos (ms). A FCF média foi calculada em cada período, e também as diferenças entre períodos adjacentes. Os parâmetros incluíram: FCF basal, acelerações transitórias, duração dos episódios de alta variação, duração dos episódios de baixa variação e variação de curto prazo. Os resultados foram analisados pelos testes t de Student, teste do qui-quadrado e teste exato de Fischer. Foi adotado nível de significância de 0,05. RESULTADOS: dezoito gestações de 2ºT foram comparadas com 25 gestações de 3ºT. Houve diferença significativa nos parâmetros da FCF avaliada pela cardiotocografia computadorizada quando comparados os fetos de 2ºT e os de 3ºT em relação aos seguintes resultados: média da FCF basal (143,8 bpm versus 134,0 bpm, p=0,009), média do número de acelerações transitórias >10 bpm (3,7 versus 8,4, p<0,001) e >15 bpm (0,9 bpm versus 5,4 bpm, p<0,001), duração média dos episódios de alta variação (8,4 min x 15,4 min, p=0,008) e média da variação de curto prazo (8,0 ms versus10,9 ms, p=0,01). Em todos os exames o perfil biofísico fetal apresentou resultado normal. CONCLUSÕES: o presente estudo constata diferenças significativas nos padrões avaliados entre gestações de segundo e terceiro trimestres, e indica a influência da maturação do sistema nervoso autonômico na regulação da FCF.

PURPOSE: to compare the patterns of fetal heart rate (FHR) in the second and third trimesters of pregnancy. METHODS: a prospective and comparative study performed between January 2008 and July 2009. The inclusion criteria were: singleton pregnancy, live fetus, pregnant women without clinical or obstetrical complications, no fetal malformation, gestational age between 24 and 27 weeks (2nd trimester - 2T) or between 36 and 40 weeks (3rd trimester - 3T). Computerized cardiotocography (System 8002 - Sonicaid) was performed for 30 minutes and the fetal biophysical profile was obtained. System 8002 analyzes the FHR tracings for periods of 3.75 seconds (1/16 minutes). During each period, the mean duration of the time intervals between successive fetal heart beats is determined in milliseconds (ms); the mean FHR and also the differences between adjacent periods are calculated for each period. The parameters included: basal FHR, FHR accelerations, duration of high variation episodes, duration of low variation episodes and short-term variation. The dataset was analyzed by the Student t test, chi-square test and Fisher's exact test. Statistical significance was set at p<0.05. RESULTS: eighteen pregnancies on the second trimester were compared to 25 pregnancies on the third trimester. There was a significant difference in the FHR parameters evaluated by computerized cardiotocography between the 2T and 3T groups, regarding the following results: mean basal FHR (mean, 143.8 bpm versus 134.0 bpm, p=0.009), mean number of transitory FHR accelerations > 10 bpm (3.7 bpm versus 8.4 bpm, p <0.001) and >15 bpm (mean, 0.9 bpm versus 5.4 bpm, p <0.001), mean duration of high variation episodes (8.4 min versus 15.4 min, p=0.008) and mean short - term variation (8.0 ms versus 10.9 ms, p=0.01). The fetal biophysical profile showed normal results in all pregnancies. CONCLUSION: the present study shows significant differences in the FHR characteristics when the 2nd and 3rd trimesters of pregnancy are compared and confirms the influence of autonomic nervous system maturation on FHR regulation.