Safety and Effectiveness of Perioperative Hyperthermic Intraperitoneal Chemotherapy with Gemcitabine in Patients with Resected Pancreatic Ductal Adenocarcinoma: Clinical Trial EudraCT 2016-004298-41.

BACKGROUND: Despite the improvement in therapies, pancreatic cancer represents one of the most cancer-related deaths. In our hypothesis, we propose that Hyperthermic Intraperitoneal Chemotherapy with gemcitabine after pancreatic cytoreductive surgery could reduce tumor progression by reducing residual neoplastic volume and residual pancreatic cancer stem cells. MATERIALS AND METHODS: A randomized trial involving 42 patients. All patients were diagnosed with pancreatic ductal adenocarcinoma. Group I: R0 resection. Group II. R0 resection and HIPEC with gemcitabine (120 mg/m2 for 30 min). Effectiveness was measured with analysis of overall survival, disease-free survival, distant recurrence, locoregional recurrence, and measuring of pancreatic cancer stem cells (EpCAM+CXCR4+CD133+). RESULTS: From 2017 to 2023, 63 patients were recruited for our clinical trial; 21 patients were included in each group, and 21 were excluded. Locoregional recurrence, p-value: 0.022, was lower in the experimental group. There were no significant differences between the two groups in hospital mortality, perioperative complications, or hospital costs. We found a significant decrease in pancreatic cancer stem cells in patients in the experimental group after treatment, p -value of 0.018. CONCLUSIONS: The use of HIPEC with gemcitabine after surgery in patients with resectable pancreatic ductal adenocarcinoma reduces locoregional recurrence and may be associated with a significant decrease in pancreatic cancer stem cells.

Paclitaxel as HIPEC-Drug after Surgical Cytoreduction for Ovarian Peritoneal Metastases: A Randomized Phase III Clinical Trial (HIPECOVA).

Multidisciplinary strategies have transformed the management of advanced ovarian cancer. We aimed to evaluate the effectiveness of paclitaxel in hyperthermic intraperitoneal chemotherapy (HIPEC) following surgical cytoreduction for ovarian peritoneal metastases in a randomized phase III trial conducted between August 2012 and December 2019. Seventy-six patients were randomized to either the HIPEC or no HIPEC group. Although median values for the primary endpoints (recurrence-free survival (RFS) and overall survival (OS)) revealed superior outcomes for the HIPEC (RFS: 23 months, OS: 48 months) over the control group (RFS: 19 months, OS: 46 months), these differences were not statistically significant (p = 0.22 and p = 0.579). Notably, the HIPEC group demonstrated significantly higher 5-year OS and 3-year RFS rates (47.2% and 47.5%) compared to patients without HIPEC (34.5% and 21.3%). Stratification according to Peritoneal Surface Disease Severity Score (PSDSS) showed improved OS and RFS for patients with lower PSDSS (I-II) in the HIPEC-treated group (p = 0.033 and p = 0.042, respectively). The Clavien-Dindo classification of adverse event grades revealed no significant differences between HIPEC and controls (p = 0.482). While overall results were not statistically significant, our long-term follow-up emphasized the potential benefit of HIPEC-associated cytoreduction with paclitaxel, particularly in selected ovarian cancer patients with lower PSDSS indices.

Corneal transplantation and concomitant SARS-CoV-2 infection: a case report / Transplante de córnea e infecção concomitante por SARS-CoV-2: relato de caso

ABSTRACT This report was aimed at presenting a case of neurotrophic keratitis and concomitant SARS-CoV-2 infection in a patient who has recently undergone a corneal DALK transplant. One month after corneal transplantation with adequate corneal epithelialization, the patient presented neurotrophic keratitis with a torpid course of the corneal transplant coinciding with a SARS-CoV-2 infection, with an excessive host immune response. In addition, the patient presented a re-positivization of nasopharyngeal polymerase chain reaction of SARS-CoV-2 with past disease after starting treatment with autologous serum eye drops. The implications at the ophthalmological level of SARS-CoV-2 infection may be clarified as the time the illness progresses and we learn more about how it acts. In this case, the disparity of signs and symptoms, the antecedent of corneal surgery, and the possibility of a herpetic infection as a cause of the primary leukoma suggested neurotrophic keratitis. Nonetheless, the involvement of systemic SARS-CoV-2 infection in the process, triggering an excessive host immune response at the corneal level with an increase in inflammatory cytokines must be taken into account. No relationship was found between treatment with autologous serum and re-positivization of nasopharyngeal polymerase chain reaction, presenting the patient a favorable response to treatment.

RESUMO O objetivo deste relato foi apresentar um caso de ceratite neurotrófica e infecção concomitante por SARS-CoV-2 em paciente submetido recentemente a transplante de córnea DALK. Um mês após o transplante de córnea com adequada epitelização da córnea, o paciente apresentou ceratite neurotrófica com curso tórpido do transplante de córnea, coincidindo com infecção por SARS-CoV-2, com resposta imune excessiva do hospedeiro. Além disso, o paciente apresentou repositivização da reação em cadeia da polimerase nasofaríngeo de SARS-CoV-2, com doença pregressa após iniciar tratamento com colírio de soro autólogo. As implicações a nível oftalmológico da infecção por SARS-CoV-2, podem ser esclarecidas à medida que a doença progride e aprendemos mais sobre sua forma de atuação. Neste caso, a disparidade de sinais e sintomas, o antecedente de cirurgia de córnea e a possibilidade de infecção herpética como causa do leucoma primário sugeriram ceratite neurotrófica. No entanto, deve-se levar em consideração o envolvimento da infecção sistêmica por SARS-CoV-2 no processo, desencadeando uma resposta imune excessiva do hospedeiro no nível da córnea, com aumento de citocinas inflamatórias. Não foi encontrada relação entre o tratamento com soro autólogo e a repositivização da reação em cadeia da polimerase nasofaríngea, apresentando ao paciente uma resposta favorável ao tratamento.

Human Placental Adaptive Changes in Response to Maternal Obesity: Sex Specificities.

Maternal obesity is increasingly prevalent and is associated with elevated morbidity and mortality rates in both mothers and children. At the interface between the mother and the fetus, the placenta mediates the impact of the maternal environment on fetal development. Most of the literature presents data on the effects of maternal obesity on placental functions and does not exclude potentially confounding factors such as metabolic diseases (e.g., gestational diabetes). In this context, the focus of this review mainly lies on the impact of maternal obesity (in the absence of gestational diabetes) on (i) endocrine function, (ii) morphological characteristics, (iii) nutrient exchanges and metabolism, (iv) inflammatory/immune status, (v) oxidative stress, and (vi) transcriptome. Moreover, some of those placental changes in response to maternal obesity could be supported by fetal sex. A better understanding of sex-specific placental responses to maternal obesity seems to be crucial for improving pregnancy outcomes and the health of mothers and children.

Should the Treatment of Patients with Repeated Embryo Implantation Failure Be Adapted as a Function of the Endometrial Cytokine Profile? A Single-Center Experience.

Repeated embryo implantation failures (RIF) is a source of distress and frustration for patients and clinicians alike. Today's approaches for treating RIF are largely empirical and have limited effectiveness. The main causes of RIF are poor endometrial receptivity and poor-quality embryos. Recent studies have suggested the involvement of immune dysregulation due to an imbalance between T-helper (Th) 1 and Th2 cytokines; this opens up perspectives for treating women with RIF and increasing the implantation rate. We conducted an interventional, longitudinal, prospective cohort study of the impact of correcting the cytokine imbalance on the clinical pregnancy rate in women with RIF. Seventy-seven women with RIF underwent an endometrial biopsy during the implantation window. The cytokine profile was evaluated by studying the activation and maturation of uterine natural killer (uNK) cells, the IL-15/Fn-14 mRNA ratio (a biomarker of uNK activation/maturation), and the IL-18/TWEAK mRNA ratio (a marker of angiogenesis and the Th1/Th2 balance). Personalized treatment was initiated for women with an abnormal endometrial cytokine profile (hyper-activation or hypo-activation). We documented the clinical pregnancy rate after subsequent embryo transfers. In total, 72.7% (56/77) of patients had an abnormal endometrial cytokine profile (hyper-activation in 68.8% (n = 53) and hypo-activation in 3.9% (n = 3). After treatment (or not) as a function of the endometrial profile, the overall clinical pregnancy rate was 30.2%. Our results indicated a potential positive effect of appropriate treatment on the ongoing pregnancy rate in women with RIF, despite the small number of cases analyzed. The results must now be validated in randomized studies with larger numbers of well-characterized patients. By applying a previously published decision tree, this treatment approach could be implemented in clinics worldwide.

Prevalência de aleitamento materno em pré-termos egressos de uma maternidade no nordeste brasileiro / Prevalence of breastfeeding in preterm infants discharged from a maternity hospital in northeastern Brazil

Objetivo: Analisar a prevalência de aleitamento materno aos seis meses de idade em pré-termos egressos de uma maternidade de referência no Nordeste brasileiro. Materiais e méto-dos: Estudo transversal com análise retrospectiva de dados secundários obtidos de 487 pré-termos, nascidos entre janeiro de 2018 e dezembro de 2019. Resultados:Aamostra foi consti-tuída de 487 recém-nascidos pré-termos, sendo 64,5% pré-termos extremos ou moderados (> 28 a < 34 semanas de idade gestacional); 30,4% prematuros tardios (> 34 e < 37 semanas de idade gestacional); e 5,1% prematuros muito extremos (idade gestacional < 28 semanas). Aprevalência de aleitamento materno aos 6 meses foi de 42,1%, estando o aleitamento materno exclusivo presente nesta idade em apenas 13,8%. Aidade média de interrupção do aleitamen-to materno foi de 4,8 meses. Houve relação de significância estatística entre a duração do aleitamento materno exclusivo e a presença do aleitamento materno aos 6 meses de idade corrigida. Conclusões: Os resultados desta pesquisa evidenciam uma baixa prevalência de aleitamento materno no primeiro ano de vida dos pré-termos egressos da maternidade, com taxa aquém do recomendado pela Organização Mundial da Saúde

Estratégias e dificuldades encontradas na comunicação de notícias difíceis em um hospital universitário / Strategies and difficulties found in communicating difficult news in a university hospital / Estrategias y dificultades encontradas para comunicar noticias difíciles en un hospital universitario

O trabalho teve como objetivo apresentar estratégias e dificuldades que influenciam o processo de Comunicação de Notícias Difíceis por médicos em um hospital universitário. Trata-se de um estudo descritivo-exploratório, de orientação qualitativa, sobre as estratégias e dificuldades encontradas por residentes (R1, R2 ou R3) e staffs, dos quatro programas da área médica: Ginecologia e Obstetrícia (GO), Pediatria, Cirurgia Geral (CG) e Clínica Médica (CM). A partir de uma entrevista semiestruturada para a análise dos dados foi utilizado o método do Discurso do Sujeito Coletivo (DSC), que mostrou como é importante utilizar protocolos para subsidiar a melhor abordagem com o paciente. Além da formação profissional, para realizar a comunicação de notícias difíceis, foi citado o protocolo SPIKES, seus pontos estratégicos e como ele pode auxiliar o profissional a realizar a melhor conduta. No que tange às dificuldades, a falta de preparo foi um dos destaques, bem como a ausência de um local adequado para a comunicação e os aspectos emocionais envolvidos, tanto por parte dos pacientes quanto dos profissionais de saúde. (AU)

The aim of this study was to present the strategies and difficulties that influence the process of communicating difficult news by doctors in a university hospital. This is a descriptive-exploratory study with a qualitative orientation on the strategies and difficulties encountered by residents (R1, R2 or R3) and staff from the four medical programs: Obstetrics and Gynecology (O&G), Pediatrics, General Surgery (GS) and Internal Medicine (IM). Based on a semi-structured interview, the Collective Subject Discourse (CSD) method was used for data analysis, which showed the importance of using protocols to support the best approach to the patient. In addition to professional training for communicating difficult news, the SPIKES protocol and its strategic points were mentioned, as well as how it can help professionals to conduct themselves effectively. The lack of preparation was one of the main difficulties reported, as well as the absence of an appropriate location for communication and the emotional aspects involved for both patients and health professionals. (AU)

El objetivo de este trabajo fue presentar estrategias y dificultades que influyen en el proceso de Comunicación de Noticias Difíciles por parte de médicos en un hospital universitario. Se trata de un estudio descriptivo-exploratorio, con orientación cualitativa, sobre las estrategias y dificultades encontradas por los residentes (R1, R2 o R3) y personal, de los cuatro programas del área médica: Ginecología y Obstetricia (GO), Pediatría, General Cirugía (CG) y Medicina Interna (CM). A partir de una entrevista semiestructurada para el análisis de los datos, se utilizó el método del Discurso del Sujeto Colectivo (CSD), que mostró cuán importante es el uso de protocolos para apoyar el mejor abordaje del paciente. Además de la formación profesional, para comunicar noticias difíciles, se mencionó el protocolo SPIKES, sus puntos estratégicos y cómo puede ayudar a los profesionales a llevar a cabo la mejor conducta. En cuanto a las dificultades, la falta de preparación fue uno de los destaques, así como la ausencia de un lugar adecuado para la comunicación y los aspectos emocionales involucrados, tanto por parte de los pacientes como de los profe-sionales de la salud. (AU)

Síndrome de POEMS: a propósito de un caso / POEMS syndrome: A case report

RESUMEN El síndrome POEMS es una enfermedad de patogenia desconocida. El acrónimo deriva de las principales manifestaciones clínicas de este cuadro: polineuropatía, organomegalia, endocrinopatía, gammapatía monoclonal y trastornos de la piel. Estudios recientes sugieren la asociación de mutaciones genéticas con inmunoglobulina λ. En este reporte presentamos el caso de un paciente de 56 años, con un cuadro clínico de diez meses de evolución. Al inicio, se presentó un edema en los miembros inferiores e hipertricosis, y luego aparecieron los síntomas gastrointestinales, linfadenopatía inguinal y parestesia de miembros inferiores. Enfatizamos la importancia de este caso clínico debido a que, en nuestro país, los informes de pacientes con el síndrome POEMS son escasos, y en el departamento de La Libertad no existe ningún reporte. Además, el tiempo para diagnosticar esta enfermedad es prolongado.

ABSTRACT POEMS syndrome is a disease of unknown pathogenesis. The acronym stands for the disease's main clinical manifestations: polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin disorders. Recent studies suggest the association of genetic mutations with immunoglobulin λ. We report the case of a 56-year-old male patient with a 10-month clinical picture, whose initial signs and symptoms were lower limb edema and hypertrichosis, followed by gastrointestinal symptoms, inguinal lymphadenopathy and lower limb paresthesia. We emphasize the importance of this clinical case, given the limited reports of POEMS syndrome at the national level and no reported cases in the department of La Libertad, and the long time it takes to diagnose such disease.

Influence of maternal obesity on human trophoblast differentiation: The role of mitochondrial status.

Maternal obesity is associated with complications of pregnancy and increases the infant's risk of developing obesity, diabetes and cardiovascular disease later in life. The placenta has an important role in determining the pregnancy outcome, and the syncytiotrophoblast (ST) is the main component of the placenta that supports the relationship between the mother and fetus. The differentiation of the cytotrophoblast (CT) into the ST is accompanied by changes in mitochondrial functions and dynamics. The objective of the present study was to investigate the effects of maternal obesity (without gestational diabetes) on the in vitro differentiation capacities of human CT isolated from term placenta by focusing on mitochondrial status. We found that, during human CT differentiation process, maternal obesity is associated with (i) a lower progesterone secretion, (ii) a transient impairment in the ST's fusion potential (via syncytin-2 and its receptor), (iii) a lower mitochondrial content, and (iv) weaker mRNA expression of oestrogen-related receptor-gamma (a key mitobiogenesis gene). Moreover, maternal obesity altered the time course of ATP and reactive oxygen species production throughout CT differentiation. The mitochondrial dysfunctions observed in isolated human CTs of obese women might explain the observed decrease in progesterone production. Our results demonstrated that obesity in pregnancy is associated with a functional impairment of the ST which might alter the foetal-maternal dialogue.

Environmental sustainability of alternative marine propulsion technologies powered by hydrogen - a life cycle assessment approach.

Shipping is a very important source of pollution worldwide. In recent years, numerous actions and measures have been developed trying to reduce the levels of greenhouse gases (GHG) from the marine exhaust emissions in the fight against climate change, boosting the Sustainable Development Goal 13. Following this target, the action of hydrogen as energy vector makes it a suitable alternative to be used as fuel, constituting a very promising energy carrier for energy transition and decarbonization in maritime transport. The objective of this study is to develop an ex-ante environmental evaluation of two promising technologies for vessels propulsion, a H2 Polymeric Electrolytic Membrane Fuel Cell (PEMFC), and a H2 Internal Combustion Engine (ICE), in order to determine their viability and eligibility compared to the traditional one, a diesel ICE. The applied methodology follows the Life Cycle Assessment (LCA) guidelines, considering a functional unit of 1 kWh of energy produced. LCA results reveal that both alternatives have great potential to promote the energy transition, particularly the H2 ICE. However, as technologies readiness level is quite low, it was concluded that the assessment has been conducted at a very early stage, so their sustainability and environmental performance may change as they become more widely developed and deployed, which can be only achieved with political and stakeholder's involvement and collaboration.

Preimplantation factor modulates trophoblastic invasion throughout the decidualization of human endometrial stromal cells.

BACKGROUND: Successful human embryo implantation requires the differentiation of endometrial stromal cells (ESCs) into decidual cells during a process called decidualization. ESCs express specific markers of decidualization, including prolactin, insulin-like growth factor-binding protein-1 (IGFBP-1), and connexin-43. Decidual cells also control of trophoblast invasion by secreting various factors, such as matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases. Preimplantation factor (PIF) is a recently identified, embryo-derived peptide with activities at the fetal-maternal interface. It creates a favorable pro-inflammatory environment in human endometrium and directly controls placental development by increasing the human trophoblastic cells' ability to invade the endometrium. We hypothesized that PIF's effects on the endometrium counteract its pro-invasive effects. METHODS: We tested sPIF effect on the expression of three decidualization markers by RT-qPCR and/or immunochemiluminescence assay. We examined sPIF effect on human ESC migration by performing an in vitro wound healing assay. We analyzed sPIF effect on endometrial control of human trophoblast invasion by performing a zymography and an invasion assay. RESULTS: Firstly, we found that a synthetic analog of PIF (sPIF) significantly upregulates the mRNA expression of IGFBP-1 and connexin-43, and prolactin secretion in ESCs - suggesting a pro-differentiation effect. Secondly, we showed that the HTR-8/SVneo trophoblastic cell line's invasive ability was low in the presence of conditioned media from ESCs cultured with sPIF. Thirdly, this PIF's anti-invasive action was associated with a specifically decrease in MMP-9 activity. CONCLUSION: Taken as a whole, our results suggest that PIF accentuates the decidualization process and the production of endometrial factors that limit trophoblast invasion. By controlling both trophoblast and endometrial cells, PIF therefore appears to be a pivotal player in the human embryo implantation process.

Safety of perioperative hyperthermic intraperitoneal chemotherapy with gemcitabine in patients with resected pancreatic adenocarcinoma: a pilot study of the clinical trial EudraCT 2016-004298-41.

BACKGROUND: Hyperthermic intraperitoneal chemotherapy (HIPEC) with gemcitabine, after cytoreductive surgery, may reduce the tumor progression of pancreatic cancer through the reduction of the neoplastic volume and the subpopulation of residual pancreatic cancer stem cells, improving the survival of patients with pancreatic cancer and decreasing the recurrence of the disease. METHODS: A pilot study is performed with the first ten patients in the experimental group. A randomized study (phase II-III clinical trial) that requires a population of 42 patients, with 21 patients in each group. All patients have a diagnosis of ductal adenocarcinoma of the pancreas, which will be surgically resected with curative intention. (I) Group I: after an R0 resection, patients receive individualized adjuvant treatments. (II) Group II: after an R0 resection, HIPEC is performed with gemcitabine (120 mg/m2 for 30 min), and they also receive individualized adjuvant treatments. To analyze the safety of the procedure, the main variables measured were as follows: grades of complications by means of the Clavien-Dindo system: pancreas surgery complications (e.g., pancreatic fistula, perioperative hemorrhage, delayed gastric emptying, biliary fistula), operative mortality, and laboratory parameters to control system functions. Values were measured three times: preoperatively, twenty-four hours after surgery, and on the 7th postoperative day. RESULTS: From 2018 to 2019, 31 patients were recruited for our clinical trial. Fifteen patients were excluded because of intraoperative unresectability or a different intraoperative histologic diagnosis. Ten patients were included in the experimental group (resection plus HIPEC gemcitabine). The mean age was 65±7 years, and six patients were female (60%). We confirmed the histologic diagnosis of ductal pancreatic adenocarcinoma in all patients prior to HIPEC. Total pancreatectomy was performed in five patients. The surgical median time was 360 min, and the hospital stay was 11 days. Four patients showed complications classified as Clavien-Dindo type II and one showing type I. Six patients were classified as having stage III tumors. To date, no hospital mortality, locoregional recurrence, or differences between the two groups in terms of perioperative complications, biochemical and gasometric values, or Clavien-Dindo complication grades were observed. CONCLUSIONS: Our clinical pilot study demonstrated a similar perioperative outcome that allows the trial until main objectives are achieved.

Predictors of mortality in patients with rib fractures.

BACKGROUND: The aim of this study was to identify risk factors for morbidity and mortality in patients with rib fractures with focus on identifying a more exact age-dependent cut-off for increased morbidity and mortality. METHODS: Retrospective study of patients 16 years or older with rib fractures from blunt trauma. EXCLUSION CRITERIA: patients undergoing rib plating. Initial chest X-ray and Computed Tomography (CT) scans were re-read for the number of rib fractures (NRF) and presence of pulmonary contusion (PC). Data included demographics, mechanism of injury (MOI), NRF, associated injuries, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), Geriatric Trauma Outcome Score (GTOS), presence of pneumothorax, hemothorax, hemo-pneumothorax, PC, Adult Respiratory Distress Syndrome (ARDS), pulmonary complications (ventilator-associated pneumonia, nosocomial pneumonia), and mortality. PC was quantified from CT scans with Mimics. Continuous data were analyzed using Student's t test. Variables significantly different by univariate analysis were analyzed by logistic regression analysis. RESULTS: The study group consisted of 1188 adult trauma patients admitted during a 2-year period; 800 males and 388 females, with a mean age of 54 ± 21. MOI: MVC, 735 (61.8%); falls, 364 (30.6%); other: 89. Mean NRF, 4 ± 2; GCS, GTOS, and ISS, 15 (15-15), 101 (82-124), and 19 ± 9, respectively. Incidence of PC was 329 (27.7%); PTX, HTX, and HTX/PTX, 264 (20.2%), 57 (4.8%), and 147 (12.4%). Flail chest, in 17 (1.4%); 321 required mechanical ventilation. Age, GCS, male gender, and ISS but not NRF and/or PC were predictive of mortality. CONCLUSIONS: Increased mortality in patients with rib fractures starts at 65 years of age without a further increase until age ≥ 80. NRF does not predict increased mortality independent of age. Severe TBI is the most common cause of death in patients 16-75 years, as opposed to respiratory complications in patients 80 years-old or greater.

Maternal Obesity Influences Placental Nutrient Transport, Inflammatory Status, and Morphology in Human Term Placenta.

CONTEXT: Maternal obesity has a significant impact on placental development. However, this impact on the placenta's structure and function (ie, nutrient transport and hormone and cytokine production) is a controversial subject. OBJECTIVE: We hypothesized that maternal obesity is associated with morphologic, secretory, and nutrient-related changes and elevated levels of inflammation in the placenta. DESIGN: We collected samples of placental tissue from 2 well-defined groups of pregnant women from 2017 to 2019. We compared the 2 groups regarding placental cytokine and hormone secretion, immune cell content, morphology, and placental nutrient transporter expressions. SETTING: Placenta were collected after caesarean section performed by experienced clinicians at Centre Hospitalier Intercommunal (CHI) of Poissy-Saint-Germain-en-Laye. PATIENTS: The main inclusion criteria were an age between 27 and 37 years old, no complications of pregnancy, and a first-trimester body mass index of 18-25 kg/m2 for the nonobese (control) group and 30-40 kg/m2 for the obese group. RESULTS: In contrast to our starting hypothesis, we observed that maternal obesity was associated with (1) lower placental IL-6 expression and macrophage/leukocyte infiltration, (2) lower placental expression of GLUT1 and SNAT1-2, (3) a lower placental vessel density, and (4) lower levels of placental leptin and human chorionic gonadotropin production. CONCLUSION: These results suggest that the placenta is a plastic organ and could optimize fetal growth. A better understanding of placental adaptation is required because these changes may partly determine the fetal outcome in cases of maternal obesity.

Qualidade de vida de mulheres negras com câncer de mama: uma revisão de literatura / Quality of life of black women with breast cancer: a literature review

Há mais de duas décadas, a Organização da Mundial da Saúde propôs uma definição para Qualidade de Vida (QV) e, desde então, numerosas pesquisas têm sido desenvolvidas em diferentes especialidades. Caracterizada pela multidimensionalidade, subjetividade e dinamismo, a QV abrange diversos domínios da existência humana, incluindo-se fatores de natureza sociocultural, como gênero e etnia. Considerando a necessidade de ampliar conhecimentos específicos sobre QV, realizou-se uma revisão da literatura especializada, publicada entre 2014 e 2019, sobre QV de mulheres negras com câncer de mama. Para tanto, foram consultadas as bases BVS Psi, SciELO, MEDLINE/PubMed. Identificaram-se oito artigos, cuja análise apontou alguns indicadores relacionados à percepção negativa da QV: sintomas depressivos e ansiosos, idade inferior a 50 anos, estar em quimioterapia e tipo de câncer. Constatou-se, também, que bem-estar espiritual/religioso sobressaiu como fator associado a uma percepção de QV mais favorável. Concluiu-se que mais estudos são necessários, notadamente para fundamentar intervenções em Oncologia.

More than two decades ago, the World Health Organization proposed a definition for Quality of Life (QOL) and, since then, numerous studies have been developed in different specialties. Characterized by multidimensionality, subjectivity and dynamism, QOL comprises several domains of human existence, including factors of a socio-cultural nature, such as gender and ethnicity. Considering the need to expand specific knowledge about QOL, a review of the literature published between 2014 and 2019 on the QOL of black women with breast cancer, was carried out. The BVS Psi, SciELO, MEDLINE/PubMed databases were consulted. Eight articles were identified, whose analysis pointed out some indicators related to the negative perception of QOL: depressive and anxious symptoms, age below 50 years, being on chemotherapy and type of cancer. It was also found that spiritual /religious well-being stood out as a factor associated with a more favorable perception. It was concluded that more studies were needed.

Variante anatómica sintomática de la duplicación de la vía biliar común tipo IV.

INTRODUCTION: Duplicity of the common bile duct is an unusual congenital disorder. CASE REPORT: A 80-year-old woman with duplication of the common bile duct with retrograde endoscopic cholangiopancreatography (ERCP) who did not resolve the symptoms. DISCUSSION: Our case is a variant of type IV to the classification of duplicity of the common bile duct. The magnetic resonance cholangiography and presurgical ERCP allows assessment of the bile ducts, their caliber, and assessment of abnormalities. The treatment before duplicity of the common bile duct will depend on the clinic and the type of opening of the accessory common bile duct. CONCLUSIONS: It is important to perform a pre-surgical study and during surgery with intrasurgical cholangiography.

INTRODUCCIÓN: La duplicidad del conducto biliar común es una alteración congénita insólita. CASO CLÍNICO: Mujer de 80 años con duplicación de la vía biliar común con colangiopancreatografías retrógradas endoscópicas (CPRE) que no solventan la clínica. DISCUSIÓN: Nuestro caso es una variante del tipo IV de la clasificación de duplicidad del conducto biliar común. La colangiopancreatografía por resonancia magnética y la CPRE prequirúrgica permiten valorar las vías biliares, su calibre y sus posibles anormalidades. El tratamiento dependerá de la clínica y del tipo de apertura del conducto biliar común accesorio. CONCLUSIONES: Es importante realizar un estudio prequirúrgico y durante la cirugía con colangiografía intraoperatoria.

Anatomy variant symptomatic of the duplication of the common bile duct type IV.

INTRODUCTION: Duplicity of the common bile duct (BCBD) is an unusual congenital disorder. CASE REPORT: A 80-year-old woman with duplication of the common bile duct with retrograde endoscopic cholangiopancreatography (ERCP) who did not resolve the symptoms. DISCUSSION: Our case is a variant of type IV to the classification of DCBC. The MR cholangiography and presurgical ERCP allows assessment of the bile ducts, their caliber, and assessment of abnormalities. The treatment before DCBC will depend on the clinic and the type of opening of the CBCA. CONCLUSIONS: It is important to perform a pre-surgical study and during surgery with CIO.

INTRODUCCIÓN: La duplicidad del conducto biliar común (DCBC) es una alteración congénita insólita. CASO CLÍNICO: Mujer de 80 años con duplicación de la vía biliar común con colangiopancreatografía retrógrada endoscópica (CPRE) que no dilucida la clínica. DISCUSIÓN: Este caso es una variante del tipo IV de la clasificación de DCBC. La colangiorresonancia y la CPRE prequirúrgica permiten valorar las vías biliares, su calibre y las anormalidades. El tratamiento depende de la clínica y el tipo de apertura del conducto biliar común accesorio. CONCLUSIONES: Es importante realizar estudio prequirúrgico y durante la operación con colangiografía intraoperatoria.

Manifestaciones dermatológicas de la infección por COVID-19 en Pediatría / Dermatological manifestations of COVID-19 infection in paediatrics

Las manifestaciones clínicas de la COVID-19 son múltiples y variadas. Últimamente se han descrito lesiones cutáneas inespecíficas, más frecuentemente en niños y adolescentes, a veces como único síntoma clínico o en el contexto del cuadro típico de la infección. Presentamos el caso de un niño de 10 años con manifestaciones cutáneas como única clínica de infección por SARS-CoV-2 en el contexto epidemiológico y familiar propio de la enfermedad. Las situaciones de pandemia incrementan la relevancia de ampliar la sospecha diagnóstica ante cualquier tipo de síntomas e incluir aspectos epidemiológicos en el proceso diagnóstico. El pronóstico en niños sin comorbilidades, por lo general, es favorable, debiendo prestar especial atención a los signos inflamatorios y protrombóticos secundarios al SARS-CoV-2

Clinical manifestations of COVID-19 are multiple and varied. Non-specific skin lesions have been lately described, more frequently in children and adolescents, sometimes as the only clinical symptom or in the context of the typical picture of the infection. We present the case of a 10-year-old boy with skin manifestations as the only symptom of SARS-CoV-2 infection in the epidemiological and family context of the disease. Pandemic situations increase the relevance of extending diagnostic suspicion at any kind of symptom, and to include epidemiological aspects in the diagnostic process. Prognosis in children without comorbidities is usually favourable, but particular attention should be paid to inflammatory and prothrombotic signs secondary to SARS-CoV-2

Colorectal cancer metastases to the thyroid gland: A case report.

BACKGROUND: Secondary malignancies of the thyroid gland are a rare finding in clinical practice. In addition, colorectal metastasis to the thyroid (CMT) is even more infrequently diagnosed. The source of the primary tumor follows demographic and ethnic patterns, which reflects the most prevalent malignancies in the different populations. Colorectal cancer is one of the most common types of cancer worldwide; nevertheless, CMT is infrequently diagnosed. Most of them are identified during the follow-up of gastrointestinal primary malignancies. Due to the improvement of image techniques, oncological treatment, and follow-up, survival and consequent diagnosis of metastatic disease are more frequent. Those facts make this entity a diagnostic and therapeutic challenge, due to the lack of information and the difficulties performing clinical trials and research. CASE SUMMARY: Here, we present a case report of a patient diagnosed with CMT of adenocarcinoma of the rectum evidenced during follow-up, 4 years after neoadjuvant chemoradiotherapy, who had subsequent curative surgical treatment of the primary tumor and inter-current lung bilateral metastases. CONCLUSION: Thyroid metastases of extra-thyroid origin are an uncommon finding, even rarer in cases of CMT. The diagnostic process, as well as survival of oncologic patients is improving, and consequently the number of metastases to the thyroid gland is increasing.