The value of PET/CT for cytoreductive surgery selection in recurrent ovarian carcinoma.

OBJECTIVE: To evaluate the value of positron emission tomography/computed tomography (PET/CT) in predicting no residual disease (NRD) after secondary cytoreductive surgery (SCS) compared with MSK criteria, the iMODEL, and the AGO score. METHODS: We analyzed 112 patients with platinum-sensitive ovarian carcinoma who underwent SCS. We excluded patients for whom PET/CT was not performed, those without sufficient data, and who received chemotherapy before SCS. Ultimately, 69 patients were included. RESULTS: Variables that correlated with NRD were peritoneal carcinomatosis index (odds ratio [OR]=0.91; 95% confidence interval [CI]=0.83-0.99; p=0.044), European Cooperative Oncology Group Performance Status (ECOG) 0 (OR=8.0; 95% CI=1.34-47.5; p=0.022), and ≤2 lesions by PET/CT (OR=4.36; 95% CI=1.07-17.7; p=0.039). Of the patients with ≤2 lesions by PET/CT, 48 (92.3%) underwent complete SCS. The sensitivity, positive predictive value, negative predictive value, and accuracy of PET/CT for NRD were 85.7%, 92.3%, 33.3%, and 81.2%, respectively. NRD was achieved after fulfilling the MSK criteria, iMODEL and AGO Score in 89.1%, 88.1% and 85.9%, respectively. The accuracy of the MSK criteria, iMODEL, and AGO score in predicting NRD was 87%, 83.3%, and 77.3%, respectively. The PET/CT findings agreed well with the AGO score and iMODEL. The addition of PET/CT to these models increased the NRD rates (92.2%, 91.8%, and 89.4% for MSK+PET/CT, iMODEL+PET/CT, and AGO+PET/CT, respectively), but lowered their accuracy. CONCLUSION: We observed NRD in 92.3% of patients with ≤2 lesions by PET/CT, with an accuracy of 81.2%. PET/CT did not increase the accuracy of the MSK criteria, iMODEL, or AGO score models.

Impact of lymph node staging in presumed early-stage ovarian carcinoma.

OBJECTIVE: Our objective was to analyze the prevalence of lymph node metastasis in early-stage ovarian carcinoma after systematic lymph node dissection and its impact on indication of adjuvant chemotherapy. STUDY DESIGN: We evaluated a series of 765 patients diagnosed with ovarian carcinoma who underwent surgical treatment from February 2007 to December 2019. Patients with peritoneal disease and incomplete surgical staging were excluded. All cases underwent systematic pelvic and para-aortic lymphadenectomy up to the renal vessels. RESULTS: A total of 142 cases were analyzed. Median pelvic and para-aortic lymph node dissected were 30 (range, 6-81) and 21 (range, 3-86), respectively. Twelve (8.4%) patients had metastatic lymph nodes - high-grade serous, 10.4% (5/48); clear cell, 17.2% (5/29) and endometrioid, 5.7% (2/35). Any other histology (low grade serous, mucinous, carcinosarcoma or mixed) had lymph node metastasis. Notably, 50% of patients with positive lymph nodes had preoperative suspicious lymph nodes in imaging. The median hospital stay length was 6 days (range, 2-33) and 4.2% cases had grade ≥ 3 complications. A total of 110 (77.6%) patients underwent adjuvant chemotherapy and all cases had indication of adjuvant chemotherapy after histological type, despite the lymph node status. After a median follow-up of 52.5 months, we noted 24 (16.9%) recurrences. The 5-year recurrence-free survival and overall survival were 86.4% and 98.1%, respectively. High grade histology was the only variable that negatively impacted disease-free survival in univariate analysis [HR 4.70 (95%CI: 1.09-20); p = 0.037]. CONCLUSIONS: We found a positive lymph node rate of less than 10% after lymphadenectomy in presumed early-stage ovarian carcinoma. Lymph node status was not determinant for adjuvant chemotherapy.

Condições sanitárias de açúcar mascavo, demerara e de coco comercializados a granel na cidade de Maceió, AL / Sanitary, demerara and coconut health conditions marketed in bulk in the city of Maceió, AL

Independentemente do tipo de açúcar, este alimento é utilizado pela população, que o adquire tanto na forma embalada como a granel. Diversos micro-organismos presentes no ambiente podem contaminar alimentos, principalmente em produtos comercializados a granel, que são extremamente manipulados, existindo uma preocupação maior em se aplicar corretamente as boas práticas de fabricação tanto na produção como na comercialização deste tipo de produto. O objetivo deste estudo foi analisar microbiologicamente açúcares mascavo, demerara e de coco,comercializados a granel, em lojas de produtos naturais, na cidade de Maceió-AL. Foram escolhidas aleatoriamente dez lojas localizadas em diversos bairros. Foram quantificados bactérias do grupo coliformes e fungos por meio da técnica dos tubos múltiplos e do plaqueamento por semeadura em superfície de meio de cultura seletivo, respectivamente. As amostras de açúcares (100g) de cada tipo, foram adquiridas, em cada estabelecimento, de acordo com a disponibilidade destes. As amostras foram transportadas em temperatura ambiente para o laboratório de microbiologia para a realização das análises. 100% das amostras apresentaram contaminação por coliformes a 35°C e 45ºC e 84% por bolores e leveduras. Porém das oito amostras do açúcar de coco, sete do demerara e dez do mascavo apenas 2 amostras, uma da loja B e outra da loja G (20%), do açúcar mascavo apresentaram valores para coliformes a 45ºC acima do permitido pela legislação federal. Por meio deste estudo, pode-se verificar que tanto a produção como a comercialização dos açúcares a granel necessitam de uma maior fiscalização dos órgãos competentes, no que se diz respeito ao controle sanitário, para evitar que a população compre um produto de qualidade microbiológica duvidosa e fique susceptível a contrair doenças de origem alimentar.

Regardless of the type of sugar, this food is used by the population, that acquires both in packed as in bulk. Several microorganisms present in the environment can contaminate food, especially in products marketed in bulk, that are extremely manipulated, there is greater concern to apply properly the good manufacturing practices both in production and in marketing this product type. The aim of this study was to analyze microbiologically Brown sugars, demerara and coco, marketed in bulk, in natural food stores in the city of Maceió/AL. Were chosen randomly to ten stores located in various districts. Bacteria of the coliform group were quantified and fungi by means of multiple tube technique and plating for sowing in selective culture medium surface, respectively. Samples of sugar (100 g) of each type, were acquired in each establishment, according to the availability of these. The samples were transported at room temperature to the microbiology laboratory to carry out the analysis. 100% of the samples presented for coliform contamination to 35° C and 45° C and 84% for moulds and yeasts. But of the eight samples of coconut sugar, demerara seven and ten of the only 2 samples, Brown a B store and another of the store G (20%) of brown sugar apresentaramvalores to 45 ºc above the coliforms permitted by federal law. By meiodeste study, one can check that both the production and the marketing of the bulk sugar need greater supervision of competent bodies in respect of sanitary control, to prevent the people buy a product of microbiological quality and be susceptible to contracting food-borne diseases.

Qualidade microbiológica de refrigerantes industrializados comercializados na cidade de Maceió, AL / Microbiological quality of industrialized soft drinks marketed in the city of Maceio, AL

[{"text": "Refrigerantes são bebidas não alcoólicas,\r\nconsumidas mundialmente\r\npor milhões de pessoas, produzidas\r\ncom água, açúcar, suco natural ou\r\nextrato vegetal, corante, acidulante,\r\nantioxidante, aromatizante, conservador\r\ne gás carbônico. Os refrigerantes\r\nsão passíveis de contaminação\r\npor fungos e bactérias do grupo\r\ncoliformes. O objetivo desse estudo\r\nfoi pesquisar coliformes totais nos\r\nrefrigerantes industrializados acondicionados\r\ne comercializados em diversos\r\ntipos de embalagens na cidade\r\nde Maceió/AL. Participaram desta\r\npesquisa treze marcas comerciais encontradas\r\nno comercio varejista. De\r\nacordo com a disponibilidade de cada\r\nmarca, foram coletadas 51 amostras,\r\nsendo uma de cada tipo de embalagem:\r\nlata (350 mL), garrafa de vidro\r\n(290 mL e 1Litro) e garrafa PET (1 e\r\n2 Litros). Das marcas A, D, E, F e H\r\nforam coletadas cinco amostras; B e\r\nC quatro; G, I, J, K, L e M três, sendo\r\ntransportadas na embalagem original\r\nem temperatura ambiente até o laboratório\r\npara a realização das análises.\r\nOs coliformes totais foram pesquisados\r\npela técnica do Número Mais\r\nProvável. Todas as amostras apresentaram\r\n0,03 NMP/50mL evidenciando\r\nausência destes micro-organismos,\r\nenquadrando-se nos padrões\r\nestabelecidos pela legislação. Diante\r\ndos resultados pode-se constatar\r\nque, independente do sabor, do tipo\r\nde indústria e embalagem, todas as\r\nmarcas comerciais foram aprovadas,\r\nevidenciando, portanto, que as Boas\r\nPráticas de Fabricação foram aplicadas\r\ncorretamente em todos os níveis\r\nde procedimentos operacionais desta\r\nbebida não alcoólica.(AU)", "_i": "pt"}]

[Long term psychosocial outcomes of congenital heart disease in adolescents and young adults].

OBJECTIVE: Congenital heart disease (CHD) is a chronic illness with a high frequency in the worldwide population, and is normally diagnosed at birth or in uterus. Because of better conditions in diagnosis and early medical and surgical treatment, patients have survival rates of 90% and go further and further in life, facing different challenges in life cycle. In this study, we tested the effects of different demographic, clinical and psychosocial variables on the perception of quality of life (QOL), on psychosocial adjustment (PSA) and psychiatric morbidity (PM) of adolescents and young adults with CHD. We aimed to evaluate QOL, PM and PSA of adolescents and young adults with CHD and to determine which variables (demographic, clinical, and psychosocial) play a role in buffering stress and promoting resilience and which ones have a detrimental effect. METHODS: The study enrolled 150 CHD patients (87 males and 63 females), 12 to 26 years (17.45±3.373 years). The participants were interviewed regarding social support, family educational style, self-image, demographic information and physical limitations. They responded to questions in a standardized psychiatric interview (SADS-L) and completed self-reports questionnaires for assessment of QOL (WHOQOL-BREF) and PSA (YSR/ASR). RESULTS: We found a 18.7% lifetime prevalence of psychopathology in our participants (25.4% in females and 13.8% in males). 57.1% had retentions in school (1.53±0.804 year). The perception of QOL of CHD patients is better compared to the Portuguese population in the social relationships, environmental, physical and general dimensions. However, it is worse in female CHD patients and patients with poor academic performance and social support as well as in patients with complex or cyanotic CHD, moderate-to-severe residual lesions and physical limitations, and undergoing surgery. All of these variables, except presence of cyanosis, are also associated to a worse PSA. CONCLUSIONS: Female patients and patients with poor academic performance and poor social support refer worse PSA and QOL.

[Psychosocial adjustment, psychiatric morbidity and quality of life in adolescents and young adults with congenital heart disease]. / Ajustamento psicossocial, morbilidade psiquiátrica e qualidade de vida em adolescentes e jovens adultos com cardiopatias congénitas.

OBJECTIVES: We aimed to study the psychosocial adjustment (PSA), psychiatric morbidity and quality of life of adolescents and young adults with congenital heart disease (CHD) to determine which demographic and clinical variables negatively affect adjustment and which increase resilience. METHODS: The study included 74 patients with CHD, 41 male and 33 female, aged between 12 and 26 years (mean 18.76±3.86). Demographic information and a complete clinical history were obtained. The participants were interviewed regarding social support, family environment, self-image and physical limitations. A standardized psychiatric interview was conducted, and self-report questionnaires were administered for assessment of PSA (Youth Self Report and Adult Self Report) and quality of life (World Health Organization Quality of Life - Short Version). A caregiver completed an observational version of the PSA questionnaire (Child Behavior Checklist or Adult Behavior Checklist). RESULTS: Female participants showed more feelings of anxiety and depression (U=952.500; p=0.003), thought problems (U=929.500; p=0.005) and aggressive behavior (U=999.000; p=0.000). They also showed a higher rate of psychopathology. Patients with complex forms of CHD reported more thought problems (U=442.000; p=0.027) and internalization (U=429.000; p=0.021). Compared to the Portuguese population as a whole, participants showed better quality of life in the domains of social relationships (t=2.333; p=0.022) and environment (t=3.754; p=0.000). Patients who had undergone surgery had worse quality of life in physical terms (t=-1.989; p=0.050), social relationships (t=-2.012; p=0.048) and general quality of life (U=563.000; p=0.037), compared to those who were not operated. Better social support was associated with better quality of life in physical terms (t=3.287; p=0.002) and social relationships (t=3.669; p=0.000). Better school performance was also associated with better overall quality of life (U=457.000; p=0.046), less withdrawn behavior (U=812.500; p=0.031), fewer feelings of anxiety and depression (U=854.000; p=0.009), fewer attention problems (U=903.500; p=0.001), and lower scores for internalization (U=817.000; p=0.029) and externalization (U=803.500; p=0.042). Physical limitations had a detrimental effect on quality of life (U=947.500; p=0.001). DISCUSSION: Female participants were more prone to worse psychological adjustment and to psychopathology. Patients with complex forms of CHD showed worse PSA, as they need regular care, which restricts social contact with peers and family and integration in school and leisure activities. Patients who had undergone surgery showed worse quality of life as they often have long hospital stays, during which social activities are restricted, making it more difficult for them to develop a good social support network. They require close medical care, and the restrictions on their activities may be life-limiting. Their sense of survival may also be threatened. CONCLUSIONS: Patients with CHD appear to be more prone to psychopathology and female patients are more likely to show worse PSA. Social support was shown to play a crucial role in buffering stress and promoting patients' adjustment.

Long term psychosocial outcomes of congenital heart disease (CHD) in adolescents and young adults.

BACKGROUND: Congenital heart disease (CHD) is a chronic illness with a high frequency in the worldwide population, and is normally diagnosed at birth or in uterus. Because of better conditions in diagnosis and early medical and surgical treatment, patients have survival rates of 90% and go further and further in life, facing different challenges in life cycle. In this study, we tested the effects of different demographic, clinical and psychosocial variables on the perception of quality of life (QOL), on psychosocial adjustment (PSA) and psychiatric morbidity (PM) of adolescents and young adults with CHD. OBJECTIVES: We aimed to evaluate QOL, PM and PSA of adolescents and young adults with CHD and to determine which variables (demographic, clinical, and psychosocial) play a role in buffering stress and promoting resilience and which ones have a detrimental effect. METHODS: The study enrolled 150 CHD patients (87 males and 63 females), 12 to 26 years (M: 17.45±3.373 years). The participants were interviewed regarding social support, family educational style, self-image, demographic information and physical limitations. They responded to questions in a standardized psychiatric interview (SADS-L) and completed self-reports questionnaires for assessment of QOL (WHOQOL-BREF) and PSA (YSR/ASR). RESULTS: We found an 18.7% lifetime prevalence of psychopathology in our participants (25.4% in females and 13.8% in males). 57.1% had retentions in school (M: 1.53±0.804 year). The perception of QOL of CHD patients is better compared to the Portuguese population in the Social Relationships, Environmental, Physical and General Dimensions. However, it is worse in complex forms of CHD, in cyanotic patients, in moderate-to-severe residual lesions, in patients submitted to surgery and in patients with physical limitations. All of these variables, except presence of cyanosis, are also associated to a worse PSA. Social Support is very important in improving QOL of patients in all dimensions as well as academic performance. CONCLUSIONS: Female patients and patients with poor academic performance and poor social support refer worse PSA and QOL.

Quality of life experienced by adolescents and young adults with congenital heart disease.

This study aimed to assess the quality of life (QOL) experienced by adolescents and young adults with congenital heart disease (CHD) and to determine which factors negatively affect adjustment and which factors increase resilience. The participants in the study were 74 patients with CHD (41 males and 33 females) ranging in age from 12 to 26 years (mean age, 18.76 ± 3.86 years). Demographic information and a complete clinical history were obtained. The participants were interviewed regarding topics such as social support, family educational style, self-image, and physical limitations. They responded to questions in a standardized psychiatric interview (SADS-L) and completed a self-report questionnaire (WHOQOL-BREF) for assessment of QOL. Compared with the Portuguese population as a whole, the study patients had better QOL, especially with regard to the environmental dimension (t = 3.754; P = 0.000) and social relationships (t = 2.333; P = 0.022). Patients who had undergone surgery experienced poorer QOL in the physical dimension (t = -1.989; P = 0.050), in social relationships (t = -2.012; P = 0.048) and overall (Mann-Whitney U = 563.000; P = 0.037). Social support played a positive role in the QOL of the patients, both in the physical dimension (t = 3.287; P = 0.002) and in social relationships (t = 3.669; P = 0.000). A higher school achievement also was associated with higher levels of QOL overall (Mann-Whitney U = 457.000; P = 0.046) as well as in the physical (t = 2.045; P = 0.045) and environmental (t = 2.413; P = 0.018) dimensions. Physical limitations had a detrimental impact on general QOL (Mann-Whitney U = 947.500; P = 0.001) and on the physical (t = -2.910; p = 0.005) and psychological (t = -2,046; P = 0.044) dimensions. Patients with CHD tended to perceive QOL as better when their social networks were supportive.