O impacto da pandemia da COVID-19 nos exames de rastreamento do câncer no Brasil: um estudo comparativo dos cânceres de mama, próstata e colo de útero / The impact of the COVID-19 pandemic on cancer screening tests in Brazil: a comparative study of breast, prostate, and cervical cancers

Objetivo: Analisar a influência da pandemia da COVID-19 na execução dos exames de rastreamento e diagnóstico dos cânceres de próstata, mama e colo uterino na população brasileira. Métodos: Estudo analítico transversal e quantitativo com levantamento do número desses exames realizados pelo SUS (Sistema Único de Saúde). Os dados foram extraídos do Datasus nos períodos de pré-pandemia (março/2019 a fevereiro/2020) e pandemia (março/2020 a fevereiro/2021). Foram extraídos os números de exames realizados mês a mês e comparados os períodos pré-pandemia com o de pandemia. Foi realizada uma análise estatística descritiva, e as médias mensais de exames realizados nos dois períodos foram comparadas usando o teste t de Student. Resultados: Na comparação entre os períodos pré-pandemia e de pandemia, houve diminuição de média de 45,2% no número de exames citopatológicos, (194.978 exames por mês a menos; p < 0,00001), de 44,4% nos exames de mamografia (142.015 mamografias a menos por mês; p < 0,00001) e de 24,4% nos exames de antígeno prostático específico (PSA) (148.815 exames a menos por mês; p = 0,0012). Conclusão: A influência da pandemia gerou uma diminuição considerável no número de exames de rastreamento, mamografia, dosagem de PSA e citopatológico, o que deverá se traduzir em aumento nos casos de doença avançada, com graves consequências negativas para os pacientes e para o sistema de saúde.

Objective: To analyze the impact of COVID-19 pandemic on the number of screening and diagnostic cancer tests performed for prostate, breast and cervical cancer in the Brazilian population. Methods: This was a transversal analytical and quantitative study on the number of screening and diagnostic cancer tests performed in the public Brazilian health care system SUS (Sistema Único de Saúde). Data were collected from the Datasus (online SUS database) during pre-pandemic (March/2019 to February/2020) and pandemic periods (March/2020 to February/2021). We obtained the number of tests performed monthly for each of the tests and compared the two periods. Descriptive statistics were employed and the monthly average number of tests performed in each period were compared using the T Student test. Results: Comparing the pre-pandemic levels with pandemic levels, we found that there was a 45.2% decrease in the number of Papanicolaou (PAP smear) tests (194,978 less exams per month, p < 0,00001), 44.4% decrease in mammograms (142,015 less tests per month, p < 0,00001), and a reduction of 24.4% in the number of prostate specific antigen (PSA) tests per month (minus 148,815 exams performed, p < 0.0012). Conclusion: There was a statistically significant reduction in the number of screening/diagnostic mammograms, PAP smears and PSA performed during the pandemic period, compared to the period before COVID-19. This reduction may result in an increase in the number of cases diagnosed at an advanced stage, with grave consequences for the patients and for the sustainability of the healthcare system.

Amifostine reduces side effects and improves complete response rate during radiotherapy: results of a meta-analysis.

PURPOSE: To evaluate the efficacy of amifostine in diminishing radiotherapy side effects and whether or not it protects the tumor. METHODS AND MATERIALS: We performed a systematic review and meta-analysis of 14 included randomized controlled trials, comprising 1451 patients, comparing the use of radiotherapy vs. radiotherapy plus amifostine for cancer treatment. RESULTS: The use of amifostine significantly reduced the risk of developing mucositis (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.29-0.48; p < 0.00001), esophagitis (OR, 0.38; CI, 0.26-0.54; p < 0.00001), acute xerostomia (OR, 0.24; CI, 0.15-0.36; p < 0.00001), late xerostomia (OR, 0.33; CI, 0.21-0.51; p < 0.00001), dysphagia (OR, 0.26; CI, 0.07-0.92; p = 0.04), acute pneumonitis (OR, 0.15; CI, 0.07-0.31; p < 0.00001) and cystitis (OR, 0.17; CI, 0.09-0.32; p < 0.00001). There was no difference in overall response rate between the groups. However, complete response rate was superior for patients using amifostine (OR, 1.81; CI, 1.10-2.96; p = 0.02). CONCLUSIONS: This systematic review shows that amifostine significantly reduces the side effects of radiation therapy. The efficacy of radiotherapy was not itself affected by the use of this drug and patients receiving amifostine were able to achieve higher rates of complete response.

[Research]. / A pesquisa.

This text presents a reflection on the chief steps involved in experimental execution, and approaches sequentially the following aspects: a) what is research?, b) why carry out a research?, c) how can a research be useful in the future?, d) what are the stages involved in a research?, and e) who should be considered authors of a research? Finally, this article mentions the importance of results analysis and the relevance of the obtained results to the community.

A pesquisa / Research

O texto traz uma reflexão sobre os principais momentos da execução experimental, e aborda seqüencialmente: a) o que é a pesquisa?, b) por que fazer pesquisa?, c) como a pesquisa pode ser útil posteriormente?, d) quais são as etapas da pesquisa?, e) quem serão os autores da pesquisa? Finaliza citando a importância da análise de resultados e sua inserção no contexto da coletividade

Searching the Literatura Latino Americana e do Caribe em Ciências da Saúde (LILACS) database improves systematic reviews.

BACKGROUND: An unbiased systematic review (SR) should analyse as many articles as possible in order to provide the best evidence available. However, many SR use only databases with high English-language content as sources for articles. Literatura Latino Americana e do Caribe em Ciências da Saúde (LILACS) indexes 670 journals from the Latin American and Caribbean health literature but is seldom used in these SR. Our objective is to evaluate if LILACS should be used as a routine source of articles for SR. METHODS: First we identified SR published in 1997 in five medical journals with a high impact factor. Then we searched LILACS for articles that could match the inclusion criteria of these SR. We also checked if the authors had already identified these articles located in LILACS. RESULTS: In all, 64 SR were identified. Two had already searched LILACS and were excluded. In 39 of 62 (63%) SR a LILACS search identified articles that matched the inclusion criteria. In 5 (8%) our search was inconclusive and in 18 (29%) no articles were found in LILACS. Therefore, in 71% (44/72) of cases, a LILACS search could have been useful to the authors. This proportion remains the same if we consider only the 37 SR that performed a meta-analysis. In only one case had the article identified in LILACS already been located elsewhere by the authors' strategy. CONCLUSION: LILACS is an under-explored and unique source of articles whose use can improve the quality of systematic reviews. This database should be used as a routine source to identify studies for systematic reviews.