Predictors of cancer in patients with acute pulmonary embolism.

BACKGROUND: Acute pulmonary embolism (PE) can occur as a manifestation of an underlying cancer and be of paraneoplastic aetiology. A previously unknown cancer is sometimes diagnosed after the acute PE diagnosis. The identification of a group of patients with elevated probability of having an occult cancer underlying PE was never performed. We aimed to determine predictors of occult cancer in acute PE. Our hypothesis was that the D-dimer levels would be a predictor of cancer. PATIENTS AND METHODS: We retrospectively analysed a cohort of patients hospitalized with acute PE. EXCLUSION CRITERIA: <18 years, venous embolism only of veins other than pulmonary territory or when the embolism was considered chronic, and no image confirmation of acute PE. Patients were grouped according to the timing of cancer diagnosis: 1) known concomitant active cancer, 2) cancer diagnosed during acute PE admission or in the following 2 years and, 3) no known cancer during the 2-year follow-up since PE diagnosis. Predictors of concomitant cancer were determined using a logistic regression analysis. Multivariate models were built. RESULTS: We studied 562 patients; median age was 72 years and 219 (39.0 %) were men. In 223 (39.7 %) of the patients the PE was of central arteries and 61.4 % presented with bilateral PE. PE was considered unprovoked at time of discharge in 47.7 %. Median (interquartile range) D-dimer level was 7.98 (3.30-14.99) µg/mL. A total of 126 (22.4 %) patients were in group 1, 47 in group 2 (cancer diagnosed after the diagnosis of acute PE and up to 2 years) and 389 patients were in group 3. Elevated D-dimer levels were independently associated with already known cancer. D-dimer were independent predictors of future cancer diagnosis: OR = 1.07 ((95 % CI: 1.01-1.14) per each 5 ng/mL increase; for patients with D-dimer >15.0 µg/mL the OR of future cancer was 2.10 (1.05-4.18). If only patients with unprovoked PE upon admission (n = 307) were to be considered results were similar considering D-dimer; anaemia also predicted unknown cancer [OR = 2.13 (1.08-4.16)]. CONCLUSIONS: Patients with D-dimer >15 µg/mL presented a >2-fold higher risk of being diagnosed with a cancer condition in the upcoming 2 years. D-dimer may help clinicians in identifying which patients are at higher risk of occult cancer.

360 Health Analysis (H360)-A Comparison of Key Performance Indicators in Breast Cancer Management across Health Institution Settings in Portugal.

BACKGROUND: The increased focus on quality indicators (QIs) and the use of clinical registries in real-world cancer studies have increased compliance with therapeutic standards and patient survival. The European Society of Breast Cancer Specialists (EUSOMA) established QIs to assess compliance with current standards in breast cancer care. METHODS: This retrospective study is part of H360 Health Analysis and aims to describe compliance with EUSOMA QIs in breast cancer management in different hospital settings (public vs. private; general hospitals vs. oncology centers). A set of key performance indicators (KPIs) was selected based on EUSOMA and previously identified QIs. Secondary data were retrieved from patients' clinical records. Compliance with target KPIs in different disease stages was compared with minimum and target EUSOMA standards. RESULTS: A total of 259 patient records were assessed. In stages I, II, and III, 18 KPIs met target EUSOMA standards, 5 met minimum standards, and 8 failed to meet minimum standards. Compliance with KPIs varied according to the type of hospital (particularly regarding diagnosis) and disease stage. Although small differences were found in KPI compliance among institutions, several statistical differences were found among treatment KPIs according to disease stage, particularly in stage III. CONCLUSIONS: This study represents the first assessment of the quality of breast cancer care in different hospital settings in Portugal and shows that, although most QIs meet EUSOMA standards, there is room for improvement. Differences have been found across institutions, particularly between oncology centers and general hospitals, in diagnosis and compliance with KPIs among disease stages. Stage III showed the greatest variability in compliance with treatment KPIs, probably related to the lower specificity of the guidelines in this disease stage.

Effect of Impact Position on Repaired Composite Laminates Subjected to Multi-Impacts.

Because the certification of aircraft structures requires significant costs and time-consuming experimental tests, all the studies carried out are strong contributions to the applicability of repairs based on adhesively bonded fibre composite patches. In this context, the main goal of this study aims to analyse the effect of the impact position on the multi-impact response of repaired composites. The results will be compared with those obtained in composites containing holes. Therefore, experimental tests will be carried out using an energy of 8 J and centrally supported samples. It was noted that the patch region proved to be very sensitive to impact due to its thickness. Full perforation occurred after two to three impacts, and to obtain higher strength it would be necessary to increase the thickness of the patch. However, depending on the location of the repair, this could bring aerodynamic problems. For the distance of 15 mm from the centre, an overlap region, the repaired laminate shows 494.7% higher impact strength than a laminate with a hole. In this case, the effect of the stress concentration is determinant in the impact fatigue life. Finally, for the 35 mm distances that are close to the border, no significant changes in impact fatigue life were observed for both the repaired laminates and those containing the hole. This leads to the conclusion that the border effect is much more significant than the presence of the hole for this distance.

Female homicides in the state of Maranhão, Brazil, 2000-2019: an ecological study. / Homicídios femininos no Maranhão, Brasil, 2000-2019: estudo ecológico.

OBJECTIVE: To analyze the profile and temporal trends of female homicides in Maranhão, Brazil, between 2000 and 2019. METHODS: This was an ecological study using data from the Mortality Information System. The profile of the deaths, mortality rate trends (joinpoint method) and correlation with socioeconomic and health indicators (Pearson correlation) were evaluated. RESULTS: 1,915 female homicides were reported, with predominance among those between 20-29 years old (29.9%), single (62.0%), with 4-7 years schooling (29.7%), mixed race (71.3%), homicides at home (31.9%) and by firearms (41.1%). The mortality rate showed a rising trend (APC = +8.21; 95%CI 5.18;10.28). There was negative correlation between homicides and per capita income (p-value = 0.031) and positive correlation with the proportion of families headed by women (p-value = 0.001) and with the rate of male mortality due to assault (p-value = 0.001). CONCLUSION: There was an increase in female homicides, related to structural violence in society, poverty and women with greater family authority.

Direct evidence for phosphorus limitation on Amazon forest productivity.

The productivity of rainforests growing on highly weathered tropical soils is expected to be limited by phosphorus availability1. Yet, controlled fertilization experiments have been unable to demonstrate a dominant role for phosphorus in controlling tropical forest net primary productivity. Recent syntheses have demonstrated that responses to nitrogen addition are as large as to phosphorus2, and adaptations to low phosphorus availability appear to enable net primary productivity to be maintained across major soil phosphorus gradients3. Thus, the extent to which phosphorus availability limits tropical forest productivity is highly uncertain. The majority of the Amazonia, however, is characterized by soils that are more depleted in phosphorus than those in which most tropical fertilization experiments have taken place2. Thus, we established a phosphorus, nitrogen and base cation addition experiment in an old growth Amazon rainforest, with a low soil phosphorus content that is representative of approximately 60% of the Amazon basin. Here we show that net primary productivity increased exclusively with phosphorus addition. After 2 years, strong responses were observed in fine root (+29%) and canopy productivity (+19%), but not stem growth. The direct evidence of phosphorus limitation of net primary productivity suggests that phosphorus availability may restrict Amazon forest responses to CO2 fertilization4, with major implications for future carbon sequestration and forest resilience to climate change.

Homicides of women in the state of Maranhão, Brazil, 2000-2019: ecological study / Homicidios de mujeres en el estado de Maranhão, Brasil, 2000-2019: estudio ecológico / Homicídios de mulheres no Maranhão, 2000-2019: estudo ecológico

Objective: To analyze female homicides in Maranhão between 2000-2019. Methods: Ecological study, with data from the Mortality Information System. The profile of deaths, trend of mortality rates (Joinpoint method) and correlation with socioeconomic, and health indicators (Pearson correlation) were evaluated. Results: 1,915 female homicides were reported, with a predominance between 20-29 years old (29.9%), single (62.0%), with 4-7 years of study (29.7%), brown (71.3%), occurred at home (31.9%) and by firearm (41.1%). The trend of mortality rates was increasing (APC = +8.21 ­ 95%CI 5.18;10.28). There was negative correlation between homicides and per capita income (p-value = 0.031) and a positive correlation with proportion of families headed by women (p-value = 0.001) and male mortality rate due to aggression (p-value = 0.001). Conclusion: There was an increase in female homicides, related to structural violence in society, poverty and women with greater family authority.

Objetivo: Analizar homicidios de mujeres en Maranhão entre 2000-2019. Métodos: Estudio ecológico, con datos del Sistema de Información de Mortalidad. Se evaluó el perfil de muertes, la tendencia de las tasas de mortalidad (método Joinpoint) y la correlación con indicadores socioeconómicos y de salud (correlación de Pearson). Resultados: Ocurrió 1.915 homicidios de mujeres, con predominio entre 20-29 años (29,9%), solteras (62,0%), con 4-7 años de estudio (29,7%), morenas (71,3%), en casa (31,9%) y por arma de fuego (41,1%). Tendencia de las tasas de mortalidad fue creciente (VPA = +8,21; IC95% 5,18;10,28). Hubo correlación negativa entre homicidios y ingreso per capita (p-valor = 0,031) y correlación positiva con proporción de familias encabezadas por mujeres (p-valor = 0,001) y tasa de mortalidad masculina por agresión (p-valor = 0,001). Conclusión: Hubo aumento de los homicidios de mujeres, relacionado con violencia estructural en la sociedad, pobreza y mujeres con mayor autoridad familiar.

Objetivo: Analisar o perfil e tendência temporal dos homicídios femininos no Maranhão, Brasil, em 2000-2019. Métodos: Estudo ecológico, com dados do Sistema de Informações sobre Mortalidade. Foram avaliados o perfil dos óbitos, tendência das taxas de mortalidade (método: joinpoint) e correlação com indicadores socioeconômicos e de saúde (correlação de Pearson). Resultados: Foram notificados 1.915 homicídios femininos, predominando a idade de 20-29 anos (29,9%), solteiras (62,0%), 4-7 anos de estudo (29,7%), raça/cor da pele parda (71,3%), no domicílio (31,9%), por arma de fogo (41,1%). A tendência das taxas de mortalidade foi crescente (VPA = +8,21 ­ IC95% 5,18;10,28). Observou-se correlação negativa dos homicídios com renda per capita (p-valor = 0,031), e positiva com proporção de famílias chefiadas por mulheres (p-valor = 0,001) e taxa de mortalidade masculina por agressão (p-valor = 0,001). Conclusão: Houve crescimento dos homicídios femininos, relacionados com violência estrutural na sociedade, pobreza e mulheres com maior autoridade familiar.

Moral Agency, Rules, and Temporality in People Who Are Diagnosed With Mild Forms of Autism: In Defense of a Sentimentalist View.

The origin of moral agency is a much-debated issue. While rationalists or Kantians have argued that moral agency is rooted in reason, sentimentalists or Humeans have ascribed its origin to empathic feelings. This debate between rationalists and sentimentalists still stands with respect to persons with mental disorders, such as individuals diagnosed with mild forms of Autism Spectrum Disorder (ASD), without intellectual impairment. Individuals with ASD are typically regarded as moral agents, however their ability for empathy remains debated. The goal of this paper is to investigate the mechanisms of moral actions in people with ASD, by finding arguments for the origin of their moral actions, supporting either the sentimentalist or the rationalist view of the dispute. We propose to revisit the debate using Interpretative Phenomenological Analysis to study the autobiographies of individuals with High-Functioning Autism (HFA) and Asperger Syndrome (AS). While conducting the systematic analysis of 10 autobiographies, we re-examined both the rationalist and the sentimentalist positions, considering the links between empathic feelings and moral agency. The investigation of the temporal dimensions of emotional experiences, an aspect overlooked by previous research, indicated that individuals with ASD empathize with others, but in different ways as compared to neurotypicals. A relationship between emotional experience and the type of moral agency exhibited by individuals with forms of ASD was established. As a consequence, our analyses support the sentimentalist stance on moral action.

Time perspective and amnestic mild cognitive impairment.

OBJECTIVE: We examined time perspective in patients with amnesic mild cognitive impairment (aMCI). Prior research has shown that aMCI is associated with difficulties in experiencing time duration and succession. However, this line of inquiry has not been extended to time perspective. We examined associations between aMCI and multiple dimensions of time perspective including perceived orientations and relationships among the past, present, and future. METHOD: Thirty aMCI patients and thirty-three healthy controls participated. Measures were the Time Orientation Scale (TOS), the Time Relation Scale (TRS), and the Zimbardo Time Perspective Inventory (ZTPI), as well as a comprehensive neuropsychological evaluation. RESULTS: The TRS was associated with aMCI. Patients with aMCI were more likely to perceive that time was unrelated than the healthy older adults. Among patients with aMCI, an unrelated time perspective was associated with poorer performance in executive function measures. However, aMCI was not associated with the TOS or the ZTPI. CONCLUSIONS: Patients with aMCI have difficulty in perceiving relationships among the past, present, and future. This could be the consequence of deficits in executive functions. This research suggests that patients with aMCI may have limited understanding for how their current behaviours are related to both their past and future.

Acute organ failure and risk of admission to intensive medical care in cancer patients: a single center prospective cohort study. / Falência aguda de órgão e risco de admissão em unidade de terapia intensiva nos pacientes oncológicos: estudo de coorte prospectivo unicêntrico.

OBJECTIVE: To ascertain the cumulative incidence of acute organ failure and intensive care unit admission in cancer patients. METHODS: This was a single-center prospective cohort study of adult cancer patients admitted for unscheduled inpatient care while on systemic cancer treatment. RESULTS: Between August 2018 and February 2019, 10,392 patients were on systemic treatment, 358 had unscheduled inpatient care and were eligible for inclusion, and 285 were included. The mean age was 60.9 years, 50.9% were male, and 17.9% of patients had hematologic cancers. The cumulative risk of acute organ failure was 39.6% (95%CI: 35 - 44), and that of intensive care unit admission among patients with acute organ failure was 15.0% (95%CI: 12 - 18). On admission, 62.1% of patients were considered not eligible for artificial organ replacement therapy. The median follow-up time was 9.5 months. Inpatient mortality was 17.5%, with an intensive care unit mortality rate of 58.8% and a median cohort survival of 134 days (95%CI: 106 - 162). In multivariate analysis, acute organ failure was associated with 6-month postdischarge mortality (HR 1.6; 95%CI: 1.2 - 2.2). CONCLUSION: The risk of acute organ failure in cancer patients admitted for unscheduled inpatient care while on systemic treatment was 39.6%, and the risk of intensive care unit admission was 15.0%. Acute organ failure in cancer patients was an independent poor prognostic factor for inpatient hospital mortality and 6-month survival.

OBJETIVO: Determinar a incidência cumulativa de falência aguda de órgão e internamento em unidade de terapia intensiva em pacientes oncológicos. MÉTODOS: Estudo de coorte prospectivo de pacientes oncológicos adultos em tratamento sistêmico antineoplásico, internados de forma não programada. RESULTADOS: Entre agosto de 2018 e fevereiro de 2019, 10.392 pacientes foram submetidos a tratamento sistêmico antineoplásico, sendo que 358 necessitaram de internamento hospitalar não programado e foram elegíveis para inclusão; por fim, 258 desses pacientes foram incluídos. A média de idade foi de 60,9 anos, e 50,9% eram do sexo masculino; 17,9% dos pacientes tinham câncer hematológico. O risco acumulado de falência de órgãos foi de 39,6% (IC95% 35 - 44) e o risco de internamento na unidade de terapia intensiva em pacientes com falência aguda de órgão foi de 15,0% (IC95% 12 - 18). À admissão em internamento, 62,1% dos pacientes foram considerados não elegíveis para terapia de substituição artificial de órgãos. O tempo mediano de seguimento foi de 9,5 meses. A mortalidade hospitalar foi de 17,5%, na unidade de terapia intensiva de 58,8%. A mediana de sobrevivência da coorte foi de 134 dias (IC95% 106 - 162). Na análise multivariada, a falência aguda de órgão se associou com a mortalidade aos 6 meses após a alta (hazard ratio: 1,6; IC95% 1,2 - 2,2). CONCLUSÃO: O risco de falência aguda de órgão em pacientes oncológicos admitidos para tratamento hospitalar não programado durante o tratamento sistémico foi de 39,6% e o risco de internamento em unidade de terapia intensiva foi de 15,0%. A falência aguda de órgão em pacientes oncológicos foi um fator de prognóstico independente para maior mortalidade intra-hospitalar e menor sobrevivência aos 6 meses após a alta.

Pancreatic neuroendocrine neoplasms: survival trend analysis of a comprehensive center.

Objectives: Therapeutic options for pancreatic neuroendocrine neoplasia (Pan-NEN) have increased over the last decade. We aim to understand the evolution of the prognosis of patients with diagnosis of Pan-NEN within a 12-year period, considering the implementation of new treatments. Methods: This study is a retrospective cohort study of patients diagnosed with Pan-NENs between 2006 and 2017. Survival outcome estimates were calculated by Kaplan-Meier method. The impact of baseline clinicopathological characteristics on survival was explored with the use of Cox proportional hazard model. Results: Of the 97 patients, 77 (79.9%) had well-differentiated neuroendocrine tumor (NET) according to WHO 2010 classification, and 52 (53.6%) had localized or locoregional disease. There were no differences between clinicopathological characteristics and survival outcomes when comparing patients diagnosed between 2006-2011 and 2012-2017. Neuroendocrine carcinoma - HR 2.76, 95% CI 1.17-6.55 - and stages III and IV at diagnosis were independent poor prognostic factors - HR 6.02, 95% CI 2.22-16.33 and HR 6.93, 95% CI 2.94-16.32, respectively. Conclusions: The new therapeutic approaches did not induce better survival outcomes on Pan-NEN in recent years. This is possibly due to the indolent nature of NET grades 1 and 2, even metastatic, allowing patients to be submitted to new target therapies along their disease course.

Homicídios femininos no Maranhão, Brasil, 2000-2019: estudo ecológico / Homicidios de mujeres en el estado de Maranhão, Brasil, 2000-2019: estudio ecológico / Female homicides in the state of Maranhão, Brazil, 2000-2019: an ecological study

Objetivo: Analisar o perfil e tendência temporal dos homicídios femininos no Maranhão, Brasil, em 2000-2019. Métodos: Estudo ecológico, com dados do Sistema de Informações sobre Mortalidade. Foram avaliados o perfil dos óbitos, tendência das taxas de mortalidade (método joinpoint) e correlação com indicadores socioeconômicos e de saúde (correlação de Pearson). Resultados: Foram notificados 1.915 homicídios femininos, predominando a idade de 20-29 anos (29,9%), solteiras (62,0%), 4-7 anos de estudo (29,7%), raça/cor da pele parda (71,3%), no domicílio (31,9%), por arma de fogo (41,1%). A tendência das taxas de mortalidade foi crescente (VPA = +8,21; IC95% 5,18;10,28). Observou-se correlação negativa dos homicídios com renda per capita (p-valor = 0,031), e positiva com proporção de famílias chefiadas por mulheres (p-valor = 0,001) e taxa de mortalidade masculina por agressão (p-valor = 0,001). Conclusão: Houve crescimento dos homicídios femininos, relacionados com violência estrutural na sociedade, pobreza e mulheres com maior autoridade familiar.

Objetivo: Analizar el perfil y la tendencia temporal de los homicidios de mujeres en Maranhão entre 2000-2019. Métodos: Estudio ecológico, con datos del Sistema de Información de Mortalidad. Se evaluó el perfil de muertes, la tendencia de las tasas de mortalidad (método joinpoint) y la correlación con indicadores socioeconómicos y de salud (correlación de Pearson). Resultados: Ocurrieron 1.915 homicidios de mujeres, con predominio entre los 20-29 años (29,9%), solteras (62,0%), con 4-7 años de estudio (29,7%), raza/color de piel parda (71,3%), en casa (31,9%) y por arma de fuego (41,1%). La tendencia de las tasas de mortalidad fue creciente (VPA = +8,21; IC95% 5,18;10,28). Hubo correlación negativa entre homicidios e ingreso per capita (p-valor = 0,031) y correlación positiva con proporción de familias encabezadas por mujeres (p-valor = 0,001) y tasa de mortalidad masculina por agresión (p-valor = 0,001). Conclusión: Hubo aumento de los homicidios de mujeres, relacionado con violencia estructural en la sociedad, pobreza y mujeres con mayor autoridad familiar.

Objective: To analyze the profile and temporal trends of female homicides in Maranhão, Brazil, between 2000 and 2019. Methods: This was an ecological study using data from the Mortality Information System. The profile of the deaths, mortality rate trends (joinpoint method) and correlation with socioeconomic and health indicators (Pearson correlation) were evaluated. Results: 1,915 female homicides were reported, with predominance among those between 20-29 years old (29.9%), single (62.0%), with 4-7 years schooling (29.7%), mixed race (71.3%), homicides at home (31.9%) and by firearms (41.1%). The mortality rate showed a rising trend (APC = +8.21; 95%CI 5.18;10.28). There was negative correlation between homicides and per capita income (p-value = 0.031) and positive correlation with the proportion of families headed by women (p-value = 0.001) and with the rate of male mortality due to assault (p-value = 0.001). Conclusion: There was an increase in female homicides, related to structural violence in society, poverty and women with greater family authority.

Effectiveness of Telephone Monitoring in Primary Care to Detect Pneumonia and Associated Risk Factors in Patients with SARS-CoV-2.

Improved technology facilitates the acceptance of telemedicine. The aim was to analyze the effectiveness of telephone follow-up to detect severe SARS-CoV-2 cases that progressed to pneumonia. A prospective cohort study with 2-week telephone follow-up was carried out March 1 to May 4, 2020, in a primary healthcare center in Barcelona. Individuals aged ≥15 years with symptoms of SARS-CoV-2 were included. Outpatients with non-severe disease were called on days 2, 4, 7, 10 and 14 after diagnosis; patients with risk factors for pneumonia received daily calls through day 5 and then the regularly scheduled calls. Patients hospitalized due to pneumonia received calls on days 1, 3, 7 and 14 post-discharge. Of the 453 included patients, 435 (96%) were first attended to at a primary healthcare center. The 14-day follow-up was completed in 430 patients (99%), with 1798 calls performed. Of the 99 cases of pneumonia detected (incidence rate 20.8%), one-third appeared 7 to 10 days after onset of SARS-CoV-2 symptoms. Ten deaths due to pneumonia were recorded. Telephone follow-up by a primary healthcare center was effective to detect SARS-CoV-2 pneumonias and to monitor related complications. Thus, telephone appointments between a patient and their health care practitioner benefit both health outcomes and convenience.

Eighty-four per cent of all Amazonian arboreal plant individuals are useful to humans.

Plants have been used in Amazonian forests for millennia and some of these plants are disproportionally abundant (hyperdominant). At local scales, people generally use the most abundant plants, which may be abundant as the result of management of indigenous peoples and local communities. However, it is unknown whether plant use is also associated with abundance at larger scales. We used the population sizes of 4,454 arboreal species (trees and palms) estimated from 1946 forest plots and compiled information about uses from 29 Amazonian ethnobotany books and articles published between 1926 and 2013 to investigate the relationship between species usefulness and their population sizes, and how this relationship is influenced by the degree of domestication of arboreal species across Amazonia. We found that half of the arboreal species (2,253) are useful to humans, which represents 84% of the estimated individuals in Amazonian forests. Useful species have mean populations sizes six times larger than non-useful species, and their abundance is related with the probability of usefulness. Incipiently domesticated species are the most abundant. Population size was weakly related to specific uses, but strongly related with the multiplicity of uses. This study highlights the enormous usefulness of Amazonian arboreal species for local peoples. Our findings support the hypothesis that the most abundant plant species have a greater chance to be useful at both local and larger scales, and suggest that although people use the most abundant plants, indigenous people and local communities have contributed to plant abundance through long-term management.

Falência aguda de órgão e risco de admissão em unidade de terapia intensiva nos pacientes oncológicos: estudo de coorte prospectivo unicêntrico / Acute organ failure and risk of admission to intensive medical care in cancer patients: a single center prospective cohort study

RESUMO Objetivo: Determinar a incidência cumulativa de falência aguda de órgão e internamento em unidade de terapia intensiva em pacientes oncológicos. Métodos: Estudo de coorte prospectivo de pacientes oncológicos adultos em tratamento sistêmico antineoplásico, internados de forma não programada. Resultados: Entre agosto de 2018 e fevereiro de 2019, 10.392 pacientes foram submetidos a tratamento sistêmico antineoplásico, sendo que 358 necessitaram de internamento hospitalar não programado e foram elegíveis para inclusão; por fim, 258 desses pacientes foram incluídos. A média de idade foi de 60,9 anos, e 50,9% eram do sexo masculino; 17,9% dos pacientes tinham câncer hematológico. O risco acumulado de falência de órgãos foi de 39,6% (IC95% 35 - 44) e o risco de internamento na unidade de terapia intensiva em pacientes com falência aguda de órgão foi de 15,0% (IC95% 12 - 18). À admissão em internamento, 62,1% dos pacientes foram considerados não elegíveis para terapia de substituição artificial de órgãos. O tempo mediano de seguimento foi de 9,5 meses. A mortalidade hospitalar foi de 17,5%, na unidade de terapia intensiva de 58,8%. A mediana de sobrevivência da coorte foi de 134 dias (IC95% 106 - 162). Na análise multivariada, a falência aguda de órgão se associou com a mortalidade aos 6 meses após a alta (hazard ratio: 1,6; IC95% 1,2 - 2,2). Conclusão: O risco de falência aguda de órgão em pacientes oncológicos admitidos para tratamento hospitalar não programado durante o tratamento sistémico foi de 39,6% e o risco de internamento em unidade de terapia intensiva foi de 15,0%. A falência aguda de órgão em pacientes oncológicos foi um fator de prognóstico independente para maior mortalidade intra-hospitalar e menor sobrevivência aos 6 meses após a alta.

ABSTRACT Objective: To ascertain the cumulative incidence of acute organ failure and intensive care unit admission in cancer patients. Methods: This was a single-center prospective cohort study of adult cancer patients admitted for unscheduled inpatient care while on systemic cancer treatment. Results: Between August 2018 and February 2019, 10,392 patients were on systemic treatment, 358 had unscheduled inpatient care and were eligible for inclusion, and 285 were included. The mean age was 60.9 years, 50.9% were male, and 17.9% of patients had hematologic cancers. The cumulative risk of acute organ failure was 39.6% (95%CI: 35 - 44), and that of intensive care unit admission among patients with acute organ failure was 15.0% (95%CI: 12 - 18). On admission, 62.1% of patients were considered not eligible for artificial organ replacement therapy. The median follow-up time was 9.5 months. Inpatient mortality was 17.5%, with an intensive care unit mortality rate of 58.8% and a median cohort survival of 134 days (95%CI: 106 - 162). In multivariate analysis, acute organ failure was associated with 6-month postdischarge mortality (HR 1.6; 95%CI: 1.2 - 2.2). Conclusion: The risk of acute organ failure in cancer patients admitted for unscheduled inpatient care while on systemic treatment was 39.6%, and the risk of intensive care unit admission was 15.0%. Acute organ failure in cancer patients was an independent poor prognostic factor for inpatient hospital mortality and 6-month survival.

Prevalence and factors associated with intimate partner violence during pregnancy in Caxias, state of Maranhão, Brazil, 2019-2020. / Prevalência e fatores associados à violência por parceiro íntimo na gestação em Caxias, Maranhão, 2019-2020.

OBJECTIVE: To analyze prevalence and factors associated with intimate partner violence during pregnancy. METHODS: This was a cross-sectional study, with data obtained through interviews conducted with pregnant women aged 10 to 49 years during the third trimester of pregnancy, living in Caxias, state of Maranhão, Brazil (2019-2020). The instrument of the World Health Organization Violence Against Women Study was used to identify violence. A hierarchical analysis was performed using multiple logistic regression. RESULTS: 233 pregnant women were interviewed. The prevalence of violence during pregnancy was 33.0%, with predominance of psychological violence (18.9%). In the final hierarchical model, women aged <20 years old (ORadj=2.09 - 95%CI 1.17;3.54) and illicit drug use by intimate partner (ORadj=8.78 - 95%CI 2.13;28.92) remained as factors associated with the outcome. CONCLUSION: Prevalence of violence during pregnancy was high, with illegal drug use by young women and their partners being factors associated with its occurrence.

Disseminated Saprochaete capitata fungal infection in a patient with acute myeloid leukemia.

The case highlights the importance of actively obtaining informative samples at an early stage and of prompt initiation of combination therapy with antifungal drugs.

Urachal carcinoma: A case of a rare neoplasm.

INTRODUCTION: Urachal carcinoma is a rare type of non-urothelial malignancy that arises from the urachal ligament, a remnant of fetal development. It frequently involves the dome of the bladder or its midline, with adenocarcinoma being the most common histological type. This malignancy is generally diagnosed in advanced stages and is associated with poor prognosis. CASE REPORT: A 40-year-old woman was referred to hospital due to recurrent urinary tract infections. Imaging studies showed the presence of a 3.7 cm tumor in the bladder dome that extended to the posterior region of the umbilicus. A biopsy through cystoscopy confirmed the diagnosis of urachal carcinoma. Since there were no metastases, the patient underwent partial cystectomy and resection of the urachal ligament and the umbilicus. Surgical margins were negative and it was considered a complete resection. Nine months later, disease progression occurred, with peritoneal carcinomatosis, multiple adenopathies and a 4 cm mass in the pelvic cavity with invasion of the vagina, rectum, and sigmoid colon. She began palliative chemotherapy with cisplatine and 5-fluorouracil. After 7 cycles, progression was again observed, with an increase of the pelvic mass, vaginal and rectal hemorrhage, multiple intramuscular implants, bilateral axillary adenopathies, as well as lesion in the right breast, which was compatible with metastasis from urachal carcinoma. She underwent hemostatic radiotherapy to the pelvic mass and second line palliative chemotherapy with gemcitabine and paclitaxel. After 4 cycles, the patient clinically deteriorated and eventually died. CONCLUSION: Urachal carcinoma is an aggressive malignancy. Although systemic treatment may be effective in disease control, a standard chemotherapy regimen is yet to be determined. Multicenter trials are needed to clarify the best treatment approach in these patients.

Prevalence and associated factors of intimate partner violence in Caxias, Maranhão state, Brazil, 2019-2020 / Prevalencia y factores asociados con la violencia por la pareja durante el embarazo en Caxias, Maranhão, Brasil, 2019-2020 / Prevalência e fatores associados à violência por parceiro íntimo na gestação em Caxias, Maranhão, 2019-2020

Objective: To analyze prevalence and associated factors of intimate partner violence during pregnancy Methods: Cross-sectional study, with data obtained through interviews with pregnant women aged 10 to 49 years old in the third trimester of pregnancy, residing in Caxias, Maranhão, Brazil (2019-2020). The World Health Organization Violence Against Women Study instrument was used to identify violence. A hierarchical analysis was performed using multiple logistic regression. Results: 233 pregnant women were interviewed. The prevalence of violence during pregnancy was 33%, with predominance of psychological violence (18.9%). In the final hierarchical model, woman's age <20 years (AOR=2.09 ­ 95%CI 1.17;3.54) and abuse of illicit drugs by intimate partner (AOR=8.78 ­ 95%CI 2.13;28.92) remained as factors associated with the outcome. Conclusion: Violence during pregnancy had a high prevalence, with young age of the woman and partner's consumption of illegal substances factors associated with its occurrence.

Objetivo: Analisar a prevalência e fatores associados à violência por parceiro íntimo na gestação. Métodos: Estudo transversal, com dados obtidos de entrevistas com grávidas de 10 a 49 anos de idade, no terceiro trimestre gestacional, residentes em Caxias, Maranhão, Brasil (2019-2020). Utilizou-se o instrumento World Health Organization Violence Against Women Study para identificação da forma de violência. Realizou-se análise hierarquizada por regressão logística múltipla. Resultados: Foram entrevistadas 233 gestantes. A violência na gestação apresentou prevalência de 33% com predomínio da violência psicológica (18,9%). No modelo hierarquizado final, a faixa etária da mulher <20 anos (ORaj=2,09 ­ IC95% 1,17;3,54) e o consumo de drogas ilícitas pelo parceiro (ORaj=8,78 ­ IC95% 2,13;28,92) mantiveram-se associados ao desfecho de violência. Conclusão: A violência na gestação apresentou elevada prevalência, sendo a idade jovem da mulher e o uso de substâncias ilícitas pelo parceiro fatores associados a sua ocorrência.

Aspectos epidemiológicos da mortalidade infantil / Epidemiological aspects of child mortality / Aspectos epidemiológicos de la mortalidad infantil

Objetivo: analisar a taxa de mortalidade infantil no Brasil, por regiões. Método: trata-se de um estudo quantitativo, descritivo, retrospectivo, epidemiológico, transversal. Compôs-se a amostra por todos os nascidos vivos e óbitos de crianças menores de um ano registrados no SINASC e SIM, respectivamente. Obtiveram-se os dados por meio da plataforma digital DATASUS. Resultados: registraram-se 128.332 óbitos infantis na região Nordeste durante esse período, tendo como seus principais fatores a idade materna menor de 14 anos, mães sem escolaridade, gestações com duração de 22 a 27 semanas, crianças nascidas de parto vaginal, sexo masculino, cor/raça indígena, peso ao nascer menor que 999 gramas e baixa atenção à mulher na gestação. Conclusão: concluiuse que grande parte dos óbitos infantis no Nordeste está ligada a causas maternas, evidenciando-se falha na assistência de saúde. Podem-se alterar esses números por meio de uma assistência prénatal adequada, planejamento familiar e qualificação da promoção de saúde.(AU)

Objective: to analyze the infant mortality rate in Brazil, by regions. Method: it is a quantitative, descriptive, retrospective, epidemiological, cross-sectional study. The sample was composed by all live births and deaths of children under one year of age registered in SINASC and YES, respectively. The data were obtained through the DATASUS digital platform. Results: there were 128,332 infant deaths in the Northeast region during this period, the main factors being maternal age under 14, mothers without schooling, pregnancies lasting from 22 to 27 weeks, children born vaginally, male, indigenous color/race, weight at birth less than 999 grams and low attention to women in pregnancy. Conclusion: It was concluded that a large part of the childhood deaths in the Northeast are linked to maternal causes, showing a failure in health care. These numbers can be changed through adequate prenatal care, family planning and health promotion qualification.(AU)

Objetivo: analizar la tasa de mortalidad infantil en Brasil, por región. Método: se trata de un estudio cuantitativo, descriptivo, retrospectivo, epidemiológico, transversal. La muestra estuvo compuesta por todos los nacidos vivos y defunciones de niños menores de un año registrados en SINASC y SIM, respectivamente. Los datos se obtuvieron utilizando la plataforma digital DATASUS. Resultados: se registraron 128,332 muertes infantiles en la región Noreste durante este período, siendo los principales factores la edad materna menor de 14 años, madres sin educación, embarazos de 22 a 27 semanas, niños nacidos por parto vaginal, varones, color / raza indígena, peso al nacer menor a 999 gramos y poca atención a la mujer durante el embarazo. Conclusión: se concluyó que gran parte de las muertes infantiles en el Noreste está relacionada a causas maternas, evidenciando una falla en la atención de salud. Estos números pueden modificarse mediante una atención prenatal adecuada, planificación familiar y calificación de la promoción de la salud.(AU)

Implications of venous thromboembolism GWAS reported genetic makeup in the clinical outcome of ovarian cancer patients.

Ovarian cancer (OC) represents the most lethal gynaecological neoplasia. Conversely, venous thromboembolism (VTE) and OC are intricately connected, with many haemostatic components favouring OC progression. In light of this bilateral relationship, genome-wide association studies (GWAS) have reported several single-nucleotide polymorphisms (SNPs) associated with VTE risk that could be used as predictors of OC clinical outcome for better therapeutic management strategies. Thus, the present study aimed to analyse the impact of VTE GWAS-identified SNPs on the clinical outcome of 336 epithelial ovarian cancer (EOC) patients. Polymorphism genotyping was performed using the TaqMan® Allelic Discrimination methodology. Carriers with the ZFPM2 rs4734879 G allele presented a significantly higher 5-year OS, 10-year OS and disease-free survival (DFS) compared to AA genotype patients with FIGO I/II stages (P = 0.009, P = 0.001 and P = 0.003, respectively). Regarding SLC19A2 rs2038024 polymorphism, carriers with the CC genotype presented a significantly lower 5-year OS, 10-year OS and DFS compared to A allele carriers in the same FIGO subgroup (P < 0.001, P = 0.004 and P = 0.005, respectively). As for CNTN6 rs6764623 polymorphism, carriers with the CC genotype presented a significantly lower 5-year OS compared to A allele carriers with FIGO I/II stages (P = 0.015). As for OTUD7A rs7164569, F11 rs4253417 and PROCR rs10747514, no significant impact on EOC patients' survival was observed. However, future studies are required to validate these results and uncover the biological mechanisms underlying our results.