Cocaine/crack and cannabis use among transgender women in Goiás, Central Brazil.

INTRODUCTION: Illicit drug use is a significant public health problem. Studies have shown a high prevalence of cocaine and cannabis use in transgender women (TGW). OBJECTIVE: To describe the consumption patterns of cannabis and cocaine/crack use and variables associated with their use in TGW in Central Brazil. METHODS: A cross-sectional study was conducted on TGW in Goiás, Brazil. Participants were recruited using a respondent-driven sampling method and were interviewed face-to-face about cannabis and crack-cocaine and the variables associated with them. The Alcohol Smoking and Substance Involvement Screening Test was used to assess substance use. Unweighted logistic regression was used to identify variables associated with cannabis and crack cocaine use. P-values < 0.05 were considered statistically significant. RESULTS: A total of 440 transgender women participated in the study. Their median age was 25 years (interquartile range: 20.5-29.5 years). Most participants were single (85.5%) and had engaged in sex work in their lifetime (58.6%). Cannabis was reported by 68.9% and 53.4% of participants in their lifetime and in the past three months, respectively, and cocaine/crack use was reported by 59.8% and 44.1% of participants in their lifetime and the past three months, respectively. Of the participants, 10.2% reported high-risk cannabis use, and 9.1% reported high-risk cocaine/crack use. Furthermore, 35% of participants reported using both drugs. Previous physical violence (Adjusted Odds Ratio (AOR): 2.37), inconsistent condom uses during anal sex (AOR: 2.17), and moderate-/high-risk cocaine/crack use (AOR: 3.14) were associated with high-risk cannabis use. Previous sexual violence (AOR: 2.84), previous STI (AOR: 2.90), moderate-/high-risk cannabis (AOR: 3.82), and binge drinking (AOR; 3.28) were associated with high-risk cocaine/crack use. CONCLUSION: Our study found a high frequency, significant overlap in the use of cannabis and cocaine/crack use and violence associated with these drugs consumption among TGW, highlighting the urgent need for health policies for drug disorders among this socially marginalized group.

Polycyclic aromatic hydrocarbons in surface water of rivers in Sergipe State, Brazil: A comprehensive analysis of sources, spatial and temporal variation, and ecotoxicological risk.

This study conducted in Sergipe State, Brazil, aimed to investigate the presence of polycyclic aromatic hydrocarbons (PAHs) in the surface water of five rivers, determining their sources, spatial and temporal variations, and ecotoxicological risks. Correlation and principal component analyses were utilized to identify the relationship between PAH concentrations and water sample properties. Results indicated higher PAH concentrations during the rainy season, attributed to increased run-off and sediment resuspension. The composition of PAHs suggested a main petroleum source with organic material combustion in minor scale. Ecological risk assessment revealed potential risks to the ecosystem, emphasizing the need for continuous monitoring of PAHs pollution. This study highlights the importance of understanding and mitigating PAHs contamination in rivers to protect aquatic ecosystems.

Alarming patterns of moderate and high-risk alcohol use among transgender women in Goiás, Central Brazil.

Background: Scant studies have examined alcohol consumption among transgender women in Latin America. This cross-sectional study estimated the prevalence and associated factors of risky alcohol use among transgender women in Goiás, a state located in the center of Brazil. Methods: Participants were 440 transgender women (median age = 35 years, interquartile range = 9) recruited through respondent-driven sampling. All participants were interviewed about sociodemographic characteristics, violence, and risk behavior. Alcohol use was assessed using the alcohol use disorders identification test (AUDIT). An AUDIT score greater than or equal to eight was considered as risky alcohol consumption. Logistic regression analysis was used to examine predictors of risky alcohol use, and p-values <0.05 were considered significant. Results: The majority were young, single, sex workers. Most transgender women had used alcohol in the previous year (85.7%), and more than half (56.6%) reported binge drinking and risky alcohol consumption (60.2%). There was a high overlap between sexual behavior, drugs, and alcohol use. Using alcohol during sex (adjusted odds ratio [aOR]: 2.9; 95% confidence interval [CI]: 1.7-4.8), cocaine/crack use (aOR: 2.3; 95% CI: 1.5-3.7) and having a drug user as a sexual partner (aOR: 2.9; 95% CI: 1.5-5.9) were independently associated with risky alcohol consumption. Conclusion: Alcohol consumption was highly prevalent, and drugs seem to play an important role in risky alcohol consumption among transgender women Goiás. These findings support stakeholders to promote intervention strategies to reduce this pattern of alcohol consumption and reduce the burden of substance use disorders among transgender women.

Association of body composition and surgical outcomes in patients with early-stage breast cancer.

BACKGROUND: Breast cancer is a disease that requires multimodality treatment, and surgical resection of the tumor is a critical component of curative intent treatment. Obesity, defined as a body mass index (BMI) > 30, has been associated with increased surgical complications. Additionally, sarcopenia, a condition of gradual loss of muscle mass, has been associated with worse breast cancer treatment outcomes. Sarcopenia occurs with increased age, inactivity, and poor diet leading to patient frailty, which can increase medical treatment complications. Even patients with high BMI can have sarcopenia (termed sarcopenic obesity). We investigated the association of sarcopenia with surgical complications for breast cancer. METHODS: A retrospective review was performed of patients diagnosed with breast cancer who received bioelectrical impedance spectrometry analysis of skeletal muscle mass and had surgery at our institution. Patient characteristics, treatment data, surgical type and complications were obtained from medical records. Multivariate logistic regression models were used to associate sarcopenia status and BMI with surgical complications, adjusted for other patient characteristics. RESULTS: We analyzed 682 patients with stage I to III breast cancer. On multivariable logistic regression controlling for age, BMI, comorbidities, and types of surgeries (lumpectomy, mastectomy with or without reconstruction), sarcopenia (p = 0.66) was not associated with surgical complications. Obesity was associated with a higher rate of surgical complications in patients who received mastectomy with reconstruction (p = 0.01). More complex surgical approaches were associated with a higher risk of surgical complications in our series. CONCLUSION: Compared with those undergoing lumpectomy or mastectomy without reconstruction, patients undergoing mastectomy with reconstruction were more likely to experience postoperative complications and obesity was associated with higher risk of complication in the latter group. We did not identify a correlation between sarcopenia and rate of adverse surgical outcomes.

Publication Trends Studies Involving Disabled Persons with Dental Care Needs: A 20-Year Bibliometric Analysis

ABSTRACT Objective: To evaluate scientific production on disabled persons with dental care needs over a 20-year period. Material and Methods: The search was conducted in the PubMed database using the MeSH terms "Disabled Persons" AND "Dentistry". Three researchers selected articles based on readings of the title, abstract and full text. The articles were categorized according to periodical, country, study design, subject and classification of comorbidities and associated disorders. Three hundred ninety-seven articles published in 140 periodicals were included. Results: The periodicals Special Care in Dentistry (54), Dental Clinics of North America (14) and British Dental Journal (14) accounted for 21% of the publications. The studies were conducted in 50 countries, with the United States accounting for 33%. More than half (52%) of the studies had a cross-sectional design. The main subject addressed was oral diagnosis and most of the comorbidities were generalized disabilities. Conclusion: Although a large number of the periodicals have contributed to knowledge building on disabled persons with dental care needs, the number of articles is small compared to other fields of dentistry. Moreover, important gaps in knowledge persist and projects with better methodological designs are needed to offer a more substantial contribution to clinical practice.

Bibliometric analysis and diagnostic efficacy of cone-beam computed tomography studies published in Imaging Science in Dentistry from 2011 to 2022.

Purpose: This bibliometric analysis aimed to provide a comprehensive overview of the characteristics, trends, and level of diagnostic efficacy of studies on cone-beam computed tomography (CBCT) published in Imaging Science in Dentistry (ISD) from 2011 to 2022. Materials and Methods: Publications related to CBCT identified in the electronic collection of ISD were selected according to eligibility criteria by 2 independent reviewers who collected data on the characteristics of the articles (year, authors, and country). The type and topic of studies were analyzed using VOSviewer v.1.6.18 (Centre for Science and Technology Studies, Leiden University, Leiden, Netherlands). The research articles were classified according to the hierarchical scale of diagnostic efficacy. Results: Of the 236 articles included, most were from South Korea and Brazil. Bong-Hae Cho and Yun-Hoa Jung were the most prolific authors on the topic of CBCT. The most frequently published types of studies were cross-sectional and laboratory-based. The most popular topics WERE related to the diagnosis of pathologies and/or alterations, as well as anatomical variations. On the diagnostic efficacy scale, most studies were rated level 1 (technical efficacy) or 2 (diagnostic accuracy efficacy). Conclusion: A steady increase was observed in publications related to CBCT, which are of both clinical and academic interest. The trends in these publications were analyzed, revealing that most are cross-sectional studies primarily exploring the capabilities of CBCT in diagnosing pathologies and/or changes in the oral and maxillofacial complex. These studies were typically classified as level 1 or 2 on the diagnostic efficacy scale.

A privação do sono e seus impactos no desenvolvimento de transtornos neurodegenerativos / Sleep deprivation and its impacts on the development of neurodegenerative disorders / La privación del sueño y su impacto en el desarrollo de trastornos neurodegenerativos

Introdução: A redução do tempo de sono, abaixo das necessidades básicas individuais, denominada privação do sono (PS) é alvo de pesquisas que buscam entender seus efeitos no organismo humano. Estudos em indivíduos que experienciam a PS regularmente demonstraram consequências negativas da prática na saúde humana. Objetivo: A fim de aprofundar o entendimento sobre o tema, esta revisão integrativa de literatura tem o objetivo de elucidar os impactos da PS na cognição, no humor e no desenvolvimento de transtornos neurodegenerativos. Métodos: Por meio da leitura de artigos, selecionados pelo método PRISMA, e da síntese de seus resultados. Resultados: Após análise, foram selecionados 18 artigos, que discutiam sobre o desenvolvimento de doenças neurodegenerativas. Como resultado, observou-se predominância, nos artigos, de impactos negativos da PS sobre o tema estudado, com pequena minoria demonstrando resultados inconclusivos ou sem impacto/impacto significativo, e sem relatos de impactos positivos. Nota-se prejuízos da PS no desenvolvimento de doenças neurodegenerativas, com alta relação à Doença de Alzheimer e relatos sobre Doença de Parkinson, Doença de Huntington e Esclerose Múltipla. Conclusão: Portanto, constata-se como a PS pode exercer impactos negativos no ser humano, notadamente para o desenvolvimento de transtornos neurodegenerativos.

Introduction: The reduction of sleep time, below individual basic needs, called sleep deprivation (SD), is the subject of research that seeks to understand its effects on the human body. Studies in individuals who experience SD regularly have shown negative consequences of this practice on human health. Objective: In order to deepen the understanding of the subject, this integrative literature review aims to elucidate the impacts of SD on the development of neurodegenerative disorders. Methods: Through the reading of articles, selected by the PRISMA method, and the synthesis of their results. After analysis, 18 articles were selected, in which was discussed the development of neurodegenerative. Results: As a result, there was a predominance, in the articles, of negative impacts of SD on the studied aspect, with a small minority demonstrating inconclusive results or results without impact or significant impact, and without any reports of positive impacts. It is noticeable that SD results in damages in the development of neurodegenerative diseases, with great association with Alzheimer's Disease and one report associating SD and Parkinson's Disease, Huntington's Disease and Multiple Sclerosis. Conclusion: Therefore, it is clear how SD can have negative impacts on humans, notably for the development of neurodegenerative disorders.

Introducción: La reducción del tiempo de sueño, abajo de las necesidades básicas individuales, denominada privación de sueño (PS), es objeto de investigación, que busca comprender sus efectos en el organismo humano. Los estudios en individuos que experimentan PS regularmente han mostrado consecuencias negativas de esta práctica en la salud humana. Objetivo: Con el fin de profundizar en la comprensión del tema, esta revisión integrativa de la literatura tiene como objetivo dilucidar los impactos de PS en el desarrollo de trastornos neurodegenerativos. Metodología: Através de la lectura de artículos, seleccionados por el método PRISMA, y la síntesis de sus resultados. Después del análisis, se seleccionaron 18 artículos, que discutieron el desarrollo de trastornos neurodegenerativos. Resultados: Como resultado, fue observado un predominio, en los artículos, de impactos negativos de la DS sobre lo aspecto estudiado, con una pequeña minoría demostrando resultados no concluyentes o resultados sin impacto o impacto significativo, y sin informes de impactos positivos. Es notorio que la PS resulta en daños en el desarrollo de enfermedades neurodegenerativas, con gran asociación con la Enfermedad de Alzheimer y un reporte asociando SD y Enfermedad de Parkinson, Enfermedad de Huntington y Esclerosis Múltiple. Conclusión: Por lo tanto, está claro cómo el PS puede tener impactos negativos en los seres humanos, en particular para trastornos neurodegenerativos.

Mild and Rapid Light-Driven Suzuki-Miyaura Reactions Catalyzed by AuPd Nanoparticles in Water at Room Temperature.

Organic reactions carried out in water under mild conditions are state-of-the-art in terms of environmentally benign chemical processes. In this direction, plasmonic catalysis can aid in accomplishing such tasks. In the present work, cyclodextrin-mediated AuPd bimetallic nanoparticles (NPs) were applied in room-temperature aqueous Suzuki-Miyaura reactions aiming at preparing biaryl products based on fluorene, isatin, benzimidazole and resorcinol, with yields of 77 % up to 95 %. AuPd NPs were revealed to be a physical mixture of Au and Pd particles circa 20 and 2 nm, respectively, through X-ray diffraction, dynamic light scattering, UV-Vis spectroscopy and transmission electron microscopy analyses.

Association of sarcopenia with endocrine therapy toxicity in patients with early breast cancer.

BACKGROUND: Endocrine therapy reduces recurrence risk and improves survival in women with hormone receptor-positive breast cancer; however, side effects can decrease quality of life, leading to reduced treatment adherence. Sarcopenia is the loss of skeletal muscle mass that happens with age; it is associated with worse survival and reduced chemotherapy adherence in patients with breast cancer. The impact of sarcopenia on endocrine therapy tolerance has not been investigated. The current study evaluates the associations of sarcopenia with endocrine therapy toxicity and treatment tolerance. METHODS: Skeletal muscle mass was measured by bioelectrical impedance spectrometry. Skeletal muscle index (SMI) was calculated to assess for sarcopenia: SMI = (SMM kg)/(patient height, m2). Patients with SMI ≤ 6.75 kg/m2 were considered sarcopenic. A chart review was performed to obtain patient characteristics, endocrine therapy toxicity, and early treatment change or termination. Fisher's exact test was performed to associate patient characteristics and outcomes with sarcopenia status. RESULTS: Four hundred eighty-two patients with stage I-III breast cancer were prescribed endocrine therapy and had undergone sarcopenia evaluation. The median age was 61 years (29-88 years). Sarcopenia was identified in 35% of patients. Twelve percent of patients experienced grade 3-4 endocrine-related toxicities. On multivariable logistic analysis, sarcopenia was associated with increased odds of experiencing endocrine-related side effects (p = 0.006). In addition, patients with sarcopenia stopped or changed their medication due to side effects more often than those without sarcopenia (p = 0.03). CONCLUSION: The presence of sarcopenia in patients with EBC represents a potentially modifiable risk factor for more significant endocrine therapy side effects and reduced treatment tolerance.

Micro-CT analysis of the mandibular bone microarchitecture of rats after radiotherapy and low-power laser therapy.

To investigate whether low-level laser therapy (LLLT), at different times of application (immediate and late) in the region of the parotid glands, has a distance effect on the microarchitecture of the trabecular bone in mandible of rats irradiated by volumetric modular arc therapy (VMAT). Thirty adult Wistar rats were randomly divided into placebo control groups (CG, n = 2), only radiotherapy (RG, n = 2), only LPLT (LG, n = 2), and two other groups using LLLT in the immediate time (24 h) (ILG, n = 12) and late (120 h) (LLG, n = 12) to radiotherapy by VMAT in a single dose of 12 Gy. LLLT with AsGaAl laser (660 nm, 100 mW), a spot size of 0.0028 cm2, was applied in three points in the region of the right parotid gland, with energy of 2 J/cm2, 20 s per point, for 10 consecutive days. After euthanasia, the right hemimandibles of each animal were dissected, prepared, and analyzed by computerized microtomography (micro-CT) and histomorphometry. The different groups were analyzed by the Tukey and Bonferroni multiple comparison tests. The micro-CT analysis found statistically significant differences between the groups, especially in the LLG, which had the highest average bone volume compared to the CG (p = 0.001) and ILG (p = 0.002) and a greater number of trabeculae than the CG (p = 0.000) and ILG (p = 0.031). The ILG also had a higher number of trabeculae than the CG (p = 0.005). Trabecula separation (Tb.Sp) was lower in the LLG (p = 0.000) and ILG (p = 0.002) when compared to the CG. In the histomorphometry, there was no statistical difference between the groups in relation to all the analyzed variables. Micro-CT analysis showed that the LLLT, even applied at a distance, both in the immediate and late VMAT times, has an effect on the mandibular bone microarchitecture by increasing the volume and number of trabeculae and decreasing the spaces between them.

Effect of Radiotherapy and Low-Level Laser Therapy on Circulating Blood Cells of Rats.

Introduction: This study aimed to investigate the effect of low-level laser therapy (LLLT) on the blood cell count when applied to parotid glands of rats irradiated by volumetric modular arc therapy (VMAT). Methods: Thirty-two adult male Wistar rats were used in this study. Samples were randomly assigned to three groups: control group (CG, n = 8), immediate laser group (24 hours) (ILG, n=12), and late laser group (120 hours) (LLG, n=12). The two laser groups were previously subjected to VMAT radiotherapy in a single dose of 12 Gy. LLLT with an AsGaAl laser (660 nm, 100 mW) was applied at three points in the region of the parotid glands, right side, with the energy of 2 J per point (20s, 70 J/cm2) and a spot size of 0.0028 cm2 for 10 consecutive days. In the euthanasia, blood samples were obtained by cardiac puncture. The samples from each group were processed by an automatic method and analyzed for erythrogram, leukogram and platelet count values. The data were analyzed by ANOVA and each LLLT time point was analyzed in relation to the control group, with a significance level less than 0.05. Results: Groups using LLLT had higher red blood cell counts, being higher in the LLG (P = 0.000). The hematimetric indices MCV (P = 0.002) and MCH (P = 0.009) were lower than the control group, especially when compared to the group using LLLT 120h after radiotherapy (LLG). White blood cell counts were lower in the groups with radiotherapy and immediate use of LLLT (ILG) (P = 0.011), mainly at the expense of lymphocytes (P = 0.002). Conclusion: The results suggest a potential systemic effect of LLLT, especially on circulating red blood cell counts, regardless of their time of immediate or late use of radiotherapy.

Visual facial perception of postsurgical cleft lip scarring assessed by laypeople via eye-tracking.

OBJECTIVES: This study aimed to evaluate the visual facial perception in response to scars associated with repaired cleft lip (CL) on a male adolescent model, as assessed by eye-tracking technology. MATERIAL AND METHODS: Unilateral and bilateral facial images of repaired CL on the upper lip and nasal asymmetry were added to an image of a male adolescent model, using Photoshop CS5 software. 40 laypeople eye movements were tracked by an infrared sensor of the Eye Tribe hardware in conjunction with OGAMA software. An analysis of variance was used to identify differences in total fixation time for the added areas of interest. A visual analog scale of attractiveness with a questionnaire were also incorporated into the study. Statistical analysis was performed using a significance level of P < 0.05. RESULTS: Significant differences were noted between the image with no scar and the image featuring a unilateral scar for total fixation time associated with the right eye (p = 0.002) and right nose area (p = 0.003), in addition to the numbers of fixations for the right eye (p = 0.005) and right nose area (p = 0.007). Comparing the image with no scar with the image featuring a bilateral scar showed a significant difference only for the number of fixations on the right eye (p = 0.005). The heatmaps and fixation point maps for both the unilateral and bilateral scar images indicated increased fixation for the scar areas. For the image with no scar, increased fixation was captured for the right eye area. Pearson's correlation coefficient test showed a moderate positive (p = 0.692) relationship when comparing to unilateral and bilateral cleft scars. CONCLUSIONS: The participating laypeople perceived the cleft-repaired faces and did not perceive any difference in attractiveness between the images featuring the unilateral and bilateral postsurgical clefts and lip scarring.

Relationship between anemia and oral cancer: a case-control study.

The aim of this study was to investigate the occurrence, type and severity of anemia at the time of diagnosis of oral cancer, and its potential association with the degree of tumor cell differentiation. This case-control study used 366 medical records of patients treated at two referral centers for oral cancer diagnosis, specifically: cases (n=70) with a histopathological diagnosis of oral squamous cell carcinoma (OSCC) of the oral cavity, and controls (n=296) with benign oral lesions. Sociodemographic, behavioral, and clinical variables of both groups, as well as complete blood count values, were analyzed by descriptive statistics and crude/adjusted logistic regression. Anemia was detected in 15.7% of the cases and 11.8% of the controls. The presence of anemia had an OR=1.64 (odds ratio) (95%CI 0.54-5.00) for OSCC, with no significantly statistical association. Normocytic anemia was the most prevalent form of anemia when oral cancer was diagnosed (91.4% of the controls and 72.7% of the cases), and moderate to severely low hemoglobin levels were associated with OSCC diagnosis (OR 6.49; 95%CI 1.18-35.24), albeit data on hematological examinations were missing.

Relationship between anemia and oral cancer: a case-control study

Abstract The aim of this study was to investigate the occurrence, type and severity of anemia at the time of diagnosis of oral cancer, and its potential association with the degree of tumor cell differentiation. This case-control study used 366 medical records of patients treated at two referral centers for oral cancer diagnosis, specifically: cases (n=70) with a histopathological diagnosis of oral squamous cell carcinoma (OSCC) of the oral cavity, and controls (n=296) with benign oral lesions. Sociodemographic, behavioral, and clinical variables of both groups, as well as complete blood count values, were analyzed by descriptive statistics and crude/adjusted logistic regression. Anemia was detected in 15.7% of the cases and 11.8% of the controls. The presence of anemia had an OR=1.64 (odds ratio) (95%CI 0.54-5.00) for OSCC, with no significantly statistical association. Normocytic anemia was the most prevalent form of anemia when oral cancer was diagnosed (91.4% of the controls and 72.7% of the cases), and moderate to severely low hemoglobin levels were associated with OSCC diagnosis (OR 6.49; 95%CI 1.18-35.24), albeit data on hematological examinations were missing.

Evaluation of Aquaporins 1 and 5 Expression in Rat Parotid Glands After Volumetric Modulated Arc Radiotherapy and Use of Low-Level Laser Therapy at Different Times.

Introduction: This experimental study investigated the mRNA expression of aquaporins (AQPs) 1 and 5 in the parotid glands of rats irradiated with volumetric modulated arc therapy (VMAT) and subjected to low-level laser therapy (LLLT) at different time points. Methods: The sample consisted of 30 Wistar rats (Rattus norvegicus) divided into the following groups: control, LLLT alone (LG), radiotherapy alone (RG), and experimental groups that received LLLT at 24 hours (early experimental group [EEG], n=12) and 120 hours (late experimental group [LEG], n=12) after radiotherapy. VMAT was delivered at a single dose (12 Gy) and LLLT was performed with an aluminium-gallium-arsenide diode laser (660 nm, 100 mW), spot area of 0.0028 cm2, energy of 2 J/cm2 applied to 3 spots in the region corresponding to the right parotid gland, for 10 consecutive days. The right parotid gland was resected and prepared for RNA extraction. The gene expression of AQPs was evaluated by quantitative polymerase chain reaction (qPCR) using specific TaqMan probes, with the HPRT gene as an internal control. Results: The lowest AQP1 gene expression was 0.83 (0.27) with the use of LLLT 24 hours after radiotherapy (EEG), and the highest was 1.56 (0.80) with the use of LLLT alone (LG). Likewise, the lowest AQP5 gene expression was found in the EEG (mean = 0.88; SD = 0.49) and the highest in the LG (mean = 1.29; SD = 0.33). Conclusion: The use of LLLT after radiotherapy may contribute to the maintenance and an increase of these proteins, even when used at a later time point after radiotherapy.

Haemodialysis-associated thrombocytopenia: interactions among the immune system, membranes and sterilisation methods.

We present a case of a 47-year-old man with severe thrombocytopenia. The differential diagnosis for thrombocytopenia is wide. The assessment includes an evaluation for falsely low platelet counts (pseudothrombocytopenia), immune-mediated platelet destruction, bone marrow dysfunction, or increased consumption and sequestration. After extensive and systematic workup, we found a relationship of his thrombocytopenia with haemodialysis. Although not widely recognised by clinicians, partly due to an incomplete understanding of its pathophysiology, haemodialysis is also a potential cause of thrombocytopenia. His platelet counts completely normalised after the substitution of his haemodialysis membrane. We concluded that our patient had haemodialysis-induced thrombocytopenia, most likely secondary to electron-beam sterilisation.

Temozolomide-induced aplastic anaemia and incidental low-grade B-cell non-Hodgkin lymphoma in a geriatric patient with glioblastoma multiforme.

Glioblastoma multiforme is an astrocyte-derived tumour representing the most aggressive primary brain malignancy. The median overall survival is 10-12 months, but it drops to 3-8.5 months for the cohort with more than 65 years old, which account to half of all patients. Initial management in this patient population aims to balance overall patient survival and quality of life with the inherent risks of treatment intervention, which include maximal safe tumour resection, radiation and temozolomide (TMZ) chemotherapy. This is accomplished through risk stratification as a function of patient age, functional status, comorbidities, tumour location and methylguanine methyltransferase promoter methylation status. We describe the care of a patient with prolonged febrile neutropaenia, with a rare but fatal complication from TMZ-induced idiosyncratic reaction, leading to aplastic anaemia and a provoking diagnosis of low-grade B-cell non-Hodgkin's lymphoma.

Total Versus Subtotal Hysterectomy: Systematic Review and Meta-analysis of Intraoperative Outcomes and Postoperative Short-term Events.

PURPOSE: The benefits and disadvantages of cervical extraction during hysterectomy are unclear in the literature. We intended to compare total (TH) with subtotal or supracervical (SH) hysterectomy regarding intraoperative and postoperative outcomes (quality of life, sexual function, pain and cyclical bleeding). METHODS: A systematic literature search for randomized controlled trials was conducted on MEDLINE, LILACS, Cochrane CENTRAL, SCOPUS, EMBASE, Clinicaltrials.gov databases, and conference abstracts (AAGL, AUGS, ICS) from 1970 to November 2017. Two reviewers independently searched, selected and then combined the articles. Meta-analyses were conducted using a random-effect model. The risk of bias was evaluated using the Cochrane's Collaboration tool. FINDINGS: Eleven studies were included involving 1523 patients. The analyses showed that the events operative time (mean difference: 12.88 minutes, 95%CI [7.45, 18.30] p < 0.000001), hospital stay (MD .44 days, 95%CI [0.11, 0.77] p = 0.0008), and intraoperative blood loss (MD 81.06 ml, 95%CI [9.16, 152.97] p = 0.03) favored SH over TH, although the rate of blood transfusion did not differ between the groups. Conversely, TH group had less cyclical vaginal bleeding over SH (1.2% versus 14.1%; RR .14 95%CI [0.05, 0.43] p = 0.0006) during one-year follow up. Persistent pain and sexual satisfaction rates, and quality of life scores were similar in both total and subtotal hysterectomy groups up to 12 months follow up. IMPLICATIONS: Overall perioperative outcomes favored the preservation of the cervix during hysterectomy but women that had SH are more susceptible to present cyclical vaginal bleeding mimicking menstruation. Those factors should be taken into account along with patient's needs and expectations prior to selecting the procedure.

Pelvic floor symptoms 5 to 14 years after total versus subtotal hysterectomy for benign conditions: a systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: We aim to compare total versus subtotal abdominal hysterectomy regarding urinary and bowel symptoms and pelvic organ prolapse at long-term follow-up. METHODS: A systematic literature search was performed on the MEDLINE, LILACS, Cochrane CENTRAL and SCOPUS databases and conference abstracts (AAGL, AUGS, ICS) from inception up to November 2017. We included randomized trials comparing total versus subtotal hysterectomy for benign conditions that evaluated pelvic floor symptoms over 5 years of follow-up. Risk of bias and GRADE assessment for quality of evidence were performed. RESULTS: We included four studies involving 566 participants with follow-up ranging from 5 to 14 years. Women who underwent total hysterectomy presented lower risk of reported urinary incontinence [RR 0.74 (CI = 0.58, 0.94) i2 0%; p = 0.02] and stress urinary incontinence [RR 0.84 (CI = 0.71, 0.99) i2 0%; p = 0.04] than those who had subtotal hysterectomy. The events urinary frequency, urge incontinence, incomplete bladder emptying, pelvic organ prolapse, incontinence of stool and constipation did not favor one procedure over another in the long term (P > 0.05). CONCLUSIONS: Patient-reported urinary incontinence and stress urinary incontinence events favored total hysterectomy over subtotal hysterectomy up to 14-year long-term follow-up.