Delirium is a common and serious complication among elderly patients in intensive care units (ICUs), and is often associated with increased morbidity and mortality rates. The choice of sedoanalgesic may influence the incidence of delirium; however, the evidence remains unclear, particularly in the elderly population. To evaluate the association between the use of different sedoanalgesics and the incidence of delirium in elderly ICU patients, based on data from randomized clinical trials. This systematic review was conducted using data from randomized clinical trials performed in various ICU settings. A systematic search of the MEDLINE, Embase, and CENTRAL databases was performed in January 2024. The review included randomized clinical trials involving patients aged 60 years or older that examined the relationship between sedoanalgesics (midazolam, fentanyl, propofol, ketamine, and dexmedetomidine) and delirium incidence. Studies involving COVID-19 patients and non-randomized studies were excluded. A total of 1,331 patients from six studies were included. The mean age of the patients ranged from 71 to 74.7 years. Four studies compared dexmedetomidine with propofol; two found no significant difference in delirium incidence, whereas two suggested a lower incidence with dexmedetomidine. The remaining studies compared propofol with ketamine and dexmedetomidine with midazolam and showed no significant differences in the incidence of delirium. Dexmedetomidine may be associated with a lower incidence of delirium than propofol or midazolam in elderly ICU patients. However, further research is needed to confirm these findings and explore the factors contributing to delirium in this population. Registered with PROSPERO, CRD42024575693, available at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=575693.
Overseas military deployment poses a significant healthcare challenge, requiring the prevention of morbidity associated with physical strain and the environment, as well as the provision of effective medical care to ensure operational continuity in operations. To describe and analyze the medical care activity during the deployment of the Spanish contingent from the General Command of Ceuta at the Union III base (Baghdad) and to evaluate the recorded morbidity, applied treatments, and the need for medical evacuation. A prospective, observational, and analytical study was conducted during the deployment between May and November 2025 at the Union III military base in Baghdad. All medical encounters recorded by the deployed medical services were included. Demographic and clinical variables as well as the applied treatment, need for follow-up, and evacuation, were analyzed. Statistical analysis included descriptive statistics and association tests, with a p value < 0.05 considered significant. In total, 506 medical encounters were recorded. Traumatic injuries were the most frequent reason for consultation (25.7%), followed by infectious (20.9%) and digestive (17.2%) conditions. Most cases were resolved at Role 1 level, with a low evacuation rate (3.4%) and a high degree of local resolution. The deployed medical support demonstrated a high resolutive capacity, with a predominance of non-combat-related pathologies and a low need for evacuation. These results highlight the importance of maintaining effective medical structures and reinforcing preventive measures to reduce morbidity during future deployments.
Studies assessing the prevalence of mental disorders in the context of remote teaching in Brazil during the coronavirus disease (COVID-19) pandemic are scarce. To estimate the prevalence of symptoms of anxiety and depression and their relationship with sociodemographic characteristics among university students during the COVID-19 pandemic. This multicenter cross-sectional study was conducted at eight Brazilian public universities. This study was conducted on students regularly enrolled in undergraduate courses. Data were collected between October 2021 and February 2022 using an online self-administered questionnaire that addressed sociodemographic and academic characteristics, lifestyle habits, and health conditions. Anxiety and depression symptoms were assessed using the Depression, Anxiety, and Stress Scale-21. The variables were analyzed descriptively using frequency distribution, proportion, 95% confidence interval (95% CI), and Pearson's chi-squared test. A total of 8,650 students participated, and most of them were women, white, heterosexual, cisgender, and unmarried, with a mean age of 23.9 (standard deviation: ± 6.34) years and living with family members. Symptoms of anxiety and depression were observed in 59.7% (95% CI: 58.7-60.7) and 63.0% (95% CI: 62.0-64.0) of the students, respectively. These symptoms were associated with sex, age, skin color, sexual orientation, gender identity, marital status, education of the head of the family, family income, decrease in income during the pandemic, and area of knowledge. Most university students showed symptoms of anxiety and depression during the suspension of face-to-face activities in universities, indicating the need for institutional actions and public policies aimed at promoting their health and mental well-being.
This study investigated factors that may determine longevity in older adults, aiming to prolong their life expectancy and improve projections from before the coronavirus disease 2019 pandemic. To identify risk factors for mortality in older Brazilian adults. A prospective cohort study, part of the Estudo Longitudinal de Saúde do Idoso de Alcobaça. This study included 332 older adults of both sexes who were followed up for over five years (2015-2020). Vital status was determined via telephone follow-up, information provided by family members, and death certificates. To identify the sociodemographic, health, functional, and behavioral factors associated with mortality risk among older adults, Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). The risk factors for mortality among older adults included the number of people living with them (HR = 1.22; 95%CI = 1.07-1.38) and the number of prescribed drugs (HR = 1.15; 95%CI = 1.00-1.32). Factors associated with a lower risk of mortality were greater time spent in physical activity (HR = 0.99; 95%CI = 0.90-0.99) and greater hip circumference (HR = 0.95; 95%CI = 0.31-0.99). Sociodemographic, health, functional, and behavioral factors are determinants of mortality risk among older adults. Regular screening of the older adult population should be conducted to assess their general health status, allowing for more appropriate interventions to increase their quality of life and improve aging.
Frailty in older adults is a multifactorial geriatric syndrome associated with inflammation, malnutrition, and hematological decline. Objective and easily applicable laboratory-based indices may complement clinical frailty assessment by providing rapid and low-cost screening tools, particularly in primary care and resource-limited settings. To develop a simple laboratory-based frailty screening index (FINE, Frailty Index for the Elderly) using C-reactive protein (CRP), albumin, hemoglobin, and sex, and to evaluate its association with the Clinical Frailty Scale (CFS) in older adults. A retrospective descriptive study conducted using electronic health records of individuals aged 80 years and older. Data from 322 older adults were analyzed. Their FINE scores were calculated by assigning 0 or 1 point to CRP, albumin, hemoglobin, and sex based on clinically accepted reference thresholds, yielding a total score ranging from 0 to 4. Frailty was assessed using pre-recorded CFS scores. Associations between FINE scores, CFS, and individual biomarkers were examined. The screening performance was evaluated using receiver operating characteristic (ROC) curve analysis. The mean age of participants was 84.9 ± 4.0 years, and 55.6% were female. The prevalence rate of frailty was 46.6%. FINE scores exhibited a positive correlation with CFS and CRP levels, and a negative correlation with albumin and hemoglobin levels (p < 0.005). ROC analysis demonstrated a statistically significant but moderate discriminatory ability for frailty (area under the curve = 0.642; 95% confidence interval: 0.5820.703). At a cut-off value of ≥ 0.5, FINE scores demonstrated high sensitivity (89.3%) but low specificity (22.1%). The FINE score is a simple, rapid, and low-cost laboratory-based frailty screening tool that is significantly associated with clinical frailty and key biological processes underlying frailty. Although low specificity limits its use as a diagnostic instrument, it may serve as a practical first-step screening approach in primary care and resource-limited settings. Further multicenter prospective studies are required to validate these findings.
Actinic keratosis is a common preneoplastic dermatosis and is the third most common reason for dermatological consultations. Identifying the associated factors, diagnosis, and early treatment of actinic keratosis are crucial for reducing the risk of developing skin cancer and costs to the healthcare system. To evaluate the prevalence and factors associated with actinic keratosis in individuals treated at a public dermatology service. A cross-sectional observational study was conducted with 1346 patients treated by a public dermatology service. The demographic and dermatological characteristics of patients were recorded. The presence of actinic keratosis was determined by clinical dermatological identification. Most participants were elderly, white, and exposed to the sun without protection or during occupational activity. The evolution time of cutaneous lesions was <1 year in 46.8% of participants. Actinic keratosis was the most common skin lesion, being present in 29.3% of participants. The main approach adopted was cryotherapy. Keratosis was associated with white skin color, elderly age, personal and family history of skin cancer, exposure to the sun without protection at work, and limb involvement. When the associated factors were analyzed using a regression model, skin color and affected body segments were the main predictors of actinic keratosis. The prevalence of actinic keratosis was 29.3%, being higher in people with fair skin, more than two affected segments, skin lesions on the limbs, older age, and unprotected sun exposure. These indicators are important for supporting decision-making and contributing to improving public policies.
In the area of nutrition, telehealth regulations were established on October 22, 2023, through Resolution No. 760, which defines and regulates telenutrition as a form of care and/or provision of services in food and nutrition through Information and Communication Technologies. To present the profile of telenutrition users in the TeleNordeste-BP project. Design and setting: Descriptive study carried out by hospital BP - A Beneficência Portuguesa de São Paulo. All services were provided through teleconsultation with nutritionists from the TeleNordeste project between May and December 2023. Of the 884 services, 873 (98.8%) were tele-interconsultation. The distribution of services by state was: 430 (48.6%) from Maranhão; 301 (34%) from Alagoas and 153 (17.3%) are from patients from Piauí. Among the services provided, 671 (75.9%) users were female and 213 (24.1%) were male; the average age was 39.54 years (standard deviation +/- 19.9). Most adult patients were overweight: 135 (25.9%) were classified as overweight, 121 (23.2%) as grade 1 obese, 100 (19.2%) as grade 2 obese, and 66 (12.6%) as grade 3 obese. chronic non-communicable diseases (NCDs) were the main reasons for seeking nutritional services, with more than 90% of the main reasons for consultation. Access to the telenutrition service offered by the TeleNordeste-BP project not only impacted the patient in ensuring access to nutritional care but also enabled the increase of Vigilância Alimentar e Nutricional (VAN).
Chronic tension-type headache (CTTH) is a prevalent primary headache disorder that significantly affects quality of life. Hyperacusis, an abnormal intolerance to everyday sounds, is frequently observed in patients with CTTH, suggesting potential shared neural mechanisms. However, the clinical characteristics of patients with CTTH and comorbid hyperacusis remain poorly characterized. This study aimed to investigate the clinical characteristics of CTTH patients with comorbid hyperacusis, focusing on headache profiles, auditory sensitivity patterns, and psychological correlates, and to identify factors independently associated with hyperacusis in this population. A cross-sectional study was conducted at the outpatient department of the Third Affiliated Hospital of Qiqihar Medical College from January 2022 to December 2024. We consecutively enrolled 234 patients with CTTH diagnosed according to International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria were consecutively enrolled. Hyperacusis was confirmed via otolaryngological evaluation and audiometric testing (pure-tone thresholds and loudness discomfort levels [LDL]). Demographic data, headache features (frequency, intensity, and duration), hyperacusis distress severity, and psychological measures (Generalized Anxiety Disorder-7 [GAD-7], Self-rating Somatic Symptom Scale [SSS], and Pittsburgh Sleep Quality Index [PSQI]) were analyzed. Univariate analyses (Student's t-test and Chi-squared test) and multivariate logistic regression adjusted for potential confounders were performed to compare patients with (n = 47) and without (n = 187) hyperacusis. Hyperacusis prevalence was 20.09% (47/234). Compared to non-hyperacusis patients, hyperacusis patients exhibited longer headache duration (13.9 ± 3.15 versus 8.11 ± 2.74 years, P = 0.01), higher weekly headache frequency (7.30 ± 1.99 versus 4.19 ± 1.2, P = 0.005), more pericranial tenderness (95.74% versus 77.54%, P = 0.008), and poorer sleep quality (PSQI: 14.01 ± 1.13 versus 9.17 ± 0.51, P = 0.004). After adjusting for age, sex, headache duration, and pain intensity in multivariate logistic regression, higher headache frequency (odds ratio [OR] = 1.42, 95% confidence interval [CI]: 1.12-1.79, P = 0.003) and higher PSQI scores (odds ratios = 1.38, 95% CI: 1.15-1.66, P = 0.001) remained independently associated with hyperacusis. Common triggering sounds included children crying (61.7%) and traffic noise (42.55%), with predominant emotional responses being irritability (76.6%) and anxiety (65.96%). LDL classification (analyzed as an ordinal variable) was correlated with headache duration (P < 0.05), while hyperacusis distress severity was linked to headache frequency and PSQI scores (P < 0.05). CTTH with hyperacusis represents a distinct subgroup characterized by a history of prolonged headaches, increased attack frequency, and significant sleep disturbances. The independent associations identified suggest that sound sensitivity is closely linked to headache burden and sleep quality; however, causal relationships require longitudinal investigation. Integrated management addressing both headache and auditory hypersensitivity is warranted.
Postoperative delirium (POD) is a severe complication and the most frequent adverse event in older patients, particularly those with cancer. With the increase in the older surgical population and cancer diagnoses, the incidence of POD is expected to increase. To identify and evaluate major risk factors for POD in patients with cancer. Narrative review conducted at the A.C.Camargo Cancer Center in São Paulo, Brazil. PubMed, LILACS, and Embase database searches were conducted using relevant keywords from June 2023, to September 2024. We identified 279 studies; after screening and applying the eligibility criteria, 49 studies were included in the analysis. POD risk factors in patients with cancer are associated with inflammation and the cumulative burden of intensive therapeutic modalities. These factors can be categorized into three domains: directly related to cancer, indirectly related to cancer, and preexisting predisposing factors. Among these factors, age is important. Additional relevant contributors include frailty, cognitive impairment, sarcopenia, pain, anxiety, and depression. A complex interaction exists between these factors that renders POD management in patients with cancer challenging; however, the impact of each factor remains unclear. Multiple overlapping risk factors often contribute to POD development in patients with cancer. Age is a significant risk factor, as reported in the literature. Other relevant factors have been described; however, the relative contribution of each factor to the etiology of POD remains unclear. Further research is required to address this knowledge gap.
This review examined the prevalence rate of alcohol use disorders (AUDs)-including heavy episodic drinking, heavy drinking, alcohol abuse, and alcohol dependence-among individuals with borderline personality disorder (BPD). The primary objective of this meta-analysis and meta-regression study was to investigate the prevalence AUDs associated with BPD. We searched PubMed, Google Scholar, Virtual Health Library (VHL/BVS), SciELO, LILACS, EMBASE, and PsycINFO for studies, reports, or abstracts published without language restrictions. We searched for reports published from database inception through March 2024. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis Of Observational Studies in Epidemiology guidelines (MOOSE). Based on the extracted data, we performed meta-analyses and meta-regressions. The final sample included 15 articles with 15,603 individuals aged 18 years or older with BPD. The prevalence of AUDs with BPD was 55.28%, while the prevalence of alcohol dependence (AD) was 44.59%, and alcohol abuse (AA) was 18.84%. Our findings indicate a high prevalence of AUDs among individuals with BPD, underscoring the need for targeted prevention and treatment strategies. Integrated dual-diagnosis approaches addressing both disorders simultaneously are crucial for improving outcomes. This high prevalence has important implications for public health.
Sense of mastery has been described in the literature as a psychological resource potentially associated with reduced caregiver burden. However, there are no validated instruments in the Brazilian context that allow the evaluation of the sense of mastery as a possible outcome of interventions aimed at supporting unpaid caregivers of people with dementia. To validate the construct of the Brazilian version of the Pearlin Mastery Scale among unpaid caregivers of people living with dementia. This methodological study was conducted with 100 unpaid caregivers of people living with dementia, cared for at home, and who resided in Brazil. Evidence of validity was tested based on internal structure, reliability, and correlations with theoretically related constructs. Sociodemographic data on sense of mastery, burden, depressive symptoms, anxiety, and quality of life were collected. Difficulties involving burden (80%), depressive symptoms (70%), anxiety (65%), and low quality of life (62%) were reported. Satisfactory measures of adjustment were found in the factor analysis; however, by removing two inversely scored items, these measures improved, resulting in a Cronbach's alpha of 0.75. Significant correlations were found between sense of mastery and burden scores (ρ = -.56), symptoms of depression (ρ = -.57), anxiety (ρ = -.57), and quality of life (ρ = .64). Evidence of validity was found for the Pearlin Mastery Scale Brazilian version based on the internal structure, reliability, and correlations with theoretically related constructs, indicating that it is a suitable instrument for use in Brazil.
The atherogenic index of plasma (AIP), derived from the logarithmic transformation of the triglyceride to high-density lipoprotein cholesterol ratio, is frequently used to predict cardiovascular events. This study aimed to investigate the association between AIP and 1-month mortality in patients with acute ischemic stroke (AIS). Retrospective study was conducted in Türkiye. In total, 530 AIS patients were enrolled in this study. Clinical, demographic, and laboratory characteristics were recorded within 24 hours of admission. One-month mortality outcomes were analyzed in relation to the AIP of the patients. Of the 530 patients, 140 patients did not survive during the follow-up period. The mean AIP was 0.50 ± 0.33 in survivors and 0.11 ± 0.27 in the mortality group (P = 0.001). In the receiver operating characteristic analysis, the AIP value of 0.291 had a sensitivity of 74.4%, specificity of 76.4%, positive predictive value of 75.92%, and negative predictive value of 74.9% for mortality. The AIP value above 0.291 had an AUC (area under curve) of 0.829 (95% CI [confidence interval] 0.78-0.88, P = 0.0001). In Cox regression analysis, AIP values below 0.291 (HR 3.962; 95% CI 2.643-5.937) were identified as an independent predictor of mortality. Higher mortality rates were observed in patients with cryptogenic stroke and AIP below 0.291 after stratification by stroke TOAST (P = 0.003). Lower AIP is an independent predictor of short-term mortality in AIS patients, surpassing the sensitivity of traditional lipid parameters. This study provides a valuable prognostic tool for clinicians, offering a non-invasive and cost-effective test for a condition associated with substantial mortality and morbidity.
Synovial tissue proliferation in the bare area of the joint is an early indicator of synovitis. Vascularization of the pannus helps differentiate between inactive and inflammatory processes, directly impacting therapeutic management. Synovitis can be diagnosed through clinical assessment, ultrasound, and magnetic resonance imaging (MRI); however, uncertainty remains regarding the optimal imaging modality. This study aimed to determine the accuracy of ultrasonography with microbubble contrast and contrast-enhanced MRI in diagnosing synovitis, irrespective of its etiology. In addition, the study aimed to determine the joints that were most accurately assessed for synovitis using microbubble ultrasound. Electronic searches were conducted in the Cochrane Library, MEDLINE, EMBASE, LILACS, SCOPUS, CINAHL, and Web of Science up to February 8, 2025, with additional screening of reference lists. Studies assessing diagnostic accuracy or detection rates of contrast-enhanced ultrasound (CEUS) and contrast-enhanced MRI for synovitis were included without restrictions on language or publication status. Two studies were selected after quality assessment using QUADAS-2, and eight studies were assessed using the RTI item bank methodology. Diagnostic accuracies of contrast-enhanced ultrasonography (87%) and contrast-enhanced MRI (87.7%) were comparable. For knee evaluation, CEUS showed a higher detection rate (93.8%) than MRI (82.9%). Across different joints and underlying diseases, the detection rates were 81.9% and 88.3% for contrast-enhanced MRI. In patients with rheumatoid arthritis, MRI demonstrated a higher detection rate (96.2%) compared with ultrasound (67.2%). These findings indicate a similar overall diagnostic performance, although the limited number of included studies restricted generalizability. CEUS demonstrated diagnostic accuracy comparable to contrast-enhanced MRI, except in patients with rheumatoid arthritis. Given its low cost, portability, and favorable safety profile, CEUS may serve as a useful screening or follow-up tool for synovitis, pending validation in larger multicenter studies.
Monitoring tobacco consumption is important for supporting national and global agendas and commitments. To analyze the prevalence and sociodemographic and geographic factors associated with e-cigarette use in Brazil, using data from Vigitel 2023. Cross-sectional analytical study was conducted using secondary data from Vigitel 2023. Sociodemographic characteristics (sex, age, education, and ethnicity), geographic location, and e-cigarette use were analyzed. Descriptive analyses were performed using Chi-squared and Mann-Whitney U-tests. Additionally, weighted multivariable logistic regression models were used to examine independent associations between sociodemographic factors and current e-cigarette use. Post-stratification weights were applied, and adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) were estimated. Among 16,093 adults, the prevalence of current e-cigarette use was 5.55%. In the adjusted model, younger age was strongly associated with use (aOR per year increase = 0.93; 95% CI 0.92-0.94; p < 1). Men had higher odds of use than women (aOR = 1.34; 95% CI 1.12-1.6; p < 0.01). Educational level was not independently associated with usage. Caucasian individuals had higher odds compared to mixed-race individuals (aOR = 1.29; 95% CI 1.05-1.58; p = 0.015). Residents of the southern region showed increased odds (aOR = 1.48; 95% CI 1.1-1.99). Current e-cigarette use in Brazil is independently associated with younger age, male sex, Caucasian ethnicity, and residence in southern Brazil. These findings underscore the importance of strengthening public policies that regulate and control these devices as well as educational campaigns targeting high-risk groups.
Accurate T-staging of oral squamous cell carcinoma (SCC) is essential for surgical planning and prognosis. However, conventional computed tomography (CT) may underestimate tumor extent, particularly when performed without dynamic maneuvers. To evaluate the accuracy of CT in predicting the T-staging of primary SCC of the oral cavity by comparing scans in the neutral position and with the mouth open and tongue extended (MOTE) maneuver. This prospective cross-sectional study analyzed patients with oral SCC who underwent CT in both positions. Two blinded head-and-neck radiologists measured tumor size and depth of invasion (DOI). An anatomopathological study served as the reference. The accuracy of classifying early and advanced T-stage tumors was determined using diagnostic tests. Twenty-five patients (72% male, mean age 65.6 ± 11.3 years) were included. Tumor detection sensitivity increased from 72% (95% CI: 51.9-86.9) in the neutral position to 100% (95% CI: 83.4-100) with the MOTE maneuver. Correct T-staging prediction improved from 52-56% in the neutral position to 7276% with MOTE. Accuracy for early-stage (T1/T2) classification rose from 60.0% (95% CI: 39.3-78.1) to 88.0% (95% CI: 68.7-97.4, h = 0.66). Lesion size overestimation decreased from 20.9-23.7% to 15.3-16.1% (p < 0.05), whereas DOI differences were not significant (p > 0.05). The MOTE maneuver significantly improved both the sensitivity and accuracy of CT in the preoperative T-staging of oral cavity SCC. Its incorporation into diagnostic protocols may enhance lesion detection and staging reliability in daily clinical practice.
Chronic noncommunicable diseases (NCDs) have a multifactorial etiology and are associated with psychosocial factors, such as stress, anxiety, and depression. Sleep quality also influences general health and is associated with obesity and NCDs. Homeopathy, as a medical specialty, is effective in managing these conditions because of its comprehensive approach to individuals. To evaluate the influence of homeopathic treatment on sleep quality and levels of stress, anxiety, and depression. Observational, longitudinal, and prospective study on individuals over 18 years of age with homeopathic medical follow-up for 6 months in the public healthcare service of Guarulhos, São Paulo. Participants were evaluated initially (T0) and after 3 (T1) and 6 months (T2) using validated questionnaires (Pittsburgh Sleep Quality Index and the Depression Anxiety and Stress Scale), following all ethical precepts. The scores were compared over time and correlated with each other (P < 0.05). The mean patient age was 49 years. Initially, 81% of the participants had sleep disorders and severe or extremely severe levels of stress (33.78%), anxiety (28.38%), and depression (27.03%). A total of 26 patients were present at the three evaluation points, which were included as the participants of the study. Homeopathic treatment significantly improved sleep quality and reduced stress, anxiety, and depression. Sleep quality and anxiety were strongly (r = 0.53, P = 0.005) and weakly (r = 0.25, P = 0.021) correlated with stress, respectively. In the short term, homeopathic treatment had a positive impact on the sample, suggesting that this therapy can be used to prevent NCDs.
The chemotherapy response score (CRS) is a histopathological tool used to assess the tumor response in patients with high-grade serous ovarian carcinoma (HGSC) undergoing neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). This single-center retrospective study was conducted at the Faculty of Medicine at Istanbul University. The study included patients treated between January 1, 2010, and December 31, 2017 at a tertiary care hospital specializing in gynecologic oncology. This study aimed to evaluate the prognostic significance of omental and adnexal CRS in predicting overall survival (OS) and disease-free survival (DFS) in patients with advanced HGSC undergoing NACT followed by IDS. Data from 79 patients with advanced HGSC treated with NACT followed by IDS between 2010 and 2017 were analyzed. CRS was applied to both omental and adnexal samples, and its association with OS and DFS was evaluated. Statistical analyses were performed using univariate and multivariate methods with a significance level of P < 0.05. Omental CRS 1-2 was identified as an independent predictor of decreased OS (hazard ratio 2.69; 95% confidence interval 1.26-5.76, P = 0.010), whereas adnexal CRS 1-2 did not significantly impact DFS or OS in multivariate analysis. Patients with omental CRS 3 had superior outcomes, with a 5-year OS rate of 72%, compared to 30.8% in the CRS 1-2 group. The median DFS of the CRS 1-2 group was 19 months, whereas that of the CRS 3 group was 35 months (P = 0.005). Omental CRS is a strong independent predictor of OS in patients with advanced HGSC, whereas adnexal CRS has limited prognostic value. CRS should be considered in clinical practice to guide treatment decisions, and further research is warranted to refine its use by using molecular and radiological markers.
People with Autism Spectrum Disorder (ASD) experience phases of life beyond childhood, which increase the difficulties inherent in each cycle. In contrast, the scientific literature lacks broad reviews of developmental strategies regarding quality of life, even though ASD encompasses changes in social, communicative, and behavioral skills. This study aimed to identify strategies for promoting and maintaining quality of life among adults diagnosed with autism. This integrative review was conducted in Brazil. This review searched the Scopus and Web of Science databases, from strategies that combined the descriptors ("Autism Spectrum Disorder"), ("Autism"), ("Aging"), and ("Quality of life"). Original studies with the full text available in English published between 2018 and 2023 were included, if they responded to the eligibility criteria. In total, 3,098 studies were identified, of which 44 were selected to compose the bibliographic sample of this review. The population sample included 184,653 participants diagnosed with ASD, aged on average 43.5 years old. The following were described for adults with autism: 1) cognitive aspects, 2) aspects related to suffering/mental illness, and 3) strategies to promote quality of life. This research contributes to basic clinical practice and promotes responsible care that attends to the health needs of people with autism throughout life. Early interventions in autistic adults and the availability of support throughout life are essential for maintaining cognitive health and quality of life.
Surgical treatment of hemorrhoidal disease has undergone numerous modifications in recent decades. Among the technical options, stapled hemorrhoidopexy is currently considered an optimal alternative because it provides a less painful recovery. However, many reports have associated this technique with higher recurrence rates than excisional techniques. This manuscript presents a technical modification that aims to provide more extensive mucosectomy with mechanical hemorrhoidopexy. The present technical modification was developed and has been recently used in two hospitals in São Paulo (SP), Brazil. To achieve this, we placed a circumferential submucosal suture at the 3 o'clock position in the clockwise direction. When the left lateral position (9 o'clock) was reached, a loop of 2-0 non-absorbable suture thread was passed around the continuous suture and retracted to the left. Subsequently, the original suture progressed towards the point on the right lateral side, where it was started. Specifically, the modification consists of establishing two traction points from the pursestring suture; thus, the rectal mucosa entering the stapler head will be more uniform, and the retrieved mucosal strip will present a greater height. These features may play a role in effectively reducing mucosal prolapse and alleviating the symptoms. The proposed modification of the original operative technique is simple and aims to improve postoperative results by increasing the height of the mucosal specimen to be resected, thereby reducing long-term recurrence. In the future, this hypothesis will be tested in a randomized study comparing the mucosectomy height and postoperative outcomes of both technical options (classical and present).
Thyroid disorders affect a significant proportion of the population and often necessitate surgical intervention, particularly in cases of malignancy. In this study, we analyzed thyroidectomy procedures performed within the public health system (SUS) of Brazil from 2008 to 2023, with a focus on factors influencing in-hospital mortality. In the retrospective analysis, data on 230,345 thyroidectomies were extracted from SUS records and stratified by hospital volume and state-level distribution of head and neck specialists. Mortality rates were evaluated using non-parametric statistical analyses, including the Kruskal-Wallis and Spearman's correlation tests. The overall in-hospital mortality rate was 0.15%. States with fewer than 0.5 head and neck specialists per 100,000 inhabitants exhibited significantly higher mortality rates (0.2 versus 0.15, p = 0.02). Hospitals performing fewer than 25 procedures annually (very low-volume) had a fivefold increase in mortality compared with high-volume hospitals (0.51 versus 0.10, p < 0.001). When hospitals performing fewer than 10 procedures per year were excluded, significant differences in mortality among volume groups were no longer observed. Mortality increased significantly in very low-volume hospitals performing fewer than 25 thyroidectomies per year; however, this difference was no longer observed after excluding hospitals that performed fewer than 10 interventions per year. These results support restricting thyroidectomies to hospitals performing at least 10 procedures annually and promoting centralization to improve outcomes. Structured regionalization policies are needed to ensure equitable access to specialized surgical care across Brazil.