Hormone-dependent breast cancer has growth factors that respond positively to the hormones estrogen and progesterone. Thus, adjuvant endocrine therapy causes decreased or undetectable serum levels of these hormones. However, this treatment can have side effects that compromise the sexual health of patients, such as dyspareunia, vaginal dryness and decreased libido. In this scenario, the objective of this work was to document the main outcomes in sexuality in women after treatment for hormonepositive breast cancer. Thus, this is an integrative literature review, in which the following databases were used: U.S. National Library of Medicine (PubMed), Virtual Health Library (BVS), SCOPUS and Scientific Electronic Library Online (SCIELO), using the descriptors: “sexuality”, “antineoplastic agents, hormonal” and “breast neoplasms”, joined by the Boolean operator “AND”. Full articles published in the last 5 years (2017-2022) were included; written in Portuguese or English. Articles dealing with non-hormone-dependent or metastatic breast cancer, or with patients younger than 18 years, or articles that did not answer the research question were excluded. In total, 26 articles were identified, of which 7 comprised the final sample of this review. A total of 3,850 women participated in the included studies. The main sexual dysfunctions found were: dyspareunia, hot flashes, decreased libido, vaginal dryness, breast tenderness, self-image concerns and hair loss. The symptom vaginal dryness was the most prevalent, mentioned in 71.4% of the articles included. In view of the adverse effects listed in this review, there is a need to carry out more studies on this topic, since the diagnosis of this comorbidity brings clinical, psychological, emotional, sociocultural and economic outcomes for the patient. Thus, a multidisciplinary team must assertively address these complaints to improve the overall quality of life of these women.
Although ovarian cancer is the most lethal among gynecological cancers, access to massive BRCA testing is still limited. Its cost-effectiveness is still a topic of discussion in several countries. In Brazil, olaparib was recently incorporated into the public health system, access to BRCA testing is still limited. In this article, we aim to review the cost-effectiveness of offering BRCA testing to the at-risk population. A working group composed of 14 specialists in surgical oncology and cancer genetics was established to discuss the cost-effectiveness of population-based BRCA testing for ovarian cancer. The project was divided into five main areas, each with subtopics assigned among the 14 participants. They were: the existing clinical testing guidelines, the current healthcare infrastructure in the Brazilian public health system, cost-effectiveness analysis, challenges in implementing prophylactic surgeries, and family counseling and risk communication. A comprehensive literature review was conducted, followed by a series of meetings among the article's contributors to reach consensus on unresolved issues. These discussions aimed to build recommendations based on the best available scientific evidence. Using as a basis the current structure already existing within the Brazilian public health service (SUS [Sistema Único de Saude]), and based on the testing of the at-risk population chosen by our experts, we estimated savings. The net savings for a population of 100 000 women would range from BRL 7030.30 (US$1255.41) to BRL 1853.92 (US$331.05). And these costs could have an even greater impact when public service PARP inhibitors are incorporated. The working group of the Brazilian Society of Surgical Oncology understands that large-scale BRCA testing is cost-effective, especially when risk-reducing surgery is implemented. Other measures are important, such as training teams of non-specialists to recognize the population at risk, in addition to creating an entire line of care for patients with ovarian cancer in the SUS.
INTRODUCTION:Acute liver failure (ALF) is a rare and life-threatening condition characterized by rapid deterioration of liver function and often requires urgent liver transplantation (LT). This study aimed to evaluate donor and recipient factors associated with 30-day mortality after LT for ALF. METHODS:Medical records of patients who underwent LT for ALF at seven Brazilian transplant centers were reviewed. Patient data were obtained from electronic medical records. The primary outcome was 30-day mortality after LT. RESULTS:Ninety patients who underwent LT for ALF were included. Thirty-day mortality occurred in 46 of 90 patients (51%). In multivariable analysis, higher pretransplant serum creatinine levels (OR 3.49, 95% CI 1.69-8.72; p = 0.003) and the need for mechanical ventilation prior to transplantation (OR 5.46, 95% CI 1.21-28.9; p = 0.033) were independently associated with early mortality. Donor age ≥ 50 years and pretransplant vasoactive drug use were associated with mortality in univariate analysis. CONCLUSION:Higher pretransplant serum creatinine levels and the need for mechanical ventilation were independently associated with 30-day mortality, whereas donor age ≥ 50 years and pretransplant vasoactive drug use were associated with mortality only in the univariate analysis. These findings support improved pretransplant risk stratification and perioperative management in patients undergoing LT for ALF.
Surgical management in epithelial ovarian cancer (EOC) has a significant impact on overall survival (OS) and progression-free survival (PFS). The Brazilian Society of Surgical Oncology (BSSO) supported an expert-led task force for consensus: the best EOC surgery is provided by experienced and specialized trained surgeons in cancer centers. Laparoscopic or radiological staging can predict the possibility of complete cytoreduction (CC0) and help to reduce unnecessary laparotomies. Carcinomatosis and nodal extension should be evaluated at imaging. Multidisciplinary input is essential for determining the need for the selection of patients for surgery and adjuvant chemotherapy in patients with EOC. The BSSO proposes quality assurance criteria and the need for national consensus. Genetic counseling was deemed mandatory for all patients with EOC. This consensus states the final recommendations from BSSO for the management of EOC.
Multicenter retrospective cohort study. To analyze a multicenter cohort of patients who underwent surgical treatment for C7–T1 traumatic injuries, focusing on their surgical approach and complications. C7–T1 injuries are rare and biomechanically complex, with limited evidence guiding optimal surgical management. A retrospective analysis of patients with surgically treated C7–T1 traumatic injuries from 13 Latin American Institutions (2014–2023) was conducted. Demographic and clinical data was collected, with a focus on morbidity and complications. Among a multicenter database of 545 unstable cervical fractures, 55 (10%) involved the C7–T1 segment. Patients were predominantly male (n=41; 73.2%), with a mean age of 43.2 years (SD). Falls (n=28; 50%) and traffic accidents (n=20; 35.7%) were the leading causes. Neurological deficit was the rule (63.6%). Surgical approaches included single-posterior (44.6%), single-anterior (30.4%), and combined (23.2%). Surgery was performed within 24 hours in 33.9% of cases. Early complications occurred in 17.9%, with pneumonia and surgical site infections being the most common. Complications correlated with longer hospital stays ( P =0.029) and associated injuries ( P =0.028) but not with surgical delay ( P =0.256) or approach ( P =0.380). C7–T1 injuries are challenging to manage, with posterior approaches most frequently used and anterior-only techniques reserved for fractures without translation. Early complications were common and prolonged hospitalization. Their occurrence appeared to be independent of the surgical approach used. Level III.
