Introduction: The heterogeneous nature and intrinsically aggressive tumor pathology of the triple negative breast cancer subtype results in an unfavorable prognosis and limited clinical success. The use of hematological components of the systemic inflammatory response for patients with triple-negative breast cancer can add important prognostic information to the criteria traditionally used for cancer patients, since inflammation can promote tumor progression support by affecting the stages of tumorigenesis. Objectives: The aim of this study was to evaluate the hematological parameters neutrophil/lymphocyte, monocyte/lymphocyte and platelet/lymphocyte ratios as prognostic indicators in patients with triple-negative breast cancer. Methods: This was a singlecenter retrospective observational study in an oncology referral hospital in the South region of Brazil. Electronic medical records of patients diagnosed with triple-negative breast cancer from 2012 to 2016 were reviewed and analyzed using SPSS. Results: The low blood cell ratio groups had significantly higher overall survival than the high blood cell ratio groups. Univariate analysis also confirmed the correlation of patients in the high blood cell ratio groups with unfavorable results. Conclusions: Hematological components of the systemic inflammatory response are promising prognostic indicators. More studies on the subject should be carried out to assist in future medical decision-making so these parameters of easy assessment and low cost can be introduced in clinical practice.
Objective. To identify clinical characteristics and risk factors associated with mortality, with a focus on opportunistic infections (OIs), in patients with advanced HIV in Brazil. Methods. A prospective cohort study was conducted in five Brazilian tertiary hospitals, including 419 adults with advanced HIV. Baseline demographic and clinical data were collected during hospital admission, and participants were screened for tuberculosis, cryptococcosis, and histoplasmosis using rapid diagnostic tests. Participants were followed for 90 days to assess mortality, with causes of death classified using the Coding of Death in HIV (CoDe) protocol. Statistical analysis identified the variables associated with mortality. Results. The median CD4 count was 66 cells/mm³, and the median HIV viral load was 104 887 copies/mL. After 90 days, 18.1% of participants had died. ART-naive status, mental confusion, anemia, and elevated creatinine levels were strongly associated with mortality. OIs were diagnosed in 45.6% of participants, with severe histoplasmosis and cryptococcal meningitis significantly increasing the risk of mortality. Social determinants, such as sex, race, gender, and education level, did not have a significant impact on mortality, but socio-economic factors influenced health care access. Conclusion. Early HIV diagnosis and continuous ART are essential to reduce mortality. Public health strategies should prioritize improving HIV testing, treatment adherence, and addressing social disparities to mitigate health care inequalities.
OBJECTIVE:To identify predictive factors for failure in the installation of high-flow nasal cannulas in children diagnosed with acute viral bronchiolitis under 24 months of age admitted to the pediatric intensive care unit. METHODS:This work was a retrospective single-center cohort study conducted from March 2018 to July 2023 involving infants under 24 months of age who were diagnosed with acute viral bronchiolitis and who received high-flow nasal cannulas upon admission to the pediatric intensive care unit. Patients were categorized into two groups, the Success Group and Failure Group, on the basis of high-flow nasal cannula therapy efficacy. The primary outcome was treatment failure, which was defined as the transition to invasive or noninvasive ventilation. The analyzed variables included age, sex, weight, high-flow nasal cannula parameters, vital signs, risk factors, comorbidities, and imaging. Acute viral bronchiolitis severity was assessed using the Wood-Downes Scale, and functional status was assessed via the Functional Status Scale, both of which were administered by trained physiotherapists. RESULTS:In total, 162 infants with acute viral bronchiolitis used high-flow nasal cannulas, with 17.28% experiencing treatment failure. The significant differences between the Failure and Success Groups included age (p = 0.001), weight (p = 0.002), bronchiolitis severity (p = 0.004), initial high-flow nasal cannula flow (p = 0.001), and duration of use (p = 0.000). The cutoff values for initial flow (≤ 12L/min), weight (≤ 5kg), and Wood-Downes score (≥ 9 points) were determined from the ROC curves. Initial flow ≤ 12L/min was the most predictive for failure (AUC = 0.71; 95%CI: 0.61 - 0.84; p = 0.001). Multivariate analysis indicated that weight was a protective factor (RR = 0.87; 95%CI: 0.78 - 0.98), duration of use reduced the risk of failure (RR = 0.49; 95%CI: 0.38 - 0.64; p = 0.000), and Wood-Downes score was not significant (RR = 1.04; 95%CI: 0.95 - 1.14; p = 0.427). Weight explained 84.7% of the variation in initial flow. CONCLUSION:Risk factors for high-flow nasal cannula therapy failure in bronchiolitis patients include younger age, consequently lower weight, and a lower initial flow rate.
BACKGROUND AND AIMS:EMR is a well-established treatment for large laterally spreading colorectal lesions. However, recurrence remains a key limitation. Accurate endoscopic evaluation of the post-EMR scar is essential, yet white-light endoscopy (WLE) alone may miss subtle residual neoplasia, contributing to routine biopsies and increased costs. Enhanced imaging modalities, particularly narrow-band imaging (NBI), improve visualization of mucosal and vascular patterns relevant to the detection of recurrence. Despite these advances, the incremental benefit of NBI over WLE for post-EMR scars remains uncertain. We aim to evaluate the diagnostic performance of NBI for the assessment of post-EMR scars, comparing its performance with WLE. METHODS:We performed a systematic review and meta-analysis using the PubMed, Embase, and Cochrane databases. We searched for randomized and nonrandomized studies comparing WLE with NBI in patients submitted to surveillance colonoscopy after colorectal EMR and reporting at least one of the outcomes of interest. The outcomes assessed were the area under the curve (AUC), sensitivity, and specificity of both endoscopic techniques. Outcomes were reported with their respective 95% CI. RESULTS:This study included 5 studies with 848 scars evaluated. The pooled sensitivity and specificity of WLE for recurrence detection were 0.799 (95% CI, 0.705-0.868) and 0.950 (95% CI, 0.875-0.981), respectively. The pooled sensitivity and specificity of NBI for recurrence detection were 0.904 (95% CI, 0.843-0.942) and 0.936 (95% CI, 0.876-0.968), respectively. The comparison between these AUCs results in a P value of .461. CONCLUSIONS:Across 5 studies of 848 post-EMR scars, both WLE and NBI demonstrated high diagnostic performance for scar assessment. When applied in a complementary and sequential approach, with NBI performed after careful white-light evaluation, diagnostic sensitivity and confidence were enhanced, improving the ability to differentiate postresection scars from residual or recurrent neoplasia. This real-world strategy supports a selective and targeted biopsy approach, with the potential to avoid unnecessary biopsies and improve cost-effectiveness in post-EMR surveillance.
BACKGROUND:Climate change is an increasingly important determinant of global mental health, affecting emotional, cognitive, behavioral, and social functioning. The emergence of climate-anxiety and the unequal distribution of environmental risks highlight the need for cross-cultural evidence to inform equitable adaptation strategies. AIM:To examine the psychological and functional impacts of climate change across diverse populations, focusing on climate-anxiety, emotional responses, coping strategies, and perceived psychosocial support within a geopsychiatry framework. METHODS:A multinational cross-sectional survey was conducted among 388 adults from 44 countries using the Hogg Climate Anxiety Scale (HCAS) and additional items on climate-related experiences, functional disruption, coping strategies, and access to essential resources. Data were analyzed using descriptive statistics, non-parametric tests, multiple linear regression, and thematic analysis of open-ended responses. RESULTS:Overall, 83.5 % of participants reported exposure to at least one extreme climate event in the past five years, most commonly heatwaves, floods, and severe storms. Climate anxiety differed by gender in affective symptoms, rumination, and personal impact anxiety (Kruskal-Wallis, p ≤ .007). Participants exposed to extreme events reported higher affective (p = .017), behavioral (p = .001), and personal impact anxiety (p = .045). The regression model explained 25 % of the variance in total HCAS scores (R² = 0.25, p < .001), with climate-related functional disruption as the strongest predictor. CONCLUSIONS:Climate change is associated with substantial emotional and functional burden, particularly among vulnerable groups. Findings support integrating mental health screening and brief psychosocial interventions into climate adaptation policies, primary care, and community-based resilience programs.
