Tratamentos conservadores versus cirurgia radical de câncer de pênis: impacto na qualidade de vida

Penile cancer is a rare condition, but it has profound impacts on patients' quality of life, mainly due to treatment options. Conservative approaches and radical surgery have different implications for patients' sexual function, self-image and psychological well-being. This study aimed to compare the impact of conservative treatments and radical surgery on the quality of life of patients with penile cancer. An integrative review was carried out using the PubMed, Scopus and Scielo databases, covering publications from 2012 to 2024, in English and Portuguese. Clinical trials, observational studies, systematic reviews and meta-analyses addressing the impact of conservative and radical treatments on the quality of life of patients with penile cancer were included. The data extracted included patient characteristics, type of treatment and quality of life outcomes.The review indicated that conservative treatments, such as partial penectomy and organ preservation, result in better preservation of sexual function and self-image, with up to 80% of patients reporting significant maintenance of these functions. On the other hand, total penectomy has been shown to be effective for cancer control in advanced cases, but associated with more serious psychological and social impacts, with around 70% of patients reporting changes in self-image and quality of life. This review points out that in cases of early-stage or localized penile cancer, conservative treatments present a viable alternative, balancing disease control with less impact on quality of life. The choice of treatment should take into account not only the stage of the disease, but also the patient's preferences and the expected impact on their quality of life.O câncer de pênis é uma condição rara, mas com impactos profundos na qualidade de vida dos pacientes, principalmente em decorrência das opções de tratamento. Abordagens conservadoras e cirurgias radicais apresentam diferentes implicações para a função sexual, autoimagem e bem-estar psicológico dos pacientes. Este estudo teve como objetivo comparar o impacto dos tratamentos conservadores e da cirurgia radical na qualidade de vida de pacientes com câncer de pênis. Realizou-se uma revisão integrativa com busca nas bases de dados PubMed, Scopus e Scielo, abrangendo publicações de 2012 a 2024, em inglês e português. Foram incluídos ensaios clínicos, estudos observacionais, revisões sistemáticas e meta-análises que abordassem o impacto de tratamentos conservadores e radicais na qualidade de vida de pacientes com câncer de pênis. Os dados extraídos incluíram características dos pacientes, tipo de tratamento e desfechos de qualidade de vida. A revisão indicou que tratamentos conservadores, como a penectomia parcial e a preservação de órgãos, resultam em melhor preservação da função sexual e autoimagem, com até 80% dos pacientes relatando manutenção significativa dessas funções. Por outro lado, a penectomia total mostrou-se eficaz para o controle oncológico em casos avançados, mas associada a impactos psicológicos e sociais mais graves, com cerca de 70% dos pacientes relatando alterações na autoimagem e na qualidade de vida. Esta revisão aponta que, em casos de câncer de pênis de estágio inicial ou localizado, os tratamentos conservadores apresentam uma alternativa viável, equilibrando o controle da doença com menor impacto na qualidade de vida. A escolha do tratamento deve considerar não apenas o estadiamento da doença, mas também as preferências dos pacientes e o impacto previsto em sua qualidade de vida. &nbsp

Efeitos adversos e comorbidades associadas ao uso antibióticos na população pediátrica no início do desenvolvimento

Introdução: Infecções bacterianas de diversos tipos são eventos comuns na infância, com o índice epidemiológico importante. Dito isso, é necessário estudar os efeitos adversos dos antibióticos, já que são os medicamentos usados no tratamento dessas diversas doenças. O objetivo desse estudo foi fazer uma correlação com os perigos do uso de antibióticos no início da vida e quais comorbidades ela se relaciona no futuro. Métodos: O artigo em questão consiste em uma revisão bibliográfica do tipo integrativa, de abordagem qualitativa e natureza aplicada. Resultados e Discussão: Cerca de 50% (N=4) dos estudos analisados eram voltados a Terapêutica Antibiótica, apenas um dos estudos era descritivo multicêntrico, foi focado em prescrições médicas e não no decorrer do tratamento, avaliando assim, que houve um aumento no número de prescrições em emergências hospitalares em relação à atenção primária. Analisou-se também que em 60% dos casos a prescrição era incorreta, entretanto era maior em emergências hospitalares, sendo assim o tratamento era mais adequado na atenção primária. Conclusão: o uso indiscriminado de antibióticos, em casos de amigdalites virais e amigdalectomias, estão efetivamente relacionados ao aumento da resistência antibiótica e impactos a curto e longo prazo na resposta imunológica.</jats:p

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research