Predominance Of Cases Research Articles

PERFIL EPIDEMIOLÓGICO DOS CASOS DE HEPATITE C NA CIDADE MANAUS DE 2019 A 2023

Hepatitis is a multifactorial disease caused by viruses, drugs, alcohol, medications, or genetic, autoimmune, and metabolic conditions that cause inflammation in the liver. Among viral hepatitis, hepatitis C stands out, belonging to the Flaviviridae family, identified in patients with non-A and non-B hepatitis. Hepatitis C represents a major public health challenge, and can lead to serious complications, such as cirrhosis and liver carcinoma, in addition to causing systemic conditions, such as cryoglobulinemic vasculitis and chronic inflammation. The general objective of the research was to characterize the epidemiological profile of hepatitis C cases in the city of Manaus from 2019 to 2023. This is a cross-sectional descriptive epidemiological study, based on data from SINAN and the FVS-RCP Viral Hepatitis Monitoring Panel, involving 804 cases of hepatitis C reported in Manaus-AM between 2019 and 2023. Between 2019 and 2023, 804 cases of hepatitis C were recorded in Manaus, with variations over the years, with the highest percentage in 2019 (27%) and the lowest in 2020 (15%). There was a predominance of cases among men (54%) compared to women (46%). The most affected age group was 40 to 59 years old (42%), followed by people aged 60 and over (40%). The main route of infection identified was sexual transmission, responsible for 35% of cases, and deaths, which totaled 103, occurred mostly among men (74%). The strengthening of primary care and awareness campaigns are essential to contain the spread of hepatitis C. The data collected can guide the planning of specific public health actions in Manaus.

Cases of Human Visceral Leishmaniasis in the Municipality of Coité do Noia - AL, from 2013 to 2019, Brazil.

Canine Leishmaniasis visceral is a common disease in countries of the Americas. In Brazil, its occurrence has been increasing in municipalities in the Brazilian Northeast due to the increase in the number of animals within the country, which may increase the number of animals infected by the protozoan Leishmania. The objective was to report the temporal trend and describe the distribution of incidence rates of Leishmaniose visceral in the municipality of Coité do Noia, state of Alagoas, from 2013 to 2019. An epidemiological survey was carried out in the State of Alagoas and in the municipality of Coité de Nóia - AL, from 2013 to 2019. The data used were obtained from the website of the Department of Informatics of the Sistema Único de Saúde (DATASUS), selecting the Leishmaniose Visceral item, the information was compiled from the number of cases notified in the region of Alagoas in Brazil. From 2013 to 2019, 15 cases of Leishmaniose Visceral were confirmed, with 2 deaths. There was a predominance of cases in women with 12 cases, and 4 for men. The study showed a higher occurrence for the municipality of Coite do Noia between 2018 and 2019 with prevalence for women.

Male rape in Brazil: A descriptive analysis from 2010 to 2022

Male rape is a relatively under-discussed topic in scientific literature, despite its significant relevance and prevalence worldwide, including in Brazil. To inform public health and safety policies, this study aimed to analyze cases of male rape using data from SINAN, the Information System for Notifiable Diseases, a division of the Brazilian Ministry of Health, for the years 2010–2022. Our findings reveal a 469 % increase in male rape cases in the country over the study period, with a predominance of cases in the state of São Paulo. Also, a higher prevalence of cases was observed among individuals aged 5–9 years. Furthermore, we identified a correlation between the occurrence of rape and certain factors, including individuals with less than 4 years of formal education if they were over the age of 50, and those who had a history of being sexually abused between the ages of 5 and 14. Additionally, this study reinforces the prevalence of rape cases occurring within domestic environments and perpetrated by individuals closely related to the victims. This study contributes to filling the gap in research on male rape in Brazil, laying the foundation for the development of strategies to prevent and combat rape in the country.

Differences in the dynamics of schizophrenia with the formation of episodic and persistent apathetic depressions

IntroductionApathy in endogenous depressions is a complex mental phenomenon (it is characterized by indifference and loss of interests, reduced incentives and motivation, decreased mental and physical activity). Apathy becomes the cause of pronounced social maladaptation and untimely seeking medical help. Different depressions vary in psychopathological features of apathy, in addition, there are also different dimensions of the general dynamics of endogenous disease.ObjectivesStudy of the features of the course of schizophrenia, in which apathetic depressions develop with episodic and persistent type of dynamicsMethodsThe study included 36 patients (15 men, 21 women, average age 34.9 years) with schizophrenia. In 17 cases, apathetic depressions occurred as short-term episodes, in 19 cases, depression took a persistent (close to chronic) course.Results Schizophrenia with an episodic type of dynamics of apathetic depressions was characterized by: the predominance of cases with early onset of the disease; alternation of apathetic and other type depressions; equal occurrence of mono- and bipolar types of desease; low severity of negative symptoms and slight changes in social and labor functioning. Apathy has always been present during the whole lenght of depression, its picture was dominated by a motivational decline. The studied cases were prognostically favorable. The features of the course of schizophrenia with chronic apathetic depression were: hyperthymic (10 out of 19 observations) and sensitive schizoid (6 out of 19 observations) premorbid personality; bipolar forms of the disease (94.7%, p < 0.05); the predominance of apathetic depression over other depression types, atypical form of depression; short duration of remissions; frequent course of the disease with the presence of only apathetic depressions (12 out of 19, 63.1%, p < 0.05); significant severity of negative symptoms. Apathy occupied only as a part of the duration of the state, as a rule, after anxiety depression. The picture of apathy was dominated by a decrease in initiative or motivation. This clinical group is the most prognostically unfavorable.ConclusionsSchizophrenia, occurring with the presence of persistent forms of apathetic depression, has a greater impact on the functioning of patients and has a less favorable prognosis.Disclosure of InterestNone Declared

CLINICAL, ANGIOGRAPHIC AND FUNCTIONAL PARAMETERS DETERMINING DECISION TO PERFORM REVASCULARIZATION IN STABLE CORONARY ARTERY DISEASE PATIENTS WITH INTERMEDIATE CORONARY LESIONS

The aim: to study the clinical, angiographic and functional parameters, and their relation to the decision on percutaneous coronary intervention (PCI) in stable coronary artery disease (CAD) patients with intermediate coronary stenoses (ІСS) at patient and lesion levels.
 Materials and methods. The cross-sectional study enrolled 123 patients (62±9 years; 73,2 % males) with stable CAD and angiographically ICS (50-90 %). Stable angina CCS class II (CCSII) was diagnosed in 70 (56,9 %) patients, class III (CCSIII) – 29 (23,6 %); 24 (19,5 %) patients were free from angina (Afree). Fractional flow reserve (FFR) was assessed in 74 (60,2 %) patients (min per patient). The hemodynamically significant lesion was considered if FFR ≤0,80 a.u. The decision to perform PCI was undertaken in 93 (76 %) patients. In addition, the functional data from 128 lesions were analyzed.
 Results. The CCSIII group was characterized by less frequent previous PCI (21 % vs. 46 % in the pooled group [CCSII + Afree]; р=0,018); the predominance of cases with (max) severe [70-90 %] coronary stenosis (96 % vs. 78 % in CCSII and 54 % in Afree; ptrend<0,001); the lower (min) FFR ([median, quartiles] 0,70 (0,64-0,74) vs. 0,87 (0,81-0,90) in Afree; p˂0,002); and the decision to perform PCI in the vast majority of cases (93 % vs. 79 % in CCSII and 46 % in Afree; ptrend<0,001). The Afree/CCSII/CCSIII groups demonstrated a trend towards a decrease in frequency of cases with (max) [60-69 %] stenosis (38 %, 13 % and none, respectively; ptrend<0,001), and a tendency towards the cases with (max) [80-90 %] stenosis to be more prevalent (29 %, 39 % and 55 %, respectively; ptrend=0,051). The frequency of cases with (max) stenosis [70-79 %] was comparable in the studied groups (Afree/CCSII/CCSIII: 25 %/39 %/41 %, respectively [ptrend=0,240]). At lesion-level, all [80-90 %] lesions (n=28) appeared to be hemodynamically significant. In turn, the [60-69 %] lesions (n=24) included 5 (21 %) significant ones. Finally, the [70-79 %] lesions (n=44) included 28 (64 %) significant and 16 (36 %) non-significant ones.
 Conclusions. Among the stable CAD patients with angiographically ICS, those with CCSIII were characterized by less frequent previous PCI, significant decrease in FFR and the decision to perform index PCI in the vast majority of cases. There is a need for more precise diagnosis and assessment of myocardial ischemia in patients with an intermediate pre-test obstructive CAD probability, including the cases of previously performed PCI.

Epidemiological profile of Visceral Leishmaniasis in Brazil between 2011-2020

The purpose of this study was to carry out an epidemiological analysis of Visceral Leishmaniasis cases registered by the Notifiable Diseases Information System (SINAN-DATASUS) in Brazil between the years 2011 and 2020. The variables verified were: year, region of notification, gender, age group, and disease progression. In the time range studied, 34,386 cases were registered in the Brazilian territory. The year 2017 stood out with the highest number of cases: 4,462, and 2020 presented the lowest number: 1,908. Such variations proved to be related to global climatic and epidemiological events: 2017 was evaluated as the 3rd hottest year in history by the North American Entity NOAA (National Oceanic Atmospheric Administration), with the consulted literature pointing to relations of growth in the incidence of high temperature climatic events. The year 2020 faced the COVID-19 pandemic break-out. There was a predominance of cases in the Northeast (54.96%), followed by the Southeast (18.67%), North (18.05%), Midwest (8.01%) and South (0.31%). The gender variable shows a predominance of incidence of 65.08% in males and 34.91% in females, which is compatible with the literature. Another parameter that remains within the literature is the age group, where the highest incidence in the 1-4 age group was 23.77%, remaining a disease that severely affects children. The percentages found are in line with the literature and the disease has changed its spread in the Northeast region of the country from about 90% to 55% in two decades, still remaining the most affected region of the country. The disease appears to be more widespread and urban in current studies. There are new and efficient multidisciplinary resources – pharmacological, geographic, climatic and environmental – which, if continued, expanded, and articulated, can strengthen the fight against this serious harm to human health.

COVID-19 (SARS-CoV-2) in Children Attended-to in the Health UNIC System (HUS) With flu and Respiratory Symptoms in Three Brazilian Municipalities in an International Border Region.

The aim of this study was to investigate the occurrence of the disease and research risk factors through sociodemographic data of children aged 0 to 15 years, with symptoms suggestive of COVID-19 in 3 Brazilian municipalities in an international border region. Epidemiological and RT-PCR test results were collected from the COVID-19 notification records in suspected children and adolescents from March 1 to August 31, 2020, in municipalities (Assis Chateaubriand, Tupãssi, and Formosa do Oeste) located in an international border region. The results obtained and the variables associated were subjected to statistical analysis using the Chi-Square Test (x2) or Fisher's Exact Test, using the statistical program SPSS v. 21.0 (IBM Corp., Armonk, New York, USA) at the 5% significance level. Among the 147 children from the 3 municipalities, 20 (13.60%) were diagnosed as positive. The predominance of cases was in male children (60.00%) and in children living in urban areas (80%). The most frequent symptoms observed in children were fever (65.00% of the cases), followed by headache (60.00%), cough (55.00%), and nasal congestion, as well as sore throat, both found in 35.00% of the cases. All these data highlight the importance and the need for more epidemiological studies, especially in children and adolescents, as COVID-19 becomes part of the child health panorama worldwide, with serious direct and indirect impacts for humans, animals, and the environment.

GASTRIC NEUROENDOCRINE TUMOR: WHEN SURGICAL TREATMENT IS INDICATED?

Gastric neuroendocrine tumors are a heterogeneous group of neoplasms that produce bioactive substances. Their treatment varies according to staging and classification, using endoscopic techniques, open surgery, chemotherapy, radiotherapy, and drugs analogous to somatostatin. To identify and review cases of gastric neuroendocrine neoplasia submitted to surgical treatment. Review of surgically treated patients from 1983 to 2018. Fifteen patients were included, predominantly female (73.33%), with a mean age of 55.93 years. The most common symptom was epigastric pain (93.3%), and the mean time of symptom onset was 10.07 months. The preoperative upper digestive endoscopy (UDE) indicated a predominance of cases with 0 to 1 lesion (60%), sizing ≥1.5 cm (40%), located in the gastric antrum (53.33%), with ulceration (60%), and Borrmann III (33.33%) classification. The assessment of the surgical specimen indicated a predominance of invasive neuroendocrine tumors (60%), with angiolymphatic invasion in most cases (80%). Immunohistochemistry for chromogranin A was positive in 60% of cases and for synaptophysin in 66.7%, with a predominant Ki-67 index between 0 and 2%. Metastasis was observed in 20% of patients. The surgical procedure most performed was subtotal gastrectomy with Roux-en-Y reconstruction (53.3%). Tumor recurrence occurred in 20% of cases and a new treatment was required in 26.67%. Gastric neuroendocrine tumors have a low incidence in the general population, and surgical treatment is indicated for advanced lesions. The study of its management gains importance in view of the specificities of each case and the need for adequate conduct to prevent recurrences and complications.

ANÁLISE DO NÚMERO DE CASOS DE ESTUPRO EM UM MUNICÍPIO NO NORTE FLUMINENSE

Introduction: Rape means any oppression to the free exercise of an individual’s sexuality, whether for the purpose of reproduction or the pursuit of pleasure. Objective: Analyzing the cases of rape in Campos dos Goytacazes/RJ, computing its incidence, percentage in different perspectives and identifying the prevalence. Material and methods: Conducted through an exploratory and descriptive research, with a survey of data available at the Institute of Public Security of the State of Rio de Janeiro, being computed the data referring to Campos dos Goytacazes, North Fluminense Region and State of Rio de Janeiro, for comparison of information, between January and September of the years 2019 and 2020. Results: There was a drop in rape reports between the years analyzed. Within this perspective, it is questioned whether there was a reduction in cases or notifications. Regarding victims, there is a prevalence of women in relation to men, with a preponderance of white victims, followed by brown and black victims. About age, there is a predominance of minors and a predominance of cases that occur in the family environment. Conclusion: From the data analyzed, we observed that Campos dos Goytacazes follows part of the national standards and the scientific literature regarding rape, occurring predominantly with women, minors and in the family environment, however, in the city there is a prevalence of crime with white women, while nationally there is a predominance of blacks and browns. Also, there was a decrease in reports of domestic violence, which may have occurred due to different factors.

Medical mystery: Deposition of calcium oxalate and phosphate stones in soft tissues

Calcinosis cutis (CC) [1] is an unusual disorder characterized by calcium-phosphate deposition into cutaneous and subcutaneous tissues. There are five subtypes: dystrophic, metastatic, idiopathic, iatrogenic and calciphylaxis. Calciphylaxis or calcifying panniculitis is defined as small vessel calcification mainly affecting blood vessels of the dermis and subcutaneous fat. Despite the predominance of cases in patients with ESRD, calciphylaxis can also be found in patients with normal renal function and normal levels of calcium and phosphate. These cases are often referred to as nonuremic calciphylaxis (NUC), a heterogeneous category with several associations. Literature reveals an association with hyperparathyroidism (28%), malignancy (22%), alcoholic liver disease (17%) and connective tissue diseases (11%) while obesity, liver disease, high-serum calcium (Ca) × phosphorus (P) levels, combined therapies of calcium salts with vitamin D, warfarin and corticosteroids have been observed to increase the likelihood of this disease [2]. The lesions in both nonuremic and uremic calciphylaxis tend to be indistinguishable from each other, initially presenting as tender subcutaneous plaques that progress into nonhealing ulcers with overlying black eschar. Skin changes often begin with a livedo reticularis pattern that can progress to livedo racemes and ultimately retiform purpura. In our clinical case, we describe a patient with multiple risk factors for calciphylaxis, intense widespread calcification (vessels, tendons, joints) and cutaneous calcific stone of calcium and phosphate oxalate not elsewhere described before.

COVID-19 (SARS-CoV-2) in Patients Treated in The Unified Health System (SUS) with Flu and Respiratory Symptoms from Three Brazilian Municipalities in the Border Region.

The objective of this study was to investigate the prevalence and carry out epidemiology using sociodemographic data from patients with symptoms suggestive of coronavirus disease (COVID-19) (SARS-CoV-2) in 3 bordering Brazilian municipalities. An epidemiological survey of positive cases of COVID-19 through reverse transcriptase polymerase chain reaction (RT-PCR) was carried out in 1874 patients, seen in the Unified Health System (SUS), ages between 0 and 99 years, who had symptoms suggestive of COVID-19, from the cities of Assis Chateaubriand, Tupãssi, and Formosa do Oeste. It was possible to observe that of the 1874 patients seen in the public health network of the 3 municipalities, 354 were diagnosed as positive. The predominance of cases was in female patients (51.97%) and in patients who lived in urban areas (93.50%), and the predominant age group was 20-29 years (19.78%). The result of this study demonstrated the epidemiological profile of patients with respiratory and flu-like symptoms, positive for COVID-19, in 3 municipalities bordering Paraguay and Argentina. It was evident that the age group has its specificities regarding the susceptibility of the infection. Although the borders are closed, there was probably a spread of the virus in this region, due to the diversion, which showed an increase during the pandemic period.

Epidemiological profile of tuberculosis cases in Belém - PA from 2016 to 2019

Introduction: Tuberculosis is a chronic and progressive infection, often with a latency period following the initial infection. Clinical manifestations include productive cough, hyperthermia, weight loss and malaise. Method: This is a quantitative research, data were collected from the database of the Notifiable Diseases Information System (SINAN)[14] database, the analyzed variables: schooling; breed; sex; age range and type of entry. Result and Discussion: Males have the highest percentage, representing 67.1%. The age range was between 20 and 39 years old, totaling 43.5%. There is a high prevalence of notification of new cases among the types of entry, totaling 83.1%. The predominance of cases is found in the brown race with a percentage of 81.2% and when related to education the highest number is of those who have completed high school, with 29.4%. Conclusion: In view of this, there is a need for government intervention for more exposed groups, application of public policies aimed at this vulnerable public and the entire population of the municipality, aiming at the prevention, treatment and recovery of the disease.

Клініко-анамнестичні характеристики та медикаментозний супровід вагітних жінок із обтяженим акушерським анамнезом і тромбофіліями

The purpose of the study was to determine the clinical and anamnestic features (age characteristics of women and anamnestic features of previous pregnancies) of pregnant women with burdened obstetric history and thrombophilia with the establishment of the main pharmacological mechanisms of therapeutic support. Materials and methods. The study was performed at the Department of Clinical Laboratory Diagnostics of Kharkiv National Medical University and at the Kharkiv Clinical Laboratory Center in the period from 2017 to 2021. We examined 137 pregnant women: the main group (101 women – pregnant women with a burdened obstetric history and thrombophilia aged 29.0 to 37.0 years) and the control group (36 women – pregnant women with a burdened obstetric history without thrombophilia aged 26.0 to 30.0 years). In general, the predominance of one (35.8 %) and two (46.7 %) pregnancies in the history of women with a burdened obstetric history compared to three (17.5 %) was noted. Results and discussion. An increase (U = 706.0; p <0.001) in the chances of developing negative consequences of pregnancy in thrombophilia with increasing age due to negative idiopathic thromboembolic effects due to thrombophilia was noted. A higher mean age of pregnant women with a burdened obstetric history in the presence of thrombophilia (33.0 [29.0; 37.0] years) was determined compared with the control (28.0 [26.0; 30.0] years). The maximum negative manifestations of idiopathic thromboembolic effects due to thrombophilia in the first pregnancy were found. The predominance of cases of fetal death in the first pregnancy of women with two (94.1 %) and three (78.3 %) pregnancies was determined. In general, the need for antiplatelet therapy in thrombophilia was stated. Its use (χ2 = 46,950; p <0.001) was determined in 85.1 % of cases, the majority (65.3 %) of one drug (probably (χ2 = 164.54; p <0.001) more often (52.5 %) acetylsalicylic acid compared with dipyridamole (5.9 %)). It was found that anti aggregate therapy, which included two drugs (combination: acetylsalicylic acid, dipyridamole or klexan) was most often used in the first (40.7%) pregnancy in contrast to the second (11.8%) and third (13.0 %). Conclusion. The study found that antiplatelet therapy with only one drug (acetylsalicylic acid, dipyridamole or klexan) was more commonly used in the second (74.5%) and third (73.9%) pregnancies than in the first one (40.7%). It was naturally determined that the absence of any medication was noted most often by pregnant women in the first (18.5%) pregnancy in contrast to the second (13.7%) and third (13.0%)

Perfil epidemiológico e análise de tendência das internações hospitalares por asma no Brasil de 2008-2018

Asthma is a chronic inflammatory disease that represents the fourth largest cause of hospitalization in Brazil. For this reason, the present work seeks to describe the distribution of asthma hospitalizations in Brazil and their temporal trend between 2008 and 2018. For this purpose, asthma hospitalization data were collected in Brazil between 2008-2018 extracted from DATASUS. The Joinpoint software was then used to analyze trends. A total of 1,567,952 asthma hospitalizations were reported, with a significant downward trend in both genders, all regions and age groups. There was a predominance of cases in the Northeast region and in children and adolescents. The decrease in asthma hospitalizations in Brazil may probably be related to improvements in access to health services, such as the free distribution of drugs for the treatment of the disease. The data showed that asthma hospitalizations have been decreasing, being more prevalent in children and adolescents and residents of the Northeast region. It is hoped that this data can help in health planning and resource allocation.

Clinical, epidemiological and climatic factors related to the occurrence of cutaneous leishmaniasis in an endemic area in northeastern Brazil.

Cutaneous leishmaniasis (CL) is a neglected tropical disease with a wide distribution in the Americas. Brazil is an endemic country and present cases in all states. This study aimed to describe the occurrence, the underlying clinical and epidemiological factors, and the correlation of climatic variables with the frequency of reported CL cases in the municipality of Caxias, state of Maranhão, Brazil. This is a retrospective and descriptive epidemiological study based on data extracted from the Brazilian Information System of Diseases Notification, from 2007 to 2017. Maximum and minimum temperature, precipitation, and relative air humidity data were provided by the Brazilian National Institute of Meteorology. A total of 201 reported autochthonous CL cases were analyzed. The predominance of cases was observed in males (70.1%). The age range between 31 and 60 years old was the most affected, with 96 cases (47.9%). Of the total number of registered cases, 38.8% of the affected individuals were engaged in agriculture-related activities. The georeferenced distribution revealed the heterogeneity of disease occurrence, with cases concentrated in the Western and Southern regions of the municipality. An association was detected between relative air humidity (monthly mean) and the number of CL cases per month (p = 0.04). CL continues to be a concerning public health issue in Caxias. In this context, there is a pressing need to strengthen measures of prevention and control of the disease through the network of health services of the municipality, considering local and regional particularities.

Emergence of a Novel Clinical Entity within Myelodysplastic Syndromes Marked By Absence of Quantifiable Terminal Erythroid Differentiation, More Profound Anemia and Significantly Worse Survival across All Prognostic Risk Categories

Introduction:The observable behavior of a cell, or its phenotype, results from a combination of both its genotype and the microenvironment. Anemia is the defining feature in most patients with myelodysplastic syndromes (MDS), yet very few studies have comprehensively characterized disordered terminal erythroid differentiation (TED) in fresh bone marrow (BM) cells in MDS. One reason could be the lack of appropriate technology for study of TED but another is undue focus on defining gene defects alone at the expense of examining overall cellular function and defects. The current study represents an attempt to develop a phenotypic understanding while simultaneously examining the genotype. TED consists of five distinct phases - proerythroblasts (pros), early basophilic erythroblasts (EBs), late basophilic erythroblasts (LBs), polychromatic erythroblasts (polys), to orthochromatic erythroblasts (orthos) which upon enucleation generate reticulocytes. By examining the dynamic changes in the expression of three salient marker proteins, we quantified erythroblasts at distinct stages of their terminal differentiation in 249 freshly obtained bone marrows (BM) and its association with clinical phenotype including overall survival.Methods:Sixteen normal and 233 BMs from MDS (n=215) and secondary acute myeloid leukemia (sAML) patients (n=18) were studied for TED by monitoring the surface expression of glycophorin A, band 3 and integrin alpha-4. Genomic DNA was extracted from BMMNCs using Qiagen's DNAeasy Blood and Tissue kit. In total, 54 genes that are part of the myeloid panel at Cancer Genetics Inc. were sequenced for mutations. Mutations were confirmed using Sanger sequencing for a subset of genes and patients.Results:Of 233 BMs, 157 exhibited quantifiable TED profile but did not follow the expected 1:2:4:8:16 doubling pattern showing significantly fewer cells in pro (P=<0.0001) and EB (P=<0.0005). At LB stage, an equal number of cells appeared in normal and MDS samples, but in the poly stage, a significantly higher percentage of cells were detected (P=<0.0001) in MDS with a sudden drop-off in ortho. This suggests a loss of cells somewhere between poly and ortho stages due to cell cycle and/or maturation arrest and resultant apoptosis. A striking reduction in polys was seen as ring sideroblasts (RS) increased, while % of ortho stage cells increased with increasing RS implying lower cell arrest at poly stage with resulting near normal TED progression in MDS with RS. Strikingly, in 33% MDS samples (76/233), there was no quantifiable TED. This group emerged as a distinct clinical entity with more profound anemia (p=0.0003), neutropenia (p=0.0245), higher blast count (p=0.003), significantly worse overall survival (56 versus 103 months, p=<0.0001) and a predominance of cases with mutations in SRSF2 (21/76, p=0.0008). The difference persisted within each subgroup examined; RCMD (p=0.024), RAEB I/II (p=0.029). When TED-positive samples were divided by those with mutations in SF3B1 or SRSF2, overall survival (OS) was worse for those with No-TED and SRSF2+ (p=0.0507). This difference in survival was seen across all IPSS-R categories (Figure 1). In a multivariate Cox regression model, absence of quantifiable TED remained independently significant across IPSS-R categories.Conclusions:Terminal erythroid differentiation is profoundly abnormal in all MDS subtypes. Absence of quantifiable TED is more commonly associated with presence of SRSF2 mutations and emerged as a powerful independent prognostic marker of poor overall survival across all IPSS-R categories in MDS. Since MDS is a heterogeneous disease where even the best of prognostic classifications do not fully define the risk of death in a substantial number of cases, we suggest that quantification of TED can serve as an independent prognostic variable. In addition, the findings open a novel area of research which could lead to identification of new therapeutic targets. [Display omitted] DisclosuresAli:Onconova Therapeutics: Consultancy; Kura Oncology: Consultancy. Hoehn:Janssen: Employment; Johnson & Johnson, LLC: Equity Ownership. Coutinho:Kura Oncology: Consultancy. Lane:Collplant: Consultancy; Kuros: Consultancy, Membership on an entity's Board of Directors or advisory committees; Bone Therapeutics: Consultancy, Membership on an entity's Board of Directors or advisory committees; Osteology: Consultancy, Membership on an entity's Board of Directors or advisory committees; Graftys: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Research Funding. Jurcic:Kura Oncology: Research Funding; Incyte: Consultancy; Genentech: Research Funding; Forma Therapeutics: Research Funding; Celgene: Research Funding; Merck: Consultancy; Alexion Pharmaceuticals: Consultancy; Actinium Pharmaceuticals, Inc.: Membership on an entity's Board of Directors or advisory committees, Research Funding; Daiichi-Sankyo: Research Funding; Astellas Pharma, Inc: Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Consultancy, Research Funding; Syros Pharmaceuticals: Research Funding; Amgen: Consultancy. Raza:Genoptix: Speakers Bureau; Onconova Therapeutics: Research Funding, Speakers Bureau; Syros Pharmaceuticals: Research Funding; Celgene Inc.: Research Funding; Novartis: Speakers Bureau; Kura Oncology: Research Funding; Janssen R&D: Research Funding.

Suicide by poisoning in Pakistan: review of regional trends, toxicity and management of commonly used agents in the past three decades.

Suicide is one of the leading mental health crises and takes one life every 40 seconds. Four out of every five suicides occur in low- and middle-income countries. Despite religion being a protective factor against suicide, the estimated number of suicides is rapidly increasing in Pakistan. Our review focuses on the trends of suicide and means of self-poisoning in the past three decades, and the management of commonly used poisons. We searched two electronic databases (PubMed and PakMediNet) for published English-language studies describing agents used for suicide in different regions of Pakistan. A total of 46 out of 85 papers (N = 54 747 cases) met our inclusion criteria. Suicidal behaviour was more common among individuals younger than 30 years. Females comprised 60% of those who attempted suicide in our study sample, although the ratio of completed suicides favoured males. There were regional trends in the choice of agent for overdose. Organophosphate poisoning was reported across the nation, with a predominance of cases from the agricultural belt of South Punjab and interior Sindh. Aluminium phosphide ('wheat pills') was a preferred agent in North Punjab, whereas paraphenylenediamine ('kala pathar') was implicated in deaths by suicide from South Punjab. Urban areas had other means for suicide, including household chemicals, benzodiazepines, kerosene oil and rat poison. Urgent steps are needed, including psychoeducational campaigns on mental health and suicide, staff training, medical resources for prompt treatment of self-poisoning and updated governmental policy to regulate pesticide sales.

COVID-19 and pregnancy: A scoping review on pregnancy characteristics and outcomes.

AimThe study aim was to map clinical characteristics and the evolution of pregnancies in pregnant women with confirmed diagnosis of SARS‐CoV‐2 infection.MethodsSearching four databases, studies were investigated that described the evolution of pregnancies in women diagnosed with SARS‐CoV‐2 infection through laboratory tests. A scoping review was undertaken, including 35 articles published in English. Two pairs of independent researchers synthesized the data.ResultsMost studies were case studies or case series and had a low risk of bias. A predominance of cases was found in women over the age of 30 years who got infected in the third term of pregnancy and who had comorbidities. The prematurity index varied with the heterogeneity of the samples, and the cases of abortion occurred in combination with severe forms of infection. Caesarean section deliveries predominated, indicated mainly by respiratory decompensation caused by infection. Most women were discharged.ConclusionBased on the reviewed studies, the profile and evolution of pregnant women infected with COVID‐19 could be evaluated.

Prevalence of Nasopharyngeal Carcinoma in Patients with Dermatomyositis: A Systematic Review and Meta-Analysis.

For more than 50 years, nasopharyngeal carcinoma (NPC) has been associated with dermatomyositis (DM), a rare idiopathic inflammatory disorder that mainly affects the skin and muscles. Although the association between these rare diseases is well-documented, the actual prevalence of NPC in DM patients remains unknown. Here, a systematic review and meta-analysis of published data was conducted in accordance with the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Electronic databases including PubMed, Scopus, ScienceDirect, and Google Scholar were searched without year or language restrictions for studies reporting the occurrence of NPC in DM patients. The study protocol was lodged with PROSPERO (CRD42021225335). A total of 95 studies covering 303 cases of NPC among 16,010 DM patients was included. Summary estimates were calculated using the random-effects model. The pooled prevalence of NPC in DM was 3.3% (95% CI, 2.5-4.3). When stratified according to study location, higher prevalence estimates were obtained for Hong Kong (36.5%), Malaysia (27.7%), and Singapore (11.9%). There was a predominance of cases among male DM patients compared with females, and most patients were aged 40 and above. Many of the NPC cases were found to be diagnosed after the diagnosis of DM. It is therefore pertinent to screen for NPC in DM patients, especially among older DM patients in the Asian region.

Role of Topical Anesthetics Versus Topical Steroids in The Management of Traumatic Ulcer: A Case Control Study

Traumatic ulcers represent one of the most common types of ulcers occurring in the oral cavity. The etiology for the causation of the traumatic ulcers might be due to mechanical trauma-which is the commonest, thermal and electrical trauma. The ulcers due to trauma are well circumscribed, most often deep with sloping margins and an erythematous halo around the ulcers. The management of traumatic ulcers usually ranges from the prescription of topical anesthetics, steroids to nutritional supplements.The aim of this study was to assess the prevalence of traumatic ulcers and to analyse the frequency of prescription of topical anesthetics and topical steroids in the management of traumatic ulcers.The study sample consisted of 94 patients with traumatic ulcer.The patients with traumatic ulcers included 56 males with a predominance of cases in the 3rd to 4th decade of life. The number of patients who were treated with topical anesthetics is 68 and topical corticosteroids are only 9. A combination of topical steroids and local anesthetics were used in 17 patients. The results reveal that the single most common drug used in the management of traumatic ulcer is the prescription of topical anesthetics. The second most common agent used is corticosteroids. On analysing the results based on the age group to the type of therapy, there was no significance. (P&gt;0.05)The use of topical anesthetics is the commonest in the management of oral traumatic ulcers.