SUS Patients Research Articles

Clinical and laboratory characteristics but not response to treatment can distinguish children with definite growth hormone deficiency from short stature unresponsive to stimulation tests.

It has been proposed that not all children with short stature displaying an inadequate response to tests for growth hormone (GH) secretion truly suffer from GH deficiency (GHD). Only children with a monogenic cause of GHD or an identifiable combined hormonal deficiency or anatomical anomaly in the hypothalamic-pituitary axis should be considered definite GHD (dGHD). The remaining patients can be defined as a separate group of patients, "short stature unresponsive to stimulation tests" (SUS). The aim of this proof-of-concept study, was to assess whether SUS patients treated with rhGH exhibit any differences compared to GHD patients undergoing the same treatment. Retrospective analysis on 153 consecutive patients with short stature and pathological response to two GH stimulation tests. Patients with dGHD were defined as those with a clear genetic or anatomical hypothalamic-pituitary anomaly, as well as those with combined pituitary hormone deficiencies and those with a known insult to the hypothalamic-pituitary axis (i.e. total brain irradiation) (n=38, 25%); those without any of the previous anomalies were defined as SUS (n=115, 75%). At diagnosis, dGHD and SUS populations did not differ significantly in sex (F 32% vs 28%, p=0.68), age (11.9 vs 12.1, p=0.45), height SDS at diagnosis (-2.2 vs. -2.0, p=0.35) and prevalence of short stature (height <-2 SDS) (56% vs 51%, p=0.45). IGF-1 SDS were significantly lower in dGHD (-2.0 vs -1.3, p<0.01). After 1 year of treatment, the prevalence of short stature was significantly reduced in both groups (31% in dGHD vs. 21% in SUS, p<0.01) without any significant differences between groups (p=0.19), while the increase in IGF-1 SDS for bone age was greater in the dGHD category (+1.9 vs. +1.5, p<0.01), with no further difference in IGF-1 SDS between groups. At the last available follow-up, 59 patients had reached the near adult height (NAH) and underwent retesting for GHD. No differences in NAH were found (-0.3 vs. -0.4 SDS, 0% vs. 4% of short stature). The prevalence of pathological retesting was higher in dGHD (60% vs. 10%, p<0.01) as well as of overweight and obesity (67% vs. 26%). Stimulation tests and the equivalent benefit from rhGH therapy, cannot distinguish between dGHD and SUS populations. In addition, lower IGF-1 concentrations at baseline and their higher increase during treatment in dGHD patients, and the lack of pathological retesting upon reaching NAH in SUS patients, are facts that suggest that deficient GH secretion may not be the cause of short stature in the SUS studied population.

Análise da percepção de médicos do Sistema Único de Saúde sobre o uso da teleinterconsulta em Campo Grande-MS, Brasil

Abstract This study aimed to analyze the perception of the use of teleconsultation by physicians of the Unified Health System in Campo Grande-MS, as an auxiliary tool for the care of SUS patients, addressing effectiveness, satisfaction and access to results, directed to physicians of different specialties. Of a total population of 127 professionals, 100 voluntarily participated in the survey. The results demonstrated that teleconsultation was perceived as advantageous, highlighting the exchange of knowledge (44.1%) and the reduction of waiting time (42.5%). Disadvantages included low investment in the operational structure (25.2%) and technical difficulties of communication (23.6%). Teleconsultation proved to be innovative, providing intense exchange of knowledge and reducing waiting time. Although it presents technical challenges, most physicians perceived it as effective and safe.

Abstract 18822: Disparities in Access and Long-Term Survival in St Elevation Myocardial Infarction Patients the Brazilian Public and Private Health Services- Victim Registry

Introduction: This study aims to evaluate the impact of disparities in access to specialized services and reperfusion therapies on the long-term survival of patients with ST-elevation myocardial infarction (STEMI) treated under the Unified Health System (SUS) and those covered by Private Healthcare Insurance (PHI). Scarce data exist for regions characterized by significant socioeconomic disparities. Methods: The VICTIM registry was utilized to compare disparities among STEMI patients treated under SUS and PHI. The registry involved all Percutaneous Coronary Intervention (PCI) hospitals in Sergipe, the smallest state in Brazil, consisting of one facility for SUS patients and three facilities for private patients. We examined the patient's opportunity to reach a PCI hospital, reperfusion data from 2014 to 2018, and long-term survival through telephone interviews between 2020 and 2021. Long-term outcomes evaluated using the Gehan-Breslow test with Dunn correction, and significance level p&lt;0.05. Results: Out of the 1.082 patients evaluated, 893 (82.53%) received treatment under SUS, while 189 (17.47%) covered by PHI. SUS patients had to travel a distance six times greater from the site of pain to the PCI hospital (58.2 km vs. 8.7 km; p&lt;0.001); had lower rates of reperfusion (49.8% vs. 67.2%; p&lt;0.001) and primary PCI (47.2% vs. 66.5%; p&lt;0.001); and often had to pass through at least one institution before reaching the PCI hospital (76.1% vs. 41%; p&lt;0.001). The time from symptom onset to seeking help was similar for both groups, but the overall time from symptom onset to arrival at the PCI hospital was longer for public service patients (10.3h vs. 5.3h; p&lt;0.001). Fibrinolytic therapy was underused (2.5% vs. 1.1%; p=0.411). Long-term survival results displayed in Figure 1. Conclusions: SUS patients exhibited higher long-term mortality rates, longer travel distances, and reduced access to reperfusion therapies compared to PHI patients, indicating disparities in care.

Timely Access to Oncological Treatment in Brazil: Analysis of the 60-Law Compliance in a State Database

In oncology, time from diagnosis to treatment has already been shown to impact outcomes. In 2012, the Brazilian Government issued the 60-day Law, which stated that cancer treatment should start no longer than 60 days after histopathological diagnosis. However, there is scarce information on the effectiveness of the Law in improving timely access to treatment. We retrospectively evaluate the Fundação Oncocentro de São Paulo (FOSP) database, which collects information on hospitals and oncology departments in the State of São Paulo, Brazil. The primary endpoint was time from diagnosis to first treatment (TDT), and we investigated the influence of medical practice (public health care system - SUS, insurance, private) and year of diagnosis (before and after 2012) on TDT. A sensitivity analysis was performed to evaluate information bias. The database included 943,660 cancer patients diagnosed between 2000 and 2020. The median age was 62 years (range 0 - 113). The mean TDT was 65.95 days (SD 149.36), and the median time was 32 days (range 0 - 6891). Data was extremely skewed to the left, reflecting the fact that for 30.76% of patients (n = 290,262), the TDT was equal to 0 days. After excluding those patients, the mean TDT was 99.03 days (SD 173.85). Mean TDT was higher after the institution of the Law (63.1 versus 70.2 days, p < 0.001). On univariable analysis, there was a significant difference between mean times between medical practice (p < 0.001), and patients in the public health care system consistently showed longer intervals (82.1 days versus 58.3 and 39.3 for SUS, insurance, and private, respectively). This pattern remained in the sensitivity analysis. Overall, 59.9% of patients began treatment up to 60 days after diagnosis. However, 30.76% of these patients had TDT equal to zero. The proportion of patients with a TDT > 60 days was higher for SUS patients (39.52%). After the Law, the proportion of patients with a TDT > 60 days increased from 28.8% to 37.95%. The approved and instituted 60-day Law did not improve timely access to treatment. Patients in the Public Healthcare System have experienced longer TDT, which could reflect barriers to access to care. The significant proportion of patients with a TDT of 0 days suggests information bias, which means that the actual scenario might be worse. There is an urgent need for public policies to ensure compliance with the Law.

Electronic monitoring with a digital smart spacer to support personalized inhaler use education in patients with asthma: The randomized controlled OUTERSPACE trial

BackgroundPoor adherence to inhaled medication has been associated with poor outcomes. Smart spacers can monitor inhaler use and technique, yet their feasibility in adults with asthma and their potential benefits are unknown. ObjectiveAssessing the feasibility of undertaking a definitive randomized controlled trial (RCT) of smart spacer-based inhaler education and explore potential clinical benefits in adults with asthma. MethodsTwo-month randomized controlled feasibility OUtcomes following Tailored Education and Retraining: Studying Performance and AdherenCE (OUTERSPACE) trial comparing personalized smart spacer-based inhaler education versus usual care. Patients were recruited in four Dutch primary care centres. Outcomes were feasibility (inclusion speed, patient acceptance), medication adherence, inhaler technique, clinical effects (lung function, ACQ, FeNO) and usability (System Usability Scale [SUS]). Results42 patients were randomized and all completed the study. The feasibility of performing a larger trial focusing on asthma patient education using a smart spacer was demonstrated with all patients included in four months and a participation rate of 86%. In the intervention group, inhalation errors per day decreased by 26.2% while in the usual care group inhalation errors increased by 14.6% (p = 0.021). Adherence decreased slightly in the intervention group as opposed to improvement in the control group (difference 12%, p = 0.028). No changes in lung function, ACQ or FeNO were observed. Usability was deemed high (SUS patients 71, nurses 89). ConclusionThis RCT showed that smart spacer-driven education in patients with asthma is feasible and in this short-term study reduced inhaler errors. Longer-term and larger studies are required to assess clinical effects.

Health intervention proposal during primary care for tuberculosis prevention: an observational cross-sectional study

The objective of the study was to evaluate the effectiveness of a health intervention to improve the knowledge of SUS patients about tuberculosis, after analyzing the epidemiological profile of this disease in a municipality in the interior of the state of São Paulo, based on the cases reported in the System of Tuberculosis Notification from 2006 to 2015. This intervention was carried out by the application of a questionnaire about this disease to users of the primary health service, before and after the delivery of an explanatory pamphlet containing various information in a simplified way about tuberculosis. The results were tabulated and statistically analyzed. Of the 1,281 cases reported during this period, the majority were males aged between 30 and 39 years and had studied for four to seven years. The analysis of the questionnaires showed that the interviewees' knowledge improved concerning most of the disease criteria after the delivery of the pamphlet. In this way, it is concluded that the intervention method, using the explanatory pamphlet on tuberculosis, proved to be efficient, in general, in making users of the Basic Health Unit aware of various aspects of tuberculosis.

Hospital Pharmacological Treatment of Acute Myocardial Infarction with st Supra: Sus x Private

Objectives: To compare the adequacy of drug therapy in STEMI in public and private hospitals. Methods: Prospective analysis of 471 patients admitted with STEMI in public and private hospitals in the state of Sergipe. Results: Clopidogrel usage fee (91% vs 36% ; p &lt; 0.001 ) and ACE inhibitors (66% vs 22 %; p &lt; 0.001 ) was higher among SUS patients, however, use of ticagrelor (61% vs 1% ; p &lt; 0.001 ) and BRA II (24% vs 9 %, p = 0.002 ) was higher among those treated in the private sector. In the pooled analysis, SUS patients received more IECA and/or BRA II than those with indication an absolute for its use (76% vs 30%; p &lt; 0.001). Conclusions: A significant difference was observed in the use of ACE inhibitors and/or ARBs among patients in both groups, a higher rate of use of these drugs was showed amongst SUS patients.

PO-1461 Impact of the COVID-19 pandemic on Radiation Oncology Departments in Brazil

Purpose or Objective: The COVID-19 pandemic brought several challenges to cancer practice, especially to ensure continuity of treatment during this period, minimizing the risks of transmission to a vulnerable population. For Radiation Oncology departments in Brazil, this contingency has become even more complex due to the significant impact observed in different sectors of society, the large number of cases and deaths by COVID-19. This study estimated the impact of the COVID-19 pandemic on Brazilian Radiation Oncology departments and the coping measures used in the country. Materials and Methods: The Brazilian Radiotherapy Society (SBRT) developed a questionnaire with 14 questions, sent to all heads of Radiation Oncology departments in the country, between May and June 2020. These data were evaluated regarding cases confirmed and deaths by COVID-19 in epidemiological week 28, on July 11, 2020. Results: One hundred twenty-six questionnaires from different regions were answered, representing 44% of the country’s services. A drop in the number of patients was observed in 61% of services. This drop was observed both in patients from the public and supplementary private health insurance systems. Regarding patients and employees with COVID-19, we observe that services that primarily treat SUS patients reported significantly fewer cases of the disease. About half of the services had collaborators and patients during radiotherapy with a positive diagnosis of COVID-19. Among the coping measures, the services used intensified hygiene and cleanliness, distance, restrictions on access to companions, and other changes in daily practice. (Figure Presented) Conclusion: There was an important drop in the number of radiotherapy patients in the country during the pandemic, and this impact happened in a similar way among the services, regardless of their characteristics and coping measures adopted during the pandemic.

Influence of Geographical Location on Access to Reperfusion Therapies and Mortality of Patients with STEMI in Sergipe: VICTIM Register.

ResumoFundamentoA concentração de serviços de alta complexidade em Aracaju/SE pode proporcionar disparidade na qualidade assistencial para os pacientes do SUS com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMcSST) cujos sintomas se iniciaram em outras regiões de saúde do estado.ObjetivoAvaliar disparidades no acesso às terapias de reperfusão e mortalidade em 30 dias, entre pacientes com IAMcSST, usuários do SUS, em cada uma das 7 regiões de saúde em Sergipe.MétodosForam avaliados 844 pacientes com IAMcSST no período de 2014 a 2018 atendidos pelo único hospital com capacidade de ofertar intervenção coronariana percutânea (ICP) primária para usuários do SUS no estado de Sergipe. Os pacientes foram divididos em 7 grupos de acordo com o local de início dos sintomas e obedecendo a divisão já existente das regiões de saúde do Estado. Para comparação entre grupos, foi considerada diferença significativa quando p < 0,05.ResultadosDo total de 844 pacientes vítimas de IAMcSST e transferidos ao hospital com ICP que atende pacientes do SUS, 386 pacientes (45,8%) realizaram angioplastia primária. A taxa média do uso de fibrinolítico foi de 2,6%, não havendo diferenças entre as regiões. O tempo médio total de chegada ao hospital com ICP foi de 21h55’ com mediana de 10h22’ (6h30’ – 22h52’). A mortalidade total em 30 dias foi 12,8%, mas sem diferenças entre as regiões, mesmo quando ajustada para idade e sexo.ConclusõesEste estudo revela que os fibrinolíticos são subutilizados em todo o estado e que existe um atraso significativo no acesso ao hospital com ICP, em todas as regiões de saúde de Sergipe.

Vestibular function assessment of Susac syndrome patients by the video head impulse test and cervical vestibular-evoked myogenic potentials.

Susac syndrome (retino-cochleo-cerebral vasculopathy, SuS) is an autoimmune endotheliopathy characterized by the clinical triad of encephalopathy, branch retinal artery occlusions and sensorineural hearing loss. In contrast to data regarding auditory function, data measuring vestibular function is sparse and the cervical vestibular-evoked myogenic potentials (cVEMPs). To determine whether the video head impulse test (vHIT) can serve as a confirmatory assessment of vestibulocochlear dysfunction in cases of suspected SuS. Seven patients diagnosed with SuS underwent pure tone audiometry, a word recognition test, cVEMPs and the vHIT. Five patients were diagnosed with definite SuS, and two with probable SuS. Two patients were asymptomatic for hearing loss or tinnitus, and no sensorineural hearing loss was detected by audiograms. Four patients complained of tinnitus, and three patients reported experiencing vertigo. Three patients had abnormal cVEMPs results. All seven patients' vHIT results were normal, except for patient #2, who was one of the three who complained of vertigo. The calculated gain of her left anterior semicircular canal was 0.5, without saccades. This is the first study to describe the results of the vHIT and cVEMPs among a group of patients with SuS. The results suggest that the vHIT should not be the only exam used to assess the function of the vestibular system of SuS patients.

Vestibular function assessment of Susac syndrome patients by the video head impulse test and cervical vestibular-evoked myogenic potentials.

Susac syndrome (retino-cochleo-cerebral vasculopathy, SuS) is an autoimmune endotheliopathy characterized by the clinical triad of encephalopathy, branch retinal artery occlusions and sensorineural hearing loss. In contrast to data regarding auditory function, data measuring vestibular function is sparse. To determine whether the video head impulse test (vHIT) can serve as a confirmatory assessment of vestibulocochlear dysfunction in cases of suspected SuS. Seven patients diagnosed with SuS underwent pure tone audiometry, a word recognition test, cervical vestibular-evoked myogenic potentials (cVEMPs), and the v-HIT. Five patients were diagnosed with definite SuS, and two with probable SuS. Two patients were asymptomatic for hearing loss or tinnitus, and no sensorineural hearing loss was detected by audiograms. Four patients complained of tinnitus, and three patients reported experiencing vertigo. Three patients had abnormal cVEMPs results. All seven patients' vHIT results were normal, except for patient #2, who was one of the three who complained of vertigo. The calculated gain of her left anterior semicircular canal was 0.5, without saccades. This is the first study to describe the results of the vHIT and cVEMPs among a group of patients with SuS. The results suggest that the vHIT should not be the only exam used to assess the function of the vestibular system of SuS patients.

Effectiveness of first-line treatment for relapsing-remitting multiple sclerosis in Brazil: A 16-year non-concurrent cohort study.

Relapsing-remitting multiple sclerosis (RRMM) is a chronic, progressive, inflammatory and immune-mediated disease that affects the central nervous system and is characterized by episodes of neurological dysfunction followed by a period of remission. The pharmacological strategy aims to delay the progression of the disease and prevent relapse. Interferon beta and glatiramer are commonly used in the Brazilian public health system and are available to patients who meet the guideline criteria. The scenario of multiple treatments available and in development brings the need for discussion and evaluation of the technologies already available before the incorporation of new drugs. This study analyses the effectiveness of first-line treatment of RRMS measured by real-world evidence data, from the Brazilian National Health System (SUS). We conducted a non-concurrent national cohort between 2000 and 2015. The study population consisted of 22,722 patients with RRMS using one of the following first-line drugs of interest: glatiramer or one of three presentations of interferon beta. Kaplan-Meier analysis was used to estimate the time to treatment failure. A univariate and multivariate Cox proportional hazard model was used to evaluate factors associated with treatment failure. In addition, patients were propensity score-matched (1:1) in six groups of comparative first-line treatments to evaluate the effectiveness among them. The analysis indicated a higher risk of treatment failure in female patients (HR = 1.08; P = 0,01), those with comorbidities at baseline (HR = 1.20; P<0,0001), in patients who developed comorbidities after starting treatment (i.e., rheumatoid arthritis-HR = 1.65; P<0,0001), those exclusive SUS patients (HR = 1.31; P<0,0001) and among patients using intramuscular interferon beta (IM βINF-1a) (28% to 60% compared to the other three treatments; P<0,0001). Lower risk of treatment failure was found among patients treated with glatiramer. This retrospective cohort suggests that glatiramer is associated with greater effectiveness compared to the three presentations of interferon beta. When evaluating beta interferons, the results suggest that the intramuscular presentation is not effective in the treatment of multiple sclerosis.

Cost-effectiveness of Drug-Eluting Stents in Percutaneous Coronary Intervention in Brazil's Unified Public Health System (SUS).

ResumoFundamento O uso do stent farmacológico (SF) comparado ao stent não farmacológico (SNF) na intervenção coronariana percutânea (ICP) reduziu o percentual de reestenose, porém sem impacto na mortalidade, com aumento no custo. A literatura carece de estudos randomizados que comparem economicamente esses dois grupos de stents na realidade do Sistema Único de Saúde (SUS).Objetivo Estimar a razão custo-efetividade incremental (RCEI) entre SF e SNF na coronariopatia uniarterial em pacientes do SUSMétodos Pacientes com coronariopatia uniarterial sintomática foram randomizados em 3 anos para uso de SF ou SNF durante a ICP, na proporção de 1:2, com seguimento clínico de 12 meses. Foram avaliados reestenose intrastent (RIS), revascularização da lesão-alvo (RLA), eventos adversos maiores e custo-efetividade (CE) de cada grupo. Os valores de p < 0,05 foram considerados significativos.Resultados No grupo SF, dos 74 pacientes (96,1%) que completaram o acompanhamento, ocorreu RIS em 1(1,4%), RLA em 1 (1,4%), óbito em 1 (1,4%), sem trombose. No grupo SNF, dos 141 pacientes (91,5%),ocorreu RIS em 14 (10,1%), RLA em 10 (7,3%), óbito em 3 (2,1%) e trombose em 1 (0,74%). Na análise econômica, o custo do procedimento foi de R$ 5.722,21 no grupo SF e de R$4.085,21 no grupo SNF. A diferença de efetividade a favor do grupo SF por RIS e RLA foi 8,7% e 5,9%, respectivamente, com RCEI de R$ 18.816,09 e R$ 27.745,76.Conclusões No SUS, o SF foi custo-efetivo, em concordância com o limiar de CE preconizado pela Organização Mundial da Saúde. (Arq Bras Cardiol. 2020; 115(1):80-89)

Effectiveness of Maintenance Immunosuppression Therapies in a Matched-Pair Analysis Cohort of 16 Years of Renal Transplant in the Brazilian National Health System.

The maintenance of patients with renal transplant typically involves two or more drugs to prevent rejection and prolong graft survival. The calcineurin inhibitors (CNI) are the most commonly recommended medicines in combinations with others. While immunosuppressive treatment regimens are well established, there is insufficient long-term effectiveness data to help guide future management decisions. The study analyzes the effectiveness of treatment regimens containing CNI after renal transplantation during 16 years of follow-up with real-world data from the Brazilian National Health System (SUS). This was a retrospective study of 2318 SUS patients after renal transplantion. Patients were propensity score-matched (1:1) by sex, age, type and year of transplantation. Kaplan–Meier analysis was used to estimate the cumulative probabilities of survival. A Cox proportional hazard model was used to evaluate factors associated with progression to graft loss. Multivariable analysis, adjusted for diabetes mellitus and race/color, showed a greater risk of graft loss for patients using tacrolimus plus mycophenolate compared to patients treated with cyclosporine plus azathioprine. In conclusion, this Brazilian real-world study, with a long follow-up period using matched analysis for relevant clinical features and the representativeness of the sample, demonstrated improved long-term effectiveness for therapeutic regimens containing cyclosporine plus azathioprine. Consequently, we recommend that protocols and clinical guidelines for renal transplantation should consider the cyclosporine plus azathioprine regimen as a potential first line option, along with others.

Abstract P6-08-34: Genetic testing for hereditary breast cancer in Brazilian public health system: The experience of tumor board reference in a cancer center

Abstract Introduction: In Brazil, genetic testing for hereditary cancer predisposition syndromes, including Hereditary Breast Cancer (HBC), is not covered by the public health system (SUS) and was only incorporated in most private health insurance (PHI) plans after 2013. Nonetheless, considering that only 22% of the Brazilian population has access to private health system and the high cost of genetic testing in private laboratories, the majority of Brazilian women at risk for HBC do not have access to a genetic diagnosis. In this context, we have implemented at A.C.Camargo Cancer Center (ACCCC – a reference Cancer Center in Brazil which serves both the private and public health systems) a pilot program that offers genetic testing for SUS patients at risk for HBC. The goal of this study is to present the adopted clinical criteria and the corresponding detection rate of pathogenic variants in HBC genes observed in our cohort in comparison to detection rates observed in private health scenario. Methods: Since 2018, 34 cases of breast cancer patients from SUS under medical follow-up at ACCCC and at risk for HBC were discussed in multidisciplinary Tumor Board meetings. The Tumor Board team consists of health care professionals from different specialties, including medical oncologists, surgeons, pathologists, molecular biologists, and clinical geneticists. The clinical criteria defined for referring patients to genetic testing were: (1) personal history of triple negative breast cancer (TNBC) in any age; (2) personal history of non-TNBC developed before 30 years old, positive family history of cancer, and a PENN II model prediction of &amp;gt;15% risk in carry a BRCA1/2 mutation; and (3) personal history of BC in any age and a PENN II model prediction of &amp;gt;30% risk in carry a BRCA1/2 mutation. Detection rates of SUS patients were compared to BRCA1/2 results obtained during the same period from the ACCCC Laboratory of Genomics Diagnostics that serves manly PHI and private patients. Genetic tests were performed using different gene panels containing 26 or 94 genes. Results: Pathogenic (P) and likely pathogenic (LP) variants were detected in 38% of SUS patients (13/34), with a higher proportion of BRCA1 carriers (69% - 9 patients) than of BRCA2 (1 patient). Aside BRCA1/2 mutations that were detected in 10 patients (29%), P/LP variants were also identified in BRIP1, CHEK2, and PALB2 (1 patient each). The rate for BRCA1/2 P/LP variants in PHI cohort was 9.8% (23/234 patients), with a lower proportion of BRCA1 carriers (22%) than of BRCA2 (40%). It was identified a high rate of P/LP variants in TNBC from SUS cohort (62% - 10/16 cases) and a marked association of BRCA1 and TNBC, with 80% (8/10) of hereditary TNBC having BRCA1 mutations. The mean turnaround time for genetic test results was 4 months, varying from 2 to 8 months. From 11 patients with P/LP variants that already received the genetic test result, 5 underwent prophylactic contralateral mastectomy and/or bilateral salpingo-oophorectomy. Conclusions: The introduction of genetic testing for HBC made possible to tailor preventative measures for women at high risk, including prophylactic surgery and screening protocols. However, in many developing countries, the high cost of genetic tests and the lack of national policies prevent its application in clinical practice for the majority of the population. By defining more stringent clinical criteria for HBC genetic test, we detected a mutation rate three times as high as that detected in the private health scenario. With the continuity our study, we expect to contribute to the development of national standards for HBC screening and to encourage the implementation of consistent and cost-effective genetic testing under the real-life conditions of our public health system, maximizing the benefit for the population with the available resources. Citation Format: Dirce M Carraro, Giovana T Torrezan, Karina M Santiago, Maria\ Nirvana da Cruz Formiga, Solange M Sanches, Fabiana BA Makdissi, Breast Cancer Tumor Board Team. Genetic testing for hereditary breast cancer in Brazilian public health system: The experience of tumor board reference in a cancer center [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-08-34.

Real-world data: evaluation of sentinel lymph node biopsy after complete pathological response of breast cancer to neoadjuvant chemotherapy in patients with triple-negative and her2 positive breast cancer in a cohort from rio grande do sul, brazil

Introduction: International publications show a high correlation of axillary response and complete pathological response (CPR) of breast cancer to neoadjuvant chemotherapy (NACT) in patients with triple-negative (TN) and HER2 positive (HER2+) tumors. The need for surgery is being questioned when percutaneous breast biopsy after NACT indicates CPR, despite recent presentations demonstrating high rates of false-negative (FN), ranging from 17–39%. The proper axillary management in patients with CPR of breast cancer is still discussed: is it possible to avoid the axillary evaluation? What is the axillary downstaging rate? Identifying any residual disease to adjust the adjuvant treatment is also a concern. Retrospective studies reveal a rate of positive lymph nodes lower than 2% in this population when CPR of breast cancer is reached. Objective: To identify the rate of complete axillary response in patients with CPR of breast cancer to NACT in TN and HER2+ tumors. Methods: This is a retrospective cohort study conducted in two health facilities in Southern Brazil. The sample consists of 130 patients who underwent NACT, followed by surgery between January 2016 and December 2018. The patients included were treated in the public health system (Sistema Único de Saúde – SUS) and private health system. Results: Among the 130 patients submitted to NACT, 76 (58%) had HER2+ and TN immunohistochemical subtypes – luminal HER2+: 23 patients, HER2+ pure: 15, TN: 38. Among these patients, 33 (43%) reached CPR of breast cancer, of which 9 corresponded to luminal HER2+, 10 to HER2+, and 14 to TN. In patients with CPR of breast cancer, 29 (87.8%) had no lymph node disease. Out of the 10 HER2+ pure with CPR of breast cancer, 100% had no lymph node disease, and 8 were positive pre-NACT. Among the 14 TN, only 1 patient had 2 positive lymph nodes (2+/10), and she was cN0 prior to NACT (with negative axillary ultrasound). Among the 5 pre-NACT clinically positive lymph nodes in TN patients (including 1 patient with cN2), all had CPR to NACT (3 axillary dissections and 2 sentinel lymph node biopsies – SLNB). Out of the 9 patients with luminal HER and CPR of breast cancer, 4 had clinically positive lymph nodes before NACT, and 3 remained positive (15% of conversion). Conclusion: In this study, CPR of breast cancer was highly correlated with negative axillary evaluation after NACT (87.8%), mainly in the TN and HER2+ pure subtypes (98%), even if the lymph node was clinically positive before NACT, with 100% of conversion of HER 2+ pure cases. SUS patients used trastuzumab as the single drug targeting anti HER2. These data agree with those found in the literature, despite the small sample. Larger studies are necessary, as around 70% of our population depend on SUS. With more published data, considering the performance of SLNB in HER2+ pure and TN patients submitted to NACT could become a common practice, reducing morbidity. The safety of this practice in the luminal HER+ subtype remains unclear.

Percepção da qualidade de vida e sintomas ansiosos e depressivos de pacientes oncológicos em tratamento quimioterápico: um comparativo entre usuários de um serviço público e um privado

OBJETIVO: Comparar a percepção da qualidade de vida (QV) e a presença de sintomas ansiosos e depressivos de pacientes em tratamento quimioterápico, usuários de um hospital público e de um privado na cidade de Maceió/AL.MÉTODOS: Estudo do tipo transversal observacional, realizado com pacientes em tratamento oncológico com quimioterápicos em um hospital público e outro privado de Maceió no período de novembro de 2015 a julho de 2016. A QV foi avaliada por meio do protocolo European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC) e a presença de sintomas ansiosos e depressivos foram observados pela Escala Hospital Anxiety and Depression (HAD). Os dados coletados foram organizados em banco de dados eletrônicos e analisados quantitativamente por meio do software estatístico Statistical Package for Social Sciences (SPSS), respeitando a natureza de distribuição das variáveis estudadas.RESULTADOS: A amostra constituiu-se de 65 pacientes, 33 (50,9%) foram atendidos em hospital conveniado ao Sistema Único de Saúde (SUS) e 32 (49,1%) no hospital particular. A média da idade foi de 54,2 anos (±11,8 DP), não havendo diferença entre os grupos (p=0,184). A maioria da amostra foi do sexo feminino (67,7%). Avaliando a frequência de indivíduos com sinais de ansiedade, observou-se que o grupo de indivíduos atendidos através do convênio particular sofre com maior possibilidade de apresentar sinais de ansiedade em comparação com o grupo atendido pelo convênio SUS (n=26, 81,2% versus n=7, 21,2%; respectivamente) (p&lt;0,001). A frequência de indivíduos com sintomas depressivos foi maior no grupo atendido pelo convênio particular (n=27, 84,3% versus n=7, 21,2%; respectivamente) (p&lt;0,001). Nas funções física, cognitiva e social, a média foi de 73,2 pontos para pacientes do SUS e 62,6 pontos para pacientes atendidos em hospital particular (p=0,005). Nas escalas de sintomas, a média foi de 29,7 para pacientes do hospital público e 34,9 para clientes do hospital particular (p = 0,043).CONCLUSÕES: A doença e o tratamento quimioterápico parecem exercer impacto mais negativo sobre a QV dos pacientes em tratamento pelo convênio particular. Entretanto, a presença de sintomas ansiosos e depressivos foi bastante frequente nos usuários de ambos os serviços hospitalares.

Clinical and imaging features distinguishing Susac syndrome from primary angiitis of the central nervous system

Introduction: To assess clinical and/or imaging features useful to distinguish between Susac syndrome (SuS) and primary angiitis of central nervous system (PACNS). Methods: Multicenter retrospective analysis of two cohorts of Argentine patients diagnosed with SuS and PACNS. Results: 13 patients diagnosed with SuS (6 women and 7 men, mean age 35 ± 10 years) and 15 with PACNS (10 women and 5 men, mean age 44 ± 18 years) were analyzed. Cognitive impairment (11 out of 13 patients vs. 5 out of 15, p = .006), ataxia (7 out of 13 vs. 2 out of 15, p = .042) and auditory disturbances (7 out of 13 vs. 0 out of 15, p = .003) were more frequent in SuS patients; whereas seizures were more frequent in PACNS patients (8 out of 15 vs. 1 out of 13, p = .035). On MRI, corpus callosum (CC) involvement was observed more often in SuS, with abnormalities in CC genu, in 13 out of 13 SuS patients vs. only 2 out of 15 PACNS patients (p < .001); in CC body these were present in 13 out of 13 SuS patients vs. 1 out of 15 PACNS patients, (p < .001); and in CC splenium in 12 out of 13 Sus patients vs. 1 of 15 PACNS, p < .001). Cortical lesions were more frequent in PACNS patients (10 out of 15 vs. 3 out of 13 SuS patients, p = .02), as were hemorrhages (5 out of 15 vs. 0 out of 13 SuS, p = .04) and multiple basal ganglia infarcts (7 out of 15 vs. 1 out of 13 Sus, p = .037). Conclusion: Specific clinical and/or MRI findings may help distinguish SuS from PACNS with potential therapeutic implications.

Association Between Obesity and Gastroesophageal Reflux Disease in SUS Patients in the State of Bahia

Association Between Obesity and Gastroesophageal Reflux Disease in SUS Patients in the State of Bahia

Estudo comparativo da evolução nutricional de pacientes candidatos à cirurgia bariátrica assistidos pelo Sistema Único de Saúde e pela Rede Suplementar de Saúde

A cross-sectional comparative study was conducted on the nutritional evolution of severely obese patients who are candidates for bariatric surgery attended by the Unified Health System (SUS) and the Supplemental Health Network (RS). The average preoperative follow-up period was 14.3 ± 7.7 months in the SUS and 2.4 ± 1.7 months in the RS. There was a predominance of females among patients attended by the SUS (80.6%) and by the RS (75.7%). A significant reduction in weight, BMI and waist circumference (WC) and total cholesterol values of patients of both health networks was observed. Patients attended by the SUS showed no significant decrease in LDL, Triglycerides and Fasting Glycemia, while patients assisted by the RS showed a significant reduction of these values. The greater weight loss among SUS patients is explained by the fact that they had been monitored for a longer period. The insignificant reduction of most biochemical indicators of SUS patients can be justified by the fact that they had a more advanced degree of obesity.