Hospital Santa Izabel

54 Background: There are limited data on the impact of TNT on complete response (CR) rates for LARC treated in community settings. Methods: A retrospective cohort study was conducted at two health centers, from January 2019 to August 2023. All consecutive patients with LARC staged cT3-cT4 and/or lymph node- positive (AJCC 8th Edition) who received at least one application of neoadjuvant therapy (NAT)—radiotherapy and/or chemotherapy—were included. The primary outcome was the overall CR rate, stratified by NAT: TNT versus Non-TNT. CR was defined as cases achieving pathological complete response (ypCR) or sustained complete clinical response (cCR) after 12 months for patients undergoing a watchful waiting protocol. Secondary endpoints were ypCR rates and clinical/ hematological toxicities (CTCAE version 5.0) stratified by NAT. Results: Overall, 137 patients were included, with 60 (43.8%) receiving TNT and 77 (56.2%) receiving Non- TNT. The median age was 58.9 years [standard deviation (SD): ±11.2] for the TNT group and 59.0 years (SD: ±11.0) for the Non-TNT group. Initial staging for the TNT and Non-TNT groups was as follows: cT3 (61.6% and 67.5%), cT4 (18.3% and 16.8%), and positive lymph nodes (68.3% and 66.2%), respectively. The median distance from the anal verge was 5.5 cm [Interquartile range (IQR): 5–9.5] for TNT and 6.0 cm (IQR: 5–10) for Non-TNT. The overall CR rates for the TNT and Non-TNT groups were 28.3% (17/60) and 11.6% (9/77), respectively [Odds ratio (OR) = 2.98; 95% CI: 1.24–7.17]. The ypCR rates were 20.0% (12/60) for TNT and 7.8% (6/77) for Non- TNT (OR = 2.96; 95% CI: 1.07–8.14). Grade ≥3 clinical toxicities during NAT occurred in 5.0% (3/60) of the TNT group and 6.4% (5/77) of the Non-TNT group (OR = 0.76; 95% CI: 0.19–3.01). Grade ≥3 hematological toxicities during NAT occurred in 3.3% (2/60) of the TNT group and 5.2% (4/77) of the Non-TNT group (OR = 0.62; 95% CI: 0.11–3.49). Conclusions: The data suggest a higher CR rate in the TNT group compared to the Non-TNT group among patients with LARC treated in community settings.

Severe spontaneous hypoglycemia (SSH) is a rare but high-risk condition in hospitalized patients, particularly among the critically ill. It is associated with increased mortality and may serve as a marker of disease severity. To describe in-hospital mortality and clinical profile observed in patients with SSH. A retrospective cohort study was conducted at Santa Izabel Hospital from November 1, 2023, to March 31, 2024. Among 5,803 hospitalized patients, 134 (2.3%) had severe hypoglycemia (≤ 40mg/dL). After excluding insulin users and measurement errors, 47 patients (0.81%) were analyzed. Data included demographics, comorbidities, hypoglycemia recurrence, and hospital outcomes. SSH prevalence was 0.81% (n = 47) among all hospitalized patients with at least one blood glucose (BG) reading, with an overall mortality rate of 66% (n = 31). Recurrence within 24h occurred in 46.8% (n = 22) of patients but was not significantly associated with increased mortality (82% with recurrence vs. 52% without recurrence; p = 0.063). Among total deaths (n = 31), 41.9% (n = 13) occurred within 24h (43.8% with recurrence vs. 38.5% without recurrence) and 22.6% (n = 7) within 12h. In the total SSH group, renal insufficiency (51%), infection (80.9%), malignancy (46.8%), and elevated lactate > 2.0 mmol/L (70.3%) were common. Patients who died had more comorbidities compared to survivors (median 4.00 vs. 2.00; [p < 0.001), elevated serum creatinine levels (1.44 vs. 0.87mg/dL; p = 0.035), and increased serum lactate concentrations (3.60 vs. 1.15 mmol/L; p = 0.002). Fasting in the 48h preceding the first hypoglycemic episode was significantly more common in the patients with at least one recurrence of SSH in 24h (70.0% vs. 20.0%; p = 0.001). In the multivariable model, none of the analyzed variables remained significantly associated with mortality. SSH is rare but patients who experience it have elevated in-hospital mortality. It is often present in the context of rapid clinical deterioration, with many deaths in this cohort occurring within 24h of the first episode. SSH may be a key marker of disease severity and can be further explored as a prognostic marker to guide management.

The aim of this study was to investigate the relationship between postural biomechanics and the incidence of orthopedic injuries in athletes from different sports. An exploratory and descriptive literature review was carried out, with a qualitative approach, based on the analysis of studies published between 2020 and 2024 in the following databases: PubMed, SciELO and BVS. Deficits in postural control significantly increase the risk of injuries, especially in sports that involve rapid changes of direction and repetitive landings. In addition, postural correction training and continuous biomechanical monitoring have proven to be effective strategies for preventing injuries. Postural biomechanics directly influence the vulnerability of athletes to musculoskeletal trauma, and that the implementation of preventive interventions, such as muscle strengthening and regular postural analysis, is essential. However, there is a need for broader and longitudinal studies to deepen knowledge about the effectiveness of these approaches in reducing sports injuries.

Advancements in prostate imaging, particularly multiparametric magnetic resonance imaging (mpMRI), have transformed the diagnosis and monitoring paradigms for prostate cancer (PCa). However, considerable interobserver variability has been reported,emphasizing the importance of standardized scoring and reporting systems. The Prostate Imaging Reporting and Data System (PI-RADS), along with quality assurance protocols such as Prostate Imaging Quality (PI-QUAL), has enhanced the diagnostic accuracy of mpMRI. While mpMRI effectively identifies extraprostatic extension, emerging hybrid positron emission tomography/magnetic resonance imaging (PET/MRI) and radio labeled prostate-specific membrane antigen (PSMA) tracers have improved metastasis detection. In active surveillance settings, the Prostate Cancer Radiologic Estimation of Change in Sequential Evaluation (PRECISE) recommendations enable the assessment of longitudinal PCa changes. Post-treatment evaluation can also employ dedicated frameworks, such as the Prostate Imaging for Recurrence Reporting (PI-RR) after radical prostatectomy, and either the Prostate Imaging after Focal Ablation (PI-FAB) or the Transatlantic Recommendations for Prostate Gland Evaluation with MRI after Focal Therapy (TARGET). This article reviews key aspects of mpMRI, including structured interpretation frameworks beyond the widely recognized PI-RADS.