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Background: Studies on the long-term risk of treated cervical intraepithelial neoplasia (CIN), have shown that these women have a higher risk of invasive cancer in the remaining cervix or vagina, when compared to the general population. This risk persists, for at least, ten years after initial treatment. Methods: Retrospective cohort study to evaluate the long-term risk of vaginal cancer after treatment of high-grade cervical intraepithelial neoplasia. Results: The data comprised 460 women with high-grade cervical intraepithelial neoplasia treated at our institution, from January 2012 to December 2020. Three women developed vaginal cancer. The rate of invasive cancer during this period was 181 per 100 000 woman-years. The increased risk of developing cancer was noticed during the first 5 years of follow-up, in women older than 50, and with human papillomavirus (HPV) 16 infections. Conclusions: Women previously treated for high-grade lesions, are at an increased risk of developing invasive vaginal cancer. This risk is higher in older women. Follow-up of these women should be based on risk, by a combination of co-testing and clinical evaluation.

ObjectiveTo evaluate whether compliance with European Society of Gynaecological Oncology (ESGO) surgery quality indicators impacts disease-free survival in patients undergoing radical hysterectomy for cervical cancer.MethodsIn this retrospective cohort study, 15 ESGO quality indicators were assessed in the SUCCOR database (patients who underwent radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) stage 2009 IB1, FIGO 2018 IB1, and IB2 cervical cancer between January 2013 and December 2014), and the final score ranged between 0 and 16 points. Centers with more than 13 points were classified as high-quality indicator compliance centers. We constructed a weighted cohort using inverse probability weighting to adjust for the variables. We compared disease-free survival and overall survival using Cox proportional hazards regression analysis in the weighted cohort.ResultsA total of 838 patients were included in the study. The mean number of quality indicators compliance in this cohort was 13.6 (SD 1.45). A total of 479 (57.2%) patients were operated on at high compliance centers and 359 (42.8%) patients at low compliance centers. High compliance centers performed more open surgeries (58.4% vs 36.7%, pConclusionsPatients with early cervical cancer who underwent radical hysterectomy in centers with high compliance with ESGO quality indicators had a lower risk of recurrence and death.

Objective Based on the SUCCOR study database, our primary objective was to identify the independent clinical pathological variables associated with the risk of relapse in patients with stage IB1 cervical cancer who underwent a radical hysterectomy. Our secondary goal was to design and validate a risk predictive index (RPI) for classifying patients depending on the risk of recurrence. Methods Overall, 1116 women were included from January 2013 to December 2014. We randomly divided our sample into two cohorts: discovery and validation cohorts. The test group was used to identify the independent variables associated with relapse, and with these variables, we designed our RPI. The index was applied to calculate a relapse risk score for each participant in the validation group. Results A previous cone biopsy was the most significant independent variable that lowered the rate of relapse (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.17–0.60). Additionally, patients with a tumor diameter >2 cm on preoperative imaging assessment (OR 2.15, 95% CI 1.33–3.5) and operated by the minimally invasive approach (OR 1.61, 95% CI 1.00–2.57) were more likely to have a recurrence. Based on these findings, patients in the validation cohort were classified according to the RPI of low, medium, or high risk of relapse, with rates of 3.4%, 9.8%, and 21.3% observed in each group, respectively. With a median follow-up of 58 months, the 5-year disease-free survival rates were 97.2% for the low-risk group, 88.0% for the medium-risk group, and 80.5% for the high-risk group (p < 0.001). Conclusion Previous conization to radical hysterectomy was the most powerful protective variable of relapse. Our risk predictor index was validated to identify patients at risk of recurrence.

IntroductionComprehensive updated information on cervical cancer surgical treatment in Europe is scarce.ObjectiveTo evaluate baseline characteristics of women with early cervical cancer and to analyze the outcomes of the ESGO quality indicators after radical hysterectomy in the SUCCOR database.MethodsThe SUCCOR database consisted of 1272 patients who underwent radical hysterectomy for stage IB1 cervical cancer (FIGO 2009) between January 2013 and December 2014. After exclusion criteria, the final sample included 1156 patients. This study first described the clinical, surgical, pathological, and follow-up variables of this population and then analyzed the outcomes (disease-free survival and overall survival) after radical hysterectomy. Surgical-related ESGO quality indicators were assessed and the accomplishment of the stated recommendations was verified.ResultsThe mean age of the patients was 47.1 years (SD 10.8), with a mean body mass index of 25.4 kg/m2 (SD 4.9). A total of 423 (36.6%) patients had a previous cone biopsy. Tumor size (clinical examination) ConclusionsIn this European cohort, the rate of adjuvant therapy after radical hysterectomy is higher than for most similar patients reported in the literature. The majority of centers were already following the European recommendations even 5 years prior to the ESGO quality indicator implementations.

A 63-year-old woman was referred to a nephrologist for evaluation of decreased kidney function. The patient had no specific urinary symptoms or history of recurrent urinary tract infections, leg edema or kidney stones. She did not have nausea, vomiting, diarrhea or symptoms of steatorrhea, and had

Este projeto tem como principal objetivo dar a conhecer o latim como língua moderna que é e passível de se poder relacionar com as diferentes disciplinas dos atuais curricula do ensino básico do sistema educativo português. Assim, este trabalho tenta mostrar a verdadeira importância do latim, nomeadamente ao nível do conhecimento e do raciocínio; de forma a seduzir os jovens por meio de um método de ensino/aprendizagem que os leve ao estudo da própria língua, quer como língua de conhecimento, quer como língua de comunicação, para além da sua vertente humanista e a sua influência nas correntes de pensamento no mundo ocidental, o que se traduz em verdadeiras virtudes de um cidadão responsável. Com o objetivo de experimentar uma estratégia como esta, que se quer inovadora, foi desenvolvido este trabalho que não pretende ser mais do que um documento de trabalho com a finalidade de poder vir a transformar-se em componente letiva de oferta de escola, de acordo com as orientações do Projeto Educativo da Escola em que for implementada, para além de se coadunar com as normas vigentes do que é o Programa Nacional de Promoção do Sucesso Escolar, uma vez que ao despertar para o conhecimento do latim, em particular, vai ajudar a adquirir competências em outras áreas do saber, ou seja, possibilita estratégias de melhoria das aprendizagens e do sucesso escolar. This project has as main objective to introduce Latin as a modern language that is and can be related to the different disciplines of the current curricula of the basic education of the Portuguese educational system. So, this work tries to show the true importance of the Latin language, namely at the level of knowledge and reasoning; In order to seduce young people through a teaching / learning method that leads them to study their own language, both as a language of knowledge and as a language of communication, beyond their humanist side and their influence on the currents of thought in the Western world, letting it show the true virtues of a responsible citizen. In order to try out a strategy like this one, which wants to be innovative, this work has been developed, which is intended to be nothing more than a working document in order to be able to become a learner component of school supply, according to the guidelines of the Educational Project of the School in which it is implemented, in addition to be aligned with the current norms of what is the National Program for the Promotion of School Success, since in awakening to the knowledge of Latin, in particular, it will help to acquire skills in other areas of knowledge, that is, enables strategies to improve learning and school success.

Com a evolução da medicina, as características específicas das organizações de saúde, o estado da saúde da população e a adversidade económica existente, levou as instituições de saúde a adotarem estratégias de marketing relacional por forma a aumentar a satisfação e a fidelização de clientes. Este estudo debruça-se sobre a satisfação e fidelização de clientes no âmbito da área da saúde, sendo o seu objetivo principal: avaliar a satisfação e fidelização dos clientes da unidade de saúde oral dos Serviços de Assistência Médico Social (SAMS). Foi aplicado um questionário a uma amostra, por conveniência, de 260 indivíduos (143 de sexo feminino e 117 do sexo masculino) com idades compreendidas entre os 18 e os 94 anos, no período de 10 de Outubro a 18 de Novembro de 2016 na unidade de saúde oral dos SAMS. Após a análise dos dados, concluímos que, em caso de necessidade de cuidados de saúde oral a maior parte da amostra afirma recorrer à unidade de saúde oral dos SAMS, o que reforça a sua satisfação e, ao mesmo tempo, a sua fidelização com esta unidade de saúde. A correlação entre a satisfação, a idade e sistemas de saúde, indicou para a existência de uma correlação significativa positiva para beneficiários dos SAMS. Ou seja, os utentes também recorrem à unidade de saúde oral devido às vantagens de que usufruem, que também servem para os fidelizar. Não se encontrou qualquer relação entre a frequência com que os clientes vêm à unidade de saúde oral em análise e as dimensões do ECSI, confiança e compromisso. With the evolution of medicine, the specific characteristics of health organizations, the health status of the population and the existing economic adversity, led health institutions to adopt relational marketing strategies in order to increase customer satisfaction and loyalty. This study focuses on the satisfaction and loyalty of clients in the health area, and its main objective is to evaluate the satisfaction and loyalty of the customers of the oral healthcare unit of the Social Medical Assistance Services (SAMS). A questionnaire was applied to a convenience sample, of 260 costumers (143 female and 117 male) between the ages of 18 and 94 years, from October 10 to November 18, 2016 at the unit of SAMS oral health. After analyzing the data, we conclude that, in the case of oral health care, most of the sample claims to have recourse to the SAMS oral health unit, which reinforces their satisfaction and, at the same time, their loyalty to it. Health unit. The correlation between satisfaction, age and health systems indicated for the existence of a significant positive correlation for SAMS beneficiaries. That is, the users also use the oral health unit because of the advantages they enjoy, which also serve to retain them. No relationship was found between the frequency with which costumers come to the oral health unit under analysis and the dimensions of ECSI, trust and commitment.

The occurrence of primary breast cancer of the vulva is extremely rare (24 cases described in the English-language literature). We report a case of a primary breast carcinoma of the vulva. An 82-year-old woman presented with a nodule of the left labia minor, which was excised. The histologic examination revealed the presence of adenocarcinoma of mammary origin, positive for common breast markers and for estrogen and progesterone receptors. The study for orthotopic breast carcinoma was negative, as well as the study for metastatic disease. The diagnosis of primary breast carcinoma was established. Our patient was then submitted to pelvic and inguinal radiotherapy as well as an aromatase inhibitor (letrozole), and she remained completely asymptomatic. Because of the rarity of this condition, guidelines for therapy are unavailable. The management suggested in the literature is that of primary orthotopic breast neoplasm of a similar stage.