- BACKGROUND: Gallbladder diseases (GBD) are one of the most common medical conditions requiring surgical intervention, both electively and urgently. It is widely accepted that sex and ethnic characteristics mighty influence both prevalence and outcomes. AIM: This study aimed to evaluate the differences on distributions of gender and ethnicity related to the epidemiology of GBD in the Brazilian public health system. METHODS: DATASUS was used to retrieve patients’ data recorded under the International Code of Diseases (ICD-10) - code K80 from January 2008 to December 2019. The number of admissions, modality of care, number of deaths, and in-hospital mortality rate were analyzed by gender and ethnic groups. RESULTS: Between 2008 and 2019, a total of 2,899,712 patients with cholelithiasis/cholecystitis (K80) were admitted to the hospitals of the Brazilian Unified Health System, of whom only 22.7% were males. Yet, the in-hospital mortality rate was significantly higher in males (15.9 per 1,000 male patients) than females (6.3 per 1,000 female patients) (p<0.05). Moreover, men presented a significantly higher risk of death (RR=2.5; p<0.05) and longer hospital stay (4.4 days vs. 3.3 days; p<0.05) than females. Compared to females, men presented a higher risk of death across all self-declared ethnic groups: whites (RR=2.4; p<0.05), blacks (RR=2.7; p<0.05), browns (RR=2.6; p<0.05), and Brazilian Indians (RR=2.13; p<0.05). CONCLUSION: In the years 2008-2019, women presented the highest prevalence of hospital admissions for GBD in Brazil, and men were associated with worse outcomes, including all ethnic groups.

Acute appendicitis is the leading cause of abdominal emergency surgery worldwide and appendectomy continues to be the definitive treatment of choice. This cost-effectiveness analysis evaluates laparoscopic versus open appendectomies performed in public health services in the state of Bahia (Brazil). We conducted a retrospective observational study using the database from the Department of Informatics of the Unified Health System (DATASUS). Available data on appendectomies between 2008 and 2019 were included, and we evaluated the temporal trend of hospital admissions, procedure-related mortality rates, length of stay, and costs. Statistical analysis was performed using the R-software (R Foundation, v.4.0.3) and the BioEstat software (IMDS, v. 5.3), considering p<0.05 as significant. During 2008-2019, 53,024 appendectomies were performed in the public health services in Bahia, of which 94.9% were open surgeries. The open technique was associated with a higher mortality rate (4.9/1,000 procedures; p<0.05) and a higher risk of death (RR=4.5; p<0.05) compared to laparoscopy (1.1/1,000 procedures). Laparoscopic appendectomy (median of 2.7 days) had a shorter length of stay compared to laparotomy (median of 4.15 days) (p<0.05). There was no difference in the medians of costs nor hospital services, per procedure (p=0.08 and p=0.08, respectively). Laparoscopic professional median costs were higher by US$ 1.39 (p<0.05). Minimally invasive surgery for appendicitis is a safe and efficacious procedure in Brazilian public health care services, as it provides advantages over the open method (including lower procedure-related mortality rate and earlier discharges), and it did not imply higher expenses for public service budgets in the state of Bahia.

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O carcinoma de células de Merkel (CCM) é um tumor neuroendócrino maligno raro, agressivo, com tendência à recidiva precoce e metástases à distância. As células de Merkel são mecanorreceptores localizados na camada basal da epiderme, conectadas a terminais nervosos e bainha radicular de grandes folículos pilosos. Embora seja 40 vezes menos frequente que o melanoma, é considerado o câncer de pele mais letal. Dados epidemiológicos sugerem incidência de aproximadamente 2.500 novos casos por ano na União Europeia. Destes, 1.000 evoluem a óbito pela doença no período.

Background Short period from diagnosis to breast cancer (BC) treatment initiation remains challenging for the public health system in Brazil, which may have been further affected by the coronavirus disease-2019 (COVID-19) pandemic. This study assessed BC diagnosis-to-treatment intervals (DTi) in Brazil and the possible effects of the COVID-19 outbreak on delays. Methods The Painel de Monitoramento de Tratamento Oncológico database was queried to obtain the number of Brazilian patients with a BC confirmed diagnosis and initiating cancer treatment in the pre-COVID-19 (2013–2019) and during the COVID-19 (2020–2021) periods, adopting a 60-day limit as timely treatment. A p -value of <0.05 was considered significant. Results A total of 315,951 cases were included (females: 99.3% and males: 0.7%), of which 251,667 and 64,284 records were computed before and during the COVID-19 years, respectively. Most patients failed to perform the first cancer treatment within 60 days (>60: 51.8%). We observed an upward trend in the number of BC treatments provided in the pre-COVID-19 years ( r 2 = 0.9575; p < 0.05), but the volume of treatments exhibited an average reduction of 24.6% yearly during the COVID-19 pandemic. The average DTi in days was 122.4, 122.5 and 122.3 in the total period studied, before and during the COVID-19 outbreak, respectively. The arrival of COVID-19 in Brazil increased the chances of treatment delay (OR = 1.043; p < 0.05) and inverted the proportion of early/advanced stages at BC diagnosis (55.8%/44.2%–48.4%/51.6%). Conclusion COVID-19 has imposed changes in BC care in Brazil, reducing the number of treatments provided by the Brazilian public health system, increasing the chances of delayed treatment initiation despite no differences in DTi averages being identified, and raising the proportion of advanced-stage diagnoses.