BACKGROUNDsquamous cell carcinoma is the second most common type of skin malignancy and may evolve to regional lymph node and distant metastases. OBJECTIVEThe objective of this study was to evaluate patients with head and neck cutaneous squamous cell carcinoma to identify its clinical and histopathological characteristics, as well as the frequency of local recurrence and metastasis. METHODSA retrospective cohort of patients with head and neck cutaneous squamous cell carcinoma. Inclusion criteria: histopathological confirmation, follow-up for longer than one year after diagnosis. Exclusion criteria: immunosuppression; lip and oral cavity squamous cell carcinoma; and non-surgical resection of the lesion. We evaluated demographic, clinical and anatomopathologic findings and explored their associations.RESULTSSixty-one patients with 79 tumors and followed by 4.8±3.0 years were selected. The average age was 67.1 years, and 63% of tumors had up to two centimeters. Seven tumors (8.9%) recurred and two of them had positive margins. Recurrence was associated with higher Broders' grade (p<0.01). Two patients (3.3%) had regional lymph node metastases. There were no distant metastases. Seventy tumors were considered to be usual tumors (89.7%), and 68 (87.2%) were classified as Broders' grade 1 and 2. Additionally, 64.1% of tumors had a depth of invasion below four millimeters. Thirteen tumors (16.7%) had positive histological margins. CONCLUSIONSMost patients had good prognosis in the first year of follow-up, confirming that head and neck cutaneous squamous cell carcinoma has a better prognosis than squamous cell carcinoma of other regions such as mucosa, oral cavity, and internal organs.

Chronic sclerosing sialadenitis is an uncommon cause of salivary gland enlargement mainly occurring in the fifth and seventh decade of life. In the Western population, chronic sclerosing sialadenitis has been characterized as an IgG4-related disease. Although rare, this lesion occurs in children. To increase awareness about this entity in the pediatric age group, we report the case of an 11-year-old boy with a hard, 4.0-cm circumscribed mass in the right submandibular gland. Histologically there was marked distortion of the gland architecture by a dense lymphocytic infiltrate and extensive fibrosis with septa that crossed and distorted the gland, leaving atrophic acini and dilated, irregular ducts. The lymphoid infiltrate formed multiple follicles with active germinal centers, numerous plasma cells, and areas with diffuse arrangement. Immunophenotyping showed abundant CD20- and CD3-positive lymphocytes; cytokeratin AE1/AE3 highlighted the distorted architectural pattern; IgG staining showed large numbers of positive cells infiltrating the interstitium and surrounding the atrophic acini and ducts. IgG4 staining revealed a large proportion of positive infiltrating elements. Küttner tumor belongs to the group of IgG4-related sclerosing diseases. The differential diagnosis includes pleomorphic adenoma and other salivary gland neoplasms. Its recognition in children is important clinically because this entity is amenable to steroid treatment, and additional work up and follow up is warranted to stave off other IgG4-related diseases/complications.

Objective: To investigate the histological subtypes and mutational profiles of non-small cell lung cancer in Brazil, looking for correlations among histological subtypes, expression of anaplastic lymphoma kinase (ALK), EGFR mutation status, and programmed death-ligand 1 (PD-L1) expression. Methods: We evaluated 173 specimens obtained from patients with lung adenocarcinoma in northeastern Brazil. Expression of PD-L1 and ALK was evaluated by immunohistochemistry; EGFR mutation status was evaluated by sequencing. We categorized the histological subtypes in accordance with the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. Results: The most common histological subtypes of lung adenocarcinoma were solid predominant (in 46.8%), acinar predominant (in 37.0%), and lepidic predominant (in 9.8%). ALK expression was detected in 10.4% of the samples, and 22.0% of the tumors harbored EGFR mutations. The most common EGFR mutation was an exon 21 L858R point mutation (in 45.5%), followed by an exon 19 deletion (in 36.3%). The tumor proportion score for PD-L1 expression was ≥ 50% in 18.2% of the samples, 1-49% in 32.7%, and 0% in 49.5%. The solid predominant subtype was significantly associated with wild-type EGFR status (p = 0.047). Positivity for PD-L1 expression was not found to be significantly associated with ALK expression or EGFR mutation status. Conclusions: Our results suggest that the molecular profile of non-small cell lung cancer in northeastern Brazil differs from those of populations in other regions of the country, with ALK positivity being higher than the other biomarkers. Further studies including clinical and genetic information are required to confirm these differences, as well as studies focusing on populations living in different areas of the country.

Objetivo: Investigar as dificuldades intraescolares para efetividade da cultura de paz na escola.Método: configura-se como um estudo exploratório e descritivo, com abordagem qualitativa, concretizado num estudo de caso em uma escola pública da Rede Municipal de Fortaleza-Ceará, com o grupo gestor e professores da referida escola. A coleta de dados foi de fevereiro a junho de 2015. A produção dos dados foi realizada por intermédio de entrevista semiestruturada. A análise e organização dos dados foram realizadas mediante Análise de Conteúdo.Resultado: verificou-se falha de comunicação, desgaste e desmotivação dos docentes, despreparo para realizarem atividades que contemplem a paz, assim como a ausência de parcerias municipais e governamentais.Conclusão: necessidade de capacitação dos professores e gestores para que ocorra de forma efetiva a promoção da Cultura de Paz nas escolas.

O tabagismo é um problema de saúde pública. As tecnologias eletrônicas oferecem suporte a educação em saúde, acompanhamento dos pacientes e cessação do tabagismo. O protótipo do aplicativo TabCess foi concebido e desenvolvido de 2019 a 2020. Este trabalho justifica-se pela necessidade de implementação de melhorias na ferramenta. Descrever o processo de concepção, desenvolvimento e aprimoramento do aplicativo TabCess voltado à cessação do tabagismo. Pesquisa qualitativa, descritiva, aplicada, realizada em universidade brasileira, de janeiro de 2021 a março de 2022, em duas etapas: análise do protótipo por profissionais da saúde e informática; e aprimoramento do protótipo com desenvolvimento da versão teste do aplicativo. A pesquisa qualitativa perpassa todo esse estudo, pois diários de campo, formulário de avaliação da tecnologia e relatórios das discussões semanais foram submetidos a análise de conteúdo na modalidade temática, elucidando as temáticas que versaram sobre as necessidades de ajustes e melhorias. Na primeira etapa, a análise das telas e ferramentas do protótipo resultou na elaboração do plano de trabalho para inclusão de novas sessões evidenciadas pelas temáticas de análise (cadastro de metas, relatório de uso do aplicativo, relato diário do paciente, benefícios e malefícios do cigarro, tabagismo passivo, vídeos educativos, enfrentamento da fissura). Na segunda etapa, a equipe de informática implementou novas telas e ambientes, criando a versão teste; e realizou, junto à equipe de saúde envolvida no projeto, os testes de usabilidade. A nova ferramenta foi aprovada para o teste de validação com especialistas (pneumologistas, psicólogos, fonoaudiólogos e dentistas), o que será descrito em outro trabalho. O TabCess oferecerá suporte àqueles que buscam cessar o tabagismo e fortalecerá as estratégias anti-tabagistas. Será um subsídio para os profissionais de saúde que atuam no contexto dos serviços e das políticas públicas voltadas a cessação do tabagismo.

Características epidemiológicas dos pacientes com câncer de pulmão em tratamento quimioterápico no Ceará Epidemiological characteristics of lung cancer patients undergoing chemotherapy treatment in Ceará

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