Background: Breast cancer is the primary cause of cancer-related deaths among women globally, with a particularly high incidence in low- and middle-income nations. In Brazil, disparities in access to diagnosis and treatment contribute to worse clinical outcomes, particularly in regions with a lower Human Development Index (HDI). This study evaluated the association between the delay between diagnosis and treatment initiation, and clinical outcomes of breast cancer across various Brazilian regions. Methods: This observational study utilized publicly available secondary data from the Department of Informatics of the Unified Health System (DATASUS), collected between 2013 and 2023. Data included age group, treatment type (surgery, chemotherapy, radiotherapy), and delay between diagnosis and treatment initiation (≤30 days, 31–60 days, >60 days). Regional disparities were analyzed according to the HDI. Statistical analyses were performed using GraphPad Prism 8.0.1, applying Pearson’s correlation coefficient (r) and linear regression (R²) to assess associations between treatment delay and the number of cases or deaths. Results: Radiotherapy demonstrated the most significant negative correlation (r = −0.6624), and delays exceeding 60 days were consistently linked to poorer outcomes. In regions with lower Human Development Index (HDI), specifically the North and Northeast, longer treatment delays were observed, alongside a stronger correlation between delayed initiation of treatment and increased mortality. Conversely, shorter delays (30 days or less) demonstrated a weaker or absent correlation with improved outcomes. This suggests that other critical factors, such as the stage of cancer at diagnosis, the quality of care provided, and the consistency of treatment, are also significant determinants. Conclusions: Delays in treatment, particularly for radiotherapy and surgery, adversely affect breast cancer outcomes in Brazil. This impact is more pronounced in areas with lower Human Development Index (HDI), underscoring the critical need for targeted regional public policies. Such policies are essential to guarantee prompt diagnosis and treatment, thereby mitigating inequalities and enhancing survival rates.

This article describes Neocosmospora keratoplastica as an etiological onychomycosis agent. Ex vivo studies were initially performed to demonstrate the ability of this species to grow and form a well-organized characteristic biofilm on sterilized healthy nails. Based on the history of excellent results, both for antifungal and antibiofilm, of propolis resin gum, we evaluated its activity using artificially formed biofilm. In vitro, the minimal biofilm eradication concentration of the propolis extract (PE) was 375 µg of total polyphenol content (TPC) per mL, while for the propolis gel (PG) it was 450 µg of TPC per mL. In biofilm exposed to the propolis products, a decrease in hyphae and conidia was evident, accompanied by a disorganization of the extracellular matrix. Additionally, this low concentration of PE was able to significantly reduce the number of colony-forming units and the metabolic activity. Furthermore, the treatment of a 15-year nail infection due to N. keratoplastica was carried out exclusively using a topical treatment with a gel containing propolis (30%) with a daily dosage. This treatment achieved complete remission of the onychomycosis in 12 months. It is important to point out that some inconveniences previously reported by other patients treated with propolis extract were eliminated, increasing adherence to treatment.

We evaluated a hydroalcoholic extract of Sapindus saponaria L. pericarps (ETHOSS), as a candidate to a topical antifungal medicine for onychomycosis. ETHOSS was produced by extracting the crushed fruits in ethanol. The saponin contents were identified and characterized by electrospray ionization mass spectrometry. We measured the in vitro antifungal activity against three dermatophyte fungi, isolated from onychomycosis: Trichophyton rubrum, T. mentagrophytes, and T. interdigitale, using broth microdilution tests. The minimum fungicide concentration of ETHOSS ranged from 195.31 to 781.25 μg/mL. The cytotoxicity of the crude extract was tested on the HeLa cell line, and its ability to permeate into healthy human nails by photoacoustic spectroscopy and Fourier transformation infrared spectrometer (FTIR) spectroscopy by attenuated total reflection. Besides its strong antifungal activity, ETHOSS showed low cytotoxicity in human cells. It was able to permeate and reach the full thickness of the nail in one hour, without the aid of facilitating vehicles, and remained there for at least 24 h. These results suggest that ETHOSS has great potential for treating onychomycosis.