The role of immune checkpoint inhibitor therapy in advanced adrenocortical carcinoma revisited: review of literature.

PURPOSE: Adrenocortical carcinoma (ACC) is a rare disease with few therapeutic options. There is an urgency of new effective therapeutic options for these patients. The role of immune checkpoint inhibitors (ICI) in advanced ACC patients is still unclear. METHODS: We conducted a MEDLINE search using the following string: adrenocortical carcinoma and immunotherapy or checkpoint inhibitors. RESULTS: We found four case series comprising 10 patients, and four prospective studies totaling 115 patients. The response rate (RR) in the group of 10 patients was 1 complete response, 3 partial response (PR), 4 stable disease (SD), and 2 progressive disease (PD). The median progression-free survival (mPFS) ranged from 2 to 31 months and the median overall survival (mOS) ranged from 4.3 to 31 months. The results in the 115 patients from prospective trials was variable, the PR ranged from 6 to 23%, the SD ranged from 18 to 50% and overall disease control rate ranged from 30 to 64%. The mPFS reported varied from 1.8 to 2.6 months while the mOS varied from 10.6 to 24.9 months. There were five patients with sustained response for more than 24 months. The most common treatment-related adverse event (TRAE) was the increase in liver enzymes. No treatment-related deaths were reported. Better results in terms of RR and survival were observed in studies that used pembrolizumab. No predictive biomarker of response was found up to now. CONCLUSION: ICI, mainly pembrolizumab, is a potential therapeutic option, which is safe and associated with prolonged OS benefit, in selected patients with advanced ACC.

Association of social network and social support with health-related quality of life and fatigue in long-term survivors of Hodgkin lymphoma.

PURPOSE: As the number of survivors of Hodgkin's lymphoma (HL) increases, there has been a growing interest in long-term treatment-related side effects and their impact on the quality of life (QoL). The aim of this study was to assess the association of social network and social support with the QoL and fatigue among long-term HL survivors. METHODS: A total of 200 HL survivors were included. The generic Short Form-12 (SF-12) questionnaire, the QoL cancer survivor's questionnaire (QOL-CS), and the Multidimensional Fatigue Inventory were used to assess QoL and fatigue. Social network and social support were evaluated with the Social Support Survey. RESULTS: Social network and all social support measures were favorably associated with two or more SF-12 scales, mainly with physical functioning and the mental health scales. Social network and social support dimensions were also associated with better QOL-CS scores. Affective support, informational support, positive interaction, and emotional support were associated with less fatigue. CONCLUSIONS: Both social network and social support are associated with better QoL and lower levels of fatigue in HL survivors. This information may be useful to health professionals and community organizations in implementing effective interventions to improve these patients' quality of life.

Osteosarcoma and acromegaly: a case report and review of the literature.

A 72-yr-old acromegalic man, who presented with pain in the left femur, was found to have a metastatic osteosarcoma. Only three cases describing the coexistence of acromegaly and osteosarcoma have been reported by the literature. As the patient didn't have other risk factors for osteosarcoma, the hypothesis that accelerated rate of bone turnover caused by long-term exposure to high GH and IGF-I could act as a predisposing factor in the development of this malignant bone tumor is discussed.

A contribution to the establishment of reference values for total mercury levels in hair and fish in amazonia.

Studies on mercury levels in the Amazonian Region have typically lacked background or reference parameters. A sectional study on Hg concentration in hair and fish was conducted, together with an assessment of the prevalence of signs and symptoms related to Hg poisoning, in four communities in the Amazon Basin not impacted by gold mining, located either by a river course (Santana do Ituqui and Caxiuanã) or by a lake (Aldeia do Lago Grande and Vila do Tabatinga). Mercury determinations in hair and fish were made by flameless atomic absorption spectrophotometry. Mean total Hg in hair was 4.33 microg/g (0.40-11.60 microg/g) in 321 individuals from Santana do Ituqui, 3.98 microg/g (0.40-11.76 microg/g) for 316 persons in Aldeia do Lago Grande, 5.46 microg/g (0.37-49.85 microg/g) for 504 individuals from Vila do Tabatinga and 8.58 microg/g (0.61-45.59 microg/g) for 203 inhabitants from Caxiuanã. Fish consumption was very high in all those communities but no signs or symptoms associated with Hg poisoning were found. Mean Hg concentration in fish varied from 0.006 to 2.529 microg/g for carnivores and from 0.008 to 0.871 microg/g for noncarnivores. These values suggest that further studies including a larger number of communities would eventually lead to values of "normal" Hg concentration in the Amazonian Region quite above the limits suggested by the World Health Organization.

Mercury contamination of fish and exposures of an indigenous community in Pará state, Brazil.

Fish consumption is an important source of protein among indigenous communities in Amazonian Brazil. Exposures to mercury via fish were studied in an indigenous community of the Munduruku reserve, located in the Tapajós River basin in the state of Pará, one of the oldest and most productive gold mining areas in the Amazon region. This study summarizes the results of mercury (Hg) analyses of fish consumed by inhabitants of the Munduruku settlement of Sai Cinza. The most frequently consumed fish, reported by 330 persons interviewed for this study, were tucunaré, pacu, jaraqui, traíra, aracu, matrinchã, and caratinga. The mean mercury concentration in carnivorous fish was 0.297 microg.g(-1) while in noncarnivorous fish mean mercury concentration was 0.095 microg.g(-1). Only in caratinga was there a significant relationship between fish size, weight, and mercury levels. Levels of methylmercury in the tucunaré averaged 0.170 microg.g(-1), while in traíra the mean level of methylmercury was 0.212 microg.g(-1). Although the levels of Hg in fish consumed by the Sai Cinza community are below the Brazilian limit value for consumption, the high rates and amounts of fish consumed by this population are relevant to evaluating risks of mercury contamination for communities with limited food resources.

Mercury exposures in riverside Amazon communities in Pará, Brazil.

Cross-sectional studies were conducted in three riverside communities in the state of Pará in the Amazon Region of Brazil. Two of these communities, Brasília Legal and São Luís do Tapajós, are located in a watershed exposed to mercury pollution from artisanal gold mining, and the third, Santana do Ituqui, is outside this area. The studies were based upon a community census and included all persons volunteering for participation in each community. All participants were surveyed by questionnaire for health history, occupation, residence, and diet. Clinical evaluations were also done on each subject, along with collection of blood, urine, feces, and hair. Fish samples were collected to represent the most frequently consumed species. Mercury was measured in hair and fish. Although no signs or symptoms of overt mercury intoxication were observed, persons in Brasília Legal and São Luís do Tapajós had higher levels of mercury in hair than residents of Santana de Ituqui, located out of the risk area. Levels of mercury in fish were below Brazilian health guidance limits, but the high rates of fish consumption among these populations raise concerns for the possible effects of chronic exposure, especially among young children and women of childbearing age.

Evaluation of total mercury concentrations in fish consumed in the municipality of Itaituba, Tapajós River Basin, Pará, Brazil.

The environmental exposure to mercury by riverine and Indian communities can occur through the ingestion of fish and products contaminated by mercury compounds. The present study aims to evaluate the total mercury concentration in the different fish species most consumed in the municipality of Itaituba, Tapajós river basin, where there are intense gold-mining activities. These fish samples were analyzed by atomic absorption spectrophotometry by cold vapor technique, Automatic Mercury Analyzer HG-3500. The largest mercury concentrations were found in the carnivorous species ranging from 112.4 to 2250 microg/g, while the detritivorous, herbivorous and omnivorous species presented total mercury levels ranging from 3.2 to 309.8 microg/g, which is below the limit established by the World Health Organization. This paper also reports and identifies which species are more polluted and present a statistical relationship among concentration and weight of the carnivorous species studied in detail, Brachyplatystoma flavicans (dourada) (r2 = 0.691) and Pseudoplatystoma sp. (surubim) (r2 = 0.654).

Determination of total mercury in workers' urine in gold shops of Itaituba, Pará State, Brazil.

Gold extraction and its commercialization in the Amazon region is mainly by rudimentary procedures. Therefore, during the process of extraction and recovery of this precious metal, large amounts of mercury vapors are thrown into the environment. This paper is an attempt to establish a correlation between the concentration of total mercury in the urine of workers at the gold shop in the Municipality of Itaituba, Pará, and the information related to the lifestyles of each individual studied. Through statistical analysis, it was possible to divide the workers into three groups: people with normal mercury concentrations, [Hg] < or = 10 ppb, (29%); with concentrations at the biological limit of tolerance, [Hg] up to 50 ppb, (49%); and contaminated people, [Hg] > or = 50 ppb (22%). It may be concluded that fish consumption, time of alcohol consumption, number of amalgam fillings, as well as working hours, are important variables when evaluating mercurial contamination of people who are occupationally exposed to mercury vapors.

Mercury contamination in fish from Santarém, Pará, brazil.

This paper reports on total mercury concentrations in edible tissue from 11 fish species caught in the Municipality of Santarém, Tapajós River Basin, Pará State, which are most consumed by the local population and investigates the influence of the distance between the goldmining areas and Santarém city on fish contamination by mercury. It was found that the carnivorous species reached an average of 222.1 ng.g(-1) (n=69), higher than the herbivorous species with 31.9 ng.g(-1) (n=30) and the omnivorous species with 68.7 ng.g(-1) (n=10). Significant relationships are found between fish weight and total mercury concentrations by using descriptive statistical and regression analysis for the two species, the carnivorous Pellona sp. (Sarda, r=0.73) and Pseudoplatystoma sp. (Surubim, r=0.63).

[Mercury levels in fish consumed by the Sai Cinza indigenous community, Munduruku Reservation, Jacareacanga County, State of Pará, Brazil]. / Níveis de mercúrio em peixes consumidos pela comunidade indígena de Sai Cinza na Reserva Munduruku, Município de Jacareacanga, Estado do Pará, Brasil.

This study evaluated fish consumption and mercury levels in fish consumed by an indigenous community in the State of Pará. Eighty fish samples were collected (barbado, surubim, traíra, tucunaré, piranha, aruanã, caratinga, aracu, mandiá, jandiá, and pacu). Mercury analysis was performed using a Mercury Analyzer HG-3500. Average mercury concentration in carnivorous species was 0.293 (g/g (SD=0.104), while in non-carnivorous species it was 0.112 (g/g (SD=0. 036). Brazilian legislation establishes a maximum permissible limit of 0.5 (g/g for fish consumption. No significant correlation was found between fish length or weight and mercury concentration. Types of fish most frequently consumed by the community were tucunaré, pacu, jaraqui, traíra, aracu, matrinchã, and caratinga. Carnivorous species, especially tucunaré and traíra, amongst the most frequently eaten, had higher mercury levels than non-carnivorous species. Frequency of consumption is crucial to assess the risk of mercury contamination in communities who lack alternative food sources.

[Diagnosis of health conditions in a pan-mining community in the Tapajós River Basin, Itaituba, Par , Brazil, 1992]. / Diagnóstico das condições de saúde de uma comunidade garimpeira na regiõ o do Rio Tapajós, Itaituba, Pará, Brasil, 1992.

The purpose of this article is to describe health conditions in a pan-mining community, in particular the interaction of mercury contamination with other health problems. This study was carried out in a panning mine located on Rato Creek, a tributary of the Tapajó s River Basin in the municipality of Itaituba, State of Par The study population consisted of 223 individuals. An epidemiological questionnaire was applied, medical treatment was given, and biological specimens were collected. Testing of fecal samples showed that 96.1% of the individuals had parasites and 66.4% were anemic. Prevalence of hepatitis B virus was 85.0%, and 11 individuals (6.0%) were virus carriers (HBsAg positive). Of 186 patients tested for malaria, 65 individuals (35.0%) had the infection, of whom 34 (52.3%) were asymptomatic. Prevalence of syphillis was 41.6%. Urine mercury levels were measured in 173 individuals. Some 16 (9.2%) of those tested had mercury levels between 10 and 19 ug/l, while 9 patients (5.2%) had levels above 20 ug/l. An overview of general health conditions showed a combination of problems in individuals, who lacked adequate diagnosis, in addition to a high level of self-medication, given the absence of health facilities. In addition, these individuals are threatened by critical levels of mercury contamination. In conclusion, this article gives a general overview of health conditions in these pan-mining communities, demonstrating the multicausal nature of health conditions in the Amazon region, a fact which should be considered when planning appropriate strategies for clinical treatment.

C-MOPP/ABV yields good results in a public hospital population with Hodgkin disease in Brazil.

BACKGROUND: Over the last 15 years, a number of combination chemotherapy regimens have been reported to induce more than 80% complete remissions (CR) in patients with advanced Hodgkin disease (HD). Almost all such studies have been conducted in large institutions from North America and Europe. It remains to be proven, however, that those regimens are equally effective for the larger population of patients with HD who live in very different social conditions in third-world countries. METHODS: Fifty-nine patients with advanced-stage or early bulky HD were treated in two public hospitals with the C-MOPP/ABV hybrid program, in which cyclophosphamide was substituted for mechlorethamine. RESULTS: The median number of cycles administered was six, and the median follow-up was 32 months. Fifty patients (85%) reached a CR. The actuarial failure-free survival (FFS) rate was 69%, and the actuarial overall survival rate was 78% at 68 months. The only significant prognostic factor that predicted for improved FFS rate was the absence of B symptoms (P = 0.02). Overall survival was better for patients who reached a CR (P = 0.0003) and those with no systemic symptoms (P = 0.007). Toxic effects were moderate, with one treatment-related death and six episodes of serious infection. CONCLUSIONS: The target population consisted of lower-class Brazilians, many living in poor social conditions. Nevertheless, these results compare equitably with other results reported in the literature. C-MOPP/ABV is an adequate treatment for HD in third-world populations.