Primary thromboprophylaxis in cancer outpatients - real-world evidence.

INTRODUCTION: Cancer-associated thrombosis (CAT) is a significant concern among patients with malignant diseases, leading to increased mortality. While current guidelines recommend primary thromboprophylaxis for venous thromboembolism (VTE) in medium-to-high-risk outpatients, this practice remains controversial. A better understanding of primary thromboprophylaxis is crucial, yet there is a lack of Real-World Evidence (RWE) in Portugal. AIMS: This RWE study aimed to elucidate primary thromboprophylaxis practices among cancer outpatients in Portugal. METHODS: A five-year observational multicentric study in eight Portuguese health institutions enrolled 124 adult cancer outpatients under primary thromboprophylaxis for VTE. The endpoints were CAT, bleeding, cancer progression and death. RESULTS: High thrombotic risk tumours were prevalent, with 57% (71) of the patients presenting with pancreatic and gastric cancers. Regarding primary thromboprophylaxis, 55% (68) received Low-Molecular-Weight Heparin (LMWH). VTE was presented in 11% (14) of the patients and major bleeding in 2% (2). Vascular compression, elevated D-dimer and previous VTE were significantly associated with VTE occurrence under primary thromboprophylaxis. The Onkotev model was shown to be the best risk assessment model (RAM) in this population (p = 0.007). CAT patients exhibited a lower progression-free survival than non-CAT patients (p = 0.021), while thrombosis did not influence overall survival (p = 0.542). CONCLUSION: Primary thromboprophylaxis in medium-to-high-risk cancer outpatients is a safe and effective practice in real-world settings. This study is the first Portuguese RWE on primary thromboprophylaxis, highlighting evidence for improving prophylactic strategies in this population.

Emerging pharmacotherapy trends in preventing and managing oral mucositis induced by chemoradiotherapy and targeted agents.

INTRODUCTION: The introduction of targeted therapy and immunotherapy has tremendously changed the clinical outcomes and prognosis of cancer patients. Despite innovative pharmacological therapies and improved radiotherapy (RT) techniques, patients continue to suffer from side effects, of which oral mucositis (OM) is still the most impactful, especially for quality of life. AREAS COVERED: We provide an overview of current advances in cancer pharmacotherapy and RT, in relation to their potential to cause OM, and of the less explored and more recent literature reports related to the best management of OM. We have analyzed natural/antioxidant agents, probiotics, mucosal protectants and healing coadjuvants, pharmacotherapies, immunomodulatory and anticancer agents, photobiomodulation and the impact of technology. EXPERT OPINION: The discovery of more precise pathophysiologic mechanisms of CT and RT-induced OM has outlined that OM has a multifactorial origin, including direct effects, oxidative damage, upregulation of immunologic factors, and effects on oral flora. A persistent upregulated immune response, associated with factors related to patients' characteristics, may contribute to more severe and long-lasting OM. The goal is strategies to conjugate individual patient, disease, and therapy-related factors to guide OM prevention or treatment. Despite further high-quality research is warranted, the issue of prevention is paramount in future strategies.

Innovation and Precision Medicine Applied to a Medullary Thyroid Cancer: A Clinical Case.

Medullary thyroid carcinoma (MTC) is a rare type of neuroendocrine tumor, accounting for 3%-4% of all thyroid cancers. Seventy-five percent are sporadic, of which 60% have pathogenic REarranged during Transfection (RET) somatic mutations. The sporadic RET-mutated MTC poses novel challenges for targeted treatment. The authors present a case of a 60-year-old male diagnosed in 2018 with MTC who underwent total thyroidectomy with sternotomy and bilateral cervical lymph node dissection - pT3N1b R1 L1 V1 Pn0 cM1 (hepatic and lung metastasis). According to the decisions made by the multidisciplinary tumor board, the patient received multiple palliative systemic treatments. Despite an initial response, vandetanib was accompanied by grade 3 high blood pressure and progression after 14 months of treatment. The patient also received cabozantinib, which led to an initial response, but with grade 3 hypertension and skin toxicity. The patient progressed, including symptomatic bone metastasis, after 15 months of treatment. Following the next sequencing genome result, which showed a somatic mutation in the RET M918T gene, the patient was treated with selpercatinib, a highly selective and potent RET inhibitor. The treatment led to clinical and radiological responses without significant toxicities. The objective of this case report is to highlight the impact of innovative treatment and precision medicine on the management of cancer patients, which not only has a direct effect on their survival but also on their quality of life.

Geriatric Assessment of Older Adults With Cancer During Acute Hospitalizations: Challenges and Opportunities.

Introduction Geriatrics is a discipline that covers all adult healthcare, and oncology is no exception. The global geriatric assessment process plays a crucial role, impacting research, funding, resource allocation, as well as therapeutic decision-making. Thus, greater knowledge of the epidemiology of the frailty and functionality of elderly patients with cancer will allow for the development of a global care strategy. This study aimed to assess the prevalence of geriatric conditions in elderly cancer patients admitted to a medical geriatric unit following unplanned hospitalisation. Methods A retrospective, single-centre cohort study was conducted of patients aged ≥ 75 with an active oncological disease who were admitted to a geriatric medicine unit over a two-year period. Results A total of 65 patients were included. The median age was 85 (IQR 81-88), and 86% were aged ≥ 80. A moderate-to-high functional dependence was found: 67.7% on ≥ 3 basic activities of daily living (Katz ≥ D), with the majority classified as severely dependent based on the Barthel Index (mean 49.0 ± 33.7). Frailty was found in 90.7%. A high prevalence of geriatric syndromes was observed: malnutrition (84.6%), polypharmacy (64.6%), urinary incontinence (58.5%) and pressure ulcers (33.8%). The mortality rate was 36.9% during hospitalisation and 13.8%, 30 days post-discharge. Conclusions The study revealed a high prevalence of geriatric conditions, emphasising the importance of comprehensive assessment in managing elderly patients at different stages of the disease. This multidimensional and multidisciplinary approach optimises patient care throughout admission, hospitalisation and discharge.

[Pregnancy after Breast Cancer: State of the Art]. / Gravidez após o Cancro da Mama: Estado da Arte.

Breast cancer survivors have given rise to several issues of major relevance from a clinical and scientific point of view. In fact, breast cancer is the most prevalent malignancy in women of reproductive age. The effect of pregnancy on overall survival and in the recurrence after treatment of breast cancer, as well as the questions related to heredity continue to be matter of the highest timeliness and scientific interest. Most recent studies seem to agree in admitting that pregnancy after breast cancer appears to be potentially safe to both the women and her offspring, although this issue remains complex. Heredity and genetics seem to play an important role in this subject, but the conclusions lack absolute and unequivocal consistency. There is a need for meta-analysis, cohort and case-control studies, translational and prospective studies extended in time, in order to obtain greater safety in the establishment of strategies and guidelines for clinicians and adequate objective information for young breast cancer patients.

As sobreviventes de cancro da mama têm originado um conjunto de questões da maior relevância sob o ponto de vista clínico e científico. De facto, o cancro da mama é a neoplasia mais prevalente em mulheres em idade reprodutiva. O efeito da gravidez na sobrevida global e na recorrência após tratamento de cancro da mama, bem como as questões relacionadas com a hereditariedade continuam a ser matéria da maior atualidade e do mais elevado interesse científico. Os estudos mais recentes são consensuais em admitir que a gravidez após o cancro da mama é potencialmente segura para a doente e sua descendência, embora a questão permaneça complexa. A hereditariedade e a genética parecem desempenhar um papel importante nesta temática mas, também aqui, as conclusões carecem de absoluta e inequívoca consistência. Verifica-se a necessidade de meta-análises, estudos coorte e caso-controlo, translacionais e prospetivos, alargados e prolongados no tempo, no sentido de obter uma maior segurança no estabelecimento de estratégias e linhas de orientação para os clínicos e informação adequada e objetiva para as jovens doentes com cancro da mama.

(Re)Construindo cenários de atuação em saúde mental na Estratégia Saúde da Família / (Re)Constructing scenarios for action in mental health in the Family Health Strategy

Objetivos: Avaliar a interação entre a saúde mental e a atenção básica, bem como analisar se esses serviços possibilitam o processo de acolhimento e reinserção do usuário na família e na comunidade. Métodos: Estudo exploratório com abordagem qualitativa, desenvolvido em 13 unidades básicas de saúde (UBS) e no Centro Atenção Psicossocial (CAPS) tipo II do município de Cajazeiras-PB, Brasil. Os instrumentos utilizados na coleta de dados foram: observação simples, diário de campo e entrevista semiestruturada, tendo como sujeitos da pesquisa os enfermeiros das UBS e profissionais de nível superior do CAPS II. Resultados: Percebe-se a falta de articulação entre a equipe de saúde da família e a da saúde mental, resultando no cuidado dispensado ao usuário com sofrimento psíquico centrado no CAPS II, sem uma articulação possível com a rede de atenção básica. Conclusão: A falta de integração entre ESF e CAPS II no tocante ao cuidado realizado ao usuário com sofrimento psíquico indica a necessidade de implantação de políticas públicas municipais que promovam a interrelação entre saúde mental e rede básica de atenção.

Objectives: To assess the interaction between mental health and primary care, as well as analyze if these services enable the embracement process and reintegration of users in family and community. Methods: An exploratory study with qualitative approach developed in 13 basic health units (UBS) and type II Center of Psychosocial Attention (CAPS II) in Cajazeiras-PB, Brazil. The instruments used in data collection were simple observation, diaries and semi-structured interview. Study subjects were nurses of UBS and graduate professionals of CAPS II. Results: We perceive the lack of coordination between the Family Health Strategy team and Mental Health team, resulting in the care provided to the user with mental distress centered in CAPS II with no coordination with primary care network. Conclusion: The lack of integration between ESF and CAPS II regarding the care provided to the user with psychological distress indicate the need for deployment of municipal public policies that promote the interrelationship between mental health and primary care network.

Genetic polymorphism of the serine rich antigen N-terminal region in Plasmodium falciparum field isolates from Brazil.

In this work we investigated the frequency of polymorphism in exon II of the gene encoding most of the amino-terminal region of the serine rich antigen (SERA) in Plasmodium falciparum field samples. The blood samples were collected from P. falciparum infected individuals in three areas of the Brazilian Amazon. Two fragments have been characterized by polymerase chain reaction: one of 175 bp corresponding to the repeat region with 5 octamer units and one other of 199 bp related to the 6 repeat octamer units of SERA protein. The 199 bp fragment was the predominant one in all the studied areas. The higher frequency of this fragment has not been described before and could be explained by an immunological selection of the plasmodial population in the infected individuals under study. Since repeat motifs in the amino-terminal region of SERA contain epitopes recognized by parasite-inhibitor antibodies, data reported here suggest that the analysis of the polymorphism of P. falciparum isolates in different geographical areas is a preliminary stage before the final drawing of an universal vaccine against malaria can be reached.

Resultados do controle de qualidade de produtos hemoderivados: análise sanitária / Results of quality control of plasma derivatives products: sanitary analysis

O Instituto Nacional de Controle de Qualidade em Saúde - INCQS, unidade técnico-científica da Fundação Oswaldo Cruz - Fiocruz, desempenha seu papel no controle de qualidade pericial, de bens e serviços sujeitos ao regime de Vigilância Sanitária, em particular medicamentos denominados de hemoderivados. Este trabalho fundamentou-se na análise de 3.100 lotes de hemoderivados, no período de janeiro de 2000 a dezembro de 2004, assim distribuídos: 31,6 por cento (n=980) de albumina humana, 28,7 por cento (n=890) de fator VIII, 21,4 por cento (n=662) de imunoglobulina humana, 8,3 por cento (n=257) de fator IX, 7,1 por cento (n=220) de imunoglobulinas específicas como anti-Rho (D), antitetânica, anti-rábica, anti-Hepatite B e antivaricela zoster e 2,9 por cento (n=91) de complexo protrombínico. As amostras foram recebidas para análise oriundas dos segmentos: portos, aeroportos e fronteiras de Brasília, Rio de Janeiro e São Paulo e de apreensões realizadas pelos estados de Pernambuco, Santa Catarina, Rio de Janeiro e Rio Grande do Sul. Quanto à modalidade de análise: 92,3 por cento correspondem à análise controle, 5,9 por cento fiscal, 1,4 por cento orientação e 0,4 por cento análise prévia. Da internalização dos hemoderivados importados: 40,0 por cento ocorreram pelo aeroporto de Brasília, 26,9 por cento por São Paulo e 25,2 por cento pelo Rio de Janeiro. Concluindo, dos lotes de hemoderivados analisados, 99,1 por cento apresentaram resultados satisfatórios e 0,9 por cento foram insatisfatórios quanto ao ensaio de inspeção visual, solubilidade, ensaio de estabilidade e químico, e quanto ao teste de pirogênio e toxicidade inespecífica. Desta forma, monitorar a qualidade dos produtos hemoderivados é um instrumento fundamental no exercício das ações de Vigilância Sanitária.

The technical scientific unit of the National Institute of Quality Control in Health (INCQS), part of the Oswaldo Cruz Foundation, has a role of investigational quality control of products and services related to health surveillance, in particular medicines denominated plasma derivative products. This paper is based on the analysis of the 3100 plasma derivative products from January 2000 to December 2004: 31.6 percent (n=980) of human albumin, 28.7 percent (n=890) of factor VIII, 21.4 percent (n=662) of human immunoglobulins, 8.3 percent (n=257) of factor IX, 7.1 percent (n=22) of specific immunoglobulin classes containing anti-Rho (D) immunoglobulin, anti-hepatitis B, anti-tetanus, anti-rabies and anti-varicella-zoster and 2.91 percent (n=91) of prothrombin complex. The products submitted to analysis came from airports and frontiers of Brasília, Rio de Janeiro and São Paulo, and products confiscated by the states of Pernambuco, Santa Catarina, Rio de Janeiro and Rio Grande do Sul. The type of analysis was characterized as: 92.3 percent control analysis; 5.9 percent fiscal analysis; 1.4 percent guidance and 0.4 percent preliminary analysis. In respect to imported plasma derivatives, 40.0 percent originated from the airport in Brasilia, 26.9 percent in São Paulo and 25.2 percent in Rio de Janeiro. In conclusion, 99.1 percent of the plasma derivative products analyzed was considered satisfactory and 0.9 percent unsatisfactory as identified by visual inspection, solubility, stability and chemical assays and pyrogenic and unspecific toxicity tests. Thus, the assessment of the quality of plasma derivative products is an essential tool for health surveillance.

Genetic polymorphism of the serine rich antigen N-terminal region in Plasmodium falciparum field isolates from Brazil

In this work we investigated the frequency of polymorphism in exon II of the gene encoding most of the amino-terminal region of the serine rich antigen (SERA) in Plasmodium falciparum field samples. The blood samples were colleted from P. falciparum infected individuals in three areas of the Brazilian Amazon. Two fragments have been characterized by polymerase chain reaction: one of 175 bp corresponding to the repeat region with 5 octamer units and one other of 199 bp related to the 6 repeat octamer units of SERA protein. The 199 bp fragment was the predominant one in all the studied areas. The higher frequency of this fragment has not been described before and could be explained by an immunological selection of the plasmodial population in the infected individuals under study. Since repeat motifs in the amino-terminal region of SERA contain epitopes recognized by parasite-inhibitor antibodies, data reported here suggest that the analysis of the polymorphism of P. falciparum isolates in different geographical areas is a preliminary stage before the final drawing of an universal vaccine against malaria can be reached.

Analysis of toxoplasma gondii proteins after Triton X-114 solubilization and hidropholic chromotograhy

A distribuiçäo das proteínas superficiais de Toxoplasma gondii radiodinadas, foram estudadas usando a técnica de separaçäo de fases e a capacidade de ligaçäo em coluna de fenil-Sepharose. Oito polipeptídeos com peso molecular entre 22 e 180.000 distribuíram-se exclusivamente na fase rica em detergente enquanto seis polipeptídeos com PM entre 15.00 e 76.000 distribuíram-se exclusivamente na fase pobre em detergente. Dois polipeptídeos com 15.00 e 70.000 distribuem-se em ambas as fases. Todos os polipeptídeos presentes na fase rica em detergente foram retidos por coluna de fenil-Sepharose e isolados em dois picos de acordo com sua hidrofobicidade relativa