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Clonal heterogeneity in multisited or recurrent lymphoid neoplasms is a phenomenon that has been increasingly studied in recent years. However, in mucosa-associated lymphoid tissue (MALT) lymphomas it remains largely unexplored. Patients diagnosed at our institution with multisited MALT lymphoma, from January 2009 to October 2018, were studied. Molecular studies were performed for the detection of clonally rearranged immunoglobulin by polymerase chain reaction.In all, 91 patients were included. Of those, 28 had a multisited disease and in 16 clonality studies were done. In eight cases, multifocal involvement was synchronous and in eight metachronous. Patients with non-gastric gastrointestinal tract involvement tended to disseminate within the same tract, without observing other specific dissemination patterns. Four cases (25%) had clonal heterogeneity at the different organs involved. All patients with late relapses (two patients) had different clones. The majority of patients with multisited MALT lymphomas presented with the same clone in the different involved organs, identifying a different clone in those with late relapses. These patients could represent de novo neoplasms, rather than a relapse. This could mean that some individuals might have a genetic predisposition to develop this type of lymphoma and it could also have clinical implications regarding therapeutic decisions.
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Reordenamiento Génico de Linfocito B , Linfoma de Células B de la Zona Marginal/genética , Adulto , Anciano , Femenino , Humanos , Linfoma de Células B de la Zona Marginal/metabolismo , Linfoma de Células B de la Zona Marginal/terapia , Masculino , Persona de Mediana EdadRESUMEN
Richter syndrome (RS) is an uncommon evolution of chronic lymphocytic leukaemia (CLL) with a dismal prognosis. Clinical-biological features predicting outcome and best therapeutic approach for these patients remain to be established. In this study, 128 patients with RS, including 112 diffuse large B-cell lymphoma (DLBCL)-type RS, 15 Hodgkin lymphoma (HL)-type RS, and one plasmablastic lymphoma, were identified in 11 centres of the Spanish CLL Study Group (GELLC). The median overall survival (OS) was 5·9 months for DLBCL-type RS and 30·8 months for HL-type RS. Eastern Cooperative Oncology Group Performance Status, haemoglobin level, platelet count, serum lactate dehydrogenase and ß2-microglobulin levels, tumour protein p53 (TP53) abnormalities in the CLL clone concomitant to RS, number of prior therapies, and clonal relationship between CLL and RS, were associated with OS in patients with DLBCL-type RS. A platelet count of <100 × 109 /l, prior CLL therapy (0 vs. ≥1), and presence of TP53 alterations maintained an independent prognostic impact in the multivariate analysis. Patients without any of these factors had a better clinical outcome, with a median OS of 75·3 months, while patients with one or two or more of these factors presented a median OS of 25·5 and 3 months, respectively. Although OS of patients with RS is generally poor, a proportion of patients achieved prolonged survival. Treatment of RS remains a medical need, and further therapeutic approaches with novel therapies are warranted.
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Enfermedad de Hodgkin , Leucemia Linfocítica Crónica de Células B , Linfoma de Células B Grandes Difuso , Adulto , Anciano , Anciano de 80 o más Años , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Enfermedad de Hodgkin/sangre , Enfermedad de Hodgkin/genética , Enfermedad de Hodgkin/mortalidad , Enfermedad de Hodgkin/terapia , Humanos , Leucemia Linfocítica Crónica de Células B/sangre , Leucemia Linfocítica Crónica de Células B/genética , Leucemia Linfocítica Crónica de Células B/mortalidad , Leucemia Linfocítica Crónica de Células B/terapia , Linfoma de Células B Grandes Difuso/sangre , Linfoma de Células B Grandes Difuso/genética , Linfoma de Células B Grandes Difuso/mortalidad , Linfoma de Células B Grandes Difuso/terapia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , España , Tasa de Supervivencia , SíndromeRESUMEN
OBJECTIVES: To clarify the impact of histological grades in follicular lymphoma. METHODS: We retrospectively analysed 250 patients diagnosed with FL treated with chemoimmunotherapy: 188 patients were grades 1-2 and 62 grade 3A. RESULTS: In our series, grade 3A FL patients were older, higher proportion of localised disease and lower bone marrow infiltration at diagnosis comparing grades 1-2 FL patients. Estimated six-year progression-free survival and time to progression showed no differences between both groups [grade 3A: 56% (95%CI: 39%-73%) and 51% (95%CI: 41%-61%) vs grades 1-2:55% (95%CI: 46%-63%) and 57% (95%CI: 49%-65%), P = .782 and P = .521, respectively]. Estimated six-year overall survival was lower, 76% (95%CI: 64%-88%) for the grade 3A group than grades 1-2 83% (95%CI: 77%-89%); P = .044. In addition to that, cumulative incidence curves of death not related to lymphoma at 10 years between groups were as follows: [0.26 (95%CI: 0.25-0.27) and 0.05 (95%CI: 0.04-0.06) for G3AFL and G1-2FL, respectively], P = .010. Grade 3A FL showed in PFS curve no relapses after 6 years. These results were absolutely reproduced in 199 patients receiving R-CHOP regimen as induction. CONCLUSIONS: Our results indicate similar long-term outcomes in terms of progression-free survival and time to progression in grades 1-2 and 3A. No relapses were observed in G3AFL group after 6 years.
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Antineoplásicos Inmunológicos/uso terapéutico , Linfoma Folicular/tratamiento farmacológico , Linfoma Folicular/patología , Adulto , Anciano , Antineoplásicos Inmunológicos/administración & dosificación , Antineoplásicos Inmunológicos/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Causas de Muerte , Femenino , Humanos , Quimioterapia de Inducción , Linfoma Folicular/mortalidad , Quimioterapia de Mantención , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Pronóstico , Recurrencia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Introduction: The present study evaluates CD30 expression by immunohistochemistry (IHQ) in 216 patients with de novo DLBCL.Methods: CD30 expression was assessed retrospectively in all cases by IHQ. More than >0% and >20% of CD30 expression in the malignant cells were used as a cut-off for positivity. Survival was analysed in 176 patients treated with R-CHOP/R-CHOP-like regimens.Results: CD30 expression >0% was found in 66 (31%) patients, and >20% in 41 (19%). Younger patients <60 years (p = 0.03), good performance status (p = 0.04), and non-GCB subtype (p = 0.004) correlated with CD30 expression. No significant differences were found in overall survival and progression-free survival (PFS), although there was a trend towards better PFS in CD30-positive patients (p = 0.07). Among 7 patients with Epstein-Barr virus (EBV)-positive-DLBCL, CD30 was expressed in 71%, and 2-year PFS significantly inferior compared with CD30-positive EBV-negative-DLBCL patients (p = 0.01).Conclusion: CD30 is expressed in 30% of DLBCL patients, in whom targeted therapy with an anti-CD30 monoclonal antibody could be explored. CD30 is expressed more frequently younger patients, with better performance status and in the non-GCB subtype and its expression trends towards a better PFS. No significant differences regarding characteristics at diagnosis or prognosis were found between groups with different cut-off for positivity.
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Biomarcadores de Tumor/análisis , Antígeno Ki-1/análisis , Linfoma de Células B Grandes Difuso/inmunología , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Ciclofosfamida/administración & dosificación , Doxorrubicina/administración & dosificación , Femenino , Humanos , Inmunohistoquímica , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Linfoma de Células B Grandes Difuso/mortalidad , Linfoma de Células B Grandes Difuso/patología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Prednisona/administración & dosificación , Supervivencia sin Progresión , Estudios Retrospectivos , Rituximab/administración & dosificación , Vincristina/administración & dosificación , Adulto JovenRESUMEN
Caesalpinioideae is the second largest subfamily of legumes (Leguminosae) with ca. 4680 species and 163 genera. It is an ecologically and economically important group formed of mostly woody perennials that range from large canopy emergent trees to functionally herbaceous geoxyles, lianas and shrubs, and which has a global distribution, occurring on every continent except Antarctica. Following the recent re-circumscription of 15 Caesalpinioideae genera as presented in Advances in Legume Systematics 14, Part 1, and using as a basis a phylogenomic analysis of 997 nuclear gene sequences for 420 species and all but five of the genera currently recognised in the subfamily, we present a new higher-level classification for the subfamily. The new classification of Caesalpinioideae comprises eleven tribes, all of which are either new, reinstated or re-circumscribed at this rank: Caesalpinieae Rchb. (27 genera / ca. 223 species), Campsiandreae LPWG (2 / 5-22), Cassieae Bronn (7 / 695), Ceratonieae Rchb. (4 / 6), Dimorphandreae Benth. (4 / 35), Erythrophleeae LPWG (2 /13), Gleditsieae Nakai (3 / 20), Mimoseae Bronn (100 / ca. 3510), Pterogyneae LPWG (1 / 1), Schizolobieae Nakai (8 / 42-43), Sclerolobieae Benth. & Hook. f. (5 / ca. 113). Although many of these lineages have been recognised and named in the past, either as tribes or informal generic groups, their circumscriptions have varied widely and changed over the past decades, such that all the tribes described here differ in generic membership from those previously recognised. Importantly, the approximately 3500 species and 100 genera of the former subfamily Mimosoideae are now placed in the reinstated, but newly circumscribed, tribe Mimoseae. Because of the large size and ecological importance of the tribe, we also provide a clade-based classification system for Mimoseae that includes 17 named lower-level clades. Fourteen of the 100 Mimoseae genera remain unplaced in these lower-level clades: eight are resolved in two grades and six are phylogenetically isolated monogeneric lineages. In addition to the new classification, we provide a key to genera, morphological descriptions and notes for all 163 genera, all tribes, and all named clades. The diversity of growth forms, foliage, flowers and fruits are illustrated for all genera, and for each genus we also provide a distribution map, based on quality-controlled herbarium specimen localities. A glossary for specialised terms used in legume morphology is provided. This new phylogenetically based classification of Caesalpinioideae provides a solid system for communication and a framework for downstream analyses of biogeography, trait evolution and diversification, as well as for taxonomic revision of still understudied genera.
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INTRODUCTION: Hemodialysis patients have complications that increase fear of falling (FOF). This study evaluated the association between FOF and a retrospective history of falls in hemodialysis patients and investigated the ability of the Fall Efficacy Scale-International (FES-I) to discriminate fallers from nonfallers. METHODS: A retrospective study was conducted with 183 patients to investigate the history of falls in the last 12 months and to evaluate FOF by the FES-I. RESULTS: The univariate linear regression model showed that the FES-I score was significantly associated with a history of falls (p = 0.01). After adjustment for potential confounders, this association remained significant (R2 = 0.19, p < 0.001). The FES-I score showed an area under the curve of 0.660 with a cutoff point of 25 (sensitivity-61.8%; specificity-62.2%). CONCLUSION: FOF was associated with a history of falls in the 12-month period in hemodialysis patients, and FOF assessed by the FES-I was able to discriminate fallers from nonfallers.
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Miedo , Fallo Renal Crónico , Humanos , Estudios Retrospectivos , Diálisis RenalRESUMEN
Cardiovascular disease is a common problem in cancer patients that is becoming more widely recognized. This may be a consequence of prior cardiovascular risk factors but could also be secondary to the anticancer treatments. With the goal of offering a multidisciplinary approach to guaranteeing optimal cancer therapy and the early detection of related cardiac diseases, and in light of the recent ESC Cardio-Oncology Guideline recommendations, we developed a Cardio-Oncology unit devoted to the prevention and management of these specific complications. This document brings together important aspects to consider for the development and organization of a Cardio-Oncology program through our own experience and the current evidence.
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Leucemia Linfocítica Crónica de Células B/genética , Leucemia Linfocítica Crónica de Células B/mortalidad , Monosomía , Adulto , Anciano , Anciano de 80 o más Años , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Tasa de SupervivenciaRESUMEN
The discriminative power of International Prognostic Index (IPI) in diffuse large B-cell lymphoma (DLBCL) decreased with the addition of rituximab to chemotherapy. The National Comprehensive Cancer Network (NCCN)-IPI and the Grupo Español de Linfomas y Trasplante Autólogo de Médula Ósea (GELTAMO)-IPI were developed to improve the risk prediction for DLBCL patients. We aim to validate the NCCN-IPI and GELTAMO-IPI in a large and homogeneous cohort of 337 DLBCL patients treated with curative intent with R-CHOP/R-CHOP-like immunochemotherapy. The IPI stratifies patients in two independent risk groups and the estimated 5-year overall survival (OS) of the high-risk (HR) group was 43%. NCCN-IPI discriminated four risk groups and GELTAMO-IPI three risk groups of patients. The predicted 5-year OS of the HR group was 38% and 29%, respectively. NCCN-IPI and GELTAMO-IPI are more accurate prognostic indices than IPI in DBLCL patients treated with immunochemotherapy. GELTAMO-IPI demonstrated enhanced discrimination than NCCN-IPI for the higher-risk population.
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Protocolos de Quimioterapia Combinada Antineoplásica , Linfoma de Células B Grandes Difuso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Ciclofosfamida/uso terapéutico , Doxorrubicina/uso terapéutico , Humanos , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Prednisona/uso terapéutico , Pronóstico , Estudios Retrospectivos , Rituximab/uso terapéutico , Vincristina/uso terapéuticoRESUMEN
Purpose: We evaluated the effects of supervised intradialytic resistance training on physical activity in daily life (PADL), muscle strength, physical capacity and quality of life (QoL) in hemodialysis patients.Methods: Twenty-four hemodialysis patients were randomly assigned to either a 12-weeks moderate-intensity resistance training or a control period. An accelerometer evaluated PADL for seven consecutive days, measuring the time spent in different activities and positions of daily routine and the number of steps taken. Muscle strength, physical capacity and QoL were evaluated.Results: After 12 weeks of training, we did not find significant difference (post-pre values) in walking time (-1.2 ± 18.3 vs. -9.2 ± 13.1 min/day); standing time (-10.2 ± 28.6 vs. 3.2 ± 20.1 min/day); sitting time (20.8 ± 58.9 vs. -30.0 ± 53.0 min/day); lying down time (-9.3 ± 57.9 vs. 34.6 ± 54.0 min/day); number of steps taken [-147 (1834) vs. -454 (2066)] and muscle strength in training and control group, respectively. There was a significant increase in the six-minute walking test distance (48.8 ± 35.9 vs. 6.9 ± 45.9 m, p < 0.05) and some domains of QoL in the training compared to the control group.Conclusions: PADL was not modified after 12 weeks of intradialytic resistance training in hemodialysis patients. However, the exercise program was able to increase the physical capacity and some domains of QoL.Implications for rehabilitationPhysical activity in daily life was not modified after 12 weeks of intradialytic resistance training in hemodialysis patients.The exercise program was able to increase the physical capacity, efficacy of dialysis and some domains of quality of life in hemodialysis patients.The protocol used in this study was safe since no complications were observed during and after resistance training.These results should be interpreted with caution because we applied a moderate resistance training in both lower limbs and in the contralateral arteriovenous fistula upper limb, using perceived exertion by Borg scale to exercise prescription. Moreover, the safety protocol evaluation was not conducted.
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Calidad de Vida , Entrenamiento de Fuerza , Ejercicio Físico , Humanos , Fuerza Muscular , Diálisis RenalRESUMEN
Importance: Because exposure to UV radiation early in life is an important risk factor for melanoma development, reducing UV exposure in children and adolescents is of paramount importance. New interventions are urgently required. Objective: To determine the effect of the free face-aging mobile app Sunface on the skin cancer protection behavior of adolescents. Design, Setting, and Participants: This cluster-randomized clinical trial included a single intervention and a 6-month follow-up from February 1 to November 30, 2018. Randomization was performed on the class level in 52 school classes within 8 public secondary schools (grades 9-12) in Itauna, Southeast Brazil. Data were analyzed from May 1 to October 10, 2019. Interventions: In a classroom seminar delivered by medical students, adolescents' selfies were altered by the app to show UV effects on their future faces and were shown in front of their class, accompanied by information about UV protection. Information about relevant parameters was collected via anonymous questionnaires before and 3 and 6 months after the intervention. Main Outcomes and Measures: The primary end point of the study was the difference in daily sunscreen use at 6 months of follow-up. Secondary end points included the difference in daily sunscreen use at 3 months of follow-up, at least 1 skin self-examination within 6 months, and at least 1 tanning session in the preceding 30 days. All analyses were predefined and based on intention to treat. Cluster effects were taken into account. Results: Participants included 1573 pupils (812 girls [51.6%] and 761 boys [48.4%]; mean [SD] age, 15.9 [1.3] years) from 52 school classes. Daily sunscreen use increased from 110 of 734 pupils (15.0%) to 139 of 607 (22.9%; P < .001) at the 6-month follow-up in the intervention group. The proportion of pupils performing at least 1 skin self-examination in the intervention group rose from 184 of 734 (25.1%) to 300 of 607 (49.4%; P < .001). Use of tanning decreased from 138 of 734 pupils (18.8%) to 92 of 607 (15.2%; P = .04). No significant changes were observed in the control group. The intervention was more effective for female students (number needed to treat for the primary end point: 8 for girls and 31 for boys). Conclusions and Relevance: These findings suggest that interventions based on face-aging apps may increase skin cancer protection behavior in Brazilian adolescents. Further studies are required to maximize the effect and to investigate the generalizability of the effects. Trial Registration: ClinicalTrials.gov Identifier: NCT03178240.
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Aplicaciones Móviles , Autoexamen/estadística & datos numéricos , Envejecimiento de la Piel/efectos de la radiación , Neoplasias Cutáneas/prevención & control , Piel , Protectores Solares/uso terapéutico , Adolescente , Brasil , Cara/efectos de la radiación , Femenino , Estudios de Seguimiento , Conductas Relacionadas con la Salud , Humanos , Masculino , Instituciones Académicas , Factores Sexuales , Baño de Sol/estadística & datos numéricos , Encuestas y Cuestionarios , Factores de Tiempo , Rayos Ultravioleta/efectos adversosRESUMEN
INTRODUCTION: The incidence of melanoma is increasing faster than any other major cancer both in Brazil and worldwide. The Southeast of Brazil has especially high incidences of melanoma, and early detection is low. Exposure to UV radiation represents a primary risk factor for developing melanoma. Increasing attractiveness is a major motivation for adolescents for tanning. A medical student-delivered intervention that harnesses the broad availability of mobile phones as well as adolescents' interest in their appearance may represent a novel method to improve skin cancer prevention. METHODS AND ANALYSIS: We developed a free mobile app (Sunface), which will be implemented in at least 30 secondary school classes, each with 21 students (at least 30 classes with 21 students for control) in February 2018 in Southeast Brazil via a novel method called mirroring. In a 45 min classroom seminar, the students' altered three-dimensional selfies on tablets are 'mirrored' via a projector in front of their entire class, showing the effects of unprotected UV exposure on their future faces. External block randomisation via computer is performed on the class level with a 1:1 allocation. Sociodemographic data, as well as skin type, ancestry, UV protection behaviour and its predictors are measured via a paper-pencil questionnaire before as well as at 3 and 6 months postintervention. The primary end point is the group difference in the 30-day prevalence of daily sunscreen use at a 6-month follow-up. Secondary end points include (1) the difference in daily sunscreen use at a 3-month follow-up, (2) if a self-skin examination in accordance with the ABCDE rule was performed within the 6-month follow-up and (3) the number of tanning sessions. ETHICS AND DISSEMINATION: Ethical approval was obtained from the ethics committee of the University of Itauna. Results will be disseminated at conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03178240; Pre-results.
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Promoción de la Salud/métodos , Melanoma/prevención & control , Aplicaciones Móviles , Motivación , Servicios de Salud Escolar , Estudiantes , Protectores Solares/administración & dosificación , Adolescente , Brasil , Teléfono Celular , Cara/efectos de la radiación , Femenino , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Melanoma/etiología , Apariencia Física , Proyectos de Investigación , Instituciones Académicas , Piel/efectos de la radiación , Estudiantes de Medicina , Baño de Sol , Protectores Solares/uso terapéutico , Encuestas y Cuestionarios , Telemedicina/métodosRESUMEN
Introdução: A incidência do câncer de cavidade oral entre adultos jovens tem crescido ao longo dos últimos anos, não estando clara a etiologia e a patogênese da neoplasia nesse grupo. Objetivo: Descrever o perfil dos adultos jovens brasileiros diagnosticados com carcinoma de células escamosas (CCE) em cavidade oral e a relação com o óbito entre 1985 e 2017. Método: Estudo transversal de base hospitalar, com indivíduos de 19 a 40 anos, diagnosticados com CCE a partir dos Registros Hospitalares de Câncer do Brasil. Foi realizada a análise descritiva e calculados o teste qui-quadrado, a razão de prevalência (RP) e a regressão logística com intervalo de confiança de 95%. Resultados: Foram elegíveis 1.761 casos de CCE em adultos jovens no período em estudo. O maior número de casos se concentrou na faixa etária de 31≥40 anos (79,80%), homens (71,90%), brancos (50,20%), moradores da Região Sudeste (36,40%), sem companheiro (58,00%) e com o ensino fundamental completo (63,40%). A maioria apresentava hábitos tabagistas (61,60%) e etilistas (56,70%), 18,50% eram profissionais da agricultura/aquicultura e 40,70% relataram histórico familiar de câncer. Foram diagnosticados em estádio avançado 68,10% e 25,50% dos casos foram a óbito. Os casos diagnosticados na língua foram os mais frequentes (42,40%) e apresentaram RP=2,638 (IC95% 2,050-3,394) vezes maior para óbito em relação aos casos no lábio e após ajuste, a odds ratio para esse local aumentou para 7,832 (IC95% 2,625-23,374, p<0,0001). Conclusão: O CCE nessa população necessita de maior atenção para reduzir a incidência e a letalidade desse problema de saúde pública
Introduction: The incidence of oral cavity cancer among young adults has grown over the past few years, and the etiology and pathogenesis of the neoplasm in this group is unclear. Objective: To describe the profile of Brazilian young adults diagnosed with squamous cell carcinoma (SCC) in the oral cavity and the relationship with death between 1985 and 2017. Method: Hospital-based cross-sectional study with individuals, aged 19 to 40, diagnosed with SCC from the Brazilian Cancer Hospital Records. Descriptive analysis was performed and chi-square test, prevalence ratio (PR) and logistic regression were calculated with 95% confidence interval. Results: 1,761 cases of SCC in young adults were retrieved during the study period. The highest number of cases was concentrated in the age group of 31≥40 years (79.80%), males (71.90%), white (50.20%), residents of the Southeast region (36.40%), without partner (58.00%) and completed elementary education (63.40%). 61.60% were smokers, 56.70%, alcoholics, 18.50%, agriculture/aquaculture professionals and 40.70% reported family cancer history. 68.10% were diagnosed at an advanced stage and about 25.50% of the cases died. Cases in the tongue were the most frequent (42.40%) with PR=2.638 (95%CI 2.050-3.394) times higher for death compared to cases in the lip and after adjustment, the odds ratio increased to 7.832 (CI95% 2.625-23.374, p<0.0001). Conclusion: It is necessary to pay more attention to the population with SCC, in order to reduce the incidence and lethality of this public health problem
Introducción: La incidencia de cáncer de cavidad oral entre adultos jóvenes ha aumentado en los últimos años y la etiología y patogenia de la neoplasia en este grupo no está clara. Objetivo: Describir el perfil de los jóvenes adultos brasileños diagnosticados de carcinoma epidermoide (CCE) en la cavidad oral y la relación con la muerte entre 1985 y 2017. Método: Estudio transversal hospitalario con individuos de 19 a 40 años, diagnosticados de CCE a partir de los registros hospitalarios oncológicos de Brasil. Se realizó análisis descriptivo, y se calculó la prueba de chi-cuadrado, razón de prevalencia (RP) y regresión logística con un intervalo de confianza del 95%. Resultados: Un total de 1.761 casos de CCE en adultos jóvenes fueron elegibles durante el período de estudio. El mayor número de casos se concentró en el grupo de edad de 31≥40 años (79,80%), hombres (71,90%), blancos (50,20%), residentes del Sureste (36,40%), sin pareja (58,00%) y con educación básica (63,40%). La mayoría (61,60%) tenía hábito de fumar y beber (56,70%), el 18,50% eran profesionales de la agricultura/acuicultura y el 40,70% referían antecedentes familiares de cáncer. El 68,10% fueron diagnosticados en estadio avanzado y alrededor del 25,50% de los casos fallecieron. Los casos con localización en la lengua fueron los más frecuentes (42,40%) y presentaron RP=2,638 (IC 95% 2,050-3,394) veces mayor para muerte en comparación con los casos en el labio y luego del ajuste, la odds ratio para esta localización aumentó 7,832 (IC95% 2,625 23,374, p<0,0001). Conclusión: El CCE en esta población necesita más atención para reducir la incidencia y la letalidad de este problema de salud pública
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Humanos , Masculino , Femenino , Neoplasias de la Boca , Carcinoma de Células Escamosas/epidemiología , Factores de Riesgo , Adulto JovenRESUMEN
INTRODUCTION: Most smokers start smoking during their early adolescence, often with the idea that smoking is glamorous; the dramatic health consequences are too far in the future to fathom. We recently designed and tested an intervention that takes advantage of the broad availability of mobile phones as well as adolescents' interest in their appearance. A free photoageing mobile app (Smokerface) was implemented by medical students in secondary schools via a novel method called mirroring. The pupils' altered three-dimensional selfies on tablets were 'mirrored' via a projector in front of their whole grade. This is the first randomised trial to measure the effectiveness of the mirroring approach on smoking behaviour in secondary schools. METHODS AND ANALYSIS: The mirroring intervention, which lasts 45 min, is implemented by Brazilian medical students in at least 35 secondary school classes with 21 participants each (at least 35 classes with 21 participants for control) in February 2018 in the city of Itauna, Brazil. External block randomisation via computer is performed on the class level with a 1:1 allocation. In addition to sociodemographic data, smoking behaviour is measured via a paper-pencil questionnaire before, 3 and 6 months postintervention plus a random carbon monoxide breathing test at baseline and end line. The primary outcome is cigarette smoking in the past week at 6 months follow-up. Smoking behaviour (smoking onset, quitting) and effects on the different genders are studied as secondary outcomes. Analysis is by intention to treat. ETHICS AND DISSEMINATION: Ethical approval is obtained from the ethics committee of the University of Itauna in Brazil. Results will be disseminated at conferences, in peer-reviewed journals, throughout the Education Against Tobacco network social media channels and on our websites. TRIAL REGISTRATION NUMBER: NCT03178227.
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Envejecimiento , Aplicaciones Móviles , Fotograbar , Cese del Hábito de Fumar , Prevención del Hábito de Fumar/métodos , Fumar/efectos adversos , Adolescente , Brasil , Teléfono Celular , Femenino , Humanos , Masculino , Evaluación de Resultado en la Atención de Salud , Servicios de Salud Escolar , Instituciones Académicas , Factores Sexuales , Fumar/psicología , Estudiantes de Medicina , Encuestas y CuestionariosRESUMEN
Although i(17q) [i(17q)] is frequently detected in hematological malignancies, few studies have assessed its clinical role in chronic lymphocytic leukemia (CLL). We recruited a cohort of 22 CLL patients with i(17q) and described their biological characteristics, mutational status of the genes TP53 and IGHV and genomic complexity. Furthermore, we analyzed the impact of the type of cytogenetic anomaly bearing the TP53 defect on the outcome of CLL patients and compared the progression-free survival (PFS) and overall survival (OS) of i(17q) cases with those of a group of 38 CLL patients harboring other 17p aberrations. We detected IGHV somatic hypermutation in all assessed patients, and TP53 mutations were observed in 71.4% of the cases. Patients with i(17q) were more commonly associated with complex karyotypes (CK) and tended to have a poorer OS than patients with other anomalies affecting 17p13 (median OS, 44 vs 120 months, P = 0.084). Regarding chromosomal alterations, significant differences in the median OS were found among groups (P = 0.044). In conclusion, our findings provide new insights regarding i(17q) in CLL and show a subgroup with adverse prognostic features.
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Cromosomas Humanos Par 17 , Genes p53 , Isocromosomas , Leucemia Linfocítica Crónica de Células B/genética , Mutación , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Cariotipo , Leucemia Linfocítica Crónica de Células B/patología , Masculino , Persona de Mediana EdadRESUMEN
Bariatric surgery (BS) is an increasingly used therapeutic option for severe obesity which allows patients to achieve sustained weight loss over time and resolution or improvement in most associated pathological conditions. Major mid- and long-term complications of BS include iron deficiency and iron-deficient anemia, which may occur in up to 50% of cases and significantly impair patient quality of life. These changes may be present before surgery. The aim of this review was to prepare schemes for diagnosis and treatment of iron deficiency and iron-deficient anemia before and after bariatric surgery.
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Anemia/diagnóstico , Anemia/terapia , Cirugía Bariátrica , Deficiencias de Hierro , Humanos , Obesidad Mórbida/cirugía , Calidad de VidaRESUMEN
Resumo Objetivo: conhecer as estratégias que podem auxiliar pessoas enlutadas pela morte de familiares pela covid-19 a lidarem com a perda. Metodologia: revisão narrativa realizada na plataforma PubCovid-19 por meio dos descritores "death" "bereavement", "grief" e "mourning". Foram incluídos dez artigos. Resultados: as estratégias encontradas dizem respeito à adoção de chamadas telefônicas, à gravação de áudios, à elaboração de cartas e à seleção das fotos, as quais são classificadas como imediatas e de longo prazo, focadas no cuidado com a saúde mental, a qual pode ser afetada pela depressão e pelos distúrbios psicológicos. Conclusões: urge que sejam criados programas de aconselhamento que ofereçam, aos parentes dos falecidos pela covid-19, um atendimento holístico, humanizado, contínuo, com foco na saúde mental.
Resumen Objetivo: conocer las estrategias que pueden ayudar a las personas en duelo por la muerte de miembro de la familia por la covid-19 para afrontar la pérdida. Metodología: revisión narrativa realizada en la plataforma PubCovid-19 por medio de los descriptores "death; "mourning"; "Covid-19"; "coping strategies". Se incluyeron diez artículos. Resultados: las estrategias encontradas se relacionan con la adopción de llamadas telefónicas, grabación de audios, cartas y fotos, las que se clasifican como inmediatas y a largo plazo centradas en la atención de la salud mental, la que puede ser afectada por la depresión y los trastornos psicológicos. Conclusiones: es urgente la creación de programas de asesoramiento para los familiares de los fallecidos por la covid-19, con el fin de ofrecer una atención integral, humanizada y continua, con un enfoque en la salud mental.
Abstract Objective: To explore the strategies that can help individuals mourning a family member's death from Covid-19 to cope with the loss. Method: We carried out a narrative review on the PubCovid-19 platform using the descriptors "death," "mourning," "Covid-19," and "coping strategies." Ten articles were included. Results: The strategies found are phone calls, audio recording, letters, and photos, classified as immediate and long-term. These strategies are focused on mental health, which can be adversely affected by depression and psychological disorders. Conclusions: Creating counseling programs for the relatives of those who died from Covid-19 is urgent. They must offer comprehensive, humanized, and continuous mental health care.
Asunto(s)
Aflicción , Adaptación Psicológica , Muerte , COVID-19RESUMEN
The emergence of clonal chromosomal abnormalities in Philadelphia-negative cells during treatment with imatinib in patients with Philadelphia-positive chronic myeloid leukemia has been reported. We add information to this issue presenting a series of 29 patients in complete cytogenetic response after imatinib treatment, three of whom developed clonal aberrations.
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Antineoplásicos/uso terapéutico , Aberraciones Cromosómicas/efectos de los fármacos , Leucemia Mielógena Crónica BCR-ABL Positiva/tratamiento farmacológico , Leucemia Mielógena Crónica BCR-ABL Positiva/genética , Leucemia Mieloide Crónica Atípica BCR-ABL Negativa/tratamiento farmacológico , Piperazinas/uso terapéutico , Pirimidinas/uso terapéutico , Antineoplásicos/farmacología , Benzamidas , Humanos , Mesilato de Imatinib , Piperazinas/farmacología , Pirimidinas/farmacologíaRESUMEN
Objetivo: conhecer as implicações sociais e para a saúde que acometem pessoas enlutadas pela morte de familiares vítimas da COVID-19. Método: trata-se de revisão narrativa realizada na plataforma PubCovid-19. Resultados: foi desenvolvido um quadro apresentando as características das dez publicações segundo título, autoria, ano de publicação, país e periódico. Conclusão: as implicações sociais e de saúde que acometem pessoas enlutadas pela morte de familiares por COVID-19 decorrem do distanciamento social que gera a impossibilidade da realização de rituais de despedida prejudicando a vivência normal do luto, levando ao luto complicado e ao possível adoecimento psíquico.
Objetivo: conocer las implicaciones sociales y para la salud que afectan a las personas en luto por la muerte de familiares víctimas de COVID-19. Método: esta es una revisión narrativa realizada en la plataforma PubCovid-19. Resultados: se elaboró un cuadro que presenta las características de las diez publicaciones por título, autoría, año de publicación, país y periódico. Conclusión: las implicaciones sociales y para la salud que afectan a las personas en luto por la muerte de familiares por la COVID-19 se derivan del distanciamiento social que genera la imposibilidad de realizar los rituales de despedida, perjudicando la vivencia normal del luto, provocando el complicado luto y la posible enfermedad psíquica.
Objective: to know the social and health implications that affect people bereaved by the death of relatives who were victims of COVID-19. Method: this is a narrative review carried out on the PubCovid-19 platform. Results: a chart was developed presenting the characteristics of the ten publications by title, authorship, year of publication, country and journal. Conclusion: the social and health implications that affect people bereaved by the death of family members by COVID-19 derive from the social distancing that generates the impossibility of performing farewell rituals, damaging the normal experience of mourning, leading to complicated mourning and possible psychic illness.
Asunto(s)
Humanos , Enfermería Psiquiátrica , Aflicción , Actitud Frente a la Muerte , Salud Mental , Infecciones por CoronavirusRESUMEN
OBJECTIVE: The aim of this study was to analyze the criteria employed for the requesting of preoperative tests among maxillofacial surgeons. MATERIALS AND METHODS: Thirty maxillofacial surgeons working in Aracaju (Brazil) received a questionnaire to fill out. The study inquired about the practice of requesting preoperative tests for healthy patients scheduled to undergo elective surgery. RESULTS: Most of the surgeons interviewed requested tests that are not recommended for the case in question. The highest frequency of requests was a complete blood count, coagulation test, blood glucose test and chest radiograph. CONCLUSION: The absence of strict rules for the requesting of preoperative tests causes uncertainty and a lack of criteria regarding pre-surgical conduct. It was not possible to clearly define the criteria used by surgeons for requesting such tests, as the clinical characteristics of the hypothetical case presented suggest a smaller number of tests.