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.

Responsiveness of Candidate Genes on CoPv01CDRK/PhgPv01CDRK Loci in Common Bean Challenged by Anthracnose and Angular Leaf Spot Pathogens.

Anthracnose (ANT) and angular leaf spot (ALS) are significant diseases in common bean, leading to considerable yield losses under specific environmental conditions. The California Dark Red Kidney (CDRK) bean cultivar is known for its resistance to multiple races of both pathogens. Previous studies have identified the CoPv01CDRK/PhgPv01CDRK resistance loci on chromosome Pv01. Here, we evaluated the expression levels of ten candidate genes near the CoPv01CDRK/PhgPv01CDRK loci and plant defense genes using quantitative real-time PCR in CDRK cultivar inoculated with races 73 of Colletotrichum lindemuthianum and 63-39 of Pseudocercospora griseola. Gene expression analysis revealed that the Phvul.001G246300 gene exhibited the most elevated levels, showing remarkable 7.8-fold and 8.5-fold increases for ANT and ALS, respectively. The Phvul.001G246300 gene encodes an abscisic acid (ABA) receptor with pyrabactin resistance, PYR1-like (PYL) protein, which plays a central role in the crosstalk between ABA and jasmonic acid responses. Interestingly, our results also showed that the other defense genes were initially activated. These findings provide critical insights into the molecular mechanisms underlying plant defense against these diseases and could contribute to the development of more effective disease management strategies in the future.

Evaluation of Current Antiemetic Therapy Response in Patients Undergoing MEC or HEC Regimens in Portugal.

Chemotherapy-induced nausea and vomiting (CINV) negatively impact cancer patients' quality of life and treatment outcomes. This study evaluated the achievement of complete response to CINV prophylaxis during the first five days after chemotherapy in adult outpatient cancer clinics with solid malignant tumours receiving Moderate or Highly Emetogenic Chemotherapy (MEC or HEC) in Portugal. During the study, patients completed three evaluations, and nausea severity and CINV impact on patients' daily life was assessed. A complete response (no emetic episodes, no use of rescue antiemetic medication, and no more than mild nausea) was observed in 72% of the cycles (N = 161) throughout the five days after chemotherapy. Amongst the patient population, 25% classified their CINV episodes as severe. Though more than half of the patients achieved a complete response, suggesting that a therapeutic effort is being made to minimise this side effect, the overall scenario is barely optimistic. Significantly, new CINV-control measures in MEC/HEC patients should be adopted, specifically avoiding the single use of dexamethasone and 5-HT3 and raising awareness of using NK1-RAs. Thus, it is critical to improve CINV prophylactic treatment and implement practical international antiemetic guidelines in Portuguese clinical practice, envisaging the improvement of supportive care for cancer patients.

Contralateral internal mammary vessels - a rescue recipient vessels option in breast reconstruction.

The most used vessels for free flap breast reconstruction are the internal mammary, the thoracodorsal and the circumflex scapular. We present a case where those were inadequate. DIEP vessels were passed through a created sternal groove and anastomosed to the contralateral IM vessels, accessed by the breast symmetrisation incisions.

CHEST WALL RECONSTRUCTION USING CUSTOMIZED NEO-RIBS: CASE REPORT.

Chest wall tumours are challenging subjects. In the present article we describe a case of a 51 year old female who developed an angiosarcoma eight years after radiotherapy treatment due to left breast cancer at age 41. She had resection of the anterior segments of the 3rd to 5thribs followed by chest wall reconstruction, using MatrixRib fixation system®, Marlex® mesh and latissimus dorsi muscle flap. After two years the angiosarcoma relapsed. Considering the predicted extent of the chest wall resection, a reconstruction using titanium plates was not an option, so we opted to shape neo-ribs of Methyl Methacrylate using rubber drains as a mold. It affords very good anatomical contour of the chest wall and more physiological function than other options, although only long-term follow-up and future studies will determine the performance of this method.

A panel of intestinal differentiation markers (CDX2, GPA33, and LI-cadherin) identifies gastric cancer patients with favourable prognosis.

BACKGROUND: Gastric cancer is the fifth most common cancer and the third cause of global cancer mortality. CDX2 is an intestinal differentiation marker with prognostic value in gastric cancer and transcriptionally regulates the expression of glycoprotein A33 (GPA33) and liver intestine cadherin (LI-cadherin). METHODS: This study evaluated the clinical significance of the combined expression of CDX2 and its targets GPA33 and LI-cadherin in gastric cancer by fluorescence-based multiplex immunohistochemistry together with digital image analysis and chromogenic immunohistochemistry in 329 gastric cancer samples arranged in tissue microarrays. Additionally, publicly available RNA-seq expression data from 354 gastric cancer samples from the TCGA database were used to validate the immunohistochemistry results. RESULTS: Expression of the three markers (CDX2, GPA33, and LI-cadherin) was strongly correlated, defining an intestinal differentiation panel. Low or negative protein expression of the intestinal differentiation panel identified patients with particularly poor overall survival, irrespective of the methodology used, and was validated in the independent series at the RNA-seq level. CONCLUSIONS: Expression of the intestinal differentiation panel (CDX2, GPA33, and LI-cadherin) defines a set of biomarkers with a strong biological rationale and favourable impact for prognostication of gastric cancer patients.

Expression and Clinical Relevance of SOX9 in Gastric Cancer.

Gastric cancer is one of the most frequent tumours and the third leading cause of cancer-related death worldwide. The investigation of new biomarkers that can predict patient outcome more accurately and allow better treatment and follow-up decisions is of crucial importance. SOX9 (sex-determining region Y (SRY)-box 9) is a regulator of cell fate decisions in embryogenesis and adulthood. Here, we sought to ascertain the relevance of SOX9 transcription factor as a prognostic marker in gastric cancer. SOX9 expression was analyzed by immunohistochemistry in 333 gastric adenocarcinoma cases, and its association with clinicopathological and follow-up data was evaluated. SOX9 nuclear expression was absent in 17% of gastric cancer cases and predicted worse disease-free survival (P = 0.03). SOX9 expression was associated with lower risk of relapse in Cox univariable analysis (HR = 0.58; 95% CI = 0.35-0.97; P = 0.04). The prognostic value of SOX9 was more pronounced in tumours with expansive growth (P = 0.01) or with venous invasion (P = 0.02). Two validation cohorts from the Cancer Genome Atlas (TCGA) and the Asian Cancer Research Group (ACRG) confirmed that low SOX9 expression was significantly associated with poor patient outcome. In conclusion, we have identified SOX9 as a biomarker of disease relapse in gastric cancer patients. Further experiments are needed to elucidate its biological relevance at the cellular level.

Role of intravenous iron in the treatment of anemia in patients with gastrointestinal tract tumors undergoing chemotherapy: a single-center, observational study.

PURPOSE: The prevalence of anemia ranges between 30% and 90% in cancer patients, affecting the health status, quality of life, and treatment outcome. Therefore, a proper diagnosis and management of anemia is crucial in these patients. Iron deficiency is diagnosed in~32%-60% of the cases. In this observational study, we evaluated the efficacy and safety of intravenous iron (ferric carboxymaltose [FCM], Ferinject®) in the treatment of iron-deficiency anemia in patients with gastrointestinal tumors undergoing palliative or adjuvant chemotherapy. PATIENTS AND METHODS: Thirty patients with gastrointestinal tumors undergoing chemotherapy diagnosed with iron-deficiency anemia were included in the study and received at least one FCM administration. The need for iron replacement therapy was evaluated by the assessment of hemoglobin and iron status parameters, and patients could be treated with FCM during 12-14 weeks. Paired t-test approach was used to evaluate the mean differences between the baseline and the end of the study. A p-value of <0.05 was considered statistically significant. RESULTS: Data showed that there was a statistically significant increase in the mean of hemoglobin (10.3 vs 11.2 g/dL), ferritin (230.3 vs 877.0 ng/mL), transferrin saturation (13.0% vs 19.7%), and serum iron (42.3 vs 59.6 mg/mL) from the baseline to the end of the study in cancer patients. Most of the patients (n=25) were only administered one dose of FCM. There was one FCM-related adverse event during the study. CONCLUSION: FCM was well tolerated and had a positive impact in the treatment of iron-deficiency anemia in patients with gastrointestinal tract tumors undergoing chemotherapy.

Mucins MUC16 and MUC1 are major carriers of SLe(a) and SLe(x) in borderline and malignant serous ovarian tumors.

Mucins are heavily glycosylated proteins overexpressed and associated with truncated or sialylated glycans upon malignant transformation. We previously identified a panel of four glyco-mucin profiles (MUC16/Tn, MUC16/STn, MUC1/Tn, and MUC1/STn) with 100 % specificity and 100 % positive predictive value for detection of borderline/malignant serous tumors of the ovary, using proximity ligation assay (PLA). In the present work, using the same method, we studied other mucin glycosylation profiles that might add relevant information for diagnostic purposes. We used PLA probes to MUC16, MUC1, sialyl Lewis(a) (SLe(a)), and sialyl Lewis(x) (SLe(x)) to study a series of 39 ovarian serous tumors (14 adenocarcinomas, 10 borderline ovarian tumors (BOTs), and 15 cystadenomas). Our results demonstrated that, in adenocarcinomas and BOTs, the major carriers of SLe(a) and SLe(x) are MUC16 and/or MUC1 (100 and 92 % for SLe(a) and 64 and 70 % for SLe(x), respectively). In cystadenomas, SLe(a) and SLe(x) are mainly carried by unidentified proteins (85 and 78 %, respectively). Our study identified, for the first time, the major protein carriers of SLe(a) and SLe(x) in ovarian adenocarcinomas and BOTs, MUC1 and MUC16, and also that distinct unidentified carriers are involved in cystadenomas. These results emphasize the relevance of multiple biomarker recognition provided by multiplex assays, such as PLA, to enhance sensitivity and specificity of serum and tissue assays.

Perfil epidemiológico de gestantes e qualidade do pré-natal em unidade básica de saúde em Porto Alegre, Rio Grande do Sul, Brasil / Epidemiological profile of pregnant women and prenatal care quality in a healthcare center in Porto Alegre, Rio Grande do Sul, Brazil / Perfil epidemiológico de las gestantes y calidad de la atención prenatal en un centro de salud en Porto Alegre, Rio Grande do Sul, Brasil

Objetivo: Conhecer o perfil e avaliar a qualidade do pré-natal de gestantes que deram à luz em 2008 atendidas na Unidade Básica de Saúde (UBS) Panorama em Porto Alegre, RS, Brasil. Método: estudo transversal com questionário aplicado às gestantes no domicílio e na UBS, buscando informações sobre características demográficas, reprodutivas e sobre o tipo de assistência recebida durante a gestação e o parto. A análise consistiu de listagem de frequência e obtenção de medidas de tendência central e dispersão. Resultados: Dentre as 238 gestantes entrevistadas, 20% eram adolescentes, 38% possuía nove ou mais anos de estudo, três quartos viviam com companheiro e 40% trabalharam fora de casa durante a gravidez; um quarto das famílias possuía renda mensal inferior a um salário mínimo (SM), com mediana de R$ 700,00. Com relação à saúde reprodutiva: em média, a menarca ocorreu aos 13 anos e a primeira relação sexual aos 16, 25% referiram ter sofrido pelo menos um aborto e, aos 19 anos, 60% já eram mães. No pré-natal, 87% consultaram seis ou mais vezes, cerca de três quartos o iniciaram no primeiro trimestre e 85% receberam vacina antitetânica e suplementação com sulfato ferroso. De acordo com o Índice de Kessner modificado por Takeda e Silveira, o cuidado pré-natal foi considerado adequado em 80% e 49% dos casos, respectivamente. Conclusões: a UBS Panorama atende gestantes carentes socioeconomicamente mas que iniciam o pré-natal cedo, realizando elevado número de consultas de pré-natal, porém, em termos qualitativos, recebem serviço insatisfatório quanto à assistência à gestação e ao parto.

Objective: To understand the profile and assess the quality of care received by pregnant women, who gave birth in 2008, attending the Panorama healthcare centre (HC) in Porto Alegre, Rio Grande do Sul state (RS). Methods: A cross-sectional survey was carried out using pre-codified questionnaires applied at households and HCs investigating the mothers' demographic reproductive characteristics and the healthcare received during antenatal period and delivery. Analysis consisted of frequency distribution of variables and their mean, median and standard deviations. Results: Amongst the 238 women interviewed, 20% were teenagers, 38% had at least nine years of schooling, three quarters were living with a partner and 40% had a paid job during gestational period; a quarter had family income of a minimum wage (average of US$ 350/month). Regarding their reproductive health, on average, menarche occurred at 13 years old, sexual intercourse started at 16 years old, 25% had already had an abortion and, by 19 years old, 60% had already given birth. Concerning prenatal care, 87% attended at least six medical appointments, three quarters started prenatal care in the first trimester of pregnancy and 85% received tetanus vaccine and iron supplementation during antenatal period. According to the Kessner Index modified by Takeda and Silveira, the antenatal care was considered adequate for 80% and 49% of all pregnant women, respectively. Conclusion: Panorama HC attends socioeconomic deprived pregnant women that started early antenatal care, performing a high amount of medical appointments, but, in general, the healthcare quality offered both during prenatal and delivery was unsatisfactory.

Objetivo: conocer el perfil y evaluar la calidad de la atención prenatal recibida por gestantes atendidas en el centro de salud Panorama en Porto Alegre, RS, Brasil, que dieron a luz en 2008. Método: estudio transversal con cuestionario aplicado en domicilio y en el centro de salud, buscando informaciones sobre características demográficas, reproductivas y tipo de asistencia recibida durante la gestación y el parto. Se analizó la frecuencia y distribución de las variables y sus medidas de tendencia central y dispersión (media, mediana y desvío estándar). Resultados: Entre las 238 gestantes incluidas en este estudio, 20% eran adolescentes, 38% tenían nueve años o más de escolaridad, tres cuartos vivían con un compañero y 40% trabajaran fuera de casa durante el embarazo; un cuarto tenía renta mensual deun salario mínimo (promedio de U$S 350). Con relación a la salud reproductiva, la menarca ocurrió, en promedio, a los 13 años, la primera relación sexual a los 16, 25% refirió haber sufrido al menos un aborto y 60% había sido madre antes de los 19 años. Con relación a la atención prenatal, 87% consultó al médico seis o más veces, tres cuartos iniciaron las consultas durante el primer trimestre, y 85% recibió vacuna antitetánica y suplemento con hierro durante la gestación. De acuerdo al Indice de Kessner modificado por Takeda y Silveira, el cuidado prenatal fue considerado adecuado en 80% y 49% de los casos, respectivamente. Conclusiones: el centro de salud Panorama atiende gestantes socioeconómicamente vulnerables, que inician el prenatal tempranamente, realizan elevado número de consultas prenatales, pero, de modo general, recibieron atención insatisfactoria tanto durante la gestación como durante el parto.

Teste in vitro do efeito acaricida do óleo essencial de Melaleuca alternifolia sobre Otodectes cynotis In vitro test of the acaricide effect of the Melaleuca alternifolia essential oil on Otodectes cynotis

A otocariose é uma doença parasitária causada pelo ácaro Otodectes cynotis, sendo frequentemente observado no ouvido de cães e gatos, como um dos principais causadores de otite externa. Para o tratamento da otocariose é necessário o uso de substâncias acaricidas. No entanto é crescente o número de relatos sobre a resistência parasitária, sendo este um motivo de preocupação por parte de clínicos e proprietários. Este trabalho teve por objetivo testar o efeito acaricida, in vitro, do óleo essencial de melaleuca (Melaleuca alternifolia) contra o ácaro Otodectes cynotis. Foram selecionados ácaros coletados do conduto auditivo de cães, tendo como critério a integridade estrutural e a ativa movimentação.  Estes ácaros foram mantidos em placas de Petri e distribuídos em três grupos, correspondendo a três tratamentos diferentes: loção a 5% de óleo essencial de melaleuca; loção a 5% de tiabendazol e loção não-iônica, veículo utilizado nas duas loções anteriores. Foram realizados exames com intervalos regulares de uma hora após o início do experimento, até o total de 5 horas, utilizando a motilidade e integridade estrutural como parâmetros de avaliação. O óleo essencial de melaleuca apresentou propriedade acaricida, in vitro, desde a primeira hora de tratamento, podendo vir a ser uma opção de tratamento eficiente para a otocariose.

Efeito acaricida do óleo essencial de Melaleuca alternifolia sobre Otodectes cynotis

A otocariose é uma doença parasitária causada pelo ácaro Otodectes cynotis, sendo frequentemente observado no ouvido de cãese gatos, como um dos principais causadores de otite externa. Para o tratamento da otocariose é necessário o uso de substânciasacaricidas. No entanto, é crescente o número de relatos sobre a resistência parasitária, sendo este um motivo de preocupação porparte de clínicos e proprietários. Com o objetivo de avaliar o efeito acaricida do óleo essencial de Melaleuca alternifolia (tea tree)sobre a sarna Otodectes cynotis, foram formados três grupos experimentais de dez animais cada, que receberam os seguintestratamentos: Grupo um: loção a 5% de óleo essencial de M. alternifolia; Grupo dois: loção a 5% de tiabendazol; Grupo três: loçãoà base de uma cera emulsificante não iônica. Todos os animais tiveram seus condutos auditivos externos tratados durante setedias consecutivos e examinados periodicamente a fim de se observar a eficácia dos produtos. Concluiu-se que o óleo essencialde M. alternifolia pode ser empregado na espécie canina, como forma de tratamento para otite por O. cynotis.

Fatores epidemiológicos da infestação por Otodectes cynotis em cães no município de Cuiabá

Dentre os fatores causadores da otite externa destaca-se o ácaro Otodectes cynotis, parasito encontrado frequentemente noouvido de cães e gatos, com relevante importância na clínica médica de pequenos animais. Trezentos e vinte cães, residentesno município de Cuiabá, Mato Grosso, sendo 160 oriundos de um abrigo de cães e 160 de atendimentos clínicos no HospitalVeterinário da Universidade Federal de Mato Grosso tiveram seus condutos auditivos examinados, por otoscopia e peloexame do swab parasitológico, com o objetivo de se determinar a prevalência do parasitismo pelo ácaro O. cynotis. Osexames dos cães revelaram uma prevalência de 67,5% de animais portadores de otocariose na população do abrigo, contra21,5% dos cães atendidos no Hospital Veterinário, evidenciando uma diferença significativa (p 0,001) na prevalência entreas duas populações.

Estratégias de Coping em educadores de infância portugueses / Estrategias de Coping en profesores infantiles portugueses / Coping Strategies in portuguese kindergarten teachers

O presente estudo teve como objectivo identificar os mecanismos de coping (estratégias para lidar com situações difíceis) utilizados por Educadores de Infância quando se encontram em situações de stresse, bem como estudar as características do respectivo instrumento de avaliação na versão Portuguesa. A amostra é constituída por 247 Educadores de Infância (diplomados e em situação de estágio pedagógico) com idades compreendidas entre os 20 e os 57 anos de idade. Da Bateria Differential Stress Inventory (DSI), de Lefèvre e Kubinger (2004) foi utilizado o questionário Estratégias de Coping (EC) tipo Likert, adaptada para a população portuguesa por Gomes, Pereira e Gil (2006), revelando boas características psicométricas. Os principais resultados mostram que perante situações indutoras de stresse os Educadores de Infância utilizam mais as estratégias de coping focadas na emoção, do que as estratégias de coping focadas no problema. São referidas ainda algumas implicações deste estudo para a formação destes profissionais.

The aim of this study is to identify the mechanisms of coping (strategies to deal with difficult situations) used by kindergarten Teachers when they face situations of stress, as well as to study respective characteristics of the used evaluation instrument in a Portuguese version. The sample is constituted by 247 kindergarten teachers (graduated and training students) with ages between 20 and 57 years old. The Strategies of Coping (EC) likert type scale from the Differential Stress Inventory (DSI), of Lefèvre & Kubinger (2004) was adapted for the Portuguese population by Gomes, Pereira & Gil (2006), which revealed good psychometric characteristics. The main results show that kindergarten Teachers, when experiencing stress inducing situations, frequently appeal to coping strategies with focus in emotion, than based in the problem solving situation. Will be discussed further implications of this research to the professional training.

Este estudio tuvo como objetivo identificar los mecanismos de coping (estrategias para lidiar con situaciones difíciles) utilizados por profesores infantiles cuando están en situación de stress, así como también estudiar las características del respectivo instrumento de evaluación en la versión Portuguesa. La muestra es constituida por 247 profesores infantiles (diplomados y en situación de práctica pedagógica) con edades entre los 20 y los 57 años de edad. De la Bateria Differential Stress Inventory (DSI), de Lefèvre y Kubinger (2004) fue utilizado el cuestionario Estratégias de Coping (EC) tipo Likert, adaptada para la población portuguesa por Gomes, Pereira y Gil (2006), revelando buenas características psicométricas. Los resultados principales muestran que frente a situaciones incitadoras de stress los profesores infantiles utilizan más las estrategias de coping focalizadas en la emoción que las estrategias de coping focalizadas en el problema. Todavía, son mencionadas algunas implicaciones de este estudio para la formación de estos profesionales.

Perfil demográfico e clínico da população com Diabetes Mellitus atendida na Unidade de Saúde Jardim Leopoldina do Serviço de Saúde Comunitária do Grupo Hospitalar Conceição

O presente estudo trata sobre o perfil demográfico e clínico da população com Diabetes Mellitus atendido na unidade de saúde Jardim Leopoldina do GHC (local onde se pratica atenção primária à saúde) e, a partir dos dados obtidos nesse estudo, estratégias preventivas e terapêuticas poderão ser melhor adaptadas ao perfil populacional presente na atenção primária à saúde pública com consequente redução da morbi-mortalidade associada ao diabetes.