Prognostic risk stratification using C-reactive protein, albumin, and associated inflammatory biomarkers in patients with advanced cancer in palliative care.

PURPOSE: To evaluate the prognostic value of C-reactive protein (CRP), albumin, CRP/albumin ratio (CAR), and modified Glasgow Prognostic Score (mGPS) at different thresholds in patients with advanced cancer in palliative care. METHODS: Prospective cohort study with patients evaluated at a palliative care unit in Brazil between July 2016 and March 2020. We included patients ≥ 20 years old, both sexes, able to provide the necessary information or accompanied by someone able to do so, and Karnofsky Performance Status ≥ 30 %. The exclusion criteria were the absence of laboratory data and previous diagnosis of autoimmune and infectious diseases. The thresholds analyzed were: CRP < 5 vs. 5-10 vs. > 10 mg/L, albumin < 2.4 vs. 2.4-2.9 vs. 3.0-3.5 vs. > 3.5 g/dL; CAR <1.2 vs. 1.2-2.0 vs. > 2.0, and mGPS equal to 0 vs. 1 vs. 2. Kaplan-Meier curves and Cox regression models (with hazard ratios [HR] and 95% confidence interval [CI]) were used to evaluate prognostic value, and the concordance statistic (C-statistic) was used to evaluate the predictive accuracy of these thresholds to predict death within 90 days. RESULTS: A total of 1,877 patients were included. Median overall survival was 51 (19;124) days and decreased in line with the deterioration of the inflammatory biomarkers. According to the Cox regression models, HR increased as the thresholds worsened (CRP: 1.74 [95% CI, 1.50-2.02] to 2.30 [95% CI, 2.00-2.64]; albumin: 1.77 [95% CI, 1.52-2.07] to 2.60 [95% CI, 2.15-3.14]; CAR: 1.47 [95% CI, 1.21-1.77] to 2.35 [95% CI, 2.05-2.69]; mGPS: 1.78 [95% CI, 1.40-2.23] to 1.89 [95% CI, 1.65-2.15]). All the inflammatory biomarkers evaluated showed discriminatory accuracy for predicting death (C-statistic >0.70), with CAR as the best parameter (C-statistic: 0.80). CONCLUSION: Our results suggest that CRP, albumin, CAR, and mGPS can be used as clinically meaningful biomarkers to stratify patients with advanced cancer in palliative care according to the severity of these indicators.

Quality of Arabica coffee grown in Brazilian Savannah and impact of potassium sources.

Located in Brazil's Central Plateau, the Cerrado Savannah is an emerging coffee-growing region with significant potential for the national coffee market. This study investigated the impact of potassium fertilization on Arabica coffee quality in the Cerrado, using three potassium sources (K2SO4, KCl, and KNO3) and five cultivars (Arara, Aranãs, IPR103, Catiguá and Topázio) across two consecutive harvests. We focused on productivity, granulometry, chemical composition, and sensory characteristics. No significant difference in productivity across the cultivars studied or potassium sources as isolated factors were observed. Regarding chemical parameters, potassium sources only affected NO3- and SO42- levels in the grains. Cultivar-specific differences were noted in caffeine (CAF), citric acid (CA), and sucrose (SUC), highlighting a strong genetic influence. K2SO4 improved productivity in Arara (15 %) and IPR103 (11 %), while KNO3 reduced flat grain percentage to 70 % in Catiguá. Sensory evaluation showed that all potassium sources and cultivars produced specialty coffees, with the Arara cultivar treated with K2SO4 achieving the highest SCA score (83.3) while IPR 103 treated with KCl scored the lowest at 78. Only three treatments were below but very close to the threshold (80). Multivariate analysis indicated a trend where specific treatments correlated with higher productivity and quality. Despite the subtle differences in productivity and quality among potassium sources, a cost-benefit analysis may favor KCl due to its affordability, suggesting its viability as a potassium fertilization option in coffee cultivation. Future research is needed to confirm these trends and optimize potassium source selection to enhance coffee quality in the Cerrado.

Association of the muscle mass phenotype as assessed by a grading system with the quality of life of patients with incurable cancer in palliative care.

BACKGROUND: Loss of muscle mass (MM) is common in advanced stages of cancer, with an impact on worsening quality of life (QoL). In the current study the relationship of a previously proposed simple grade system to assess MM phenotypes with QoL was investigated to strengthen its clinical significance. AIM: To verify whether the MM phenotypes, which were evaluated by using a grading system, are associated with the quality of life (QoL) of patients with incurable cancer. METHODS: Secondary data from a cohort of patients with incurable cancer in palliative care were analyzed. The grade system considers measurements of the muscle area arm and handgrip strength. Based on these measurements, patients are classified as probably non-sarcopenic (NSarc), probably sarcopenic (PSarc), and sarcopenic (Sarc). The outcome measure was QoL domains assessed by the EORTC QoL Questionnaire Core-15. Logistic regression models were used to verify the association of the domains of QoL with the MM phenotypes. RESULTS: A total of 770 patients were included, median age of 62 years and 56.6% females. The PSarc group had significantly worse scores in the QoL domains when compared to the NSarc group (physical p = 0.001, emotional p = 0.018, fatigue p < 0.001, nausea p = 0.017, insomnia p = 0.001, appetite loss p = 0.002, and global health p = 0.043). Adjusted logistic regression analysis showed an increased risk of worse QoL in the PSarc and Sarc, when compared to NSarc, respectively (odds ratio [OR], 95% confidence interval [CI]): physical (OR: 2.54, CI: 1.78-3.62 and OR: 7.18, CI: 4.24-12.17), emotional (OR: 1.61, CI: 1.15-2.24 and OR: 1.49, CI: 1.01-2.20), fatigue (OR: 1.89, CI: 1.35-2.64 and OR: 1.83, CI: 1.23-2.71), insomnia (OR: 2.01, CI: 1.43-2.83 and OR: 3.11, CI: 2.04-4.75), while appetite loss domain was associated with the PSarc (OR: 1.40, CI: 1.02-1.96), together with global health in the Sarc group (OR: 1.56, CI: 1.06-2.29). CONCLUSION: The severity of the MM phenotype was associated with a worse QoL domains. Our results highlight the importance of MM preserving to affecting QoL status. The grading system can be useful for predicting the QoL in those patients, and its usefulness can potentially impact clinical and therapeutic decision-making.

Exploring factors and trends in place of death by cancer: a population-based study in Brazil.

Background: The place of death profoundly affects end-of-life care quality, particularly in cancer. Assisting individuals at home enhances support, privacy, and control, reducing healthcare costs. This study seeks to elucidate factors associated and trends in place of death by cancer in Brazil. Methods: Using data obtained from the National Mortality Information System, this study extracted tumour topography, sociodemographic characteristics, and the place of death (outcome classified into hospital or home death) by cancer in Brazil from 2002 to 2021. Findings: The analysis included 3,677,415 cases, with 82.3% of deaths occurring in hospitals and 17.7% at home. Most participants were male (53.1%), had gastrointestinal tumours (32.2%), and resided in the Southeastern region (48.7%). Home deaths were more frequent in the Northeastern (30.2%) and Northern (24.8%) regions compared to the Southern (17.1%) and Southeastern (12.2%) regions. A strong inverse correlation was found between home deaths and the Human Development Index of the region. Over the years, there was a reduction in home deaths, followed by a recent increase. Individuals with no formal education, indigenous individuals, and patients from the North, Northeast, and Central-West regions had higher rates of home deaths, while patients with haematological malignancies had lower rates compared to those with gastrointestinal tumours. Interpretation: The minority of deaths by cancer in Brazil occur at home, with distinct trends over time. Home death was associated with regional, racial and educational level differences. Funding: No funding.

A Scoping Review on Carotenoid Profiling in Passiflora spp.: A Vast Avenue for Expanding the Knowledge on the Species.

The Passiflora genus is recognised for its ethnopharmacological, sensorial, and nutritional significance. Yet, the screening of its dietary and bioactive molecules has mainly targeted hydrophilic metabolites. Following the PRISMA-P protocol, this review assessed the current knowledge on carotenoid composition and analysis within Passiflora, examining 968 records from seven databases and including 17 studies focusing on carotenoid separation and identification in plant parts. Those publications originated in America and Asia. P. edulis was the most frequently examined species of a total of ten, while pulp was the most studied plant part (16 studies). Carotenoid analysis involved primarily high-performance liquid chromatography separation on C18 columns and detection using diode array detectors (64.71%). Most studies identified the provitamin A ß-carotene and xanthophylls lutein and zeaxanthin, with their geometric configuration often neglected. Only one study described carotenoid esters. Besides the methodology's insufficient description, the lack of use of more accurate techniques and practices led to a high risk of bias in the carotenoid assignment in 17.65% of the articles. This review highlights the opportunity to broaden carotenoid studies to other species and parts within the diverse Passiflora genus, especially to wild, locally available fruits, which may have a strategic role in enhancing food diversity and security amidst climatic changes. Additionally, it urges the use of more accurate and efficient analytical methods based on green chemistry to better identify Passiflora carotenoids.

Sorghum phytonutrients and their health benefits: A systematic review from cell to clinical trials.

Sorghum is key for global food security due to its genetic variability, resilience, and rich phytonutrient content, which are linked to numerous health benefits. A systematic review assessed the health effects of sorghum by analyzing cell (n = 22), animal (n = 20), and human (n = 7) studies across antioxidant, anti-inflammatory, obesity, cancer, cardiovascular, and diabetes outcomes. This review, involving 42 papers and 177 researchers from 12 countries, collected data from sorghum accessions (acc) and significant effects. Studies used 68 identified and 8 unidentified sorghums, 57% red (n = 20), brown (n = 5), and black (n = 17) pericarp colors, and evaluated whole (n = 31), brans (n = 11), and decorticated grains (n = 2). Colored sorghum, richer in phenolic compounds, especially 3-deoxyanthocyanins and tannins, inhibited cancer cell activities, including proliferation, tumor growth, and ROS activity, and promoted cell cycle arrest and apoptosis. Sorghum elevated HO1 and eNOS expression for cardiovascular, health-reduced platelet aggregation, and modulated platelet microparticles. They also suppressed inflammation markers and decreased lipid accumulation. Animal studies indicated sorghum's potential across antioxidant capacity, cancer and inflammation mitigation, and lipid and glucose metabolism. Translating these findings to human scenarios requires caution, especially considering cell studies do not fully represent polyphenol metabolism. Human studies provided mixed results, indicating antioxidant and potential anti-inflammatory benefits and nuanced effects on glucose and lipid metabolism. The main risks of bias highlighted challenges in quantifying phytonutrients, identifying sorghum acc features, and lack of assessors blinding. Nonetheless, sorghum emerges as a promising functional food for countering chronic diseases in Western diets.

The effect of biopolymer gel derived from sugarcane on healing of traumatic oral ulcers: an experimental study.

PURPOSE: The extracellular polysaccharide (EPS) is produced by the bacterium Zoogloea sp. and plays a positive role in tissue repair. The purpose of this study was to clinically and histologically compare the effects of EPS in the healing of traumatic oral ulcers in rats with the effects of triamcinolone. METHODS: Ulcers were induced in the oral mucous of 45 male Wistar rats, divided into three groups: control group, treated with triamcinolone, and treated with biopolymer gel. In the clinical evaluation, we considered the weight variation of the animals and the size of the lesion area, at baseline and on treatment days 1, 3 and 7. The histological parameters evaluated were the type and intensity of the inflammatory infiltration, the presence of necrosis and foreign body granuloma and the degree of re-epithelialization of the lesion. RESULTS: The reduction of the lesion area was greater in the animals treated with EPS, with no difference in the intensity of the inflammatory infiltration between the groups on days 3 and 7 of treatment. CONCLUSIONS: The results suggest that topical application of EPS in traumatic oral ulcers of rats promotes faster repair than triamcinolone ointment, without increasing the intensity of inflammatory infiltration under the lesion.

Clinical usefulness of the patient-generated subjective global assessment short form© for nutritional screening in patients with head and neck cancer: a multicentric study.

Nutritional screening and assessment are considered essential steps in nutritional care for cancer patients, malnutrition remains underreported in clinical practice. The aim of this study was to analyse the clinical usefulness of the Patient-Generated Subjective Global Assessment short form (PG-SGA SF©) for nutritional screening in patients with head and neck cancer (HNC). This is a multicentre, cross-sectional study involving patients with HNC. The final score of the PG-SGA SF© was obtained and the nutritional status was diagnosed using the Patient-Generated Subjective Global Assessment (PG-SGA)®, classifying them as well-nourished or malnourished. Receiver operating characteristic curve, ordinal logistic regression, and C-statistic were used. In total, 353 patients with HNC were enrolled and the prevalence of malnutrition, according to the PG-SGA®, was 64.02% and the median final score of PG-SGA SF© was 11 points. The final score of the PG-SGA SF© had high accuracy (area under the curve = 0.915), and scores ≥9 had the best performance in diagnosing malnutrition. PG-SGA SF© final score ≥9 was associated with malnutrition (odds ratio = 28.32, 95% confidence interval= 15.98-50.17), with excellent discriminatory power (C-statistic = 0.872). In conclusion, the PG-SGA SF© demonstrated excellent performance for nutritional screening in patients with HNC. Given that it is a simple instrument that is faster to administer than the PG-SGA®, we recommend its use in clinical practice among such patients.

Pain management effectiveness in advanced cancer: palliative care unit inpatient study.

OBJECTIVES: The aim of this study is to evaluate pain management adequacy based on the Pain Management Index (PMI), and its association with the Brief Pain Inventory (BPI) in advanced cancer inpatients to a palliative care unit. METHODS: This is a quantitative study concerning advanced cancer inpatients in a specialised palliative care unit between June 2021 and February 2022. The BPI was applied, and analgesia was observed on the first (D1), third (D3) and seventh (D7) day of hospitalisation. Adequate analgesia was considered when PMI≥0. RESULTS: A total of 104 patients were evaluated on D1, 68 on D3 and 45 on D7, with a mean age of 53.6 years (SD±14.1), most of them female (65.4%), with the most frequent primary tumour site located in the gastrointestinal tract (22.1%). The observed analgesia was adequate (PMI≥0) in 52.9% of all patients on D1, 95.6% on D3 and 100% on D7 (p value=0.012). The number of patients with moderate to severe pain interference in general activities (p value 0.012), mood (p value 0.014), walking ability (p value 0.047), normal work (p value 0.038) and pleasure of living (p value 0.025) decreased during hospitalisation. CONCLUSIONS: Pain is a prevalent and impacting symptom in patients undergoing palliative care. Thus, objective analgesic adequacy assessments in specialised services are required. These findings reinforce the importance of effective pain control and corroborate the importance of employing objective tools in evaluating medical services and improving quality of life of patients.

Factors associated with variability in skeletal muscle radiodensity in patients with metastatic cancer.

OBJECTIVES: This study aimed to explore factors associated with skeletal muscle radiodensity (SMD) variability in patients with metastatic cancer. METHODS: This study included 393 patients (median age 61 y, 70% women) who had computed tomography (CT) scans within 30 days of inclusion in the study. SMD was evaluated from CT by averaging the Hounsfield unit value of the total muscle area. Skeletal muscle index (SMI), visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI), and total adipose tissue index (TATI) were also assessed by CT. Additionally, age, sex, race/skin color, disease characteristics, comorbidities, inflammatory markers, handgrip strength (HGS), and body mass index (BMI) were recorded and evaluated in the linear regression analysis to identify factors associated with SMD variability. RESULTS: Multivariate explanatory models having SMD as an independent variable were performed and included BMI (model 1, r2 = 0.699), TATI (model 2, r2 = 0.712) or VATI and SATI (model 3, r2 = 0.706) in addition to age, race/skin color, tumor site, kidney disease, serum albumin, HGS, and SMI as dependent variables. For all models, lower SMD was associated with higher age, BMI, and adiposity measurements, kidney disease, White race/skin color, and lower serum albumin, HGS, and SMI. The primary tumor site also contributed to changes in SMD in all models, specifically those located in the gastrointestinal tract, gynecologic, and bone and connective tissue. CONCLUSION: In this group of patients with metastatic cancer, lower SMD was associated with older age, White race/skin color, and an overall worse clinical condition.

Local anesthetics as a tool for Staphylococcus spp. control: a systematic review.

The objective of this work was to carry out a systematic review on the effectiveness of local anesthetics as antimicrobial agents against Staphylococcus spp. Searches were performed in the PubMed, Web of science, Scopus, Embase and Lilacs databases. As inclusion criteria, complete original articles, with in vitro experimental tests with the application of selected anesthetics and bacteria of the genus Staphylococcus spp. This review followed the methodological checklist for writing papers reporting systematic reviews by the PRISMA statement. The risk of bias was assessed according to the JBI critical appraisal checklist. Analysis was performed using an anesthetic-moderated simple linear regression model. This systematic review was registered by the Open Science Framework-OSF ( https://doi.org/10.17605/OSF.IO/C5JM7 ). Initially, 1141 articles were found, of which, after careful selection, 52 articles were analyzed. Lidocaine was the most commonly used anesthetic, being evaluated in 35 of the articles. S. aureus ATCC 25923 was the standard microorganism in 17 articles. The impact of the anesthetic concentration in relation to the antimicrobial effect was evaluated and the results showed that there was no statistically significant difference. (F [5, 12] = 0.688 p = 0.642), even when taking into account the moderator effect of anesthetics individually. Therefore, although the antimicrobial effect of local anesthetics was demonstrated in 82.7% of the studies evaluated, great heterogeneity of the results was found, which made it impossible to carry out a meta-analysis and make recommendations based on the evidence.

Decision tree algorithm to predict mortality in incurable cancer: a new prognostic model.

OBJECTIVES: To develop and validate a new prognostic model to predict 90-day mortality in patients with incurable cancer. METHODS: In this prospective cohort study, patients with incurable cancer receiving palliative care (n = 1322) were randomly divided into two groups: development (n = 926, 70%) and validation (n = 396, 30%). A decision tree algorithm was used to develop a prognostic model with clinical variables. The accuracy and applicability of the proposed model were assessed by the C-statistic, calibration and receiver operating characteristic (ROC) curve. RESULTS: Albumin (75.2%), C reactive protein (CRP) (47.7%) and Karnofsky Performance Status (KPS) ≥50% (26.5%) were the variables that most contributed to the classification power of the prognostic model, named Simple decision Tree algorithm for predicting mortality in patients with Incurable Cancer (acromion STIC). This was used to identify three groups of increasing risk of 90-day mortality: STIC-1 - low risk (probability of death: 0.30): albumin ≥3.6 g/dL, CRP <7.8 mg/dL and KPS ≥50%; STIC-2 - medium risk (probability of death: 0.66 to 0.69): albumin ≥3.6 g/dL, CRP <7.8 mg/dL and KPS <50%, or albumin ≥3.6 g/dL and CRP ≥7.8 mg/dL; STIC-3 - high risk (probability of death: 0.79): albumin <3.6 g/dL. In the validation dataset, good accuracy (C-statistic ≥0.71), Hosmer-Lemeshow p=0.12 and area under the ROC curve=0.707 were found. CONCLUSIONS: STIC is a valid, practical tool for stratifying patients with incurable cancer into three risk groups for 90-day mortality.

Proposal of a nutrition screening algorithm for patients with incurable cancer receiving palliative care: Data from a prospective cohort.

OBJECTIVE: To propose and evaluate the clinical utility of a new nutrition screening algorithm, NutriPal, to detect the degree of nutritional risk in patients with incurable cancer receiving palliative care. METHODS: It is a prospective cohort conducted in an oncology palliative care unit. The NutriPal algorithm was used in a three-step process: (i) administration of the Patient-Generated Subjective Global Assessment short form; (ii) calculation of the Glasgow Prognostic Score; and (iii) application of the algorithm to classify patients into four degrees of nutritional risk. The higher the degrees of NutriPal, the worse the nutritional risk, comparing nutritional measures, laboratory data, and overall survival (OS). RESULTS: The study included 451 patients that were classified using the NutriPal. They were allocated to the degrees: 1 (31.26%), 2 (27.49%), 3 (21.73%), and 4 (19.71%). Statistically significant differences were found in most of the nutritional and laboratory parameters and in OS with each increment in the NutriPal degrees, and OS was reduced (log-rank <0.001). In addition, NutriPal was able to predict a 120-day mortality: there was a significantly higher risk of death in the patients classified as degrees 4 (hazard ratio [HR], 3.03; 95% confidence interval [95% CI], 2.18-4.19), 3 (HR, 2.01; 95% CI, 1.46-2.78), and 2 (HR, 1.42; 95% CI; 1.04-1.95) than in those classified as degree 1. It also showed good predictive accuracy (concordance statistic, 0.76). CONCLUSION: The NutriPal is associated to nutritional and laboratory parameters and can predict survival. It could therefore be incorporated into clinical practice for patients with incurable cancer receiving palliative care.

Quality of death educational programme in a national reference palliative care unit.

OBJECTIVE: To report the experience of offering the Quality End of Life Care for All (QELCA) Programme, highlighting the distinct methodology for the training of health professionals. DEVELOPMENT: The QELCA Programme, intellectual property of St Christopher's Hospice, was offered to seven health professionals working in the hospital palliative care unit at the National Cancer Institute, between June and December 2022, with the support of Premier Institute. The programme, which originates in the UK, has been evaluated there and is currently being evaluated in Hong Kong, and is delivered in two phases: (1) a 5-day immersion programme; (2) monthly sessions of Action Learning for 6 months. Participants realised that communication between members of the multidisciplinary team, as well as between health professionals and patients/loved ones, was one of the key challenges for achieving quality of death in the hospital palliative care unit. This insight empowered them to drive forward significant changes in practice that promise to improve quality of care. CONCLUSION: The QELCA Programme enabled participants to engage in active problem-solving to promote the relief of suffering of patients and their families in end-of-life care.

Construction of a Guide for Assessment and Physiotherapeutic Management of Pain in Cancer Patients / Construction of a Guide for Assessment and Physiotherapeutic Management of Pain in Cancer Patients / Construção de um Guia para Avaliação e Manejo Fisioterapêutico da Dor em Pacientes com Câncer

Physiotherapy can contribute to control pain in cancer patients and educational strategies should be developed to increase physiotherapeutic actions in this context. Objective: To develop a guide for the assessment and physiotherapeutic management of cancer pain. Method: Study developed in three stages: 1. Descriptive analysis of sociodemographic, clinical, functional data, pain characteristics and physiotherapeutic treatments performed on cancer patients receiving palliative care; 2. Development of the preliminary version of the guide based on the results of the first stage and theoretical content; 3. Focus group formed by physiotherapists that resulted in the final version of the guide. Results: 62 patients were included, mainly females (69.3%). The most common tumor site was gynecological (25.8%) and half presented bone metastasis. Neuropathic pain (51.6%), located in the spine (29.0%) was the most prevalent type of pain. The physiotherapeutic treatments most used were: positioning (98.0%), kinesiotherapy (68.0%), walking (39.0%), orthoses (32.0%) and transcutaneous electrical nerve stimulation (21.0%). The focus group suggested changes and positively evaluated the preliminary version of the guide, highlighting that, in addition to an easy-to-understand language, it provided a comprehensive view of the methods for evaluating and physiotherapy treatment of pain.

A fisioterapia pode contribuir para o controle da dor em pacientes com câncer e estratégias educativas devem ser desenvolvidas para aumentar as ações fisioterapêuticas nesse contexto. Objetivo: Elaborar um guia para avaliação e manejo fisioterapêutico da dor no câncer. Método:Estudo desenvolvido em três etapas: 1. Análise descritiva de dados sociodemográficos, clínicos, funcionais, características da dor e tratamentos fisioterapêuticos realizados em pacientes com câncer em cuidados paliativos; 2. Desenvolvimento da versão preliminar do guia a partir dos resultados da primeira etapa e de conteúdo teórico na temática; 3. Realização de grupo focal composto por fisioterapeutas que originou a versão final do guia. Resultados: Foram incluídos 62 pacientes, principalmente do sexo feminino (69,3%). O sítio tumoral mais frequente foi o ginecológico (25,8%) e metade apresentou metástase óssea. O tipo de dor mais prevalente foi a neuropática (51,6%), localizada na coluna (29,0%). Os tratamentos fisioterapêuticos mais utilizados foram: posicionamento (98,0%), cinesioterapia (68,0%), deambulação (39,0%), uso de órteses (32,0%) e transcutaneous electrical nerve stimulation (21,0%). O grupo focal sugeriu alterações e avaliou positivamente a versão preliminar do guia, ressaltando que, além de ser elaborado com linguagem de fácil compreensão, possibilitou a visão integral sobre os métodos para avaliação e tratamento fisioterapêutico da dor.

La fisioterapia puede contribuir al control del dolor en pacientes con cáncer y se deben desarrollar estrategias educativas para incrementar las acciones fisioterapéuticas en este contexto. Objetivo:Desarrollar una guía para la evaluación y manejo fisioterapéutico del dolor oncológico. Método: Estudio desarrollado en tres etapas: 1. Análisis descriptivo de datos sociodemográficos, clínicos, funcionales, características del dolor y tratamientos fisioterapéuticos realizados a pacientes con cáncer que reciben cuidados paliativos; 2. Elaboración de la versión preliminar de la guía con base en los resultados de la primera etapa y contenidos teóricos sobre el tema; 3. Realización de un grupo focal compuesto por fisioterapeutas que dio como resultado la versión final de la guía. Resultados: Se incluyeron 62 pacientes, principalmente mujeres (69,3%). La localización tumoral más frecuente fue ginecológica (25,8%) y la mitad presentó metástasis óseas. El tipo de dolor más prevalente fue el neuropático (51,6%), localizado en la columna (29,0%). Los tratamientos fisioterapéuticos más utilizados fueron: posicionamiento (98,0%), kinesioterapia (68,0%), marcha (39,0%), uso de órtesis (32,0%) y estimulación nerviosa eléctrica transcutánea (21,0%). El grupo focal sugirió cambios y evaluó positivamente la versión preliminar de la guía, destacando que, además de estar elaborada en un lenguaje fácil de entender, proporcionó una visión integral de los métodos de evaluación y tratamiento fisioterapéutico del dolor.

The effect of biopolymer gel derived from sugarcane on healing of traumatic oral ulcers: an experimental study

ABSTRACT Purpose: The extracellular polysaccharide (EPS) is produced by the bacterium Zoogloea sp. and plays a positive role in tissue repair. The purpose of this study was to clinically and histologically compare the effects of EPS in the healing of traumatic oral ulcers in rats with the effects of triamcinolone. Methods: Ulcers were induced in the oral mucous of 45 male Wistar rats, divided into three groups: control group, treated with triamcinolone, and treated with biopolymer gel. In the clinical evaluation, we considered the weight variation of the animals and the size of the lesion area, at baseline and on treatment days 1, 3 and 7. The histological parameters evaluated were the type and intensity of the inflammatory infiltration, the presence of necrosis and foreign body granuloma and the degree of re-epithelialization of the lesion. Results: The reduction of the lesion area was greater in the animals treated with EPS, with no difference in the intensity of the inflammatory infiltration between the groups on days 3 and 7 of treatment. Conclusions: The results suggest that topical application of EPS in traumatic oral ulcers of rats promotes faster repair than triamcinolone ointment, without increasing the intensity of inflammatory infiltration under the lesion.

The relevance of the optional use of fasting in laboratory measurements that make up the lipid profile: A systematic literature review.

The objective of this study was to evaluate the impact of fasting easing on laboratory measurements of the lipid profile, in order to contribute to the fidelity of interpretation of laboratory results. Starting in October 2022, a Systematic Literature Review (SRL) was carried out, using articles indexed in the electronic databases PubMed/MEDLINE, EMBASE, Scopus, LILACS and Cochrane Library, following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes Group (PRISMA). This RSL was registered with PROSPERO, under registration number CRD42022370007. For inclusion, articles had to be original and developed in humans. After evaluating the methodological quality and analyzing the risk of bias, we obtained 16 articles published between 1994 and 2021, providing data on a total of 398,709 individuals, aged between 3 and 93 years. According to the selected studies, lipid profile measurements performed with flexible fasting, in addition to bringing benefits to patients and the pre-analytical system of the clinical laboratory, are more suitable for determining cardiovascular risk, mainly through the assessment of values obtained in the determination of triglycerides. It is therefore concluded that the optional use of fasting must be established through medical advice. In addition, laboratory methods and readings must be readjusted to this reality, informing through the report the parameters related to the lipid profile with and without the use of a 12-hour fast.

Safe administration of yellow fever vaccine in patients with suspected egg allergy.

Background: The evidence available in the literature on the administration and safety of the yellow fever vaccine in patients with egg allergy is limited. Objective: We sought to describe the administration of yellow fever vaccine in children with suspected egg allergy using a simplified protocol. Methods: Children referred to the service from February 2018 to January 2020 with a history of possible egg allergy were classified as probably egg-allergic or not on the basis of history and specific IgE testing. A vaccine prick test was performed only in those with a history of an anaphylactic reaction to egg ingestion and if the result was positive the vaccine was administered in a 2-step protocol (2 equal doses of 0.25 mL with an interval of 30 minutes between the 2 applications). All other children received the vaccine as a single dose. Results: A total of 435 children were evaluated; 48.27% were probably not allergic, and 51.72% were probably allergic to egg, of which 32.88% were considered anaphylactic. A total of 414 (95.2%) children had no vaccine reactions. Of the 21 (4.8%) children who had some reaction, 10 experienced a local reaction, 9 a mild skin reaction distant from the vaccine site, 1 presented local cutaneous reaction distant to the vaccination site, and 1 patient developed possible anaphylaxis. The vaccine prick test did not predict a vaccine reaction (odds ratio, 1.29; 95% CI, 0.25-6.72; P = .67). Conclusions: Yellow fever vaccine can be safely administered as a single dose in children with a confirmed or suspected egg allergy.

Nutritional support in palliative cancer care: quality of life in oral versus tube feeding.

BACKGROUND: Nutritional support (NS) offered through oral nutritional supplements (ONS) or enteral nutrition (EN) and its impact on quality of life (QoL) is a controversial topic in patients with cancer receiving palliative care (PC). AIMS: To compare the QoL of patients without and with use of NS, including ONS or EN in patients with incurable cancer receiving PC. METHODS: Cross-sectional analysis with patients that were evaluated at PC Unit between June 2021 and February 2023. QoL was assessed using the Quality of Life Questionnaire Core 15. Patients were classified into three groups according to the NS: ONS (n=72; 33%), EN (n=61; 28%) and control group (CG) (n=87; 39%), the last one being formed by patients not using NS. Adjusted logistic regression models were used to verify the association of the domains of QoL with the type of NS. RESULTS: A total of 220 patients were included, with a median age of 64 (58-70) years, predominantly male (54.1%). The EN group had worse scores in physical function when compared with the ONS group (p=0.037) and appetite loss when compared with the CG (p=0.013). The ONS (OR: 2.70; 95% CI 1.32 to 5.49) and EN groups (OR: 2.61; 95% CI 1.24 to 5.49) were independently associated with a higher chance of presenting appetite loss in relation to the CG. CONCLUSION: In general, there was no difference in the QoL of patients using NS when compared with patients not using NS. However, patients using NS have more chance of having appetite loss.

Carbonic anhydrase II deficiency syndrome with amelogenesis imperfecta linked to a homozygous CA2 deletion.

We performed a study to present a phenotypic and genotypic characterization of a patient clinically diagnosed with carbonic anhydrase II (CAII) deficiency syndrome. Medical records were reviewed, and oral examination was performed. Sanger sequencing was undertaken for molecular diagnosis. The patient presented with osteopetrosis, renal tubular acidosis, cerebral calcification, blindness, deafness, and development delay. The oral manifestations included anterior open bite, posterior crossbite, tooth eruption impairment, and hypoplastic amelogenesis imperfecta (AI). Molecular analysis revealed a CA2 homozygous deletion (c.753delG, p.Asn252Thrfs*14) and confirmed the clinical diagnosis. This study suggests that AI can be another feature of CAII deficiency syndrome. For the first time, a CA2 disease-causing variant is reported to be associated with syndromic AI.