Rationale, design and methodology of TESEO study: a registry of thrombosis and neoplasia of SEOM (Spanish Society of Medical Oncology).

BACKGROUND AND RATIONALE: Thromboembolic complications are a serious, preventable and common event in cancer patients that contributes to increasing morbidity and mortality. Despite increasing knowledge on cancer-associated thrombosis (CAT), there are still several aspects of diagnosis, clinical management, treatment and prognosis with uncertainties that are under-represented in randomized clinical trials. For this reason, the Spanish Society of Medical Oncology (SEOM) launched in June 2018 a registry of CAT. METHODS/DESIGN: TESEO is an ongoing prospective, non-interventional, multicentric study in consecutive cancer patients with newly diagnosed of thromboembolic event (TEE). Eligibility criteria include being > 18 years with a histologically confirmed diagnosis of cancer and a symptomatic or incidental TEE confirmed with an imaging technique in the previous month or any time after the cancer diagnosis and signing of informed consent. The study consists of two types of integrated but independent prospective registries. Regular CAT sub-registry includes information on patient's cancer´s characteristics, anticoagulant treatment provided and outcome data. Special CAT sub-registry includes variables related to special situations of CAT that comprise patients with severe kidney failure, thrombocytopenia, high risk of bleeding related to the cancer or with coexistence of bleeding and patients who receive new treatments such a targeted therapy, antiangiogenics agents and immunotherapy. The registry considers the status of the cancer and the time to assess how the prognosis is changed based on when the thrombus occurs. Some outcomes such as rethrombosis, major bleeding, tumor progression and survival will be valued in various time intervals including 1, 3, 6 and 12 months after the even in the first year; and then every 6 months until the patient's death. RESULTS: After 18 months and with 35 centers and researchers, the registry has 1128 patients. CONCLUSION: TESEO registry will provide clinical real-world evidence for prevention, treatment and complications of CAT in different scenarios that are under-represented in randomized clinical trials.

SEOM clinical practice guideline: management and prevention of febrile neutropenia in adults with solid tumors (2018).

Febrile neutropenia (FN) is a common dose-limiting toxicity of chemotherapy, with a profound impact on the evolution of patients with cancer, due to the potential development of serious complications, mortality, delays, and decrease in treatment intensity. This article seeks to present an updated clinical guideline, with recommendations regarding the diagnosis, prevention, and treatment of febrile neutropenia in adults with solid tumors. The aspects covered include how to properly approach the risk of microbial resistances, epidemiological aspects, considerations about the initial empirical approach adapted to the risk, special situations, and prevention of complications. A decision-making algorithm is included for use in the emergency department based on a new, validated tool, the Clinical Index of Stable Febrile Neutropenia, which can be used in patients with solid tumors who appear stable in the initial phase of neutropenic infections, and can help detect those at high risk for complications in whom early discharge must be avoided.

Performance of the clinical index of stable febrile neutropenia (CISNE) in different types of infections and tumors.

PURPOSE: The clinical index of stable febrile neutropenia (CISNE) can contribute to patient safety without increasing the complexity of decision-making. However, febrile neutropenia (FN) is a diverse syndrome. The aim of this analysis is to assess the performance of CISNE according to the type of tumor and infection and to characterize these patients. METHODS: We prospectively recruited 1383 FN episodes in situations of apparent clinical stability. Bonferroni-adjusted z tests of proportions were used to assess the association between the infections suspected at the time of onset and the type of tumor with the risk of serious complications and mortality. The performance of CISNE was appraised in each category using the Breslow-Day test for homogeneity of odds ratios and Forest Plots. RESULTS: 171 patients had a serious complication (12.3 %, 95 % confidence interval 10.7-14.2 %). The most common initial assumptive diagnoses were: fever without focus (34.5 %), upper respiratory infection (14.9 %), enteritis (12.7 %), stomatitis (11.8 %), and acute bronchitis (10.7 %). Lung and breast were the most common tumors, accounting for approximately 56 % of the series. The distribution of complications, mortality, and bacteremia varies for each of these categories. However, Breslow-Day tests indicate homogeneity of the odds ratio of the dichotomized CISNE score to predict complications in all infection and tumor subtypes. CONCLUSION: Despite FN's clinical and microbiological heterogeneity, the CISNE score was seen to be consistent and robust in spite of these variations. Hence, it appears to be a safe tool in seemingly stable FN.

Estudo farmacobotânico das folhas de Garcinia brasiliensis Mart. (Clusiaceae) / Pharmacobotanical studies of Garcinia brasiliensis Mart. (Clusiaceae) leaves

A espécie Garcinia brasiliensis Mart. (Clusiaceae), nativa da região Amazônica e cultivada em todo o território brasileiro, vem sendo bastante estudada devido seu potencial farmacológico, porém são escassos estudos que tratam da caracterização farmacobotânica desta espécie. Considerando as propriedades terapêuticas para tornar-se um medicamento fitoterápico, o presente trabalho teve como objetivos estudar a anatomia e histoquímica da folha e do pecíolo e elaborar dados macroscópicos e microscópicos que forneçam características marcantes para sua identificação além de dar subsídios para a análise farmacognóstica no controle de qualidade da droga vegetal. O material vegetal foi fixado e submetido às técnicas usuais de microscopia de luz e a testes histoquímicos. As folhas de G. brasiliensis são opostas, simples, descolores, forma elíptica com nervação peninérvia. As células epidérmicas, em vista frontal, apresentam contorno sinuoso e estômatos paracíticos somente na face abaxial. O mesofilo é dorsiventral, a nervura central apresenta contorno biconvexo e feixe vascular em forma de semi-arco fechado envolto por bainha esclerenquimática. Inclusões inorgânicas de cristais na forma de drusas e orgânicas representadas por compostos fenólicos e grãos de amidos estão dispersos ao longo de toda lâmina foliar e pecíolo. Observa-se com frequência a presença de canais secretores preenchidos por um conteúdo lipídico dispersos pelo parênquima fundamental e próximos aos feixes vasculares. Estes dados fornecem subsídios para o controle de qualidade da matéria-prima utilizada para a produção de fitoterápicos.

The Garcinia brasiliensis Mart. (Clusiaceae) species, native of the Amazon region and cultivated throughout the Brazilian territory, has been widely studied due to its pharmacological potential, but there are few studies dealing with the pharmacobotanic characterization of this species. Considering the therapeutic properties in order to become an herbal medicine, the present paper had the purpose of studying the anatomical and histochemical characterization of the leaf and petiole, as well as producing macroscopic and microscopic data that provide important characteristics for its identification, in addition to providing subsidies for the pharmacognostical analysis in order to offer elements for the quality assurance of the drug. The botanical material was prepared through the usual optical and histochemical microtechniques. The leaves of G. brasiliensis are simple, opposed, colorless, and they show an elliptical shape. As seen from the front, the epidermal cells have a sinuous contour, and paracytic stomata occur on the low surface. The leaves are hipostomatic and dorsiventral with heterogeneous mesophile. The mesophile is dorsiventral, the central midrib shows a biconvex contour and vascular system in a semi-closed arch shape surrounded by a sclerenchymatic sheath. Inorganic inclusions of crystals in the shape of druses, and organic inclusions represented by phenolic compounds and starch grains are found throughout the leaf blade and petiole. It is common to find secretory canals filled with a lipid content dispersed throughout the parenchyma and near the vascular bundles. These data support the quality assurance of the elements used to produce herbal medicines.

[Thoracic actinomycosis and an intrabronchial foreign body. Apropos 2 cases]. / Actinomicosis torácica y cuerpo extraño intrabronquial. A propósito de dos casos.

We present two cases of thoracic actinomycosis which bronchoscopically resembled a bronchial tumoration, existing simultaneously in both cases a foreign body located at the intermediate bronchium. We discuss the characteristics of the disease and we review the literature on this topic.

[Russel's syndrome. Report of a case with development of precocious puberty]. / Síndrome de russel. Apresentação de um caso com desenvolvimento de puberdade precoce.

The Russel's syndrome is characterized by emaciation and hyperactivity in children and is caused by hypothalamic expansive process. This report presents the typical signs of the syndrome associated with growth hormone secretion disorders and precocious puberty pattern appearing at the age of four. The pathogenesis of the disorder is discussed and related to the hypothalamus-pituitary axis dysfunction caused by the tumor growth.