Radiation therapy with curative intention in men with de novo metastatic prostate carcinoma: shoot'em all!

BACKGROUND: About 5% of prostate cancer cases are metastatic at diagnoses. Radiotherapy of both primary tumor and secondary lesions can be, in addition to systemic treatments, a radical alternative for selected patients. MATERIALS AND METHODS: Patients with de novo prostate carcinoma with bone or lymph node metastases were retrospectively reviewed. All patients received moderate hypofractionated IMRT/VMAT up to 63 Gy in 21 daily fractions of 3 Gy to prostate and metastases with neoadjuvant and concurrent androgen deprivation therapy (ADT). According to known advances some patients also received abiraterone, enzalutamide, or docetaxel. RESULTS: Between 2015-2020, we attended 26 prostate cancer patients (median age 69.5 years, range 52-84) with simultaneous oligometastases [mean 2.1 metastases, median 1.5 metastases (range 1-6)]. Eighteen patients (69%) presented lymph node metastases, 4 (15.5%) bone metastases and 4 (15.5%) both lymph node and bone metastases. With a median follow-up of 15.5 months (range 3-65 months), 16 patients (62%) are alive and tumor free while 10 (38%) are alive with tumor. Four patients (17%) developed tumor progression, out of irradiated area in all cases, with a median time to progression of 43.5 months (range 27-56 months). Actuarial progression-free survival (PFS) rates at 12 and 24 months were 94.1% and 84.7%, respectively. No grade > 2 acute or late complications were recorded. CONCLUSIONS: Simultaneous directed radical hypofractionated radiation therapy for prostate and metastases is feasible, well tolerated and achieves an acceptable PFS rate. However, further studies with longer follow-up are necessary to definitively address these observations.

Development of a Culinary Medicine Toolkit to Improve Implementation of Virtual Cooking Classes for Low-Income Adults with Type 2 Diabetes.

Culinary medicine (CM) addresses diseases through nutrition and culinary education. To promote access to educational material for people with diabetes and engagement in virtual classes, we created a virtual culinary medicine toolkit (VCMT) sensitive to literacy levels and language preferences. The VCMT was developed to accompany existing virtual CM programs and help improve participant interaction and retention, offering educational materials for providers and participants. The provider VCMT offers level-setting education to reduce mixed nutrition messaging, including educational resources discussing inclusive nutrition and mindful eating topics. Each handout has a QR code and link to engaging, animated videos that provide further explanation. The participant VCMT offers a range of fundamental cooking skill videos and infographics, including knife skills and preparing whole grains and healthy beverages. Participant handouts and animated videos, which are played during the virtual CM class, allow participants to learn more about diabetes management and food literacy topics, including interpreting nutrition labels, and are employed during a CM to facilitate discussion and reflection. The animated videos replace a traditional slide-based lecture, allowing space for patient-centered facilitated discussions during virtual cooking sessions. The VCMT could guide the development of virtual CM interventions to shift learning from lecture-based to patient-centered discussions via a visual and inclusive medium.

Pilot Implementation of a Nutrition-Focused Community-Health-Worker Intervention among Formerly Chronically Homeless Adults in Permanent Supportive Housing.

Food insecurity is a known health equity threat for formerly chronically homeless populations even after they transition into permanent housing. This project utilized a human-centered design methodology to plan and implement a nutrition-focused community-health-worker (CHW) intervention in permanent supportive housing (PSH). The project aimed to increase access to healthy foods, improve nutritional literacy, healthy cooking/eating practices, and build community/social connectedness among 140 PSH residents. Validated food-security screening conducted by CHWs identified low or very low food security among 64% of 83 residents who completed the baseline survey, which is similar to rates found in a previous study among formerly homeless populations placed in PSH. Major themes identified through an analysis of resident feedback include (1) lack of needed kitchenware/appliances for food preparation, (2) knowledge gaps on how to purchase and prepare healthier food, (3) positive perceptions of healthy food options, (4) expanded preferences for healthy, easy-to-prepare foods, (5) regaining cooking skills lost during homelessness, (6) positive experiences participating in group activities, (7) community re-entry, and (8) resident ownership. Preliminary findings suggest the use of a human-centered design methodology for planning and implementing this multi-level CHW intervention helped reduce food insecurity, engaged participants in learning and adopting healthy and safe cooking and eating practices, and fostered social connectedness and feelings of community among formerly chronically homeless PSH residents.

Prevalence of COPD in five Colombian cities situated at low, medium, and high altitude (PREPOCOL study).

BACKGROUND: The prevalence of COPD in Colombia is unknown. This study aimed to investigate COPD prevalence in five Colombian cities and measure the association between COPD and altitude. METHODS: A cross-sectional design and a random, multistage, cluster-sampling strategy were used to provide representative samples of adults aged >or= 40 years. Each participant was interviewed (validated Spanish version of the Ferris Respiratory Questionnaire) and performed spirometry before and after 200 microg of inhaled salbutamol, using a portable spirometer according to American Thoracic Society recommendations. COPD definitions were as follows: (1) spirometric: fixed ratio (primary definition): FEV1/FVC < 70% after bronchodilator; (2) medical: a diagnosis of chronic bronchitis, emphysema, or COPD made by a physician; (3) clinical: cough and phlegm >or= 3 months every year during >or= 2 consecutive years (chronic bronchitis). Analysis was performed using statistical software. RESULTS: A total of 5,539 orsubjects were included. The overall COPD prevalence using the primary definition (spirometric) was 8.9%, ranging from 6.2% in Barranquilla to 13.5% in Medellín. The prevalence measured by the spirometric definition was higher than medical (2.8%) and clinical (3.2%) definitions. After the logistic regression analysis, the factors related with COPD were age >or= 60 years, male gender, history of tuberculosis, smoking, wood smoke exposure >or= 10 years, and very low education level. There was a nonsignificant tendency toward larger prevalence with higher altitude. CONCLUSION: COPD is an important health burden in Colombia. Additional studies are needed to establish the real influence of altitude on COPD prevalence.

Diferimiento y recaída post-inducción quimioterápica en niños con leucemia linfoblástica aguda en un hospital nacional de Lambayeque / The deferral and relapse`s time post induction chemotherapy in children with acute lymphoblastic leukemia at a National Hospital in Lambayeque

Objetivo: CConocer el tiempo de diferimiento y recaída posterior a quimioterapia de inducción en niños con leucemia linfoblástica aguda (LLA) en un hospital nacional de Lambayeque. Estudio: Estudio observacional analítico, cohorte retrospectiva. Se revisaron las historias clínicas de pacientes de 2 y 15 años con diagnóstico de LLA que alcanzaron remisión completa al término de la inducción atendidos en un hospital nacional de Lambayeque. Hallazgos: Los pacientes presentaron una mediana de edad de 5 años. Aunque la mayoría respondió al término de la inducción IA; 43/75 niños con LLA recayeron. Los niños con recaída tuvieron un diferimiento de 6 días [RIC: 0-25] entre fin de la inducción y el inicio de la fase de consolidación. Conclusión: el diferimiento ≥ 7 días en los esquemas de quimioterapia afecta a la sostenibilidad de la remisión.

Objetive:To know the delay and relapse time after induction chemotherapy in children with acute lymphoblastic leukemia (ALL) in a national hospital in Lambayeque. Analytical observational study of a retrospective The study:cohort. The medical records of patients whose age is 2 and 15 years with diagnosis of ALLwho achieved complete remission at the end of induction treated and a national hospital in Lambayeque ,were reviewed. The Findings:patients studied had a median age of 5 years. Although the majority responded at the end of IAinduction, still 43/75 children with ALLrelapsed. Children with relapse had a delay of 6 days [IQR: 0-25] between the end of induction and the beginningoftheconsolidationphase.Delay≥7daysin Conclusion:chemotherapy regimens affects the sustainability of remission

Frecuencia de mutación y de variantes de secuencia para los genes BRCA1 y BRCA2 en una muestra de mujeres colombianas con sospecha de síndrome de cáncer de mama hereditario: serie de casos / Frequency of sequence mutations and variants for the BRCA1 and BRCA2 genes in a sample of Colombian women with suspected hereditary breast cancer syndrome: Case series

Describir variantes de secuencia en los genes BRCA1 y BRCA2 en una muestra de pacientes colombianas con historia personal o familiar de cáncer de mama sugestiva de riesgo genético.Materiales y métodos: serie de casos compuesta por 67 pacientes que fueron remitidas para estudio genético por sospecha de síndrome de cáncer de mama y ovario hereditario (HBOC). De los 67 casos, 42 (62,7 %) cumplieron con los criterios de indicación médica de la National Comprehensive Cancer Network (NCCN) del 2013, y en ellos se realizó secuenciación completa de los genes BRCA1 y BRCA2. Se determinó la frecuencia de mutación, variantes de secuencia y significancia clínica de las variantes halladas con base en Breast Cancer Information Core (BIC).Resultados: se identificaron mutaciones para el gen BRCA1 en seis pacientes (14,3 %), no se documentó mutación para el gen BRCA2, además se detectaron 43 variantes genéticas en 27 pacientes (64,2 % de 42 casos). De estas, 21 (48,8 %) fueron identificadas en el gen BRCA1 y 22 (51,2 %) en el gen BRCA2. Dentro de estas variantes, se identificaron 5 mutaciones patogénicas solo en el gen BRCA1, de las cuales solo una había sido reportada previamente en Colombia.Conclusiones: este estudio identifica variantes genéticas patogénicas en el gen BRCA1 no descritas en estudios previos en la población colombiana y otras conocidas en diferentes poblaciones; permitiendo de esta forma ampliar el conocimiento sobre las variantes en población colombiana de los genes BRCA1 y BRCA2. Sin embargo, se requieren más estudios con suficiente poder y calidad metodológica para poder estimar la frecuencia de mutaciones y de variantes de secuencia para estos genes en mujeres colombianas con sospecha de síndrome de cáncer de mama u ovario hereditario...

To describe sequence variants in the BRCA1 and BRCA2 genes in a sample of Colombian patients with a personal or family history of breast cancer suggestive of genetic risk.Materials and methods: Case series consisting of 67 patients referred for genetic testing because of suspected hereditary breast and ovarian cancer syndrome (HBOC). Of the 67 cases, 42 (62.7%) met the medical indication criteria of the 2013 National Comprehensive Cancer Network (NCCN) and they were subjected to the entire sequencing of the BRCA1 and BRCA2 genes. A determination was made of the frequency of sequence mutation, variants, and of the clinical significance of the variants found based on the Breast Cancer Information Core (BIC).Results: Mutations were identified for the BRCA 1 gene in six patients (14.3%), no mutation was documented for the BRCA 2 gene, and 43 genetic variants were found in 27 patients (64.2% of 42 cases). Of these, 21 (48.8%) were identified in the BRCA1 gene and 22 (51.2%) in the BRCA 2 gene. Among these variants, 5 pathogenic mutations were found only in the BRCA1 gene and, of those, only 1 had been reported previously in Colombia.Conclusions: This study identifies pathogenic genetic variants in the BRCA1 gene not described previously in the Colombian population, as well as others known in different populations. Therefore, it helps expand knowledge regarding the variants of the BRCA1 and BRCA2 genes in the Colombian population. However, additional studies are required with sufficient power and methodological quality to estimate the frequency of sequence mutations and variants for the BRCA1 and BRCA2 genes in Colombian women suspected of having the hereditary breast or ovarian cancer syndrome...

Generacion de valores de referencia para la evaluacion de la espirometria: Estudio en una poblacion colombiana / Spirometric reference values

Objetivo: derivar valores de referencia para Colombia de los parámetros espirométricos (CVF, VEF1, VEF1/CV, y FEF) más utilizados en la evaluación funcional del sistema respiratorio. Diseño: análisis secundario de datos generados en un estudio observacional analítico de corte transversal, que obtuvo información sobre antecedentes familiares y personales de síntomas o enfermedades pulmonares, en muestra probabilística de 4.224 personas de ambos sexos, a quienes se les realizó curvas de flujo volumen. Lugar: cinco municipios del Valle del Cauca. Pacientes: 1558 niños entre 9 y 18 años y 1150 adultos entre 19 y 65 años, libres de alteración pulmonar determinada por encuesta (Ferris B., 1978). Mediciones: 2708 curvas de flujo volumen realizadas de acuerdo con recomendaciones de la Sociedad Torácia Americana (ATS). Resultados: de la población general, 63,8 por ciento fueron mujeres. Entre la población adulta, 19,5 por ciento hombres. La población infantil se distribuyó homogéneamente entre ambos sexos. La descripción gráfica de los datos permitió establecer puntos de corte para la edad en 18 años para mujeres y 20 años para hombres. Se generaron ecuaciones de predicción para cuatro variables espirométricas considerando talla y edad como factores predictores para cada sexo y grupo de edad definido. Estas ecuaciones permiten el cálculo de valores de referencia y obtención del límite inferior de normalidad de cada parámetro estudiado. Conclusiones: los modelos obtenidos para VEF1 y CVF mostraron el mayor ajuste y precisión. La mayor variabilidad observada en los hombres, hace que se requiera, en estudios posteriores, mayor tamaño de muestra para predecir los parámetros de curvas de flujo volumen con una mejor precisión. Los valores de referencia generados, muestran similitud en la tendencia con los obtenidos por otros autores, pero cuantitativamente son diferentes. Estas ecuaciones deben ser validadas en poblaciones similares a aquélla de donde fueron derivadas.