A Complete Response to Pembrolizumab in Malignant Peritoneal Mesothelioma: A Case Report.

Malignant peritoneal mesothelioma (MPeM) is a rare cancer of the peritoneum with a poor prognosis and nonspecific clinical course. We discuss a case of MPeM in a 59-year-old male who presented with abdominal pain and distension, without any known previous asbestos exposure. The diagnosis was made after a second biopsy finally confirmed epithelioid MPeM in an advanced stage with pleural effusion. The patient underwent six cycles of chemotherapy with cisplatin and pemetrexed, experienced disease progression, and was then started on pembrolizumab as a second-line treatment. The patient achieved a complete response after two years of treatment with pembrolizumab and has been disease-free for almost four years with an Eastern Cooperative Oncology Group (ECOG) performance status of 0. Despite the lack of evidence to support the treatment with immunotherapy for MPeM, our case report encourages its use, highlighting its ability to enable a complete response with pembrolizumab with an excellent quality of life.

Clinical and Molecular Determinants of Clonal Evolution in Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria.

PURPOSE: Secondary myeloid neoplasms (sMNs) remain the most serious long-term complications in patients with aplastic anemia (AA) and paroxysmal nocturnal hemoglobinuria (PNH). However, sMNs lack specific predictors, dedicated surveillance measures, and early therapeutic interventions. PATIENTS AND METHODS: We studied a multicenter, retrospective cohort of 1,008 patients (median follow-up 8.6 years) with AA and PNH to assess clinical and molecular determinants of clonal evolution. RESULTS: Although none of the patients transplanted upfront (n = 117) developed clonal complications (either sMN or secondary PNH), the 10-year cumulative incidence of sMN in nontransplanted cases was 11.6%. In severe AA, older age at presentation and lack of response to immunosuppressive therapy were independently associated with increased risk of sMN, whereas untreated patients had the highest risk among nonsevere cases. The elapsed time from AA to sMN was 4.5 years. sMN developed in 94 patients. The 5-year overall survival reached 40% and was independently associated with bone marrow blasts at sMN onset. Myelodysplastic syndrome with high-risk phenotypes, del7/7q, and ASXL1, SETBP1, RUNX1, and RAS pathway gene mutations were the most frequent characteristics. Cross-sectional studies of clonal dynamics from baseline to evolution revealed that PIGA/human leukocyte antigen lesions decreased over time, being replaced by clones with myeloid hits. PIGA and BCOR/L1 mutation carriers had a lower risk of sMN progression, whereas myeloid driver lesions marked the group with a higher risk. CONCLUSION: The risk of sMN in AA is associated with disease severity, lack of response to treatment, and patients' age. sMNs display high-risk morphological, karyotypic, and molecular features. The landscape of acquired somatic mutations is complex and incompletely understood and should be considered with caution in medical management.

Impact of the COVID-19 Pandemic on Breast Cancer Management in Portugal: A Cross-Sectional Survey-Based Study of Medical Oncologists.

INTRODUCTION: Cancer care providers have faced many challenges in delivering safe care for patients during the COVID-19 pandemic. This cross-sectional survey-based study investigated the impact of the pandemic on clinical practices of Portuguese medical oncologists caring for patients with breast cancer. METHODS: An anonymous online survey comprising 42 questions gathered information regarding COVID-19 testing, treatment in (neo)adjuvant and metastatic settings, and other aspects of breast cancer management. Practices before and during the pandemic were compared, and potential differences in outcomes according to respondents' regions, case volumes, and practice type were explored. RESULTS: Of 129 respondents, 108 worked in the public health system, giving a representative national picture of the impact of the COVID-19 pandemic on breast cancer management. Seventy-one percent of respondents reported a reduction in visits for new cases of breast cancer, and there was a shift towards increased use of telemedicine. Clinical decision-making was largely unaffected in the most aggressive indications (i.e., triple-negative, HER2-positive, visceral crisis). The use of neoadjuvant therapy increased when access to surgery was difficult, whereas dose-dense regimens decreased, and cyclin-dependent kinase 4/6 inhibitor treatment decreased for less aggressive disease and increased for more aggressive disease. The use of oral formulations and metronomic chemotherapy regimens increased, and clinical trial participation decreased. Some differences by respondents' region and case volume were noted. CONCLUSION: Medical oncologists in Portugal implemented many changes during the COVID-19 pandemic, most of which were logical and reasonable responses to the current healthcare emergency; however, the true impact on patient outcomes remains unknown.

This study was an online survey of Portuguese medical oncologists to determine how they managed patients with breast cancer during the COVID-19 pandemic. Forty-two questions covered topics such as how COVID testing was done, the types of cancer treatments used, and how this compared to before the pandemic. It also examined whether the geographic region, the number of patients each doctor was responsible for (caseload), and the type of medical institution influenced how patients with breast cancer were managed. One hundred and twenty-nine oncologists completed the survey, of whom 108 worked in the public health system, making this survey representative of breast cancer management during the COVID-19 pandemic across Portugal. Most (71%) said there were fewer visits for new cases of breast cancer during lockdown. The use of telemedicine increased, as did the use of pre-surgery hormone therapy or chemotherapy when access to surgery was difficult, and the use of anticancer medications taken orally or metronomically (low doses given frequently over a long time period). Chemotherapy given very frequently (dose-dense) was used less often, and fewer patients participated in clinical trials. Treatment decisions for patients with aggressive breast cancer types (e.g., triple-negative breast cancer) were largely unchanged, except for greater use of cyclin-dependent kinase 4/6 inhibitors­drugs targeting the cell cycle and cell division control. Geographic region and caseload influenced treatment decisions. All of these changes in breast cancer treatment during the COVID-19 pandemic were logical and reasonable for the circumstances, but their long-term impact is not yet known.

[Insertion of USP nursing graduates into the job market: facilities and difficulties]. / Inserção dos Egressos da Escola de Enfermagem da USP no Mercado de Trabalho: Facilidades e Dificuldades.

This descriptive, quantitative-based exploratory study was carried out between 2000 and 2005 and aimed at characterizing the profile of students who had completed the Nursing Course at the University of Sao Paulo. From the 465 graduates found in the period of the research, 175 (37.6%) provided responses for the data collection instrument. Their insertion in the job market occurred most of all into private hospitals by means of election processes in the city of Sao Paulo. The majority of the subjects remained in their first jobs from one to six months. The wage of the major part of the graduates ranged from US$ 950.50 to US$ 1520.00. In the data collection process, most of the researched participants had a formal job in private healthcare institutions, with average salaries of US$ 1437.50. Results showed that there was a quick insertion of the graduates into the job market.

Palliative approach to leptomeningeal carcinomatosis in oesophagogastric junction cancer.

Leptomeningeal carcinomatosis (LC) is rare in solid tumours, particularly in gastrointestinal cancers. While other treatment strategies remain undefined, inclusion of palliative care is essential due to its very poor prognosis and variable manifestations. We report a case of oesophagogastric junction adenocarcinoma, previously submitted to surgery and chemotherapy, diagnosed with LC and followed in a palliative care unit. Treatment was comanaged with the oncology team and a palliative approach was decided. In this report, we review the literature and evaluate treatment options, with focus on the importance of palliative care and its potential benefits in patients diagnosed with this rare entity.

Depression and quality of life in patients with breast cancer undergoing chemotherapy and monoclonal antibodies.

BACKGROUND: Depression is one of the major psychiatric morbidities in cancer patients. The purpose of our study was to evaluate the impact of depressive symptoms in the quality of life (QoL) of patients with breast cancer undergoing chemotherapy and monoclonal antibodies treatments. METHODS: Observational, cross-sectional study conducted between April and November 2016. To evaluate the QoL, the EORTC QLQ-C30 and QLQ-BR23 questionnaire were used. The patients were screened for depressive symptoms using the Hospital Anxiety and Depression Scale (HADS-D) and those with a positive HADS-D positive questionnaire were referenced to the Psychiatry and Mental Health Department for further assessment and follow-up. RESULTS: We included 45 female patients. Sixteen (35.6%) patients had a positive HADS-D questionnaire and depressive symptoms confirmed by a psychiatric physician. Of those patients, 7 (15.6%) had a major depressive episode confirmed by psychiatric interview. There was a significant association of depressive symptoms with the future perspectives scale (p = 0.022), breast symptoms scale (p = 0.011) and arm symptom scale (p = 0.005). Significant differences were found in the fatigue (p = 0.024), pain (p = 0.037) and dyspnea (p = 0.009) subscales being worse in patients with depressive symptoms. The association between having depressive symptoms or not was shown to be significant or marginally significant for the variables stage of the tumour (p = 0.057), presence of distant metastasis (p = 0.072) and previous diagnosis of depression (p = 0.011). The patients treated with regimens containing monoclonal antibodies presented better outcomes in various subscales of the EORTC QLQ-C30 and QLQ-B23 questionnaires than those patients treated with chemotherapy regimens without monoclonal antibodies. CONCLUSIONS: Despite the small sample of our study, this study provided evidence that depressive symptoms in patients with breast cancer undergoing chemotherapy and monoclonal antibodies treatments detrimentally reduced various aspects of QoL.

Fasciotomia em membro superior após síndrome compartimental por acidente ofídico com posterior enxertia e plástica em Z: relato de caso / Fasciotomy in the upper limb after compartment syndrome due to snakebite with subsequent grafting and z-plasty: case report

Este relato de caso aborda o curso clínico de um envenenamento botrópico ocorrido no município de Jarinu, SP, no ano de 2021. O paciente necessitou de fasciotomia em membro superior após síndrome compartimental aguda com enxertia dermoepidérmica em um segundo momento cirúrgico. No pós-operatório tardio, o paciente evoluiu com retração, necessitando de reabordagem cirúrgica com correção de retração de membro superior esquerdo. Discute-se a gravidade do acidente ofídico, efeitos do veneno nos tecidos, complicações, síndrome compartimental aguda, indicação e técnica da fasciotomia descompressiva com base na literatura.

This case study examines the clinical course of a Bothrops snakebite poisoning that occurred in Jarinu, São Paulo, Brazil, in 2021. The patient required a fasciotomy in the upper limb due to acute compartment syndrome, followed by a second surgical procedure involving dermo-epidermal grafting. In the late postoperative period, the patient experienced retraction, leading to a subsequent surgical intervention to correct the retraction in the left upper limb. The severity of the snakebite accident, the effects of venom on tissues, complications, acute compartment syndrome, as well as the indications and techniques for decompressive fasciotomy, are discussed based on the available literature.

Triple-negative breast cancer with brain metastasis in a pregnant woman.

A woman aged 35 years was diagnosed with triple-negative breast cancer in October 2012. During the investigation, it was discovered that she was pregnant, the patient decided to have an abortion. She was submitted to a radical modified mastectomy and adjuvant chemotherapy followed by adjuvant breast radiotherapy of the left breast. 2 months after the adjuvant treatment, she began to have headaches and dizziness. The cranial MRI (head MRI) showed brain metastasis. She was then treated with whole brain radiotherapy, stereotactic radiosurgery and concomitant temozolomide which resulted in complete response. 1.5 year later, she was able to get pregnant and gave birth to a baby without complications. The previous imaging reassessment performed in September 2016 shows no evidence of recurrent breast cancer.

Epidemiological study on Fournier syndrome in a tertiary hospital in Jundiaí-SP from October 2016 to October 2018 / Estudo epidemiológico sobre síndrome de Fournier em um hospital terciario de Jundiaí-SP de Outubro de 2016 a Outubro de 2018

Abstract Introduction: Fournier's gangrene is a polymicrobial infection caused by aerobic and anaerobic microorganisms, which determine a fast and progressive necrotizing fasciitis, compromising mainly the perineal region and the genital region, being able to evolve to sepsis, multiple organ failure and death. Treatment consists of early surgical diagnosis and debridement, associated with broad-spectrum antibiotic therapy and hyperbaric oxygen therapy. Objective: Compare the most prevalent epidemiological data of patients with Fournier's Syndrome with the data examined in the literature in order to evaluate the incidence in the analyzed service, treatment form and evolution of the patients with the disease. Materials and methods: Observational transversal study from the medical records of patients diagnosed with the disease at the São Vicente de Paulo Charity Hospital in Jundiaí, SP, from October 2016 to October 2018. Results: 23 patients with Fournier's Syndrome, all included in the study, and were analyzed. The most prevalent epidemiological data on the disease, such as age, sex, association with other comorbidities, treatment performed, mortality and early surgical procedure, had obtained a similar data as compared as the medical literature that was in studied. Conclusion: Despite the recognized severity of Fournier's Syndrome, early diagnosis combined with extensive surgical debridement, broad-spectrum antibiotic therapy and measures and oxygen therapy when available are important measures to contain the rapid progression of the disease, thus decreasing its levels of mortality.

Resumo Introdução: A Gangrena de Fournier é uma infecção polimicrobiana ocasionada por microrganismos aeróbios e anaeróbios, que determinam uma fascite necrosante rápida e progressiva, comprometendo principalmente a região do períneo e a região genital, podendo evoluir para sepse, falência de múltiplos órgãos e óbito. O tratamento consiste no diagnóstico e desbridamento cirúrgico precoce, associado à antibioticoterapia de largo espectro e oxigenoterapia hiperbárica. Objetivo: Comparar dados epidemiológicos mais prevalentes dos pacientes diagnosticados com Síndrome de Fournier com os dados já descritos na literatura a fim de avaliar a incidência no serviço em questão analisado, forma de tratamento e evolução dos pacientes com a doença. Materiais e métodos: Estudo transversal observacional a partir da análise de prontuários de pacientes diagnosticados com a doença no Hospital de Caridade São Vicente de Paulo de Jundiaí-SP, no período entre Outubro de 2016 a Outubro de 2018. Resultados: Foram analisados 23 pacientes com diagnóstico de Síndrome de Fournier, todos incluídos na pesquisa. Avaliado os dados epidemiológicos mais prevalentes na doença, como faixa etária, sexo, associação com outras comorbidades, tratamento realizado, mortalidade decorrente da doença, período médio de internação, uso de antibioticoterapia e necessidade de procedimento cirúrgico, obtendo-se dados semelhantes com os já descritos na literatura médica. Conclusão: Apesar da reconhecida gravidade da Síndrome de Fournier, o diagnóstico precoce aliado ao desbridamento cirúrgico extenso, antibioticoterapia de amplo espectro e medidas e oxigenioterapia quando disponível são medidas importantes na contenção da rápida progressão da doença, diminuindo assim seus níveis de mortalidade.

Inserção dos egressos da Escola de Enfermagem da USP no mercado de trabalho: facilidades e dificuldades / Inserción de los egresados de la escuela de enfermería de la USP en el mercado de trabajo: facilidades e dificultades / Insertion of USP nursing graduates into the job market: facilities and difficulties

Com o objetivo de caracterizar os egressos do Curso de Graduação em Enfermagem da Escola de Enfermagem da Universidade de São Paulo, no período de 2000 a 2005, realizou-se um estudo descritivo exploratório, numa abordagem quantitativa. Dos 465 egressos do período pesquisado, 175 (37,6 por cento) responderam ao instrumento de coleta de dados. A inserção no mercado de trabalho se deu majoritariamente em instituições hospitalares privadas, por meio de processo seletivo, no município de São Paulo, na área de assistência. A maioria permaneceu nos primeiros empregos por um a seis meses. A faixa salarial predominante no primeiro emprego variou de US$950.50 a US$1,520.00. No momento da coleta de dados, grande parte dos participantes possuía um vínculo empregatício e estava inserida em instituições hospitalares privadas, com média salarial de US$1,437.50. Os resultados dessa pesquisa evidenciam que houve rápida inserção dos egressos no mercado de trabalho.

This descriptive, quantitative-based exploratory study was carried out between 2000 and 2005 and aimed at characterizing the profile of students who had completed the Nursing Course at the University of Sao Paulo. From the 465 graduates found in the period of the research, 175 (37.6 percent) provided responses for the data collection instrument. Their insertion in the job market occurred most of all into private hospitals by means of election processes in the city of Sao Paulo. The majority of the subjects remained in their first jobs from one to six months. The wage of the major part of the graduates ranged from US$ 950.50 to US$ 1,520.00. In the data collection process, most of the researched participants had a formal job in private healthcare institutions, with average salaries of US$ 1,437.50. Results showed that there was a quick insertion of the graduates into the job market.

Con el objetivo de caracterizar a los egresados del Curso de Graduación en Enfermería de la Escuela de Enfermería de la Universidad de San Pablo, en el período de 2.000 a 2.005, se realizó un estudio descriptivo y exploratorio, con un abordaje cuantitativo. De los 465 egresados en el período investigado, 175 (37,6 por ciento) respondieron al instrumento de recolección de datos. La inserción en el mercado de trabajo sucedió mayoritariamente en instituciones hospitalarias, privadas, por medio de proceso selectivo, en el municipio de San Pablo, en el área de asistencia. La mayoría permaneció en el primer empleo de uno a seis meses. El intervalo salarial predominante en el primer empleo varió de US$950.50 a US$1,520.00. En el momento de la recolección de datos, gran parte de los participantes poseía un vínculo de la institución y estaba actuando en instituciones hospitalarias, privadas, con un promedio salarial de US$1,437.50. Los resultados de esta investigación colocan en evidencia que hubo una rápida inserción de los egresados en el mercado de trabajo.