Penile cancer in Maranhão, Northeast Brazil: the highest incidence globally?

BACKGROUND: The objectives of this study were to determine the minimum incidence of penile cancer in the poorest Brazilian state, and to describe the epidemiologic and clinical characteristics of patients diagnosed with the disease. METHODS: A retrospective study of 392 patients diagnosed with penile cancer in the three most important referral center in the state was conducted during 2004-2014. RESULTS: The age-standardized incidence was 6.15 per 100,000 and the crude annual incidence was 1.18 per 100,000. More than half (61.1%) of the tumors were histological grades 2 and 3, and 66.4% of tumors were classified as at least stage T2. The average age of patients was 58.6 ± 15.7 years (range, 18 to 103 years), with 20.8% of patients ≤40 years of age at diagnosis. The vast majority underwent penectomy (93%). Only 41.8% underwent lymphadenectomy, 58 patients (14.8%) received chemotherapy, and 54 patients (13.8%) received radiotherapy. Stage 3/4 and vascular invasion were statically significant at disease-free survival analysis. CONCLUSION: The state of Maranhão has the highest incidence of penile cancer in Brazil and globally. Tumors are locally advanced and at the time of diagnosis, and there is a high frequency among young individuals. Patients have a low socioeconomic status, making it difficult to complete treatment and receive appropriate follow-up.

Low-dose granisetron for prophylaxis of acute chemotherapy-induced nausea and vomiting: a pilot study.

OBJECTIVES: Chemotherapy-induced nausea and vomiting (QTNV) are very uncomfortable symptoms for patients with cancer, which can be circumvented in most of them with drug combinations containing serotonin receptor antagonists (5-HT3 receptor antagonists) such as granisetron. In an attempt to decrease costs of QTNV prophylaxis, we studied a lower dose regimen of granisetron. PATIENTS AND METHODS: Sixty patients with cancer scheduled to receive moderately/highly emetogenic chemotherapy were pretreated 1 h before with 0.5 mg granisetron p.o. combined with dexamethasone 20 mg i.v. RESULTS: We observed complete control for nausea, vomiting, and nausea and vomiting in 78% [95% confidence interval (CI), 67-89%], 61% (95% CI, 47.5-74.5%), and 58% (95% CI, 44.3-71.7%) of the patients, respectively. This regimen was very well tolerated; headache (35%), xerostomia (11%), and constipation (5%) were the most frequent adverse symptoms reported. CONCLUSIONS: The regimen with lower dose granisetron is effective for acute QTNV prophylaxis and offers a cheaper alternative for QTNV control. We feel that these encouraging results should be confirmed in a randomized comparative trial.

O babaçu (Orbignya phalerata martins) como provável fator de risco de infecçäo humana pelo agente da cromoblastomicose no estado do Maranhäo, Brasil / The coconut babaçu (Orbignya phalerata martins) as a probable risk of human infection by the agent of chromoblastomycosis in the State of Maranhäo, Brazil

Após estudo de 3O pacientes portadores de cromoblastomicose, acompanhados no hospital dos servidores do Estado do Maranhao, verificou-se em 2 (6,6 por cento) lesoes na regiao glútea, diferindo do que geralmente se observa, pois na cromoblastomicose existe sempre história de microtraumatismo sofridos durante o trabalho na lavoura, propiciando o desenvolvimento mais freqüente das lesoes nas extremidades, principalmente dos membros inferiores. Ambos pacientes, doentes há 10 anos, apresentavam lesoes modulares e verrugo-confluentes em placas coalescentes na regiao glútea direita. O diagnóstico etiológico foi firmado através de exame histopatológico e cultura, com isolamento de Fonsecaea pedrosoi. Na investigaçao epidemiológica do tipo de exposiçao verificou-se que os mesmos desempenhavam a profissao de quebradores de coco-babaçú, atividade relativamente comum no Estado. Parece evidente a relaçao entre o tipo de atividade profissional e o desenvolvimento da infecçao.