Implementation and evaluation of a remote geriatric assessment and intervention program in Brazil.

BACKGROUND: This study sought to determine the feasibility and acceptability of a remote geriatric assessment (GA) and implementation (GAIN) program in Brazil. The authors also explored the effect of this program on health-related quality of life (HR-QOL) outcomes 3 months after initiating treatment. METHODS: This is a longitudinal study enrolling older adults (65+ years), diagnosed with any type of solid tumor, scheduled to initiate chemotherapy in a networked Brazilian cancer center. The GA was performed through telehealth. We assessed the feasibility of the remote GA, acceptability to patients, and changes in patient-centered outcomes (HR-QOL, mood, function) from baseline to month 3. Linear mixed model analysis was done, adjusting for age, gender, race, income, and disease stage. RESULTS: Fifty-six patients completed all intended assessments. Notably, the threshold of feasibility was 70% and there was 92% complete adherence. Average age was 76 years old (SD = 7.2). Most patients were female (57%), married (59%), and had a college degree (46%). The most common diagnoses were gastrointestinal (39%) and gynecological cancers (18%); most were diagnosed at an advance disease stage (77%). A total of 32 patients were referred to a remote appointment and 86% followed this recommendation(s). Significant improvement in Functional Assessment of Cancer Therapy - General FACT-G (mean difference, 6.04; p < .001), Geriatric Depression Scale (mean difference, -0.86; p = .008), and instrumental activities of daily living ratio (mean difference, 0.17; p < .001) were found. CONCLUSION: Remote GAIN is feasible and acceptable to older adults with cancer receiving treatment in Brazil. The authors also found significant improvement in HR-QOL outcomes over time. Notably, this GAIN program could guide early detection of chemotherapy toxicity and improving patient-reported outcomes in low-resource environments.

Patients' Perceptions Regarding the Relevance of Items Contained in the Functional Assessment of Cancer Therapy Kidney Symptom Index-19.

BACKGROUND: There is a lack of consensus regarding the optimal method of assessing health-related quality of life (HR-QOL) among patients with metastatic renal cell carcinoma (mRCC). This study explored the perceived relevance of items that make up the Functional Assessment of Cancer Therapy Kidney Symptom Index-19 (FKSI-19), as judged by patients with mRCC. METHODS: This was a multinational cross-sectional survey. Eligible patients responded to a questionnaire composed of 18 items that assessed the perceived relevance of each item in the FKSI-19 questionnaire. Open-ended questions assessed additional issues deemed relevant by patients. Responses were grouped as relevant (scores 2-5) or nonrelevant (score 1). Descriptive statistics were collated, and open-ended questions were analyzed and categorized into descriptive categories. Spearman correlation statistics were used to test the association between relevance and clinical characteristics. RESULTS: A total of 151 patients were included (gender: 78.1 M, 21.9F; median age: 64; treatment: 38.4 immunotherapy, 29.8 targeted therapy, 13.9 immuno-TKI combination therapy) in the study. The most relevant questions evaluated fatigue (77.5), lack of energy (72.2), and worry that their condition will get worse (71.5). Most patients rated blood in urine (15.2), fevers (16.6), and lack of appetite (23.2) as least relevant. Qualitative analysis of open-ended questions revealed several themes, including emotional and physical symptoms, ability to live independently, effectiveness of treatment, family, spirituality, and financial toxicity. CONCLUSION: There is a need to refine widely used HR-QOL measures that are employed among patients diagnosed with mRCC treated with contemporary therapies. Guidance was provided for the inclusion of more relevant items to patients' cancer journey.

Impact of a Biopsychosocial Screening Program on Clinical and Hospital-Based Outcomes in Cancer.

BACKGROUND: The integration of a biopsychosocial screening (BPS) program has been proposed by international agencies to better identify and effectively manage unmet needs among patients with cancer. We sought to evaluate the effect of a BPS program on hospital admissions and length of stay (LOS) among a diverse sample of patients with cancer and receiving treatment in Brazil. METHODS: A retrospective analysis was performed from March 2020 to December 2021. Eligible patients were diagnosed with cancer and were receiving treatment at a private practice in Brazil. Clinical characteristics, participation in the BPS program, hospital admissions, reason, and LOS in hospital were evaluated. We compared the number of hospital admissions and LOS between groups (participation v no participation). T test and Chi-square test were used to test for differences between groups. RESULTS: A total of 1,014 patients were included in the analysis. Baseline clinical characteristics were well balanced between groups (n = 459 patients who participated and n = 555 patients who did not). The median age of patients was 63 years. Breast and hematological cancers were the most common types of cancer; 60% were diagnosed at an advanced disease stage. A smaller proportion of patients who participated in the BPS program were hospitalized compared with patients who did not participate (8% v 32%, P = .001). Patients who participated in the program also spent less days in the hospital compared with patients who did not participate in the program (M = 4.2 days v 9.8 days, P = .001). CONCLUSION: Engagement in a BPS program was associated with reduced hospital admissions and LOS. This study provides novel insight into the potential broader implications of BPS programs for clinical care systems. Future studies are needed to explore the mechanisms behind such associations.

Fear of cancer recurrence among Brazilian patients with cancer: Translation and cultural adaptation of FCR4/7 and FCRI-SF measures.

OBJECTIVE: Fear of cancer recurrence or progression (FCR) is considered one of the most common unmet needs among patients with cancer. This study sought to translate and evaluate the psychometric properties of the Fear of Cancer Recurrence scale (FCR4/7) and Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF). METHODS: This study involved three phases: (1) translation and cultural adaptation of the FCR4/7 and FCRI-SF measures, (2) validity and reliability testing of the Portuguese version of these measures, and (3) examining patient's perceptions of these measures. Eligible patients were diagnosed with localized breast cancer, and patients with metastatic cancer. Descriptive analyses were collated, and psychometric analysis were conducted (confirmatory factor analysis). RESULTS: A total of 200 patients were recruited (100 patients with localized and 100 patients with metastatic cancer). A significant proportion of patients reported moderate to severe FCR (FCR7: 32.0% and FCRI-SF: 43.0%). Female gender, younger age and metastatic cancer were associated with higher levels of FCR. Psychometric analyses suggested that the Portuguese versions of the FCR4/7 and FCRI-SF were valid, unidimensional in nature, with acceptable reliability coefficients across all scales. In a sub-sample qualitative analysis (n = 75), most patients were satisfied with the relevance of both measures. CONCLUSION: Our findings suggest the Portuguese versions of the FCR4/7 and FCRI-SF are valid tools to assess FCR among patients with localized and metastatic cancer. Future research can now extend our understanding of FCR and assess this construct among Portuguese speaking patients, to guide the development of effective and targeted interventions for patients globally.

Avaliação psicológica hospitalar: experiência de parametrização de intervenções assistenciais em maternidade-escola de alto risco / Hospital psychological assessment: experience of parameterisation of maternity-high-risk school care interventions / Evaluación psicológica hospitalaria: experiencia de la parametrización de las intervenciones de asistencia en maternidad escolar de alto riesgo

Objetivo: Apresentar a experiência de parametrização de intervenções de avaliação psicológica hospitalar de gestantes e puérperas internadas em situação de alto risco. Relato de experiencia: A atividade foi empreendida em Maternidade-Escola pública de alta complexidade, referência em alto risco, em Teresina, Piauí, de abril a junho de 2023, circunscrita ao Estágio Supervisionado Profissionalizante em Psicologia da Saúde. A partir da imersão no campo para articulação ensino-serviço, com supervisão teórico- prática semanal in loco (presencial) e mediante reuniões síncronas (Google Meet), realizou-se debates sobre as experiências de ensino-aprendizagem e para confecção de uma proposta de roteiro de exame e avaliação psicológica, com o intuito de nortear a atuação dos estagiários, bem como de contribuir com o robustecimento da instrumentalização e orientação das intervenções assistenciais de psicologia na instituição hospitalar. A proposta de instrumento orientador desenvolvido possui doze partes: identificação; motivo da hospitalização; situação de saúde; situação de crise; exame psíquico; sono; sintomas psicossomáticos emergentes; sentido da vida; maternagem e cuidado ao bebê; estratégias de coping; síntese; hipótese diagnóstica. Considerações finais: O roteiro de exame e avaliação psicológica robustece a parametrização de intervenções de psicologia em saúde nos hospitais; vivifica o desenvolvimento e fortalecimento de competências e habilidades para conduzir a avaliação psicológica hospitalar de maneira eficiente, técnica, ética, que dignifique o cuidado perinatal materno sob a égide da integralidade e baseado em evidências.

Objective: To present the experience of parameterisation of hospital psychological evaluation interventions of pregnant women and those who have recently given birth in a high risk situation. Experience report: The activity was undertaken in Maternity-High complexity public school, reference in high risk, in Teresina, Piauí, from April to June 2023, circumscribed to the Supervised Professional Internship in Health Psychology. From immersion in the field for teaching-service articulation, with weekly theoretical-practical supervision in loco (in person) and through synchronous meetings (Google Meet), debates were held on teaching-learning experiences and to prepare a proposal for a roadmap for psychological examination and evaluation, with the aim of guiding the work of trainees, as well as contributing to the strengthening of the instrumentalisation and orientation of psychological assistance interventions in the hospital institution. The proposed guiding instrument developed has twelve parts: identification; reason for hospitalisation; health situation; crisis situation; psychic examination; sleep; emerging psychosomatic symptoms; sense of life; maternity and baby care; coping strategies; synthesis; diagnostic hypothesis. Concluding considerations: The psychological examination and assessment roadmap strengthens the parametrisation of health psychology interventions in hospitals; it vivifies the development and strengthening of competencies and skills to conduct hospital psychological assessment in an efficient, technical, ethical manner, that dignifies maternal perinatal care under the aegis of completeness and evidence-based.

Propósito: Proporcionar la experiencia de parametrización de las intervenciones de evaluación psicológica hospitalaria de las mujeres embarazadas y las personas que adoptan a temprana edad en situaciones de alto riesgo. Informe de la experiencia: La actividad se realizó en la Escuela Maternidad-Pública de alta complejidad, una referencia de alto riesgo en Teresina, Piauí, de abril a junio de 2023, limitada a la Etapa altamente profesional supervisada en Psicología de la Salud. A raíz de la inmersión en el ámbito de la vinculación entre la educación y los servicios, con la supervisión teórico-práctica in loco (asistencia) y mediante reuniones sincrónicas (Google Meet), se celebraron debates sobre las experiencias de enseñanza-aprendizaje y una propuesta de hoja de ruta para el examen y la evaluación psicológicos, con el fin de orientar la labor de los pasantes y contribuir a fortalecer la instrumentalización y orientación de las intervenciones de asistencia psicológica en el hospital. La propuesta de un instrumento de orientación desarrollada consta de doce partes: identificación; motivo de hospitalización; situación de salud; situación de crisis; examen psicológico; sueño; síntomas psicosomáticos emergentes; sentido de la vida; maternidad y cuidado del bebé; estrategias de afrontamiento; síntesis; hipótesis diagnósticas. Consideraciones finales: La hoja de ruta para el examen y la evaluación psicológicos fortalece la parametrización de las intervenciones de psicología sanitaria en los hospitales; ilustra el desarrollo y el fortalecimiento de las aptitudes y capacidades para llevar a cabo una evaluación psicológica hospitalaria de manera eficiente, técnica y ética que dignifica la atención perinatal materna bajo los auspicios de la exhaustividad y basada en pruebas.

Hiperplasia epitelial focal: relato de caso clínico / Focal epithelial hyperplasia: case report

Introdução: a hiperplasia epitelial focal (HEF) ou doença de Heck, caracteriza-se por ser uma lesão benigna rara da mucosa bucal. Geralmente, está associada a proliferação do epitélio pavimentoso atribuída principalmente ao papiloma vírus humano (HPV) dos subtipos 13 e 32. Objetivo: relatar o caso de um paciente, com suspeita diagnóstica de HEF, descrever suas manifestações clínicas bucais e histopatológicas. Metodologia: homem, 38 anos, melanoderma, compareceu no Serviço Universitário com queixa de ardência em mucosa bucal. Ao exame clínico, apresentava múltiplas lesões papulares, firmes à palpação, de coloração rósea, com pápulas aglomeradas ou isoladas, localizadas em rebordo alveolares, gengiva inserida e livre da arcada superior e inferior, mucosas jugais e labiais, compatíveis com lesões causadas por HPV. Realizou-se biópsia incisional das lesões bucais, o laudo histopatológico descreveu o fragmento de mucosa bucal que estava revestida por epitélio pavimentoso estratificado paraceratinizado com acantose proeminente, projeções focais confluentes para o tecido conjuntivo, confirmando a suspeita diagnóstica clínica. Conclusão: a HEF é uma patologia rara, benigna da mucosa, indolor e que pode se resolver espontaneamente. Portanto, é necessário o diagnóstico adequado através da biopsia e laudo histopatológico.

Introduction: focal epithelial hyperplasia (FEH) or Heck's disease is characterized as a rare benign lesion of the oral mucosa. It is usually associated with proliferation of the squamous epithelium, mainly attributed to human papillomavirus (HPV) subtypes 13 and 32. Objective: to report the case of a patient with a diagnostic suspicion of HEF, to describe its oral clinical and histopathological manifestations. Methodology: hale, 38 years old, black, attended the University Service with a complaint of burning in the oral mucosa. On clinical examination, she presented multiple papular lesions, firm to palpation, pink in color, with agglomerated or isolated papules, located in the alveolar ridge, inserted gingiva free from the upper and lower arch, jugal and labial mucosa, compatible with lesions caused by HPV. An incisional biopsy of the oral lesions was performed, the histopathological report described the fragment of oral mucosa that was lined with parakeratinized stratified squamous epithelium with prominent acanthosis, focal projections confluent to the connective tissue, confirming the clinical diagnostic suspicion. Conclusion: FEH is a rare, benign mucosal pathology, painless and can resolve spontaneously. Therefore, proper diagnosis through biopsy and histopathological report is necessary.

Cisto ósseo simples: relato de 7 casos / Simple bone cyst: report of 7 cases / Quiste óseo simple: reporte de 7 casos

Introdução: O cisto ósseo simples (COS) é definido como uma cavidade intraóssea de etiologia desconhecida, desprovida de revestimento epitelial e vazia ou preenchida com líquido. Na região facial, o COS é mais comumente observado no corpo da mandíbula. Objetivo: O objetivo deste artigo é relatar uma série de casos de COS, discutindo aspectos relevantes das características clínicas e terapêutica adequada. Relato de caso: A série de casos demonstrou que a presença de lesões radiolúcidas assintomáticas nos maxilares, nos quais os diagnósticos clínico, laboratorial e imaginológico não foram conclusivos, a realização de uma biópsia é sempre indicada. Considerações finais: Os casos de múltiplas lesões de COS, ou quando estão associadas a displasias cemento-ósseas, uma abordagem cirúrgica torna-se imperiosa... (AU)

Introduction: Simple bone cyst (COS) is defined as an intraosseous cavity of unknown etiology, devoid of epithelial lining and empty or filled with fluid. In the facial region, COS is most commonly seen in the body of the mandible. Objective: The aim of this article is to re port a series of COS cases, discussing relevant aspects of the clinical characteristics and adequate treatment. Case report: The case series demonstrated that the presence of asymptomatic radiolucent lesions in the jaws, in which clinical, laboratory and imaging diagnoses were not conclusive, a biopsy is always indicated. Final considerations: In cases of multiple COS lesions, or when they are associated with cemento-osseous dysplasias, a surgical approach is imperative... (AU)

Introducción: El quiste óseo simple (COS) se define como una cavidad intraósea de etiología desconocida, desprovista de revestimiento epitelial y vacía o llena de líquido. En la región facial, la COS se observa con mayor frecuencia en el cuerpo de la mandíbula. Objetivo: El objetivo de este artículo es reportar una serie de casos de COS, discutiendo aspectos relevantes de las características clínicas y el tratamiento adecuado. Caso clínico: La serie de casos demostró que ante la presencia de lesiones radiotransparentes asintomáticas en los maxilares, en las que los diagnósticos clínicos, de laboratorio y de imagen no fueron concluyentes, siempre está indicada una biopsia. Consideraciones finales: En casos de múltiples lesiones de COS, o cuando se asocian a displasias cemento-óseas, es imprescindible un abordaje quirúrgico... (AU)

Cisto odontogênico glandular: relato de caso raro / Glandular odontogenic cyst: rare case report / Quiste dental glandular: reporte de un caso raro

Introdução: O cisto odontogênico glandular (COG) é um cisto odontogênico de desenvolvimento raro com potencial para agressividade e alta recorrência. Inicialmente denominado cisto sialodontogênico, por acreditarem que sua etiologia estaria possivelmente associada às glândulas salivares, posteriormente foi proposto o nome de COG e enfatizada a origem odontogênica para o mesmo. O objetivo deste trabalho foi relatar e discutir um caso de COG, analisando-se os aspectos clínicos, imaginológico e histológicos, discutindo com dados provenientes da literatura. Relato de caso: Paciente do sexo masculino, 22 anos, com diversas patologias de desenvolvimento dentário, cuja lesão localizava-se na região posterior da mandíbula associada a unidades dentárias não vitais simulando sinais de cisto radicular, foi realizada abordagem cirúrgica para extração dos dentes 36 e 37, curetagem da lesão e posterior acompanhamento de 5 anos sem recidiva. Considerações finais: O caso clínico demonstrou um COG que, pelas suas características clínicas e radiográficas, assemelhava-se a um cisto radicular em um paciente que apresentava alterações no desenvolvimento das unidades dentárias, contudo o laudo histopatológico foi fundamental para a elucidação diagnóstica e terapêutica adequada... (AU)

Introduction: Glandular odontogenic cyst (GOC) is a rare developing odontogenic cyst with potential for aggressiveness and high recurrence. Initially called sialodontogenic cyst, as they believed that its etiology was possibly associated with salivary glands, the name of COG was later proposed and its odontogenic origin was emphasized. The objective of this work was to report and discuss a case of COG, analyzing the clinical, imaging and histological aspects, discussing with data from the literature. Case report: Male patient, 22 years old, with several pathologies of dental development, whose lesion was located in the posterior region of the mandible associated with non-vital dental units simulating signs of radicular cyst, a surgical approach was performed to extract the teeth 36 and 37, curettage of the lesion and subsequent follow-up of 5 years without recurrence. Final considerations: The clinical case demonstrated a COG that, due to its clinical and radiographic characteristics, resembled a radicular cyst in a patient who presented alterations in the development of dental units, however the histopathological report was essential for the proper diagnostic and therapeutic elucidation... (AU)

Introducción: El quiste odontogénico glandular (GOC) es un quiste odontogénico en desarrollo poco común con potencial de agresividad y alta recurrencia. Inicialmente denominado quiste sialodontogénico, ya que creían que su etiología posiblemente estaba asociada a glándulas salivales, posteriormente se propuso el nombre COG y se enfatizó su origen odontogénico. El objetivo de este trabajo fue informar y discutir un caso de COG, analizando los aspectos clínicos, imagenológicos e histológicos, discutiendo con datos de la literatura. Caso clínico: Paciente masculino de 22 años con diversas patologías del desarrollo dental, cuya lesión se localizó en la región posterior de la mandíbula asociada a unidades dentales no vitales simulando signos de quiste radicular, se realizó un abordaje quirúrgico para extraer el dientes 36 y 37, curetaje de la lesión y seguimiento posterior de 5 años sin recidiva. Consideraciones finales: El caso clínico mostró un COG que por sus características clínicas y radiográficas se asemejaba a un quiste radicular en un paciente que presentaba alteraciones en el desarrollo de las unidades dentales, sin embargo el informe histopatológico fue fundamental para el adecuado esclarecimiento diagnóstico y terapêutico... (AU)

Liposomal paclitaxel induces apoptosis, cell death, inhibition of migration capacity and antitumoral activity in ovarian cancer.

The main goal of this study is to evaluate the efficacy of the paclitaxel (PTX) drug formulated with a liposomal nanosystem (L-PTX) in a peritoneal carcinomatosis derived from ovarian cancer. In vitro cell viability studies with the human ovarian cancer line A2780 showed a 50% decrease in the inhibitory concentration for L-PTX compared to free PTX. A2780 cells treated with the L-PTX formulation demonstrated a reduced capacity to form colonies in comparison to those treated with PTX. Cell death following L-PTX administration hinted at apoptosis, with most cells undergoing initial apoptosis. A2780 cells exhibited an inhibitory migration profile when analyzed by Wound Healing and real-time cell analysis (xCELLigence) methods after L-PTX administration. This inhibition was related to decreased expression of the zinc finger E-box-binding homeobox 1 (ZEB1) and transforming growth factor 2 (TGF-ß2) genes. In vivoL-PTX administration strongly inhibited tumor cell proliferation in ovarian peritoneal carcinomatosis derived from ovarian cancer, indicating higher antitumor activity than PTX. L-PTX formulation did not show toxicity in the mice model. This study demonstrated that liposomal paclitaxel formulations are less toxic to normal tissues than free paclitaxel and are more effective in inhibiting tumor cell proliferation/migration and inducing ZEB1/TGF-ß2 gene expression.

Granuloma piogênico em assoalho bucal: relato de caso / Pyogenic granuloma in mouth floor: case report

O Granuloma Piogênico (GP) é uma lesão de caráter inflamatório originado da membrana mucosa ou do tecido conjuntivo, que possui predileção por pacientes leucodermas, do sexo feminino, entre 11 e 40 anos, especialmente durante a gravidez. Clinicamente apresentase preferencialmente na maxila, com forma irregular, consistente, pediculado, de crescimento lento e sem sintomatologia dolorosa. As principais causas do GP são os traumas ou irritantes locais associados à má higiene oral. Histologicamente apresenta-se bastante vascularizado, organizado em agregados lobulares. O tratamento cirúrgico de escolha é a exérese total da lesão. O objetivo deste trabalho é relatar um caso de granuloma piogênico com características clínicas incomuns, tratado cirurgicamente... (AU)

Piogenic Granuloma (GP) is an inflammatory lesion originating from the mucous membrane or connective tissue, which is predilected by female patients, between 11 and 40 years old, especially during pregnancy. Clinically it presents preferably in the maxilla, with irregular shape, consistent, pediculated, slow-growing and without painful symptomatology. The main causes of GP are the traumas or local irritants associated with poor oral hygiene. Histologically, it is quite vascularized, organized in lobular aggregates. The surgical treatment of choice is the total exeresis of the lesion. The objective of this study is to report a case of pyogenic granuloma with unusual clinical features, treated surgically... (AU)

Lipoma: relato de caso / Lipoma: case report

O lipoma é uma neoplasia benigna mesenquimal de rara ocorrência em cavidade bucal, com maior predileção, principalmente pela mucosa bucal, em indivíduos acima da quarta década de vida. Clinicamente o lipoma se caracteriza por um aumento de volume flácido à palpação, de coloração amarelada ou normal de mucosa, com crescimento lento e geralmente assintomático. Histologicamente o lipoma apresenta presença de tecido adiposo maduro com células adiposas de aparência semelhante à gordura normal adjacente, bem circunscrito e podendo apresentar uma fina cápsula fibrosa. O tratamento do lipoma é cirúrgico e consiste na excisão da lesão. Assim, o objetivo do presente trabalho é relatar dois casos de lipoma em cavidade oral localizados em região de mucosa bucal tratado cirurgicamente. Paciente de 50 anos, sexo feminino, melanoderma, cursando com aumento de volume em região de mucosa bucal esquerda com 05 meses de evolução. Ao exame clínico foi possível avaliar lesão em região de mucosa bucal esquerda de aproximadamente 02 cm de diâmetro, flácido à palpação e coloração normal de mucosa. Foi realizada biopsia excisional sob anestesia local e posterior enucleação da lesão. A paciente evolui com 06 meses de pós-operatório sem evidências clínicas de recidiva da lesão ou complicações associadas. O lipoma é de difícil ocorrência em região intra-oral e mesmo quando tratada de maneira conservadora através da enucleação lesão possui baixas taxas de recidiva(AU)

Lipoma is a benign mesenchymal neoplasm of rare occurrence in the oral cavity, with a higher predilection, mainly by the buccal mucosa, in individuals above the fourth decade of life. Clinically lipoma is characterized by an increase in flaccid volume at palpation, yellowing or normal mucosa, with slow and usually asymptomatic growth. Histologically, lipoma has the presence of mature adipose tissue with adipose cells similar in appearance to adjacent normal fat, well circumscribed and may have a thin fibrous capsule. The treatment of lipoma is surgical and involves the excision of the lesion. Thus, the objective of the present study is to report two cases of lipoma in the oral cavity located in a region of buccal mucosa treated surgically. A 50-year-old female patient, melanoderma, with an increase in volume in the region of the left buccal mucosa with 05 months of evolution. At the clinical examination it was possible to evaluate lesion in the region of the left buccal mucosa of approximately 02 cm in diameter, flaccid to palpation and normal mucosa staining. An excisional biopsy was performed under local anesthesia and subsequent enucleation of the lesion. The patient ev olves at 06 months postoperatively without clinical evidence of recurrence of the lesion or associated complications. Lipoma is difficult to perform in the intra-oral region and even when treated conservatively through the enucleation lesion has low rates of relapse(AU)

Cisto Odontogênico Ortoceratinizado: Relato de caso / Orthokeratinized Odontogenic Cyst: Case Report

O Cisto Odontogênico Ortoceratinizado (COO) é um cisto de desenvolvimento que ocorre nos maxilares, com maior predileção pela região posterior da mandíbula, em pacientes jovens do gênero masculino. O COO é caracterizado radiograficamente como uma área radiolúcida, unilocular bem definida e identificado histologicamente pela presença de uma cavidade cística fibrosa, revestida por epitélio estratificado pavimentoso ortoceratinizado. O tratamento do COO geralmente conservador, consiste na enucleação associada à curetagem óssea. O objetivo deste trabalho é relatar um caso de COO localizado em mandíbula... (AU)

The Orthokeratinized Odontogenic Cyst (OOC) is a developmental cyst that occurs in the jaws, with a greater predilection in the posterior region of the mandible in young male patients. OOC is characterized radiographically as a well-defined radiolucent, unilocular area and histologically identified by the presence of a fibrous cystic cavity lined by orthokeratinized squamous epithelium. Treatment of OOC is usually conservative and consists of enucleation associated with bone curettage. The objective of this study is to report a case of OOC located in the mandible... (AU)

Reconstrução aloplástica do côndilo mandibular: relato de caso / Alloplastic reconstruction of mandibular condyle: case report

Dentre os componentes presentes na articulação temporomandibular (ATM), destacam-se a fossa e o côndilo mandibular. Essa articulação é responsável pelos movimentos mandibulares, mastigatórios e fonéticos, além da propriocepção e equilíbrio do sistema estomatognático. Dentre as fraturas na região maxilofacial, as fraturas condilares destacam se devido a sua alta prevalência. Os principais sinais e sintomas associados a essas fraturas são: maloclusão, crepitação, limitação da abertura bucal e dor articular. As fraturas condilares por projétil de arma de fogo (PAF) destacam-se no panorama atual. Devido à grande velocidade e impacto do projétil contra a estrutura articular, as fraturas condilares por PAF geralmente são diagnosticadas como fraturas cominutivas. Assim, o tratamento conservador nesses casos se torna inviável, pois a redução estrutural é dificultada. A reconstrução total da ATM é indicada nesses casos e consiste na substituição protética da articulação por materiais aloplásticos. O objetivo deste presente estudo consiste em relatar um caso de um paciente vítima de fratura cominutiva de côndilo mandibular, causada por projétil de arma de fogo (PAF), tratada por reconstrução total aloplástica da ATM... (AU)

Among the components present in the temporomandibular joint (TMJ), the fossa and mandible condyle should be highlighted. This joint is responsible for masticatory jaw movements and phonetic, as well as proprioception and balance of the stomatognathic system. Regarding to fractures in the maxillofacial region, condylar fractures stand out due to its high prevalence. The main signs and symptoms associated with those fractures are malocclusion, crepitation, limited mouth opening and joint pain. The condylar fractures by firearm projectile stand out in the current scenario. Due to the high speed and impact of the projectile against the joint structure, condylar fractures by PAF are usually diagnosed as comminuted fractures. Thus, conservative treatment in those cases is not recommended because the structural reduction is difficult. The total reconstruction of the TMJ emerges such as indicated in those cases and it consists in a prosthetic joint replacement by alloplastic materials. Therefore, the aim of this present study is to report a case of a patient comminuted fracture victim of mandibular condyle caused by a firearm projectile treated for TMJ total alloplastic reconstruction... (AU)

A randomised phase II study of chemoradiotherapy with or without nimotuzumab in locally advanced oesophageal cancer: NICE trial.

PURPOSE: Chemoradiotherapy is the standard treatment for patients with inoperable locally advanced oesophageal cancer. We sought to assess the safety and efficacy of chemoradiation combined with nimotuzumab, a humanised antibody directed against epidermal growth factor receptor (EGFR). PATIENTS AND METHODS: Untreated patients with inoperable locally advanced oesophageal cancer and no distant metastases were randomised to chemoradiotherapy (cisplatin and fluorouracil combined with external beam radiation) alone or in combination with nimotuzumab. The primary end-point was the endoscopic complete response (eCR) rate, and secondary end-points comprised quality of life (QoL) and safety. The combined eCR and pathologic complete response (cEPCR) and overall survival (OS) were also evaluated. RESULTS: We enrolled 107 patients with a mean age of 59 years, and 93% had squamous cell carcinoma. Toxicity was manageable in both arms with no important differences in adverse events (AEs). We performed post-treatment endoscopies in 67 patients, including 60 who had a biopsy. In the intent-to-treat population, the eCR rates with and without nimotuzumab were 47.2% and 33.3% (P = 0.17), respectively, and the cEPCR rates were 62.3% and 37.0% (P = 0.02), respectively. With a median follow-up of 14.7 months, the hazard ratio (HR) for OS was 0.68 (95% confidence interval (CI): 0.44-1.07; P = 0.09) with a median OS of 15.9 months for the nimotuzumab arm and 11.5 months for the control arm. Regarding QoL, a significant difference was observed for the physical subscale score (P = 0.03) with lower values for the control arm. CONCLUSION: Combined chemoradiotherapy plus nimotuzumab is safe for patients with locally advanced oesophageal cancer, it appears to increase the cEPCR rate, and without compromising QoL. CLINICAL TRIALS: Identification number: EF024-201; Trial registry: NCT01249352.

A phase III, randomized, non-inferiority study comparing the efficacy and safety of biosimilar filgrastim versus originator filgrastim for chemotherapy-induced neutropenia in breast cancer patients.

OBJECTIVES:: To compare the efficacy and safety of two filgrastim formulations for controlling chemotherapy-induced neutropenia and to evaluate the non-inferiority of the test drug relative to the originator. METHODS:: This phase III non-inferiority study had a randomized, multicenter, and open-label design. The patients were randomized at a ratio of 1:1 with a follow-up period of 6 weeks for each patient. In both study arms, filgrastim was administered subcutaneously at a daily dose of 5 mg/kg body weight. The primary endpoint was the rate of grade 4 neutropenia in the first treatment cycle. The secondary endpoints were the duration of grade 4 neutropenia, the generation of anti-filgrastim antibodies, and the rates of adverse events, laboratory abnormalities, febrile neutropenia, and neutropenia of any grade. RESULTS:: The primary efficacy analysis demonstrated the non-inferiority of the test drug compared with the originator drug; the upper limit of the 90% confidence interval (CI) for the rate of neutropenia between the two groups (12.61%) was lower than the established margin of non-inferiority. The two treatments were similar with respect to the secondary endpoints and safety. CONCLUSION:: The efficacy and safety profile of the test drug were similar to those of the originator product based on the rate of grade 4 neutropenia in the first treatment cycle. This study supports Anvisa's approval of the first biosimilar drug manufactured by the Brazilian industry (Fiprima¯).

A phase III, randomized, non-inferiority study comparing the efficacy and safety of biosimilar filgrastim versus originator filgrastim for chemotherapy-induced neutropenia in breast cancer patients

OBJECTIVES: To compare the efficacy and safety of two filgrastim formulations for controlling chemotherapy-induced neutropenia and to evaluate the non-inferiority of the test drug relative to the originator. METHODS: This phase III non-inferiority study had a randomized, multicenter, and open-label design. The patients were randomized at a ratio of 1:1 with a follow-up period of 6 weeks for each patient. In both study arms, filgrastim was administered subcutaneously at a daily dose of 5 mg/kg body weight. The primary endpoint was the rate of grade 4 neutropenia in the first treatment cycle. The secondary endpoints were the duration of grade 4 neutropenia, the generation of anti-filgrastim antibodies, and the rates of adverse events, laboratory abnormalities, febrile neutropenia, and neutropenia of any grade. RESULTS: The primary efficacy analysis demonstrated the non-inferiority of the test drug compared with the originator drug; the upper limit of the 90% confidence interval (CI) for the rate of neutropenia between the two groups (12.61%) was lower than the established margin of non-inferiority. The two treatments were similar with respect to the secondary endpoints and safety. CONCLUSION: The efficacy and safety profile of the test drug were similar to those of the originator product based on the rate of grade 4 neutropenia in the first treatment cycle. This study supports Anvisa’s approval of the first biosimilar drug manufactured by the Brazilian industry (Fiprima¯).

Development and implementation of a comprehensive psychosocial screening program in a Brazilian cancer center.

OBJECTIVE: International guidelines recommend routine screening for distress as part of care practices. Accordingly, a Brazilian cancer center developed and implemented a distress screening program (DS) in 2007, which was enhanced in 2009 through the inclusion of a psychosocial care meeting group (DS + PCM) regarding patients' psychosocial needs. The current paper will provide an overview of the development and pilot implementation of this program and initial analyses to assess patient outcomes and report initial results to extend international research on this key aspect of cancer care. METHOD: Patients were assessed for distress, anxiety and depression, and in the DS+PCM phase for quality of life at the first day of chemotherapy infusion, at midpoint, and at treatment end. We compared data from program phases (DS vs DS + PCM), with a sequential cohort design and mixed effects modeling. RESULTS: Clinical and demographic characteristics were similar between groups. Patients receiving DS + PCM showed significantly lower distress and depression/anxiety upon chemotherapy initiation (Ps < .001). While both groups reported significantly lowered distress and total depression/anxiety scores across time (Ps < .003), patients receiving DS + PCM maintained the lowest distress and total anxiety/depression at all assessments. Patients from DS + PCM group also reported improvements in quality of life over time. CONCLUSIONS: The current study provides preliminary evidence that a multidisciplinary structured screening program utilizing validated measures and team meetings is associated with reduced impairment in patients' psychological well being. This program provided more opportunities for collaboration among providers with increased multidisciplinary meetings, enabled patients to more easily report problems, and ensured rapid access to relevant resources.

Adenoma pleomórfico em lábio superior: relato de caso / Upper lip pleomorphic adenoma: case report

As glândulas salivares são órgãos anexos de grande importância para o sistema estomatognático. Estão susceptíveis a uma série de patologias benignas e malignas e, dentre as benignas, o tumor mais comum é o adenoma pleomórfico. Tal patologia tem etiologia desconhecida e acomete com mais frequência as glândulas salivares maiores. Em casos mais raros, pode ocorrer em glândulas salivares menores, em variadas regiões na cavidade oral. Possui crescimento lento, e apresenta-se como aumento de volume firme, encapsulado e assintomático. Seu tratamento baseia-se na excisão cirúrgica e apresenta baixas taxas de recidiva. O presente trabalho objetiva relatar um raro caso de adenoma pleomórfico em lábio superior e discutir o tratamento instituído... (AU)

The salivary glands are attached organs of great importance to the stomatognathic system. Are susceptible to a number of benign and malignant disorders, and among the most common benign tumor is the pleomorphic adenoma. This pathology has unknown etiology, affecting more often the major salivary glands. In rare cases, can occur in the minor salivary glands in different sites in the oral cavity. It grows slowly and is presented as increase in firm volume, encapsulated and asymptomatic. Its treatment is based on surgical excision and has a low recurrence rate. This study reports a rare case of pleomorphic adenoma in the upper lip and discuss the treatment instituted... (AU)

Combined paclitaxel, cisplatin and fluorouracil therapy enhances ionizing radiation effects, inhibits migration and induces G0/G1 cell cycle arrest and apoptosis in oral carcinoma cell lines.

Although taxels (in particular paclitaxel), cisplatin and fluorouracil (TPF) chemotherapy has been approved for use in the treatment of head and neck squamous cell carcinoma (HNSCC), little is known with regard to the cellular mechanisms of this novel drug association. In order to investigate the reaction of cells to this novel treatment, the present study aimed to examine the cytotoxic effect of TPF in HNSCC cell lines in combination with irradiation, to analyze its effect on cell cycle progression and cell death, and to evaluate its ability to alter cell migration. An MTT assay was used to determine cell viability following TPF and cisplatin treatments in two human HNSCC cell lines (FaDu and SCC-9) and one keratinocyte cell line (HaCaT). The concurrent use of TPF or cisplatin and irradiation was also analyzed. Flow cytometric analysis was utilized to determine the cell cycle distribution and to verify the induction of apoptosis. The capacity of the drugs to alter oral cancer cell migration was also evaluated using a Transwell migration assay. The results indicated that TPF and cisplatin were cytotoxic to all cell lines, and enhanced the effects of ionizing radiation. FaDu cells were significantly more sensitive to the two treatments, and TPF was more cytotoxic than cisplatin for all cells. Flow cytometric analysis revealed that TPF increased the number of cells in G0/G1 phase in the SCC-9 cell line, and indicated apoptotic cell death. The results of the Transwell assay demonstrated that TPF inhibited migration in oral carcinoma cell lines. The results of the present study indicated that TPF functions in oral carcinoma cell lines through the enhancement of ionizing radiation effects, inducing cell cycle arrest at G0/G1 and apoptosis, in addition to inhibiting migration.

Ferimento provocado por arma branca impactada em região maxilofacial: relato de caso / Injury caused by spiked stab wound in the maxillofacial region: case report

A agressão física é uma das maiores causas de atendimento nas emergências hospitalares. Afetando, principalmente, jovens do gênero masculino, elas resultam em acometimento do complexo maxilofacial, entretanto ferimentos a faca impactada nessa região são incomuns, e o conhecimento acerca de suas peculiaridades é fundamental para o tratamento. Cuidados acerca da manutenção das vias aéreas e da hemodinâmica do paciente bem como os aspectos neurológicos, oftalmológicos e vasculares fazem parte desse tratamento interdisciplinar. Assim, o objetivo deste trabalho foi relatar o tratamento de um paciente do gênero masculino em meia-idade, acometido por ferimento de arma branca, com uma faca impactada em região maxilofacial... (AU)

Physical agression is a major cause of hospital care in emergencies. Affecting mainly young males, they result in impairment of the maxillofacial complex. However stab wounds impacted this region are uncommon and knowledge of its peculiarities is essential for treatment. Care about the maintenance of airway and hemodynamic parameters as well as neurological, ophthalmological and vascular aspects are part of this interdisciplinary treatment. The objective of this study was to report the treatment of a male patient in middle age, affected by stab wound with a knife impacted in the maxillofacial region... (AU)