Applicability of modified Glasgow Prognostic Score in the assessment of elderly patients with cancer: A pilot study.

OBJECTIVES: To evaluate the relationship between inflammatory parameters through the modified Glasgow Prognostic Score (mGPS) and other clinical characteristics of elderly patients with cancer, including frailty evaluated by the Edmonton Frailty Scale (EFS). MATERIALS AND METHODS: We included patients from the oncology service at Faculdade de Medicina do ABC with a confirmed diagnosis of solid tumor aged 65 years or more at diagnosis. Patients were assessed by applying the translated and validated to Portuguese version of the EFS and also had blood sample collection for the evaluation of C-reactive protein (CRP) and albumin for calculation of the mGPS. RESULTS: We included 52 patients of both sexes, with median age of 72.5 years, of these 67.3% had localized disease and 32.7% metastatic disease. The mGPS presented 17.3% of high-risk patients. The frailty evaluated by EFS occurred in 57.6% of patients. Patients with both abnormal parameters (CRP and albumin) in the mGPS had significantly higher scores on EFS when compared to those with no change (6 vs. 9.56 points, p=0.021). The mGPS correlated also with clinical staging (p=0.019) and performance status (p=0.039). CONCLUSIONS: Inflammatory parameters correlate significantly with frailty, more advanced clinical stage and poor functional status.

Carcinoma tímico metastático com resposta prolongada a pemetrexed e octreotide / Metastatic thymic carcinoma with prolonged response to pemetrexed and octreotide

Em adultos os carcinomas tímicos representam cerca de 20% das neoplasias mediastinais. A maioria dos pacientes tem entre 40 e 60 anos de idade e há ligeira predominância do sexo masculino. Em função da raridade da doença não há ensaios clínicos randomizados realizados para orientar a escolha do tratamento na doença metastática refratária ou recorrente. Alguns regimes de segunda linha têm sido usados, a maioria baseada em cisplatina. Como linhas alternativas as opções são pemetrexed, 5-flourouracil associado a leucovorin, gemcitabina, capecitabina e paclitaxel, todas com taxas de resposta pequenas. Relatamos neste artigo um caso de carcinoma tímico tratado com pemetrexed e octreotide com resposta prolongada ao tratamento.

Antiphospholipid syndrome plus rheumatic fever: a higher risk factor for stroke?

To compare clinical and laboratory findings between patients with primary antiphospholipid syndrome (PAPS) versus secondary APS due to rheumatic fever (APS-RF) (according to Jones criteria). Seventy-three APS patients (Sapporo criteria) were enrolled, and demographic, clinical, and laboratory data were collected. Exclusion criteria were heart congenital abnormalities and previous infectious endocarditis. Patients were divided into two groups: PAPS (n = 68) and APS-RF (n = 5). The mean current age, disease duration, frequencies of female gender, and Caucasian race were similar in APS-RF and PAPS patients (P > 0.05). Remarkably, the frequency of stroke was significantly higher in APS-RF compared to PAPS patients (80% vs. 25%, P = 0.02). Of note, echocardiogram of these patients did not show intracardiac thrombus. No significant differences were found in peripheral thromboembolic events (P = 1.0), pulmonary thromboembolism (P = 1.0), miscarriage (P = 0.16), thrombocytopenia (P = 0.36), arterial events (P = 0.58), and thrombosis of small vessels (P = 1.0). There were no differences in the frequencies of comorbidities such as diabetes mellitus, hypertension, smoking, and hyperlipidemia in both groups (P > 0.05). The frequencies of lupus anticoagulant, IgG, and IgM anticardiolipin were similar in two groups. APS patients associated with rheumatic fever without infective endocarditis may imply a high stroke risk as compared with PAPS, and future studies are needed to confirm this finding.