A Health App for Evidence-Based Postpartum Information: Development and Validation Study.

BACKGROUND: After childbirth, women undergo substantial physical and emotional changes. Therefore, it is important to provide them with information that helps them identify what is expected during this stage, as well as signs and symptoms that indicate complications after they have been discharged from the hospital. OBJECTIVE: This study aimed to develop a health app-Towards Motherhood-that provides evidence-based information about the postpartum period and evaluate the usability of the app with the target population. METHODS: This was a validation study involving 80 participants, including 24 professionals from the obstetric health field, 15 professionals from the technology field, and 41 postpartum women. The app was developed using React Native technology. Health professionals evaluated the app's content using the Content Validity Index, technology professionals completed a validated evaluation to assess the appearance of the app, and postpartum women completed the System Usability Scale (SUS) to measure the usability of the app. RESULTS: The measurement of content validity using a Likert scale obtained an approval score of 99%. Regarding the app's appearance, 92% of responses were positive, reflecting favorable approval. The SUS usability score was 86.2, which represents excellent acceptance. CONCLUSIONS: The Towards Motherhood mobile app is a valid tool for promoting self-care during the postpartum period. The app's evidence-based information, user-friendly design, and high usability make it an essential resource for women during this critical stage of their live.

Obstetric and neonatal adverse events and association with care models: a cohort study / Eventos adversos obstétricos y neonatales y asociación con modelos de atención: un estudio de cohorte / Eventos adversos obstétricos e neonatais e associação com os modelos de assistência: um estudo coorte

ABSTRACT Objective: to analyze the prevalence of practices in childbirth care, obstetric and neonatal adverse events and their association with care models in three public health services. Method: this is a prospective cohort study carried out with 548 dyads, postpartum women and their newborns, whose pregnancy was of usual risk and vaginal birth, admitted to hospital in three public services, one with an exclusive care model by nurse-midwives (service A), one with a collaborative model involving obstetric doctors and nurses (service B) and one with an exclusive medical care model (service C). Initially, an interview was carried out with participants, and a second contact was carried out 42 days after birth to complement the collection of the adverse event outcome. Results: in service A, no woman underwent the Kristeller maneuver, episiotomy, directed pushing or more than one vaginal examination per hour. Meanwhile, in service C, 19.3%, 39.9%, 77.1% and 26.3% of women underwent these interventions, respectively. Adverse events occurred in 19.2% of the dyads. Occurrence of adverse events was associated with not using partograph (p=0.001; OR: 11.03; CI: 2.64-45.99) and episiotomy (p=0.042; OR: 1.72; CI: 1. 02-2.91). The mean probability of experiencing an adverse event was 5% in service A, 21% in service B and 24% in service C. Conclusion: adverse events had a lower mean probability of occurrence in the service exclusively operated by nurse-midwives, in which greater application of recommendations for labor and birth care was identified.

RESUMEN Objetivo: analizar la prevalencia de prácticas en la atención del childbirth, eventos adversos obstétricos y neonatales y su asociación con los modelos de atención en tres servicios públicos de salud. Método: estudio de cohorte prospectivo realizado con 548 binomios, puérperas y sus recién nacidos, cuyo embarazo fue de riesgo habitual y childbirth vaginal, hospitalizados en tres servicios públicos, uno con modelo de atención exclusiva por enfermeras obstétricas (servicio A), otro con modelo colaborativo. modelo con la labor de médicos y enfermeras obstetras (servicio B) y otro con un modelo de asistencia médica exclusiva (servicio C). Inicialmente se realizó una entrevista a los participantes y se realizó un segundo contacto a los 42 días del nacimiento para complementar la recopilación del resultado del evento adverso. Resultados: en el servicio A ninguna mujer fue sometida a maniobra de Kristeller, episiotomía, pujo dirigido o más de un examen vaginal por hora. Mientras tanto, en el servicio C, el 19,3%, 39,9%, 77,1% y 26,3% de las mujeres se sometieron a estas intervenciones, respectivamente. Los eventos adversos ocurrieron en el 19,2% de los binomios. La aparición de eventos adversos se asoció con la no utilización del partographa (p=0,001; OR: 11,03; IC: 2,64-45,99) y episiotomía (p=0,042; OR: 1,72; IC: 1,02-2,91). La probabilidad promedio de experimentar un evento adverso fue del 5% en el servicio A, del 21% en el servicio B y del 24% en el servicio C. Conclusión: los eventos adversos tuvieron menor probabilidad promedio de ocurrencia en el servicio operado exclusivamente por enfermeras obstétricas, en el que se identificó mayor aplicación de las recomendaciones de asistencia al childbirth y nacimiento.

RESUMO Objetivo: analisar a prevalência de práticas na atenção ao parto, eventos adversos obstétricos e neonatais e sua associação com modelos assistenciais em três serviços de saúde públicos. Método: estudo coorte prospectivo realizado com 548 binômios, puérperas e seus recém-nascidos, cuja gestação foi de risco habitual e o parto vaginal, internados em três serviços públicos, sendo um com modelo de assistência exclusivo por enfermeiras obstetras (serviço A), um com modelo colaborativo com atuação de médicos e enfermeiras obstetras (serviço B) e um com modelo de assistência exclusiva médica (serviço C). Inicialmente, foi realizada uma entrevista com as participantes e um segundo contato foi realizado após 42 dias do parto para complementar a coleta do desfecho evento adverso. Resultados: no serviço A, nenhuma mulher foi submetida à manobra de Kristeller, episiotomia, incentivos a puxos dirigidos ou mais de um toque vaginal por hora. Enquanto, no serviço C, 19,3%, 39,9%, 77,1% e 26,3% das mulheres foram submetidas a essas intervenções, respectivamente. Os eventos adversos ocorreram em 19,2% dos binômios. A ocorrência dos eventos adversos foi associada ao não uso do partograma (p=0,001; OR: 11,03; IC: 2,64-45,99) e episiotomia (p=0,042; OR: 1,72; IC: 1,02-2,91). A probabilidade média de apresentar algum evento adverso foi de 5% no serviço A, 21% no serviço B e 24% no serviço C. Conclusão: os eventos adversos apresentaram menor probabilidade média de ocorrência no serviço com atuação exclusiva de enfermeiras obstetras, no qual se identificou maior aplicação das recomendações para assistência ao parto e nascimento.

My child is growing and now? Exploring the environmental needs of children with congenital Zika syndrome according to their caregivers' perceptions.

INTRODUCTION: Promoting social inclusion of children with congenital Zika virus syndrome (CZS) is challenging, mostly, when there is a transport problem, low access to information and a long distance between the house and health services. Participation can be understood as involvement in a life situation and is strongly influenced by physical, social and attitudinal environmental factors; however, was still little explored in the case of children with CZS. In this sense, this study aimed to explore the perception of caregivers about the environmental needs of children with CZS, differentiating barriers and facilitators. METHODS: This is qualitative research. Thematic analysis was used to identify the environmental needs perceived by caregivers of children with CZS. The patient public involvement (PPI) approach was incorporated with the purpose of validating the data analysis performed by the researchers. After this step, the data were categorized in terms of barriers and facilitators and validated by the group of researchers. RESULTS: A relevant environmental need reported by caregivers as a barrier was social support for children with CZS. Ableism was also evidenced as an important attitudinal barrier. Health services were essential for the lives of children with CZS and the availability of auxiliary devices as facilitators of participation. Environmental factors related to medication and food routines were, for the most part, facilitators. CONCLUSION: This study contributes to critical approaches to the impacts linked to environmental factors of children with CZS, recognition of these children is an evolving process and fundamental to basic rights for adequate living in society. The data point to the need to implement public policies aimed at children with CZS, as well as the availability of qualified professionals to apply family-centred care and skills-focused management. Building friendly environments that promote broad social participation will contribute to the healthy growth of children with CZS. PATIENT OR PUBLIC CONTRIBUTION: Six caregivers (20% of the caregivers) as part of the PPI approach were contacted and participated in individual virtual meetings to discuss the results of the thematic analysis regarding the environmental needs of children with CZS.

Impact of the SARS-CoV-2 pandemic on urinary incontinence and quality of life of nulliparous women.

OBJECTIVES: To evaluate the impact of social isolation due to SARS-CoV-2 on the prevalence and severity of urinary incontinence and how this correlates with the quality of life of the nulliparous women evaluated. METHOD: Observational, longitudinal study, carried out from August/2019 to September/2020, at the Faculdade de Ciências da Saúde do Trairi/RN, with 37 nulliparous women from 18 to 35 years old, who answered the socio-anthropometric assessment, to the Incontinence Severity Index Questionnaire and King's Health Questionnaire, before and during isolation due to SARS-CoV-2. Statistical analysis: Wilcoxon test, and Spearman's correlation coefficient. Significance level p≤0.05. RESULTS: During social isolation, there was an improvement in urge incontinence (p=0.01) and in the frequency of urinary incontinence (p=0.03). The severity of urinary incontinence correlated with: general health perception (p=0.02; r=0.65); physical limitations (p=0.03; r=0.60); social (p=0.001; r=0.82). CONCLUSION: The social isolation from SARS-CoV-2 improved urge incontinence and frequency of urinary incontinence. The more severe the urinary incontinence, the worse the general health perception, physical and social limitations during isolation.

Evaluation of the female pelvic floor with infrared thermography: a cross sectional study.

BACKGROUND: Infrared thermography (IRT) is an easy-to-use, noninvasive and pain-free tool that can be used to evaluate function of the pelvic floor (PF) muscles. OBJECTIVE: To analyze vaginal manometry, temperature, and percentage of colors achieved through IRT of the PF muscles at rest and during maximum voluntary contraction. The relationship between PF muscles strength and IRT temperature was also assessed. METHODS: Two-hundred and thirty-one women (mean ± SD age: 58.4±5.9 years) participated in this study. IRT recorded the minimum, average, and maximum temperatures, and the colors of the PF area at rest and during maximum voluntary contraction. The pressure applied during the three maximum voluntary PF contractions was evaluated through vaginal manometry. RESULTS: The women had a PF average temperature of 36.4 ± 0.8°C. There were no differences in the IRT temperatures between rest and during PF muscles contraction. The percentages of white, red, orange, yellow, green, cyan, and blue colors were different at rest and during contraction. Warm colors became more visible in the center of the image during the PF muscles maximum voluntary contraction. There was a positive correlation between the PF average temperature and PF manometry (r=0.7; p=0.001). CONCLUSION: The IRT was not able to detect differences in the temperature of the PF area between at rest and during contraction. However, a strong correlation between PF temperature and vaginal manometry was found.

Natural cururu toad (Rhinella sp.) poisoning in a free-ranging lesser grison (Galictis cuja): Outcomes in a new susceptible predator with a novel peptide description.

Cururu toad (Rhinella marina group) is widely distributed in Brazil. Lesser grison (Galitic cuja) is a South American mustelid. This is the first report of natural poisoning in a free-ranging lesser grison by Rhinella toad parotoid gland secretion (PGS). Five minutes after biting a toad, the lesser grison developed convulsion, dying within 1.5 h. Mass spectrometry analysis of a milky-whitish secretion found in the lesser grison oral cavity allowed identification of a bufotoxin and a new bufonid peptide.

Trastuzumab Emtansine-Induced Nodular Regenerative Hyperplasia: Is Dose Reduction Enough as a Preventable Measure?

INTRODUCTION: Trastuzumab emtansine (T-DM1) is a novel antibody-drug conjugate targeting the human epidermal growth factor receptor 2, used in some recurrent metastatic cancers. It was linked to modest increases in serum aminotransferase elevations and bilirubin. More recently, some cases of noncirrhotic portal hypertension have been described in patients on long-term T-DM1. The underlying liver condition is usually nodular regenerative hyperplasia (NRH) with elements of sinusoidal obstruction. CASE REPORT: We report the case of a 52-year-old woman who started T-DM1 therapy for recurrent metastatic lung adenocarcinoma. Although a progressive reduction in lung nodules was noticed, there was a new-onset cytocholestasis and elevation in bilirubin. A reduction in platelet count was also apparent over several months during the T-DM1 therapy. Liver biopsy revealed NRH and so the dose of T-DM1 was reduced. Thereafter, the patient had normalization of liver tests and platelet count. T-DM1 was continued for more than 9 months with no signs of portal hypertension or cancer progression. CONCLUSIONS: We presented a rare case of NRH induced by T-DM1 in a patient with lung adenocarcinoma. A high index of suspicion for liver injury and NRH must be maintained for patients who develop liver test abnormalities and/or signs of portal hypertension during treatment with T-DM1. This is the first report of a successful dose reduction in a patient with NRH induced by T-DM1, suggesting that it is possible to maintain the drug while it is being effective for lung cancer treatment.

The Role of Ultrasonography in the Diagnosis and Decision Algorithm for the Management of Pneumothorax after Transbronchial Lung Cryobiopsy.

BACKGROUND: Pneumothorax is one of the main complications of transbronchial lung cryobiopsy (TBLC). Chest ultrasound (CUS) is a radiation-free alternative method for pneumothorax detection. OBJECTIVE: We tested CUS diagnostic accuracy for pneumothorax and assessed its role in the decision algorithm for pneumothorax management. Secondary objectives were to evaluate the post-procedure pneumothorax occurrence and risk factors. METHODS: Eligible patients underwent TBLC, followed by chest X-ray (CXR) evaluation 2 h after the procedure, as our standard protocol. Bedside CUS was performed within 30 min and 2 h after TBLC. Pneumothorax by CUS was defined by the absence of lung sliding and comet-tail artefacts and confirmed with the stratosphere sign on M-mode. Pneumothorax size was determined through lung point projection on CUS and interpleural distance on CXR and properly managed according to clinical status. RESULTS: Sixty-seven patients were included. Nineteen pneumothoraces were detected at 2 h after the procedure, of which 8 (42.1%) were already present at the first CUS evaluation. All CXR-detected pneumothoraces had a positive CUS detection. There were 3 discordant cases (κ = 0.88, 95% CI: 0.76-1.00, p < 0.001), which were detected by CUS but not by inspiration CXR. We calculated a specificity of 97.5% (95% CI: 86.8-99.9) and a sensitivity of 100% (95% CI: 87.2-100) for CUS. Pneumothorax rate was higher when biopsies were taken in 2 lobes and if histology had pleural representation. Final diagnosis was achieved in 79.1% of patients, with the most frequent diagnosis being hypersensitivity pneumonitis. Regarding patients with large-volume pneumothorax needing drainage, the rate of detection was similar between CUS and CRX. CONCLUSION: CUS can replace CXR in detecting the presence of pneumothorax after TBLC, and the lung point site can reliably indicate its size. This useful method optimizes time spent at the bronchology unit and allows immediate response in symptomatic patients, helping to choose optimal treatment strategies, while preventing ionizing radiation exposure.

Impact of the SARS-CoV-2 pandemic on urinary incontinence and quality of life of nulliparous women / Impacto de la pandemia del SARS-CoV-2 en la incontinencia urinaria y la calidad de vida de mujeres nulíparas / Impacto da pandemia de SARS-CoV-2 na incontinência urinária e qualidade de vida de mulheres nulíparas

ABSTRACT Objectives: To evaluate the impact of social isolation due to SARS-CoV-2 on the prevalence and severity of urinary incontinence and how this correlates with the quality of life of the nulliparous women evaluated. Method: Observational, longitudinal study, carried out from August/2019 to September/2020, at the Faculdade de Ciências da Saúde do Trairi/RN, with 37 nulliparous women from 18 to 35 years old, who answered the socio-anthropometric assessment, to the Incontinence Severity Index Questionnaire and King's Health Questionnaire, before and during isolation due to SARS-CoV-2. Statistical analysis: Wilcoxon test, and Spearman's correlation coefficient. Significance level p≤0.05. Results: During social isolation, there was an improvement in urge incontinence (p=0.01) and in the frequency of urinary incontinence (p=0.03). The severity of urinary incontinence correlated with: general health perception (p=0.02; r=0.65); physical limitations (p=0.03; r=0.60); social (p=0.001; r=0.82). Conclusion: The social isolation from SARS-CoV-2 improved urge incontinence and frequency of urinary incontinence. The more severe the urinary incontinence, the worse the general health perception, physical and social limitations during isolation.

RESUMEN Objetivo: Evaluar el impacto del aislamiento social debido al SARS-CoV-2 sobre la prevalencia y severidad de la incontinencia urinaria y cómo esto se correlaciona con la calidad de vida de las mujeres nulíparas evaluadas. Método: Estudio observacional, longitudinal, realizado de agosto/2019 a septiembre/2020, en la Faculdade de Ciências da Saúde do Trairi/RN, con 37 mujeres nulíparas de 18 a 35 años, que respondieron la evaluación socio-antropométrica, al Incontinence Severity Index Questionaire y al King's Health Questionnaire, antes y durante el aislamiento por SARS-CoV-2. Análisis estadístico: prueba de Wilcoxon y coeficiente de correlación de Spearman. Nivel de significancia p≤0.05. Resultados: Durante el aislamiento social, hubo una mejora en la incontinencia de urgencia (p=0,01) y en la frecuencia de la incontinencia urinaria (p=0,03). La gravedad de la incontinencia urinaria se correlacionó con: percepción general de salud (p=0,02; r=0,65); limitaciones físicas (p=0,03; r=0,60); (p=0,001; r=0,82). Conclusión: El aislamiento social del SARS-CoV-2 mejoró la incontinencia de urgencia y la frecuencia de la incontinencia urinaria. Cuanto más grave es la incontinencia urinaria, peor es la percepción general de las limitaciones de salud, físicas y sociales durante el aislamiento.

RESUMO Objetivo: Avaliar o impacto do isolamento social devido a SARS-CoV-2 na prevalência e gravidade da incontinência urinária e como isso se correlaciona com a qualidade de vida das mulheres nulíparas avaliadas. Métodos: Estudo observacional, longitudinal, realizado de agosto/2019 a setembro/2020, na Faculdade de Ciências da Saúde do Trairi/RN, com 37 nulíparas de 18 a 35 anos, que responderam a avaliação socioantropométrica, ao Incontinence Severity Index Questionaire e ao King's Health Questionnaire, antes e durante o isolamento devido a SARS-CoV-2. Análise estatística: Teste de Wilcoxon, e Coeficiente de Correlação de Spearman. Nível de significância p≤0,05. Resultados: Durante o isolamento social houve melhora na urgeincontinência (p=0,01) e na frequência da incontinência urinária (p=0,03). A gravidade da incontinência urinária teve correlação com: percepção geral de saúde (p=0,02; r=0,65); limitações físicas (p=0,03; r=0,60); sociais (p=0,001; r=0,82). Conclusão: O isolamento social da SARS-CoV-2 melhorou a urgeincontinência e frequência da incontinência urinária. Quanto mais grave a incontinência urinária pior a percepção geral de saúde, limitações físicas e sociais durante o isolamento.

Endobronchial mucoepidermoid carcinoma in a child with postinfectious bronchiolitis obliterans.

Endobronchial mucoepidermoid tumors are rare neoplasms. Due to nonspecific symptoms, diagnosis can be challenging, but early diagnosis and treatment are crucial for prognosis. We present the case of a boy, with chronic respiratory insufficiency due to bronchiolitis obliterans, that presented worsening exertional dyspnea at 12 years. Spirometry showed unexpected deterioration of respiratory function and a computed tomography scan revealed an obstructive polypoid mass in the intermediate bronchus. Given the severe basal ventilatory compromise and risk associated with surgical treatment, rigid bronchoscopy, and laser photocoagulation were performed, with clinical and functional improvement. The histological examination revealed a low-grade mucoepidermoid carcinoma. The option for a minimally invasive procedure requires careful follow-up due to the risk of tumor recurrence.

Enlightening clinical and therapeutic heterogeneity in thoracic actinomycosis: A review in bronchiectasis and non-bronchiectasis patients.

Actinomycosis is a rare chronic infection triggered by species of Actinomyces. Although thoracic involvement represents about 15% of human actinomycosis, its true incidence may be underestimated, not only because of its challenging diagnosis, but also because it can be treated unintentionally with antibiotics for other diseases. In this sense, this work aims at providing an up-to-date literature review on thoracic actinomycoses, with particular emphasis on presentation, diagnostic and therapeutic approaches, also paving upcoming clinical interventions from findings obtained of a presentation of a case series. Data discussed here clearly denote the rarity, non-specificity and heterogeneity of clinical presentations of the disease, reinforcing the need for individualized therapeutic approaches.

Liquid Biopsy for Disease Monitoring in Non-Small Cell Lung Cancer: The Link between Biology and the Clinic.

INTRODUCTION: Cell-free DNA (cfDNA) analysis offers a non-invasive method to identify sensitising and resistance mutations in advanced Non-Small Cell Lung Cancer (NSCLC) patients. Next-generation sequencing (NGS) of circulating free DNA (cfDNA) is a valuable tool for mutations detection and disease's clonal monitoring. MATERIAL AND METHODS: An amplicon-based targeted gene NGS panel was used to analyse 101 plasma samples of advanced non-small cell lung cancer (NSCLC) patients with known oncogenic mutations, mostly EGFR mutations, serially collected at different clinically relevant time points of the disease. RESULTS: The variant allelic frequency (VAF) monitoring in consecutive plasma samples demonstrated different molecular response and progression patterns. The decrease in or the clearance of the mutant alleles was associated with response and the increase in or the emergence of novel alterations with progression. At the best response, the median VAF was 0% (0.0% to 3.62%), lower than that at baseline, with a median of 0.53% (0.0% to 9.9%) (p = 0.004). At progression, the VAF was significantly higher (median 4.67; range: 0.0-36.9%) than that observed at the best response (p = 0.001) and baseline (p = 0.006). These variations anticipated radiographic changes in most cases, with a median time of 0.86 months. Overall, the VAF evolution of different oncogenic mutations predicts clinical outcomes. CONCLUSION: The targeted NGS of circulating tumour DNA (ctDNA) has clinical utility to monitor treatment response in patients with advanced lung adenocarcinoma.

Management of Coronavirus Disease 2019 Patients With Lung Cancer: Experience From a Thoracic Oncology Center.

BACKGROUND: Cancer patients appear to be at a higher risk of complications from coronavirus disease 2019 (COVID-19). Specific data related to lung cancer (LC) patient management, active treatment, and/or recent diagnosis are still very limited. Here, we aimed to investigate the clinical presentation, baseline features, and clinical outcomes of LC patients with COVID-19. METHODS: A retrospective case study was performed at Centro Hospitalar Universitário de São Joao, a tertiary hospital in the North of Portugal. Data from LC patients diagnosed with COVID-19 were collected during the first 10 months of the COVID-19 pandemic (March 2020-January 2021). RESULTS: Twenty-eight patients with active LC were diagnosed with COVID-19, being adenocarcinoma the most common histological type present (n = 13, 46.4%). Sixteen patients had metastatic stage IV LC (61.5%). Twenty-five patients (89.3%) had relevant comorbidities including hypertension (39.3%) and chronic obstructive pulmonary disease (32.1%). For patients undergoing antineoplastic treatment, the median time from the last chemotherapy administration to COVID-19 diagnosis was of 16 days (interquartile range = 13-41 days). Half of patients were previously on corticosteroid therapy. Twenty patients (71.4%) needed hospitalization, 18 received oxygen therapy (64.3%), 3 (10.7%) of them received high-flow nasal cannula with good tolerability, and 1 (3.6%) needed non-invasive ventilation. Hydroxychloroquine and antibiotics were given to 4 (14.3%) and 12 (42.9%) patients, respectively. Seven patients (25%) died at a median time of 5 days following COVID-19 diagnosis. CONCLUSION: This is one of the first studies reporting the adverse outcomes associated with COVID-19 in LC patients at same time that adds evidence regarding the need to create protocols and guidelines to reduce the infection risk in such patients.

Clinical Application of Next-Generation Sequencing of Plasma Cell-Free DNA for Genotyping Untreated Advanced Non-Small Cell Lung Cancer.

BACKGROUND: Analysis of circulating tumor DNA (ctDNA) has remarkable potential as a non-invasive lung cancer molecular diagnostic method. This prospective study addressed the clinical value of a targeted-gene amplicon-based plasma next-generation sequencing (NGS) assay to detect actionable mutations in ctDNA in patients with newly diagnosed advanced lung adenocarcinoma. METHODS: ctDNA test performance and concordance with tissue NGS were determined, and the correlation between ctDNA findings, clinical features, and clinical outcomes was evaluated in 115 patients with paired plasma and tissue samples. RESULTS: Targeted-gene NGS-based ctDNA and NGS-based tissue analysis detected 54 and 63 genomic alterations, respectively; 11 patients presented co-mutations, totalizing 66 hotspot mutations detected, 51 on both tissue and plasma, 12 exclusively on tissue, and 3 exclusively on plasma. NGS-based ctDNA revealed a diagnostic performance with 81.0% sensitivity, 95.3% specificity, 94.4% PPV, 83.6% NPV, test accuracy of 88.2%, and Cohen's Kappa 0.764. PFS and OS assessed by both assays did not significantly differ. Detection of ctDNA alterations was statistically associated with metastatic disease (p = 0.013), extra-thoracic metastasis (p = 0.004) and the number of organs involved (p = 0.010). CONCLUSIONS: This study highlights the potential use of ctDNA for mutation detection in newly diagnosed NSCLC patients due to its high accuracy and correlation with clinical outcomes.

Resistance Profile of Osimertinib in Pre-treated Patients With EGFR T790M-Mutated Non-small Cell Lung Cancer.

Background: Osimertinib efficacy in pre-treated patients with epidermal growth factor receptor (EGFR) T790M-mutated non-small cell lung cancer (NSCLC) has been demonstrated in clinical trials, but real-world data, particularly regarding resistance profile, remains limited. This study aims to analyze the resistance mechanisms acquired after treatment with Osimertinib. Methods: Clinical outcomes and molecular results from re-biopsies at the time of osimertinib progression of EGFR T790M-mutated NSCLC patient were analyzed. Results: Twenty-one patients with stage IV adenocarcinoma were included [median 69 years; 57.1% female; 85.7% never-smokers; 23.8% ECOG performance status (PS) ≥2]. Median PFS and OS were 13.4 (95% CI: 8.0-18.9) and 26.4 (95% IC: 8.9-43.8) months, respectively. At the time of analysis, 10 patients had tumor progression (47.6%). T790M loss occurred in 50%, being associated with earlier progression (median PFS 8.1 vs. 21.4 months, p = 0.011). Diverse molecular alterations were identified, including C797S mutation (n = 1), PIK3CA mutation (n = 2), MET amplification (n = 1), CTNNB1 mutation (n = 1), and DCTN1-ALK fusion (n = 1). Histological transformation into small cell carcinoma occurred in one patient. Conclusions: This real-world life study highlights the relevance of re-biopsy at the time of disease progression, contributing to understand resistance mechanisms and to guide treatment strategies.

16 Years in the Trachea / 16 años en la tráquea

No disponible

Modified Glasgow Prognostic Score predicts survival among advanced non-small cell lung carcinoma patients treated with anti-PD1 agents.

Immune checkpoint inhibitors were approved for advanced nonsmall cell lung cancer (NSCLC) treatment. Despite improved survival, not all patients benefit from these agents. Here, the prognostic impact of pretreatment modified Glasgow Prognostic Score (mGPS) and neutrophil-to-lymphocyte ratio (NLR) was assessed. From 77 patients included, 83.2% received at least one prior systemic therapy. Immune-related adverse events (irAE) occurred in 20 patients. A lower mGPS was associated with higher median overall survival (OS), and a lower Eastern Cooperative Oncology Group (ECOG), irAE and fewer metastatic sites with better survival. A trend towards greater OS and progression-free survival (PFS) was stated among patients with NLR <5. mGPS 0 was associated with better survival; ≥3 metastatic sites with worse PFS and OS; ECOG >2 with worse OS and irAE with better survival. Pretreatment mGPS seems to be useful for predicting survival among advanced NSCLC patients treated with anti-programmed cell death 1 drugs, with ECOG performance status, irAE occurrence, and number of metastatic sites acting as survival predictors.