Actividad citotóxica y antiproliferativa de un extracto rico en fucoidan de Lessonia trabeculata sobre células de adenocarcinoma mamario murino 4T1

Introducción. Los tumores neoplásicos se caracterizan por su invasividad y metástasis. Las células neoplásicas tienen heterogeneidad genética, por lo cual pueden desarrollar resistencia a los quimioterápicos. Por esta razón, las plantas continúan siendo una fuente importante de nuevos productos anticancerígenos. Objetivo. Evaluar la actividad citotóxica y antiproliferativa de un extracto rico en fucoidan de Lessonia trabeculata nativa (EFLt) sobre la línea celular de adenocarcinoma mamario murino, triple negativo 4T1. Métodos. La citotoxicidad y la IC50 se determinaron en monocapas de 4T1 empleando el reactivo MTT. Para demostrar la actividad antiproliferativa se aplicaron los métodos de cierre de herida y anticlonogénico utilizando las IC50 del EFLt y Dox (doxorubicina). El cierre de herida fue evaluado mediante barrido de tiempos discretos; el efecto anticlonogénico fue evaluado 7 días postratamiento mediante el conteo de colonias y se determinó la fracción de sobrevivencia. Adicionalmente, se evaluaron la citotoxicidad y actividad antiproliferativa combinando las IC50 de EFLt y Dox. El porcentaje de migración y conteo de colonias se realizó con el programa ImageJ. Resultados. La IC50 del EFLt (950 μg/mL) produjo 56% de citotoxicidad, 80,3% de inhibición de la migración celular, 68% de inhibición en la formación de colonias. La IC50 de Dox fue 0,5 μg/mL. Conclusiones. El EFLt ejerce citotoxicidad dependiente de la concentración y tiene efecto antiproliferativo sobre 4T1. Se requiere continuar los ensayos en modelos de mayor complejidad que permitan esclarecer el potencial antitumoral del EFLt.

Introduction. Neoplastic tumors are characterized by invasiveness and metastasis. Neoplastic cells are genetically heterogeneous and can develop resistance to chemotherapeutic agents. For this reason, plants continue to be an important source of new anticancer products. Objective. To determine the cytotoxic and antiproliferative activity of a fucoidan-rich extract of native Lessonia trabeculata (EFLt) on the tripe negative murine mammary adenocarcinoma cell line 4T1. Methods. Cytotoxicity and IC50 were determined in 4T1 monolayers using the MTT reagent. To demonstrate antiproliferative activity, "wound" closure and anticlonogenic methods were applied using the IC50 of EFLt and Doc (doxorubicin). "Wound" closure was evaluated by discrete times sweep to determine percentage inhibition of cell migration; the anticlonogenic effect was evaluated by colony counting 7 days after treatment and the survival fraction was determined. In addition, cytotoxicity and antiproliferative activity were evaluated by combining the IC50 of EFLt and Dox. Percent migration and colony counts were performed using ImageJ software. Results. The IC50 (950 μg/mL) of EFLt was 56% cytotoxicity, 80,3% inhibition of cell migration, 68% inhibition of colony formation.The ICof Dox was 0,5 μg/mL. Conclusions. EFLt exerts concentration-dependent cytotoxicity and antiproliferative effect on 4T1. Further studies in more complex models are needed to elucidate the anti-tumor potential of EFLt.

Avaliação de sintomas climatéricos em mulheres jovens submetidas à quimioterapia / Assessment of climacteric symptoms in young women undergoing chemotherapy / Evaluación de síntomas climatéricos en mujeres jóvenes sometidas a quimioterapia

RESUMO Objetivo: Descrever a prevalência de sintomas climatéricos em mulheres submetidas a tratamento oncológico e analisar sua relação com a quantidade de ciclos quimioterápicos. Métodos: Estudo transversal com 47 mulheres submetidas à quimioterapia em dois hospitais de referência oncológica de São Luís, Maranhão, Brasil, entre março de 2019 e julho de 2020. Utilizou-se questionário estruturado contendo variáveis sociodemográficas e informações sobre função menstrual e sintomas. Foram realizadas análise bivariada e regressão logística binária para avaliar a relação entre as variáveis previsoras e quantidade de ciclos quimioterápicos. Resultados: Média de idade de 31,71 anos, amenorreia e fogacho, foram os sintomas mais frequentes, porém, sem relação com o número de ciclos quimioterápicos. Não houve associação entre a presença de efeitos climatéricos com o tipo de quimioterapia (p=0,15). Conclusão: Reafirma-se que quimioterápicos podem causar sintomas climatéricos enfatizando a necessidade de medidas para amenizar os sintomas nas pacientes que enfrentam essa problemática.

ABSTRACT Objective: To describe the prevalence of climacteric symptoms in women undergoing cancer treatment and to analyze its relationship with the number of chemotherapy cycles. Methods: Cross-sectional study with 47 women undergoing chemotherapy in two cancer reference hospitals in São Luís, Maranhão, Brazil, between March 2019 and July 2020. A structured questionnaire was used containing sociodemographic variables and information on menstrual function and symptoms. Bivariate analysis and binary logistic regression were performed to assess the relationship between predictor variables and number of chemotherapy cycles. Results: Mean age was 31.71 years, and amenorrhea and hot flushes were the most frequent symptoms, however, unrelated to the number of chemotherapy cycles. There was no association between the presence of climacteric effects and the type of chemotherapy (p=0.15). Conclusion: The results reaffirmed that chemotherapy can cause climacteric symptoms, thus emphasizing the need for measures to alleviate symptoms in patients facing this problem.

RESUMEN Objetivo: Describir la prevalencia de síntomas climatéricos en mujeres sometidas a tratamiento oncológico y analizar su relación con la cantidad de ciclos quimioterápicos. Métodos: Estudio transversal con 47 mujeres sometidas a quimioterapia en dos hospitales oncológicos de referencia de São Luis, Maranhão, entre marzo de 2019 y julio de 2020. Se utilizó cuestionario estructurado incluyendo variables sociodemográficas e información sobre función menstrual y síntomas. Fueron practicados análisis bivariado y regresión logística binaria para evaluar la relación entre las variables de previsión y la cantidad de ciclos quimioterápicos. Resultados: Media etaria de 31,71 años, los síntomas más frecuentes fueron amenorrea y sofocos, aunque sin relación con la cantidad de ciclos quimioterápicos. No hubo asociación entre presencia de efectos climatéricos y tipo de quimioterapia (p=0,15). Conclusión: Se reafirma que los quimioterápicos pueden causar síntomas climatéricos, enfatizándose la necesidad de medidas para aliviar los síntomas en las pacientes que enfrentan esta problemática.

A logarithmic model for hormone receptor-positive and breast cancer patients treated with neoadjuvant chemotherapy

SUMMARY OBJECTIVE: The aim of this study was to investigate the predictive importance of the previously validated log(ER)*log(PgR)/Ki-67 predictive model in a larger patient population. METHODS: Patients with hormone receptor positive/HER-2 negative and clinical node positive before chemotherapy were included. Log(ER)*log(PgR)/Ki-67 values of the patients were determined, and the ideal cutoff value was calculated using a receiver operating characteristic curve analysis. It was analyzed with a logistic regression model along with other clinical and pathological characteristics. RESULTS: A total of 181 patients were included in the study. The ideal cutoff value for pathological response was 0.12 (area under the curve=0.585, p=0.032). In the univariate analysis, no statistical correlation was observed between luminal subtype (p=0.294), histological type (p=0.238), clinical t-stage (p=0.927), progesterone receptor level (p=0.261), Ki-67 cutoff value (p=0.425), and pathological complete response. There was a positive relationship between numerical increase in age and residual disease. As the grade of the patients increased, the probability of residual disease decreased. Patients with log(ER)*log(PgR)/Ki-67 above 0.12 had an approximately threefold increased risk of residual disease when compared to patients with 0.12 and below (odds ratio: 3.17, 95% confidence interval: 1.48-6.75, p=0.003). When age, grade, and logarithmic formula were assessed together, the logarithmic formula maintained its statistical significance (odds ratio: 2.47, 95% confidence interval: 1.07-5.69, p=0.034). CONCLUSION: In hormone receptor-positive breast cancer patients receiving neoadjuvant chemotherapy, the logarithmic model has been shown in a larger patient population to be an inexpensive, easy, and rapidly applicable predictive marker that can be used to predict response.

Osimertinibe comparado a Erlotinibe Gefitinibe ou quimioterapia para tratamento de carcinoma pulmonar de células não pequenas com mutação do gene do receptor do fator de crescimento epidérmico (EFGR): revisão rápida / Osimertinib compared to erlotinib, gefitinib or chemotherapy for the treatment of non-small cell pumonary carcinoma with epidermal growth factor receptor (EFGR) gene mutation: rapid review

Mesilato de osimertinibe, gefitinibe, erlotinibe, quimioterapia padrão. Indicação: Câncer de pulmão de células não pequenas com mutação do receptor do fator de crescimento epidérmico (EGFR). Pergunta: Mesilato de osimertinibe é mais eficaz e seguro que gefitinibe, erlotinibe ou quimioterapia para os desfechos de sobrevida global, sobrevida livre de progressão e de segurança no tratamento de carcinoma pulmonar de células não pequenas com mutação do EGFR? Métodos: Levantamento bibliográfico foi realizado na base de dados PUBMED e EPISTEMONIKOS, seguindo estratégias de buscas predefinidas. Foi feita avaliação da qualidade metodológica das revisões sistemáticas com a ferramenta AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews Version 2). Resultados: Foram selecionadas duas revisões sistemáticas que atenderam aos critérios de elegibilidade. Conclusão: Mesilato de osimertinibe é mais eficaz do que gefitinibe ou erlotinibe na melhora da sobrevida global e da sobrevida livre de progressão em pacientes virgens de tratamento. Em pacientes previamente tratados, o mesilato de osimertinibe não é superior à quimioterapia padrão à base de platina no prolongamento da sobrevida global, mas é mais eficaz no aumento da sobrevida livre de progressão. Para câncer avançado, mesilato de osimertinibe não é mais eficaz do que a quimioterapia com ou sem pemetrexede para prolongar a sobrevida global, mas é mais eficaz em melhorar a sobrevida livre de progressão. Gefitinibe combinado com quimioterapia à base de pemetrexede foi superior à quimioterapia com ou sem pemetrexede na melhora da sobrevida global e da sobrevida livre de progressão

Osimertinib mesylate, gefitinib, erlotinib, standard chemotherapy. Indication: Non-small cell lung cancer with epidermal growth factor receptor (EGFR) mutation. Question: Is osimertinib mesylate more effective and safer than gefitinib, erlotinib or chemotherapy for overall survival, progression-free survival and safety outcomes in the treatment of non-small cell lung cancer with EGFR mutation? Methods: A bibliographic search was done in the PUBMED and EPISTEMONIKOS database, following predefined search strategies. The methodological quality of systematic reviews was evaluated using the Assessing the Methodological Quality of Systematic Reviews Version 2 tool. Results: Two systematic reviews were selected because they met the eligibility criteria. Conclusion: Osimertinib mesylate is more effective than gefitinib or erlotinib in improving overall survival and progression-free survival in treatment-naive patients. In previously treated patients, osimertinib mesylate is not superior to standard platinum-based chemotherapy in prolonging overall survival, but it is more effective in increasing progression-free survival. For advanced cancer, osimertinib mesylate is not more effective than chemotherapy with or without pemetrexed in prolonging overall survival, but it is more effective in improving progression-free survival. Gefitinib combined with pemetrexed-based chemotherapy was superior to chemotherapy with or without pemetrexed in improving overall survival and progression-free survival

Evaluation of acupuncture and auriculotherapy in the control of chemotherapy-induced nausea and vomiting: a Pilot Study / Evaluación de la acupuntura y la auriculoterapia en el control de las náuseas y vómitos inducidos por la quimioterapia: Estudio piloto / Avaliação da acupuntura e auriculoterapia no controle de náuseas e vômitos induzidos por quimioterapia: Estudo Piloto

ABSTRACT Objective: To evaluate the effectiveness of acupuncture and auriculotherapy protocol in relieving chemotherapy-induced nausea and vomiting in cancer patients compared to the antiemetic protocol. Method: Pilot study of a pragmatic two-arm clinical trial: an acupuncture group received systemic acupuncture, auriculotherapy, and antiemetic protocol; a control group used antiemetic protocol. The sample consisted of 42 patients with cancer of the gastrointestinal system or multiple myeloma. The outcome was assessed using the Chemotherapy-Induced Nausea and Vomiting Assessment Tool and the patient's diary. Results: There was no statistically significant difference between groups according to the assessment of the patient's diary and the Assessment Tool of chemotherapy-induced nausea and vomiting. The patients were 60 years old on average and the groups were homogeneous, except for marital status. In the diary, there was no statistical difference between groups and sessions for days of nausea (p = 0.873) and vomiting episodes (p = 0.993). Conclusion: The protocol of acupuncture and auriculotherapy as a complementary treatment of chemotherapy-induced nausea and vomiting was ineffective, considering the limitations of the study.

RESUMEN Objetivo: Evaluar la efectividad del protocolo de acupuntura y auriculoterapia para aliviar las náuseas y los vómitos inducidos por la quimioterapia en pacientes con cáncer en comparación con el protocolo antiemético. Método: Estudio piloto tipo ensayo clínico pragmático con dos brazos: el grupo de acupuntura recibió acupuntura sistémica, auriculoterapia y protocolo antiemético, el grupo control utilizó un protocolo antiemético. La muestra estuvo compuesta por 42 pacientes con cáncer del sistema gastrointestinal o mieloma múltiple. El resultado se evaluó mediante el Instrumento de Evaluación de Náuseas y Vómitos inducidos por quimioterapia y el diario del paciente. Resultados: No hubo diferencias estadísticamente significativas entre los grupos según la evaluación del diario del paciente y el Instrumento de Evaluación de náuseas y vómitos inducidos por quimioterapia. Los pacientes tenían en promedio 60 años y los grupos eran homogéneos, excepto por el estado civil. En el diario no hubo diferencia estadística entre los grupos y sesiones para los días de náuseas (p = 0,873) y episodios de vómitos (p = 0,993). Conclusión: El protocolo de acupuntura y auriculoterapia como tratamiento complementario de las náuseas y vómitos inducidos por la quimioterapia resultó ineficaz, considerando las limitaciones del estudio.

RESUMO Objetivo: Avaliar a efetividade do protocolo de acupuntura e auriculoterapia no alívio de náuseas e vômitos induzidos por quimioterapia em pacientes oncológicos em comparação ao protocolo antiemético. Método: Estudo piloto tipo ensaio clínico pragmático de dois braços: grupo acupuntura recebeu acupuntura sistêmica, auriculoterapia e protocolo antiemético, o grupo controle utilizou protocolo antiemético. A amostra foi composta por 42 pacientes com câncer do sistema gastrointestinal ou mieloma múltiplo. O desfecho foi avaliado pelo Instrumento de Avaliação de náuseas e vômitos induzidos por quimioterapia e diário do paciente. Resultados: Não houve diferença estatística significativa entre os grupos pela avaliação do diário do paciente e Instrumento de Avaliação de náuseas e vômitos induzidos por quimioterapia. Os pacientes apresentavam em média 60 anos e os grupos foram homogêneos, exceto para o estado civil. No diário, não houve diferença estatística entre os grupos e as sessões para os dias de náuseas (p = 0,873) e episódios de vômitos (p = 0,993). Conclusão: O protocolo de acupuntura e auriculoterapia como tratamento complementar de náuseas e vômitos induzidos por quimioterapia foi inefetivo, considerando as limitações do estudo.

Epidemiological profile of COVID-19 in patients with prostate cancer undergoing androgen deprivation therapy at a Brazilian Cancer Center

ABSTRACT Objective To describe the epidemiological aspects of COVID-19 in patients with prostate cancer who received androgen deprivation therapy and those who did not. Methods We retrospectively analyzed the medical records of patients with prostate cancer undergoing androgen deprivation therapy and those who did not undergo androgen deprivation therapy. These patients were treated at the A.C.Camargo Cancer Center between March 2020 and March 2021. Results Of the 78 patients with prostate cancer and positive RT-PCR test results, 50% were undergoing androgen deprivation therapy, and 49% were experiencing a non-metastatic biochemical relapse. Of these, 80.6% were symptomatic on the day of examination compared to 97.2% in the Control Group. A total of 82.1% of the patients receiving androgen deprivation therapy required hospitalization, with 30.8% admitted to the intensive care unit compared to 21.6% in the Control Group. There was no statistically significant difference in the use of a high-flow oxygen cannula, the need for orotracheal intubation and mechanical ventilation, the need for dialysis, multiple organ failure, or death. A significant difference was found between the groups in terms of the average length of stay in the intensive care unit. Conclusion Androgen deprivation therapy was not associated with protective factors or potential treatments in patients with prostate cancer and COVID-19. Although the number of patients analyzed was limited, and there may have been a selection bias, this is a unique study that cannot be expanded or replicated in similar (unvaccinated) populations.

Mucosite oral quimioinduzida: aspectos clínicos, laboratoriais, qualidade de vida, ansiedade e depressão / Chemotherapy-induced oral mucositis: clinical and laboratory aspects, quality of life, anxiety, and depression

O presente estudo é fundamentado em três objetivos: 1. sintetizar informações sobre ansiedade/depressão de indivíduos em regimes antineoplásicos que desenvolveram mucosite oral por meio de uma revisão sistemática da literatura; 2. avaliar o perfil de citocinas inflamatórias e a formação de redes extracelulares de neutrófilos em amostras de saliva de pacientes em quimioterapia e suas associações com mucosite oral; e 3. investigar ansiedade/depressão e qualidade de vida e associações com mucosite oral quimioinduzida. No primeiro estudo, buscas eletrônicas foram realizadas em cinco bases de dados, complementadas por escrutínio manual e pesquisas na literatura cinzenta. Oito estudos observacionais foram incluídos e a amostra analisada foi de 954 indivíduos. Sete instrumentos diferentes foram aplicados para mensurar ansiedade e/ou depressão. Associações de ansiedade e/ou depressão com a gravidade da mucosite oral foram observadas em 75,0% dos estudos. Os outros dois estudos foram análises longitudinais prospectivas com indivíduos adultos com diagnóstico de doenças hematolinfóides e em tratamento quimioterápico e/ou condicionamento para transplante de células-tronco hematopoiéticas no Hospital das Clínicas da Universidade Federal de Minas Gerais. Os níveis de citocinas inflamatórias (IL-1, IL-6, IL-8, TNF-α e TGF-ß1) e a formação de redes extracelulares de neutrófilos foram analisados por ELISA e identificação do complexo mieloperoxidase-DNA, respectivamente. As coletas de saliva foram realizadas em quatro momentos: dias D0, D3, D10 e D15. Dos 60 pacientes avaliados, 26 (43,3%) desenvolveram algum grau de mucosite oral. Os níveis de concentração de citocinas revelaram diferenças entre indivíduos com e sem mucosite oral. Concentrações significativamente maiores de IL-6 e TNF-α e menores concentrações de TGF-ß1 foram identificadas naqueles que desenvolveram mucosite oral. Houve uma diminuição na formação das redes extracelulares de neutrófilos entre aqueles que tiveram mucosite oral. Entretanto, não foram identificadas diferenças estatísticas entre as concentrações de citocinas e a formação de redes extracelulares de neutrófilos com variáveis clínicas e gravidade da mucosite oral. No terceiro estudo, os instrumentos Hospital Anxiety and Depression Scale, World Health Organization Quality of Life-BREF e Oral Health Impact Profile (versão abreviada ­ OHIP-14) foram aplicados a 37 pacientes nos dias D0 e D15. Aproximadamente 38% (n=14) dos indivíduos desenvolveram mucosite oral e obtiveram escores mais altos de ansiedade/depressão no início da análise. A mucosite oral teve um impacto negativo na qualidade de vida relacionada à saúde bucal, particularmente nas dimensões limitação funcional, dor física e incapacidade física. Em conjunto, os dados deste estudo contribuem para medidas preventivas e redução de comorbidades em pacientes com mucosite oral induzida por esquemas quimioterápicos. As citocinas inflamatórias participam do desenvolvimento da mucosite oral e podem ser úteis como biomarcadores na predição e monitoramento. Ademais, sintomas de ansiedade e depressão estão associados à mucosite oral que, por sua vez, afetam a saúde geral e a qualidade de vida relacionada à saúde bucal.

The present study is based on three purposes: 1. to synthesize by means of a systematic literature review information about anxiety/depression in individuals undergoing antineoplastic therapy who developed oral mucositis; 2. to evaluate the profile of inflammatory cytokines and neutrophil extracellular trap formation in salivary samples from patients undergoing chemotherapy and its associations with oral mucositis; and 3. to investigate anxiety/depression and quality of life and their associations with chemotherapy-induced oral mucositis. In the first study, electronic searches were conducted on five databases, complemented by manual scrutiny and grey literature searches in three other databases. Eight observational studies conducted on 954 individuals were included. Seven different instruments were applied to measure anxiety and/or depression. Associations of anxiety and/or depression with the severity of oral mucositis were observed in 75.0% of the studies. The other two studies were prospective longitudinal analyses of adult individuals diagnosed with hematolymphoid diseases and undergoing chemotherapy treatment and/or conditioning for hematopoietic stem-cell transplantation at the Hospital das Clínicas of Universidade Federal de Minas Gerais. The levels of inflammatory cytokines (IL-1, IL-6, IL-8, TNF-α, and TGF-ß1) and neutrophil extracellular trap formation were analyzed by ELISA and by the identification of the myeloperoxidase-DNA complex, respectively. Saliva sampling was performed at four time-points, i.e. days D0, D3, D10, and D15. Of the 60 patients evaluated, 26 (43.3%) developed some degree of oral mucositis. Cytokine concentration levels revealed differences between individuals with and without oral mucositis. Significantly higher concentrations of IL-6 and TNF-α and lower concentrations of TGF-ß1 were identified in those who developed oral mucositis. There was a decrease in neutrophil extracellular trap formation among those who experienced oral mucositis. However, no statistical differences were identified between cytokine concentrations or neutrophil extracellular trap formation and clinical variables or severity of oral mucositis. In the third study, the Hospital Anxiety and Depression Scale, World Health Organization Quality of Life-BREF and Oral Health Impact Profile (short-form ­ OHIP-14) were the instruments applied to 37 patients on days D0 and D15. Nearly 38% (n=14) of individuals developed oral mucositis and had higher anxiety/depression scores at baseline. Oral mucositis had a negative impact on quality of life related to oral health, particularly functional limitation, physical pain, and physical disability. Taken together, the data from this study contribute to the application of preventive measures and the reduction of comorbidities in patients with chemotherapy-induced oral mucositis. Inflammatory cytokines participate in the development of oral mucositis and may be useful as biomarkers in prediction and monitoring. Moreover, anxiety and depressive symptoms are associated with oral mucositis, affecting, in turn, overall health and oral health-related quality of life

Carcinogenic drug exposure among health-sector workers: the need for exposure assessment and surveillance / Exposición a medicamentos cancerígenos en trabajadores del sector de la salud: necesidad de evaluación y vigilancia de la exposición / Exposição a fármacos carcinogênicos entre profissionais de saúde: necessidade de avaliação e vigilância da exposição

ABSTRACT Antineoplastic drugs (ANDs) used for chemotherapy can cause secondary cancers in treated patients and can pose carcinogenic risks to health-sector workers anywhere along these drugs' life cycle in a facility, from production to patient administration. Several PAHO/WHO Collaborating Centers (CCs) have experience addressing these hazards in the health sector. The objectives of this report are four-fold: 1) Provide an overview of longstanding research and prevention efforts, led by PAHO/WHO and its Occupational Health CCs, aimed at reducing the burden of occupational cancer in the Americas; 2) Discuss how robust AND exposure assessment and educational/outreach work by PAHO CCs can form the basis of exposure mitigation efforts among health-sector workers; 3) Through the presentation of original AND exposure assessment data from a pharmaceutical compounding facility in Chile, highlight relatively inexpensive methods by which such data can be generated; and 4) Discuss how effective, periodic environmental surveillance in healthcare facilities results in the identification of AND contamination in the work environment and enables the implementation of low-cost, high-impact interventions to reduce the risk of occupational cancer in health-sector workers, including in limited-resource settings. The risk of health-sector worker exposure to ANDs and other hazardous drugs is an important issue for inclusion within PAHO/WHO's broader efforts at reducing the impact of occupational cancer in the Americas. This report demonstrates that a wide range of accessible AND-exposure mitigation strategies are feasible at both a facility and a national policy level across the hemisphere.

RESUMEN Los medicamentos antineoplásicos empleados en quimioterapia pueden causar distintos tipos de tumores secundarios en pacientes tratados y presentar riesgos cancerígenos para los trabajadores del sector de la salud en cualquier momento del ciclo de vida de estos medicamentos en las instalaciones, desde su producción hasta su administración al paciente. Varios centros colaboradores de la OPS/OMS tienen experiencia en cuanto a cómo abordar estos peligros en el sector de la salud. Este informe persigue cuatro objetivos: 1) ofrecer una visión general de la labor de investigación y prevención de larga data, liderada por la OPS/OMS y sus centros colaboradores de salud ocupacional, encaminada a reducir la carga del cáncer ocupacional en la Región de las Américas; 2) abordar cómo una evaluación sólida de la exposición a los medicamentos antineoplásicos y la labor educativa y divulgativa de los centros colaboradores de la OPS pueden sentar las bases de los esfuerzos de mitigación de la exposición en los trabajadores del sector de la salud; 3) mediante la presentación de datos originales sobre la evaluación de la exposición a los medicamentos antineoplásicos en una instalación de compuestos farmacéuticos en Chile, destacar métodos relativamente asequibles gracias a los cuales se pueden recopilar dichos datos; y 4) examinar cómo la vigilancia ambiental efectiva y periódica en los centros de salud permite detectar casos de contaminación de medicamentos antineoplásicos en el entorno de trabajo y facilita la ejecución de intervenciones de bajo costo y alto impacto para reducir el riesgo de cáncer ocupacional en los trabajadores del sector de la salud, incluso en entornos de recursos limitados. El riesgo de exposición de los trabajadores del sector de la salud a los medicamentos antineoplásicos y otros medicamentos peligrosos es una cuestión importante para su inclusión en los esfuerzos más amplios de la OPS/OMS para reducir los efectos del cáncer ocupacional en la Región de las Américas. En este informe se demuestra que una amplia gama de estrategias accesibles de mitigación de la exposición a los medicamentos antineoplásicos es factible tanto a nivel de las instalaciones como de las políticas nacionales en toda la Región.

RESUMO Os medicamentos antineoplásicos usados para quimioterapia podem causar cânceres secundários em pacientes tratados e apresentar riscos carcinogênicos aos profissionais de saúde em qualquer momento do ciclo de vida desses fármacos dentro de um estabelecimento, desde sua produção até a administração ao paciente. Vários centros colaboradores da OPAS/OMS têm experiência em lidar com esses riscos no setor de saúde. Este relatório tem quatro objetivos: 1) fornecer uma visão geral dos esforços de longa data em pesquisa e prevenção liderados pela OPAS/OMS e por seus centros colaboradores de saúde ocupacional, cuja meta é reduzir a carga do câncer ocupacional nas Américas; 2) discutir como uma avaliação robusta da exposição aos antineoplásicos e o trabalho de extensão/educacional dos centros colaboradores da OPAS/OMS podem embasar os esforços de mitigação da exposição entre os profissionais de saúde; 3) por meio da apresentação de dados originais de avaliação da exposição a antineoplásicos obtidos de uma central de manipulação de medicamentos no Chile, destacar métodos relativamente econômicos para gerar esse tipo de dados; e 4) discutir como a vigilância ambiental eficaz e periódica em estabelecimentos de saúde resulta na identificação de contaminação por antineoplásicos no ambiente de trabalho e permite a implementação de intervenções de baixo custo e alto impacto para reduzir o risco de câncer ocupacional em profissionais de saúde, inclusive em contextos de recursos limitados. O risco de exposição dos profissionais de saúde aos medicamentos antineoplásicos e outros fármacos perigosos é uma questão importante a ser incluída nos esforços mais amplos da OPAS/OMS de reduzir o impacto do câncer ocupacional nas Américas. Este relatório demonstra a viabilidade de uma ampla gama de estratégias acessíveis de mitigação da exposição aos antineoplásicos, tanto no nível das instituições quanto no âmbito de políticas nacionais em todo o hemisfério.

Uso do dispositivo Pegfilgrastim OBI para prevenção de neutropenia: revisão de escopo / Uso del dispositivo Pegfilgrastim OBI para prevenir la neutropenia: revisión de alcance / Pegfilgrastim OBI device use for neutropenia prevention: a scoping review

Resumo Objetivo Mapear os cuidados em saúde do dispositivo Pegfilgrastim on-body injector na prevenção de neutropenia em adultos com câncer em assistência domiciliar após quimioterapia ambulatorial. Métodos Revisão de escopo baseada na metodologia do Joanna Briggs Institute . Foram incluídos somente estudos com adultos com câncer submetidos à quimioterapia ambulatorial. A busca foi realizada nas bases de dados Cochrane, CINAHL, EMBASE, LILACS , PubMed, Scopus, LIVIVO e Web of Science, além da literatura cinzenta ProQuest, Scielo, Banco de Dados em Enfermagem, Google Scholar, Open Grey, bula do medicamento e websites . Foram esgotadas as buscas nas referências dos estudos elegidos. Todos os estudos identificados foram exportados para o gerenciador de referências EndNote para organização e remoção das duplicadas. Utilizou-se o aplicativo web Rayyan para seleção das evidências. Os estudos foram selecionados por pares e de forma independente, sendo os conflitos solucionados por um terceiro pesquisador. Resultados Foram incluídos 10 artigos cujos resultados foram subdivididos nas categorias: adesão do paciente, opinião da equipe de saúde, carga de trabalho do paciente em tratamento do câncer e uso do dispositivo na prática clínica. O dispositivo apresenta poucas falhas e foi aceito pelas equipes de saúde e pacientes na maioria dos estudos. Conclusão Os principais cuidados em saúde para o uso do dispositivo Pegfilgrastim on-body injector estão relacionados à técnica de preparo da pele onde o dispositivo será aplicado, o preparo e a administração do dispositivo. Além disso, salienta-se a importância da avaliação do conhecimento do paciente e seu familiar sobre o dispositivo, o fornecimento de todas as orientações necessárias, verbalmente e por escrito, de forma clara e objetiva, e a validação dessas informações, certificando-se que o paciente compreendeu todas elas e está seguro.

Resumen Objetivo Mapear los cuidados de la salud al utilizar el dispositivo Pegfilgrastim on-body injector para prevenir la neutropenia en adultos con cáncer en atención domiciliaria después de quimioterapia ambulatoria. Métodos Revisión de alcance basada en la metodología del Joanna Briggs Institute . Se incluyeron solamente estudios con adultos con cáncer sometidos a quimioterapia ambulatoria. La búsqueda se realizó en las bases de datos Cochrane, CINAHL, EMBASE, LILACS , PubMed, Scopus, LIVIVO y Web of Science, además de la literatura gris ProQuest, Scielo, Banco de Datos de Enfermería, Google Scholar, Open Grey, prospecto del medicamento y sitios web. Se concluyeron las búsquedas en las referencias de los estudios seleccionados. Todos los estudios identificados se exportaron al programa de gestión de referencias EndNote para organizarlas y remover las duplicadas. Se utilizó la aplicación web Rayyan para seleccionar las evidencias. Se seleccionaron los estudios por pares y de forma independiente, y los conflictos se solucionaron mediante un tercer investigador. Resultados Se incluyeron diez artículos cuyos resultados fueron subdivididos en las siguientes categorías: adhesión del paciente, opinión del equipo de salud, carga de trabajo del paciente en tratamiento de cáncer y uso del dispositivo en la práctica clínica. El dispositivo presenta pocas fallas y fue aceptado por los equipos de salud y por los pacientes en la mayoría de los estudios. Conclusión Los principales cuidados de la salud para el uso del dispositivo Pegfilgrastim on-body injector se relacionan con la técnica de preparación de la piel donde se aplicará el dispositivo, la preparación y la administración del dispositivo. Además, se destaca la importancia de la evaluación de conocimientos del paciente y su familiar sobre el dispositivo, la entrega de todas las instrucciones necesarias, verbalmente y por escrito, de forma clara y objetiva, la validación de la información y la verificación de que el paciente haya comprendido todo y esté seguro.

Abstract Objective To map the health care of Pegfilgrastim On-body Injector in neutropenia prevention in adults with cancer in home care after outpatient chemotherapy. Methods This is a scoping review based on the JBI methodology. Only studies with adults with cancer undergoing outpatient chemotherapy were included. The search was carried out in the Cochrane, CINAHL, EMBASE, LILACS, PubMed, Scopus, LIVIVO and Web of Science databases, in addition to gray literature ProQuest, SciELO, Database in Nursing, Google Scholar, Open Grey, drug leaflet and websites. The searches in the references of selected studies were exhausted. All identified studies were exported to the EndNote reference manager for organization and removal of duplicates. The Rayyan web application was used for evidence selection. The studies were selected by pairs independently, with conflicts resolved by a third researcher. Results A total of 10 articles were included, whose results were subdivided into categories: patient compliance, health team opinion, patient workload in cancer treatment and device use in clinical practice. The device has few flaws and was accepted by health care teams and patients in most studies. Conclusion The main health care for Pegfilgrastim On-body Injector use is related to the skin preparation technique where the device will be applied, in addition to device preparation and administration. Moreover, the importance of assessing the knowledge of patients and their family about the device is highlighted, providing all the necessary guidelines, verbally and in writing, clearly and objectively, and validating this information, making sure that patients have understood all of them and are safe.

Follow up of utility and value of totally implantable chemotherapy catheter in 233 brazilian patients receiving chemotherapy to treat cancer / Acompanhamento da utilidade e valor do cateter de quimioterapia totalmente implantável em 233 pacientes brasileiros que receberam quimioterapia para tratar o câncer

ABSTRACT Objectives: the present study aims to evaluate cancer patients related to the catheter flow and the general satisfaction of these patients. Methods: we studied 233 individuals diagnosed with cancer who underwent chemotherapy treatment through venous access through portocath between January 2015 and December 2019. Results: 97% of the patients consulted had palliative chemotherapy, and 99.1% of patients reported satisfaction with the implantation process and treatment method. Regarding catheter flow according to venous return and drip during drug infusion, 98.7% of individuals presented good flow. Conclusions: the results show that catheter flow was satisfactory in all implant sites observed and emphasize the advantages of using a totally implanted catheter. This benefice happens due to the reduction of emotional factors that cause stress in cancer patients receiving chemotherapy, as well as the reduction of trauma and discomfort experienced by patients during the infusion of peripheral chemotherapy.

RESUMO Objetivos: avaliar pacientes com câncer em relação ao fluxo do cateter e a satisfação geral desses pacientes. Métodos: estudo retrospectivo avaliando prontuários de 233 indivíduos com diagnóstico de câncer que realizaram tratamento quimioterápico por acesso venoso por portocath entre janeiro de 2015 e dezembro de 2019. Resultados: 97% dos pacientes realizaram quimioterapia paliativa, e 99,1% dos pacientes relataram satisfação com o processo de implantação e método de tratamento. Em relação ao fluxo do cateter de acordo com o retorno venoso e gotejamento durante a infusão da droga, 98,7% dos indivíduos apresentaram bom fluxo. Conclusões: os resultados mostram que o fluxo do cateter foi satisfatório em todos os locais de implante observados e enfatizam as vantagens do uso de um cateter totalmente implantado. Esse benefício acontece devido à redução de fatores emocionais que causam estresse em pacientes oncológicos em tratamento quimioterápico, bem como a redução de traumas e desconfortos vivenciados pelos pacientes durante a infusão de quimioterápicos periféricos.

Hormone therapy in the treatment of breast cancer and main outcomes in sexuality

Hormone-dependent breast cancer has growth factors that respond positively to the hormones estrogen and progesterone. Thus, adjuvant endocrine therapy causes decreased or undetectable serum levels of these hormones. However, this treatment can have side effects that compromise the sexual health of patients, such as dyspareunia, vaginal dryness and decreased libido. In this scenario, the objective of this work was to document the main outcomes in sexuality in women after treatment for hormonepositive breast cancer. Thus, this is an integrative literature review, in which the following databases were used: U.S. National Library of Medicine (PubMed), Virtual Health Library (BVS), SCOPUS and Scientific Electronic Library Online (SCIELO), using the descriptors: "sexuality", "antineoplastic agents, hormonal" and "breast neoplasms", joined by the Boolean operator "AND". Full articles published in the last 5 years (2017-2022) were included; written in Portuguese or English. Articles dealing with non-hormone-dependent or metastatic breast cancer, or with patients younger than 18 years, or articles that did not answer the research question were excluded. In total, 26 articles were identified, of which 7 comprised the final sample of this review. A total of 3,850 women participated in the included studies. The main sexual dysfunctions found were: dyspareunia, hot flashes, decreased libido, vaginal dryness, breast tenderness, self-image concerns and hair loss. The symptom vaginal dryness was the most prevalent, mentioned in 71.4% of the articles included. In view of the adverse effects listed in this review, there is a need to carry out more studies on this topic, since the diagnosis of this comorbidity brings clinical, psychological, emotional, sociocultural and economic outcomes for the patient. Thus, a multidisciplinary team must assertively address these complaints to improve the overall quality of life of these women (AU)

Construction and validation of an instrument to assess the comfort of adolescents undergoing chemotherapy / Construcción y validación de un instrumento para evaluar el confort de adolescentes en quimioterapia / Construção e validação de um instrumento para avaliação do conforto de adolescentes em tratamento quimioterápico

ABSTRACT Objective: To build and validate a self-report instrument to assess the comfort of adolescents with cancer undergoing chemotherapy. Methods: This methodological study was developed in five stages: scoping review; qualitative study to characterize comfort from the perspective of adolescents with cancer undergoing chemotherapy; instrument construction; instrument content validation by experts; pre-test with a group of adolescents. Results: In the scoping review, 20 comfort changes were identified; regarding the perspective of comfort for adolescents, it was possible to identify the effects on their daily lives and the impact on chemotherapy; in content validation, the index was 0.96 and Cronbach's Alpha 0.87. In the pre-test, the instrument obtained the final version with 37 items and Cronbach's Alpha 0.94. Conclusions: The constructed and validated self-report instrument showed good reliability related to satisfactory psychometric parameters and can be used by nurses in clinical practice to assess and evidence comfort changes.

RESUMEN Objetivo: Construir y validar un instrumento de autoinforme para evaluar el confort de adolescentes con cáncer en quimioterapia. Métodos: Estudio metodológico desarrollado en cinco etapas: revisión de alcance; estudio cualitativo para caracterizar el confort en la perspectiva de adolescentes con cáncer en quimioterapia; construcción de instrumentos; validación del contenido del instrumento por expertos; prueba previa con un grupo de adolescentes. Resultados: En la revisión del alcance, se identificaron 20 cambios en la comodidad; en cuanto a la perspectiva de la comodidad de los adolescentes, fue posible identificar los efectos en su vida cotidiana y el impacto en el tratamiento de quimioterapia; en la validación de contenido el índice fue de 0,96 y el Alfa de Cronbach de 0,87. En el pretest, el instrumento obtuvo la versión final con 37 ítems y Alpha de Cronbach 0,94. Conclusiones: El instrumento de autoinforme construido y validado mostró buena confiabilidad relacionada con parámetros psicométricos satisfactorios, y puede ser utilizado por enfermeros en la práctica clínica para evaluar el confort y evidenciar modificaciones.

RESUMO Objetivo: Construir e validar um instrumento de autorrelato para avaliação do conforto de adolescentes com câncer em tratamento quimioterápico. Métodos: Estudo metodológico desenvolvido em cinco etapas: revisão de escopo; estudo qualitativo para caracterização do conforto na perspectiva do adolescente com câncer em tratamento quimioterápico; construção do instrumento; validação de conteúdo do instrumento por experts; pré-teste com grupo de adolescentes. Resultados: Na revisão de escopo, identificaram-se 20 alterações de conforto; quanto à perspectiva do conforto para o adolescente, foi possível identificar os efeitos em seu cotidiano e o impacto no tratamento quimioterápico; na validação de conteúdo, o índice foi de 0,96 e Alfa de Cronbach 0,87. No pré-teste, o instrumento obteve a versão final com 37 itens e Alfa de Cronbach 0,94. Conclusões: O instrumento de autorrelato construído e validado apresentou boa confiabilidade relacionado aos parâmetros psicométricos satisfatórios, podendo ser utilizado pelo enfermeiro na prática clínica, para avaliação do conforto e evidenciar alterações.

Oral mucositis and microbial status in acute lymphoblastic leukemia subjects undergoing high-dose chemotherapy

Aim: To assess oral microbial status in patients with acute lymphoblastic leukemia (ALL) undergoing high-dose chemotherapy and to unravel possible associations between nosocomial pathogens and the establishment of chemotherapy-induced oral mucositis (CIOM). Methods: Oral mucosa, saliva, and peripheral blood samples were collected from 46 ALL subjects one day prior to chemotherapy (D0) and 2 weeks after treatment initiation (D14). Clinical intraoral inspection was performed by a single practitioner, with mucositis classification performed according to the WHO oral toxicity scale. Blood components were quantified by automatic flow cytometry, while oral Staphylococcus aureus and Pseudomonas aeruginosa were detected by Polymerase Chain Reaction with species-specific primers. Associations among bacteria and clinical findings were determined by Fisher's Exact test, longitudinal bacterial changes by paired Macnemar, and correlations among blood parameters and mucositis status or bacteria via Mann-Whitney. Results: S. aureus displayed higher detection rates at D14 (p < 0.05) and was positively associated with mucositis, adoption of a non-solid diet (all p < 0.001), nausea and fever (all p < 0.05). Conversely, P. aeruginosa did not correlate to CIOM clinical parameters. At the systemic standpoint, lower hemoglobin levels associated with CIOM and fever events (all p < 0.01). Conclusion: The study evidences S. aureus as a potential pathogen in ALL-CIOM, reaffirming microbial control as an important preventive measure during high-dose immunosuppressive therapy. The weight of non-white-blood-cell parameters should be validated as novel CIOM biomarkers in prospective research

Renal injury induced by lenvatinib in advanced hepatocellular carcinoma treated with multi- drug combination: a case report and literature review / 中华肾脏病杂志

The article reported one case of renal damage caused by lenvatinib in the treatment of advanced primary liver cancer. The patient was a 63-year-old male who was admitted to the hospital due to "liver cancer for 4 years, blood pressure elevation for nearly 2 years, and edema for 7 months". During the treatment of liver tumors with atezolizumab combined with lenvatinib, blood pressure increased and renal insufficiency aggravated progressively. Pathological light microscopy of renal biopsy showed endothelial cell lesion and tubulointerstitial damage, and electron microscopy showed moderate proliferation of mesangial cells and deposition of mesangial matrix. There were many agglomerated low-electron density deposits in the mesangial area, and a small amount of electron dense deposits in the subendothelium. The pathological diagnosis was endothelial cell disease (thrombotic microangiopathy) and secondary focal segmental glomerulosclerosis. Renal injury was considered as secondary to lenvatinib. After discontinuing lenvatinib and giving angiotensin receptor antagonist treatment, blood pressure was normal, urine protein turned negative, and renal function improved significantly after 8 months of outpatient follow-up.

In vitro and in vivo anticancer potential and molecular targets of the new colchicine analog IIIM-067 / 中西医结合学报

OBJECTIVE@#The current study evaluated various new colchicine analogs for their anticancer activity and to study the primary mechanism of apoptosis and in vivo antitumor activity of the analogs with selective anticancer properties and minimal toxicity to normal cells.@*METHODS@#Sulforhodamine B (SRB) assay was used to screen various colchicine analogs for their in vitro cytotoxicity. The effect of N-[(7S)-1,2,3-trimethoxy-9-oxo-10-(pyrrolidine-1-yl)5,6,7,9-tetrahydrobenzo[a] heptalene-7-yl] acetamide (IIIM-067) on clonogenicity, apoptotic induction, and invasiveness of A549 cells was determined using a clonogenic assay, scratch assay, and staining with 4',6-diamidino-2-phenylindole (DAPI) and annexin V/propidium iodide. Mitochondrial membrane potential (MMP) and reactive oxygen species (ROS) levels were observed using fluorescence microscopy. Western blot analysis was used to quantify expression of proteins involved in apoptosis, cell cycle, and phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) signaling. Pharmacokinetic and in vivo efficacy studies against Ehrlich ascites carcinoma (EAC) and Ehrlich solid tumor models were conducted using Swiss albino mice.@*RESULTS@#IIIM-067 showed potent cytotoxicity and better selectivity than all other colchicine analogs screened in this study. The selective activity of IIIM-067 toward A549 cells was higher among other cancer cell lines, with a selectivity index (SI) value of 2.28. IIIM-067 demonstrated concentration- and time-dependent cytotoxicity against A549 cells with half-maximal inhibitory concentration values of 0.207, 0.150 and 0.106 μmol/L at 24, 48 and 72 h, respectively. It also had reduced toxicity to normal cells (SI > 1) than the parent compound colchicine (SI = 1). IIIM-067 reduced the clonogenic ability of A549 cells in a dose-dependent manner. IIIM-067 enhanced ROS production from 24.6% at 0.05 μmol/L to 82.1% at 0.4 μmol/L and substantially decreased the MMP (100% in control to 5.6% at 0.4 μmol/L). The annexin V-FITC assay demonstrated 78% apoptosis at 0.4 μmol/L. IIIM-067 significantly (P < 0.5) induced the expression of various intrinsic apoptotic pathway proteins, and it differentially regulated the PI3K/AKT/mTOR signaling pathway. Furthermore, IIIM-067 exhibited remarkable in vivo anticancer activity against the murine EAC model, with tumor growth inhibition (TGI) of 67.0% at a dose of 6 mg/kg (i.p.) and a reduced mortality compared to colchicine. IIIM-067 also effectively inhibited the tumor growth in the murine solid tumor model with TGI rates of 48.10%, 55.68% and 44.00% at doses of 5 mg/kg (i.p.), 6 mg/kg (i.p.) and 7 mg/kg (p.o.), respectively.@*CONCLUSION@#IIIM-067 exhibited significant anticancer activity with reduced toxicity both in vitro and in vivo and is a promising anticancer candidate. However, further studies are required in clinical settings to fully understand its potential.

Risk factors to port-a-cat damage/removal in patients in antineoplastic chemotherapy: a retrospective observational study / Fatores de risco para danos ou retirada de port-a-cath em pacientes em quimioterapia antineoplásica: Um estudo observacional retrospective

Objective: To identify the prevalence and risk factors for damage or removal of fully implanted long-term catheters from patients undergoing antineoplastic chemotherapy. Methods: This is an observational, cross-sectional study that evaluated medical records of patients undergoing placement of a fully implanted catheter for antineoplastic chemotherapy from January 2015 to December 2019. Clinical and sociodemographic data were collected that were associated with catheter survival using Log-Rank Mantel-Cox and Cox Regression tests (SPSS, p<0.05). Results: Of 58 devices evaluated, most patients were higher educated married females, younger than 60 years old. The most frequent side of catheter implantation was the right side, and the most prevalent implantation site was the internal jugular vein. Less than 1/3 of patients (29.3%) had port-a-cath loss due to complications with a five-year follow-up survival of 35.73±3.76 (95% CI = 28.35-43.11). Two patients (4.7%) needed removal due to device exposure, three (7.0%) due to obstruction, and 12 (27.9%) due to infection. Female patients (p=0.019) and patients with breast tumors (p=0.049) had a shorter mean survival time. The women showed port-a-cath survival 9.25 times (95% CI = 1.35-50.25) shorter in the multivariate analysis. Conclusion: port-a-cath catheter loss is around 30% and being female is a determining risk factor.

Objetivo: Identificar a prevalência e os fatores de risco para danos ou retirada de cateter de longa permanência totalmente implantado em pacientes submetidos à quimioterapia antineoplásica. Metodos: Trata-se de um estudo observacional transversal que avaliou prontuários de pacientes submetidos à colocação de cateter totalmente implantado para quimioterapia antineoplásica, no período de janeiro de 2015 a dezembro de 2019. Foram coletados dados clínicos e sociodemográficos associados à sobrevida do cateter por meio do Log-Rank testes de Mantel-Cox e Regressão de Cox (SPSS, p<0,005). Resultados: Dos 58 dispositivos avaliados, a maioria dos pacientes era mulheres casadas com nivel superior de escolaridade e com idade inferior a 60 anos. O lado mais frequente de implantação do cateter foi o direito, e o local de implantação mais prevalente foi a veia jugular interna. Pouco menos de 1/3 dos pacientes (29,3%) tiveram perda de port-a-cath devido complicações com uma sobrevida de seguimento de cinco anos de 35,73±3.76 (IC 95% = 28.35-43.11). Dois pacientes (4,7%) necessitaram de remoção por exposição do dispositivo, três (7,0%) por obstrução e 12 (27,9%) por infecção. Pacientes do sexo feminino (p=0,0019) e pacientes com tumores de mama (p=0,049) apresentam menor tempo médio de sobrevida. As mulheres apresentaram sobrevida port-a-cath 9,25 vezes (IC 95%=1,35-50,25) menor na análise multivariada. Conclusão: A perda do cateter port-a-cath foi de aproximadamente 30% e ser do sexo feminino foi um fator de risco importante.

Does systemic anticancer gemcitabine compromise oral soft tissue wound healing? / ¿La gemcitabina anticancerígena sistémica compromete la cicatrización de heridas en tejidos blandos orales?

Background: Numerous types of cancer are of substantial medical and social concern, posing a major challenge to modern medicine. Chemotherapeutic drugs include the use of nucleosides, which are composed of nucleic acid and sugar. Objective: This study aims to assess the impact of systemic chemotherapeutic drugs at a therapeutic dose on the wound healing process of the oral mucosa. Material and Methods: 30 healthy rats were randomly divided into two main groups based on the study material, 15 rats in each group. Group A (control) was given a single dose of normal saline (1ml/kg, intraperitoneal), and Group B (study) a single injection of gemcitabine (50 mg /Kg, intraperitoneal). After anesthesia, a full-thickness soft tissue incision (0.5 cm length) on the right side of the buccal mucosa was made in the animals of both groups. Each group was subdivided according to the time of sacrifice into 3, 7, 14 days after surgery, at the end of the experimental periods, specimens were collected for histopathological study, and samples of blood were obtained from retro-orbital venous plexus and collected in microfuge tubes and levels of antioxidant enzymes were measured by ELISA. The data were analyzed statistically at a 0.05 level of significance. Results: Gemcitabine delayed the onset of wound cascade (inflammation and re-epithelization) which lead to worsening healing of the oral tissue; it also resulted in a decrease of the antioxidant activity of glutathione peroxidase and catalase, as well as activated caspase 3, which induces cell apoptosis. Conclusion: Gemcitabine showed negative feedback on oral tissue wound healing through delayed wound healing cascade and by inducing apoptosis.

Antecedentes: numerosos tipos de cáncer son motivo de gran preocupación médica y social, lo que representa un gran desafío para la medicina moderna. Los fármacos quimioterapéuticos incluyen el uso de nucleósidos, que están compuestos de ácido nucleico y azúcar. Objetivo: Este estudio tiene como objetivo evaluar el impacto de los fármacos quimioterapéuticos sistémicos a una dosis terapéutica en el proceso de cicatrización de heridas de la mucosa oral. Material y Métodos: 30 ratas sanas se dividieron aleatoriamente en dos grupos principales según el material de estudio, 15 ratas en cada grupo. Al grupo A (control) se le administró una dosis única de solución salina normal (1 ml/kg, intraperitoneal) y al grupo B (estudio) una inyección única de gemcitabina (50 mg/kg, intraperitoneal). Después de la anestesia, se realizó una incisión de tejido blando de espesor total (0,5 cm de longitud) en el lado derecho de la mucosa bucal en los animales de ambos grupos. Cada grupo se subdividió de acuerdo al tiempo de sacrificio en 3, 7, 14 días después de la cirugía, al final de los períodos experimentales se colectaron especímenes para estudio histopatológico, se obtuvieron muestras de sangre del plexo venoso retroorbitario y se recolectaron en tubos de microcentrífuga y los niveles de enzimas antioxidantes se midieron por ELISA. Los datos se analizaron estadísticamente a un nivel de significación de 0,05. Resultados: La gemcitabina retrasó el inicio de la cascada de heridas (inflamación y reepitelización) que condujo a un empeoramiento de la cicatrización del tejido oral; también resultó en una disminución de la actividad antioxidante de la glutatión peroxidasa y la catalasa, así como de la caspasa 3 activada, que induce la apoptosis celular. Conclusión: La gemcitabina mostró retroalimentación negativa sobre la cicatrización de heridas del tejido oral a través de una cascada de cicatrización retardada y mediante la inducción de apoptosis.

Infusão de quimioterápicos antineoplásicos em adultos: construção de um e-book e audiobook para enfermeiros líderes / Infusion of antineoplastic chemotherapy drugs in adults: construction of an e-book and audiobook for leading nurses

Resumo: Pesquisa aplicada de produção tecnológica motivada pela vivência em uma instituição hospitalar filantrópica, terciária, com foco no tratamento clínico e cirúrgico de pacientes com câncer e doenças oncológicas, localizada em Curitiba ­ Paraná, cujo objetivo foi desenvolver uma tecnologia educacional em formato de e-book e audiobook referente à infusão de quimioterápicos antineoplásicos em adultos para enfermeiros líderes. A produção tecnológica foi financiada pelo Convênio entre a Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes) e o Conselho Federal de Enfermagem (Cofen), cuja finalidade é promover o aperfeiçoamento profissional dos enfermeiros atuantes em instituições públicas ou privadas. Realizou-se uma revisão de literatura extensiva sobre a temática escolhida no banco de dados da Biblioteca Virtual em Saúde (BVS), sendo selecionadas as bases de dados eletrônicas: Literatura Latino-Americana e do Caribe em Ciências e Saúde (Lilacs), Medical Literature Analysis and Retrieval System Online (Medline/PubMed) e Bdenf (Banco de dados Bibliográficos Especializado na Área de Enfermagem do Brasil) e o período de seleção dos artigos ocorreu entre dezembro/2021 a abril/2022. Foram selecionados 142 documentos para composição do e-book/audiobook, sendo 70 artigos por meio de estratégias de busca, 56 artigos para complementação teórica e 47 documentos provenientes da literatura cinzenta. Os resultados produziram os quatro capítulos que compõem o e-book/audiobook intitulado: O cuidado de enfermagem na infusão de quimioterápicos antineoplásicos em adultos e a liderança do enfermeiro, sendo eles: 1. Liderança do enfermeiro na gestão do cuidado e a educação permanente em saúde, 2. Cuidados de enfermagem para a administração de medicamentos pela via endovenosa, 3. Cuidados de enfermagem para infusão de quimioterápico antineoplásico e o manejo das toxicidades, 4. Medidas de segurança no trabalho para administração de quimioterapia antineoplásica. A tecnologia será divulgada via plataforma Cofenplay. Espera-se que esse produto possa auxiliar os enfermeiros quanto aos cuidados de enfermagem necessários para a infusão de quimioterápicos antineoplásicos em adultos. Ainda, acredita-se que essa tecnologia fortalecerá o enfermeiro como líder da equipe, fornecendo a ele conhecimento para que realize educação permanente quanto à eficiente infusão de medicamentos pela via endovenosa, principalmente o quimioterápico antineoplásico; atendendo a terceira meta internacional de segurança do paciente, auxiliando-o em tomadas de decisão e diminuindo risco de eventos adversos que possam causar prejuízos aos pacientes, profissionais de enfermagem, instituição e à sociedade.

Abstract: Applied research of technological production motivated by the experience in a philanthropic, tertiary hospital institution, focusing on the clinical and surgical treatment of patients with cancer and oncological diseases, located in Curitiba ­ Paraná, Brazil educational technology in e-book and audiobook format referring to the infusion of antineoplastic chemotherapy in adults for leading nurses. The technological production was financed by the Agreement between the Coordination of Improvement of Higher Education Personnel (Capes) and the Federal Nursing Council (Cofen) whose purpose is to promote the professional improvement of nurses working in public or private institutions. An extensive literature review was carried out on the theme chosen in the database of the Virtual Health Library (VHL), being selected the electronic databases: Latin American and Caribbean Literature in Science and Health (LILACS), Medical Literature Analysis and Retrieval System Online (Medline/PubMed) and Bdenf (Specialized Bibliographic Database in the Nursing Area of Brazil) and the period of selection of articles occurred between December/2021 and April/2022. 142 documents were selected for the composition of the e-book/audiobook, 70 articles through search strategies, 56 articles for theoretical complementation and 47 documents from the gray literature. The results produced the four chapters that make up the e-book/audiobook entitled: Nursing care in the infusion of antineoplastic chemotherapy in adults and nurse leadership, which are: 1. Nurse leadership in health care management and continuing education, 2. Nursing care for intravenous drug administration, 3. Nursing care for the infusion of antineoplastic chemotherapy and the management of toxicities, 4. Occupational safety measures for administration of antineoplastic chemotherapy. The technology will be disclosed via Cofenplay platform. It is expected that this product can help nurses with the nursing care necessary for the infusion of antineoplastic chemotherapy in adults. Furthermore, it is believed that this technology will strengthen the nurse as leader of the team, providing him with knowledge to carry out permanent education regarding the efficient infusion of drugs through the intravenous route, especially the antineoplastic chemotherapy; taking into account the third international goal of patient safety, assisting in decision-making and reducing the risk of adverse events that may cause harm to patients, nursing professionals, institution and society.

Infección por COVID-19 en pacientes oncológicos y asociación con el tratamiento recibido / COVID-19 infection in cancer patients and association with the antineoplastic treatment

Resumen La evidencia que relaciona la terapia oncológica con la incidencia por COVID-19 varía según el tipo de terapia administrada. La incidencia informada en pacientes que reciben tratamiento oncológico varía entre 1 y 4%. El objetivo del presente estudio fue determinar la incidencia por COVID-19 en pacientes oncológicos en tratamiento activo y evaluar si existe asociación con el esquema recibido. Se utilizó una cohorte retrospectiva que incluyó de forma consecutiva a los pacientes adultos que realizaron tratamiento ambulatorio desde marzo/2020 hasta abril/2021 en un Hospital Público de referencia. El evento principal fue el diagnóstico confirmado de COVID-19. La asociación con los tratamientos oncológicos fue evaluada mediante regresión logís tica multivariada ajustando por edad, sexo, localización del tumor, cobertura de salud y localidad de residencia. Se incluyeron 463 pacientes, mediana de edad 58 años (RIC = 47-66), 73.3% (n = 337) mujeres. La incidencia de COVID-19 fue 5.6% (n = 26) con una tasa de mortalidad del 12% (n = 3). El riesgo de infección fue mayor en los que estaban realizando tratamiento únicamente con anticuerpos monoclonales, 14.3% vs. 4.9% (OR-ajustado = 3.3, p = 0.03) y aquellos en tratamiento con inhibidores de puntos de control inmunológicos, 23.1% vs. 5.1% (OR-ajustado = 5.8, p = 0.03). La quimioterapia citotóxica, sola o en combinación con anticuerpos mo noclonales, no presentó mayor riesgo de infección. La edad, sexo, sitio tumoral, cobertura de salud y localidad de residencia no se asoció con la incidencia de COVID-19. En base a nuestros resultados, el tratamiento con anticuerpos monoclonales o inhibidores de puntos de control inmunológicos se asoció con mayor incidencia de infección por COVID-19.

Abstract Evidence linking anticancer therapy with the incidence of COVID-19 varies according to the type of therapy administered. The reported COVID-19 incidence in patients receiving antineoplastic treatment varies between 1 and 4%. The aim of this study was to determine the incidence of COVID-19 in cancer patients under active treatment and to assess whether there is an association with the received anticancer therapy. It was a retrospective cohort that consecutively included adult outpatients who underwent treatment in a referral center from March 2020 to April 2021. The primary endpoint was the confirmed diagnosis of COVID-19. The association with anticancer treatments was evaluated using multivariate logistic regression adjusting for age, sex, tumor site, health coverage status, and place of residence. The sample included 463 patients, the median age was 58 years (IQR = 47-66), 73.3% (n = 337) were women. The incidence of COVID-19 was 5.6% (n = 26) with a mortality rate of 12% (n = 3). The risk of infection was higher in patients undergoing treatment only with monoclonal antibod ies, 14.3% vs. 4.9% (adjusted OR = 3.3, p = 0.03) and those in treatment with immunotherapy, 23.1% vs. 5.1% (adjusted OR = 5.8, p = 0.03). Cytotoxic chemotherapy, alone or in combination with monoclonal antibodies, did not present an increased risk of infection. Age, sex, tumor site, health coverage, and place of residence did not show association with the incidence of COVID-19. Based on our results, treatment with monoclonal antibodies or immunotherapy was associated with a higher rate of COVID-19 infection while chemotherapy did not modify the incidence of COVID-19.