Correlación entre las ecuaciones para la estimación del filtrado glomerular (MDRD, CKD-EPI,) y la depuración de creatinina en orina de 24 horas en pacientes oncológicos / Correlation between the equations for the estimation of the filtering glomerular (MDRD, CKD-EPI,) and creatinine clearance in 24-hour urine in cancer patients

Demostrar la correlación entre las ecuaciones MDRD, CKD-EPI con la depuración de creatinina de 24 horas en pacientes oncológicos. Estudio transversal realizado en el Instituto Oncológico Nacional Dr Juan Tanca Marengo durante el periodo de tiempo comprendido entre el mes de agosto 2019 a agosto de 2020. Al evaluar las distintas variable MDRD obtuvo un valor promedio de 44,81 ml/min/m2 con un intervalo de 41,07 ­ 48,55 ml/min/m2 , la variable CKD-EPI el valor promedio fue 43,59 + 18,09 ml/min/m2 con un intervalo de 40,01 ­ 47,18 ml/min/m2 , para el estándar de referencia depuración de creatinina de 24 horas el promedio fue de 54ml/min/m2 Al evaluar la relación entre los dos estimadores de TFG se encontró que ambos presentan una fiabilidad regular presentando una correlación intraclase de 0,43 (p<0,05) entre los estimadores CKD-EPI y MDRD en relación con la TFG de creatinina de 24horas. Cuando se evaluó pacientes con tumores sólidos y hematológicos, se encontró una mayor correlación intraclase con la escala MDRD-4 0,60 (0,25 ­ 0,82) < 0,05 en tumores hematológicos en comparación con CKD-EPI. En la población general, CKD-EPI es la fórmula recomendada, y se está recomendado con mayor frecuencia en pacientes oncológicos. Nuestro estudio demostró que la ecuación MDRD es la fórmula que mejor se correlaciona con la depuración de creatinina de 24 horas, siendo mejor en el grupo de tumores hematológicos, pero no existe diferencia estadísticamente significativa entre las dos ecuaciones.

To demonstrate the correlation between the MDRD, CKD-EPI equations with the 24-hour creatinine clearance in cancer patients. Cross-sectional study carried out at the National Oncological Institute Dr Juan Tanca Marengo during the period of time between the month of August 2019 to August 2020. When evaluating the different MDRD variables, an average value of 44.81 ml / min / m2 was obtained with an interval of 41.07 ­ 48.55 ml / min / m2, the CKD-EPI variable the average value was 43.59 + 18 , 09 ml / min / m2 with an interval of 40.01 ­ 47.18 ml / min / m2, for the reference standard creatinine clearance of 24 hours the average was 54 ml / min / m2 When evaluating the relationship between the two estimators of GFR, it was found that both present a regular reliability, presenting an intraclass correlation of 0.43 (p <0.05) between the CKD-EPI and MDRD estimators in relation to the 24-hour creatinine GFR. When patients with solid and hematological tumors were evaluated, a higher intraclass correlation was found with the MDRD-4 scale 0.60 (0.25 ­ 0.82) <0.05 in hematological tumors compared to CKD-EPI. In the general population, CKD-EPI is the recommended formulation, and it is more frequently recommended in cancer patients. Our study showed that the MDRD equation is the formula that best correlates with 24-hour creatinine clearance, being better in the group of hematological tumors, but there is no statistically significant difference between the two equations.

Nutritional status in children with cancer: comparison of deuterium oxide dilution with bioelectric impedance analysis and anthropometry / Estado nutricional em crianças com câncer: comparação entre diluição de deutério, impedância bioelétrica e antropometria

ABSTRACT Objective: To explore changes in the nutritional status of pediatric cancer patients before and after chemotherapy and evaluate the correlation between deuterium oxide dilution, bioelectric impedance analysis, and anthropometry for assessment of body composition. Methods: This study included 14 children (aged 5.6 to 13.6 years) and classified them as having hematologic or solid tumors. They had their body composition analyzed according to deuterium oxide, bioelectric impedance, and anthropometric measurements before the first chemotherapy cycle and after three and six months of therapy. Results: The patients in the hematologic tumor group had an increase in weight, height, body mass index, waist, hip, and arm circumference, subscapular skinfold thickness, and fat mass with the isotope dilution technique during chemotherapy. In the solid tumor group, the children showed a reduction in fat-free mass when assessed by bioimpedance analysis. We found a positive correlation between the triceps skinfold thickness and fat mass determined by bioimpedance analysis and deuterium oxide. The arm muscle circumference correlated with the fat-free mass estimated by bioimpedance analysis and deuterium oxide. Conclusions: Patients with hematologic tumors had an increase in body weight, height, and fat mass, which was not identified in the solid tumor group. The positive correlation between anthropometry (triceps skinfold thickness and arm muscle circumference), deuterium oxide dilution, and bioelectric impedance analysis shows the applicability of anthropometry in clinical practice.

RESUMO Objetivo: Verificar mudanças no estado nutricional de crianças com câncer antes e após o tratamento quimioterápico e avaliar a correlação entre diluição de óxido de deutério, análise de impedância bioelétrica (BIA) e dados antropométricos. Métodos: Quatorze crianças (entre 5,6 e 13,6 anos de idade) foram incluídas e classificadas como tendo tumores hematológicos ou sólidos. A composição corporal foi medida pelo óxido de deutério, impedância bioelétrica e medidas antropométricas antes da primeira quimioterapia e após três e seis meses de terapia. Resultados: Os pacientes do grupo de tumores hematológicos aumentaram o peso, a estatura, o índice de massa corporal, a circunferência da cintura, quadril e braço, dobra cutânea subescapular e a massa gorda com a técnica de diluição isotópica durante o tratamento quimioterápico. No grupo de tumores sólidos, as crianças mostraram uma redução na massa magra quando avaliadas por análise de impedância. Houve uma correlação positiva entre a dobra cutânea tricipital e a massa gorda determinadas pela análise de impedância e pelo óxido de deutério. A circunferência muscular do braço correlacionou-se com a massa magra estimada pela análise de impedância e pelo óxido de deutério. Conclusões: Pacientes com tumores hematológicos tiveram aumento no peso corporal, estatura e massa gorda, o que não foi observado naqueles com tumores sólidos. A boa correlação entre a antropometria (dobra cutânea tricipital e circunferência muscular do braço), a diluição do óxido de deutério e a análise da impedância bioelétrica mostra a aplicabilidade da antropometria na prática clínica.

Acute kidney injury in cancer patients

SUMMARY The increasing prevalence of neoplasias is associated with new clinical challenges, one of which is acute kidney injury (AKI). In addition to possibly constituting a clinical emergency, kidney failure significantly interferes with the choice and continuation of antineoplastic therapy, with prognostic implications in cancer patients. Some types of neoplasia are more susceptible to AKI, such as multiple myeloma and renal carcinoma. In cancer patients, AKI can be divided into pre-renal, renal (intrinsic), and post-renal. Conventional platinum-based chemotherapy and new targeted therapy agents against cancer are examples of drugs that cause an intrinsic renal lesion in this group of patients. This topic is of great importance to the daily practice of nephrologists and even constitutes a subspecialty in the field, the onco-nephrology.

RESUMO A crescente prevalência de neoplasias se associa a novos desafios clínicos, sendo a lesão renal aguda (LRA) um deles. Além de ser possível emergência clínica, a insuficiência renal interfere significativamente na escolha e continuação da terapia antineoplásica, tendo implicações prognósticas no paciente com câncer. Alguns tipos de neoplasias são mais suscetíveis a LRA, como o mieloma múltiplo e o carcinoma renal. Nos pacientes oncológicos, a LRA pode ser dividida em pré-renal, renal (intrínseca) e pós-renal. A quimioterapia convencional com platinas e os novos agentes de terapia-alvo contra o câncer são exemplos de drogas que causam lesão renal intrínseca nesse grupo de pacientes. Este tema é de grande importância atual para a prática diária do nefrologista, tornando-se inclusive subespecialidade na área, a onconefrologia.

Validación del índice neutrófilo/linfocito predictivo de gravedad en el paciente oncológico quirúrgico / Validation of neutrophil/lymphocyte index predictive of severity in the surgical cancer patient

Introducción: La inflamación desempeña un papel protagonista en la fisiopatología del cáncer. Objetivo: Validar el índice neutrófilo/linfocito predictivo de gravedad en el paciente electivo oncológico quirúrgico. Métodos: Se realizó un estudio cuasiexperimental para un solo grupo en los pacientes quirúrgicos con el diagnóstico de enfermedad oncológica, intervenidos electivo por las diferentes especialidades quirúrgicas en el Hospital Oncológico Marie Curie en el período de enero a diciembre de 2019. Resultados: La curva Receiver Operating Characteristic se mostró asociada al modelo de regresión logística como estima el umbral de 0,23 por encima del cual se declarará la probabilidad de gravedad. En la validación entre los pacientes hay 23 que sí tuvieron riesgo de gravedad. Estos son los falsos positivos sobre los cuales se optimizó el preoperatorio. Conclusiones: El índice neutrófilo/linfocito mostró utilidad en predecir la gravedad en el paciente oncológico quirúrgico, y permitió individualizar el tratamiento prequirúrgico para que este tuviera mayor éxito(AU)

Introduction: Inflammation plays a leading role in the pathophysiology of cancer. Objective: To validate the predictive severity neutrophil/lymphocyte index in the elective surgical oncology patient. Methods: A quasi-experimental study was carried out for a single group in surgical patients diagnosed with oncological disease, electively operated by the different surgical specialties at Marie Curie Cancer Hospital from January to December 2019. Results: The Receiver Operating Characteristic curve was associated with the logistic regression model as it estimates the threshold of 0.23 above which the probability of severity will be declared. In the validation among the patients, there are 23 who did have a serious risk. These are the false positives on which the preoperative period was optimized. Conclusions: The neutrophil/lymphocyte index showed utility in predicting severity in the surgical oncology patient, and made it possible to individualize the pre-surgical treatment so that it would be more successful(AU)

Perfil clínico-funcional de niños que ingresan a un programa de rehabilitación oncológica en una ONG chilena / Clinical-functional profile of children admitted into an oncology rehabilitation program in a Chilean NGO

INTRODUCCIÓN: Los pacientes oncológicos infantiles presentan diversas deficiencias en sus funciones y estructuras corporales derivados de los tumores mismos o de los distintos tratamientos empleados, ya sea cirugía, quimioterapia, radioterapia o la suma de ellos. Estas deficiencias generan gran discapacidad en todas las áreas del funcionamiento. OBJETIVO: Describir el perfil clínico y funcional de niños que ingresan a un programa de rehabilitación oncológica. MATERIALES Y MÉTODOS: Estudio observacional, restrospectivo y descriptivo. Se revisaron 109 fichas clínicas de pacientes ingresados al programa de rehabilitación oncológica de Fundación Nuestros Hijos entre los años 2014 y 2017, que cumplieron criterios de ingreso. Se obtuvieron los datos de la evaluación clínica realizada por médico fisiatra y pruebas funcionales al ingreso, incluyendo Timed Up and Go Test, Pediatric Balance Scale y test de Marcha de 6 min. RESULTADOS: El promedio de edad fue de 8,7 ± 3,4 años. Los diagnósticos más frecuentes fueron tumores de sistema nervioso central (50,4%), leucemias y linfomas (24,4%). Un 53,2% de los pacientes se encontraba en tratamiento activo al momento del ingreso. El déficit motor fue el más frecuente (79,8%). Dentro de este grupo, 19 niños (17,4%) presentaron hemiparesia y 18 niños (16,5%) tetraparesia. Del total, 44% reportó presencia de fatiga, 28,4% presentó trastorno de la deglución, 34,9% trastorno visual y un 56,9% compromiso cognitivo.CONCLUSIONES: Los niños que ingresan a rehabilitación oncológica presentan múltiples deficiencias en diversas áreas de su funcionamiento, tanto en etapas tempranas como tardías de su tratamiento. El compromiso, motor, deglutorio, visual y cognitivo son las deficiencias más frecuentes de encontrar, sobre todo en pacientes con tumores de SNC.

INTRODUCTION: Pediatric cancer patients present several dysfunctions in their body functions and structures caused by the tumors or by therapies, such as surgery, chemotherapy, radiotherapy or the sum of all of these treatments. these dysfunctions cause impairment of all areas of functioning. OBJECTIVE: to describe the clinical and functional profile of children admitted to an oncology rehabilitation program. MATERIALS AND METHODS: A retrospective, descriptive, observational study that reviewed 109 clinical records of patients admitted between 2014 and 2017 to the oncology rehabilitation program of 'Fundación Nuestros Hijos', in compliance with the admission criteria. Data were obtained from the clinical assessment performed by the physiatrist and from functional tests such as 'Timed Up and Go Test', 'Pediatric Balance Scale' and '6-minute walk test'. RESULTS: Average age was 8.7 ± 3.4 years. the most frequent diagnoses were central nervous system (CNS) tumors (50.4%), leukemia and lymphoma (24.4%). A 53.2% of the patients were under active treatment at the time of admission. Motor deficit was the most frequent symptom (79.8%). In this group, 19 children (17.4%) had hemiparesis and 18 (16.5%) quadraparesis. of the total, 44% reported fatigue, 28.4% swallowing disorders, 34.9% vision disorders, and 56% cognitive impairment. CONCLUSIONS: Children admitted to oncology rehabilitation programs present several deficiencies in areas of functioning, both in early and late stages of their treatment. Motor, visual and swallowing impairment are the most common dysfunctions, particularly in patients with CNS tumors.

Appetite Assessment of Hospitalized Cancer Patients in Brazil - A Validation Study

OBJECTIVES: Appetite loss, a common symptom in cancer patients, contributes to worsened nutritional status. A validated specific tool to assess appetite is clinically useful for diagnosing and identifying symptoms and signs that could be reversed with nutritional and pharmacological therapies. The aim of this study is to produce a Brazilian Portuguese version of the Hill and Blundell visual analog scale (VAS) for appetite and investigate its validity among hospitalized cancer patients. METHODS: The original English VAS version was translated into Brazilian Portuguese in full accordance with the guidelines in the literature and adapted to the Brazilian context by conducting interviews and meetings with an expert committee until the final version was reached. Afterwards, the version was validated in hospitalized cancer patients in a cross-sectional study at São Paulo Cancer Institute (ICESP), where the relationships between breakfast intake (rest-ingestion index) and VAS were compared. The Spearman test was used to verify the correlation between the rest-ingestion index and the VAS ratings. RESULTS: Sixty-four patients with a mean age of 56.1 (±12.3) years answered the Portuguese VAS version, and their breakfast intake was evaluated. The mean rest-ingestion index was 18.8%. The correlations between the rest-ingestion index (food acceptance) and three questions of the Portuguese visual analog scale version were inverse and significant: first question (ρ -0.3028 p=0.0046), second question (ρ -0.2317 p=0.0319) and third question (ρ -0.3049 p=0.0043). CONCLUSION: The "Appetite Assessment Scale of Brazilian Oncology Patients" is a valid instrument to assess appetite in hospitalized cancer patients in Brazil.

Updating the role of matrix metalloproteinases in mineralized tissue and related diseases

Abstract Bone development and healing processes involve a complex cascade of biological events requiring well-orchestrated synergism with bone cells, growth factors, and other trophic signaling molecules and cellular structures. Beyond health processes, MMPs play several key roles in the installation of heart and blood vessel related diseases and cancer, ranging from accelerating metastatic cells to ectopic vascular mineralization by smooth muscle cells in complementary manner. The tissue inhibitors of MMPs (TIMPs) have an important role in controlling proteolysis. Paired with the post-transcriptional efficiency of specific miRNAs, they modulate MMP performance. If druggable, these molecules are suggested to be a platform for development of "smart" medications and further clinical trials. Thus, considering the pleiotropic effect of MMPs on mammals, the purpose of this review is to update the role of those multifaceted proteases in mineralized tissues in health, such as bone, and pathophysiological disorders, such as ectopic vascular calcification and cancer.

Incorporation of the antitumor drug miltefosine into polymeric micelles / Desenvolvimento de nanoestruturas poliméricas para encapsulação do antitumoral miltefosina

Miltefosine (hexadecylphosphocholine, HePC), a synthetic antitumor designed from natural phospholipids, is clinically approved for cutaneous metastases of breast cancer and cutaneous lymphoma. This drug acts mainly at cellular membrane level, where it accumulates and interferes with lipid metabolism and lipid-dependent signaling pathways leading the cells to apoptosis. However, HePC systemic and peroral administration induces hemolysis and mucosal toxicity, respectively. To overcome these limitations, we investigated the protective properties of colloidal polymeric micelles (PM) composed by Pluronics, triblock copolymers of poly(ethylene oxide) and poly(propylene oxide). We found that both Pluronic composition and concentration modulate the hemolytic profile of incorporated drug (HePC-PM) by increasing the drug amount to cause in vitro hemolysis. Moreover, small-angle X-ray scattering (SAXS) was used to assess structural information of interactions between HePC and PM. Additionally, we showed that HePC-PM prevented mucosal irritation, decreasing bleeding and lysis of blood vessels in a chicken chorioallantoic membrane model. Interestingly, HePC-PM increased the in vitro selective cytotoxicity against cervix tumor cells rather healthy fibroblasts, suggesting a differential uptake of these nanostructures by tumor cells. Furthermore, we also found that HePC induces cytotoxicity and decrease cell survival, migration and proliferation in osteosarcoma cells in vitro. We showed that cytotoxicity by HePC is associated with caspase-3 activation, DNA fragmentation, apoptotic-like bodys formation and inhibition of both constitutive and cytokine-stimulated Akt/PKB phosphorylation. HePC-PM clearly reduces the drug cytotoxic effects. Finally, we demonstrated that Pluronic F127 polymeric micelles are efficient for cargo delivering the encapsulated drug preferentially into tumor cells rather than healthy cells. These findings together suggest that Pluronic F127 PM reduce drug side effects and provide a potential alternative for systemic delivery of HePC, as well as other amphiphilic drugs

Miltefosina (hexadecilfosfocolina, HePC), um fármaco antitumoral sintético desenvolvido a partir de fosfolipídios naturais, é clinicamente aprovada para o tratamento tópico de metástases de câncer de mama e linfomas cutâneos. Atua principalmente nas membranas celulares, onde se acumula e interfere no metabolismo lipídico e nas vias de sinalização dependentes de lipídios levando as células à apoptose. No entanto, quando administrada sistemicamente ou oralmente a HePC induz hemólise e toxicidade de mucosas, respectivamente. Para superar estas reações adversas investigamos os efeitos protetores conferidos por micelas poliméricas coloidais (PM) compostas por Pluronics, copolímeros tribloco de poli(óxido de etileno) e poli(óxido de propileno). Inicialmente, encontramos que a composição e concentração do Pluronic modulam o perfil hemolítico do fármaco encapsulado (HePC-PM), aumentando a quantidade necessária de HePC para causar hemólise in vitro. Além disso, utilizamos o espalhamento de raios-X a baixo ângulo (SAXS) para obter informações estruturais das interações entre HePC e PM. Em seguida, mostramos que HePC-PM preveniu a irritação da mucosa, diminuindo a hemorragia e a vasoconstricção em membrana corioalantóica de ovos embrionados. Estudos in vitro demonstraram que a HePC-PM aumentou seletivamente a citotoxicidade contra células de carcinoma HeLa em relação a fibroblastos saudáveis, sugerindo captação diferencial dessas nanoestruturas pelas células tumorais. Além disso, relatamos que, in vitro, a HePC induz citotoxicidade, diminui a sobrevivência, migração e proliferação osteossarcomas. Esta citotoxicidade está associada à ativação da caspase-3, fragmentação do DNA, formação de corpos apoptóticos e inibição da fosforilação de Akt/PKB. Adicionalmente, HePC-PM reduz os efeitos citotóxicos nestas linhagens. Finalmente, demonstramos que as micelas poliméricas de Pluronic F127 são eficientes para a entrega intracelular fármacos preferencialmente em células tumorais, e em menor grau em células saudáveis. Em conjunto, os dados sugerem que este sistema nanoestruturado reduz a toxicidade da HePC e representa uma alternativa potencial para a administração sistêmica deste e de outros fármacos anfifílicos

Alta incidencia de patologías neoplásicas en biopsias ganglionares de pacientes asistidos en un hospital de enfermedades infecciosas / High incidence of neoplasmic diseases in lymph node biopsies in assisted patients in an infectious diseases hospital

La presencia de adenopatías periféricas con rango adenomegálico es un hallazgo clínico frecuente, tanto en los pacientes con serología reactiva como en los no infectados por el VIH. En este estudio retrospectivo se analizaron 132 muestras de biopsias quirúrgicas ganglionares obtenidas de pacientes internados en un hospital de referencia en Enfermedades Infecciosas del GCABA, Argentina, en el período comprendido entre enero de 2011 y diciembre de 2015. La mayoría de los pacientes (100/132, 75,8%) tuvieron serología reactiva para VIH; en este subgrupok de sujetos, la mediana del recuento de linfocitos T CD-4 positivos fue de 141 cél/µL. El diagnóstico histopatológico más frecuente resultó la infiltración ganglionar por neoplasias linfoides primarias (linfomas) o metástasis de carcinomas (41%). Entre las patologías infecciosas predominaron las micobacteriosis, en especial la tuberculosis. Solo en 3 de 132 (2,3%) muestras de biopsias los hallazgos histológicos fueron normales. En conclusión, la biopsia quirúrgica de adenopatías periféricas resulta un método muy valioso y mínimamente invasivo para el diagnóstico de patologías infecciosas y tumorales. Una alta incidencia de enfermedades neoplásicas se detectaron en este estudio realizado en un hospital de Enfermedades Infecciosas.

Peripheral lymphadenopathy is a common clinical condition in both HIV-infected and non-HIV patients and has a wide spectrum of differential diagnoses. In this retrospective study, we carried out a cross-sectional study of peripheral lymph node biopsies performed from January 2011 to December 2015 in a reference hospital of Infectious Diseases in Argentina. We include a 132 patients underwent excisional lymph node biopsies during the time of study. The majority of patients were HIV-seropositive (100/132; 75,8%); the median of CD4 T-cell count was 141 cell/µL. The most common histopathological diagnosis was primitive or secondary neoplasms (54/132; 40,9%). In 51/132 biopsies the diagnosis corresponded to infectious pathologies, especially mycobacterial diseases, including tuberculosis. Only 3 of 132 biopsies (2,3%) included in the evaluation had only with normal findings. Peripheral lymph node biopsy is a simple and useful tool to diagnose opportunistic diseases and neoplasms in HIV and non-HIV infected patients. A high incidence of neoplasm diseases (41%) were obtained in this retrospective study

Odor evaluation scales for odor in neoplastic wounds: an integrative review / Escalas de evaluación de olores en heridas neoplásicas: una revisión integrativa / Escalas de avaliação de odor em feridas neoplásicas: uma revisão integrativa

ABSTRACT Objective: Checking for the existence of assessment instruments for odor in neoplastic wounds. Method: Integrative review performed in the databases Lilacs, SCiELO, Ibecs and MedLine, including national and international publications. Results: 15 articles were analyzed, in its majority performed by nurses and being of the revision type. Nine scales were found, of which the majority assesses only the odor intensity. The scale most used to evaluate products and/or bandage covers for neoplastic injuries was the Odor Evaluation Guideline, of qualitative-quantitative nature, that establishes the symptom within four levels; only one of which being validated (Teler scale). Conclusion: The results of this study showed that, currently, there is only one scale that is validated for assessing odor in neoplastic wounds, pointing towards the need to develop new instruments that incorporate validated and reliable instruments in clinical practice.

RESUMEN Objetivo: Verificar la existencia de instrumentos de evaluación del olor en heridas neoplásicas. Método: Revisión integrativa realizada en las bases de datos Lilacs, SCiELO, Ibecs y MedLine, incluyendo las publicaciones nacionales e internacionales. Resultados: Se analizaron 15 artículos, en su mayoría realizados por enfermeros y del tipo revisión Se encontraron nueve escalas, de las cuales gran parte evalúa sólo la intensidad del olor. La escala más utilizada para evaluar productos y/o coberturas en los curativos de heridas neoplásicas fue la guía de evaluación del olor, de naturaleza cuali-cuantitativa, que puntualiza el síntoma en cuatro niveles; y sólo una era validada (escala de Teler). Conclusión: Los resultados mostraron que hasta el momento sólo existe una escala de evaluación del olor en heridas neoplásicas validada, apuntando a la necesidad de desarrollar nuevas herramientas que incorporen instrumentos validados y confiables en la práctica clínica.

RESUMO Objetivo: Verificar a existência de instrumentos de avaliação do odor em feridas neoplásicas. Método: Revisão integrativa realizada nas bases de dados Lilacs, SCiELO, Ibecs e MedLine, incluindo publicações nacionais e internacionais. Resultados: Foram analisados 15 artigos, em sua maioria realizados por enfermeiros e do tipo revisão. Foram encontradas nove escalas, das quais a maioria avalia apenas a intensidade do odor. A escala mais utilizada para avaliar produtos e/ou coberturas nos curativos de feridas neoplásicas foi o guia de avaliação do odor, de natureza quali-quantitativa, que pontua o sintoma em quatro níveis; e apenas uma delas era validada (escala de Teler). Conclusão: Os resultados deste estudo demonstraram que até o momento só existe uma escala de avaliação do odor em feridas neoplásicas validada, apontando para necessidade de desenvolvimento de novas ferramentas que incorporem na prática clínica instrumentos validados e confiáveis.

Fadiga: Um sintoma complexo e seu impacto no câncer e na Insuficiência cardíaca / Fatigue: a complex symptom and its impact on cancer heart failure

Nas doenças crônicas, como câncer e insuficiência cardíaca (IC), a fadiga é um sintoma comum e complexo do ponto de vista etiológico e fisiopatológico, portanto, um tema de relevância na recente área da cardio-oncologia. A fadiga é prevalente em 80-90% dos pacientes oncológicos tratados com quimioterapia e/ou radioterapia e acomete cerca de 50-96% dos indivíduos com IC. A toxicidade atribuída aos quimioterápicos pode determinar o grau de fadiga do paciente e até predizer sua sobrevida. Nas últimas décadas, o avanço das terapias antineoplásicas impactaram substancialmente a sobrevida dos pacientes com câncer, e os riscos dos efeitos lesivos destas terapias ao sistema cardiovascular têm sido cada vez mais descritos. Portanto, a cooperação entre oncologistas e cardiologistas levou ao surgimento da cardio-oncologia e do novo conceito de cardiovigilância. A cardiotoxicidade é uma das complicações clínicas no tratamento do câncer, apresentando como manifestação típica a disfunção sistólica ventricular esquerda. Novas estratégias diagnósticas e terapêuticas têm sido empregadas na cardiovigilância em pacientes com câncer. A fadiga nestes pacientes vem sendo estudada criteriosamente com um olhar multidisciplinar e com o desenvolvimento de escalas visuais para melhor quantificar e correlacionar o seu real impacto na qualidade de vida e sobrevida destes indivíduos. O Pictograma de Fadiga e Escala de Fadiga de Piper são ferramentas cada vez mais utilizadas na pesquisa e na prática clínica. Os mecanismos envolvidos na fadiga, do ponto de vista conceitual, podem ser de origem central (sistema nervoso central) ou periférica (musculoesquelética), ambos os quais podem estar presentes no paciente com câncer. A presente revisão objetiva discutir os novos conceitos na avaliação da fadiga em pacientes oncológicos. Esses conceitos são fundamentais aos profissionais que atuam na emergente área da cardio-oncologia

Autophagy and intermittent fasting: the connection for cancer therapy?

Cancer is a leading cause of death worldwide, and its incidence is continually increasing. Although anticancer therapy has improved significantly, it still has limited efficacy for tumor eradication and is highly toxic to healthy cells. Thus, novel therapeutic strategies to improve chemotherapy, radiotherapy and targeted therapy are an important goal in cancer research. Macroautophagy (herein referred to as autophagy) is a conserved lysosomal degradation pathway for the intracellular recycling of macromolecules and clearance of damaged organelles and misfolded proteins to ensure cellular homeostasis. Dysfunctional autophagy contributes to many diseases, including cancer. Autophagy can suppress or promote tumors depending on the developmental stage and tumor type, and modulating autophagy for cancer treatment is an interesting therapeutic approach currently under intense investigation. Nutritional restriction is a promising protocol to modulate autophagy and enhance the efficacy of anticancer therapies while protecting normal cells. Here, the description and role of autophagy in tumorigenesis will be summarized. Moreover, the possibility of using fasting as an adjuvant therapy for cancer treatment, as well as the molecular mechanisms underlying this approach, will be presented.

A Nexus model of cellular transition in cancer

The exact cause of cancer is one of the most immutable medical questions of the century. Cancer as an evolutionary disease must have a purpose and understanding the purpose is more important than decoding the cause. The model of cancer proposed herein, provides a link between the cellular biochemistry and cellular genetics of cancer evolution. We thus call this model as the "Nexus model" of cancer. The Nexus model is an effort to identify the most apparent route to the disease. We have tried to utilize existing cancer literature to identify the most plausible causes of cellular transition in cancer, where the primary cancer-causing agents (physical, chemical or biological) act as inducing factors to produce cellular impeders. These cellular impeders are further linked to the Nexus. The Nexus then generates codes for epigenetics and genetics in cancer development.

Reacciones adversas medicamentosas en pacientes con cáncer atendidos en el Hospital Oncológico Docente Conrado Benítez / Medication adverse reactions in patients with cancer assisted in Conrado Benítez Teaching Cancer Hospital

Se efectuó un estudio descriptivo y transversal de 42 pacientes con reacciones adversas a medicamentos, atendidos en el Hospital Oncológico Docente Conrado Benítez de Santiago de Cuba durante el segundo semestre del 2016, con vistas a determinar las más frecuentes, así como los fármacos que más repercutieron en ello. En la serie, la mayoría de estas reacciones fueron notificadas por los licenciados en farmacia (76,2 por ciento) y entre estas sobresalieron la leucopenia, la erupción prurítica, el temblor y la taquicardia. Por otra parte, los grupos farmacológicos predominantes resultaron ser los antineoplásicos e inmunosupresores, de los cuales la ciclofosfamida fue el medicamento de mayor incidencia, seguido por el concentrado de eritrocitos y el gluconato de calcio, respectivamente

A descriptive and cross-sectional study of 42 patients with adverse reactions to medications, assisted in Conrado Benítez Teaching Oncological Hospital of Santiago de Cuba was carried out during the second semester of 2016, aimed at determining the most frequent ones, as well as the drugs that had a higher effect on such reactions. In the series, most of these reactions were notified by the graduates in pharmacy (76.2 percent) and among them the leukopenia, pruritic eruption, shivering and tachycardia were the most notable. On the other hand, the predominant pharmacological groups were the antineoplastic and immunosupressant ones, of which cyclophosphamide was the drugs of more incidence, followed by red blood cells concentrate and calcium gluconate, respectively

Métodos diagnósticos em cardio-oncologia / Diagnostc methods in cardio-oncology

As complicações cardiovasculares relacionadas com o tratamento contra o câncer têm grande impacto na morbidade e mortalidade desta população em questão. O reconhecimento precoce da cardiotoxicidade e o início de cardioproteção são fundamentais para melhor prognóstico desses pacientes. Os critérios para definir e monitorar a presença de toxicidade cardíaca relacionada com o tratamento contra o câncer incluem parâmetros clínicos, laboratoriais e métodos de diagnóstico por imagem. Sinais e sintomas clínicos, apesar de importantes, ocorrem tardiamente. O uso de biomarcadores cardíacos, em especial a troponina I, pode ser considerado para a detecção precoce de cardiotoxicidade. Entre os principais métodos de diagnóstico por imagem, o ecocardiograma tem sido a opção mais utilizada. O principal parâmetro ecocardiográfico envolvido ainda é a fração de ejeção do ventrículo esquerdo que, apesar de importante fator prognóstico, frequentemente falha na detecção precoce de cardiotoxicidade. Nesse contexto, a análise da deformação miocárdica pelo speckle tracking bidimensional tem demonstrado importante papel no diagnóstico precoce e subclínico de cardiotoxicidade. A avaliação da função sistólica do ventrículo esquerdo por meio da medicina nuclear é altamente reprodutível e especialmente útil em pacientes com definição ecocardiográ- fica inadequada. Esse método apresenta, entretanto, desvantagens como a exposição do paciente à radioatividade e a limitação na identificação de outras anormalidades cardíacas estruturais associadas. A ressonância magnética cardíaca é considerada o método padrão de referência para a avaliação dos volumes, massa e fração de ejeção do ventrículo esquerdo, sendo ferramenta muito útil nos pacientes em tratamento quimioterápico, especialmente ao incluir o estudo de realce tardio. Entretanto, essa técnica tem baixa disponibilidade e alto custo

The cardiovascular complications related to cancer treatment have an important impact on the morbidity and mortality of this population in question. Early recognition of cardiotoxicity and the start of cardioprotection are fundamental for the best prognosis of these patients. The criteria for defining and monitoring the presence of cardiotoxicity related to cancer treatment involve clinical parameters, laboratory indices, and diagnostic imaging methods. Although important, the clinical signs and symptoms occur later. The use of cardiac biomarkers, especially troponin I, may be considered for early detection of cardiotoxicity. Among the main diagnostic imaging methods, echocardiography has been the most widely used option. The main echocardiographic parameter involved is still left ventricular ejection fraction, which, although an important prognostic factor, frequently failed to detect early cardiotoxicity. In this context, evaluation of myocardial deformation by two-dimensional speckle tracking echocardiography has demonstrated an important role in the early and subclinical diagnosis of cardiotoxicity. Evaluation of left ventricular systolic function through nuclear medicine is highly reproducible, and is especially useful in patients with inadequate echocardiographic image. However, this method has disadvantages, such as exposure of the patient to radioactivity, and is limited in the identification of other associated structural cardiac abnormalities. Cardiac magnetic resonance is considered the gold standard for evaluating volumes, mass, and left ventricular ejection fraction, and is a very useful method in patients undergoing chemotherapy, especially as it includes the study of the late enhancement. However, this technique has low availability and high cost

O tratamento oncológico e a doença arterial coronariana / Cancer treatment and coronary artery disease

A concomitância de doença arterial coronariana e câncer é uma apresentação frequente na prática da cardiologia. Além de compartilharem os mesmos fatores de risco para seu desenvolvimento e, portanto, os mesmos grupos demográficos, a toxicidade vascular da quimioterapia e da radioterapia torna mais alta a incidência da doença no grande grupo de sobreviventes do câncer. No ciclo do tratamento oncológico, a ocorrência de eventos cardíacos maiores, secundários ou não à cardiotoxicidade, é determinante de alteração ou interrupção de tratamento, com efeito importante na sobrevida. O objetivo da assistência especializada é retornar o paciente ao tratamento o mais precocemente possível e, na fase tardia, evitar a morte por doença cardiovascular. As peculiaridades da apresentação da doença coronariana e do diagnóstico e tratamento percutâneo são aqui discutidas

Concomitant coronary artery disease and cancer is a common presentation in current cardiovascular practice. Besides sharing the same risk factors for their development, and accordingly, the same demographic groups, vascular toxicity from chemotherapy and radiotherapy make the incidence of the disease higher in the large group of cancer survivors. During the cancer treatment cycle, the occurrence of major cardiac events, whether due to cardiotoxicity or not, is responsible for changes or interruption of treatment, with important effects on survival. The goal of specialized care is to return the patient to treatment as early as possible and in the later phase, to avoid death from cardiovascular disease. The specific characteristics of coronary disease and percutaneous diagnosis and treatment are discussed here

Autofagia, una estrategia de supervivencia celular / Autophagy. A strategy for cell survival

La autofagia es un proceso de reciclado de partes de la célula. Como se describe en esta revisión, ocurre naturalmente preservando a las células de la acumulación de toxinas, moléculas y organelas dañadas y además permite los procesos de desarrollo y diferenciación de los tejidos. En el transcurso de la autofagia, el procesamiento de los sustratos a reciclar genera ATP, lo que constituye una fuente alternativa de energía en situaciones de estrés. En este sentido, bajo condiciones hostiles como hipoxia o falta de nutrientes, el proceso puede dispararse de modo exacerbado llevando a la muerte celular. Algunas alteraciones en su funcionamiento pueden involucrar el desarrollo de diversas patologías, tales como el daño hepático, el cáncer y las enfermedades neurodegenerativas.

Autophagy is a process of recycling parts of the cell. As described in this review, it occurs naturally in order to preserve cells from the accumulation of toxins, damaged molecules and organelles, and to allow processes of tissue development and differentiation. In the course of autophagy, the processing of the substrates to be recycled generates ATP, thus providing an alternative source of energy in stress situations. In this sense, under hostile conditions such as hypoxia or lack of nutrients, the autophagy process can be exacerbated leading to cell death. Some alterations in its functioning may involve the development of various pathologies, including liver damage, cancer and neurodegenerative diseases.

Signs and symptoms of rheumatic diseases as first manifestation of pediatric cancer: diagnosis and prognosis implications / Sinais e sintomas sugestivos de doenças reumáticas como primeira manifestação de doenças neoplásicas na infância: implicações no diagnóstico e prognóstico

ABSTRACT Objective: To assess the prevalence and describe the clinical, laboratory and radiological findings, treatment and outcome of children with cancer initially referred to a tertiary outpatient pediatric rheumatology clinic. Methods: Retrospective analysis of medical records from patients identified in a list of 250 new patients attending the tertiary Pediatric Rheumatology Clinic, Ribeirão Preto Medical School hospital, University of São Paulo, from July 2013 to July 2015, whose final diagnosis was cancer. Results: Of 250 patients seen during the study period, 5 (2%) had a cancer diagnosis. Among them, 80% had constitutional symptoms, especially weight loss and asthenia, and 60% had arthritis. Initially, all patients had at least one alteration in their blood count, lactate dehydrogenase was increased in 80% and a bone marrow smear was conclusive in 60% of patients. Bone and intestine biopsies were necessary for the diagnosis in 2 patients. JIA was the most common initial diagnosis. The definitive diagnosis was acute lymphoblastic leukemia (2 patients), M3 acute myeloid leukemia, lymphoma, and neuroblastoma (one case each). Of 5 patients studied, 3 (60%) are in remission and 2 (40%) died, one of them with prior use of steroids. Conclusion: The constitutional and musculoskeletal symptoms common to rheumatic and neoplastic diseases can delay the diagnosis and consequently worsen the prognosis of neoplasms. Initial blood count and bone marrow smear may be normal in the initial framework of neoplasms. Thus, the clinical follow-up of these cases becomes imperative and the treatment, mainly with corticosteroids, should be delayed until diagnostic definition.

RESUMO Objetivo: Avaliar a prevalência e descrever as principais manifestações clínicas, os exames complementares, o tratamento e a evolução de crianças com doenças neoplásicas atendidas inicialmente em um serviço terciário de reumatologia pediátrica. Métodos: Analisamos retrospectivamente o prontuário médico de pacientes com diagnóstico definitivo de neoplasia, identificados entre 250 casos novos atendidos no ambulatório de reumatologia pediátrica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP, de julho de 2013 a julho de 2015. Resultados: Dos 250 pacientes, cinco (2%) tiveram diagnóstico de neoplasia. Desses, 80% apresentavam sintomas constitucionais, principalmente perda de peso e astenia e 60% artrite. Inicialmente, todos apresentavam pelo menos uma série alterada no hemograma, 80% aumento da desidrogenase lática (LDH) e 60% mielograma confirmatório. Dois pacientes necessitaram de biópsia, óssea e de intestino, para o diagnóstico final. Artrite idiopática juvenil foi o diagnóstico inicial mais frequente. Os diagnósticos definitivos foram leucemia linfoide aguda (dois casos), leucemia mieloide aguda-M3, neuroblastoma e linfoma (um caso cada). Dos pacientes estudados, três (60%) estão em remissão. Dois pacientes foram a óbito (40%), um deles com uso prévio de corticoide. Conclusão: Os sintomas constitucionais e musculoesqueléticos comuns às doenças reumáticas e neoplásicas podem retardar o diagnóstico e consequentemente agravar o prognóstico das neoplasias. O hemograma inicial, assim como o mielograma, podem estar normais no quadro inicial das neoplasias. Dessa forma, o seguimento clínico evolutivo desses casos torna-se imperativo e o tratamento, principalmente com corticoides, deve ser retardado até definição diagnóstica.