Phytophotodermatitis Due to Fig Tree Sap Activated by Ultraviolet Light: A Case Report.

Phytophotodermatitis is a dermatological reaction caused by exposure to certain plants, which becomes activated upon subsequent exposure to sunlight. This can frequently result in a rash. Typically, supportive treatment is recommended. In this report, we describe the case of phytophotodermatitis in a 57-year-old man who experienced a painful rash with streaked lesions following the pruning of a fig tree during the summer. The patient, with no significant medical history, presented to the emergency department in July with a painful, streaked rash on both forearms. The lesions appeared overnight, predominantly on areas of skin exposed while sleeping. The patient denied contact with potential irritants and had not engaged in recent travel or altered his usual habits. Laboratory tests, including complete blood count and markers of inflammation, showed no abnormalities. A thorough patient history revealed recent fig tree pruning, a task usually undertaken in winter. The diagnosis of phytophotodermatitis was made based on the characteristic skin lesions and the patient's history of exposure to fig tree sap. Treatment with antihistamines led to improvement in symptoms, and the patient was discharged with a week-long course of antihistamines and advice to avoid sunlight and contact with fig trees. This case underscores the importance of a detailed medical history, especially in the context of dermatological lesions, to accurately diagnose and treat conditions like phytophotodermatitis.

Characteristics and patient-reported outcomes of long-term lung cancer survivors.

Background: Due to advances in screening and treatment of lung cancer, there has been increased interest in long-term lung cancer survivors (LTLCS). The aim of this study was to evaluate the prevalence of LTLCS, their characteristics and patient-reported outcomes (PROs) of LTLCS. Methods: Cross-sectional study that included patients diagnosed with primary lung cancer between Jan 2012 and Dec 2016 whose overall survival (OS) was greater than 5 years. A self-administered questionnaire was applied, including European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30), Patient Health Questionnaire-4 (PHQ-4) and two open questions regarding quality of life (QoL) and suggestions for improvements. Factors potentially related to QoL were analysed. Results: Of 767 lung cancer patients, 158 (20.6%) were LTLCS and LTLCS' proportion increased yearly. Most patients were male (70.9%) with median age of 65 [interquartile range (IQR), 56-71] years. Fifty-seven percent had adenocarcinoma, 66.2% were diagnosed at early stages but 8.9% were at stage IV. During follow-up, 77.1% quitted smoking, 31.8% had disease progression/relapse and 15.2% developed other tumours. Of all living LTLCS, 100 (85%) patients answered the PROs questionnaire. The median Global Health score was 66.67 (IQR, 50-83), social functioning had the best score and emotional functioning the worst. Pain and fatigue were the symptoms with the worst impact on QoL. PHQ-4 identified mental distress in 36% and patients with a lower QoL were more likely to present anxiety (35.3% vs. 9.4%, P=0.007) or depression (27.9% vs. 3%, P=0.006). In the open questions, patients reported pain (17%), lack of familiar/financial support (16%), dyspnoea (14%), depression (8%), concern for the future (8%) and limitations performing daily activities (8%) as the aspects with most impact in QoL. The most suggested measures were improvement of care provided by health institutions (25%) and better social support (16%). Conclusions: Prevalence of LTLCS is increasing and survivors may experience a high prevalence of anxiety and depression as well as a high disease burden affecting QoL. Therefore, it's important to provide multidisciplinary continuous patient-centred care and a careful follow-up for all lung cancer patients, including LTLCS.

Epidemiological and molecular evidence of intrafamilial transmission through sexual and vertical routes in Bahia, the state with the highest prevalence of HTLV-1 in Brazil.

INTRODUCTION: Familial clustering of HTLV-1 and related diseases has been reported in Brazil. However, intrafamilial transmission of HTLV-1 based on molecular analysis has been studied only in a few communities of Japanese immigrants and African-Brazilians. OBJECTIVE: To investigate the familial clustering of HTLV-1 infection and to determine the likely routes of transmission through epidemiological and genetic analyzes. METHODS: Medical records of 1,759 HTLV-1+ patients from de the Center for HTLV in Salvador, Brazil, were evaluated to identify first-degree relatives previously tested for HTLV-1. Familial clustering was assumed if more than one member of the same family was HTLV-1+. LTR regions of HTLV-1 sequences were analyzed for the presence of intrafamilial polymorphisms. Family pedigrees were constructed and analyzed to infer the likely transmission routes of HTLV-1. RESULTS: In 154 patients at least one other family member had tested positive for HTLV-1 (a total of 182 first-degree relatives). Of the 91 couples (182 individuals), 51.6% were breastfed, and 67.4% reported never using a condom. Of the 42 mother-child pairs, 23.8% had a child aged 13 years or younger; all mothers reported breastfeeding their babies. Pedigrees of families with 4 or more members suggests that vertical transmission is a likely mode of transmission in three families. Three families may have had both vertical and sexual transmission routes for HTLV-1. The genetic signatures of the LTR region of 8 families revealed 3 families with evidence of vertical transmission, another 3 families (spouses) with sexual transmission, and one family with both transmission routes. HTLV-1 sequences belonged to Cosmopolitan subtype HTLV-1a Transcontinental subgroup A. CONCLUSION: Sexual and vertical transmission routes contribute to the intrafamilial spread of HTLV-1 in the state of Bahia.

Colecistectomias: análise de um hospital escola / Cholecystectomies - analysis in a school hospital

Introdução: A colecistopatia calculosa atinge cerca de 20% da população ocidental adulta, e dela 15% tornam-se sintomáticos. No Brasil foram realizadas, entre 12/2019 e 11/2020, 138.154 colecistectomias pelo Sistema Único de Saúde Objetivo: Levantar dados das colecistectomias realizadas em 2 anos em um hospital escola, analisando o perfil epidemiológico dos pacientes e resultados operatórios. Método: Foram analizadas 942 colecistectomias. Compararam-se os procedimentos eletivos com os de urgência quanto à necessidade de drenagem, reoperação, complicações pós-operatórias e da ferida operatória. Resultados: Do total, 75,9% eram mulheres com média de 48,2 anos de idade. Procedimentos urgentes foram realizadas em 34,9%. Houve mais complicações nas urgências e nos que necessitaram de drenagem. Houve mais complicações na ferida operatória nos pacientes submetidos à reoperação. Conclusão: A análise dos dados mostrou independência de 5 variáveis na evolução pós-operatória das colecistectomias e elas interferiram negativamente quer por si só, quer em associação. Foram elas: drenagem vs. porta de entrada; drenagem vs. reoperação; porta de entrada vs. complicações pós-operatórias; reoperação vs. complicações no pós-operatório; e reoperação vs. complicações na ferida operatória.

Introduction: Calculous cholecystopathy affects about 20% of the Western adult population, and 15% of them become symptomatic. About 138.154 cholecystectomies were performed between 12/2019 and 11/2020 at Brazil, by the public health system. Objective: To collect data from cholecystectomies performed during 2 years in a teaching hospital, analyzing the epidemiological profile of patients and operative results. Method: 942 cholecystectomies were analyzed. Elective and emergency procedures were compared regarding the need for drainage, reoperation, postoperative and wound complications. Results: Of the total, 75.9% were women with a mean age of 48.2 years. Urgent procedures were performed in 34.9%. There were more complications in emergencies and in those requiring drainage. There were more complications in the surgical wound in patients undergoing reoperation. Conclusion: Data analysis showed independence of 5 variables in the postoperative evolution of cholecystectomies and they negatively interfered either by themselves or in combination. They were: drainage vs. hospital entrance; drainage vs. reoperation; hospital entrance vs. postoperative complications; reoperation vs. postoperative complications; and reoperation vs. complications in the surgical wound.

Simulação de alta-fidelidade na formação pós-graduada de enfermeiros: satisfação e ganhos percebidos / High-fidelity simulation in the postgraduate training of nurses: satisfaction and perceived gains

Considerando que a pessoa em situação crítica tem a vida ameaçada por falência iminente de uma ou mais funções vitais e que para sobreviver depende de meios avançados de monitorização, vigilância e terapêutica, requer cuidados altamente qualificados e contínuos, como resposta às necessidades afetadas, no sentido de prevenir complicações e limitar incapacidades, tendo em vista a sua recuperação total. Estas crescentes exigências dos cuidados de saúde, conduzem os enfermeiros, como estratégia de desenvolvimento profissional, a investir na sua formação procurando níveis cada vez mais específicos e elevados para que sejam cada vez mais competentes. A abordagem de enfermagem à pessoa em situação critica exige que o enfermeiro seja detentor de competências especificas e de uma formação estruturada e organizada que lhe permita maximizar a sua práxis clínica. Com base nestes pressupostos, pretendemos com este estudo analisar a influência da Simulação de Alta-fidelidade (SAF) na satisfação e nos ganhos percebidos pelos estudantes do curso de mestrado em Enfermagem Médico-cirúrgica, na abordagem à pessoa em situação critica Neste sentido, desenvolveu-se um estudo descritivo-correlacional, observacional e transversal com uma amostra de 38 enfermeiros, estudantes do Curso de Mestrado em Enfermagem Médico-cirúrgica de uma escola de saúde do Norte do país. Com instrumentos de colheita de dados, utilizou-se um questionário de caraterização socioprofissional, a Escala de Satisfação com Experiências Clínica Simulada (ESECS) e a Escala de Ganhos Percebidos com a Simulação de Alta-fidelidade (EGPSA), complementados com um conjunto de questões abertas dirigidas às expetativas e perceções dos estudantes quanto às experiências clínicas simuladas (ECS) em laboratório de alta-fidelidade, no âmbito de UC do plano curricular do curso de mestrado. Os resultados indicaram um elevado grau de Satisfação com a SAF, obtendo valores médios de 8,82 ± 0,82 na totalidade da escala (ESECS), em que o nível de satisfação varia entre 1 e 10, sendo a Dimensão Cognitiva a que obteve maior média de satisfação (9,09 ± 0,94) e a Dimensão Prática o menor valor médio com (8,71 ± 0,94). Não se observaram diferenças estatisticamente significativas entre variáveis sociodemográficas e profissionais e a satisfação com as experiências clínicas simuladas. Quanto aos Ganhos Percebidos com a SAF, de uma forma global, e na maioria das dimensões, os participantes posicionaram-se no atributo "melhorei consideravelmente" (M>4,0), à exceção das dimensões Atitudinal e Técnico-prática que obtiveram médias de 3,99 e 3,93, respetivamente, muito próximas da propriedade "melhorei consideravelmente". Na análise das correlações, apenas se verificaram correlações negativas, de baixas a moderadas, entre a aprendizagem global (p<0,05), e as suas dimensões Reconhecimento e Decisão, Cognitiva e Técnico-prática, (p<0,05), com o tempo de serviço, inferindo-se que quanto menor for o tempo de exercício profissional dos participantes, maiores são os ganhos percebidos. Não se constataram associações entre a satisfação e os ganhos percebidos com outras variáveis socioprofissionais. Por sua vez, observou-se associação muito significativa e positiva entre a ESECS total e a EGPSA total (p=0,01), concluindo que quanto maiores os ganhos percebidos pelos estudantes, maior a satisfação com a SAF. Pela análise de conteúdo das questões abertas, os estudantes demonstram elevadas expectativas relativamente às ECS com recurso a SAF, alegando que serão uma mais-valia na aquisição/desenvolvimento de aprendizagens, permitindo a consolidação/desenvolvimento de conhecimentos e competências, favorecendo o trabalho em equipa e melhorando a prática profissional. O realismo dos cenários, o debriefing, assim como, a segurança, foram apontados como aspetos positivos das práticas clínicas simuladas, para o desenvolvimento da aprendizagem. No entanto, o planeamento das ECS e a diversidade de cenários são aspetos a ser melhorados. Em síntese, considerando estes resultados é notória a importância que as ECS com recurso a SAF têm, como estratégia formativa, sugerindo que promove a aquisição/desenvolvimento de competências, traduzindo-se numa melhor prestação de cuidados, comprovando a mais-valia desta, como recurso na formação contínua de enfermeiros.

Considering that the person in critical condition is life threatened by the imminent failure of one or more vital functions, and that, for surviving they depend on advanced means of monitoring, surveillance and therapy, they require highly qualified and continuous care, in response to the affected needs, in the sense to prevent complications and limit disabilities, with a view to their full recovery. These growing health care demands, lead nurses, as a professional development strategy to invest in their training, seeking increasingly high and specific levels so that they became increasingly competent. The nursing approach to the patient in critical situation requires that nurses have specific skills and a structured and organized training that allows them to maximize nursing practices. Based on these assumptions, we intend with this study to analyze the influence of High-Fidelity Simulation (HFS) on the satisfaction and gains perceived by students of the Master's course in Medical-surgical Nursing, in the approach to people in critical situations. In this sense, a descriptive, correlational and cross-sectional study was developed with a sample that included 38 nurses, students of the Master's Course in Medical-surgical Nursing at a health school in the North of the country. As data collection instruments, the Scale of Satisfaction with Simulated Clinical Experiences (SSSCE) and Scale of Perception of Gains with the High-fidelity Simulation (PGHFS), were used, complemented with a set of open questions aimed to the expectation and perception of the students regarding the simulated clinical experiences in a High-fidelity laboratory, within the scope of CU of the master's course curriculum The results indicate a high degree of satisfaction with the HFS, obtaining mean values of 8,82 ± 0,82 in the entire scale of Satisfaction of Simulated Clinical Experiments (SSCE), in which the level of satisfaction varies between 1 and 10, being the Cognitive Dimension the one that obtained highest mean of satisfaction (9,09 ± 0,94) and the Practical Dimension the lowest mean value with (8,71 ± 0,94). There were no statistically significant differences between sociodemographic and professional variables and satisfaction with simulated clinical experiences. Regarding the Gains Perceived with HFS, in a global way, an in most of the dimensions, the participants positioned themselves in the attribute "I improved considerably" (M>4,0), except for the attitudinal and technical-practical dimensions that obtained averages of 3.99 and 3.93, respectively, very close to the property "improved considerably".In the analysis of the correlations, there were only negative correlations, from low to moderate, between global learning (p<0.05), and its Recognition and Decision, Cognitive and Technical-practice dimensions, (p<0.05), with the length of service, inferring that the shorter the professional exercise time of the participants, the greater the perceived gains. There were no associations between satisfaction and perceived gains with other socio-professional variables. In turn, a very significant positive association was also observed between the total Scale of Satisfaction of Simulated Clinical Experiments and the total Scale of Perception of Learning with the High-fidelity Simulation (p=0,01), inferring that the greater the Gains Perceived by the students, the greater is the satisfaction with the HFS. By analyzing the content of the open questions, students demonstrate high expectations regarding the Simulated Clinical Experiments (SCE) employing the HFS, claiming that it will be an asset in the acquisition/development of learning, allowing the consolidation/development of knowledge and skills, favoring the teamwork and improving professional practice. The realism of the scenarios, the debriefing, as well as the safety, were pointed out as positive aspects of the simulated clinical practices, for the development of learning. However, the planning of the SCE and the diversity of the scenarios are aspects to be improved. In summary, considering these results, the importance of ECS using the SAF is notorious as a training strategy, suggesting that it promotes the acquisition/development of skills, resulting in better care provision, proving its added value, as resource in the continuing education of nurses.

Detection of early seeding of Richter transformation in chronic lymphocytic leukemia.

Richter transformation (RT) is a paradigmatic evolution of chronic lymphocytic leukemia (CLL) into a very aggressive large B cell lymphoma conferring a dismal prognosis. The mechanisms driving RT remain largely unknown. We characterized the whole genome, epigenome and transcriptome, combined with single-cell DNA/RNA-sequencing analyses and functional experiments, of 19 cases of CLL developing RT. Studying 54 longitudinal samples covering up to 19 years of disease course, we uncovered minute subclones carrying genomic, immunogenetic and transcriptomic features of RT cells already at CLL diagnosis, which were dormant for up to 19 years before transformation. We also identified new driver alterations, discovered a new mutational signature (SBS-RT), recognized an oxidative phosphorylation (OXPHOS)high-B cell receptor (BCR)low-signaling transcriptional axis in RT and showed that OXPHOS inhibition reduces the proliferation of RT cells. These findings demonstrate the early seeding of subclones driving advanced stages of cancer evolution and uncover potential therapeutic targets for RT.

Portuguese Consensus Recommendations for Next-Generation Sequencing of Lung Cancer, Rare Tumors, and Cancers of Unknown Primary Origin in Clinical Practice.

Next-generation sequencing (NGS) has been implemented in clinical oncology for diagnosis, prognosis, and therapeutic guidance. Among the various NGS applications in molecular oncology, we focused on the following topics: laboratory standards for targeted gene panels (somatic mutations) and therapeutic guidance based on NGS of lung cancer and rare cancers, namely sarcomas and cancers of unknown primary. Multiple quality control checkpoints should be addressed in the pre-analytical phase for good quality and interpretation of the NGS results. It includes tumor size and cellularity, tissue processing and decalcification, tumor fraction, tumor viability, fixatives, and staining. Communication between clinicians and laboratory support is also essential. In lung cancer, all patients with non-squamous non-small cell lung cancer should be tested with a NGS panel, and it should include not only genes with approved targeted therapies (ALK, BRAF, EGFR, MET, NTRK, RET, and ROS1) but also genes with potentially actionable genomic alterations (HER2 and KRAS). Since there is a lack of extensive knowledge regarding the use of NGS in rare tumors performing comprehensive genomic profiling, NGS panels to better manage the disease are recommended. Moreover, other patients with other incurable solid tumors may benefit from being included in biomarker-driven clinical trials. Multidisciplinary tumor boards with the participation of experts with the ability to integrate genomic profiling data are essential to tailor the best strategy for each patient. Considering that there are no national guidelines, this article aims to guide laboratory and clinical practice for the use of NGS in the context of lung cancer, rare tumors, and cancer of unknown primary in Portugal.

Na área da oncologia clínica, a sequenciação de nova geração (NGS) foi implementada com o objetivo de contribuir para o diagnóstico, prognóstico e orientação terapêutica. A utilização de NGS em oncologia molecular é vasta, focalizando-se estas recomendações nas: normas laboratoriais para painéis genéticos direcionados (mutações somáticas) e na orientação terapêutica baseada em NGS de cancro do pulmão e cancros raros, nomeadamente sarcomas e cancros de origem desconhecida. Para que sejam obtidos resultados de NGS com a qualidade que permita a sua correta interpretação, devem ser abordados múltiplos controlos de qualidade na fase pré-analítica que disponibilizem informação sobre o tamanho e celularidade do tumor, processamento e descalcificação de tecidos, fração tumoral, viabilidade do tumor, fixadores e coloração utilizados. A comunicação entre os diferentes intervenientes no processo, em particular entre os clínicos e o laboratório também contribui, de forma inequívoca, para a interpretação dos resultados de NGS. Todos os doentes com cancro do pulmão de não pequenas células não escamoso devem ser testados com um painel de NGS, que deve incluir não só genes com terapias dirigidas aprovadas (ALK, BRAF, EGFR, MET, NTRK, RET e ROS1), mas também genes com alterações genómicas identificadas como potenciais alvos terapêuticos (HER2 e KRAS). Dada a escassez de evidência científica sobre a utilização de NGS em tumores raros, recomenda-se a realização de painéis genómicos abrangentes que poderão contribuir para uma melhor gestão da doença. Adicionalmente, outros doentes, com outros tumores sólidos incuráveis, podem beneficiar da inclusão em ensaios clínicos orientados por biomarcadores. A realização de reuniões multidisciplinares com a participação de diferentes especialistas capazes de integrar dados dos perfis genómicos são fundamentais para a escolha da melhor estratégia para cada doente. Considerando que não existem recomendações nacionais, este artigo visa orientar a prática laboratorial e clínica para a utilização de NGS em tumores do pulmão, raros e cancros de origem primária desconhecida em Portugal.

Uso "off label" de plantas medicinais para tratamento do diabete melito / "Off label" use of medicinal plants for the treatment of diabetes mellitus

As plantas medicinais são de fácil aquisição sem receita médica. Algumas delas possuem comprovação científica para o efeito hipoglicemiante, outras não. O objetivo deste estudo foi conhecer a prevalência e o perfil do paciente que usa plantas medicinais como coadjuvantes no tratamento do diabete. Foram entrevistados 140 diabéticos e pré-diabéticos agrupados em quem fazia o uso dessa alternativa e os que não. Em conclusão, a prevalência foi de 15,7%, maior em mulheres. A medicação prescrita foi metformina. A planta mais utilizada foi a pata-de-vaca. O grupo em uso referiu melhora glicêmica com a terapia complementar quando questionados sobre a glicemia uma semana antes e na semana de uso

Medicinal plants are easily available without a prescription. Some of them have scientific proof for the hypoglycemic effect, others do not. The objective of this study was to know the prevalence and profile of patients who use medicinal plants as adjuncts in the treatment of diabetes. A total of 140 diabetics and pre-diabetics were interviewed, grouped into those who used this alternative and those who did not. In conclusion, the prevalence was 15.7%, higher in women. The medication prescribed was metformin. The most used plant was the pata-de-vaca. The group in use reported glycemic improvement with the complementary therapy when asked about the glycemia one week before and in the week of use

Integrative and Multidisciplinary Care for People Living With Human T-Cell Lymphotropic Virus in Bahia, Brazil: 20 Years of Experience.

Brazil is home to the highest absolute number of human T-cell lymphotropic virus type-1 (HTLV-1)-infected individuals worldwide; the city of Salvador, Bahia, has the highest prevalence of HTLV-1 infection in Brazil. Due to the complex nature of several diseases associated with this retrovirus, a multidisciplinary health care approach is necessary to care for people living with HTLV-1. The Bahia School of Medicine and Public Health's Integrative Multidisciplinary HTLV Center (CHTLV) has been providing support to people living with HTLV and their families since 2002, striving to ensure physical and mental well-being by addressing biopsychosocial aspects, providing clinical care and follow-up, including to pregnant/postpartum women, as well as comprehensive laboratory diagnostics, psychological therapy, and counseling to family members. To date, CHTLV has served a total of 2,169 HTLV-infected patients. The average patient age is 49.8 (SD 15.9) years, 70.3% are female, most are considered low-income and have low levels of education. The majority (98.9%) are HTLV-1 cases, and approximately 10% have been diagnosed with tropical spastic paraparesis/HTLV-1-associated myelopathy (TSP/HAM), while 2.2% have infective dermatitis and 1.1% have adult T-cell lymphoma. In all, 178 pregnant/postpartum women [mean age: 32.7 (±6.5) years] have received care at CHTLV. Regarding vertical transmission, 53% of breastfed infants screened for HTLV tested positive in their second year of life, nearly 18 times the rate found in non-breastfed infants. This article documents 20 years of experience in implementing an integrative and multidisciplinary care center for people living with HTLV in Bahia, Brazil. Still, significant challenges remain regarding infection control, and HTLV-infected individuals continue to struggle with the obtainment of equitable and efficient healthcare.

Clinical and radiological manifestations of acute disseminated encephalomyelitis associated with the main arboviruses / Manifestaciones clínicas y radiográficas de la encefalomielitis aguda diseminada asociada a los principales Arbovirus

ABSTRACT Introduction: Acute disseminated encephalomyelitis (ADEM) is an acute and inflammatory neuropathic disease that causes demyelination, predominantly affecting the white matter. Clinical manifestations of ADEM may be associated with the arboviruses zika fever, dengue fever, and chikungunya. Objective: The aim of the present study was to carry out a bibliographical survey about the clinical manifestations and radiological findings of ADEM after infection with dengue, zika, and chikungunya viruses, as well as their correlation. Methods: MEDLINE, LILACS, Web of Science, and Scopus databases were searched for articles published between 2010 and 2020, written in English, Spanish, and Portuguese, about the occurrence of ADEM in patients affected by zika fever, dengue fever, or chikungunya. The search yielded articles that demonstrated the occurrence of five cases of ADEM associated with zika fever, ten cases post-infection with the dengue virus cases, and two cases related to chikungunya. Conclusions: The most common initial clinical presentations of ADEM were fever, nausea and/or vomiting, myalgia, headache, skin rashes, and arthralgia. The main neurological symptoms reported were changes in the level of consciousness, pyramidal signs, tonic-clonic seizures, visual changes, and urinary disorders. The most common radiological findings were T2/FLAIR hyperintense lesions on magnetic resonance imaging (MRI), affecting mainly the subcortical and central white matter. It is highlighted the importance of monitoring patients with dengue fever, zika fever, or chikungunya to identify clinical manifestations of ADEM that may contribute to an early and correct diagnosis of this encephalomyelitis, and, consequently, to intervene and obtain better patient prognosis.

RESUMEN Introducción: La encefalomielitis diseminada aguda (EMDA) es una enfermedad neuropática aguda e inflamatoria que provoca desmielinización, y afecta predominantemente la materia blanca. Las manifestaciones clínicas de la EMDA pueden estar asociadas a los arbovirus Zika, dengue y chikungunya. Objetivo: Realizar una encuesta bibliográfica sobre las manifestaciones clínicas y los hallazgos radiográficos de la EMDA después de la infección por los virus del dengue, del Zika y del chikungunya, así como su correlación. Métodos: Se realizó una búsqueda, en las bases de datos MEDLINE, LILACS, Web of Science y Scopus, de artículos publicados entre 2010 y 2020, escritos en inglés, español y portugués, sobre la aparición de EMDA en pacientes afectados por la fiebre del Zika, la fiebre del dengue o del chikungunya. Se hallaron artículos que demostraron la ocurrencia de cinco casos de EMDA asociados con la fiebre del Zika, diez casos posteriores a la infección por el virus del dengue y dos casos relacionados con el chikungunya. Conclusiones: Las presentaciones clínicas iniciales más comunes de EMDA fueron fiebre, náuseas o vómitos, mialgia, dolor de cabeza, erupciones cutáneas y artralgia. Los principales síntomas neurológicos reportados fueron cambios en el nivel de conciencia, signos piramidales, convulsiones tónico-clónicas, cambios visuales y trastornos urinarios. Los hallazgos radiográficos más comunes fueron lesiones hiperintensas T2/FLAIR en imágenes de resonancia magnética. Estas lesiones afectaron principalmente la subcortical y la materia blanca central. Se destaca la importancia de la vigilancia de los pacientes con dengue, Zika o chikungunya para identificar las manifestaciones clínicas de la EMDA que puedan contribuir a un diagnóstico precoz y correcto de esta encefalomielitis y, por consiguiente, para intervenir y obtener un mejor pronóstico del paciente.

Peripheral blood eosinophilia may be a prognostic biomarker in non-small cell lung cancer patients treated with immunotherapy.

BACKGROUND: Eosinophils have been traditionally associated with the initiation and propagation of inflammatory responses, particularly in allergic diseases and helminth infections. More recently, an association between eosinophils and cancer has been the focus of several studies, but controversial results have emerged. This study aims to evaluate the prognostic role of peripheral blood eosinophilia in non-small cell lung cancer (NSCLC) patients receiving immunotherapy (IO). We also evaluated the impact of peripheral eosinophilia on the occurrence of immune-related adverse effects (irAEs). METHODS: Advanced NSCLC patients under IO were included in a retrospective single-center study. Peripheral blood eosinophilia was defined by a count greater than 500/µL. Patients were analyzed for eosinophil counts, overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and disease control rate (DCR). RESULTS: A total of 121 NSCLC patients receiving IO were included. Thirty-three (27.3%) patients presented peripheral blood eosinophilia during treatment. Patients with peripheral eosinophilia presented more frequently non-progression as best overall response to IO (83.3% vs. 58.1%, P=0.014), higher median OS (26.6 vs. 9.5 months, P=0.022) and higher median PFS (13.8 vs. 4.6 months, P=0.013). IrAEs were more common in patients with peripheral eosinophilia (66.7% vs. 36.4%, P=0.003). CONCLUSIONS: This study suggests that peripheral blood eosinophilia may predict better outcomes in NSCLC patients receiving IO, despite being associated with an increased risk of irAEs. According to our findings eosinophils may be involved in immune response against tumor. Routine eosinophils count assessment may be an additional prognostic tool in NSCLC patients receiving IO.

Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia: A Clinical Case.

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare pulmonary condition characterized by diffuse proliferation of neuroendocrine cells in the epithelium of the bronchial wall. DIPNECH may be easily missed in daily clinical practice and diagnosis is often delayed, which may impair prognosis since this condition is considered a pre-invasive lesion for lung carcinoid tumours. We report a clinical case of DIPNECH in order to discuss the diagnostic and therapeutic approach for this entity, the management of which is not yet well established in the literature. LEARNING POINTS: DIPNECH is a poorly understood lung condition characterized histologically by diffuse proliferation of pulmonary neuroendocrine cells in the bronchial wall, clinically by obstructive respiratory symptoms and radiologically by small airway disease features and pulmonary nodules.DIPNECH is considered to be a preneoplastic lesion within the spectrum of pulmonary neuroendocrine tumours.Treatment is usually guided by the symptoms and prognosis is highly variable.

Pan-cancer analysis of whole genomes identifies driver rearrangements promoted by LINE-1 retrotransposition.

About half of all cancers have somatic integrations of retrotransposons. Here, to characterize their role in oncogenesis, we analyzed the patterns and mechanisms of somatic retrotransposition in 2,954 cancer genomes from 38 histological cancer subtypes within the framework of the Pan-Cancer Analysis of Whole Genomes (PCAWG) project. We identified 19,166 somatically acquired retrotransposition events, which affected 35% of samples and spanned a range of event types. Long interspersed nuclear element (LINE-1; L1 hereafter) insertions emerged as the first most frequent type of somatic structural variation in esophageal adenocarcinoma, and the second most frequent in head-and-neck and colorectal cancers. Aberrant L1 integrations can delete megabase-scale regions of a chromosome, which sometimes leads to the removal of tumor-suppressor genes, and can induce complex translocations and large-scale duplications. Somatic retrotranspositions can also initiate breakage-fusion-bridge cycles, leading to high-level amplification of oncogenes. These observations illuminate a relevant role of L1 retrotransposition in remodeling the cancer genome, with potential implications for the development of human tumors.

Nivolumab-induced hypothyroidism followed by isolated ACTH deficiency.

Cancer immunotherapy has been used in several malignancies with clinical benefit. Despite the clinical success, immune-related adverse events are frequent and endocrinopathies can be particularly severe. We report a 55-year-old male patient with stage IV pulmonary carcinoma treated with nivolumab who presented with thyroid dysfunction after the sixth administration of the drug. One year after thyroid dysfunction, the patient complained of severe fatigue, asthenia and weight loss. Laboratory testing showed low morning cortisol with undetected adrenocorticotropic hormone; other pituitary hormones were normal and MRI showed homogeneous enhancement of the pituitary gland and no space-occupying lesions. The diagnosis of nivolumab-induced hypophysitis was made and replacement treatment with hydrocortisone was started with clinical improvement. This case demonstrates that patients under immunotherapy are at risk for a large spectrum of endocrine dysfunctions that may worsen their prognosis. Close monitoring of these patients is warranted.

Pulmonary cement embolism following balloon kyphoplasty: The impact of a procedural complication in a new era for lung cancer management.

Pulmonary cement embolism (PCE) is a recognized complication of balloon kyphoplasty, a vertebral augmentation technique that stabilizes vertebral compression fractures, alleviating associated pain. Balloon kyphoplasty is particularly relevant when patients with advanced stages of cancer present with longer survival times, and therefore benefit from such augmentation techniques to improve pain and prevent additional complications. The embolization of cement to pulmonary vasculature may be unnoticed given the frequent absence of symptoms and routine imaging tests following the procedure. The present study reports the case of a 58-year-old female with stage IV lung cancer with a painful compression L3 fracture who underwent balloon kyphoplasty with no initially reported complications. The patient maintained the usual respiratory symptoms; therefore, the diagnosis was only made in a routine CT scan 3 months after the surgery. A literature review of PCE is performed, integrating the current evidence regarding diagnosis, therapeutics, prognosis and prevention. Certain poorly clarified aspects are identified as potential investigation starting points.