Calotropis procera (Aiton) Dryand (Apocynaceae) as an anti-cancer agent against canine mammary tumor and osteosarcoma cells.

Our goal was to evaluate phytochemical characterization and the antitumor potential of Calotropis procera. The phytochemical constitution of the crude extract (CE) revealed the presence of flavonoids, glycosides and cardenolide. The MTT assay was used to evaluate the cytotoxicity of CE, methanolic (MF) and ethyl acetate fractions (EAF) of C. procera in canine osteosarcoma cells (OST), canine mammary tumor (CMT), and canine skin fibroblasts (non-tumor cell). Doxorubicin was also used as a positive control. Results showed that CE, MF and EAF promoted a decrease in the viability of OST and CMT cells and did not alter the fibroblasts viability. C. procera also decreased the number of cells, corroborating to the decrease in proliferation and the cell cycle arrest in the G0/G1 phase. It was also evaluated the cell morphology by light and fluorescence microscopy, being demonstrated a reduction in cytoplasmic and cell rounding characteristic of programmed cell death. Moreover, flow cytometry data demonstrated that CE treatment promoted increase of caspase-3 and p53, showing that the cell death was activated in OST cells. In addition, there was a decrease in CD31, VEGF, osteopontin and TGF-ß after CE treatment, suggesting that CE exerts its antitumor effect by reducing angiogenesis and tumor progression in OST cells. Moreover, CMT cells showed a reduction in PCNA after treatment with MF and CE. Analyzing the data together, C. procera, especially CE, showed an antitumor potential in both OST and CMT cells, encouraging us to continue investigating its use in cancer therapy.

Sobrecarga e sintomatologia depressiva em familiares cuidadores de pessoas dependentes de álcool e outras drogas / Burden and depressive symptomatology in family caregivers of people dependent on alcohol and other drugs

Este estudo avaliou a sobrecarga subjetiva e a sintomatologia depressiva de familiares cuidadores de pessoas com dependência de álcool e outras drogas. Foram entrevistados 50 familiares de pacientes de uma instituição filantrópica de tratamento para abuso de substâncias psicoativas. Utilizou-se a escala de avaliação da sobrecarga Burden Interview, o Inventário de Depressão de Beck e um questionário sociodemográfico e clínico. A maioria dos familiares apresentou sobrecarga entre leve a moderada e grave, e aproximadamente metade apresentou sintomatologia depressiva entre leve e grave. Os preditores da sintomatologia depressiva, identificados pela análise de regressão linear múltipla, foram: em primeiro lugar, o grau de sobrecarga e, em seguida, as variáveis: baixa renda, não viver com um companheiro, avaliação negativa do relacionamento com o paciente e maior número de comportamentos problemáticos do paciente. Esses resultados indicam a necessidade de os serviços desenvolverem intervenções psicossociais que diminuam o grau de sobrecarga dos familiares cuidadores e melhorem o relacionamento com os pacientes, de forma a prevenir o desenvolvimento de uma sintomatologia depressiva.

This study evaluated the subjective burden and depressive symptomatology in family caregivers of patients with alcohol and other drugs dependence. Fifty family members of patients from a philanthropic institution for the treatment of substance abuse were interviewed. The Burden Interview for overload assessment scale, the Beck Depression Inventory and a sociodemographic and clinical questionnaire were used. Most family members had a burden between mild to moderate and severe, and approximately half had depressive symptoms between mild and severe. The predictors of depressive symptomatology identified by multiple linear regression analysis, were: first, the degree of burden and, then, the variables: low income, not living with a partner, negative assessment of the relationship with the patient and greater number of problematic patient behaviors. These results indicate the need for services to develop psychosocial interventions that reduce the degree of burden on family caregivers and improve the relationship with patients, in order to prevent the development of depressive symptoms.

Imunoterapia em Oncologia em uma Cidade do Interior de Minas Gerais: Análise da Década 2010-2019 / Immunotherapy in Oncology in a Countryside City of Minas Gerais: Analysis of the decade 2010-2019 / Inmunoterapia en Oncología en una Ciudad del Interior de Minas Gerais: Analisis de la Década 2010-2019

Introdução: Nos últimos anos, a terapia sistêmica em oncologia sofreu mudanças substanciais e a imunoterapia destacou-se como forma de tratamento adjuvante. No Brasil, as diferenças do acesso a essa terapêutica podem ser observadas de maneira relevante e ainda não há amplo conhecimento sobre o seu uso nas diferentes Regiões do país. Objetivo: Analisar o panorama da utilização de imunoterapia no tratamento oncológico em Barbacena-MG na última década. Método: Estudo descritivo de centro único. Os pacientes maiores de 18 anos, diagnosticados com câncer e que utilizaram imunoterápicos no período de 2010 a 2019, foram selecionados por meio de consulta ao Registro Hospitalar de Câncer, e as informações constantes nesse sistema, bem como prontuários, foram utilizadas para obtenção de dados sociodemográficos e clínicos. Resultados: A imunoterapia foi utilizada no tratamento de 90 pacientes (4,9%), totalizando 95 tratamentos. Entre os medicamentos utilizados, destacaram-se o Bacillus Calmette-Guérin (BCG), o trastuzumabe e o imatinibe. Observou-se um aumento na utilização de imunoterápicos ao longo da década, bem como uma maior variedade de tratamentos realizados. O imatinibe e o pazopanibe obtiveram maior porcentagem de óbitos durante o tratamento e 77,9% dos medicamentos utilizados foram custeados pelo Sistema Único de Saúde (SUS). O tempo de tratamento da maioria dos pacientes se manteve próximo a dez meses, sendo menor para aqueles que se trataram com BCG. Conclusão: O uso da imunoterapia em oncologia em Barbacena apresentou um avanço no período de 2010 a 2019, tanto no quantitativo quanto na variedade de tratamentos, com incorporação de novos medicamentos.

Introduction: In recent years, systemic therapy in oncology has undergone substantial changes and immunotherapy has spread out as a form of adjuvant treatment. In Brazil, differences of access to this therapy are relevant and there is still no extensive knowledge about the use of immunotherapy in different regions of the country. Objective: To analyze the panorama of immunotherapy in cancer treatment in Barbacena-MG in the last decade.Method: Single-centre descriptive study. Patients over 18 years diagnosed with cancer who used immunotherapies in the period from 2010 to 2019 were selected by reviewing the Hospital Cancer Registry and the information contained in this system, as well as charts, were used to obtain sociodemographic and clinical data. Results: Immunotherapy was used to treat 90 patients (4.9%), totalling 95 treatments. Bacillus Calmette-Guérin (BCG), trastuzumab and imatinib were the drugs most used. There was an increase in the use of immunotherapeutic agents over the decade, as well as in the variety of treatments performed. Imatinib and pazopanib had a higher percentage of deaths during treatment and 77.9% of the drugs used were funded by the Unified Health System (SUS). Treatment duration for most patients remained close to 10 months, being shorter for those who were treated with BCG. Conclusion: The use of immunotherapy in oncology in Barbacena has grown from 2010 to 2019, in number and variety of treatments, with incorporation of new drugs.

Introducción: En las últimas décadas han permitido el desarrollo de nuevas modalidades de tratamientos anticancerosos y la inmunoterapia se ha destacado. En Brasil, el acceso desigual a inmunoterapia es relevante y todavía no hay amplio conocimiento sobre su uso en las distintas regiones del país. Objetivo: Analizar el panorama de la inmunoterapia en el tratamiento anticanceroso en Barbacena-MG en la última década. Método: Estudio descriptivo de centro único, con datos del Registro Hospitalario de Cáncer y registros médicos de los pacientes que usaron inmunoterapéuticos en el tratamiento anticanceroso de 2010 a 2019. Resultados: Se utilizó inmunoterapéuticos para tratar a 90 pacientes (4,9%), totalizando 95 tratamientos. Entre los medicamentos utilizados, se destacaron Bacillus Calmette-Guérin (BCG), trastuzumab e imatinib. Hubo un aumento en el uso de inmunoterapéuticos en la década, así como una mayor variedad de tratamientos realizados. Imatinib y pazopanib tuvieron un mayor porcentaje de muertes durante el tratamiento y 77,9% de los medicamentos utilizados fueron financiados por el Sistema Único de Salud (SUS). El tiempo de tratamiento para la mayoría de los pacientes fue diez meses, siendo más corto para el tratamiento con BCG. Conclusión: El uso de la inmunoterapia en oncología en Barbacena ha avanzado en el período de 2010 a 2019, tanto en cantidad como variedad de tratamientos, con incorporación de nuevos medicamentos.

Oncology pharmacy units: a safety policy for handling hazardous drugs and related waste in low- and middle-income African countries-Angolan experience.

In African countries, higher rates of late-stage cancers at the time of first diagnosis are a reality. In this context, hazardous drugs (HDs), such as chemotherapy, play an important role and have immense benefits for patients' treatment. HDs should be handled under specific conditions. At least a class 5 environment primary engineering control (PEC), physically located in an appropriate buffer area, is mandatory for sterile HDs compounding, as well as administrative control, personal protective equipment, work practices and other engineering and environmental controls, in order to protect the environment, patient, and worker. The aim of this study is to describe the Angolan experience regarding the development of oncology pharmacy units and discuss international evidence-based guidelines on handling HDs and related waste. Measures to incorporate modern and economical solutions to upgrade or build adequate and safe facilities and staff training, in order to comply with international guidelines in this area, are crucial tasks for African countries of low and middle income.

Establishing of cancer units in low or middle income African countries: Angolan experience--a preliminary report.

INTRODUCTION: The number of cancer cases and related deaths worldwide is expected to double over the next 20-30 years. African countries will be the most affected by the burden of cancer. The improving economic situation of Angola creates conditions for an increase in life expectancy which by itself is associated with an increased risk of oncological diseases. Because cancer therapy requires a multidisciplinary approach, trained health professionals, satisfactory infrastructure and appropriate facilities, the availability of effective cancer therapy is a difficult task that requires support. The aim of this article is to share our experience achieved in the establishment of cancer units in Angola and to validate our checklist for this action. METHODS: The survey method was a questionnaire addressed to Angolan cancer units, in order to evaluate the usefulness and feasibility of a checklist developed by the authors--The Cancer Units Assessment Checklist for low or middle income African countries--which was used previously in the establishment of those units. Afterwards, the crucial steps taken for the establishing of the main sites of each cancer unit considering, facilities, resources and professionals, were also recorded. RESULTS: All cancer units reported that the checklist was a useful tool in the development of the cancer program for the improvement of the unit or the establishing of cancer unit sites. This instrument helped identifying resources, defining the best practice and identifying barriers. Local experts, who know the best practices in oncology and who are recognized by the local heads, are also important and they proved to be the major facilitators. CONCLUSION: The fight against cancer has just started in Angola. The training, education, advocacy and legislation are ongoing. According to our results, the assessment checklist for the establishment of cancer units is a useful instrument.