Prevalence of muscle atrophy in pediatric patients during ICU hospitalization.

To evaluate the muscle thickness and prevalence of muscle atrophy of the biceps brachii/brachialis (BB) and quadriceps femoris (QF) in critically ill children using ultrasound (US). The prospective longitudinal study was conducted in the pediatric intensive care unit (PICU) of a tertiary hospital in southern Brazil with children and adolescents of both sexes, aged 1 month to 12 years, on invasive mechanical ventilation for 24 h. US measurements were taken up to 24 h after admission, 72 h after, and weekly until discharge from the PICU. One hundred one patients were selected, of whom 97 underwent two evaluations, 68 three evaluations, and 26 four ultrasound evaluations. The median age was 6 months, with 63 (62.4%) < 1 year old. The most prevalent clinical diagnosis was respiratory diseases (70.3%). There was a reduction in BB thickness from 1 to 2 weeks (- 0.10 cm, p = 0.009) and in QF from 24 h to 2 weeks (- 0.20 cm, p = 0.013) and 72 h to 2 weeks (- 0.18 cm, p = 0.045). The prevalence of muscle atrophy (decrease > 10% in thickness) was 41.2% in at least one muscle group between 24 and 72 h, 39.7% between 24 h and 1 week, and 59.3% between 24 h and 2 weeks. The US allows the evaluation of BB and QF muscle thickness in critically ill children, and monitoring muscles during PICU hospitalization is important. The prevalence of muscle atrophy was 30.8% in the biceps brachii and 46.2% in the quadriceps femoris at the end of 2 weeks of PICU hospitalization, regardless of age and diagnosis. What is Known: • Ultrasound has emerged as a promising method, being a clinically valuable tool for bedside muscle monitoring in critical patients. • Using the ultrasound to measure the muscle thickness in adults has demonstrated good sensitivity for detecting muscle atrophy. However, this method has only been previously validated in few studies with small sample of pediatric patients. What is New: • Using the ultrasound, we observed that critically ill children experienced a loss of muscle thickness and muscle atrophy, especially during the second week of intubation. • The significant prevalence of muscle atrophy at the end of PICU hospitalization highlights the importance of ultrasound in identifying muscle loss.

Vozes que vem dos territórios: a participação popular que emerge do cotidiano / Voices from the territories: popular participation emerging from everyday life

Esta coletânea nos conduz por experiências trilhadas por educandos (as) e educadores (as) à colheita da Especialização e Aperfeiçoamento em Educação Popular e Promoção de Territórios Saudáveis na Convivência com o Semiárido com participantes do Ceará e do Rio Grande do Norte. Esse processo formativo se desenvolveu como uma das estratégias da Política Nacional de Educação Popular em Saúde (PNEPS-SUS) em uma profícua articulação entre movimentos de educação popular em saúde e movimentos que atuam no campo das lutas do campo e da cidade. No primeiro volume desta coletânea intitulada "Entrelaçando arte, cultura e saúde: possibilidades de coracionar o cuidado com a vida" estão as produções construídas por esse conjunto de sujeitos sociais durante o curso nos trabalhos de conclusão do curso, articulados na temática da arte, cultura e saúde. Neste segundo volume das produções advindas desses trabalhos de conclusão de curso tem como foco a participação popular a partir das experiências nos territórios. Assim, essa obra intitulada "Vozes que vem dos territórios: a participação popular que emerge do cotidiano" evidencia a diversidade de trilhas que advêm dessa questão geral a fim de que os leitores (as) possam refletir sobre as diversas formas de participação social e popular presente nas comunidades e territórios. Esta obra está organizada em três seções, a saber: "Lutas e Organização Popular em Territórios Urbanos, do Campo e das Águas"; "Educação do campo e promoção da saúde" e "A força das mulheres, das juventudes e do controle social em contextos urbanos e comunidades tradicionais". Ao trilhar essa obra esperamos que as reflexões aqui trazidas possam contribuir para fomentar, pensar e construir novas possibilidades e perspectivas de ampliação da participação popular, do protagonismo dos diferentes sujeitos sociais, na radicalização da democracia onde todas as decisões possam ter a voz e as diversas vozes presentes nos territórios onde os processos de saúde-adoecimento-cuidado e a defesa da vida acontecem no cotidiano.

Management of infusion-related reactions in cancer therapy: strategies and challenges.

Several anticancer therapies have the potential to cause infusion-related reactions (IRRs) in the form of adverse events that typically occur within minutes to hours after drug infusion. IRRs can range in severity from mild to severe anaphylaxis-like reactions. Careful monitoring at infusion initiation, prompt recognition, and appropriate clinical assessment of the IRR and its severity, followed by immediate management, are required to ensure patient safety and optimal outcomes. Lack of standardization in the prevention, management, and reporting of IRRs across cancer-treating institutions represents not only a quality and safety gap but also a disparity in cancer care. The present article, supported by recently published data, was developed to standardize these procedures across institutions and provide a useful tool for health care providers in clinical practice to recognize early signs and symptoms of an IRR and promptly and appropriately manage the event.

Lung cancer screening in Brazil: recommendations from the Brazilian Society of Thoracic Surgery, Brazilian Thoracic Association, and Brazilian College of Radiology and Diagnostic Imaging.

Although lung cancer (LC) is one of the most common and lethal tumors, only 15% of patients are diagnosed at an early stage. Smoking is still responsible for more than 85% of cases. Lung cancer screening (LCS) with low-dose CT (LDCT) reduces LC-related mortality by 20%, and that reduction reaches 38% when LCS by LDCT is combined with smoking cessation. In the last decade, a number of countries have adopted population-based LCS as a public health recommendation. Albeit still incipient, discussion on this topic in Brazil is becoming increasingly broad and necessary. With the aim of increasing knowledge and stimulating debate on LCS, the Brazilian Society of Thoracic Surgery, the Brazilian Thoracic Association, and the Brazilian College of Radiology and Diagnostic Imaging convened a panel of experts to prepare recommendations for LCS in Brazil. The recommendations presented here were based on a narrative review of the literature, with an emphasis on large population-based studies, systematic reviews, and the recommendations of international guidelines, and were developed after extensive discussion by the panel of experts. The following topics were reviewed: reasons for screening; general considerations about smoking; epidemiology of LC; eligibility criteria; incidental findings; granulomatous lesions; probabilistic models; minimum requirements for LDCT; volumetric acquisition; risks of screening; minimum structure and role of the multidisciplinary team; practice according to the Lung CT Screening Reporting and Data System; costs versus benefits of screening; and future perspectives for LCS.

Unresectable stage III non-small cell lung cancer: Insights from a Portuguese expert panel.

INTRODUCTION: The management of unresectable stage III non-small cell lung cancer (NSCLC) is clinically challenging and there is no current consensus on optimal strategies. Herein, a panel of Portuguese experts aims to present practical recommendations for the global management of unresectable stage III NSCLC patients. METHODS: A group of Portuguese lung cancer experts debated aspects related to the diagnosis, staging and treatment of unresectable stage III NSCLC in light of current evidence. Recent breakthroughs in immunotherapy as part of a standard therapeutic approach were also discussed. This review exposes the major conclusions obtained. RESULTS: Practical recommendations for the management of unresectable stage III NSCLC were proposed, aiming to improve the pathways of diagnosis and treatment in the Portuguese healthcare system. Clinical heterogeneity of patients with stage III NSCLC hinders the development of single standardised algorithm where all fit. CONCLUSIONS: A timely diagnosis and a proper staging contribute to the best management of each patient, optimizing treatment tolerance and effectiveness. The expert panel considered chemoradiotherapy as the preferable approach when surgery is not possible. Management of adverse events and immunotherapy as a consolidation therapy are also essential steps for a successful strategy.

Lung cancer screening in Brazil: recommendations from the Brazilian Society of Thoracic Surgery, Brazilian Thoracic Association, and Brazilian College of Radiology and Diagnostic Imaging / Recomendações da Sociedade Brasileira de Cirurgia Torácica, Sociedade Brasileira de Pneumologia e Tisiologia e Colégio Brasileiro de Radiologia e Diagnóstico por Imagem para o rastreamento do câncer de pulmão no Brasil

ABSTRACT Although lung cancer (LC) is one of the most common and lethal tumors, only 15% of patients are diagnosed at an early stage. Smoking is still responsible for more than 85% of cases. Lung cancer screening (LCS) with low-dose CT (LDCT) reduces LC-related mortality by 20%, and that reduction reaches 38% when LCS by LDCT is combined with smoking cessation. In the last decade, a number of countries have adopted population-based LCS as a public health recommendation. Albeit still incipient, discussion on this topic in Brazil is becoming increasingly broad and necessary. With the aim of increasing knowledge and stimulating debate on LCS, the Brazilian Society of Thoracic Surgery, the Brazilian Thoracic Association, and the Brazilian College of Radiology and Diagnostic Imaging convened a panel of experts to prepare recommendations for LCS in Brazil. The recommendations presented here were based on a narrative review of the literature, with an emphasis on large population-based studies, systematic reviews, and the recommendations of international guidelines, and were developed after extensive discussion by the panel of experts. The following topics were reviewed: reasons for screening; general considerations about smoking; epidemiology of LC; eligibility criteria; incidental findings; granulomatous lesions; probabilistic models; minimum requirements for LDCT; volumetric acquisition; risks of screening; minimum structure and role of the multidisciplinary team; practice according to the Lung CT Screening Reporting and Data System; costs versus benefits of screening; and future perspectives for LCS.

RESUMO O câncer de pulmão (CP) é uma das neoplasias mais comuns e letais no Brasil, e apenas 15% dos pacientes são diagnosticados nos estágios iniciais. O tabagismo persiste como o responsável por mais de 85% de todos os casos. O rastreamento do CP (RCP) por meio da TC de baixa dosagem de radiação (TCBD) reduz a mortalidade do CP em 20%, e, quando combinado com a cessação do tabagismo, essa redução chega a 38%. Na última década, diversos países adotaram o RCP como recomendação de saúde populacional. No Brasil, embora ainda incipiente, a discussão sobre o tema é cada vez mais ampla e necessária. Com o intuito de aumentar o conhecimento e estimular o debate sobre o RCP, a Sociedade Brasileira de Cirurgia Torácica, a Sociedade Brasileira de Pneumologia e Tisiologia e o Colégio Brasileiro de Radiologia e Diagnóstico por Imagem constituíram um painel de especialistas para elaborar as recomendações para o RCP. As recomendações aqui apresentadas foram baseadas em revisão narrativa da literatura, com ênfase em grandes estudos populacionais, em revisões sistemáticas e em recomendações de diretrizes internacionais, sendo construídas após ampla discussão pelo grupo de especialistas. Os temas revisados foram os seguintes: porque rastrear, considerações gerais sobre tabagismo, epidemiologia do CP, critérios de elegibilidade, achados incidentais, lesões granulomatosas, modelos probabilísticos, requisitos mínimos da TCBD, aquisições volumétricas, riscos do rastreamento, estrutura mínima e papel da equipe multidisciplinar, conduta segundo o Lung CT Screening Reporting and Data System (Lung-RADS), custos vs. benefícios e perspectivas do rastreamento.

CD114 MEMBRANE RECEPTORS CAN HELP IN THE ASSESSMENT OF MOLECULAR MORTALITY IN MEDULOBLASTOMAS? / RECEPTORES DE MEMBRANA CD114 PODEM AUXILIAR NA AVALIAÇÃO DA MORTALIDADE MOLECULAR EM MEDULOBLASTOMAS?

Introduction: Medulloblastomas are the most common solid tumors of childhood and many studies seek to develop new chemotherapy drugs by identifying genes whose expression is new molecular targets for drugs, such as membrane receptors associated with cell replication. Objective: To review existing knowledge about the association of CD114 expression with mortality in medulloblastoma. Method: Narrative review collecting information with material for reading and analysis selected from research on virtual platforms (SciELO, Pubmed and Scopus). Initially, a search was carried out for descriptors related to the topic, which were identified through MESH using the following terms: "neurosurgery, surgical oncology, molecular targeted therapy, medulloblastoma" with AND or OR search, considering the title and/or abstract. After, the search was carried out, the title and abstract were analyzed and those that could be included were read in full. Results: 23 articles were included. Conclusion: There is no direct relationship between the expression of the CD114 membrane receptor and mortality in patients with medulloblastoma, and additional studies should be carried out on the intracellular signaling pathways associated with this receptor and its gene, CSF3R

Introdução: Meduloblastomas são os tumores sólidos mais comuns da infância e muitos estudos buscam desenvolvimento de novos quimioterápicos com a identificação de genes cuja expressão sejam novos alvos moleculares para drogas, como receptores de membrana associados à replicação celular. Objetivo: Revisar o cohecimento existente sobre a associação da expressão de CD114 com a mortalidade no meduloblastoma. Método: Revisão narrativa colhendo informações com o material para leitura e análise selecionado a partir de pesquisa em plataformas virtuais (SciELO, Pubmed e Scopus). Inicialmente foi realizada busca por descritores relacionados ao tema, os quais foram identificados por meio do DeCS utilizando os seguintes termos: "neurocirurgia, oncologia cirúrgica, terapia de alvo molecular, meduloblastoma" " e seus equivalentes em inglês  "neurosurgery, surgical oncology, molecular targeted therapy, medulloblastoma" com busca AND ou OR, considerando o título e/ou resumo. Feita a busca, foi realizada análise do título, resumo e lidos na íntegra aqueles que poderiam ser incluídos.  Resultados: Foram incluídos 23 artigos. Conclusão: Não há relação direta entre a expressão do receptor de membrana CD114 e a mortalidade em pacientes portadores de meduloblastoma e estudos adicionais devem ser feitos sobre as vias de sinalização intracelulares associadas a esse receptor e ao seu gene, o CSF3R.

Fiabilidad de la ecografía en la evaluación del grosor muscular en niños críticamente enfermos / Reliability of ultrasound in the assessment of muscle thickness in critically ill children

Introducción: La ecografía se ha utilizado para cuantificar y calificar la morfología muscular de niños críticamente enfermos, detectando posibles cambios en el grosor muscular. El objetivo del estudio fue evaluar la fiabilidad de la medición por ecografía del grosor muscular en niños críticamente enfermos, y comparar la evaluación de un examinador experto con la de examinadores con poca experiencia. Material y métodos: Estudio observacional transversal en la unidad de cuidados intensivos pediátricos de un hospital universitario de tercer nivel en Brasil. Se incluyeron pacientes entre un mes y 12 años, que recibieron ventilación mecánica invasiva durante un mínimo de 24h. Se obtuvieron imágenes ecográficas del bíceps braquial/braquial y cuádriceps femoral en evaluaciones realizadas por un ecografista experimentado y ecografistas inexpertos. La concordancia intra- e interevaluador se estableció mediante el coeficiente de correlación intraclase (CCI) y el análisis gráfico de Bland-Altman. Resultados: Se midió el grosor muscular en 10 niños con una edad media de 15,5 meses. El grosor medio de los músculos evaluados fue de 1,14 ±0,27cm para el bíceps braquial/braquial y de 1,85±0,61cm para el cuádriceps femoral. La fiabilidad intraevaluador e interevaluador fue muy buena (CCI>0,81) para todos los ecografistas. Las diferencias fueron pequeñas, sin detectarse en el análisis de los gráficos de Bland-Altman, y todas las mediciones estuvieron dentro de los límites de concordancia, excepto una medición de bíceps y cuádriceps. Conclusión: La ecografía se puede utilizar en niños en estado crítico para evaluar con precisión los cambios en el grosor muscular, incluso por diferentes evaluadores. Se necesitan más estudios para establecer un enfoque estandarizado en el uso de esta herramienta para la monitorización de la pérdida muscular con el fin de incorporar su uso en la práctica clínica. (AU)

Introduction: Ultrasound has been used to quantify and qualify muscle morphology in critically ill children and can detect changes in muscle thickness. The aim of this study was to assess the reliability of ultrasound measurement of muscle thickness in critically ill children and to compare the assessments made by an expert with those made by inexperienced sonographers. Material and methods: Cross-sectional observational study conducted in the paediatric intensive care unit of a tertiary care university hospital in Brazil. The sample included patients aged 1 month to 12 years who received invasive mechanical ventilation for at least 24hours. Ultrasound images of the biceps brachii/brachialis and quadriceps femoris were obtained by one experienced sonographer and several inexperienced sonographers. We assessed intrarater and inter-rater reliability by means of the intraclass correlation coefficient (ICC) and Bland-Altman plot analysis. Results: Muscle thickness was measured in 10 children with a mean age of 15.5 months. The mean thickness of the assessed muscles was 1.14cm for the biceps brachii/brachialis (standard deviation [SD]: 0.27) and 1.85cm for the quadriceps femoris (SD: 0.61). The intrarater and inter-rater reliability were good for all sonographers (ICC>0.81). The differences were small, there was no significant bias in the Bland-Altman plots and all measurements were within the limits of agreement, except for 1 measurement of biceps and quadriceps. Conclusion: Sonography can be used in critically ill children to accurately assess changes in muscle thickness, even by different evaluators. More studies are needed to establish a standardised approach to the use of ultrasound for monitoring muscle loss in order to incorporate it in clinical practice. (AU)

Reliability of ultrasound in the assessment of muscle thickness in critically ill children.

INTRODUCTION: Ultrasound has been used to quantify and qualify muscle morphology in critically ill children and can detect changes in muscle thickness. The aim of this study was to assess the reliability of ultrasound measurement of muscle thickness in critically ill children and to compare the assessments made by an expert with those made by inexperienced sonographers. MATERIAL AND METHODS: Cross-sectional observational study conducted in the paediatric intensive care unit of a tertiary care university hospital in Brazil. The sample included patients aged 1 month to 12 years who received invasive mechanical ventilation for at least 24 h. Ultrasound images of the biceps brachii/brachialis and quadriceps femoris were obtained by one experienced sonographer and several inexperienced sonographers. We assessed intrarater and inter-rater reliability by means of the intraclass correlation coefficient (ICC) and Bland-Altman plot analysis. RESULTS: Muscle thickness was measured in 10 children with a mean age of 15.5 months. The mean thickness of the assessed muscles as 1.14 cm for the biceps brachii/brachialis (standard deviation [SD], 0.27) and 1.85 cm for the quadriceps femoris (SD, 0.61). The intrarater and inter-rater reliability were good for all sonographers (ICC > 0.81). The differences were small, there was no significant bias in the Bland-Altman plots and all measurements were within the limits of agreement, except for 1 measurement of biceps and quadriceps. CONCLUSION: Sonography can be used in critically ill children to accurately assess changes in muscle thickness, even by different evaluators. More studies are needed to establish a standardised approach to the use of ultrasound for monitoring muscle loss in order to incorporate it in clinical practice.