Adenosine pathway inhibitors: novel investigational agents for the treatment of metastatic breast cancer.

INTRODUCTION: The adenosine pathway has been suggested to play a key role in several carcinogenetic processes, with the metabolism of adenosine-5'-triphosphate (ATP) and its derivatives reported to be dysregulated in breast cancer. Preclinical evidence has supported the role of adenosine in the pathogenesis of this malignancy as well as the development of selective adenosine pathway inhibitors. AREAS COVERED: The paper overviews the evidence regarding the use of adenosine pathway inhibitors in breast cancer; a literature search was conducted in January 2022 of Pubmed/Medline, Cochrane library, and Scopus databases. EXPERT OPINION: The adenosine pathway regulates inflammation, apoptosis, metastasis, and cell proliferation in breast cancer cells, and adenosine pathway inhibitors have yielded encouraging results in early-phase clinical trials. Well-designed, multicenter studies focused on monotherapies and combination therapies (which include immune checkpoint inhibitors) are warranted in this setting.

A New Score to Assess the Perioperative Period of the Cancer Patient Undergoing Non-Palliative Elective Surgery: A Retrospective Evaluation of a Case Report by PERIDIA Score.

The complexity of cancer patients and the use of advanced and demolitive surgical techniques frequently need post-operatory ICU hospitalization. To increase safety and to select the best medical strategies for the patient, a multidisciplinary team has performed a new peri-operatory assessment, arising from evidence-based literature data. Verifying that most of the cancer patients, admitted to the intensive care unit, undergo major surgery with localizations in the supramesocolic thoraco-abdominal area, the team focused the attention on supramesocolic peridiaphragmatic cancer surgery. Some scores already in use in clinical practice were selected for the peri-operatory evaluation process. None of them evaluate parameters relating to the entire peri-operative period. In detail, only a few study models were found that concern the assessment of the intra-operative period. Therefore, we wanted to see if using a mix of validated scores, it was possible to build a single evaluation score (named PERIDIAphragmatic surgery score or PERIDIA-score) for the entire peri-operative period that could be obtained at the end of the patient's hospitalization period in post-operative ICU. The main property sought with the creation of the PERIDIA-score is the proportionality between the score and the incidence of injuries, deaths, and the length of stay in the ward. This property could organize a tailor-made therapeutic path for the patient based on pre-rehabilitation, physiotherapy, activation of social assistance services, targeted counseling, collaborations with the continuity of care network. Furthermore, if the pre-operative score is particularly high, it could suggest different or less invasive therapeutic options, and if the intra-operative score is particularly high, it could suggest a prolongation of hospitalization in ICU. The retrospective prospective study conducted on 83 patients is still ongoing. The first data would seem to prove an increase of clinical complications in patients who were assigned a one-third score with respect to the maximum (16/48) of PERIDIA-score. Moreover, patients with a 10/16 score within each phase of the evaluation (pre, peri, and post) more frequently develop injuries. In the light of these evidence, the 29-point score assigned to our patient can be considered as predictive for the subsequent critical and fatal complications the patient faced up.

Spontaneous abdominal bleeding associated with SARS-CoV-2 infection: causality or coincidence?

Authors present 6 cases of abdominal bleeding associated with COVID-19, representing 1.35% of all hospitalized COVID-19 patients and hypothesize that there could be, although not very frequently, a relationship between SARS-CoV2 and bleeding. They excluded a side effect of the low molecular weight heparin therapy that all patients underwent during the course of the disease or other possible causes. Alterations of the coagulation state or a weakness of the vascular wall due toa presumed endotheliitis SARS-CoV-2 infection induced, are hypothesized by the authors. Investigation and follow-up for possible hemorrhagic problems in patients with COVID-19 is recommended. In particular, clinicians should be vigilant about retroperitoneal hemorrhage in COVID-19 patients. In addition to the fact that these patients are being treated with anticoagulants, anemia and abdominal pain are the signs that should lead us to suspect this type of haemorrhage. More studies are needed to understand if COVID-19 can be directly associated with bleeding. (www.actabiomedica.it)

Manifestaçöes reumatológicas na acromegalia / Rheumatologic manifestations in acromegaly

Os autores relatam 13 casos de acromegalia, todos apresentando aumento das extremidades e alteraçöes nos níveis séricos do hormônio de crescimento, atendidos no Hospital de Clínicas-UFPR entre 1979 e 1986, sendo sete mulheres e seis homens, idade entre 16 e 68, tempo de doença variando de seis meses até 20 anos. Chamam a atençäo para as manifestaçöes osteoarticulares encontradas em 77% dos casos, sendo as mais freqüentes a dor articular aos movimentos (30,7%), parestesias de MMSS (23%) e de MMII (15,3%)

O efeito da ciclosporina na diabetes "mellitus" insulino-dependente de início recente: estudo preliminares / Cyclosporine effects on diabetes mellitus insulin-dependent of recent onset: preliminary studies

Cada vez mais a literatura tem mostrado a importância imunológica na etiopatogenia do diabetes mellitus tipo I. Várias drogas com atividade imunossupressora têm sido usadas nestes pacientes com o objetivo de "sustar" o processo imunológico durante a fase de remissäo da doença. Assim o levamizole, prednisona, azatioprina e interferon foram ensaiados, porém a ciclosporina parece ser, devido a seu mecanismo de açäo, a droga imunossupressora mais efetiva no diabetes mellitus tipo I. Analisamos o resultado, incidência de remissäo, recuperaçäo de funçäo das células beta e efeitos adversos de seis pacientes tratados com ciclosporina por um período de quatro a 12 meses

Reorganizaçäo das unidades de internaçäo e assistenciais do H.S.P.M / Reorganization of nursing and outpatients units of the Municipal Functionaries Hospital

Apresenta-se em linhas gerais as necessidades de prover as unidades de enfermagem de recursos humanos e materiais, por meio de uma sistematizaçäo e padronizaçäo de atividades.