Beyond Clinical Trials: Understanding Neurotrophic Tropomyosin Receptor Kinase Inhibitor Challenges and Efficacy in Real-World Pediatric Oncology.

PURPOSE: Our study aimed to explore real-world treatment scenarios for children and adolescents with neurotrophic tropomyosin receptor kinase (NTRK)-fused tumors, emphasizing access, responses, side effects, and outcomes. PATIENTS AND METHODS: Pooled clinical data from 17 pediatric cases (11 soft-tissue sarcomas, five brain tumors, and one neuroblastoma) treated with larotrectinib and radiologic images for 14 patients were centrally reviewed. Testing for gene fusions was prompted by poor response to treatment, tumor progression, or aggressiveness. RESULTS: Six different NTRK fusion subtypes were detected, and various payment sources for testing and medication were reported. Radiologic review revealed objective tumor responses (OR) in 11 of 14 patients: Complete responses: two; partial responses: nine; and stable disease: three cases. Grades 1 or 2 Common Terminology Criteria for Adverse Events adverse effects were reported in five patients. Regarding the entire cohort's clinical information, 15 of 17 patients remain alive (median observation time: 25 months): four with no evidence of disease and 11 alive with disease (10 without progression). One patient developed resistance to the NTRK inhibitor and died from disease progression while another patient died due to an unrelated cause. CONCLUSION: This real-world study confirms favorable agnostic tumor OR rates to larotrectinib in children with NTRK-fused tumors. Better coordination to facilitate access to medication remains a challenge, particularly in middle-income countries like Brazil.

Characterization of military police officers of Alagoas affected by COVID-19.

Introduction: COVID-19 has greatly affected society by limiting the functioning of sectors of the economy and public services. Considering the essential character of many of these services, especially public security, it is necessary to understand how the disease has affected different groups within the population so that public policies for facing this problem can be implemented. Objectives: To identify and describe the profile of military police officers affected by COVID-19. Methods: This is a descriptive observational study with a quantitative approach, based on secondary data. The electronic medical records of 737 military police officers affected by COVID-19 were accessed; sociodemographic, biological, and professional data were collected, as well as data on disease progression. Data were analyzed using Bioestat® software, v5.3. Results: The peak of the COVID-19 contagion curve happened first among military police officers of the state of Alagoas than in the general population, and a positive effect of social distancing was observed in the containment of disease spread. Moreover, specialized operations units had a higher contagion rate in view of the higher level of exposure linked to their work activities. Conclusions: This study described the profile of military police officers affected by COVID-19, which can substantiate the adoption of public policies and new strategies to fight this disease among officers in Alagoas, thus ensuring the continuity of the service provided to society.

PEDIATRICIANS AFTER RESIDENCY: A SURVEY OF PERSONAL/PROFESSIONAL DATA AND ISSUES.

OBJECTIVE: To assess personal, professional, medical, and scientific educational characteristics and issues reported by pediatricians. METHODS: Cross-sectional study based on an online survey including 614 pediatricians who graduated in the last 15 years at a University Pediatric Department in Brazil. RESULTS: The response rate was 331/614(54%). The majority were females (82%), the median age was 33 years (27-40) and median years of pediatric practice was 5 (1-13). High workload (>60 hours/week) occurred in 25% and 47% earned ≥15 minimum wages/month. The most work-related issues reported were long working hours, poor social life and a sedentary lifestyle (>50%). Pediatricians were further divided into two groups, according to years of pediatric clinical practice: group 1 (≤5 years) and group 2 (>5 years). The median of overall satisfaction with pediatric residency [8(0-10) vs. 9 (4-10); p=0.002] was significantly reduced in group 1. The frequencies of workload >60 hours, work on pediatric ward and pediatric intensive care were significantly higher in the first group (p<0.05). Regarding main issues related to clinical practice in the last year, long working hours (73 vs. 53%; p<0.001), poor social life (75 vs. 62%; p=0.018) and harassment (23 vs. 4%; p=0.003) were significantly higher in the first group. CONCLUSIONS: Very early career pediatricians (≤5 years) reported higher workload, lower income, work-related issues and different location of pediatric practice compared to early career pediatricians (>5 years). The overall satisfaction with pediatric residency was good, however, reduced in very early career pediatricians.

Pediatricians after residency: a survey of personal/professional data and issues / Pediatras após a residência médica: um questionário sobre dados e problemas pessoais/profissionais

ABSTRACT Objective: To assess personal, professional, medical, and scientific educational characteristics and issues reported by pediatricians. Methods: Cross-sectional study based on an online survey including 614 pediatricians who graduated in the last 15 years at a University Pediatric Department in Brazil. Results: The response rate was 331/614(54%). The majority were females (82%), the median age was 33 years (27-40) and median years of pediatric practice was 5 (1-13). High workload (>60 hours/week) occurred in 25% and 47% earned ≥15 minimum wages/month. The most work-related issues reported were long working hours, poor social life and a sedentary lifestyle (>50%). Pediatricians were further divided into two groups, according to years of pediatric clinical practice: group 1 (≤5 years) and group 2 (>5 years). The median of overall satisfaction with pediatric residency [8(0-10) vs. 9 (4-10); p=0.002] was significantly reduced in group 1. The frequencies of workload >60 hours, work on pediatric ward and pediatric intensive care were significantly higher in the first group (p<0.05). Regarding main issues related to clinical practice in the last year, long working hours (73 vs. 53%; p<0.001), poor social life (75 vs. 62%; p=0.018) and harassment (23 vs. 4%; p=0.003) were significantly higher in the first group. Conclusions: Very early career pediatricians (≤5 years) reported higher workload, lower income, work-related issues and different location of pediatric practice compared to early career pediatricians (>5 years). The overall satisfaction with pediatric residency was good, however, reduced in very early career pediatricians.

RESUMO Objetivo: Avaliar características e problemas pessoais, profissionais, médicos e de educação científica reportados por pediatras. Métodos: Estudo transversal com base em uma pesquisa online, incluindo 614 pediatras formados nos últimos 15 anos no Departamento de Pediatria de uma universidade brasileira. Resultados: A taxa de resposta foi de 331/614 (54%). A maioria dos participantes era do sexo feminino (82%), a mediana de idade foi de 33 anos (27-40 anos) e a mediana de tempo de prática pediátrica foi de 5 anos (1-13). Jornada de trabalho elevada (>60 horas/semana) foi relatada por 25% dos entrevistados e 47% recebiam ≥15 salários mínimos/mês. Os problemas relacionados ao trabalho mais frequentes foram jornadas longas de trabalho, vida social insatisfatória e sedentarismo (>50%). Os pediatras foram divididos em dois grupos de acordo com os anos de prática clínica pediátrica: grupo 1 (≤5 anos) e grupo 2 (>5 anos). A mediana de satisfação geral com a residência pediátrica [8 (0-10) versus 9 (4-10); p=0,002] foi significativamente menor no grupo 1. As frequências de jornada de trabalho >60 horas, trabalho na enfermaria pediátrica e na terapia intensiva pediátrica foram significativamente maiores no primeiro grupo (p<0,05). Quanto aos principais problemas relacionados à prática clínica no ano anterior, jornadas longas de trabalho (73 versus 53%; p<0,001), vida social insatisfatória (75 versus 62%; p=0,018) e assédio (23 versus 4%; p=0,003) foram significativamente mais elevados no grupo 1. Conclusões: Pediatras em início de carreira (≤5 anos) relataram maior jornada de trabalho, menor renda, problemas relacionados ao trabalho e diferentes locais de trabalho em comparação com pediatras mais experientes (>5 anos). A satisfação geral com a residência pediátrica foi boa, porém menor em pediatras do primeiro grupo.

Incidência de traumatismo de pescoço na Unidade de Emergência Dr. Armando Lages / Incidence of neck injuries in the Unidade de Emergência Dr. Armando Lages

Num período de dois anos, terminando em dezembro de 1984, 88 pacientes com traumatismo de pescoço foram estudados, com faixa variando entre 01 e 87 anos. A ocorrência mais alta foi encontrada no grupo dos 20 a 29 anos. A incidência foi maior no sexo masculino do que no feminino, em todas as faixas etárias. Arma de fogo e arma branca foram as causas mais comuns de traumatismo de pescoço. A maioria das estruturas lesadas eram vasculares - veias principalmente. Do número total, 54 pacientes apresentaram ferimento penetrante do pescoço. 21 foram observados, 33 foram explorados imediatamente. Dos 21 selecionados para a observaçäo, nenhum necessitou de cirurgia posterior. Houve um índice de exploraçäo negativa de 42%. Se todos os pacientes tivessem sido explorados, o índice seria de 65%. Concordamos que a exploraçäo seletiva, baseada na avaliaçäo clínica cuidadosa, é confiável nos casos de traumatismo penetrante do pescoço

Ferimentos penetrante do pericárdio e do coraçäo: análise de 41 casos / Penetrating wounds of the pericardium and heart: analysis of 41 cases

Apresenta-se um estudo estatístico de 41 casos de ferimentos penetrantes do pericárdio e do coraçäo, durante o período de janeiro de 1980 a outubro de 1985, na Unidade de Emergência de Maceió. A maioria dos pacientes sofreu ferimentos por arma branca ou arma de fogo. A mortalidade foi de 21.95%. Analisa-se ainda os meios diagnósticos e os métodos terapêuticos empregados, com revisäo da literatura

Doença de Hodgkin: consideraçöes sobre um caso / Hodgkin's disease: considerations on a case

Tecem-se consideraçöes gerais sobre a Doença de Hodgkin, abordando: etiologia, epidemiologia, aspectos clínicos, classificaçäo e tratamento. Por fim, apresenta-se um caso da referida patologia, mostrando uma paciente com estadiamento pós-cirúrgico Ia