Availability of palliative care cancer services in Brazil

It has been a difficult task to define the number of patients in need of palliative care, the necessary resources and the specific criteria to structure and adapt palliative care services in Brazil. Until now the quantification of palliative care needs in our country has been estimated in an isolated way and based on international experiences. However, there are doubts about the applicability of these parameters considering the population and territorial dimensions, as well as the regional diversities. The analysis of the population morbidity and mortality profiles is necessary to the establishment of possible parameters to be employed for the assistance in palliative care, such as hospital admissions for the treatment of clinical intercurrences of cancer patients. Aims: To develop estimates of the current situation, the coverage and the need for palliative care services. Identify the number of hospitals that admitted potential patients with palliative care needs and the number of hospital beds used for the hospitalizations. Methods: Retrospective and observation analysis of the hospital admission registers of cancer patients were performed to verify the number of cancer patients in need of palliative care and the number of clinic hospital beds used yearly to admit these patients. Data on hospital admission of cancer patients, like average length of stay and hospital mortality were used. Results: Between 2008 and 2016, were registered in the Hospital Information System of SUS (SIH-SUS) 1,7 million hospitalizations for treatment of clinical intercurrence of cancer patient. These admissions were identified on 3,374 different health units around the country. An average of 91% of all hospitalizations for treatment of clinical intercurrence of cancer patient were registered in 380 hospitals Conclusions: To improve the quality of life, relieve physical suffering, cater for the psychological, spiritual and social needs of people with severe and advanced diseases, as well as to provide support to families and caregivers, it is indispensable to consider the existing models of health care. The inclusion or expansion of palliative attention meets the size, nature and severity of the needs of cancer patients

Síndrome de Down : características clínicas, perfil epidemiológico e citogenético em recém-nascidos no Hospital de Clínicas de Porto Alegre

Este trabalho tem como objetivo descrever as caracteristicas dos recém-nascidos com síndrome de Down no HCPA entre junho de 1988 e março de 1995 com relação à freqüência de achados fenotípicos, perfil citogenético e fatores de risco, usando controles contemporâneos. A incidência de Síndrome de Down no HCPA foi de 2,21 por 1.000 nascimentos. As características mais freqüentes foram: fendas palpebrais oblíquas, hipotonia muscular, perfil facial achatado, epicanto, clinodactilia e prega simiesca. Os casos foram significativamente diferentes dos controles com relação a peso ao nascer, idade da mãe e do pai e apresentação ao parto. Dos 39 casos que realizaram cariotipagem, 33 eram trissomias livres, 4 translocações e 2 mosaicos. Os dados da casuística do HCPA são condizentes com a literatura em relação ao perfil citogenético, caracteristicas fenotípicas e fatores associados. O conhecimento das características semiológicas mais freqüentes na população local é importante para realizar um rastreamento adequado.The aim of this study was to describe the profile of Down Syndrome children born in the Hospital de Clínicas de Porto Alegre between June/88 and March/95, regarding to the frequency of clinical traits, cytogenetic and risk factors, using contemporary controls. The incidence of Down syndrome in the Hospital was2,21 per 1,000 births. The most frequent traits were palpebral fissures slant down to the midline, muscular hypotonia, flat facial profile, epicanthal folds, clinodactyly and single palmar crease. The cases were statistically different from controls regarding to body weight at birth, maternal and paternal age, and presentation at parturition. Cytogenetic analysis was performed in 39 cases, 33 of which were 21 trissomy, 4 were translocation and 2 were mosaicism. The data from HCPA match the literature in respect to cytogenetics, physical traits and associated factors. The knowledge of most frequent traits in the local population is important to accomplish an adequate screening of the disease

EFETIVIDADE DA TERAPIA COM LASER DE BAIXA DOSE PARA O TRATAMENTO DA MUCOSITE EM PACIENTES ONCOLÓGICOS: UMA REVISÃO SISTEMÁTICA E METANÁLISE

Um dos efeitos adversos da terapia anticâncer é a mucosite oral (MO) que apresenta complicações relevantes na qualidade de vida, como dor e dificuldades nutricionais. A laserterapia de baixa dose (LLLT) é uma das intervenções profiláticas e terapêuticas para a MO. O objetivo deste trabalho foi investigar a efetividade da LLLT no tratamento curativo da MO em pacientes em oncoterapia. Uma revisão sistemática com metanálise foi realizada nas bases de dados Medline, Embase, Cochrane Library de acordo com as diretrizes do PRISMA é usada para identificar ensaios clínicos randomizados, com grupo controle, sobre MO provocada em pacientes durante e/ou após oncoterapia e a abordagem terapêutica se deu com LLLT, cujos comprimentos de onda estavam entre 632 e 970 nm. O protocolo desta revisão sistemática foi registrado no site https://www.crd.york.ac.uk/PROSPERO, a priori. Foram encontrados cinco estudos clínicos randomizados com um total de 315 pacientes, com metodologia adequada. Houve uma redução de 62% no risco de MO nos pacientes que receberam LLLT em comparação com o grupo controle (RR=0.38 [95% IC, 0.19 a 0.75]). Quando analisamos em subgrupos, o RR nos estudos com adultos foi de 0.28 (IC 0.17 a 0.46) e de 0.90 (IC 0.46 a 1.78) nos estudos com crianças e adolescentes. Identificou-se um pequeno número de estudos com a abordagem terapêutica da LLLT na MO, o que pode trazer limitações aos resultados, nossa metanálise demonstrou que a estratégia de tratamento é efetiva em pacientes adultos

Isatuximab as monotherapy and combined with dexamethasone in patients with relapsed/refractory multiple myeloma

This phase 2 study evaluated isatuximab as monotherapy or combined with dexamethasone in relapsed/refractory multiple myeloma (RRMM). Patients had RRMM refractory to an immunomodulatory drug (IMiD) and a proteasome inhibitor (PI) or had received >= 3 prior lines of therapy incorporating an IMiD and PI. Patients received isatuximab either as monotherapy (20 mg/kg on days 1, 8, 15, and 22 [once weekly] of cycle 1 followed by 20 mg/kg on days 1 and 15 of subsequent cycles; Isa group) or in combination with dexamethasone (40 mg/d [20 mg/d in patients aged >= 75 years] once weekly; Isa-dex group). Treated patients (N=164) had received a median of 4 (range, 2-10) prior treatment lines. Patients received a median of 5 (1-24) and 7 (1-22) treatment cycles; at data cutoff, 13 (11.9%) of 109 and 15 (27.3%) of 55 patients remained on treatment in the Isa and Isa-dex arms, respectively. Overall response rate (primary efficacy end point) was 23.9% in the Isa arm and 43.6% in the Isa-dex arm (odds ratio, 0.405; 95% confidence interval, 0.192-0.859; P=.008). Median progression-free survival and overall survival were 4.9 and 18.9 months for Isa, and 10.2 and 17.3 months for Isa-dex. Infusion reactions (mostly grade 1/2) and hematologic abnormalities were the most common adverse events. There was a similar incidence of grade 3 or higher infections in both groups (22.0% and 21.8%). In conclusion, addition of dexamethasone to isatuximab increased response rates and survival outcomes with no detrimental effect on safety.Peer reviewe

Isatuximab, carfilzomib, and dexamethasone in patients with relapsed multiple myeloma: updated results from IKEMA, a randomized Phase 3 study

Longer-term outcomes with the anti-CD38 antibody isatuximab in combination with carfilzomib-dexamethasone (Isa-Kd) were evaluated in the randomized Phase 3 trial IKEMA (NCT03275285), in a prespecified, follow-up analysis of progression-free survival (PFS, primary study endpoint), final complete response (CR) using Hydrashift Isa immunofixation assay, minimal residual disease (MRD) negativity, and safety. Enrolled patients had relapsed/refractory multiple myeloma (1-3 prior treatment lines). Isa 10 mg/kg was administered intravenously weekly in cycle 1 then biweekly. Efficacy analyses were performed in the intent-to-treat population (Isa-Kd: n = 179, Kd: n = 123) and safety evaluated in treated patients (Isa-Kd: n = 177, Kd: n = 122). Consistent with the primary interim analysis, the addition of Isa to Kd prolonged PFS (HR 0.58, 95.4% CI: 0.42-0.79; median PFS 35.7 [95% CI: 25.8-44.0] vs 19.2 [95% CI: 15.8-25.0] months). PFS benefit was observed with Isa-Kd across subgroups, including patients with poor prognosis. The stringent CR/CR rate was 44.1% vs 28.5% (odds-ratio: 2.09, 95% CI: 1.26-3.48), the MRD negativity rate 33.5% vs 15.4% (odds-ratio: 2.78, 95% CI: 1.55-4.99) and the MRD negativity CR rate 26.3% vs 12.2%, with Isa-Kd vs Kd. The safety profile of Isa-Kd was similar to that reported in the prior interim analysis. These findings further support Isa-Kd as a standard-of-care treatment for relapsed multiple myeloma patients.Clinical trial information: ClinicalTrials.gov, NCT03275285

Composted Sewage Sludge Application Reduces Mineral Fertilization Requirements and Improves Soil Fertility in Sugarcane Seedling Nurseries

Sugarcane demands large amounts of nutrients to reach a high level of productivity. Nutrients are generally supplied by mineral fertilizers, but their high costs and negative environmental impacts have generated interest in greater use of organic nutrient sources such as composted sewage sludge (CSS). In this study, we evaluated changes in soil chemical properties after the application of CSS or CSS/mineral fertilizer (MF) combinations to soil containing sugarcane seedlings under nursery conditions. Treatments included: T1: conventional mineral fertilization (MF) without application of CSS, T2: 100% of the recommended MF (06–30–24); T3: application of 2.5 Mg−1 CSS; T4: 5.0 Mg−1 CSS, T5: 7.5 Mg−1 CSS, T6: 2.5 Mg−1 CSS and 50% MF, T7: 5.0 Mg−1 CSS and 50% MF, T8: 7.5 Mg−1 CSS and 50% MF, T9: 2.5 Mg−1 CSS and 100% MF, T10: 5.0 Mg−1 CSS and 100% MF, T11: 7.5 Mg−1 CSS and 100% MF. Soil chemical properties were evaluated from the soil surface (0.0–0.25 m) and subsurface (0.25–0.50 m) horizons. The results showed that the increase in CSS application did not affect soil organic matter content at either depth, while Zn concentrations increased in the soil subsurface horizon. The application of CSS at 5.0 Mg ha−1 with or without 50% MF resulted in the highest pH values, sum of bases, cation-exchange capacity, P, K, Ca, Mg, Cu, and Zn in surface horizons. The use of CSS as an organic fertilizer in sugarcane nurseries improves soil fertility, reduces mineral fertilizer requirements, and, thus, facilitates the sustainable disposal of sewage sludge

Advancing human health in the decade ahead: pregnancy as a key window for discovery: A Burroughs Wellcome Fund Pregnancy Think Tank.

Recent revolutionary advances at the intersection of medicine, omics, data sciences, computing, epidemiology, and related technologies inspire us to ponder their impact on health. Their potential impact is particularly germane to the biology of pregnancy and perinatal medicine, where limited improvement in health outcomes for women and children has remained a global challenge. We assembled a group of experts to establish a Pregnancy Think Tank to discuss a broad spectrum of major gestational disorders and adverse pregnancy outcomes that affect maternal-infant lifelong health and should serve as targets for leveraging the many recent advances. This report reflects avenues for future effects that hold great potential in 3 major areas: developmental genomics, including the application of methodologies designed to bridge genotypes, physiology, and diseases, addressing vexing questions in early human development; gestational physiology, from immune tolerance to growth and the timing of parturition; and personalized and population medicine, focusing on amalgamating health record data and deep phenotypes to create broad knowledge that can be integrated into healthcare systems and drive discovery to address pregnancy-related disease and promote general health. We propose a series of questions reflecting development, systems biology, diseases, clinical approaches and tools, and population health, and a call for scientific action. Clearly, transdisciplinary science must advance and accelerate to address adverse pregnancy outcomes. Disciplines not traditionally involved in the reproductive sciences, such as computer science, engineering, mathematics, and pharmacology, should be engaged at the study design phase to optimize the information gathered and to identify and further evaluate potentially actionable therapeutic targets. Information sources should include noninvasive personalized sensors and monitors, alongside instructive "liquid biopsies" for noninvasive pregnancy assessment. Future research should also address the diversity of human cohorts in terms of geography, racial and ethnic distributions, and social and health disparities. Modern technologies, for both data-gathering and data-analyzing, make this possible at a scale that was previously unachievable. Finally, the psychosocial and economic environment in which pregnancy takes place must be considered to promote the health and wellness of communities worldwide

Palliative Care in Brazil: With a View to Future Needs?

Background: Chronic non-communicable diseases (CNCD) constitute a health problem of growing magnitude in Brazil, leading concerns, to the Ministry of Health (MOH), about the care of persons with chronic conditions (due to advanced diseases), multiple harms to health, convalescents and in need of long-term care, requiring continuous assistance, physical and functional rehabilitation. However, few data exist on the size of the population potentially in need of palliative care in Brazil. Aim: this study is to estimate the size of the Brazilian population that could benefit from palliative care across 26 federated states and the Federal District. Design: this is a cross-sectional study, using national death certificate and hospital admission data. Brazilian death registration and hospital admission data from 1st of January to 31st of December 2014 were analyzed and compared with estimation methods of Rosenwax and Murtagh. Setting/participants: all adults (≥ 15 years old) who died in the period of 1st of January to 31st of December 2014 in Brazil. Results: the proportion of individuals who died from diseases that indicate palliative care needs at the end of life ranged from 24.6% to 85.2%.   Keywords: palliative care; estimating population; chronic non-communicable diseases; cancer; health planning