Hospital Araújo Jorge

BackgroundTriple-negative breast cancer is an aggressive breast cancer subtype, and there remains an unmet need to improve outcomes in patients with previously untreated, programmed death ligand 1 (PD-L1)–positive, locally advanced unresectable or metastatic triple-negative breast cancer.MethodsIn this phase 3, open-label, international trial, we randomly assigned patients in a 1:1 ratio to receive sacituzumab govitecan plus pembrolizumab or chemotherapy plus pembrolizumab. The primary end point was progression-free survival as assessed by blinded independent central review. Secondary end points included overall survival, objective response (complete or partial response) and duration of response as assessed by blinded independent central review, and safety.ResultsA total of 443 patients were randomly assigned to receive sacituzumab govitecan plus pembrolizumab (221 patients) or chemotherapy plus pembrolizumab (222 patients). The median progression-free survival was 11.2 months (95% confidence interval [CI], 9.3 to 16.7) with sacituzumab govitecan plus pembrolizumab and 7.8 months (95% CI, 7.3 to 9.3) with chemotherapy plus pembrolizumab (hazard ratio for disease progression or death, 0.65; 95% CI, 0.51 to 0.84; two-sided P<0.001). Data for overall survival were immature. The percentage of patients with an objective response was 60% (95% CI, 53 to 66) with sacituzumab govitecan plus pembrolizumab and 53% (95% CI, 46 to 60) with chemotherapy plus pembrolizumab; among patients with a response, the median duration of response was 16.5 months (95% CI, 12.7 to 19.5) and 9.2 months (95% CI, 7.6 to 11.3), respectively. Adverse events of grade 3 or higher occurred in 71% of the patients receiving sacituzumab govitecan plus pembrolizumab and in 70% of those receiving chemotherapy plus pembrolizumab; the incidence of treatment discontinuation due to adverse events was 12% and 31%, respectively. Adverse events leading to death occurred in 3% of the patients in each group.ConclusionsSacituzumab govitecan plus pembrolizumab led to significantly longer progression-free survival than chemotherapy plus pembrolizumab among patients with previously untreated, PD-L1–positive, advanced triple-negative breast cancer. (Funded by Gilead Sciences; ASCENT-04/KEYNOTE-D19 ClinicalTrials.gov number, NCT05382286.)

Objective: To compare the mean incision time, blood loss and post-operative pain with diathermy verses scalpel in caesarian sections for abdominal incisions. Methods: This is a prospective randomized study was conducted in the Department of Gynaecology &amp; Obstetrics, of a tertiary hospital in Bangladesh from January 2022 to December 2022 for a period of 12 months. Total 436 women with singleton pregnancy of gestational age 37-41 weeks undergoing cesarean section of 20-40 years of age were selected and randomly divided into two groups of 218 women in each. Patients were randomized to have either scalpel or diathermy incisions. The duration used in making the skin incision was noted. Blood loss, postoperative pain, duration of wound healing and the occurrence of surgical site infection were also noted. Results: The mode of presentation was predominantly elective. The incision time was shorter in the Group A (Diathermy group) 3.7 ± 1.3 minutes while in Group B (Scalpel group) was 5.4 ± 1.7 minutes (P &lt; 0.001). The blood loss was less with the diathermy compared to the scalpel (4.45 ± 2.27 ml vs. 7.32 ± 3.47ml, P &lt; 0.001). The cumulative numerical rating scale score for pain was 12.75 (standard deviation [SD] 6.07) and 17.65 (SD 9.59) in the diathermy and scalpel groups respectively (P &lt; 0.001). There was no statistically significant difference in wound infection and wound closure (epithelialization time) (P = 0.207).Conclusions: This study concluded that the diathermy incision is better than scalpel skin incisions in terms of incision time, blood loss and post-operative pain. Central Medical College Journal Vol 9 No 1 January 2025 Page: 18-22

Exocrine pancreatic insufficiency (EPI) in oncology patients requires careful attention due to its clinical significance and frequent underdiagnosis. This narrative review and Guideline established by the Brazilian Society of Surgical Oncology suggest a practical approach to diagnosis and pancreatic enzyme replacement therapy (PERT). This promising approach can improve symptoms, nutritional status, and quality of life, potentially positively impacting survival in unresectable pancreatic cancer and postsurgical settings.

Tobacco smoke, alone or combined with alcohol, is the predominant cause of head and neck cancer (HNC). We explore how tobacco exposure contributes to cancer development by mutational signature analysis of 265 whole-genome sequenced HNC samples from eight countries. Six tobacco-associated mutational signatures were detected, including some not previously reported. Differences in HNC incidence between countries corresponded with differences in mutation burdens of tobacco-associated signatures, consistent with the dominant role of tobacco in HNC causation. Differences were found in the burden of tobacco-associated signatures between anatomical subsites, suggesting that tissue-specific factors modulate mutagenesis. We identified an association between tobacco smoking and alcohol-related signatures, indicating a combined effect of these exposures. Tobacco smoking was associated with differences in the mutational spectra, repertoire of driver mutations in cancer genes and patterns of copy number change. Our results demonstrate the multiple pathways by which tobacco smoke can influence the evolution of cancer cell clones.

Myelomeningocele (MMC) is the most common type of congenital spinal malformation, typically requiring surgical intervention. While prenatal repair is increasingly favored, postnatal repair remains the standard in many settings. This study aims to evaluate the antibiotics prescribed to neonates with MMC and their correlation with central nervous system (CNS) infection rates following postnatal surgical repair. A retrospective cohort study was conducted, including newborns who underwent postnatal MMC repair between August 2017 and June 2021 at the Children's Hospital of Goiânia. The study examined variables related to the pregnancy and birth periods, as well as anatomical and neurosurgical factors. Neonates were categorized into four groups based on the time interval between birth and surgical repair (within 24, 48, 72h, and beyond 72h) and were evaluated for CNS infection rates. A total of 38 neonates were included, with 24.32% diagnosed with CNS infections post-surgery. Notably, 22.86% of mothers did not receive prenatal care. Cesarean section was the predominant mode of delivery, accounting for 77.78% of cases. The average time from birth to surgery was 67h. At admission, 73.68% of MMC cases presented with a rupture of the MMC membrane, and 78.94% of newborns received intravenous antibiotics. The mean surgical time was 60min, with 78.94% of surgeries performed by experienced surgeons. Timely surgical intervention and the use of prophylactic antibiotics are critical in reducing CNS infection rates in neonates undergoing postnatal MMC repair. Delays in surgery and the lack of antibiotic prophylaxis were associated with higher infection rates, whereas factors such as delivery mode and surgeon experience had less impact on infection outcomes. These findings highlight the need for standardized care protocols and improved prenatal care to optimize neonatal outcomes.

ABSTRACTBackground: Despite the widespread adoption of single-operator cholangiopancreatoscopy for the management of biliary and pancreatic diseases, this method was recently introduced in Brazil. This study aimed to develop a Brazilian consensus for the diagnostic and therapeutic use of single-operator cholangiopancreatoscopy for the management of pancreatobiliary diseases. Methods: A working group from the Brazilian Society of Digestive Endoscopy (SOBED) specialists, using a Delphi methodology, formulated statements across six topics: indeterminate biliary strictures, complex biliary stones, primary sclerosing cholangitis, peroral pancreatoscopy, post-liver transplantation, and antibiotic prophylaxis. Eighteen experts evaluated these statements using an anonymous electronic voting system. Consensus was defined as ≥80% agreement. Results: Eighteen statements were formulated and voted on by a panel of experts to reach a consensus. The panel consisted of 18 endoscopy specialists from various regions of Brazil, with an average of 20.4 years of experience. Consensus was achieved on all statements in the first round. Conclusion: These recommendations establish the role of cholangiopancreatoscopy in diagnostic and therapeutic for indeterminate biliary strictures, complex biliary stones, primary sclerosing cholangitis, peroral pancreatoscopy, post-liver transplantation, and antibiotic prophylaxis, providing a background for its standardized use in Brazil.

We identified that oncological treatments in general (chemotherapies, immunotherapies, and radiotherapies) often cause peripheral neuropathy, including cramps, characterized by an excess of protons due to metabolic and neuronal factors, such as sudden changes in pH, uremia, and aspects affecting neuromotor functions. Such situations and similar ones were eligible for an approach to decrease excessive ionic loads, expecting that such reduction would reduce or eliminate cramps, hypothesizing that such elimination would decrease muscle vulnerability to action impulses and increase relaxation power by the same mechanism. Forty (40) adult patients with cramps generated by oncological treatments were tested in this double-blind, randomized clinical trial, and the degree of efficiency of the product named "Magicramp® Electrostatic Charge Reducing Cushion" (MECRC), which aimed to reduce cramps by eliminating excess electrostatic ionic charges, was verified.

Tobacco smoke, alone or combined with alcohol, is the predominant cause of head and neck cancer (HNC). Here, we further explore how tobacco exposure contributes to cancer development by mutational signature analysis of 265 whole-genome sequenced HNC from eight countries. Six tobacco-associated mutational signatures were detected, including some not previously reported. Differences in HNC incidence between countries corresponded with differences in mutation burdens of tobacco-associated signatures, consistent with the dominant role of tobacco in HNC causation. Differences were found in the burden of tobacco-associated signatures between anatomical subsites, suggesting that tissue-specific factors modulate mutagenesis. We identified an association between tobacco smoking and three additional alcohol-related signatures indicating synergism between the two exposures. Tobacco smoking was associated with differences in the mutational spectra and repertoire of driver mutations in cancer genes, and in patterns of copy number change. Together, the results demonstrate the multiple pathways by which tobacco smoke can influence the evolution of cancer cell clones.