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Targeting BRAF V600E in metastatic colorectal cancer: where are we today?
No full textColorectal cancer (CRC) is the second most frequent cause of direct cancer death worldwide. The study of the molecular state of oncogenes has predictive and prognostic value in metastatic CRC (mCRC). The B-raf proto-oncogene (BRAF) gene mutation represents the 8%-12% of all mutations in mCRC. The BRAF V600E mutation, considered the most common alteration of BRAF, corresponds to a constitutive kinase with a high activating capacity of the RAS/RAF/MEK/ERK pathway after a cascade of successive phosphorylations in the transcription of genes. BRAF V600E mutation is more prevalent in women, elderly, right-sided colon cancer and Caucasian population. Unfortunately, it is considered a poor predictive and prognosis biomarker. Patients with mCRC BRAF V600E mutated (BRAFm) are generally associated with poor response to chemotherapy and short progression-free survival and overall survival. Recently, randomised clinical trials have studied the combination of different chemotherapy regimens with angiogenic inhibitors in mCRC BRAFm. In addition, new anti-BRAF and immunotherapy agents have also been studied in this population, with positive results. The objective of this review is to acknowledge the biology and molecular pathway of BRAF, critically analyse the clinical trials and the therapy options published until today and evaluate the options of treatment according to the patient's clinical presentation
A preoperative nomogram for predicting long-term survival after resection of large hepatocellular carcinoma (>10 cm)
No full textBackground: It has previously been demonstrated that a fraction of patients with hepatocellular carcinoma (HCC) > 10 cm can benefit from liver resection. However, there is still a lack of effective decision-making tools to inform intervention in these patients. Methods: We analysed a comprehensive set of clinical data from 234 patients who underwent liver resection for HCC >10 cm at the National Cancer Institute of Peru between 1990 and 2015, monitored their survival, and constructed a nomogram to predict the surgical outcome based on preoperative variables. Results: We identified cirrhosis, multifocality, macroscopic vascular invasion, and spontaneous tumour rupture as independent predictors of survival and integrated them into a nomogram model. The nomogram's ability to forecast survival at 1, 3, and 5 years was subsequently confirmed with high concordance using an internal validation. Through applying this nomogram, we stratified three groups of patients with different survival probabilities. Conclusion: We constructed a preoperative nomogram to predict long-term survival in patients with HCC >10 cm. This nomogram is useful in determining whether a patient with large HCC might truly benefit from liver resection, which is paramount in low- and middle-income countries where HCC is often diagnosed at advanced stages. © 2021 The Author(s
Proceso de cuidado de Enfermeria en infante con Sindrome Obstructivo Bronquial (SOB) neumonia hospitalizado en emergencia de un hospital de Lima ,2021
No full textThe present work develops the nursing care process (NCP) to a pediatric patient, with the aim of identifying problems and managing comprehensive care for infants with a diagnosis of broncho-obstructive syndrome (BOS)-Pneumonia hospitalized in the emergency area. Single case study, qualitative approach, NCP method. The data collection was carried out through the observation technique, physical examination and as an instrument the assessment framework for 11 functional patterns of Marjory Gordon, identifying 5 Nursing Diagnoses prioritizing three of them: Ineffective cleaning of the airways related to excessive mucus, evidenced by abnormal respiratory sounds crackles, wheezing, persistent cough with abundant yellowish and dense secretions in regular quantity, respiratory rate 46 breaths per minute. Impaired gas exchange associated with changes in the alveolar-capillary membrane, evidenced by dyspnea, decompensated respiratory alkalosis, abnormal arterial pH 7.50, pCO2: 33 mm Hg, hypoxemia pO2: 88 mm Hg and HR tachycardia: 126 x ', oxygen saturation 86%. Hyperthermia associated with disease secondary to BOS Pneumonia, evidenced by skin hot to the touch, tachypnea (146 x '), Temperature: 38 °C planning with taxonomy II NANDA I NOC (or Nursing Outcomes Classification) and NIC (or Nursing Interventions Classification), intervention labels were executed with programmed activities being then evaluated with NOC labels and indicators respectively. The results were +1, +1, +3. Concluding that the management of care, applying NCP in a pediatric patient with BOS-pneumonia was effective, indicates that the child did not present any complications during the shifts attended in the study
Durvalumab After Chemoradiation for Unresectable Stage III Non-Small Cell Lung Cancer: Inferior Outcomes and Lack of Health Equity in Hispanic Patients Treated With PACIFIC Protocol (LA1-CLICaP)
No full textObjectives: To compare the rate disparity between outcomes (overall survival (OS), progression-free survival (PFS), and safety) of concurrent chemoradiation (cCRT) followed by durvalumab in two patient cohorts with locally advanced (LA) stage III non-small cell lung cancer (NSCLC), one non-Hispanic White (NHW), and the other Latin-American. Methods: A multicenter retrospective study was performed, including 80 Hispanic and 45 NHW LA stage III NSCLC patients treated with cCRT followed by durvalumab. Both cohorts were analyzed in terms of main outcomes (OS, PFS, and safety) and compared between them and with the PACIFIC trial population outcomes. The efficacy-effectiveness gap was assessed using an efficacy-effectiveness (EE) factor that was calculated by dividing each cohort median overall survival by the corresponding reference OS from the PACIFIC trial. In both cohorts, results of PD-L1 testing were recorded, and the main outcomes were compared according to PD-1 expression levels (≥50%, 1–49%, and <1%). Results: For the entire population (N=125), the overall response rate (ORR) was 57.6% (N=72), and 18.4% (N=25) achieved stable disease. OS was 26.3 months (95%CI 23.9-28.6), and PFS was 20.5 months (95%CI 18.0-23.0). PFS assessed by ethnicity showed a median for the Hispanic population of 19.4 months (95%CI 16.4-22.5) and 21.2 months (95%CI 17.2-23.3 p=0.76) for the NHW group. OS by race showed a significant difference in favor of the NHW group, with a median OS of 27.7 months (95%CI 24.6-30.9) vs. 20.0 months (95%CI 16.4-23.5) for Hispanics. (P=0.032). Unadjusted 12-month and 24-month OS was 86.6% (95%CI 79.9–88.0) and 46.6% (95%CI 40.2–48.3) for NHW compared to 82.5% (95%CI 77.1–84.2) and 17.5% (95%CI 15.6-24.5) in Hispanics. NHW had an EE factor of 0.78 and Hispanics had 0.58, showing a reduction in survival versus NHW and PACIFIC of 20% and 42%, respectively. HR for the OS among NHWs and Hispanics was 1.53 (95%CI 1.12-1.71 P=0.052) and 2.31 (95%CI 1.76-2.49 P=0.004). Fifty-six patients (44.8%) had some degree of pneumonitis due to cCRT plus durvalumab. There was no difference in the proportion of pneumonitis according to race (P=0.95), and the severity of pneumonitis was not significantly different between Hispanics and NHWs (P=0.41). Conclusions: Among patients with LA stage III NSCLC, NHW had better survival outcomes when compared to Hispanics, with an OS that seems to favor the NHW population and with an EE factor that shows a shorter survival in Hispanics compared with NHW and with the PACIFIC trial group
Challenges to sustainability of pediatric early warning systems (PEWS) in low-resource hospitals in Latin America
No full textBackground: Sustainability, or continued use of evidence-based interventions for long-term patient benefit, is the least studied aspect of implementation science. In this study, we evaluate sustainability of a Pediatric Early Warning System (PEWS), an evidence-based intervention to improve early identification of clinical deterioration in hospitalized children, in low-resource settings using the Clinical Capacity for Sustainability Framework (CCS). Methods: We conducted a secondary analysis of a qualitative study to identify barriers and enablers to PEWS implementation. Semi-structured interviews with PEWS implementation leaders and hospital directors at 5 Latin American pediatric oncology centers sustaining PEWS were conducted virtually in Spanish from June to August 2020. Interviews were recorded, professionally transcribed, and translated into English. Exploratory thematic content analysis yielded staff perceptions on PEWS sustainability. Coded segments were analyzed to identify participant perception about the current state and importance of sustaining PEWS, as well as sustainability successes and challenges. Identified sustainability determinants were mapped to the CCS to evaluate its applicability. Results: We interviewed 71 staff including physicians (45%), nurses (45%), and administrators (10%). Participants emphasized the importance of sustaining PEWS for continued patient benefits. Identified sustainability determinants included supportive leadership encouraging ongoing interest in PEWS, beneficial patient outcomes enhancing perceived value of PEWS, integrating PEWS into the routine of patient care, ongoing staff turnover creating training challenges, adequate material resources to promote PEWS use, and the COVID-19 pandemic. While most identified factors mapped to the CCS, COVID-19 emerged as an additional external sustainability challenge. Together, these challenges resulted in multiple impacts on PEWS sustainment, ranging from a small reduction in PEWS quality to complete disruption of PEWS use and subsequent loss of benefits to patients. Participants described several innovative strategies to address identified challenges and promote PEWS sustainability. Conclusion: This study describes clinician perspectives on sustainable implementation of evidence-based interventions in low-resource settings, including sustainability determinants and potential sustainability strategies. Identified factors mapped well to the CCS, however, external factors, such as the COVID pandemic, may additionally impact sustainability. This work highlights an urgent need for theoretically-driven, empirically-informed strategies to support sustainable implementation of evidence-based interventions in settings of all resource-levels. Copyright © 2022 Agulnik, Schmidt-Grimminger, Ferrara, Puerto-Torres, Gillipelli, Elish, Muniz-Talavera, Gonzalez-Ruiz, Armenta, Barra, Diaz-Coronado, Hernandez, Juarez, Loeza, Mendez, Montalvo, Penafiel, Pineda, Graetz and McKay
Acciones preventivas sobre extravasacion por medio de contraste en pacientes
No full textObjective: To analyze scientific evidence on prevention measures related to contrast media extravasation in patients. Methodology: A literature review was conducted using 4 databases SciELO, Pubmed, Scopus and Google Scholar in the last ten years, including studies in English, Spanish and Portuguese published in full text indexed journals, carrying a critical analysis of each selected article, reflecting a matrix to sort and categorize. Results: of the 15 scientific articles of the results found show the need to provide the identification of the risk scale (low. mild moderate and high) The affected areas usually present benign lesions characterized by hypervolemia and localized erythema that tend to heal spontaneously without sequelae. However, severe lesions, such as compartment syndrome, can also occur. For these reasons, it is necessary to know the patients at risk, technical characteristics, early diagnosis and timely management of this complication. These are the basic skills that every specialist nursing professional should possess. Conclusions: Extravasation considered an indicator of quality-of-care service in nursing care, with which preventive, corrective and educational measures should be taken in the area where venous accesses are manipulated, an adequate choice of injection site, puncturing thick veins from the elbow crease towards proximal avoiding future complications to reduce the incidence as a zero objective
Impact of cancer awareness campaigns in Peru: a 5-year Google Trends analysis
No full textBackground: The aim of this research was to characterise the interest on the most frequent cancers in Peru through Google Trends, its geographic and temporal relationship with massive awareness campaigns. Methods: A temporal trends analysis for the last 5 years was carried out, comparing the Relative Search Volume (RSV) with the dates of mass cancer awareness campaigns in Peru. Google Trends application was used to evaluate the interest in the topics: breast, prostate, cervical stomach and colorectal cancer between 1 January 2016 and 31 December 2020, expressed in RSV. The annual RSV for each neoplasm was compared, as well as its annual variation using the Kruskal-Wallis test. The correlation between the RSV and the estimated incidence for each province was measured using the Spearman test. Results: The topics with the highest RSV were breast (median: 20, range: 6-100) and prostate cancer (median: 28, range: 9-48). The topic 'breast cancer' showed a cyclical punctual increase in October, its awareness month. Searches for cervical, stomach and colorectal cancer were smaller and did not show peaks of interest. It was observed that the RSV was variable when compared with previous years (p 0.05) was found for breast, cervical and colorectal cancer. Conclusions: This study suggests a positive temporal correlation between RSV and awareness cancer campaigns in Peru specially to breast cancer and, to a lesser extent, prostate cancer. Significant variations of interest were demonstrated for each neoplasm among the evaluated years. No significant correlation was found between the incidence rate and the average RSV among Peruvian provinces
Disección radical de axila por carcinoma de ovario metastásico
No full textMetastatic ovarian carcinoma involving axillary nodes is a rare condition that guides us to rule out breast cancer. We report the case of a patient with this entity who underwent surgical treatment and was subsequently referred for complementary treatment. © 2020 SESP
SELNET clinical practice guidelines for soft tissue sarcoma and GIST
No full textSoft tissue sarcoma (STS) and gastrointestinal tumors (GIST) encompass > 80 different histologic subtypes.
Clinical practice guidelines for STS and GIST still lack in Latin-American countries.
Tailored clinical guidelines are instrumental to improve outcome in sarcoma patients in LatinAmerican countries.
This is the first review establishing STS and GIST guidelines for the purpose of LatinAmerican clinical practices to our knowledge
Carcinoma coloide pancreático y tumor del estroma gastrointestinal del estómago sincrónicos: reporte de caso y revisión de la literatura
No full textColloid carcinoma (CC) is a rare histological type of adenocarcinoma of the pancreatic duct and is characterized by the presence of large lakes of extracellular mucin containing neoplastic cells. Its 5 year prognosis is more favourable than that of ductal, tubular or not otherwise specified (NOS) adenocarcinomas. We present the case of a 74-year-old woman with a thin walled, multicystic lesion in the tail of the pancreas, radiologically suggestive of a serous cystadenoma as opposed to a mucinous neoplasm. Surgery revealed a 10 x 6 cm lesion invading the splenic hilum and transverse mesocolon. Two nodes on the wall of the gastric fundus were also removed. Histopathology showed the pancreatic tumour to be a colloid carcinoma with a synchronous gastrointestinal stromal tumour of the gastric fundus