Political analysis of the neonatal screening for severe combined immunodeficiency - Curitiba, Brazil

Severe Combined Immunodeficiency (SCID) is the most aggressive form of primary immunodeficiencies, being able to death within 2 years after birth. In the USA, the screening found that the incidence of SCID was double that previously stipulated, before screening. Israel, Taiwan, Spain and others European countries are also testing for SCID. The long-term survival of patients diagnosed and treated before 4 months of life reaches 94%. Brazil does not perform neonatal screening for SCID through the Public Health System (SUS), numbers are unknown and under-diagnosed, even the treatment for SCID is funded by SUS. Analyze the political dimensions of the bill that aims to implement neonatal screening for SCID in Curitiba, Brazil. Participatory research was carried out between March - October 2019 and, bibliographic research on policy analysis in the context of emerging countries, to understand the criteria are taken into account for the political agenda, the influence of interest groups and the influence of the political arena in the implementation of a public policy through policy analysis. The project is pending in the municipal legislature of Curitiba and faces issues related to the financing of the implementation - a wide range of dependent variables act in the construction of a public policy. Its materialization, although important for public health, must consider real possibilities of implementation. In parallel, independent of the bill, a screening pilot project is under preparation by doctors, academics, and civil society. Brazil has a feasible technique that can be implemented on a large scale for neonatal SCID screening. However, although strongly recommended by the medical community, the implementation of this policy can be unviable by political and financial issues.

Key messages

The implementation of a public policy involves decisions between institutions, rules of the game and political forces. Early diagnosis may reduce treatment costs, requiring public policies for SCID.

Abstract P5-14-10: Adjuvant intra-operative electron-beam therapy for early invasive breast carcinoma using non-dedicated linear accelerator: Toxicity, efficacy, and aesthetic satisfaction

INTRODUCTION: In May 2004 we started a prospective trial on adjuvant intraoperative electron-beam therapy (IORT) in early invasive breast cancer, but instead of a dedicated machine, we used a non-dedicated linear accelerator (NDLA).

OBJECTIVES: To analyze early and late complications, cosmetic satisfaction of patients, and recurrence rates.

METHODS: Patients with the following characteristics were included: invasive breast ductal carcinoma, local staging with mammogram, ultrasound and magnetic resonance imaging showing uni-central and uni-focal tumor, age≥40 years, T1N0. The procedure is done according to the following steps on table 1:

PROTOCOL STEPS1Surgery performed in an operative room close to linear accelerator suite2Wide local excision with frozen sections of surgical margins and sentinel lymph node biopsy3If positive margins, they are expanded until negativity. If sentinel node positive, or multicentric/multifocal tumor, IORT is aborted4With both margins and sentinel lymph node free, the parenchyma round the surgical cavity is detached from skin and pectoralis major muscle. A shield (lead/aluminum/silicone disc) is placed underneath the breast parenchyma to avoid foward radiation5The breast parenchyma is sutured above the shield surface6The parenchyma thickness is measured for selection of the suitable electron energy7A collimator (cilindrical radiation applicator) is chosen for entire coverage of parenchyma8The patient is transferred from operative room to linear accelerator room and the collimator is attached to the machine9A portal-film (6MV photon-beam) is taken to check the alignment between the shield and applicator10If portal-film shows unfavorable positioning, the shield is realigned and a new portal-film is taken. Upon satisfactory condition, a single dose of 21Gy is delivered at 90% isodosis11After IORT completion the surgical procedure is ended

RESULTS: Initially 194 patients were included, but due to intraoperative exclusion criteria (positive sentinel lymph nodes or margins), 159 were analyzed. The median age was 57.9 (40 to 85.4) years and the median follow-up was 56.6 (1 to 103.2) months. Seven patients recurred (4 local and 3 regional). The average estimates for overall and event-free survival were respectively 95.4 (CI 95% 93.1-97.6) months and 90.1 (CI 95% 85.8-94.5) months. The crude incidences for acute (up to one month after surgery) and late (after one month) toxicities were respectively 8.2% and 26.2%. Excellent, good, fair and bad cosmetic outcomes (Harvard/NSABP/RT OG scale) were observed in 70.9%, 14.2%, 3.7% and 3.0%, respectively. Collimator sizes were 4cm in 18.7%, 5cm in 80.6%, and 7cm in 0.7% of cases. The electron energy chosen for treatment was 6MeV in 7.4%, 9MeV in 52.2%, 12MeV in 35.8%, 15MeV in 3.7% and 18MeV in 0.7%. The alignment between the shield and the collimator was appropriate in 72.4% (27.6% of patients required repositioning). No infection cases were related to peri-hospitalar time.

CONCLUSIONS: IORT using NDLA has shown low toxicity profile, high favorable aesthetics outcomes, and good oncologic efficacy. The use of NDLA may be usefull in settings without dedicated equipment for breast IORT.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-14-10.

Pollen mother cells of Tradescantia clone 4430 and Tradescantia pallida var. purpurea are equally sensitive to the clastogenic effects of X-rays

The Tradescantia micronucleus test is a sensitive bioassay for mutagenesis that may be employed both under field and laboratory conditions. This test has been standardized mostly on the basis of the results obtained with clone 4430. However, this clone is not well adapted to tropical weather, frequently showing problems with growth and flowering. In addition, it is attacked by parasites and insects, a fact that limits its use in field studies aiming at the biomonitoring of air pollution. In the city of São Paulo, Tradescantia pallida (Rose) Hunt. var. purpurea Boom is widely distributed as an ornamental plant in gardens and along roadsides and streets, mostly because of its natural resistance and its easy propagation. In this report, we present dose-response curves indicating that the sensitivity of T. pallida and clone 4430 to X-radiation (1, 10, 25 and 50 cGy) is similar. The results confirm our previous suggestion that T. pallida represents a good alternative for in situ mutagenesis testing in tropical regions, especially biomonitoring studies in which the exposure conditions may not be fully controllable.

Exploring the clastogenic effects of air pollutants in São Paulo (Brazil) using the Tradescantia micronuclei assay

This study was designed to determine the clastogenicity of particulate matter (aerodynamic diameter smaller than 10 microm) in the urban polluted air in the city of São Paulo. The Tradescantia-micronucleus (Trad-MCN) assay was used throughout this study to evaluate the clastogenicity of the extracts of the particulate matter. Tradescantia pallida (Rose) Hunt. cv. purpurea, an indigenous cultivar, was used in the Trad-MCN assay. The efficacy of this plant material for the Trad-MCN assay was validated with dose-response studies using formaldehyde and beta radiation. Dose-response curves were established with these known mutagens. The extracts of the PM10 particles at concentrations between 5 and 50 ppm induced a dose-related increase in MCN frequencies. The results indicate that T. pallida is equally sensitive to mutagens as the standard Tradescantia clone 4430 or 03 and the particulate matter in the urban air are clastogenic to the chromosomes of this plant. Inhalation of these particles by urban dwellers may affect their health by inducing similar genetic damage.

Stereological estimates of the nuclear/cytoplasmic ratio and star volume on fibreoptic biopsies are of prognostic value for survival in a preliminary study of advanced squamous cell carcinoma of the lung

AIMS

This study evaluated the role of morphometric and clinical parameters in establishing the prognosis of patients submitted to radiotherapy for advanced squamous cell carcinoma of the lung.

METHODS AND RESULTS

Morphometric studies were performed by point counting techniques. Forty patients were included in this study. Group 1 patients (n = 22) were those with survival equal to or less than 6 months; group 2 (n = 10) patients had a survival of 7 to 12 months; and group 3 (n = 8) included patients with survival greater than 12 months. To characterize these three groups of patients, models combining categorical and continuous variables were constructed by means of discriminant analysis. Weight loss, histological grade, nuclear/cytoplasmic ratio and star volume of the nuclei were selected during the backward procedure as relevant variables to characterize the three groups of patients. The overall sensitivity of the model was 90%.

CONCLUSIONS

Our results indicate that histopathological data may help to predict prognosis in patients with advanced squamous cell lung carcinoma, and encourage the use of morphometric procedures in histopathological analysis of this type of lung tumour.

[High dose rate brachytherapy]

The high dose rate brachytherapy uses a single source os 192Ir with 10Ci of nominal activity in a remote afterloading machine. This technique allows an outpatient treatment, without the inconveniences of the conventional low dose rate brachytherapy such as use of general anesthesia, rhachianesthesia, prolonged immobilization, and personal exposition to radiation. The radiotherapy department is now studying 5 basic treatment schemes concerning carcinomas of the uterine cervix, endometrium, lung, esophagus and central nervous system tumors. With the Micro Selectron HDR, 257 treatment sessions were done in 90 patients. Mostly were treated with weekly fractions, receiving a total of three to four treatments each. No complications were observed neither during nor after the procedure. Doses, fraction and ideal associations still have to be studied, so that a higher therapeutic ratio can be reached.

Ultrasonic recognition of a cystic seminal vesicle with ipsilateral renal agenesis

We report a case of a cystic seminal vesicle detected sonographically during investigation for infertility. The importance of this lesion in cases of ipsilateral renal agenesis and the value of transrectal sonography in its detection are discussed.