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Radin M, Schreiber K, Cecchi I, Signorelli F, De Jesùs G, Aso K, Kono M, Urban ML, Bacco B, Gallo Cassarino S, Lo Sardo L, Foddai SG, Barinotti A, Gómez García I, Quaglia MI, Tissera Y, Gervasoni F, Aguirre-Zamorano MÁ, Alba P, Benedetto C, Atsumi T, Amengual O, Emmi G, Andrade D, Marozio L, Roccatello D, Sciascia S. AB0458 DISEASE ACTIVITY AT CONCEPTION PREDICTS LUPUS FLARE UP TO 2 YEARS AFTER BIRTH: A MULTICENTRE LONG TERM FOLLOW-UP STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundSystemic lupus erythematosus (SLE) often affects women in their childbearing years, and pregnancy may affect SLE disease activity during pregnancy and post-partum (1,2). Limited data assessing the likelihood and characteristics of SLE activity in an extended time period post-partum which may be relevant as patients may wish further pregnancies exist.ObjectivesTo assess predicting factors that might influence SLE disease activity in women in an extended follow-up period of 2 years after giving birth and clinical assessment every three months.MethodsThe study was design as an international retrospective, data-driven case collection study, enrolling 119 women with a first birth and with a strictly monitored follow-up period of 2 years.ResultsTable 1 shows pregnancy outcomes of all pregnancies. When considering disease manifestations, joint involvement was present in 80% of patients, acute cutaneous in 64%, haematological in 54%and renal in 41%; 75% of patients were positive for anti-dsDNA, 49% for anti-ENA and 37% for anti-Ro/SSA positive. The mean SLE disease activity index 2000(SLEDAI-2k) at diagnosis was 13.5±6.8 and at first birth was 2.8±4.4.Table 1.Pregnancy outcomes of all pregnancies and relative breastfeeding dataPregnancy CharacteristicsAll (214)%OutcomesLive births16979Miscarriages3717.3Stillbirths83.7Maternal and Foetal ComplicationsPrematurity3918.2Pre-eclampsia2310.7HELLP syndrome41.9Placental Infarction125.6Breastfeeding (all pregnancies)Any breastfeeding (n, %)10964.5*Exclusive breastfeeding (n, %)8751.5*Breastfeeding (after first birth)Any breastfeeding (n, %)8773.1**Any breastfeeding duration (months) (m±sd)10.29±10.04Exclusive breastfeeding*** (n, %)6252.1**Exclusive breastfeeding*** duration (months) (m±sd)6.07±6*Percentages are calculated considering viable babies (total= 169)**Percentages are calculated considering first birth (total= 119)***Exclusive breastfeeding was defined as feeding infants only breast milkAt follow-up, 51.3% of patients had at least one flare after a mean time after birth of 9±6.3 months(mean flare per patient 0.94±1.1). The most frequent flare manifestations were joint involvement(48%), followed by renal(33%), cutaneous(28%) and haematologic(20%).Patients with remission of disease(SLEDAI-2K=0; no clinical or laboratory manifestations of SLE) at conception had significantly lower rates of flares than those not in remission (18/49–37% vs. 43/70–61%;p=0.008) (Figure 1).Figure 1.Flare proportion: Survival Curve based on remission status at conception of the patients included in the study.Patients who experienced a flare during pregnancy (17 patients), when compared to those who did not, had higher rates of flares during follow-up (76% vs. 47%, respectively, p=0.019), lower time for first flare (4.4±2.3 months vs. 10.3±6.5, respectively, p<0.001), lower rate of remission of disease at conception (12% vs. 46%, respectively, p<0.001), lower rates of SLEDAI 2K at conception (5.9±5.6 vs. 2.3±4, respectively, p<0.001) and lower rates of exclusive breastfeeding (24% vs. 57%, respectively, p=0.009).Remission of disease and flares during pregnancy remained significantly associated with the development of flares during follow-up after multivariate analysis.ConclusionRemission at conception can influence SLE disease positively, even at long-term. Planned pregnancy counseling is fundamental when managing SLE patients.References[1]Tincani A, Nalli C, Khizroeva J, Bitsadze V, Lojacono A, Andreoli L, et al. Autoimmune diseases and pregnancy. Best Pract Res Clin Endocrinol Metab 2019;33.[2]Clowse MEB, Magder LS, Witter F, Petri M. The impact of increased lupus activity on obstetric outcomes. Arthritis Rheum 2005;52:514–521.Disclosure of InterestsNone declared
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Chighizola C, Pregnolato F, Andrade D, Tektonidou M, Sciascia S, Pengo V, Ugarte A, Belmont HM, Gerosa M, Fortin P, Lopez-Pedrera C, Zhang Z, Atsumi T, De Jesùs G, Kello N, Branch DW, Andreoli L, Wahl D, Petri MA, Rodríguez Almaraz E, Cervera R, Pons Estel G, Knight J, Willis R, Barber M, Artim Esen B, Efthymiou M, Erkan D, Bertolaccini ML. POS0462 HYDROXYCHLOROQUINE REDUCES THE TITERS OF ANTI-DOMAIN 1 ANTIBODIES OVER TIME IN PATIENTS WITH PERSISTENTLY POSITIVE ANTIPHOSPHOLIPID ANTIBODIES: RESULTS FROM THE APS ACTION CLINICAL DATABASE AND REPOSITORY (“REGISTRY”). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundData on fluctuation of antibodies directed against domain 1 (anti-D1) of β2-glycoprotein I (β2GPI) are scarce. Patients with antiphospholipid syndrome (APS) and all three criteria tests for antiphospholipid antibodies (aPL) display higher titers of anti-D1, which correlate with anti-β2GPI levels.ObjectivesThis project aims at evaluating predictors of the variation of anti-D1 titers over time in a large international cohort of persistently aPL positive patients.MethodsAntiPhospholipid Syndrome Alliance For Clinical Trials and InternatiOnal Networking (APS ACTION) Registry was created to study the course of persistently aPL-positive patients with or without autoimmune disorders over at least 10 years. Inclusion criteria are positive aPL by Updated Sapporo Criteria tested within one year prior to enrolment. Patients are followed every 12±3 months with clinical data and blood collection. Patients with available blood samples from at least three time points were included in this analysis. Anti-β2GPI and anti-D1 IgG were tested by chemiluminescence (BioFlash, Werfen) at APS ACTION core laboratories. Positive results were defined as >20 CU, according to the manufacturer. Clinical data were retrieved from APS ACTION online database. Anti-D1 titers within the same subject were compared by Friedman’s test. A mixed linear model was built to identify predictors of the fluctuation of anti-D1 antibody titers over time.ResultsIn this longitudinal study, 230 patients with anti-D1 tested at 4 time points were included (Table 1). Patients with thrombotic APS had anti-D1 titers significantly higher than those without thrombosis (p=0.022). Among 135 patients with at least one anti-D1 positive result, anti-D1 titers varied significantly over time (Friedman statistics: 508.5, p<0.0001; anti-D1 geometric mean at baseline 189.0; T1 132.3 [-15%]; T2 113.8 [-17%]; T3 109.2 [-6% versus T2, -38% versus T1]). Anti-D1 titers were significantly higher at baseline compared to T3 (p=0.029). In the 4 years of follow-up, 18 new thrombotic events occurred. Patients with double/triple aPL positivity displayed 12.5 fold increase [95%CI 7.4-20.0] in baseline anti-D1 titers. After adjustment for age, gender and number of positive aPL tests, the fluctuation of anti-D1 titers was associated with treatment with hydroxychloroquine (HCQ) at each time-point. In particular, treatment with HCQ, but not those with conventional immunosuppressors, was associated with a 1.3-fold decrease in anti-D1 titers [95%CI 1.1-1.5]. In the same multivariable model, incident vascular events were associated with a 1.5 fold increase of anti-D1 titers. A concomitant diagnosis of systemic lupus erythematosus did not affect the fluctuation of anti-D1 titers.Table 1.Demographic and Clinical Characteristics of 230 APS ACTION Registry Patients with anti-D1 tested ≥3 time points during the follow-upAnti-D1 pos samplesAnti-D1 neg samplesp-valueOverall sample(n=135)(n=95)(n=230)Age [years] mean (SD)42.3 (11.8)48.8 (13.0)0.000145.0 (12.7)%Female (n)71.9 (97)65.3 (62)0.35869.1 (159)Associated systemic autoimmune disease39.3 (53)44.2 (42)0.53941.3 (95)aPL without APS19.3 (26)34.7 (33)0.01025.7 (59)Thrombotic APS54.1 (73)53.7 (51)53.9 (124)Obstetric APS11.9 (16)5.3 (5)9.1 (21)Thrombotic/+obstetric APS14.8 (20)6.3 (6)11.3 (26)aCL IgG89.5 (119/133)25.5 (24/94)<0.000163.0 (143/227)aCL, IgM36.1 (48/133)27.7 (26/94)0.23432.6 (74/227)Anti-2GPI, IgG93.2 (124/133)39.4 (37/94)<0.000170.9 (161/227)Anti-2GPI, IgM34.6 (46/133)21.3 (20/94)0.04329.1 (66/227)LA82.8 (82/99)59.5 (44/74)0.00172.8 (126/173)ConclusionTreatment with HCQ and vascular events during follow-up were identified as significant predictors of the fluctuation of anti-D1 antibody titers over time.Disclosure of InterestsNone declared.
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Yamamoto-Furusho JK, Andrade D, Barahona J, Bautista S, Bosques-Padilla F, de Paula J, Galiano MT, Iade B, Juliao-Baños F, Otoya G, Steinwurz F, Torres E, Veitia G, Barreiro-de Acosta M. Latin American consensus on the quality indicators for comprehensive care clinics for patients with inflammatory bowel disease: PANCCO-GETECCU. Rev Gastroenterol Mex (Engl Ed) 2022; 87:89-102. [PMID: 34866040 DOI: 10.1016/j.rgmxen.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/18/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Inflammatory bowel disease (IBD) is a chronic and incurable entity. The aim of the Pan American Crohn's and Colitis Organisation (PANCCO) is to create awareness of IBD, with special emphasis on Latin America, and the primary objective of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU, the Spanish acronym) is to obtain the accreditation of the clinical and therapeutic criteria for the diagnosis and treatment of IBD. AIM To carry out a consensus for evaluating the approval criteria that a Comprehensive Care Clinic for Latin American IBD patients must meet, to be considered a center of excellence. MATERIALS AND METHODS Fourteen clinical experts participated in the consensus. They were made up of specialists in gastroenterology, with broad clinical experience, spanning several years, in managing the care of a large number of patients with IBD, as well as advanced specialists in IBD. Thirteen of the participants came from 11 Latin American countries (Argentina, Brazil, Colombia, Dominican Republic, Ecuador, Guatemala, Mexico, Peru, Puerto Rico, Uruguay, and Venezuela) that have IBD clinics. An expert from Spain, representing the GETECCU, provided the methodologic support. The consensus consisted of 52 statements divided into three sections: 1) Structure indicators, 2) Process indicators, and 3) Result indicators. The Delphi panel method was applied. RESULTS The present Latin American consensus describes the quality indicators that a Comprehensive Care Clinic for IBD patients must meet, to be considered a center of excellence, taking into account the needs of our region. CONCLUSIONS This is the first Latin American consensus, jointly carried out by the PANCCO and GETECCU, to present accreditation standards for centers of excellence in the care of patients with IBD.
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Affiliation(s)
- J K Yamamoto-Furusho
- Inflammatory Bowel Disease Clinic, Gastroenterology Department, National Institute of Medical Science and Nutrition Salvador Zubirán, Mexico City, Mexico.
| | - D Andrade
- Servicio de Gastroenterología y Endoscopía Digestiva, Unidad de Intestino Clínica de Enfermedad Inflamatoria Intestinal, Hospital José Carrasco Arteaga, Instituto Ecuatoriano de Seguridad Social, Cuenca, Ecuador
| | - J Barahona
- Enfermedades Digestivas de Guatemala, Ciudad de Guatemala, Guatemala
| | - S Bautista
- CEDIMAT Gastroenterology Center, Santo Domingo, Dominican Republic
| | - F Bosques-Padilla
- Department of Gastroenterology, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - J de Paula
- Gastroenterology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - B Iade
- Unidad de Enfermedad Inflamatoria Intestinal, Hospital Maciel ASSE, CASMU y COSEM, Montevideo, Uruguay
| | - F Juliao-Baños
- Inflammatory Bowel Disease Clinic, Gastroenterology Unit, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - G Otoya
- Private Practice, Lima, Peru
| | - F Steinwurz
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - E Torres
- University of Puerto Rico, San Juan, Puerto Rico
| | - G Veitia
- Gastroenterology Service, Hospital Vargas de Caracas, Caracas, Venezuela
| | - M Barreiro-de Acosta
- Gastroenterology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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Zagui GS, Tonani KAA, Fregonesi BM, Machado GP, Silva TV, Andrade LN, Andrade D, Segura-Muñoz SI. Tertiary hospital sewage as reservoir of bacteria expressing MDR phenotype in Brazil. BRAZ J BIOL 2021; 82:e234471. [PMID: 33681897 DOI: 10.1590/1519-6984.234471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/21/2020] [Indexed: 11/22/2022] Open
Abstract
High doses of antibiotics used in hospitals can affect the microbial composition of sewers, selecting resistant bacteria. In this sense, we evaluated the antibiotic resistance profile and the multiresistant phenotype of bacteria isolated in sewage from a tertiary hospital in the interior São Paulo state, Brazil. For bacteria isolation, 10 µL of sewage samples were sown in selective culture media and the isolates were identified using VITEK-2 automatized system. The antibiotic sensitivity test was performed by disk diffusion. High percentages of resistance were found for amoxicillin, ampicillin, ceftazidime, clindamycin, vancomycin and the multidrug-resistant phenotype (MDR) was attributed to 60.7% of the isolates. Our results show bacteria classified as critical/high priority by WHO List of Priority Pathogens (Enterococcus and Staphylococcus aureus resistant to vancomycin and Enterobacteriaceae resistant to carbapenems) in hospital sewage. Therefore, the implementation of disinfection technologies for hospital sewage would reduce the bacterial load in the sewage that will reach urban wastewater treatment plants, minimizing superficial water contamination and bacterial resistance spread in the environment.
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Affiliation(s)
- G S Zagui
- Universidade de São Paulo - USP, Escola de Enfermagem de Ribeirão Preto, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Ribeirão Preto, SP, Brasil
| | - K A A Tonani
- Universidade de São Paulo - USP, Escola de Enfermagem de Ribeirão Preto, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Ribeirão Preto, SP, Brasil
| | - B M Fregonesi
- Universidade de São Paulo - USP, Escola de Enfermagem de Ribeirão Preto, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Ribeirão Preto, SP, Brasil
| | - G P Machado
- Universidade de São Paulo - USP, Escola de Enfermagem de Ribeirão Preto, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Ribeirão Preto, SP, Brasil
| | - T V Silva
- Universidade de São Paulo - USP, Escola de Enfermagem de Ribeirão Preto, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Ribeirão Preto, SP, Brasil
| | - L N Andrade
- Universidade de São Paulo - USP, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Ribeirão Preto, SP, Brasil
| | - D Andrade
- Universidade de Ribeirão Preto, Escola de Enfermagem de Ribeirão Preto, Departamento de Enfermagem Geral e Especializada, Ribeirão Preto, SP, Brasil
| | - S I Segura-Muñoz
- Universidade de São Paulo - USP, Escola de Enfermagem de Ribeirão Preto, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Ribeirão Preto, SP, Brasil
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Cruz Z, Nóvoa M, Leiva B, Andrade D, Quaresma M. Donkey welfare assessment in north-east Portugal. Anim Welf 2021. [DOI: 10.7120/09627286.30.1.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The well-documented versatility of donkeys (Equus africanus asinus) means that issues concerning their welfare can vary depending on how they are mainly used and their geographic location. The present study is the first assessment of donkey welfare to be systematically conducted
in the Iberian Peninsula. This area is characterised by the coexistence of high levels of mechanisation and industrialisation, and human populations with low levels of formal education, still making use of donkeys in their daily work. This study aims to evaluate the main welfare problems affecting
donkeys within this context. The welfare assessment was carried out in accordance with the first level of the AWIN protocol for donkeys. Only 37.6% of the animals evaluated showed all positive indicators, with no physical problem detected while the remaining 62.4% revealed at least one negative
health indicator. Body Condition Score (BCS) was one of the main concerns, with around half of the donkeys exhibiting an inadequate body condition. Dental evaluation revealed similarly concerning results, with 62.8% of the animals assessed requiring treatment. Indications of hoof neglect were
noted in 39.5% of the animals evaluated with a 9.84% incidence of lameness. Skin problems affected 26.7% of individuals. Only 41% of the animals displayed positive results for all behavioural indicators. Aside from BCS, the most prevalent problems were sub-optimal behaviour, pain reaction
to cheek palpation, hoof disease and integument alterations. These issues should be prioritised, both as regards this specific donkey population and the education of their caretakers.
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Cunha E, Guzela V, Balbi GGM, Sobrado C, Andrade D. Anorectal diseases in patients with Antiphospholipid syndrome: a cross-sectional study. Adv Rheumatol 2020; 60:51. [PMID: 33028422 DOI: 10.1186/s42358-020-00153-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hemorrhoid disease (HD) is one of the most common gastrointestinal complaints worldwide, affecting 4.4% of the general population in the United States. Since antiphospholipid syndrome (APS) may lead to intra-abdominal thrombosis, one may expect that this condition can impact the risk for HD development. Additionally, as APS patients are more prone to thrombosis and treatment with anticoagulants may increase risk of bleeding, one may also infer that rates of HD complications may be higher in this scenario. Nevertheless, no data in these regards have been published until now. The objective of the present study is to evaluate frequency of HD and describe its complications rates in antiphospholipid syndrome APS patients. METHODS We consecutively invited patients who fulfilled APS criteria to undergo proctological examination. After examination, patients were divided in two groups, based on the presence of HD, and compared regarding different clinical manifestations and antiphospholipid profile. We performed the analysis of the data, using chi-square and Mann Whitney U when applicable and considering a significance level of 0.05. Multivariate regression analysis included age and variables with p < 0.10 in the bivariate analysis. RESULTS Forty-one APS patients agreed to undergo proctological examination. All were female and overall median age was 43 (36-49). Seventeen (41.4%) patients were diagnosed with HD, with the following frequency distribution: 7 internal (41.2%), 4 external (23.5%) and 5 mixed hemorrhoids (29.4%). Of the internal hemorrhoids, 5 patients were classified as grade I (71.4%), 1 grade II (14.3%), and 1 grade IV (14.3%). Prior gestation (p = 0.067) and constipation (p = 0.067) correlated with a higher frequency of HD. In multivariate analysis, constipation remained as an important risk factor (OR 3.92,CI95% 1.03-14.2,p = 0.037). Five out of 17 patients (29.4%) reported anal bleeding, but it did not correlate with warfarin dose (p = 0.949). Surgical treatment was indicated for 10 patients (58.8%). Other anorectal findings were anal fissure, plicoma, condyloma and one chlamydial retitis. CONCLUSION We found an unexpected high frequency of hemorrhoids in APS patients, with a great proportion requiring surgical treatment.
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Affiliation(s)
- E Cunha
- Undergraduate student, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - V Guzela
- Discipline of Colorectal Surgery, Hospital das Clínicas/Faculdade de Medicina (HC-FMUSP), University of São Paulo, São Paulo, SP, Brazil
| | - G G M Balbi
- Discipline of Rheumatology, Hospital das Clínicas/Faculdade de Medicina (HC-FMUSP), University of São Paulo, Av. Dr. Arnaldo 455, Third Floor, Room 3109, São Paulo, 01246903, Brazil.,Discipline of Rheumatology, Hospital Universitário, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - C Sobrado
- Discipline of Colorectal Surgery, Hospital das Clínicas/Faculdade de Medicina (HC-FMUSP), University of São Paulo, São Paulo, SP, Brazil
| | - D Andrade
- Discipline of Rheumatology, Hospital das Clínicas/Faculdade de Medicina (HC-FMUSP), University of São Paulo, Av. Dr. Arnaldo 455, Third Floor, Room 3109, São Paulo, 01246903, Brazil.
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Siqueira V, Helbingen M, Luppino-Assad AP, Carriço Da Silva H, Andrade D, Medeiros-Ribeiro AC, Sampaio-Barros PD. SAT0341 PREDICTORS TO PROGRESSION TO SYSTEMIC SCLEROSIS IN A GROUP OF SECONDARY RAYNAUD PHENOMENON OBSERVED IN A LARGE SINGLE BRAZILIAN COHORT. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The 2013 ACR/EULAR classification criteria for systemic sclerosis (SSc) allowed the inclusion of a subset of patients without skin involvement, emphasizing the need of early diagnosis of SSc.Objectives:In this setting, the objective of this study was to classify, according to ACR/EULAR SSc criteria, patients with Raynaud phenomenon (RP) and at least one SSc manifestation, except for skin involvement, and analyze predictors for development of SSc.Methods:This is a cross-sectional single-center analysis of consecutive patients presenting RP and a characteristic SSc manifestation (SSc autoantibody, SSc visceral involvement or SD pattern at nailfold capillaroscopy - NFC), without skin involvement, who attended a scleroderma outpatient clinic between 2010 and 2019. Patients were classified as SSc (according to ACR/EULAR SSc criteria) or undifferetiated connective tissue disease (UCTD) in their last medical visit and compared. Additionally, a longitudinal retrospective analysis of both groups was performed to find predictors for development of SSc. Data were obtained from an electronic register database. Statistical significance was set up as p<0.05.Results:Among 217 patients, 153 (70.5%) were classified as SSc, at the last medical visit, including 65 (30%) after the first investigation. During a comparable median follow-up [4.9±3.8 vs. 4.6±3.0 years;p=0.90], patients with SSc presented more frequently puffy fingers (PF:73% vs. 6.3%;p<0.01), pitting scars (87.4% vs. 4.7%;p<0.01), digital ulcers (25.2% vs. 1.6%;p<0.01), telangiectasias (52.3% vs. 7.8%;p<0.01), interstitial lung disease (ILD:66.7% vs. 34.4%;p<0.01), pulmonary hypertension (PH:18.3% vs. 7.9%;p=0.049) and esophageal dismotility (ED: 58.9% vs. 43.8%:p=0.02) than secondary RP patients without SSc. Moreover, SSc patients had more SD pattern at NFC (83.4%vs. 57.8%;p<0.01), anti-Scl70 antibody (16.6%vs. 3.1%;p<0.01), and nucleolar ANA pattern (22.5%vs. 10.9%;p=0.048). Furthermore, SSc patients were more frequently treated with immunosuppressive therapy (80.1%vs. 37.5%;p<0.01) and presented an increased death rate (9.9%vs. 1.6%;p<0.01 and Figure 1). For the analysis of the predictors to SSc, patients who had already fulfilled SSc criteria at baseline were excluded and 152 patients were analysed: 88 progressed to SSc and 64 remained as UCTD. After multivariate analyses, puffy fingers (OR=4.48; 95%CI 1.17-17.17;p=0.029) and a higher SSc score, both at baseline, (OR: 1.97; 95%CI 1.33-2.92;p<0.001) were predictors to SSc, while esophageal symptoms (OR=0.18; 95%CI 0.05-0.67; p=0.01) and absence of clinical symptoms (OR=0.08; 95%CI 0.01-0.40; p=0.002) were negative predictive factors. When analyzing the combination of SSc features, RP + PF + positive ANA (OR=15.5; 95%CI 4.5-53.1;p<0.001), RP + PF + positive ANA + SD-NFC (OR=12.3; 95%CI 2.8-54.2;p<0.001), RP + PF + SD-NFC (OR=12; 95%CI 2.79-54.1;p<0.01), and RP + lung disease (ILD/HAP) + SD-NFC (OR=3.0; 95%CI 1.1-10.5;p<0.04) were associated with classification as SSc, while combinations without non-RP clinical symptoms, as RP + SD-NFC (OR=0.027; 95%CI 0.003-0.210;p<0.001) and RP + anticentromere + SD-NFC (OR=0.050; 95%CI 0.007-0.440;p<0.001) were not associated with SSc.Conclusion:Among patients with RP and SSc features, but without skin involvement, those with SSc had a more severe disease with worse prognosis than UCTD with RP. Puffy fingers and a higher baseline SSc score, especially in combinations including PF or lung disease were predictors of SSc, reinforcing the strength of the ACR/EULAR classification criteria and the presence of specific non-RP symptoms.Disclosure of Interests:Valdirene Siqueira: None declared, Mariely Helbingen: None declared, Ana Paula Luppino-Assad: None declared, Henrique Carriço da Silva: None declared, Danieli Andrade: None declared, Ana Cristina Medeiros-Ribeiro: None declared, Percival D. Sampaio-Barros Consultant of: Abbvie, Boehringer Ingelheim, Lilly, Novartis, Speakers bureau: Abbvie, Janssen, Lilly, Novartis
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Santos LCS, Parvin F, Huizer-Pajkos A, Wang J, Inglis DW, Andrade D, Hu H, Vickery K. Contribution of usage to endoscope working channel damage and bacterial contamination. J Hosp Infect 2020; 105:176-182. [PMID: 32169614 DOI: 10.1016/j.jhin.2020.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 03/04/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Biofilm formation has been shown to be associated with damaged areas of endoscope channels. It was hypothesized that the passage of instruments and brushes through endoscope channels during procedures and cleaning contributes to channel damage, bacterial attachment and biofilm formation. AIM To compare surface roughness and bacterial attachment in used and new endoscope channels in vivo and in vitro. METHODS Surface roughness of 10 clinically used (retired) and seven new colonoscope biopsy channels was analysed by a surface profiler. For the in-vitro study, a flexible endoscope biopsy forceps was passed repeatedly through a curved 3.0-mm-diameter Teflon tube 100, 200 and 500 times. Atomic force microscopy was used to determine the degree of inner surface damage. The number of Escherichia coli or Enterococcus faecium attached to the inner surface of the new Teflon tube and the tube with 500 forceps passes in 1 h at 37oC was determined by culture. RESULTS The average surface roughness of the used biopsy channels was found to be 1.5 times greater than that of the new biopsy channels (P=0.03). Surface roughness of Teflon tubes with 100, 200 and 500 forceps passes was 1.05-, 1.12- and 3.2-fold (P=0.025) greater than the roughness of the new Teflon tubes, respectively. The number of E. coli and E. faecium attached to Teflon tubes with 500 forceps passes was 2.9-fold (P=0.021) and 4.3-fold (P=0.004) higher compared with the number of E. coli and E. faecium attached to the new Teflon tubes, respectively. CONCLUSION An association was found between endoscope usage with damage to the biopsy channel and increased bacterial attachment.
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Affiliation(s)
- L C S Santos
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia; Ribeirao Preto Nursing School, Sao Paulo University, Ribeirao Preto, Sao Paulo, Brazil
| | - F Parvin
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - A Huizer-Pajkos
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - J Wang
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - D W Inglis
- School of Engineering, Macquarie University, Sydney, Australia
| | - D Andrade
- Ribeirao Preto Nursing School, Sao Paulo University, Ribeirao Preto, Sao Paulo, Brazil
| | - H Hu
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - K Vickery
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
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9
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Torricelli AK, Ugolini-Lopes MR, Bonfá E, Andrade D. Antiphospholipid syndrome damage index (DIAPS): distinct long-term kinetic in primary antiphospholipid syndrome and antiphospholipid syndrome related to systemic lupus erythematosus. Lupus 2020; 29:256-262. [PMID: 31986962 DOI: 10.1177/0961203320901598] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Antiphospholipid syndrome (APS) is an acquired thrombophilia that affects young productive individuals, with permanent damage and negative impact on quality of life. Recently, a damage index specific for APS (DIAPS) was developed. There are, however, no data regarding the comparison of its performance and long-term damage in primary antiphospholipid syndrome (PAPS) and APS related to systemic lupus erythematosus (SLE; APS + SLE). The primary purpose of this study was therefore to compare the long-term damage in patients with these conditions. METHODS This is a retrospective analysis of a single tertiary center cohort followed for approximately 10 years using a standardized prospective electronic chart database. Fifty consecutive PAPS patients age matched with 50 APS+SLE patients were consecutively selected for the study, and DIAPS was calculated once a year during follow-up. Long-term damage and damage kinetics in both groups were compared. RESULTS PAPS and APS + SLE had comparable age (47.10 ± 12.4 vs. 44.04 ± 10.80 years; p = 0.19) and time of follow-up (9.40 ± 3.60 vs. 10.94 ± 4.50 years; p = 0.06). At diagnosis, PAPS had higher DIAPS than APS + SLE (1.72 ± 1.17 vs. 0.82 ± 0.96; p < 0.001). At the end of the 10-year follow-up, both groups presented comparable mean damage scores (2.04 ± 1.50 vs. 2.24 ± 1.61; p = 0.52). The damage increment throughout the observation period for PAPS was solely 35%, whereas for APS + SLE it was gradual, persistent and reached 139% at the end of follow-up, with a total damage increment for PAPS lower than APS + SLE (0.43 ± 0.30 vs. 1.22 ± 1.24; p < 0.001). Of note, the frequency of individuals who acquired damage was lower in PAPS than in APS + SLE (32% vs. 71%; p < 0.001). PAPS also had a longer delay in diagnosis than APS + SLE (4.00 ± 4.20 vs. 2.54 ± 3.05 years; p = 0.04). This delay was positively correlated with a higher damage score at diagnosis (r = 0.36, p < 0.001) in all groups. CONCLUSION We identified a distinct pattern of damage in PAPS and APS related to SLE. Damage in PAPS is an early event, while APS+SLE is associated with higher long-term damage, with a striking increment of damage along the follow-up. A diagnosis delay is correlated with higher damage scores. Damage surveillance therefore requires different approaches for these two conditions.
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Affiliation(s)
- A Kuhl Torricelli
- Rheumatology Division - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil
| | - M Remião Ugolini-Lopes
- Rheumatology Division - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil
| | - E Bonfá
- Rheumatology Division - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil
| | - D Andrade
- Rheumatology Division - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil
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10
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Andrade D, Tituaña P, Vela D, Ponce C. PSXI-6 Evaluation of Palm kernel meal supplementation on grazing dairy cows at highlands. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D Andrade
- Universidad de las Fuerzas Armadas-ESPE,Latacunga, Ecuador
| | - P Tituaña
- Universidad de las Fuerzas Armadas-ESPE, Sangolqui, Ecuador
| | - D Vela
- Universidad de las Fuerzas Armadas-ESPE, Sangolqui, Ecuador
| | - C Ponce
- Universidad San Francisco de Quito,Quito, Ecuador
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11
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de Jesús GR, Sciascia S, Andrade D, Barbhaiya M, Tektonidou M, Banzato A, Pengo V, Ji L, Meroni PL, Ugarte A, Cohen H, Branch DW, Andreoli L, Belmont HM, Fortin PR, Petri M, Rodriguez E, Cervera R, Knight JS, Atsumi T, Willis R, Nascimento IS, Rosa R, Erkan D, Levy RA. Factors associated with first thrombosis in patients presenting with obstetric antiphospholipid syndrome (APS) in the APS Alliance for Clinical Trials and International Networking Clinical Database and Repository: a retrospective study. BJOG 2018; 126:656-661. [PMID: 30222236 DOI: 10.1111/1471-0528.15469] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the subsequent rate of thrombosis among women with obstetric antiphospholipid syndrome (Ob-APS) in a multicentre database of antiphospholipid antibody (aPL)-positive patients, and the clinical utility of the adjusted Global Antiphospholipid Syndrome Score (aGAPSS), a validated tool to assess the likelihood of developing new thrombosis, in this group of patients. DESIGN Retrospective study. SETTING The Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking Clinical Database and Repository. POPULATION Women with Ob-APS. METHODS Comparison of clinical and laboratory characteristics and measurement of aGAPSS in women with Ob-APS, with or without thrombosis, after initial pregnancy morbidity (PM). MAIN OUTCOME MEASURES Risk factors for thrombosis and aGAPSS. RESULTS Of 550 patients, 126 had Ob-APS; 74/126 (59%) presented with thrombosis, and 47 (63%) of these women developed thrombosis after initial PM, in a mean time of 7.6 ± 8.2 years (4.9/100 patient years). Younger age at diagnosis of Ob-APS, additional cardiovascular risk factors, superficial vein thrombosis, heart valve disease, and multiple aPL positivity increased the risk of first thrombosis after PM. Women with thrombosis after PM had a higher aGAPSS compared with women with Ob-APS alone [median 11.5 (4-16) versus 9 (4-13); P = 0.0089]. CONCLUSION Based on a retrospective analysis of our multicentre aPL database, 63% of women with Ob-APS developed thrombosis after initial obstetric morbidity; additional thrombosis risk factors, selected clinical manifestations, and high-risk aPL profile increased the risk. Women with subsequent thrombosis after Ob-APS had a higher aGAPSS at entry to the registry. We believe that aGAPSS is a valid tool to improve risk stratification in aPL-positive women. TWEETABLE ABSTRACT More than 60% of women with obstetric antiphospholipid syndrome had thrombosis after initial pregnancy morbidity.
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Affiliation(s)
- G R de Jesús
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - S Sciascia
- Department of Clinical and Biological Sciences, Centre of Research of Immunopathology and Rare Diseases, University of Turin, Turin, Italy
| | - D Andrade
- Departament of Rheumatology, Universidade de São Paulo, São Paulo, Brazil
| | - M Barbhaiya
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
| | - M Tektonidou
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, University of Athens, Athens, Greece
| | - A Banzato
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - V Pengo
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - L Ji
- Rheumatology and Immunology Department, Peking University, First Hospital, Beijing, China
| | - P L Meroni
- Department of Rheumatology, University of Milan, Milan, Italy
| | - A Ugarte
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Hospital Universitario Cruces, Barakaldo, Spain
| | - H Cohen
- Department of Haematology, University College London, London, UK
| | - D W Branch
- Department of Obstetrics and Gynecology, University of Utah Health Sciences and Intermountain Healthcare, Salt Lake City, UT, USA
| | - L Andreoli
- Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - H M Belmont
- Division of Rheumatology, NYU School of Medicine, New York, NY, USA
| | - P R Fortin
- Division of Rheumatology, Centre Hospitalier de l'Université Laval, Québec, QC, Canada
| | - M Petri
- Division of Rheumatology, John Hopkins University, Baltimore, MD, USA
| | - E Rodriguez
- Rheumatology Department, Hospital 12 de Octubre, Madrid, Spain
| | - R Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
| | - J S Knight
- Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - T Atsumi
- Department of Rheumatology, Endocrinology, and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - R Willis
- Antiphospholipid Standardization Laboratory, Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - I S Nascimento
- Departament of Rheumatology, Universidade de São Paulo, São Paulo, Brazil
| | - R Rosa
- Departament of Rheumatology, Universidade de São Paulo, São Paulo, Brazil
| | - D Erkan
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
| | - R A Levy
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.,GlaxoSmithKline Immunology and Inflammation, Upper Providence, PA, USA
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12
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Ricarte IF, Dutra LA, Abrantes FF, Toso FF, Barsottini OGP, Silva GS, de Souza AWS, Andrade D. Neurologic manifestations of antiphospholipid syndrome. Lupus 2018; 27:1404-1414. [DOI: 10.1177/0961203318776110] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Neurological involvement in antiphospholipid antibody syndrome (APS) is common, and its occurrence increases morbidity and mortality. Patients may present variable neurological involvement, such as cerebrovascular disease, cognitive dysfunction, headache, seizures, movement disorders, multiple sclerosis-like syndrome, transverse myelitis and ocular symptoms. Most neurological manifestations are associated with thrombosis of the microcirculation or of large vessels; nonetheless, there is compelling evidence suggesting that, in some cases, symptoms are secondary to an immune-mediated pathogenesis, with direct binding of aPL on neurons and glia. Herein we describe clinical characteristics and management of neurological APS manifestations.
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Affiliation(s)
- I F Ricarte
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil
| | - L A Dutra
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - F F Abrantes
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil
| | - F F Toso
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil
| | - O G P Barsottini
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil
| | - G S Silva
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - A W S de Souza
- Rheumatology Division, Department of Internal Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
| | - D Andrade
- Rheumatology Division, Department of Internal Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
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13
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Albuquerque C, Debiasi M, Werutsky G, Uema D, Cronenberger E, Cordeiro de Lima VC, de Sant'ana RO, Bines J, Santi PX, Goés RS, Liedke P, Batista MLM, Dybal V, Nerón YV, Beato CA, Borges G, Giacomazzi J, dos Santos LV, Ismael G, Rosa DD, Azambuja A, Andrade D, Martinez-Mesa J, Zaffaroni F, Barrios CH. Abstract P1-17-10: Survival outcomes related to health care coverage in breast cancer patients with brain metastases in Brazil: A sub-analysis from the LACOG-0312 study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-17-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
The incidence of brain metastases among women with metastatic breast cancer (MBC) ranges from 10 to 30% depending of breast cancer (BC) subtype. Inequities in the access to optimal treatment and shorter survival of BC by type of health care coverage were previously reported in an observational study in Brazil. The present analysis aims to analyze the impact of the type of health care coverage on survival outcomes of patients with MBC and brain involvement.
Methods
LACOG-0312 is a retrospective cohort study that enrolled patients with metastatic or locally advanced/recurrent unresectable BC diagnosed during 2012 in Brazil. Overall survival (OS) was defined as the time from the diagnosis of brain metastases and death from any cause. Comparisons were made using the Kaplan-Meier method based on the type of health care coverage (public vs. private) among patients who developed brain metastases. Cox regression analysis was performed for identification of independent prognostic factors associated with survival after brain metastases diagnosis.
Results
Among the 690 MBC patients included in the LACOG-0312 study, 145 (21%) were diagnosed with brain metastases. Of them, 94 (71,75%) were covered by the Brazilian public health care and 37 (28,25%) had private coverage. Baseline characteristics such as age at MBC diagnosis, stage IV at diagnosis and tumor subtypes were similar between both groups.
Median time to develop brain metastases after diagnosis of MBC was 14 months in the whole population with no differences between public and private patients (13 vs. 17 months p=0.172).
Median OS from the date of brain metastases diagnosis was similar for both groups: 10.0 months in private and 9.0 months in public health insured patients (HR 0.92 – 95%CI 0.55-1.51; p=0.729). In a multivariable analysis including type of health care coverage, only the triple negative BC subtype was associated with a worse survival post brain metastases diagnosis.
Conclusion
Our study indicates that health care coverage is not associated with survival outcomes in patients with MBC and brain metastases. Potential differences in the access to optimal care such as radiotherapy, surgery and systemic treatments may not play a significant role in the survival of theses patients possibly due to small clinical benefit of the current treatment options for brain metastases in breast cancer.
Citation Format: Albuquerque C, Debiasi M, Werutsky G, Uema D, Cronenberger E, Cordeiro de Lima VC, de Sant'ana RO, Bines J, Santi PX, Goés RS, Liedke P, Batista MLM, Dybal V, Nerón YV, Beato CA, Borges G, Giacomazzi J, dos Santos LV, Ismael G, Rosa DD, Azambuja A, Andrade D, Martinez-Mesa J, Zaffaroni F, Barrios CH. Survival outcomes related to health care coverage in breast cancer patients with brain metastases in Brazil: A sub-analysis from the LACOG-0312 study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-17-10.
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Affiliation(s)
- C Albuquerque
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - M Debiasi
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - G Werutsky
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - D Uema
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - E Cronenberger
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - VC Cordeiro de Lima
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - RO de Sant'ana
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - J Bines
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - PX Santi
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - RS Goés
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - P Liedke
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - MLM Batista
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - V Dybal
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - YV Nerón
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - CA Beato
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - G Borges
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - J Giacomazzi
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - LV dos Santos
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - G Ismael
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - DD Rosa
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - A Azambuja
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - D Andrade
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - J Martinez-Mesa
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - F Zaffaroni
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - CH Barrios
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
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Werutsky G, Zaffaroni F, Uema D, Cronenberger E, Cordeiro de Lima VC, de Sant'ana RO, Bines J, Santi PX, Goés RS, Liedke P, Batista MLM, Dybal V, Nerón YV, Beato CA, Borges G, Giacomazzi J, dos Santos LV, Ismael G, Rosa DD, Azambuja A, Andrade D, Martinez-Mesa J, Debiasi M, Barrios CH. Abstract P4-10-17: Survival outcomes related to health care coverage in metastatic breast cancer in Brazil: A sub-analysis from the LACOG-0312 study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-10-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Metastatic breast cancer (MBC) is an incurable disease in which latest therapies have evolving and improving patients survival. Inequities in the access to optimal treatment and shorter survival of BC by type of health care coverage were previously reported in an observational study in Brazil. In Brazil patients with private health coverage have access to the most recent therapies, however the public health system does not provide several therapies approved for the treatment of MBC such as everolimus, trastuzuman, eribulin, TDM-1, pertuzumab among others. The present analysis aims to analyze the impact of the type of health care coverage on survival outcomes of patients with MBC.
Methods
LACOG-0312 is a retrospective cohort study that enrolled patients with metastatic or locally advanced/recurrent unresectable BC diagnosed during 2012 in Brazil. Overall survival was defined as the time from the diagnosis of MBC and death from any cause. Comparisons were made using the Kaplan-Meier method based on the type of health care coverage (public vs. private). Cox regression analysis was performed for identification of independent prognostic factors associated with overall survival.
Results
A total of 634 patients with MBC were included in the study. Baseline characteristics by type of health care coverage was similar for visceral disease (43% in public and 44% in private, p=0.78), age at MBC diagnosis (median 62 years in public and 64 years in private, p=0.25), BC subtype (p=0.89), however more patients public insured were metastatic at diagnosis (42% vs. 33%) and had performance status >= 2 (12% vs. 3%).
The proportion of patients that received any first-line systemic therapy was similar in both groups (95.2% in public and 95.5% in private, p=1.0), however more patients with private insurance received second (82% vs. 71.6%, p=0.013) and third line (56% vs. 45%, p=0.024) therapy compared to public health covered patients.
OS from the date of MBC diagnosis in whole population was 36 months. There was no difference in terms of OS between private (42 months) and public (35 months) health insured patients (p=0.65). OS by BC subtype was 15 months for triple negative, 23 months in HER2 positive, 44 and 42 months for Luminal A and B respectively. There was no difference in OS by type of health insurance coverage in any BC subtypes.
In a multivariate analysis type of health care coverage did not associate with survival, only triple negative (HR (95% CI) – 3.495 (2.448 - 4.989); p <0.001), HER2 positive (HR (95% CI) - 2.287 (1.394 - 3.572); p = 0.001) BC subtypes and visceral metastases (HR (95% CI) – 1.413 (1.075 - 1.858); p <0.013) were correlated with a worse survival.
Conclusion
Our study suggestes that health care coverage is not associated with survival outcomes in patients with MBC. Potential differences in the access to optimal systemic treatments may not play a significant role in the survival of these patients. Real-world studies addressing the impact of new cancer therapies for different BC subtypes in MBC are needed.
Citation Format: Werutsky G, Zaffaroni F, Uema D, Cronenberger E, Cordeiro de Lima VC, de Sant'ana RO, Bines J, Santi PX, Goés RS, Liedke P, Batista MLM, Dybal V, Nerón YV, Beato CA, Borges G, Giacomazzi J, dos Santos LV, Ismael G, Rosa DD, Azambuja A, Andrade D, Martinez-Mesa J, Debiasi M, Barrios CH. Survival outcomes related to health care coverage in metastatic breast cancer in Brazil: A sub-analysis from the LACOG-0312 study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-17.
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Affiliation(s)
- G Werutsky
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - F Zaffaroni
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - D Uema
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - E Cronenberger
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - VC Cordeiro de Lima
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - RO de Sant'ana
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - J Bines
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - PX Santi
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - RS Goés
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - P Liedke
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - MLM Batista
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - V Dybal
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - YV Nerón
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - CA Beato
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - G Borges
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - J Giacomazzi
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - LV dos Santos
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - G Ismael
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - DD Rosa
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - A Azambuja
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - D Andrade
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - J Martinez-Mesa
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - M Debiasi
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - CH Barrios
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
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Herman T, Andrade D, Mehta M, Griffith J, Jin H, Ahmad S, Algan O, Munshi A. Targeted Inhibition of Rad51 Renders Non–small Cell Lung Cancer Cells More Sensitive to Proton Therapy. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.2034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Barrios CH, Uema D, Cronenberger E, Lima V, Bines J, de Sant'ana RO, Batista ML, Dybal V, Liedke P, Beato C, Nerón YV, Giacomazzi J, dos Santos L, Ismael G, Azambuja A, Andrade D, Rosa DD, Borges G, Mano M, Martinez-Mesa J, Zaffaroni F, Werutsky G. Abstract P6-16-04: Real World data and patterns of care of metastatic breast cancer (MBC) in Brazil: First results of LACOG 0312 retrospective study. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-16-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Randomised clinical trials (RCT) are considered a gold standard generating efficacy and safety data supporting drug approval. However, real world data (RWD) reflecting health care delivery is becoming increasingly important. RWD on patient profiles and patterns of care in MBC are scarce in developing countries. As an example, observational studies suggest that despite guideline recommendations clearly indicating ET for hormone receptor positive MBC, a considerable proportion of patients in clinical practice begin chemotherapy in early lines of therapy. This pragmatic information addresses the uptake and applicability of the RCT results and should be able to help informing health care planning complementing RCT generated data. The objective of this study is to describe patient characteristics and evaluate actual physician-reported treatments for MBC in Brazil.
Methods
This analysis addresses the first 362 patients included in LACOG-0312, a retrospective study planning to recruit over 700 patients (cut-off date April 30th 2016) with recurrent locally advanced or MBC diagnosed in 2012 in 18 institutions across Brazil. Patient characteristics, type of health insurance coverage, treatment and survival outcome were analysed.
Results
Median age at BC diagnosis was 53 years and 37% were premenopausal. Regarding the educational level, 63.2% had completed elementary (primary) schooling, 75.7% were covered by the public health system while 24.3% had some form of private coverage. 70% of patients had hormone receptor positive (HR+) and 18% had HER2 positive tumors. Median disease free survival time from surgery was 29 months. Interestingly, 30% of patients underwent a biopsy of a metastatic site. Of the 362 patients, 349 (96.9%) received some form of palliative systemic therapy. Median time from diagnosis of metastatic disease to first-line therapy initiation was 46 days but a significant difference was noted between patients with public versus private health insurance (50 vs. 33 days p=0.012). Half of the patients received at least 3 lines of therapy (chemo or endocrine) to a maximum of 9 lines. In patients with HR+ tumors, endocrine therapy was administered in 47% in first, 65% in second and 61% in third-line, respectively. Median overall survival (OS) from diagnosis of metastatic disease was 34 months (CI 95%: 25.7-44.3) and no differences in OS were observed between patients with public or private coverage (34 months vs. 35 months p=0.808). Causes of death were cancer in 85.2% of patients and treatment toxicity in 3.6%.
Conclusion
Our study included a population with predominantly low educational level and mostly public health insurance. This likely corresponds to the majority of cases and reflects cancer care patterns in Brazil and many developing countries. A considerable proportion of patients were premenopausal at MBC diagnosis. More than half of HR+ patients received at least 3 lines of endocrine therapy although 54% of them had chemotherapy as the first systemic treatment. Patients from the public health system experienced a delay in starting first-line therapy but this didn't seem to jeopardize cancer outcomes in this setting.
Citation Format: Barrios CH, Uema D, Cronenberger E, Lima V, Bines J, de Sant'ana RO, Batista ML, Dybal V, Liedke P, Beato C, Nerón YV, Giacomazzi J, dos Santos L, Ismael G, Azambuja A, Andrade D, Rosa DD, Borges G, Mano M, Martinez-Mesa J, Zaffaroni F, Werutsky G. Real World data and patterns of care of metastatic breast cancer (MBC) in Brazil: First results of LACOG 0312 retrospective study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-16-04.
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Affiliation(s)
- CH Barrios
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - D Uema
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - E Cronenberger
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - V Lima
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - J Bines
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - RO de Sant'ana
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - ML Batista
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - V Dybal
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - P Liedke
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - C Beato
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - YV Nerón
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - J Giacomazzi
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - L dos Santos
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - G Ismael
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - A Azambuja
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - D Andrade
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - DD Rosa
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - G Borges
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - M Mano
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - J Martinez-Mesa
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - F Zaffaroni
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - G Werutsky
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
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Torricelli A, Lopes M, Bonfá E, Andrade D. AVALIAÇÃO LONGITUDINAL DOS ÍNDICES DE DANO PERMANENTE SLICC E DIAPS EM PACIENTES COM SÍNDROME ANTIFOSFOLÍPIDE. Revista Brasileira de Reumatologia 2017. [DOI: 10.1016/j.rbr.2017.07.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Torricelli A, Lopes M, Bonfá E, Andrade D. A IMPORTÂNCIA DO DIAGNÓSTICO PRECOCE NA SÍNDROME ANTIFOSFOLÍPIDE: MINIMIZANDO DANOS. Revista Brasileira de Reumatologia 2017. [DOI: 10.1016/j.rbr.2017.07.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Drehmer MN, Andrade D, Pereira IA, Marrero AR, Muniz YCN, de Souza IR, Löfgren SE. Estrogen receptor alpha gene (ESR1) polymorphism can contribute to clinical findings in systemic lupus erythematosus patients. Lupus 2016; 26:294-298. [DOI: 10.1177/0961203316668041] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Estrogens have a modulatory effect on several immune responses, many of which are correlated to autoimmune diseases. Estrogens act through binding to their receptors, and an overexpression of these receptors has been identified in patients with different autoimmune diseases. Here we analyzed the association of a putative functional genetic variant in the main estrogen receptor (ERα) gene ( ESR1), and the susceptibility to clinical findings and severity of SLE. Methods A total of 426 individuals (266 healthy controls and 160 SLE patients) were genotyped for the polymorphism rs2234693 in the ESR1 gene. Allele and genotype frequencies were calculated and analyzed between cases and controls using Unphased software. Results The SNP rs2234693 was not associated with SLE per se but the minor allele rs2234693-C was correlated with the presence of nephritis and discoid skin rash. On the other hand, the rs2234693-CC genotype was correlated with the absence of arthritis as well as anti-ANA and anti-RNP autoantibodies. The comprehensive clinical analysis of these patients revealed a more severe status of the disease, characterized by a younger age of onset and higher number of organs involved when compared to European populations. Conclusions Minor allele rs2234693-C was associated with renal and cutaneous involvement, as well as the absence of arthritis, anti-ANA and anti-RNP autoantibodies.
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Affiliation(s)
- M N Drehmer
- Federal University of Santa Catarina, Department of Cell Biology, Embryology and Genetics, Florianopolis, Brazil
| | - D Andrade
- Federal University of Santa Catarina, Department of Cell Biology, Embryology and Genetics, Florianopolis, Brazil
| | - I A Pereira
- University Hospital, Rheumatology division, Federal University of Santa Catarina, Florianopolis, Brazil
| | - A R Marrero
- Federal University of Santa Catarina, Department of Cell Biology, Embryology and Genetics, Florianopolis, Brazil
| | - Y C N Muniz
- Federal University of Santa Catarina, Department of Cell Biology, Embryology and Genetics, Florianopolis, Brazil
| | - I R de Souza
- Federal University of Santa Catarina, Department of Cell Biology, Embryology and Genetics, Florianopolis, Brazil
| | - S E Löfgren
- Federal University of Santa Catarina, Department of Cell Biology, Embryology and Genetics, Florianopolis, Brazil
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Zuily S, Andrade D, Erkan D, Tektonidou M. FRI0314 Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking (APS Action) Clinical Database and Repository Analysis: The Impact of Systemic Lupus Erythematosus on The Clinical Phenotype of Antiphospholipid Antibody-Positive Patients. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Andrade D, Bortolotto L, Bonfá E, Borba E. Primary antiphospholipid syndrome: absence of premature atherosclerosis in patients without traditional coronary artery disease risk factors. Lupus 2015; 25:472-8. [PMID: 26585072 DOI: 10.1177/0961203315617841] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 10/23/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate if patients with Primary Antiphospholipid Syndrome (PAPS) with venous and/or arterial thrombosis without traditional coronary artery disease (CAD) risk factors develop early atherosclerotic vascular damage. METHODS 27 female patients with PAPS (Sidney criteria) and 27 age, body mass index (BMI), and sex matched controls were consecutively selected. Exclusion criteria were: black race, age ≥55 years, traditional cardiovascular risk factors, other thrombophilias or connective tissue diseases, corticosteroids use and pregnancy. All subjects underwent Pulse Wave Velocity (PWV) and Echo-Tracking (ET), both in carotidal bed, to analyse vascular functional properties. RESULTS Age (p = 0.92) and BMI (p = 0.91) were comparable in both groups. PAPS patients and controls had similar PWV (9.07 ± 1.08 m/s vs 9.42 ± 1.47 m/s, p = 0.34) as well as echo tracking parameters such as intima-media thickness (683 ± 171 µm vs 636 ± 140 µm, p = 0.52), carotideal diameter (p = 0.26), distensibility (p = 0.92), compliance coefficients (p = 0.36) and elastic modulus (p = 0.78). Patients with exclusively venous thrombosis showed lower PWV than patients with arterial thrombosis (8.55 ± 0.70 m/s vs 9.56 ± 0.94 m/s, p = 0.01), but no difference regarding intima-media thickness (683 ± 171 µm vs 636 ± 140 µm, p = 0.52) was observed. CONCLUSION Patients with PAPS do not seem to be at higher risk of developing premature atherosclerosis. Patients who suffered exclusively venous thrombosis seem to be at lower risk than those with exclusively arterial events. Other studies need to confirm our findings.
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Affiliation(s)
- D Andrade
- Rheumatology Division, São Paulo University, São Paulo, Brazil
| | - L Bortolotto
- Heart Institute of São Paulo University, São Paulo, Brazil
| | - E Bonfá
- Rheumatology Division, São Paulo University, São Paulo, Brazil
| | - E Borba
- Rheumatology Division, São Paulo University, São Paulo, Brazil
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Silva-Souza JG, Andrade D, Vidal Júnior MV, Farias WM, Valério Júnior JF, Mendonça, PP. Eugenol como anestésico para oscar, Astronotus ocellatus. ARCH ZOOTEC 2015. [DOI: 10.21071/az.v64i247.409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A utilização de anestésicos durante práticas de manejo na piscicultura é considerada uma medida mitigadora do estresse dos peixes. A espécie utilizada no experimento, o oscar, é um peixe nativo da Bacia Amazônica de grande importância para a piscicultura ornamental e amplamente difundida na aquariofilia mundial. O objetivo deste trabalho foi avaliar o efeito anestésico do eugenol sobre juvenis de oscar. Foram utilizados juvenis com peso de 4,61 ± 0,83 g e comprimento total de 6,36 ± 0,32 cm submetidos a diferentes concentrações de eugenol na água, em aquários distintos e posteriormente foi observada sua recuperação em aquários sem eugenol. Foram avaliadas quatro concentrações de eugenol: 40; 60; 80 e 100 mg/L. Os valores referentes ao tempo de permanência nos estágios de sedação e recuperação, bem como o tempo para completa sedação e retorno à natação normal foram avaliados e analisados via ANOVA (P
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Bertolaccini M, Willis R, Lakos G, Andrade D, Pengo V, Banzato A, Krilis S, Erkan D. AB1071 Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking (APS Action) Core Laboratory Validation Exercise: Comparison of Chemiluminescence Immunoassay (CIA) and Enzyme-Linked Immunosorbant Assay (ELISA):. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kobayashi CBC, Bento RH, Malheiros DMAC, Andrade D, Seguro LCP, Sampaio-Barros PD. Kidney biopsy is mandatory in cases of 'silent' arterial hypertension in scleroderma renal crisis: a case report. Clin Exp Rheumatol 2014; 32:S-233. [PMID: 25372806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 09/15/2014] [Indexed: 06/04/2023]
Affiliation(s)
- C B C Kobayashi
- Disciplina de Reumatologia, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, Brazil.
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Macho V, Coelho A, Areias C, Macedo P, Andrade D. Craniofacial features and specific oral characteristics of Down syndrome children. Oral Health Dent Manag 2014; 13:408-411. [PMID: 24984656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM This article intends to describe the characteristics of Down syndrome children in order to facilitate their management in the dental office. METHODS A review of literature was made limited to articles published between 2003 and 2013. The article is based on a literature search in PubMed and the authors' clinical experience with the patient group. DISCUSSION Individuals with Down syndrome are clinically characterized by generalized hypotonia, neurological, cardiac and respiratory problems and changes in their stomatognathic system. Almost all these patients have an occlusal disharmony, including anterior open bite, anterior and posterior crossbite, anterior proclination and underdevelopment of the maxilla and the midface. Dental anomalies such as hypodontia, peg-shaped teeth and enamel hypocalcification are also found. The dentomaxillofacial features have clinical implications in speech, nutrition, posture, ventilation and aesthetics, with enormous consequences in growth, development and social integration. CONCLUSIONS When planning the dental treatment of patients with Down syndrome, dental practitioners should always consider their general health, in order to achieve a holistic and interdisciplinary approach.
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Affiliation(s)
- V Macho
- Faculdade de Medicina Dentária da Universidade do Porto - Rua Dr. Manuel Pereira da Silva, 4200-393 Porto, Portugal; Tel: +351 220 901 100, e-mail:
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Pena D, Andrade D, Nunez F, Santos H, Orjuela H, Caicedo V. CABG in high risk patients: does the type of cardioplegia affect outcomes? J Cardiothorac Surg 2013. [PMCID: PMC3844876 DOI: 10.1186/1749-8090-8-s1-o195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Rimachi LF, Andrade D, Verástegui M, Mori J, Soto V, Estrada J. R. Variabilidad genética y distribución geográfica del maní, Arachis hypogaeaL. en la Región Ucayali, Perú. Rev peru biol 2013. [DOI: 10.15381/rpb.v19i3.1000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Weiß S, Lebuhn M, Andrade D, Zankel A, Cardinale M, Birner-Gruenberger R, Somitsch W, Ueberbacher BJ, Guebitz GM. Activated zeolite--suitable carriers for microorganisms in anaerobic digestion processes? Appl Microbiol Biotechnol 2013; 97:3225-38. [PMID: 23435898 DOI: 10.1007/s00253-013-4691-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 01/02/2013] [Accepted: 01/03/2013] [Indexed: 10/27/2022]
Abstract
Plant cell wall structures represent a barrier in the biodegradation process to produce biogas for combustion and energy production. Consequently, approaches concerning a more efficient de-polymerisation of cellulose and hemicellulose to monomeric sugars are required. Here, we show that natural activated zeolites (i.e. trace metal activated zeolites) represent eminently suitable mineral microhabitats and potential carriers for immobilisation of microorganisms responsible for anaerobic hydrolysis of biopolymers stabilising related bacterial and methanogenic communities. A strategy for comprehensive analysis of immobilised anaerobic populations was developed that includes the visualisation of biofilm formation via scanning electron microscopy and confocal laser scanning microscopy, community and fingerprint analysis as well as enzyme activity and identification analyses. Using SDS polyacrylamide gel electrophoresis, hydrolytical active protein bands were traced by congo red staining. Liquid chromatography/mass spectroscopy revealed cellulolytical endo- and exoglucanase (exocellobiohydrolase) as well as hemicellulolytical xylanase/mannase after proteolytic digestion. Relations to hydrolytic/fermentative zeolite colonisers were obtained by using single-strand conformation polymorphism analysis (SSCP) based on amplification of bacterial and archaeal 16S rRNA fragments. Thereby, dominant colonisers were affiliated to the genera Clostridium, Pseudomonas and Methanoculleus. The specific immobilisation on natural zeolites with functional microbes already colonising naturally during the fermentation offers a strategy to systematically supply the biogas formation process responsive to population dynamics and process requirements.
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Affiliation(s)
- S Weiß
- Institute of Environmental Biotechnology, Graz University of Technology, Petersgasse 12, 8010, Graz, Austria
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Garcia L, Andrade D, Salvador E, Ribeiro E, Costa E, Florindo A. Association of perceived environment with changes on walking in adults of low socioeconomic level: Preliminary results of ‘Ambiente Ativo’ Project. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Cruz C, Rocha M, Andrade D, Guimarães F, Silva V, Souza S, Moura C, Moura C. Hypertrophic pulmonary osteoarthropathy with positive antinuclear antibodies: case report. Case Rep Oncol 2012; 5:308-12. [PMID: 22740821 PMCID: PMC3383253 DOI: 10.1159/000339571] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A male Afro-descendant patient, 57 years old, complaining of polyarticular involvement and weight loss for 18 months, with a load of 13.5 pack years of smoking. On physical examination there was pain on palpation of the right knee and right leg, with signs of inflammation on the knee. We also observed digital clubbing in all fingers. Antinuclear antibodies (ANA) and anti-Sm antibodies were positive. X-rays of the legs and arm showed cortical thickening of long bones. The computed tomography demonstrated a large mass located in the middle lobe of the right lung. The anatomopathological study revealed a bronchial adenocarcinoma. The history of polyarticular involvement associated with positive anti-Sm and ANA antibodies could lead to an erroneous diagnosis of systemic lupus erythematosus. Considering the bad consequences of delayed diagnosis in this patient, the medical team should be alerted for suspecting and look for a lung cancer under these circumstances.
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Affiliation(s)
- C. Cruz
- Hospital Santo Antonio, Obras Sociais Irmã Dulce, Salvador, Brazil
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Andrade D, Seguro L, Ribeiro A, Moraes J, Saad C, Aikawa N, Calich A, Viana V, Pasoto S, Levy-Neto M, Laurindo I, Timenestsky M, Precioso A, Bonfa E, Sampaio-Barros P, Wang JC, Assassi S, Guo G, Tu WZ, Tan FK, Mayes MD, Reveille JD, Wu WY, Zou HJ, Zhao YQ, Chu HY, Liu J, Zhou XD, Dieude P, Bouaziz M, Riemekasten G, Airo P, Muller M, Cusi D, Chiocchia G, Boileau C, Allanore Y, Carmona F, Gutala R, Simeon CP, Carreira P, Ortego Centeno N, Vicente Rabaneda E, Garcia Hernandez FJ, Garcia De La Pena P, Fernandez Castro M, Martinez Estupinan L, Egurbide MV, Tsao BP, Gourh P, Agarwal SK, Assassi S, Mayes MD, Arnett FC, Tan FK, Martin J. S.12.1 Is H1N1 influenza vaccine safe and effective in patients with SSc? Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/ker486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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32
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Striano P, Belcastro V, Striano S, Irani SR, Schott JM, Vincent A, Smith SJM, Andrade D, Tai P, Dalmau J, Wennberg R. Tonic seizures: A diagnostic clue of anti-LGI1 encephalitis? Neurology 2011; 77:2140; author reply 2141-3. [DOI: 10.1212/wnl.0b013e318239c3d7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Tai P, Poochikian-Sarkissian S, Andrade D, Valiante T, del Campo M, Wennberg R. Postictal wandering is common after temporal lobe seizures. Neurology 2010; 74:932-3. [PMID: 20231671 DOI: 10.1212/wnl.0b013e3181d561b4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- P Tai
- Division of Neurology, Krembil Neuroscience Centre, University of Toronto, Toronto Western Hospital, Toronto, Canada
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Pan Z, Andrade D, Segal M, Wimberley J, McKinney N, Takle E. Uncertainty in future soil carbon trends at a central U.S. site under an ensemble of GCM scenario climates. Ecol Modell 2010. [DOI: 10.1016/j.ecolmodel.2009.11.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rosa e Silva JC, Andrade D, Becker AP, dos Reis FJC, Neto OBP, Nogueira AA. Isolated osseous ovarian metaplasia: case report. EUR J GYNAECOL ONCOL 2010; 31:469-470. [PMID: 20882899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Some ovarian metaplasias may contain bone or osteoid tissue. The most common tumors presenting these alterations are teratomas and mixed mesodermal tumors with heterologous elements. CASE REPORT We report the case of a woman who, during gynecologic follow-up for chronic anovulation at the age of 31 years, presented a solid ovarian ultrasonographic image with calcifications. After laparoscopy and histological examination it was found to be an isolated ovarian osseous metaplasia. CONCLUSION A rarely occurring condition, ovarian osseous metaplasia continues to be of uncertain clinical significance.
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Affiliation(s)
- J C Rosa e Silva
- Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirdo Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
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Ghislain M, Andrade D, Rodríguez F, Hijmans RJ, Spooner DM. Genetic analysis of the cultivated potato Solanum tuberosum L. Phureja Group using RAPDs and nuclear SSRs. Theor Appl Genet 2006; 113:1515-27. [PMID: 16972060 DOI: 10.1007/s00122-006-0399-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 08/17/2006] [Indexed: 05/11/2023]
Abstract
The Solanum tuberosum L. Phureja Group consists of potato landraces widely grown in the Andes from western Venezuela to central Bolivia, and forms an important breeding stock due to their excellent culinary properties and other traits for developing modern varieties. They have been distinguished by short-day adaptation, diploid ploidy (2n = 2x = 24), and lack of tuber dormancy. This nuclear simple sequence repeat (nSSR or microsatellite) study complements a prior random amplified polymorphic DNA (RAPD) study to explore the use of these markers to form a core collection of cultivar groups of potatoes. Like this prior RAPD study, we analyzed 128 accessions of the Phureja Group using nuclear microsatellites (nSSR). Twenty-six of the 128 accessions were invariant for 22 nSSR markers assayed. The nSSR data uncovered 25 unexpected triploid and tetraploid accessions. Chromosome counts of the 102 accessions confirmed these nSSR results and highlighted seven more triploids or tetraploids. Thus, these nSSR markers (except 1) are good indicators of ploidy for diploid potatoes in 92% of the cases. The nSSR and RAPD results: (1) were highly discordant for the remaining 70 accessions that were diploid and variable in nSSR, (2) show the utility of nSSRs to effectively uncover many ploidy variants in cultivated potato, (3) support the use of a cultivar-group (rather than a species) classification of cultivated potato, (4) fail to support a relationship between genetic distance and geographic distance, (5) question the use of any single type of molecular marker to construct core collections.
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Affiliation(s)
- M Ghislain
- International Potato Center, PO Box 1558, Lima, 12, Peru.
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Solórzano J, Acosta D, Morales H, Vásquez F, Mora G, Chávez M, Andrade D, Joutteaux R, Sánchez I, García D, Valenzuela E. [Gastric volvulus]. Cir Pediatr 2006; 19:247-9. [PMID: 17352117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Gastric volvulus is a rare condition in pediatric population in which there is an abnormal rotation of one part of the stomach around itself. It's a surgical emergency. We report a six year old female admitted in the emergency due to upper abdominal distention, nausea without vomiting, physical exam revealed upper abdominal distention and abdominal tenderness, no bowel sounds. Laparotomy was performed and a gastric volvulus with occlusive vascular involvement was found. In the post operative period she required a second laparotomy due to adhesions in small bowel.
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Affiliation(s)
- J Solórzano
- Cirugía Pediatrica, Hospital Pediátrico Dr. Roberto Gilbert E. Guayaquil-Ecuador
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Primo P, Monteiro R, Vasques L, Figueiredo I, Andrade D, Azevedo I, Calhau C. Urinary 8‐hydroxydeoxy‐2′‐guanosine evaluation in a paediatric Portuguese population with Down Syndrome. FASEB J 2006. [DOI: 10.1096/fasebj.20.5.a1458-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - I. Figueiredo
- Clinical Chemistry Dept.S. João HospitalAlameda Prof. Hernani MonteiroPorto4200‐319Portugal
| | - D. Andrade
- Fac. of Dental Med.University of PortoAlameda Prof. Hernani MonteiroPorto4200‐319Portugal
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Abstract
SUMMARYReptiles, particularly snakes, exhibit large and quantitatively similar increments in metabolic rate during muscular exercise and following a meal, when they are apparently inactive. The cardiovascular responses are similar during these two states, but the underlying autonomic control of the heart remains unknown. We describe both adrenergic and cholinergic tonus on the heart during rest, during enforced activity and during digestion (24–36 h after ingestion of 30 % of their body mass) in the snake Boa constrictor. The snakes were equipped with an arterial catheter for measurements of blood pressure and heart rate, and autonomic tonus was determined following infusion of the β-adrenergic antagonist propranolol (3 mg kg–1) and the muscarinic cholinoceptor antagonist atropine (3 mg kg–1).The mean heart rate of fasting animals at rest was 26.4±1.4 min–1, and this increased to 36.1±1.4 min–1 (means ± s.e.m.; N=8) following double autonomic block (atropine and propranolol). The calculated cholinergic and adrenergic tones were 60.1±9.3 % and 19.8±2.2 %, respectively. Heart rate increased to 61.4±1.5 min–1 during enforced activity, and this response was significantly reduced by propranolol (maximum values of 35.8±1.6 min–1), but unaffected by atropine. The cholinergic and adrenergic tones were 2.6±2.2 and 41.3±1.9 % during activity, respectively. Double autonomic block virtually abolished tachycardia associated with enforced activity (heart rate increased significantly from 36.1±1.4 to 37.6±1.3 min–1), indicating that non-adrenergic, non-cholinergic effectors are not involved in regulating heart rate during activity. Blood pressure also increased during activity.Digestion was accompanied by an increase in heart rate from 25.6±1.3 to 47.7±2.2 min–1 (N=8). In these animals, heart rate decreased to 44.2±2.7 min–1 following propranolol infusion and increased to 53.9±1.8 min–1 after infusion of atropine, resulting in small cholinergic and adrenergic tones (6.0±3.5 and 11.1±1.1 %, respectively). The heart rate of digesting snakes was 47.0±1.0 min–1 after double autonomic blockade, which is significantly higher than the value of 36.1±1.4 min–1 in double-blocked fasting animals at rest. Therefore, it appears that some other factor exerts a positive chronotropic effect during digestion, and we propose that this factor may be a circulating regulatory peptide, possibly liberated from the gastrointestinal system in response to the presence of food.
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Affiliation(s)
- T Wang
- Department of Zoology, UNESP Rio Claro, Brazil.
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Fernandes A, Mourato AP, Xavier MJ, Andrade D, Fernandes C, Palha M. Characterisation of the somatic evolution of Portuguese children with Trisomy 21--preliminary results. Downs Syndr Res Pract 2001; 6:134-8. [PMID: 11501217 DOI: 10.3104/reports.106] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We present preliminary results of a cross-sectional study which had the following objectives: 1--to develop percentile curves of weight, height and head circumference of Portuguese children with Trisomy 21 from 0 to 48 months of age; 2--a comparison of the growth of children with Trisomy 21 with a control population of their siblings, and 3--a comparison between the growth of Portuguese and American children with Trisomy 21 (based on the data of Cronk et al). We conclude that: 1--there is growth delay (weight, height, head circumference) in the Portuguese children with Trisomy 21, in all of the parameters evaluated and in all age groups; 2--Portuguese children with Trisomy 21 present values similar to those obtained by Cronk et al until 24 months of age; 3--from the age of 30 months onward Portuguese children with Trisomy 21 were heavier and taller than American children with Trisomy 21. This supports the usefulness of percentile curves specifically for Portuguese children with Trisomy 21.
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Affiliation(s)
- A Fernandes
- Child Development Centre, Paediatric Department of Hospital de Santa Maria, Lisbon.
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Matsudo V, Matsudo S, Andrade D, Andrade E, Araujo T, Figueira A, Oliveira L. PROGRAM OF PHYSICAL ACTIVITY PROMOTION IN A MEGA-COMMUNITY IN BRAZIL. Med Sci Sports Exerc 1998. [DOI: 10.1097/00005768-199805001-01150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Holland GR, Andrade D, Smith KG, Lahl S, Robinson PP, Pehowich E. A quantitative morphological comparison of cat lingual nerve repair using epineurial sutures or entubulation. J Dent Res 1996; 75:942-8. [PMID: 8675806 DOI: 10.1177/00220345960750031201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Since lingual nerves may be transected during a variety of oral surgical procedures, including third molar removal, we have investigated two possible methods of repair. Quantitative morphological observations were made on feline chorda tympani and lingual nerves proximal and distal to transection injuries repaired either by epineurial suturing or by insertion of the cut ends into a perforated silicon tube. Proximal to the repair, the most prominent difference was an increase in the number of myelinated axons in the lingual nerve following epineurial suturing but not entubulation. Proximal to the repair site, the number of nonmyelinated axons increased in comparison with controls in both chorda tympani and lingual nerves after both procedures, though the difference was statistically significant only in the lingual nerve proximal to entubulation. Distal to the injury, both types of repair showed a reduction in the number, size, and sheath thickness of myelinated axons in comparison with unoperated controls, but the difference in numbers was statistically signIficant only distal to repair by entubulation. The number of non-myelinated axons distal to the repair sites was much higher than that in controls, the difference being greater distal to entubulation repair. There were more axons per Remak bundle distal to entubulation repair than to epineurial suturing, suggesting, perhaps, that fewer axons would ultimately become myelinated. Though the morphological differences between the two repair techniques are not as striking as the parallel electrophysiological differences reported previously (Smith and Robinson, 1995a,b), they are consistent with them and support the conclusion that, for transected lingual and chorda tympani nerves, epineurial suturing is the preferred approach.
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Affiliation(s)
- G R Holland
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, Ann Arbor, Michigan 48109-1078, USA
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Abstract
Nine ovarian Sertoli-Leydig tumors, showing varying degrees of differentiation, one pure ovarian Sertoli cell tumor, and one poorly differentiated stromal tumor of the testis, were examined for the presence of testosterone, estradiol and progesterone with an indirect immunoperoxidase method on formalin fixed paraffin embedded tissue. Clinically all nine patients with Sertoli-Leydig tumors had evidence of increased androgen production, manifested by either hirsutism or virilization; elevated serum testosterone was found in all four patients in whom it was measured. The patients with the pure ovarian Sertoli cell and testicular tumors were asymptomatic except for the presence of a mass. Testosterone was identified in Leydig cells in nine instances, in Sertoli cells in six, and in poorly differentiated spindle cells resembling the mesenchyme of the embryonic gonad in two. Cells with vacuolated cytoplasm, both Sertoli and Leydig cells, though positive for lipid were consistently negative for testosterone. Estradiol was present in Leydig cells in nine instances, in Sertoli cells in five, and in primitive gonadal stomal cells in two. The pattern of distribution was similar to that of testosterone but the intensity of the reaction for estradiol was generally less than that for testosterone. Progesterone was identified in Sertoli cells in one instance and was weakly positive in Leydig cells in three instances. The presence of testosterone and estradiol in both Sertoli and Leydig cells as well as in primitive spindle cells resembling those found in the embryonic gonad suggests that the latter cell is the precursor for both Sertoli and Leydig cells.
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Magalhães LA, Camargo LA, Muniz JR, Andrade D. [New focus of Schistosomiasis mansoni in the town of Campinas (State of São Paulo,) Brazil]. Rev Inst Med Trop Sao Paulo 1967; 9:378-80. [PMID: 5605314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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