Real-world evaluation of molecular testing and treatment patterns for EGFR mutations in non-small cell lung cancer in Latin America

Lung cancer is a leading cause of cancer-related deaths in Latin America, with non-small cell lung cancer (NSCLC) being the most prevalent. The current study aimed to report real-world data on epidermal growth factor receptor (EGFR) mutational testing and treatment regimens at diagnosis and progression in patients with metastatic NSCLC across four Latin American countries (Argentina, Chile, Colombia and Uruguay). A retrospective, multicenter, observational study was conducted in patients with NSCLC using medical records from participating countries. The study population was categorized into two cohorts: Cohort 1 comprised of newly diagnosed, treatment-naïve patients with stage IV NSCLC; and cohort 2 comprised of stage IV NSCLC EGFR mutation (EGFRm)-positive patients who had progressed after first- or second-generation EGFR-tyrosine kinase inhibitor (TKI) treatment. Measures included demographic variables, health characteristics, treatment regimen, molecular testing rate and turnaround time at diagnosis and at progression for cohorts 1 and 2, respectively. Descriptive statistics were used to summarize all study measures. Of the 462 patients enrolled, 431 were newly diagnosed or treatment naïve with metastatic NSCLC. In cohort 1, the majority of patients with private health insurance (57.31%) underwent molecular diagnosis while only 41.3% of patients within the public sector had access to testing. The average molecular testing rate in cohort 1 varied across countries, with Argentina having the highest testing rate (79%) and Uruguay the lowest (27.63%). EGFRm was observed in 22% of patients. Cohort 2 comprised 31 patients who had progressed after first- or second-generation EGFR-TKI treatment and of these, only 22 (70.97%) underwent testing after progression. Access to molecular testing is still a challenge impacting the choice of first-line treatment in Latin American patients with NSCLC. These findings underline the unmet needs of ensuring early diagnosis, molecular profiling and use of correct treatment to alleviate NSCLC burden in the region.

Psychiatric reports requested by the courts in six countries

Consecutive series of individuals for whom psychiatric reports were requested by the courts in the context of criminal proceedings were studied in six countries: Brazil, Denmark, Egypt, Swaziland, Switzerland, Thailand. A total sample of 96 cases was obtained. Careful study of the court records and psychiatric reports revealed three types of situation which could trigger a request for such a report; an ‘offence-oriented’ response where the offence itself is seen as indicative of mental morbidity, a ‘patient-oriented’ response in which the patient's previous contact with the mental health system serves as trigger and a ‘behaviour-oriented’ response in which the patient's disturbed behaviour in detention or in court arouses concern. The majority of the individuals were first offenders (60 per cent), while a similar proportion had had previous psychiatric treatment.

[Kidney involvement in "mixed connective tissue disease" (Sharp syndrome)]

The case in question of the Sharp-syndrome is a mixed collagenosis with symptoms of sclerodermia, Erythematodes visceralis, dermatomyositis and rheumatoid arthritis. Apart from the clinical symptomatology the immunological profile is decisive for the ascertainment of the diagnosis. With the help of 3 descriptions of cases is referred to a frequent participation of the kidneys, particularly histologically and immune-histologically. In contrast to the hitherto existing publications also in missing pathological findings of the urine a renal biopsy should be aspired to, since important therapeutic and prognostic considerations are dependent on this.

Social control of deviants in six countries

Descriptive information on the social control network for deviants in 6 countries with diverse social, economic and cultural backgrounds has been collected and compared. In each country it was possible to identify a sequence by which deviant behaviour is controlled and managed, consisting of 5 stages: discovery, official screening, disposal, release and after-care. It was also possible to make a clear distinction between the mental health systems and the criminal justice systems in each country. Differences were apparent in the extent of community involvement in the discovery stage and in the role of the primary level of health services. In some instances, differences were also apparent between rural and urban areas and between the way in which rich and poor people were handled. In all countries community after-care services are insufficient, particularly for offenders released from the prison system.

This report is based on the first phase of a WHO collaborative study. It forms the basis for further work currently in progress which includes: (a) a review of laws to identify situations in which dangerousness is used as a criterion; (b) a study of consecutive cases of patients admitted against their will to mental hospitals and of individuals on whom the courts request psychiatric reports; and (c) a study of the reliability and reasons for dangerousness assessment made by various professional groups and based on a standard set of case histories.