Publications

BACKGROUND: Cervical cancer (CC) is a public health issue and one of the leading causes of morbidity and mortality among women. In Brazil, despite prevention and screening strategies, many cases are still diagnosed at advanced stages. This study aimed to analyse factors associated with advanced CC diagnosis in the state of Mato Grosso between 2002 and 2021.

METHOD: This is a retrospective study based on data from the Hospital Cancer Registry. A total of 1,126 women diagnosed with invasive CC (ICD-10: C53) were included. Sociodemographic, clinical and treatment access variables were analysed. Multinomial logistic regression was used to assess associations between variables and the stage at diagnosis.

RESULTS: The results showed that 58.3% of women were diagnosed at advanced stages (III and IV). Most patients were between 35 and 59 years old, had incomplete primary education and were non-white. Squamous cell carcinoma was the predominant histological type (71.8%). Women with adenocarcinoma had a lower chance of being diagnosed at an advanced stage, while the probability of a localised diagnosis decreased with age.

CONCLUSION: The high number of late CC diagnoses suggests barriers to access to screening and early treatment in Mato Grosso. Expanding screening coverage, strengthening human papillomavirus vaccination and improving oncology services are essential to reduce the incidence and mortality of the disease in the state.

TRIAL REGISTRATION: Identification/approval number by the Committee of Ethics in Research with Human Beings in the Health Area - CEP of the Federal University of Mato Grosso - UFMT, opinion number: 4.858.521.

Cancer burden is expected to increase in the next decades, especially in low- and middle-income countries (LMICs). There, including in Portuguese-speaking African countries, cancer care remains fragile and highly centralised. Global ONCOlogy Initiative (GONCO) is a pragmatic initiative launched in Portugal to support the development of decentralised oncology services through short, targeted interventions. This paper presents its conceptual design and the first two pilot projects, implemented in Lubango (Angola) and Mindelo (Cape Verde). GONCO follows a three-step model: digital planning, fieldwork and digital follow-up. In both sites, the program was co-developed with local teams and focused on establishing multidisciplinary tumour boards, improving service coordination and building capacity in clinical management, protocols and research. In Lubango, GONCO helped launch the oncology unit and research group. In Mindelo, it supported service restructure planning and the creation of a breast cancer working group. Remote collaboration sustained momentum after field visits. Challenges included hierarchical barriers, unreliable digital infrastructure and non-sustainable funding. Despite these, GONCO demonstrated that focused and adaptable models can catalyse oncology development in resource-constrained hospitals. GONCO provides a replicable, light-footprint model for early oncology development in LMICs.

Genitourinary-Rhabdomyosarcomas (GU-RMS) are challenging to treat due to the probable lifelong sequelae of local therapy. Western-world data show 3-year event-free survival (EFS) and overall survival (OS) of 77% and 86%, respectively, for localised disease, with dismal outcomes for metastatic disease. We studied the clinical profile, outcomes and prognostic factors of GU-RMS treated with a multimodal protocol. Treatment-naïve children ≤ 15years with biopsy-proven GU-RMS treated from January 2013 to June 2022 were retrospectively analysed. Local therapy performed at 10-12 weeks of induction was radiotherapy (RT) and/or surgery. Fifty-two patients with a median tumour size of 5.5 cm (range, 3.4-9.2 cm) were analysed. Four patients (7.8%) had alveolar histology. The bladder was the commonest site of primary (36.5%). Group distribution: I-7 (13.4), II-1 (1.9%), III-35 (67.3%) and IV-9 (17.3%). Local therapy was surgery in 11 (21.5%), RT in 25 (49%) or both in 14 (26.9%) patients. With a median follow-up of 56 months (95% confidence interval (CI): 49.1%-63.1%), 4-year EFS for groups I-IV, were 100%, 50% (95% CI: 41%-59%) and 33.3% (95% CI: 2.6%-64%) (p = 0.01), respectively. The corresponding 4-year OS were 100%, 72% (95% CI: 56.4%-87.6%) and 33.3% (95% CI: 2.6%-64%) (p = 0.007), respectively. Relapses were locoregional-4 (7.7%), metastatic-5 (9.6%) and combined-4 (7.7%). Tumour size > 6.45 cm significantly affected outcomes in the localised cohort (hazard ratio = 4.1, 95% CI: 1.38-12.1, p = 0.01). Outcomes of group III GU-RMS in children treated on a multimodal protocol in our study are suboptimal compared to those from co-operative group trials, probably affected by large tumours at presentation, warranting alternative strategies for optimisation of survival.

BACKGROUND: Colorectal cancer (CRC) is a major global health issue, ranking fourth in incidence and third in cancer-related deaths. In 2022, it was most prevalent in Asia, Europe and North America. Although rates in Latin America, including Mexico, are lower, they still represent a substantial public health concern. However, CRC data in Mexico are limited and outdated.

AIM: This study aimed to assess the incidence trends of CRC in a secondary-level hospital in Mexico from 2011 to 2023.

METHODS: A retrospective analysis was conducted on 819 individuals with CRC at Regional General Hospital 251 (Mexican Social Security Institute) in Metepec, Mexico. Incidence rates were calculated per 100,000 inhabitants and stratified by sex, age group, tumour site and body mass index. Trend analysis was performed using Joinpoint regression models to estimate annual percent change (APC).

RESULTS: CRC incidence showed a significant upward trend (APC = 8.81%; p = 0.01) from 2011 to 2023. A one-joinpoint model revealed an increase from 2011 to 2021 (APC = 17.90%; < 0.01), followed by a sharp decrease from 2021 to 2023 (APC = -41.34%; p = 0.03). Males had slightly higher incidence rates than females; the ≥50 age group showed the highest burden. Over half of the individuals were diagnosed at advanced stages (III-IV), with similar trends observed across the sexes.

CONCLUSION: CRC incidence increased significantly over the last decade, with a recent drop likely influenced by the COVID-19 pandemic. Despite some limitations, this is the first study of CRC trends at a secondary-level hospital in Mexico that underscores the need for enhanced screening and timely diagnosis strategies.

PURPOSE: Biomarkers for tailoring treatment in neoadjuvant triple-negative breast cancer (TNBC) are needed. We hypothesize that neutrophil-to-lymphocyte ratio (NLR) before neoadjuvant chemotherapy (NACT) can predict long-term outcomes in this population.

METHODS: We reviewed our institutional database to identify patients with clinical stages II-III TNBC who underwent NACT from 2012 to 2024 and retrospectively collected data from medical records. We calculated event-free survival (EFS) from the date of NACT initiation until death, disease recurrence or disease progression that precluded surgery; we calculated overall survival (OS) from the date of NACT initiation until death. Survival estimates were analysed using Kaplan-Meier method and compared with log rank test. The Cox regression model was used to calculate hazard ratios.

RESULTS: A total of 692 patients were included in the analysis. Of these, 63.3% had stage III disease, 60.8% had grade 3 tumours and 77.2% had a Ki-67 >50%. The most common NACT regimen used was anthracycline and taxane-based (96.8%). The overall pathological complete response (pCR) rate was 27.7%. After median follow-up of 59.6 months, NLR >2 was associated with poorer EFS (HR 1.71, 95% CI 1.33-2.18, p < 0.001) and OS (HR 1.76, 95% CI 1.34-2.31, p < 0.001). The results maintained statistical significance after adjusting for age, ki67, clinical stage and pCR status (p = 0.002).

CONCLUSION: NLR predicts long-term survival after NACT in TNBC and, as a readily and inexpensive information, should be further studied in current approaches of chemoimmunotherapy.

The 'Pancreatic Cancer' conference, held on 8 November 2024, at the San Giovanni di Dio e Ruggi d'Aragona University Hospital in Salerno, Italy, brought together leading experts in pancreatic surgery and oncology. The event aimed to provide a comprehensive overview of recent developments in the multidisciplinary treatment of pancreatic adenocarcinoma, with particular focus on advanced surgical strategies. Topics included neoadjuvant chemotherapy, surgical planning and techniques (open, laparoscopic, robotic), complex resections and management of postoperative complications. The conference was accredited by the National Continuing Medical Education Program and integrated into the regional 'Campania Pancreas' initiative. Featuring national and international speakers, including a keynote lecture by Prof. C.R. Ferrone from Cedars-Sinai Medical Centre, the meeting served as a platform for knowledge exchange and innovation in pancreatic cancer care.

PURPOSE: Evaluating cancer patients' social media use is crucial for understanding their preferences, needs and health behaviours. This study examined social media use in health management and analysed influencing factors using the Health Belief Model (HBM).

METHODS: A descriptive-analytic study was conducted in 2024 at hospitals affiliated with Urmia University of Medical Sciences. A total of 204 cancer patients who actively used social media participated. Data were collected using a structured and validated questionnaire. Descriptive statistics and regression analyses (SPSS v16) were applied to examine HBM constructs and their predictors.

RESULTS: The mean age of participants was 54 years; 54% were male and 46% female. Overall, 38% used social media for healthcare purposes. Perceptions across the HBM constructs were moderate to high. Cues to action had the highest mean score at 3.19 standard deviation (SD = 0.546), followed by perceived benefits (M = 3.13, SD = 0.429) and self-efficacy (M = 3.11, SD = 0.677). Age significantly negatively predicted self-efficacy (B = -0.223, β = -0.474, p < 0.001), perceived benefits (B = -0.144, β = -0.485, p < 0.001) and cues to action (B = -0.112, β = -0.296, p = 0.001).

CONCLUSION: The findings highlight the multifaceted role of social networks in cancer patient healthcare. Moderate HBM scores indicate the need for tailored digital interventions to strengthen perceived benefits, self-efficacy and responsiveness to cues to action, ultimately fostering patient-centred care and informed health decisions.

OBJECTIVE: This case report describes the capability of a smartphone-based electrocardiogram (ECG) in detecting multivessel coronary artery disease (CAD), with initial findings suggestive of double-vessel involvement, which was later confirmed as triple-vessel disease (TVD) by coronary angiography.

CASE REPORT: In this case report, we describe a 51-year-old woman with a known medical history of CAD, hypertension, TVD, and a prior episode of acute coronary syndrome who presented to Swami Rama Himalayan University, Dehradun, with complaints of chest pain. She had previously undergone percutaneous coronary intervention with stent placement. Conventional 12-lead ECG (Philips PageWriter ECG) indicated myocardial ischemia. Follow-up smartphone-based ECG (Spandan Pro) revealed inferolateral ischemia possibly affecting the left anterior descending artery (LAD) and left circumflex artery (LCX), with a possible diagnosis of double-vessel disease (DVD). Coronary angiography later confirmed the diagnosis of TVD with significant stenosis of the LAD, LCX, and right coronary artery, along with additional involvement of the left main coronary artery. Post-angiography, the patient was recommended for coronary artery bypass grafting as the first option and percutaneous transluminal coronary angioplasty as an alternative.

CONCLUSION: This case illustrates the clinical efficacy of the smartphone-based ECG device in detecting inferolateral ischemia suggestive of DVD in patients with suspected or known CAD and highlights its diagnostic concordance with standard investigations, particularly coronary angiography.

OBJECTIVE: The current study aims to describe the infection and infestation adverse events that may be associated with the use of ocrelizumab using real-world data.

METHODS: Infection and infestation adverse event reports with the generic name ocrelizumab as the primary suspect in the FAERS database from Q4 2003 to Q3 2024 were included in the study. The disproportionality analysis software package OpenVigil 2.1-MedDRA-v24, including the Reporting Odds Ratio (ROR) and Proportional Reporting Ratio (PRR) algorithms, was used to determine signal strength of infection and infestation adverse events associated with ocrelizumab. The signal intensity for ROR and PRR was classified as low, medium and strong according to signal strength.

RESULTS: The analysis of infection and infestation reports of the drug pharmacovigilance database on the use of ocrelizumab revealed 161 positive signals. The most common adverse event reported was COVID-19 (n=2287, ROR 24.303; PRR 22.681). According to the disproportionality analysis, the top six adverse events with the highest ROR and PRR were encephalitis enteroviral (ROR 101.831; PRR 101.809), meningitis enteroviral (ROR 76.019; PRR 76.005), fallopian tube abscess (ROR 51.225; PRR 51.221), nasal herpes (ROR 45.676; PRR 45.662), neuroborreliosis (ROR 28.563; PRR 28.559) and babesiosis (ROR 25.507; PRR 25.5).

CONCLUSION: Ocrelizumab may increase the risk of many infections and infestations, including enterovirus-related central nervous system infections, tick-borne infections, COVID-19-related disorders, genital tract infections and herpes infections, and therefore requires careful monitoring in clinical practice.

Glossopharyngeal neuralgia (GN) is a rare neuropathic disorder characterized by sudden, unilateral, electric shock-like pain in the areas innervated by the glossopharyngeal nerve. Its diagnosis is frequently delayed because of its clinical overlap with odontogenic and otorhinolaryngological conditions. In the context of the COVID-19 pandemic, different cranial neuropathies have been reported, suggesting possible post-infectious mechanisms. We describe the case of a 54-year-old male dentist, without relevant medical history, who developed recurrent episodes of intense pain in the right pharynx and base of tongue after confirmed SARS-CoV-2 infection. Symptoms were triggered by swallowing, coughing, and salivary stimulation, reaching maximum intensity on the visual analogue scale (EVA 10/10). Brain and neck magnetic resonance imaging revealed no structural abnormalities. Treatment with carbamazepine (600 mg/day) partially reduced frequency and severity of attacks, while pregabalin (300 mg/day) showed no benefit. This case highlights the need to consider SARS-CoV-2 infection as a potential trigger of GN, underscores the importance of recent infectious history in the differential diagnosis, and emphasizes the relevance of early pharmacological management in clinical improvement.