De Enfermedades Research Articles

Comparison of parasitological methods for the identification of soil-transmitted helminths, including Strongyloides stercoralis, in a regional reference laboratory in northwestern Argentina: An observational study

Soil-transmitted helminths (STH) are a significant public health problem in impoverished communities of tropical and subtropical areas. Improved diagnostic methods are crucial for Neglected Tropical Diseases programs, particularly for S. stercoralis, as traditional methods are inadequate. Thus, it is important to identify the most accurate and efficient methods for the diagnosis of STH. We performed a retrospective study analyzing laboratory data at the Instituto de Investigaciones de Enfermedades Tropicales from 2010 to 2019. The study included data from outpatients referred for stool analysis and public health interventions from urban and rural communities in northern Salta province, Argentina. Samples were included in this analysis if processed through sedimentation/concentration, Baermann, Harada-Mori and McMaster's, with a subgroup that also included Agar plate culture method (APC). Sensitivity was calculated against a composite reference standard. Of the 5625 samples collected, 944 qualified for this analysis, with a prevalence of 11.14% for A. lumbricoides, 8.16% for hookworm, 1.38% for T. trichiura, and 6.36% for S. stercoralis. The sedimentation/concentration method was the most sensitive for A. lumbricoides (96%), compared to the McMaster method, with a sensitivity of 62%. Similarly, for hookworms, sedimentation/concentration was more sensitive than McMaster's, Harada-Mori, and Baermann with sensitivities of 87%, 70%, 43%, and 13%, respectively. Most of these infections were of light intensity. For S. stercoralis, Baermann and sedimentation/concentration methods were the most sensitive, with 70% and 62% respectively, while Harada-Mori was the least sensitive. In a subset of 389 samples also analyzed by the APC, Baermann was more sensitive than APC for detecting S. stercoralis, and both methods were superior to Harada-Mori. Parasitological methods, mostly when used combined, offer adequate opportunities for the diagnosis of STH in clinical and public health laboratories. The incorporation of S. stercoralis into the control strategies of the World Health Organization requires rethinking the current diagnostic approach used for surveys. With sedimentation/concentration and Baermann appearing as the most sensitive methods for this species. Further studies, including implementation assessments, should help in identifying the most adequate and feasible all-STH diagnostic approach.

Unveiling Melanoma: A Deep Dive into Disparities at a Latin-American Cancer Institute.

The worldwide incidence of melanoma has increased in the last 40 years. Our aim was to describe the clinic-pathological characteristics and outcomes of three cohorts of patients diagnosed with melanoma in a Latin-American cancer institute during the last 20 years. We evaluated three retrospective patient cohorts diagnosed with melanoma at Instituto Nacional de Enfermedades Neoplasicas (INEN), a public hospital in Lima, Peru, for the years 2005-2006, 2010-2011, and 2017-2018. Survival rate differences were assessed using the Log-rank test. Overall, 584 patients were included (only trunk and extremities); 51% were male, the mean age was 61 (3-97) years, and 48% of patients resided in rural areas. The mean time to diagnosis was 22.6 months, and the mean Breslow thickness was 7.4 mm (T4). Lower extremity was the most common location (72%). A majority of the patients (55%) had metastases at the time of presentation, with 36% in stage III and 19% in stage IV. Cohorts were distributed as 2005-2006 (n=171), 2010-2011 (n=223), and 2017-2018 (n=190). No immunotherapy was used. Cohort C exhibited the most significant increase in stage IV diagnoses (12.3%, 15.7%, 28.4%, respectively; p<0.01). The median overall survival rates at the three-year follow-up demonstrated a decline over the years for stages II (97%, 98%, 57%, respectively; p<0.05) and III (66%, 77%, 37%; p<0.01). There has been a worsening in the incidence of late-stage metastatic melanoma in Peru throughout the years, coupled with a significant decline in overall survival rates. This is underscored by the fact that half of the population lives in regions devoid of oncological access.

Prevalence of Thai patients with advanced Parkinson’s disease and external validation of the 5–2-1 Criteria and the CDEPA Questionnaire: A single-centered, cross-sectional study

BackgroundAdvanced stage of Parkinson’s disease (APD) diagnosis is challenging for general neurologists. The 5–2–1 Criteria and the Cuestionario De Enfermedad de Parkinson Avanzada (CDEPA) have been validated for screening for APD. ObjectiveThis article reports the period-prevalence of APD defined by a movement disorder expert, the 5–2–1 Criteria, and CDEPA and to improve the screening performance of the 5–2–1 Criteria MethodsA cross-sectional retrospective study at the Parkinson’s disease (PD) clinic of a tertiary hospital in Bangkok, Thailand amongst all PD patients aged ≥ 18 years was performed from January 2016 to January 2020. We compared the characteristics of APD and non-APD patients. We externally validated the 5–2–1 Criteria and CDEPA. We explored improving the 5–2–1 Criteria. ResultsOf 480 PD patients with complete data, the period-prevalence of APD by the movement disorder expert, the 5–2–1 Criteria and CDEPA were 37.1 %, 48.5 %, and 27.5 %, respectively. Adding requiring help with an activity of daily living and freezing of gait to the original 5–2–1 Criteria enhanced the sensitivity from 86.5 % (95 %CI 80.6, 91.2) to 94.9 % (95 %CI 90.6, 97.7) and negative predictive value (NPV) from 90.3 % (95 %CI 85.9, 93.7) to 96 % (95 %CI 92.6, 98.2). However, the CDEPA had a sensitivity of 62.9 % (95 %CI 55.4, 70) and NPV of 81.0 (95 %CI 76.5, 85). ConclusionThe 5–2–1 Criteria had a good screening tool performance for general neurologists to refer APD patients for optimal treatments. The modified 5–2–1 Criteria had better performance than the original one. External validation is needed.

Clinical and outcome patterns in epithelial ovarian cancer (EOC) within a Latin American cohort.

e23308 Background: Epithelial Ovarian Cancer (EOC) is an heterogenous disease which is usually diagnosed inadvanced stages. Despite the advent of new therapies, the outcomes for this disease remain poor in certain scenarios. We describe the clinical features and survival outcomes in a developing country. Methods: Retrospective study based on case review of women with newly diagnosed EOC between 2015 and 2017 at Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima- Peru. Descriptive analysis was conducted for clinical characteristics, epidemiological factors and treatment. PFS was calculated from the date of diagnosis until the first documented progression and OS from the date of diagnosis to death. Both were calculated using the Kaplan Meier curve. Results: 234 patients were included, the most common histology subtype was high grade serous carcinoma (47,5%), followed by mucinous (15.9%) and clear cell carcinoma (15.4%). Median age was 55.7 yo (range 19-88). Breast and ovarian cancer family history were reported in 3.8% and 3.0%, respectively. 35.8% of patients were overweight, and 12.5% were obese. Most patients (61.5%) were diagnosed at advanced disease (III-IV) and the most common site of metastasis was liver (43.6%) and lung/pleural (28.2%). BCRA testing was performed only in 6% of patients, and 4/14 patients had a pathologic mutation. Ca125 was elevated in 86.2% of patients. Regarding treatment, all patients with early stage disease (I-II) underwent surgical staging. For advanced stage disease, 47.6% (69/145) of patients underwent upfront surgery and 41.4% (60/145) received platinum-based chemotherapy in neoadjuvant setting; 57.3% (35/61) of these patients achieved optimal secondary cytoreduction. With a median follow up of 74,4 months, median PFS was 32.61 months (0.6-474) and global median OS was 58.13 months. Median OS for early disease (I-II) was not reached and for advanced disease (III-IV) was 33.73 months. Survival rate at 5y for all stages was 45.2%; 60.8% and 28.4% for early and advanced disease, respectively. Conclusions: These findings highlight the prevalence of high-grade serous carcinoma and the significance of advanced-stage diagnosis in the survival outcomes. In the era of targeted therapies, the lack of access to BRCA detection tests restricts therapeutic options and, consequently, hinders responses in this group of patients.

Soft tissue sarcomas: Disease burden and health system response in Peru.

e23557 Background: The management of soft tissue sarcomas (STS) presents a challenge in Peru, with a fragmented health system and few centers specialized in sarcoma care. There is no national cancer registry, which does not allow us to have a real view of the most prevalent types. Our aim was to determine the incidence in Instituto Nacional de Enfermedades Neoplásicas (INEN) and to know the real care capacity of cancer centers nationwide. Methods: A retrospective study was carried out in INEN between 2009 and 2015 to know the incidence of STS. Also, a survey was carried out to determine the real capacity of diagnosis and treatment care of cancer centers located in different regions of our country. Results: We were able to determine the anatomopathological diagnosis in 1804 (100%) patients. 52,1% were male (n = 899). Median age was 43 years (15-96). The most frequent sarcoma was undifferentiated pleomorphic sarcoma with 482 patients(27.9%), followed by liposarcoma in 269 (15,6%) and leiomyosarcoma in 159 (9%). The most common primary location was the limbs with 892 patients (51.7%), followed by the abdomen and pelvis with 423 (24.5%), and the least common was the head and neck with 207 patients (12%), followed immediately by the thorax with 205 patients (11.9%). According to the region of origin, 551 (31.9%) patients came from the northern region, 175 (10.1%) from the south, 35 (2%) from the east, 308 (17.8%) from the central region, and 658 (38.1%) from Lima and Callao. We obtained responses from 20 oncology centers of the Ministry of Health along 12 regions operating nationwide. Eight (40%) oncology centers are located in Lima and twelve (60%) in the rest of Peru. 100% (n = 20) of centers have medical oncologists, 70% (n = 14) have surgical oncologists, 65% (n = 13) have traumatologist and pathologist. About capacity of resolution: 100% (n = 20) perform direct biopsy of soft tissue tumors and 60% (n = 12) perform image-guided biopsies; regarding pathology, 95% (n = 19) performed morphological approach and 45% (n = 9) immunohistochemistry studies. 100% (n = 20) can perform ultrasound studies, 95% (n = 19) tomography, and 35% (n = 7) magnetic resonance imaging. 90% (n = 17) accomplish radical surgeries and 60% (n = 12) limb sparing surgeries. 85% (n = 17) enforce chemotherapy treatment. Only 50% (n = 10) have a radiotherapy service. 25% (n = 5) hold multidisciplinary meetings continuously while 40% (n = 8) hold them occasionally for complex cases. Only 8 oncology centers (out of a total of 20) have all the services to care for the complexity of a patient with soft tissue sarcoma, the majority (n = 3) located in Lima. Conclusions: Nearly 1,800 patients have been diagnosed in this reference institution in a period of 5 years, however it represents an underestimation of the real incidence. Cancer centers that can provide complete care for patients with soft tissue sarcomas are scarce, creating a gap in care for this pathology.

#1602 Lupus nephritis multidisciplinary consultation: a new strategy for increasingly complex patients

Abstract Background and Aims Lupus nephritis (LN) is a major course of morbidity and mortality in patients with systemic lupus erythematosus (SLE), best managed by a multidisciplinary group. Recent management advances require greater collaboration between specialists and individualized treatments in severe cases. Method We conducted a retrospective, single-center study of a cohort of incident patients which were diagnosed with LN between 2015 and 2022 and began follow-up in the multidisciplinary rheumatology and nephrology consultation of our institution. Clinical and analytical characteristics at diagnosis and during follow-up were studied. The primary endpoint was complete remission rate at follow-up end, according to GLOSEN (Grupo de Estudio de Enfermedades Glomerulares de la SEN) [1] criteria. Changes in immunosuppression schemes over time were studied. Results 26 patients (92.3% women) were included. Median age at SLE diagnosis was 30.5 years [Interquartile range (IQR) 23.7 – 44.2]. Most patients were Hispanic (14 patients, 53.8%). Median time between SLE and LN diagnosis was 21 months (IQR 0-129 months). In 9 patients (34.6%), SLE and LN onset happened simultaneously. Most common renal manifestation was hematuria, which appeared in 19 patients (73.1%). Median proteinuria was 1.83 g/d (IQR 0.88-2.92) and serum creatinine level, 0.69 (IQR 0.51-1.18). Hypocomplementemia (88.5%) and positivity to anti-DNA (69.2%) were common. Most frequent classes found in renal biopsies were IV (30.8%) and V (23.1%). At LN debut, SLEDAI score, which assesses SLE manifestations, had a median value of 16 (IQR 12-20). Mycophenolate mofetil (96.2%) was the main induction agent. Intravenous steroids were administered in 14 patients (53.8%) and the rest received steroids at a dose of 0.5 mg/kg/day. Addition of another therapy, mainly tacrolimus (6 patients, 23.1%) and belimumab (4 patients, 15.4%), was needed to achieve remission in 12 patients (46.2%). In 8 of them (66.6%), treatments were added within the first 6 months. These 12 patients had less chronicity in the biopsy (median chronicity index: 0 vs. 2; p 0.004) and had higher proteinuria (median 1.41 g/day vs. 0.4 g/day; p 0.001). Likewise, SLEDAI score at 3 months was significantly higher in these 12 patients than in the standard of care group (median SLEDAI score 13 vs. 8; p 0.016). No differences were found in 3 month serum creatinine (p 0.181) or 3 month hematuria (p 0.496) After a median follow-up of 47 months, 15 (57.7%) and 9 patients (34.6%) achieved complete and partial remission, respectively. No differences in percentages of remission were observed between the 2 groups. Steroids were withdrawn in 12 patients (46.2%). Median steroid dose at the end of follow-up was 5 mg (IQR 3-5). Conclusion In our LN cohort, higher SLEDAI and proteinuria indicated the need for an individualized approach. Collaboration between Rheumatology and Nephrology specialists is essential to identify patients with these needs.

Abstract PO1-28-03: Impact of the Oncotype DX® test over time and association with clinicopathological characteristics of Peruvian patients with early breast cancer: Experience in the last 15 years

Abstract Introduction: Gene expression assays provide prognostic and therapy-predictive information that complements management of early breast cancer patients. Oncotype DX® had showed prognostic and prediction of adjuvant chemotherapy benefit. The present study evaluates the impact of Oncotype DX® on therapeutic decision-making for 15 years and explores the association of clinicopathological characteristics with the Recurrence Score (RS) in Peruvian patients with early breast cancer. Material and methods: A retrospective multicenter analysis of 759 breast cancer patients treated in three oncological centers in Lima-Peru (Instituto Nacional de Enfermedades Neoplásicas, Oncosalud and Ricardo Palma) between 2007 and 2022 was conducted. Risk groups were classified according to Oncotype DX® result and menopausal status. For premenopausal women ≤ 50 years: low (RS=0-20), intermediate (RS=21-25) and high-risk (RS=26-100). A descriptive analysis was evaluated to observe the trend and profile of the patients who used the Oncotype test in 5 time periods (2007-2009, 2010-2013, 2014-2016, 2017-2019, 2020-2022). Subsequently, chi-square, t-test, analysis of variance and Poisson linear regression tests were applied to compare clinicopathological features with RS. Finally, univariate and multivariate analyses were performed using Cox logistic regression to identify the probability of association with the high-risk group. Results: 642 patients were included, 78.5% were postmenopausal, and 64.2% had clinical stage (CS) I. Overall, 63.4% had no recommendation for chemotherapy and only 5.6% had recurrence. 74.8% were classified as low-risk according to the Oncotype DX® result. Postmenopausal patients had negative lymph nodes (95.4%), the majority had undergone conservative surgery (71.8%) and had a low rate of breast reconstruction (11.9%). An increase in the use of Oncotype DX® was observed over time, especially in premenopausal patients (from 4.5% in 2007 to 36.9% in 2022). A significant association was found between luminal B subtype (p &amp;lt; 0.0001), histological grade 3 (p &amp;lt; 0.0001) and T3 vs. T1/2 (p=0.025). In univariate analysis, luminal B subtype (vs. luminal A, OR=5.56, 95% CI, 2.80-12.3, p&amp;lt; 0.001), T3 (vs. T1/2, OR=2.84, 95% CI, 0.13-30.0, p=0.006), histological grade 3 (vs. 1/2, OR=13.1, 95% CI, 5.35-39.6, p&amp;lt; 0.001) and histology (other vs. ductal/lobulillar/mucinous, OR=2.94, 95% CI, 0.57-13.5, p=0.003) provided a higher probability of obtaining a high-risk RS result. Similar results were found in multivariate analysis. Conclusion: The use of the Oncotype DX® had a significant impact on therapeutic decision-making in Peruvian patients with early breast cancer, with an increase of use in the last 15 years. A high-risk RS was associated with luminal B subtype, histological grade 3 and T3 tumor size, which could facilitate risk stratification and provide valuable information for the need of adjuvant chemotherapy. Keywords: Early breast cancer, Oncotype DX®, clinicopathological characteristics, Recurrence Score (RS), Peru Oncotype PERU Table Citation Format: Steffi Katheryne Gonzalez Bocanegra, Guillermo valencia Mesías, Yomali Aroa Ferreyra Chombo, Karoll Tatiana Meza Garcia, Mariano Lopez-Pereyra, Jorge Torres Maldonado, Edgar Fermín Yan Quiroz, Zaida Morante Cruz, Jose Cotrina-Concha, Henry Gómez, Gabriela Calderon Valencia, Mauricio León Rivera. Impact of the Oncotype DX® test over time and association with clinicopathological characteristics of Peruvian patients with early breast cancer: Experience in the last 15 years [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-28-03.

Abstract PO5-06-05: DISCORDANCE BETWEEN HORMONE RECEPTORS AND HER2 STATUS IN BREAST CANCER PATIENTS RELAPSE

Abstract Introduction: Breast cancer (BC) is a heterogeneous disease, and during its progression, the tumor phenotype can undergo changes that are often associated with a poor prognosis. In this study, we aim to compare the discordance in estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER-2), and Ki-67 expression between primary and recurrent/metastatic lesions. Methods: This study is a retrospective analysis of 132 non-advanced breast cancer patients who experienced confirmed recurrence/metastasis at the Instituto Nacional de Enfermedades Neoplasicas between 2011 and 2022. Descriptive analysis was conducted to assess the expressions of ER, PgR, HER-2, and Ki-67 in primary and metastatic breast cancer, as well as clinical variables. Normality tests, including Kolmogorov-Smirnov and Shapiro-Wilk, were performed. The paired samples Wilcoxon test was used to determine significant differences between primary and recurrent/metastatic tumors. Additionally, Spearman's rank correlation coefficient was employed to evaluate the relationships of expression discordance. Results: Fifty-nine percent of patients presented locoregional recurrence, while 41% presented visceral metastasis. In the primary tumor, ER and PR expression were found in 63.6% and 55.3% of cases, respectively. HER2 status was determined as 0 (36.3%), +1 (22%), +2 (14.4%), +3 (26.5%), and not determined (0.8%) by IHC. For the recurrent/metastatic tumor, ER and PR expression were found in 59% and 34% of cases, respectively. HER2 status was determined as 0 (27.3%), +1 (19.7%), +2 (25%), +3 (25%), and not determined (3%). The median Ki-67 levels were 37% in the primary tumor and 40% in the recurrent/metastatic tumor. Significant differences were found for ER (p=0.014), PR (p&amp;lt; 0.001), and HER2 (p=0.019), but not for Ki-67 percentage (p=0.139). The discordance rates of ER, PR, HER2, and Ki-67 expression were 27.9%, 47.7%, and 26.3%, respectively. Conclussions: Discordance in hormone receptor expression between primary and recurrent/metastatic tumors is a common phenomenon, with ER showing a discordance rate of 27.9% and PR showing a higher rate of 47.7%. HER2 status also displayed significant discordance, with a 26.3% rate of discordant expression between primary and recurrent/metastatic tumors. The findings from this study emphasize the dynamic nature of breast cancer and the importance of comprehensive evaluation of biomarker expression in both primary and recurrent/metastatic tumors, to choose the best treatment options. Citation Format: Katia Roque, Iris Otoya, Natalia Valdivieso, Zaida Morante, Hugo Fuentes, Silvia Neciosup, Henry Gómez, Jorge Cotito, Gonzalo Ziegler, Estefania Peña, Tatiana Vidaurre, Ramon Andrade de Mello, Carlos Castañeda. DISCORDANCE BETWEEN HORMONE RECEPTORS AND HER2 STATUS IN BREAST CANCER PATIENTS RELAPSE [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-06-05.

Clinical and Epidemiological Characteristics of the 2022 Mpox Outbreak in Spain (CEME-22 Study).

We conducted a multicentric national study (SEIMC-CEME-22), to describe the clinical and epidemiological profile of the mpox outbreak in Spain, including the management of the disease. This was a retrospective national observational study conducted by Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC) and Foundation SEIMC-GESIDA. We included patients with a confirmed mpox diagnosis before 13 July 2022, and attended at the Spanish health network (the early phase of the outbreak). Epidemiological, clinical, and therapeutic data were collected. Of a total of 1472 patients from 52 centers included, 99% of them were cisgender men, mostly middle-aged, and 98.6% were residents in Spain. The main suspected route of transmission was sexual exposure, primarily among MSM. Occupational exposure was reported in 6 patients. Immunosuppression was present in 40% of patients, mainly due to human immunodeficiency virus (HIV). Only 6.5% of patients had been vaccinated against orthopoxvirus. Virus sequencing was performed in 147 patients (all B.1 lineage). Rash was the most frequent symptom (95.7%), followed by fever (48.2%), adenopathies (44.4%) myalgias (20.7%), proctitis (17%), and headache (14.7%). Simultaneously diagnosed sexually transmitted infections included syphilis (n = 129), gonococcal infection (n = 91), HIV (n = 67), chlamydia (n = 56), hepatitis B (n = 14), and hepatitis C (n = 11). No therapy was used in 479 patients (33%). Symptomatic therapies and antibiotics were used in 50% of cases. The most used therapy regimens were systemic corticoids (90 patients), tecovirimat (6 patients), and cidofovir (13 patients). Smallpox immunoglobulins were used in 1 patient. Fifty-eight patients were hospitalized, and 1 patient died. Mpox outbreak in Spain affected primarily middle-aged men who were sexually active and showed a high rate of HIV infection. A range of heterogeneous therapeutics options was performed.

Survival according to the site of metastasis in triple-negative breast cancer patients: The Peruvian experience.

Evidence regarding differences in survival associated with the site of metastasis in triple-negative breast cancer (TNBC) remains limited. Our aim was to analyze the overall survival (OS), distant relapse free survival (DRFS), and survival since the diagnosis of the relapse (MS), according to the side of metastasis. This was a retrospective study of TNBC patients with distant metastases at the Instituto Nacional de Enfermedades Neoplasicas (Lima, Peru) from 2000 to 2014. Prognostic factors were determined by multivariate Cox regression analysis. In total, 309 patients were included. Regarding the type of metastasis, visceral metastasis accounted for 41% and the lung was the most frequent first site of metastasis (33.3%). With a median follow-up of 10.2 years, the 5-year DRFS and OS were 10% and 26%, respectively. N staging (N2-N3 vs. N0, HR = 1.49, 95%CI: 1.04-2.14), metastasis in visceral sites (vs. bone; HR = 1.55, 95%CI: 0.94-2.56), the central nervous system (vs. bone; HR = 1.88, 95% CI: 1.10-3.22), and multiple sites (vs. bone; HR = 2.55, 95%CI:1.53-4.25) were prognostic factors of OS whereas multiple metastasis (HR = 2.30, 95% CI: 1.42-3.72) was a predictor of MS. In terms of DRFS, there were no differences according to metastasis type or solid organ. TNBC patients with multiple metastasis and CNS metastasis have an increased risk of death compared to those with bone metastasis in terms of OS and MS.

A decade of chemotherapy management in hepatocellular carcinoma: A single-center study in Latin America.

524 Background: Hepatocellular carcinoma (HC) is the most common primary tumor of the liver and is a significant health problem worldwide with check-point inhibitors and oral multikinase inhibitors (TKI) as the first-line therapy for advanced diseases. While chemotherapy treatment may not be standardized in current clinical management guidelines, it remains the only available treatment option in numerous Latin American countries. Methods: A retrospective review was carried out, in patients older than 18 years, between January 2011 and December 2020. 127 patients were analyzed and identified, they had received at least one course of chemotherapy at the Instituto Nacional de Enfermedades Neoplásicas in Lima, Perú. Results: The median age was 40 years, 40 female patients (31.5%) and 87 male patients (68.5%). Among the participants, 77 patients (60.62%) were diagnosed with hepatitis B, 2 patients (1.57%) had hepatitis C virus infections, and 48 patients didn´t have viral hepatitis. 72 patients (91.13%) underwent antiretroviral treatment. Non-cirrhotic patients were 118 (92.91%) and 111 (87.4%) had a Child A score. Chemotherapy was administered as first-line treatment to 118 patients (92.91%), with 47.61% receiving 5-FU-based chemotherapy, 11.11% Adriamycin, and 8.7% Gemcitabine-based chemotherapy. A smaller subset, consisting of 8 individuals (6.29%), received sorafenib as their first-line treatment. The overall survival (OS) rates at 12, 36, and 60 months were 74.14%, 20.69%, and 1.72%, respectively. Regarding disease-free survival (DFS) rates at 12, 24, and 48 months were 28.89%, 6.67%, and 2.22%, respectively. Conclusions: In this updated data for advanced hepatocellular carcinoma, we observed a subset of patients with advanced HC achieved favorable outcomes, with a median OS of 20.37 months and a median DFS of 6.6 months. Additional research is necessary to enhance our understanding of the molecular characteristics and resistance pathways of hepatocellular carcinoma in Peru and their correlation with the favorable survival rates observed in response to chemotherapy treatment.

Between Freud and a Naked Woman: Notes on Sabina Berman’s Dora

In January of 2001, theater-goers in Mexico City were treated to a "scene" worthy of Charcot's notorious séances with hysterics at the Salpêtrière in Paris : on the stage, a young woman called "Dora" is lying naked on an operating table, flanked by two characters called Sigmund Freud and Lou Andreas-Salomé, both of them fully dressed. Mere seconds after the latter announces in an aside to the audience that the doctor has decided to perform a "major surgery" and is preparing his symbolical scalpel to "castrate" his patient: "Si la enfermedad de la mujer independiente es un falo imaginario, hay que cortar el falo." The scene, in which Freud struggles with a woman still boldly talking back at him even though she now finds herself exposed in the utmost vulnerability of her naked body, comes toward the end of Feliz nuevo siglo Doktor Freud, itself a dramatic rewriting of the famous case of Freud's Dora by the Mexican playwright, journalist, producer and psychologist by training, Sabina Berman. Directed by Sandra Félix with a superb stage design by Philippe Amand, the play at the time of its opening featured Ricardo Blume in the role of Sigmund Freud, Marina de Tavira as Dora (also Anna Freud as well as Gloria, described in the stage directions as a 1960s-type feminist, dressed in black and with short hair - I will come back later on to this combination of roles in a single actor, which is the exact opposite of the reduplication of actors for one character that happens in the case of Freud), Juan Carlos Beyer as Freud 2 (also Herr K. and Otto Rank), Enrique Singer as Freud 3 (also Herr F., a railway worker, and Carl Gustav Jung), and Lisa Owen as Lou Andreas Salomé (also Frau K., Martha Freud, Frau F., Dora as adult, and Ernest Jones).

Brain Metastasis in Triple‐Negative Breast Cancer

Background. Breast cancer is an important cause of cancer‐related death in women worldwide and represents the second most frequent cause of brain metastases after lung cancer. The aim of this study was to determine the characteristics and outcomes of triple‐negative breast cancer (TNBC) patients with brain metastasis (BM). Methods. We retrospectively reviewed a cohort of patients diagnosed with TNBC at the “Instituto Nacional de Enfermedades Neoplasicas” (period 2000–2014) to evaluate patients who developed BM. Survival rates were assessed by the Kaplan–Meier method, and prognostic factors were identified with the Cox regression analysis. Results. Of a total of 2007 TNBC patients, 193 (9.62%) developed BM. Of these, 169 stages I–III patients with a median age of 45 years (range:21–78) were included. The stage in this cohort was 4 (2.4%) clinical stage (CS) I, 23 (13.6%) with CS II and 142 (84.0%) with CS III. Most of these patients presented ECOG ≥2 (68.6%). The most common symptom was headache (74.0%), followed by nausea‐vomiting (46.7%). Imaging showed that 80 patients (53.0%) had ≥1 metastatic brain lesion. Regarding the treatment of BM in this cohort, 132 patients (84.6%) received radiotherapy (RT), 2 (1.5%) surgery, and 6 (4.5%) surgery plus RT. The overall survival (OS) rate of BM was 59.8%, 37.3%, and 15.0% at 3, 6, and 12 months, respectively. A multivariate analysis showed RT to be the only factor with a positive impact on the OS of BM (hazard ratio (HR) = 0.48, 95% confidence interval (CI):0.30‐0.77, and p = 0.002), while ECOG ≥2 was associated with a worse OS (HR = 1.69, 95%CI:1.15–2.48, and p = 0.007). Conclusion. Despite the poor prognosis of TNBC patients who develop BM, RT showed a benefit in OS rates, while ECOG ≥2 was the only prognostic factor associated with a worse OS. These results may be useful for multidisciplinary teams for treatment planning in patients with TNBC and BM.

Clinical and radiological manifestations associated with triple-negative breast cancer in women from northern Peru. A case-control study.

Triple-negative breast cancer (TNBC) has an aggressive clinical behaviour, with advanced stages at initial diagnostic evaluation, early recurrences and poor survival, so the purpose was to determine the clinical and radiological manifestations associated with TNBC. A case-control study in women diagnosed with breast cancer from January 2015 to August 2022 at the 'Instituto Regional de Enfermedades Neoplásicas del Norte'. We classified cases (Triple Negative subtype) and controls (Luminal A, Luminal B and HER2) according to immunohistochemistry ical analysis. Bivariate and multivariate logistic regression models were used to calculate the odds ratio (OR) with their respective 95% confidence intervals (CIs). The medical reports of 88 cases and 236 controls were reviewed. Cases were more likely to report pain (p = 0.001), nodules on ultrasound (p = 0.01) and mammography (p = 0.003), superior median size (p < 0.05), posterior enhancement (p = 0.001) and moderate density (p = 0.003). Multivariate analysis identified that TNBC was more likely to have a nodular type lesion by ultrasound (OR: 9.73, 95% CI: 1.10-86.16; p = 0.04), ultrasound lesion larger than 36 mm (OR: 4.99, 95% CI: 1.75-14.17; p = 0.003) and moderate density (OR: 3.83, 95% CI: 1.44-10.14; p = 0.007). There are particular clinical and imaging manifestations of TNBC, showing that radiological lesions that presented characteristics in ultrasound as nodular type lesions larger than 36 mm and in mammography moderate grade density, were associated with this subtype of breast tumours in a Peruvian population.

Subcutaneous versus intravenous administration of Trastuzumab: a minimization cost analysis with real world data from a reference cancer centre in Peru.

Breast cancer (BC) is a global concern, with Peru experiencing a high incidence and mortality. Trastuzumab, a crucial treatment for human epidermal growth factor receptor 2-positive BC, is administered intravenously or subcutaneously (SC). This study evaluates the costs associated with both methods at Peru's Instituto Nacional de Enfermedades Neoplásicas. Real data indicate that SC administration reduces treatment costs by approximately S/15,049.09. Cross-continental comparisons highlight a global trend favouring SC administration for efficiency and cost-effectiveness. The analysis provides insights for informed decision-making in resource-constrained healthcare settings like Peru, emphasising the need to consider local contexts in optimising oncology care.

Comorbidities and their association with COVID-19 mortality in Mexico between January 2020 and August 2021.

By August 17, 2021, 4.3 million people had died globally as a result of SARS-CoV-2 infection. While data collection is ongoing, it is abundantly obvious that this is one of the most significant public health crises in modern history. Consequently, global efforts are being made to attain a greater understanding of this disease and to identify risk factors associated with more severe outcomes. The goal of this study is to identify clinical characteristics and risk factors associated with COVID-19 mortality in Mexico. The dataset used in this study was released by Sistema Nacional de Vigilancia Epidemiologica de Enfermedades Respiratorias (SISVER) de la Secretaría de Salud and contains 2.9 million COVID-19 cases. The effects of risk factors on COVID-19 mortality were estimated using multivariable logistic regression models with generalized estimation equation and Kaplan-Meier curves. Case fatality rates, case hospitalization rates are also reported using the Centers for Disease Control and Prevention (CDC) USA death-to-case ratio method. In general, older males with pre-existing conditions had higher odds of death. Age greater than 40, male sex, hypertension, diabetes, and obesity are associated with higher COVID-19 mortality. End-stage renal disease, chronic obstructive pulmonary disease, and immunosuppression are all linked with COVID-19 patient fatalities. Smoking and Asthma are associated with lower COVID-19 mortality which is consistent with findings from the article published in Nature based on National Health Service (NHS) of UK dataset (17 million cases). Intensive care unit (ICU), patient intubation, and pneumonia diagnosis are shown to substantially increase mortality risk for COVID-19 patients.

Subcutaneous Trastuzumab: An Observational Study of Safety and Tolerability in Patients With Early HER2-Positive Breast Cancer.

Purpose: In Peru, breast cancer (BC) stands as the most predominant malignancy neoplasm among women. Trastuzumab has marked a significant milestone in the management of this disease. It has been shown to improve prognosis in human epidermal growth factor receptor 2 (HER2)-expressing female patients, but its repercussions and efficacy are yet to be analyzed in a context with limited resources. Methods: The study population is made of woman patients aged 18 years and older diagnosed with HER2-positive BC at Instituto Nacional de Enfermedades Neoplásicas (INEN, Lima, Peru) during 2019-2021 and treated with at least one dose of subcutaneous trastuzumab. We reviewed medical records to register treatment characteristics, adverse events (AEs), disease progression, and survival status. We considered a median follow-up time of 36 and 45 months for progression and survival status. Results: The majority of patients were over 50 years old (54.29%). Tumor size averaged 19.7 ± 16.1 mm. Lymph nodes were present in 44.78% of patients. Most patients received adjuvant chemotherapy (63.8%) as first-line treatment. Descriptive analyses of treatment outcomes revealed a 30% toxicity rate, primarily attributed to arthralgia (47.62%), followed by diarrhea, fatigue, and injection site reactions, with relatively lower discontinuation rates compared to larger scale studies. Differences in demographic, clinical, and treatment characteristics were not statistically significant concerning the emergence of AEs (p > 0.05). Progression appeared in nine patients, and the overall survival (OS) rate stood at 98.6% and 92.8%, respectively, during a median follow-up of 36 and 45 months. Conclusion: The research suggests that subcutaneous trastuzumab is comparable in effectiveness and safety to the intravenous administration. Regional-specific studies may provide valuable insights into demographic factors influencing treatment outcomes in Peru or other countries. Furthermore, it could represent a more accessible alternative, potentially enhancing patient adherence and optimizing healthcare resource logistics.

Prognostic factors of postoperative morbidity in surgery for resectable pancreatic cancer. Regional institute of neoplastic diseases 'Dr. Luis Pinillos Ganoza' IREN Norte. 2007-2022.

To determine the prognostic factors associated with postoperative morbidity for resectable pancreatic cancer at the Instituto Regional de Enfermedades Neoplásicas del Norte 'Dr. Luis Pinillos Ganoza' - IREN Norte. 2007-2022. A study was conducted with a case-based (22 patients) and control (14 patients) design nested in a cohort that included 36 patients who underwent proximal duodenopancreatectomy (Whipple) or distal pancreatectomy for pancreatic cancer. In the present study, it was found that the total number of living patients represents 86.1% of the total (36 patients). Of the total population, patients who presented only 1 complication were 13.6% and more than 1 complication were 86.4%. It was also found that the most frequent complication in the general population was gastric emptying syndrome, which was present in 50% of all patients. In the bivariate analysis, a highly significant association was observed between the low prognostic nutritional index (p < 0.001, OD = 20.400, CI = 95%: (3.377-123.245)), the type of pancreatic resection (p < 0.001, OR = 52.500, CI = 95%: (5.174-532.669)) and postoperative morbidity. In contrast, no significant association was found between age ≥65 (p = 0.062), diabetes mellitus (p < 0.908), Wirsung diameter (p < 0.432), hospital stay (p < 0.075) and postoperative morbidity. In the multivariate analysis, serum total bilirubin level ≥20 μmol/L (p = 0.778), use of preoperative biliary drainage (p = 0.176), type of pancreatojejunal anastomosis (p = 0.533) and pancreaticogastric anastomosis (p = 0.504) were not statistically significantly associated with postoperative morbidity. The type of pancreatic resection and the nutritional prognostic index <40.5 are prognostic factors of postoperative morbidity in postoperative patients for resectable pancreatic cancer.

Core needle biopsy of breast tumours: comparison of diagnostic performance between surgery and radiology services at a national cancer centre in Latin America.

Breast pathology is a very common reason for medical attention. Tissue diagnosis is usually obtained with core needle biopsy which could be performed by breast surgeons or interventional radiologists. Our aim was to assess the comparison of diagnostic performance between the two services. A retrospective, descriptive and cross-sectional study was carried out on patients who had breast pathology at Instituto Nacional de Enfermedades Neoplasicas in 2019. Descriptive analyses, sensitivity and specificity were calculated using the R program version 4.2.3. From 1,082 patients with breast tumours who underwent core needle biopsy (CNB) during 2019, 782 cases were included. Breast surgeons performed 462 CNBs and radiologists performed 320 CNBs. The 87.5% were palpable tumours and 525 breast carcinomas were identified in the final pathology. The diagnostic performance showed that the sensitivity and specificity were greater than 95% and 98%, respectively. The waiting time in both showed that >95% underwent a CNB before 2 months. The breast surgery service performed the majority of the biopsies in less than 1 week since the indication of the execution of the CNB compared to the radiology service (90% versus 36%). Both hospital services, breast surgery and radiology, are efficient in determining an accurate diagnosis using CNB. However, the breast surgery service performs CNB in a shorter time interval. Breast surgical oncologists are encouraged to perform CNB if there are understaffed radiology services to expedite the diagnosis and treatment of breast cancer patients.

Tau pathology is associated with neuropsychiatric symptoms in a cohort of individuals of predominantly Mexican descent at risk for autosomal‐dominant Alzheimer’s disease

AbstractBackgroundNeuropsychiatric symptoms are common in Alzheimer’s disease (AD), causing significant suffering and diminished quality of life for both individuals and caregivers. The goal of this study was to investigate the relationship between tau pathology in vivo and neuropsychiatric symptoms within a cohort of individuals of predominantly Mexican ancestry at risk for fully penetrant autosomal dominant AD (ADAD) caused by mutations in PSEN1 and APP genes (Figure 1).MethodParticipants from the Estudio de la Enfermedad de Alzheimer en Jalisciences (EEAJ) cohort were selected based on availability of demographic variables, mutation carrier status, tau PET scans (flortaucipir), and completion of the neuropsychiatric inventory (NPI). Linear regression models were used to investigate whether regional tau PET standard uptake value ratio (SUVR) predicted total score on the NPI. Models were adjusted for age, sex, and mutation carrier status. Participants were characterized as carriers if they possessed one of the following ADAD mutations: PSEN1 A431E, PSEN1 I180F, or APP V717I. Analyses were done with and without outliers. The 12‐item total NPI score was used for all analyses. The primary brain regions of interest (i.e., medial orbitofrontal, caudal anterior cingulate, rostral anterior cingulate, parahippocampal, precuneus, and lateral occipital) were selected based on previous findings. Additional analyses were conducted only on individuals who were carriers of 1 of the ADAD mutations.ResultThe sample consisted of 31 participants (45% women, mean age±SD = 37.1±11.7 years, 71% ADAD mutation carriers [81% PSEN1 A431E, 16% PSEN1 I180F, and 3% APP V717I carriers]). A significant relationship was found between regional tau pathology and neuropsychiatric symptoms for all six brain regions (Table 1), all p’s &lt; 0.01. Within all regression models, regional tau pathology explained between 24% to 49% of the variance in neuropsychiatric symptoms. Sub‐set analyses completed on the ADAD mutation carriers sample exhibited similar results (Table 2). No significant results were found for non‐carriers.ConclusionRegional tau pathology within six distinct brain regions is strongly associated with neuropsychiatric symptoms in a cohort of individuals of predominantly Mexican ancestry at risk for fully penetrant ADAD caused by mutations in PSEN1 and APP genes.