Search

BACKGROUND: Immune checkpoint inhibitors (ICI) have shown clinical benefit among patients with advanced kidney cancer. Their cost burden hardens its access, especially in low- and middle-income countries. To set solutions, the impact of geographical and socioeconomic differences in the clinical outcomes and survival of renal cell carcinoma (RCC) patients needs to be explored. OBJECTIVE: This review aimed to understand if geographical differences affected the clinical outcomes of RCC patients receiving immunotherapy. METHODS: This study reviewed 45 studies that examined the OS and PFS of RCC patients undergoing ICI (2010–2020) selected from a 3028-study database search conducted on PubMed and grey literature. The selected studies were divided into groups: Asia, multicentric studies, Europe and Anglo-America. The lethality and income of the geographical locations were measured and discussed. RESULTS: Weighted average (WAVG) of mPFS and mOS were 8,47 months, and 40,6 months in Asia. The WAVG of mOS were 12.2 months, and 20.22 months in the Anglo-American population (15 studies; 943 patients). In multicentric studies (4 studies; 1834 patients) the WAVG mPFS was 10,06. European group (13 studies; 3143 patients) had 6.1 and 20.24 months mPFS and mOS, respectively. The exploratory analysis on income and RCC lethality has shown an absolute decline of 8.7% (CI 10.1 to 7.3% - p

OBJECTIVE: Since the relationship between physical activity and sleep quality has been poorly studied in nonagenarians and centenarians, this study sought to relate the sleep quality and physical activity in this age group. METHODS: This is a secondary analysis of the initial assessment of a longitudinal study involving nonagenarians and centenarians in Porto Alegre, Brazil, which included physical activity (yes or no) and sleep quality (altered or normal). The chi-square test, adjusted by logistic regression, was used to investigate the relationship between sleep quality, physical activity, and sociodemographic and clinical characteristics. RESULTS: Among the 233 participants, 26% were physically active and 53% reported altered sleep. Higher frequencies of physical activity and normal sleep occurred in men (36%, p = 0.02 and 54%, p = 0.18), in those living with a caregiver (42%, p = 0.09 and 58, p = 0.51), in those with high school or higher education (33%, p = 0.44 and 58%, p = 0.07), and in those with excellent or good self-perceived health (31%, p = 0.03 and 51%, p = 0.16). Physical activity was lower among those who reported apathy and drowsiness (83%, p = 0.03) and in those who had difficulty falling asleep (66%, p = 0.05). In the adjusted analysis, only education remained significant (p = 0.02, when comparing high school or higher with illiteracy; odds ratio: 3.91 confidence interval 1.18-12.90, p = 0.02). CONCLUSIONS: We observed a low frequency of physical activity and a high prevalence of altered sleep patterns in nonagenarians and centenarians. Factors related greater physical activity were also associated with better sleep quality. High school or higher education was a significant and independent predictor of good sleep quality in nonagenarians and centenarians.

Introdução: A pandemia por COVID-19 demandou uma restrição social principalmente à população de risco como os longevos (≥ 90 anos), o que é um fator de risco para o desenvolvimento de alterações gastrointestinais, comuns em nonagenários e centenários. Objetivos: Descrever a prevalência de alterações gastrointestinais em nonagenários e centenários durante a pandemia por COVID-19. Métodos: Estudo transversal e observacional envolvendo participantes do projeto Atenção Multiprofissional ao Longevo, avaliados por telefone no período de março a agosto de 2020. As variáveis investigadas foram características sociodemográficas e de hábitos alimentares e mudança de sintomas gastrointestinais durante a pandemia. Foram calculadas frequências e média para descrição. Resultados: Participaram da pesquisa 59 nonagenários e centenários, a maioria mulheres (77%) com média de 96,0±3,8 anos, brancos (76%), viúvas (73%), residindo com acompanhante (81%). Quanto à saúde em geral, 51% considerou ótima/boa (n=30). Em 59% (n=35) referiram ter algum sintoma no trato digestório antes da pandemia. A maior parte (93%, n=55) afirmou não ter mudanças no trato digestório durante a pandemia. Em relação à consistência das fezes, 44% referiu fezes normais (n=26). Um quarto dos participantes relatou constipação (n=15). A constipação foi mais frequente entre os participantes que consumiam

Introdução: A atividade física (AF) é considerada um importante recurso não farmacológico associado à qualidade do sono (QS), particularmente prejudicada na população idosa, mas pouco estudada em nonagenários e centenários, faixa populacional com maior crescimento no Brasil. Portanto, o presente trabalho busca relacionar a QS e a AF em nonagenários e centenários. Métodos: análise secundária dos dados do projeto Atenção Multidisciplinar Domiciliar ao Longevo (AMPAL). A coorte iniciou em 2016 com nonagenários e centenários de Porto Alegre, quando foram questionados sobre a AF e à QS. A análise de dados foi feita por meio do teste qui-quadrado. Resultados: Os participantes eram na sua maioria do mulheres, brancos e viúvos, com ensino fundamental completo (primário), entre 90 e 95 anos e moravam com familiares e 23,7% realizavam AF. Morar com um cuidador foi visto como fator de estímulo para realização de AF entre nonagenários (40%, p=0,0467). Os homens, com 34%, mostrando maior taxa de AF que as mulheres com a frequência de 20%, (p=0,0191). Estas (as mulheres) apresentaram com maior frequência pior QS (p=0,1484). Os analfabetos também apresentaram pior QS (p=0,0100). Os participantes com AF apresentaram menor frequência de queixas do sono sendo significativa para a apatia e sonolência diurna (29%, p=0,0170). Conclusão: Há escassa literatura acerca da qualidade de sono dessa faixa etária de idosos. Mesmo com as limitações do estudo observamos uma relação importante entre AF e queixas de sono em nonagenários e centenários, observação inédita na literatura.

Background: Tumor burden and metastatic disease sites are well-established prognostic factors in many malignancies, including metastatic Renal Cell Carcinoma (mRCC). Objective: We aimed to evaluate the impact of bone metastasis (BM) location on clinical outcome of mRCC patients. Methods: This study is a retrospective analysis of 4060 mRCC patients from the Latin American Renal Cancer Group (LARCG) database. Clinico-pathological characteristics, 24-months-survival, overall survival (OS), and BM sites were collected. To estimate the association between BM location and clinical outcomes we used Cox regression method. Results: Out of 4060 patients, 530 (14.5%) had metastatic disease. Among those, we analyzed the fifty-six that had only BM. The median follow-up was 20.8 months (range from 0 to 188 months). Non-spinal BM (NSBM) were identified in 33 (58.9%) patients and spinal BM (SBM) in 23 (41.1%) patients. Median OS was 35 months, and 24-months OS was 76% for patients with NSBM and 46% with SBM (HR: 2.22). In multivariable analysis SBM (HR: 3.08), ASA classification 3-4 (HR: 2.37), non-cc histology (HR: 5.11), and age (HR 1.06) were independent prognostic factors for OS. Conclusions: Our study showed that SBM predicted shorter OS, suggesting that the location of BM may impact the clinical outcome of patients with mRCC.