Acta medica portuguesa最新文献

Introduction: Scientific evidence regarding salivary gland cancer systemic treatment is limited and the therapeutic approach to locally advanced or metastatic disease is mainly based on consensus. This study aimed to evaluate treatment patterns and outcomes in patients with advanced salivary gland cancer.

Methods: We conducted a retrospective cohort study in a comprehensive cancer center in Portugal, including adult patients diagnosed with primary malignant salivary gland tumors between 2012 and 2021. Data on demographics, tumor characteristics, treatments, and outcomes were collected from institutional cancer registries and electronic medical records. The study was approved by the institutional Ethics Committee.

Results: A total of 116 patients with salivary gland cancer were identified and, of these, 45 had locally advanced or metastatic disease: 24 received systemic anti-neoplastic treatment and 21 received best supportive care. One-year overall survival in systemic anti-neoplastic treatment group was 70% (versus 14% in best supportive care group, p < 0.001) and progression-free survival was 37%. The most commonly used systemic treatment was chemotherapy (n = 29, 59%). Seven patients (14%) received androgen deprivation therapy, and two patients (4%) received other targeted therapy (olaparib and erdafitinib).

Conclusion: Systemic treatment was associated with significantly improved survival in patients with advanced salivary gland cancer. Despite the heterogeneity of therapeutic approaches, including emerging biomarker-driven therapies, clinical decision-making remains largely consensus-based. These findings underscore the need for further research to support personalized treatment strategies and guide evidence-based care.

Introduction: The development and validation of reliable and valid instruments to assess chronic pain and its impact on daily functioning are crucial in both clinical and research settings. The aim of this study was to develop and validate the scale 'Physical Function Impact Index on Chronic Pain' - PFIICP, a novel 12-item questionnaire designed to evaluate the physical functional impact of chronic pain.

Methods: A formative measurement model was used. In comparison with other established scales that have emotional, cognitive and social considerations, PFIICP is designed to be more objective, as it focuses only on the relationship between physical performance and the subject's pain.

Results: Data were collected from n = 285 patients at baseline and n = 58 patients at follow-up (3 - 6 months later). Spearman's rho correlations between the 12 items ranged from 0.153 to 0.793, all statistically significant (p < 0.05), indicating that each item contributes uniquely to the construct. The intraclass correlation coefficient (ICC) for test-retest reliability was 0.788 (95% CI: 0.731 - 0.833), demonstrating good stability over time. Convergent validity was supported by strong Pearson correlations with established measures, including the Brief Pain Inventory (BPI; r = 0.739, p < 0.05) and the Pain Disability Index (PDI; r = 0.739, p < 0.05).

Conclusion: These findings suggest that the PFIICP is a robust tool for assessing the functional impact of chronic pain through a formative model approach.

This clinical case describes the communication profile of a functional speech disorder. A 48-year-old woman was admitted to the emergency service due to sudden changes in speech, generalized dystonia and gait ataxia. Magnetic resonance imaging showed multiple supra and infratentorial inflammatory lesions involving the posterior occipito-temporal lobes bilaterally, frontal convexity bilaterally, insula and paramedian frontal cortex on the left, diencephalon, rhombencephalon. On the third day, a speech pathology evaluation was conducted, revealing inconsistencies in speech: repetitions of initial sounds, without characteristics of an acquired stutter, a clenched articulation, not justified by an orofacial motor disorder, an inconsistent pattern in voice and prosody. Three days later, another assessment was carried out, showing a significant improvement in speech intelligibility. There was a marked variability in speech features defects found over the days, as well as in their severity. These behaviors appear simultaneously with a speech pattern that is not justified by any of the neurological lesions found.