RESUMO
O dermatofibrossarcoma é um câncer raro que apresenta padrão de crescimento lento e invasão tecidual agressiva. O tratamento para esta condição envolve intervenção cirúrgica com o objetivo de obter margens livres. Neste caso particular, temos um homem de 60 anos que apresentava uma massa na região da glabela que foi extirpada duas vezes sob anestesia local em outro serviço. Os resultados de ambas as biópsias indicaram dermatofibroma. No entanto, o paciente apresentou nova recidiva, que durante a análise imuno-histoquímica da excisão inicial revelou tratar-se de dermatofibrossarcoma. Como resultado, uma ampla excisão foi realizada até que margens negativas fossem obtidas ao exame de congelação. Além disso, um retalho frontal foi empregado no procedimento para reconstrução do defeito cirúrgico. O resultado do tratamento foi considerado bem-sucedido, sem complicações.
Dermatofibrosarcoma is a rare cancer with a slow growth pattern and aggressive tissue invasion. The treatment for this condition involves surgical intervention to achieve clear margins. In this particular case, we have a 60-year-old man who had a mass in the glabella area that was excised twice under local anesthesia at a different facility. The results of both biopsies indicated dermatofibroma. However, the patient experienced a new recurrence, and during the immunohistochemistry analysis of the initial excision, it was revealed to be dermatofibrosarcoma. As a result, a broad excision was performed until negative margins were obtained based on frozen sections. Additionally, a frontal flap was employed to reconstruct the surgical defect. The outcome of the treatment was deemed successful, without complications.
RESUMO
Abstract Background Cardiac anomalies are the most prevalent congenital malformations among live births in the world. In Brazil, it is estimated that nearly 25,757 new cases occur each year, and the Southeast region presents the highest prevalence, with 10 new cases/1,000 live births. Objective The aim of this study is to evaluate the epidemiology of congenital heart disease (CHD) in the state of São Paulo. Methods This is a cross-sectional and time-series observational study with data from the Brazilian Information System on Live Births. Heart-related cardiac malformation cases — International Classification of Diseases (ICD) 10th revision Q20.0 to Q24.9 — were selected from January 2010 to December 2018, in the state of São Paulo, Brazil. This study analyzed rates of malformations per year and investigated associated factors, using single and multiple logistic regression models. The significance level adopted in this study was 5%. Results The highest cardiac malformation rate was in the São Paulo metropolitan region (2.84:1000), while the lowest was found in the region of Franca (0.3:1000). The most frequent defect was interatrial communication (38.2%). The main associated factors observed in this study were prematurity of 22 to 27 weeks (OR=4,401 95% CI: 3,796-5,104) — CI: Confidence Interval; OR: Odds ratio —, mother's age between 35 and 49 years of age (OR=1,602 95% CI: 1,525-1,682), yellow race (OR=1,481 95% CI: 1,235-1,775), triple or more pregnancy (OR=1,438 95% CI: 1,004-2,060), and history of a dead child (OR=1,213 95% CI: 1,152-1,277). Conclusion The main factors associated with this outcome, which are part of the obstetric history of mothers, should be addressed and considered when pregnancy is a planned event.
RESUMO
Type 2 Diabetes Mellitus (DM) is the most common form of diabetes. The initial treatment of type 2 DM consists of the adoption of healthy lifestyle habits together with several classes of hypoglycemic agents. However, these medications are not always able to reduce the blood glucose levels in all patients. Therefore, creatine supplementation has emerged as a new putative candidate for type 2 DM treatment. This systematic review aimed to investigate the effects (benefits and harms) of creatine supplementation in patients with type 2 diabetes through a systematic review. The studies were searched in MEDLINE, EMBASE, LILACS, CENTRAL, SPORTDiscus, and CINAHL databases, without date or language restrictions. Methodological quality was assessed using the Cochrane risk-of-bias table. The certainty of the evidence was classified using the Grading of Recommendations Assessment, Development and Evaluation approach. Three randomized controlled trials (RCTs) were included (87 participants). Overall, the methodological quality was classified as unclear to a high risk of bias. Each trial compared creatine supplementation with a different control group (placebo, metformin, and glibenclamide). Creatine supplementation seems to be effective in decreasing glycemic levels and glycosylated hemoglobin concentrations compared to placebo. No difference was observed compared to metformin or glibenclamide with creatine, and all treatments were able to reduce blood glucose levels. No major adverse effects were observed. Based on the low certainty of evidence, creatine supplementation was shown to be a hypoglycemic intervention for patients with type 2 diabetes, without major adverse events reported. However, well- designed RCTs with larger sample sizes and long-term outcomes are needed to support this evidence.
