RESUMO
INTRODUCTION: Latin American Initiative for Lifestyle Intervention to Prevent Cognitive Decline (LatAm-FINGERS) is the first non-pharmacological multicenter randomized clinical trial (RCT) to prevent cognitive impairment in Latin America (LA). Our aim is to present the study design and discuss the strategies used for multicultural harmonization. METHODS: This 1-year RCT (working on a 1-year extension) investigates the feasibility of a multi-domain lifestyle intervention in LA and the efficacy of the intervention, primarily on cognitive function. An external harmonization process was carried out to follow the FINGER model, and an internal harmonization was performed to ensure this study was feasible and comparable across the 12 participating LA countries. RESULTS: Currently, 1549 participants have been screened, and 815 randomized. Participants are ethnically diverse (56% are Nestizo) and have high cardiovascular risk (39% have metabolic syndrome). DISCUSSION: LatAm-FINGERS overcame a significant challenge to combine the region's diversity into a multi-domain risk reduction intervention feasible across LA while preserving the original FINGER design.
Assuntos
Disfunção Cognitiva , Humanos , América Latina , Disfunção Cognitiva/prevenção & controle , Estilo de Vida , Cognição , Projetos de PesquisaRESUMO
Introduction: Stroke is one of the leading causes of death in Latin America, a region with countless gaps to be addressed to decrease its burden. In 2018, at the first Latin American Stroke Ministerial Meeting, stroke physician and healthcare manager representatives from 13 countries signed the Declaration of Gramado with the priorities to improve the region, with the commitment to implement all evidence-based strategies for stroke care. The second meeting in March 2020 reviewed the achievements in 2 years and discussed new objectives. This paper will review the 2-year advances and future plans of the Latin American alliance for stroke. Method: In March 2020, a survey based on the Declaration of Gramado items was sent to the neurologists participants of the Stroke Ministerial Meetings. The results were confirmed with representatives of the Ministries of Health and leaders from the countries at the second Latin American Stroke Ministerial Meeting. Results: In 2 years, public stroke awareness initiatives increased from 25 to 75% of countries. All countries have started programs to encourage physical activity, and there has been an increase in the number of countries that implement, at least partially, strategies to identify and treat hypertension, diabetes, and lifestyle risk factors. Programs to identify and treat dyslipidemia and atrial fibrillation still remained poor. The number of stroke centers increased from 322 to 448, all of them providing intravenous thrombolysis, with an increase in countries with stroke units. All countries have mechanical thrombectomy, but mostly restricted to a few private hospitals. Pre-hospital organization remains limited. The utilization of telemedicine has increased but is restricted to a few hospitals and is not widely available throughout the country. Patients have late, if any, access to rehabilitation after hospital discharge. Conclusion: The initiative to collaborate, exchange experiences, and unite societies and governments to improve stroke care in Latin America has yielded good results. Important advances have been made in the region in terms of increasing the number of acute stroke care services, implementing reperfusion treatments and creating programs for the detection and treatment of risk factors. We hope that this approach can reduce inequalities in stroke care in Latin America and serves as a model for other under-resourced environments.
RESUMO
The large and increasing burden of stroke in Latin American countries, and the need to meet the UN and WHO requirements for reducing the burden from non-communicable disorders (including stroke), brought together stroke experts and representatives of the Ministries of Health of 13 Latin American countries for the 1st Latin American Stroke Ministerial meeting in Gramado, Brazil, to discuss the problem and identify ways of cooperating to reduce the burden of stroke in the region. Discussions were focused on the regional and country-specific activities associated with stroke prevention and treatment, including public stroke awareness, prevention strategies, delivery and organisation of care, clinical practice gaps, and unmet needs. The meeting culminated with the adoption of the special Gramado Declaration, signed by all Ministerial officials who attended the meeting. With agreed priorities for stroke prevention, treatment, and research, an opportunity now exists to translate this Declaration into an action plan to reduce the burden of stroke.
Assuntos
Efeitos Psicossociais da Doença , Política de Saúde , Acidente Vascular Cerebral/epidemiologia , Humanos , Incidência , América Latina/epidemiologia , Prevalência , Acidente Vascular Cerebral/mortalidadeRESUMO
Primary cutaneous plasmacytoma should be in the differential diagnosis in case of solitary or multiple erythematous-violaceous nodules or papules. The diagnosis relies on clinical, histological, and immunochemical findings, without underlying evidence of multiple myeloma. Treatment should be individualized, and agents such as bortezomib or lenalidomide have shown to be effective.
RESUMO
Biological drugs and nonbiological complex drugs with expired patents are followed by biosimilars and follow-on drugs that are supposedly similar and comparable with the reference product in terms of quality, safety and efficacy. Unlike simple molecules that can be copied and reproduced, biosimilars and follow-on complex drugs are heterogeneous and need specific regulations from health and pharmacovigilance agencies. A panel of 14 Latin American experts on multiple sclerosis from nine different countries met to discuss the recommendations regarding biosimilars and follow-on complex drugs for treating multiple sclerosis. Specific measures relating to manufacturing, therapeutic equivalence assessment and pharmacovigilance reports need to be implemented before commercialization. Physical, chemical, biological and immunogenic characterizations of the new product need to be available before clinical trials start. The new product must maintain the same immunogenicity as the original. Automatic substitution of biological and complex drugs poses unacceptable risks to the patient.
Assuntos
Medicamentos Biossimilares/uso terapêutico , Controle de Medicamentos e Entorpecentes , Fatores Imunológicos/uso terapêutico , Esclerose Múltipla/tratamento farmacológico , Gestão de Riscos , Prova Pericial , Humanos , América Latina/epidemiologia , Esclerose Múltipla/epidemiologiaRESUMO
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma with diverse clinical, pathological and genetic features. An 80-year-old woman was diagnosed with a stage IV-X-A (Ann Arbor staging system) low grade systemic follicular lymphoma (FL). Four months after the diagnosis, she developed asymptomatic, indurated, annular erythematous plaques with centrifugal growth on the abdomen, arms and neck. The skin biopsy revealed a dermal infiltration compatible with diffuse large B-cell lymphoma. Light chain restriction by flow cytometry was demonstrated. The variable, diverse and joining genes of immunoglobulin G heavy chains were sequenced and cloned, and showed the same pattern for both the initial follicular lymphoma and the skin infiltration. Translocation t (14;18) was present in both samples. Based on these findings, a diagnosis of transformation of follicular lymphoma into diffuse large B cell lymphoma was made. Although other hematological disorders such as primary cutaneous diffuse large B cell lymphoma, mycosis fungoides and the cutaneous infiltration of chronic juvenile myeloid leukemia can present as annular lesions, we were unable to find any previous reports of these as a manifestation of cutaneous infiltration by systemic non-Hodgkin lymphoma.
Assuntos
Progressão da Doença , Linfoma Folicular/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico , Micose Fungoide/diagnóstico , Neoplasias Cutâneas/diagnóstico , Idoso de 80 Anos ou mais , Feminino , Humanos , Linfoma Folicular/complicações , Linfoma Difuso de Grandes Células B/complicações , Micose Fungoide/complicações , Neoplasias Cutâneas/complicaçõesRESUMO
BACKGROUND AND OBJECTIVE: To analyze the risk factors associated with mortality in invasive pneumococcal disease in the university hospital Fundación Jiménez Díaz (Madrid, Spain) during 11 years. PATIENTS AND METHOD: We performed a retrospective study of patients attending the emergency service of the hospital from January 1993 to August 2003. We registered data on mortality, clinical and microbiological evolution and relapses. RESULTS: We studied 263 patients with pneumococcal baceteremia and invasive disease caused by Streptococcus pneumoniae (pneumonia, meningitis, sepsis, bacteremia of unknown origin and oligoarthritis). Mortality was 12.5%. Variables associated with mortality in a logistic regression analysis included absence of leukocytosis (p = 0.04), acidosis (p < 0.01), respiratory signs and symptoms (tachypnea, pleuritic pain) (p = 0.02), and neurologic manifestations (decreased consciousness level; (p < 0.01). CONCLUSION: Patients at highest risk of death because of invasive pneumococcal disease are critically ill, with no leukocytosis, with severe respiratory or neurological symptoms and undergoing invasive procedures such as mechanical ventilation and tracheostomy.
Assuntos
Infecções Pneumocócicas/microbiologia , Infecções Pneumocócicas/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Streptococcus pneumoniae/isolamento & purificação , Inquéritos e Questionários , Taxa de SobrevidaRESUMO
Chronic migraine is a condition with significant prevalence all around the world and high socioeconomic impact, and its handling has been challenging neurologists. Developments for understanding its mechanisms and associated conditions, as well as that of new therapies, have been quick and important, a fact which has motivated the Latin American and Brazilian Headache Societies to prepare the present consensus. The treatment of chronic migraine should always be preceded by a careful diagnosis review; the detection of possible worsening factors and associated conditions; the stratification of seriousness/impossibility to treat; and monitoring establishment, with a pain diary. The present consensus deals with pharmacological and nonpharmacological forms of treatment to be used in chronic migraine.
Assuntos
Transtornos de Enxaqueca/terapia , Doença Crônica , Comorbidade , Humanos , América Latina , Transtornos de Enxaqueca/diagnóstico , Fatores de RiscoRESUMO
Chronic migraine is a condition with significant prevalence all around the world and high socioeconomic impact, and its handling has been challenging neurologists. Developments for understanding its mechanisms and associated conditions, as well as that of new therapies, have been quick and important, a fact which has motivated the Latin American and Brazilian Headache Societies to prepare the present consensus. The treatment of chronic migraine should always be preceded by a careful diagnosis review; the detection of possible worsening factors and associated conditions; the stratification of seriousness/impossibility to treat; and monitoring establishment, with a pain diary. The present consensus deals with pharmacological and nonpharmacological forms of treatment to be used in chronic migraine.
A migrânea crônica é uma condição com prevalência significativa ao redor do mundo e alto impacto socioeconômico, sendo que seu manuseio tem desafiado os neurologistas. Os avanços na compreensão de seus mecanismos e das condições a ela associadas, bem como nas novas terapêuticas, têm sido rápidos e importantes, fato que motivou as Sociedades Latino-americana e Brasileira de Cefaleia a elaborarem o presente consenso. O tratamento da migrânea crônica deve ser sempre precedido por uma revisão cuidadosa do diagnóstico, pela detecção de possíveis fatores de piora e das condições associadas, pela estratificação de gravidade/impossibilidade de se tratar e pelo monitoramento com um diário da dor. Este consenso apresenta abordagens farmacológicas e não-farmacológicas para tratar a migrânea crônica.
Assuntos
Humanos , Transtornos de Enxaqueca/terapia , Doença Crônica , Comorbidade , América Latina , Transtornos de Enxaqueca/diagnóstico , Fatores de RiscoRESUMO
INTRODUCTION: Pemphigus vulgaris (PV) is a rare autoimmune bullous disease that affects the skin and mucosae, characterized by the presence of antibodies against desmoglein 3, that causes acantholisis and formation of intraepidermal blisters. Observation of PV cases in several members of the same family suggests the existence of genetic factors that contribute to susceptibility to suffer the disease. However, very few cases of familial PV have been described. Based on its autoimmune nature, many studies have found an association between PV and the HLA class II allele, specifically with the HLA-DRB1*0402 DQB1*0302 and HLA-DRB1*1401 DQB1*0503 haplotypes that bestows a significant risk of disease. OBJECTIVES: Study of three families with PV. PATIENTS AND METHODS: In this study, we present three families, with a total of 7 patients, diagnosed of familial PV. HLA antigens were determined with the PCR (polymerase chain reaction) technique in several members of these families. RESULTS: All the subjects affected were positive for HLA DR4 and HLA DR14. The fact that different families with PV are associated with identical haplotypes and that healthy siblings of the patients have the same haplotype is of special interest. CONCLUSION: These results support the concept of genetic predisposition in this rare disease.
Assuntos
Pênfigo/genética , Adulto , Idoso , Alelos , Feminino , Predisposição Genética para Doença , Antígenos HLA/análise , Antígenos HLA-DR/análise , Antígeno HLA-DR4/análise , Haplótipos , Humanos , Masculino , Linhagem , Pênfigo Familiar Benigno/genética , Reação em Cadeia da PolimeraseRESUMO
INTRODUCTION: Cases of pneumococcal septic arthritis treated in the Fundación Jiménez Díaz (Madrid, Spain) were reviewed. METHODS: A retrospective record review was conducted for all patients presenting with pneumococcal septic arthritis between January 1993 and August 2003. RESULTS: Four patients out of a total of 267 reviewed had a clinical and microbiological diagnosis of septic arthritis caused by Streptococcus pneumoniae. The most frequent locations were the knee, ankle and tarsus. Three of the four patients had underlying diseases and one patient died. CONCLUSIONS: Pneumococcal septic arthritis, a very rare clinical entity diagnosed by clinical and microbiological findings, should be suspected in patients with underlying disease. Early antibiotic therapy focussed on the most common microorganisms causing septic arthritis is necessary for optimal outcome.
Assuntos
Artrite Infecciosa/microbiologia , Infecções Pneumocócicas/epidemiologia , Idoso , Articulação do Tornozelo/microbiologia , Artrite Infecciosa/epidemiologia , Evolução Fatal , Hospitais Universitários , Humanos , Lactente , Articulação do Joelho/microbiologia , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Infecções Pneumocócicas/complicações , Estudos Retrospectivos , EspanhaRESUMO
Objetivos: Comparar los resultados del tratamiento de la mediatinitis en dos series sucesivas y homogéneas empleando dos modalidades terapéuticas diferentes y analizar su influencia sobre la morbimortalidad y los costos. Material y métodos: Treinta pacientes con diagnóstico de mediastinitis son comparados en este reporte. Dieciséis casos consecutivos fueron tratados con debridamiento, curas abiertas y plástica muscular diferida empleando ambos músculos pectorales (Serie A). Los siguientes 14 casos fueron tratados con debridamiento y deslizamiento miocutáneo pectoral bilateral simultáneo (Serie B). Resultados: La mortalidad hospitalaria fue del 31,2 por ciento para la Serie A y 0 por ciento para la Serie B. El promedio de internación desde el diagnóstico de mediastinitis hasta el alta fue de 47 días (rango: 20-66 días) para la Serie A y 15 días (rango: 7-32 días) para la Serie B. Requirieron hemodiálisis 25 por ciento de los pacientes de la Serie A y 7,1 por ciento de los pacientes en la Serie B. En los pacientes de la Serie A fueron necesarios al menos dos procedimientos quirúrgicos, mientras que los pacientes de la Serie B se resolvieron con un solo acto quirúrgico. Nosotros concluimos que, empleando el debridamiento y deslizamiento miocutáneo pectoral simultáneo, podemos reducir sensiblemente la morbimortalidad hospitalaria, los días de internación y los costos
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Seguimentos , Mediastinite/cirurgia , Músculos Peitorais/cirurgia , Resultado do Tratamento , Cirurgia Torácica/estatística & dados numéricos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricosAssuntos
Humanos , Masculino , Feminino , Endoscopia , Vesícula Biliar/cirurgia , Vesícula Biliar/lesões , Medicina , VenezuelaAssuntos
Humanos , Pentoxifilina/farmacologia , Dermatopatias/tratamento farmacológico , Resultado do Tratamento , Celulite (Flegmão)/tratamento farmacológico , Crioglobulinemia/tratamento farmacológico , Diabetes Mellitus , Granuloma Anular/tratamento farmacológico , Queloide/tratamento farmacológico , Melanoma/tratamento farmacológico , Pentoxifilina/administração & dosagem , Pentoxifilina/metabolismo , Pioderma Gangrenoso/tratamento farmacológico , Doença de Raynaud/tratamento farmacológico , Manifestações Cutâneas , Úlcera/tratamento farmacológico , Vasculite/tratamento farmacológicoRESUMO
La colangiopancreatografía retrógrada endoscópica, produjo un dramático impacto en el abordaje diagnósticos de las enfermedades pancreáticas y biliares, pero fue la posibilidad de que el método tuviera una aplicación terapéutica lo que cambio por completo el estudio y resolución de las patologías bilio-pancreáticas. Los primeros reportes de esfinterectomías endoscópicas, realizados en forma independiente por Kawai y Classen y Deling, dieron esa nueva visión sobre la posibilidad de solucionar por vía endoscópica las enfermedades de las vías biliares.