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4.
J Cancer Res Clin Oncol ; 146(7): 1829-1845, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32410064

RESUMO

PURPOSE: The outcome of RCC has improved considerably in the last few years, and the treatment options have increased. LACOG-GU and LARCG held a consensus meeting to develop guidelines to support the clinical decisions of physicians and other health professionals involved in the care of RCC patients. METHODS: Eighty questions addressing relevant advanced RCC treatments were previously formulated by a panel of experts. The voting panel comprised 26 specialists from the LACOG-GU/LARCG. Consensus was determined as 75% agreement. For questions with less than 75% agreement, a new discussion was held, and consensus was determined by the majority of votes after the second voting session. RESULTS: The recommendations were based on the highest level of scientific evidence or by the opinion of the RCC experts when no relevant research data were available. CONCLUSION: This manuscript provides guidance for advanced RCC treatment according to the LACOG-GU/LARCG expert recommendations.


Assuntos
Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/terapia , Neoplasias Renais/diagnóstico , Neoplasias Renais/terapia , Tomada de Decisão Clínica , Terapia Combinada , Procedimentos Cirúrgicos de Citorredução/métodos , Gerenciamento Clínico , Prova Pericial , Humanos , América Latina , Metastasectomia/métodos , Nefrectomia/métodos , Guias de Prática Clínica como Assunto , Padrão de Cuidado
6.
Bone Joint J ; 102-B(4): 501-505, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228086

RESUMO

AIMS: Early cases of cauda equina syndrome (CES) often present with nonspecific symptoms and signs, and it is recommended that patients undergo emergency MRI regardless of the time since presentation. This creates substantial pressure on resources, with many scans performed to rule out cauda equina rather than confirm it. We propose that compression of the cauda equina should be apparent with a limited sequence (LS) scan that takes significantly less time to perform. METHODS: In all, 188 patients with suspected CES underwent a LS lumbosacral MRI between the beginning of September 2017 and the end of July 2018. These images were read by a consultant musculoskeletal radiologist. All images took place on a 3T or 1.5T MRI scanner at Stoke Mandeville Hospital, Aylesbury, UK, and Royal Berkshire Hospital, Reading, UK. RESULTS: The 188 patients, all under the age of 55 years, underwent 196 LS lumbosacral MRI scans for suspected CES. Of these patients, 14 had cauda equina compression and underwent emergency decompression. No cases of CES were missed. Patients spent a mean 9.9 minutes (8 to 10) in the MRI scanner. CONCLUSION: Our results suggest that a LS lumbosacral MRI could be used to diagnose CES safely in patients under the age of 55 years, but that further research is needed to assess safety and efficacy of this technique before changes to existing protocols can be recommended. In addition, work is needed to assess if LS MRIs can be used throughout the spine and if alternative pathology is being considered. Cite this article: Bone Joint J 2020;102-B(4):501-505.


Assuntos
Síndrome da Cauda Equina/diagnóstico por imagem , Região Lombossacral/diagnóstico por imagem , Padrão de Cuidado , Adolescente , Adulto , Síndrome da Cauda Equina/cirurgia , Descompressão Cirúrgica , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/normas , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Estudos Retrospectivos , Adulto Jovem
7.
Rev Med Suisse ; 16(N° 691-2): 819-822, 2020 Apr 29.
Artigo em Francês | MEDLINE | ID: mdl-32348043

RESUMO

Medical oncologists are steering a difficult course during the COVID-19 pandemic between three opposing forces : revisiting optimal standards of cancer care, facing constantly evolving shortages as some resources are being redirected, and acknowledging the paradoxical need to keep patients away from the health care facility. This article compiles recommendations fr om cancer societies and expert opinions to provide guidance and practical solutions for the oncology clinic. We propose that optimal standards of care be upheld, and short-term safety concerns due to exposure to SARS-CoV-2 be weighed against a long-term compromise in cancer prognosis when deciding on adjustments in cancer care. Proper mitigation strategies in the clinic and use of less resource-heavy but equivalent treatment alternatives often allow optimal cancer care. The magnitude of benefit of cancer treatments needs to be systematically considered.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Neoplasias , Pandemias , Pneumonia Viral , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Humanos , Oncologia/tendências , Neoplasias/complicações , Neoplasias/diagnóstico , Neoplasias/terapia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Padrão de Cuidado
8.
Clin Gastroenterol Hepatol ; 18(8): 1882-1883, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32304737

RESUMO

Since February 20, 2020, the SARS-COV2 infection has spread in Lombardy, and in the rest of the Italian regions, forcing our government to impose a national lockdown.1 Hospitals have been forced to adapt and to restructure their units to cope with this urgent new critical situation.2 Alternative solutions have been found to manage patients with inflammatory bowel disease (IBD), including remote monitoring, drug home delivery, limitations for infusion units, and patient education on measures to prevent infection,3 to maintain high-quality care.4.


Assuntos
Doenças Inflamatórias Intestinais/epidemiologia , Telemedicina , Betacoronavirus , Infecções por Coronavirus , Humanos , Itália , Pandemias , Pneumonia Viral , Padrão de Cuidado
11.
PLoS One ; 15(3): e0229380, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32130261

RESUMO

BACKGROUND: The early use of broad-spectrum antibiotics remains the cornerstone for the treatment of neonatal late onset sepsis (LOS). However, which antibiotics should be used is still debatable, as relevant studies were conducted more than 20 years ago, recruited in single centres or countries, evaluated antibiotics not in clinical use anymore and had variable inclusion/exclusion criteria and outcome measures. Moreover, antibiotic-resistant bacteria have become a major problem in many countries worldwide. We hypothesized that efficacy of meropenem as a broad-spectrum antibiotic is superior to standard of care regimens (SOC) in empiric treatment of LOS and aimed to compare meropenem to SOC in infants aged <90 days with LOS. METHODS AND FINDINGS: NeoMero-1 was a randomized, open-label, phase III superiority trial conducted in 18 neonatal units in 6 countries. Infants with post-menstrual age (PMA) of ≤44 weeks with positive blood culture and one, or those with negative culture and at least with two predefined clinical and laboratory signs suggestive of LOS, or those with PMA >44 weeks meeting the Goldstein criteria of sepsis, were randomized in a 1:1 ratio to receive meropenem or one of the two SOC regimens (ampicillin+gentamicin or cefotaxime+gentamicin) chosen by each site prior to the start of the study for 8-14 days. The primary outcome was treatment success (survival, no modification of allocated therapy, resolution/improvement of clinical and laboratory markers, no need of additional antibiotics and presumed/confirmed eradication of pathogens) at test-of-cure visit (TOC) in full analysis set. Stool samples were tested at baseline and Day 28 for meropenem-resistant Gram-negative organisms (CRGNO). The primary analysis was performed in all randomised patients and in patients with culture confirmed LOS. Proportions of participants with successful outcome were compared by using a logistic regression model adjusted for the stratification factors. From September 3, 2012 to November 30th 2014, total of 136 patients (instead of planned 275) in each arm were randomized; 140 (52%) were culture positive. Successful outcome at TOC was achieved in 44/136 (32%) in the meropenem arm vs. 31/135 (23%) in the SOC arm (p = 0.087). The respective numbers in patients with positive cultures were 17/63 (27%) vs. 10/77 (13%) (p = 0.022). The main reason of failure was modification of allocated therapy. Treatment emergent adverse events occurred in 72% and serious adverse events in 17% of patients, the Day 28 mortality was 6%. Cumulative acquisition of CRGNO by Day 28 occurred in 4% of patients in the meropenem and 12% in the SOC arm (p = 0.052). CONCLUSIONS: Within this study population, we found no evidence that meropenem was superior to SOC in terms of success at TOC, short term hearing disturbances, safety or mortality were similar in both treatment arms but the study was underpowered to detect the planned effect. Meropenem treatment did not select for colonization with CRGNOs. We suggest that meropenem as broad-spectrum antibiotic should be reserved for neonates who are more likely to have Gram-negative LOS, especially in NICUs where microorganisms producing extended spectrum- and AmpC type beta-lactamases are circulating.


Assuntos
Meropeném/uso terapêutico , Sepse Neonatal/tratamento farmacológico , Padrão de Cuidado , Feminino , Humanos , Lactente , Masculino , Meropeném/efeitos adversos , Segurança , Resultado do Tratamento
15.
Int J Surg ; 76: 94-100, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32142903

RESUMO

INTRODUCTION: Negative pressure wound therapy (NPWT) dressings reduce wound complications in a variety of settings but it is unclear whether they reduce groin wound complications in closed incisions after vascular surgery. Therefore, we performed a systematic review and meta-analysis. METHODS: Randomised controlled trials on the use of negative pressure wound dressings on closed groin incisions following vascular surgery were identified from an electronic search of abstract databases, conference proceedings and article reference lists. The primary outcome was surgical site infection (SSI) and secondary outcomes were seromas, readmissions within 30 days postoperatively, reoperations and length of stay. RESULTS: 7 exploratory trials involving 935 incisions and an unclear number of patients were identified. 4 trials yielded primary outcome results that favoured NPWT. Meta-analysis found that NPWT dressings reduced SSIs (RR 0.47; 95%CI 0.31-0.70; 3 studies, 422 patients). No other meta-analyses could be performed. CONCLUSION: NPWT dressings are a promising intervention that may reduce the incidence of groin wound complications following vascular surgery. However, further large-scale well-designed studies are needed before NPWT dressings can become the standard of care.


Assuntos
Tratamento de Ferimentos com Pressão Negativa , Infecção da Ferida Cirúrgica/prevenção & controle , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Bandagens , Virilha/cirurgia , Humanos , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reoperação , Seroma/etiologia , Padrão de Cuidado , Infecção da Ferida Cirúrgica/etiologia , Cicatrização
17.
Medicine (Baltimore) ; 99(8): e19158, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080094

RESUMO

BACKGROUND: Shenmai injection (SMI) is a Traditional Chinese Medicine patent prescription consisting of extractions from ophiopogonis radix and ginseng radix rubra. Clinical studies showed that SMI combined with conventional medicine treatment (CMT) can enhance the therapeutic efficacy for dilated cardiomyopathy (DCM). However, there is still a lack of comprehensive and systematic evidence, which urgently requires us to verify its therapeutic efficacy. Hence, we provide a protocol for systematic review and meta-analysis. METHODS: The systematic search on the MEDLINE/PubMed, China National Knowledge Infrastructure (CNKI), Wanfang database, VIP database, the Cochrane Library, Embase and Chinese Biomedical Database (CBM) in Chinese and English language with dates ranging from the earliest record to August 8, 2019. Next, the quality of each trial was assessed according to the criteria of the Cochrane Handbook for Systematic Reviews of Interventions. Then, the outcome data were recorded and pooled by RevMan 5.3 software. RESULTS: The systematic review and meta-analysis aims to review and pool current clinical outcomes of SMI for the adjuvant treatment of DCM. CONCLUSION: This study will provide a high-quality evidence of SMI for the adjuvant treatment on DCM patients. PROSPERO REGISTRATION NUMBER: CRD42019146369.


Assuntos
Cardiomiopatia Dilatada/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Medicina Tradicional Chinesa/métodos , Combinação de Medicamentos , Quimioterapia Combinada , Medicamentos de Ervas Chinesas/administração & dosagem , Testes de Função Cardíaca , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Padrão de Cuidado , Teste de Caminhada
18.
20.
Support Care Cancer ; 28(6): 2533-2540, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32060705

RESUMO

BACKGROUND: Bisphosphonates are wildly used in breast cancer patients with bone metastasis and generally administrated every 4 weeks to lessen the risk of subsequent skeletal-related events. Bisphosphonates administration every 12 weeks is also recommended in some guidelines. Recent clinical trials suggested that bisphosphonate treatment with reduced frequency (every 12 weeks) to be non-inferior to standard therapy. The object of this analysis was to contrast the efficacy and safety of these two treatment strategies. METHOD: We systematically retrieved databases such as MEDLINE, PubMed, Embase, and Cochrane library from 1947 to present for clinical trials comparing the efficacy between standard (every 4 weeks) and de-escalation (every 12 weeks) treatment of bisphosphates. RESULTS: We identified 4 articles with available data from 4 randomized clinical trials (n = 1721). Administration of bisphosphate every 12 weeks was non-inferior to administration every 4 weeks. There existed no significant difference in on-study skeletal-related events, renal dysfunction, and osteonecrosis of jaw. In the exploratory study, patients who received intravenous bisphosphates before enrollment experienced less on-study skeletal-related events and significant difference was observed between groups. CONCLUSION: This analysis suggested that de-escalation treatment with bisphosphates may be superior to standard treatment in terms of efficacy, safety, and economic costs. But it would be better that all the patients receive bisphosphates every 4 weeks for several months before de-escalation.


Assuntos
Conservadores da Densidade Óssea/administração & dosagem , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/secundário , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Difosfonatos/administração & dosagem , Feminino , Humanos , Padrão de Cuidado
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