ABSTRACT
BACKGROUND: Despite atezolizumab and bevacizumab (A + B) is currently the first-line treatment for hepatocellular carcinoma (HCC) patients, some patients will not be adequate for this combination. In the setting of sorafenib some adverse events have been proposed as prognostic factors. OBJECTIVE: To characterize the early diarrhoea development as prognostic factor in 344 HCC patients. METHODS: The development of early diarrhoea in sorafenib treatment defined as patients who developed diarrhoea and needed dose modification within the first 60 days of treatment (e-diarrhoea) and 3-grouping variables were analysed: Patients with e-diarrhoea, patients who developed diarrhoea after the first 60 days of treatment (L-diarrhoea) and patients that never developed diarrhoea (never diarrhoea). RESULTS: The median overall survival in sorafenib treated patients was significantly different across groups (6.8 months for e-diarrhoea, 26.7 months for L-diarrhoea and 13.3 months for never-diarrhoea). The emergence of e-diarrhoea was associated with poor outcomes (hazard ratio [HR] 1.84 [95%CI 1.15-2.95]), while there was no increased/decreased risk of dismal evolution in patients with L-diarrhoea (HR 0.66 [95%CI 0.42-1.03]). CONCLUSION: The emergence of e-diarrhoea in HCC patients treated with sorafenib is an early predictor of dismal evolution under this therapy. Thus, prompt identification of these non-responders may be useful for an early switch to second-line therapies.
Subject(s)
Antineoplastic Agents/therapeutic use , Carcinoma, Hepatocellular/drug therapy , Diarrhea/chemically induced , Liver Neoplasms/drug therapy , Protein Kinase Inhibitors/therapeutic use , Aged , Antineoplastic Agents/adverse effects , Carcinoma, Hepatocellular/complications , Carcinoma, Hepatocellular/mortality , Drug Resistance, Neoplasm , Female , Humans , Liver Neoplasms/complications , Liver Neoplasms/mortality , Male , Middle Aged , Prognosis , Proportional Hazards Models , Protein Kinase Inhibitors/adverse effects , Sorafenib , Survival Rate , Time Factors , Treatment OutcomeABSTRACT
Objetivo - Estudos têm demonstrado que a terapia com beta-bloqueadores reduz a mortalidade em pacientes com insuficiência cardíaca. Entretanto, não há estudos que descrevam os efeitos do propranolol sobre a dispersão do QT nesta população. O objetivo desse trabalho foi avaliar o perfil eletrofisiológico de pacientes com insuficiência cardíaca, sobretudo a dispersão do QT, com o uso crônico do propranolol. Métodos - Durante um período de 12 meses foram avaliados 15 pacientes com insuficiência cardíaca em uso de propranolol. Eletrocardiogramas (ECG) de 12 derivações foram registrados antes do início da terapia com beta-bloqueador e após três meses de uso da droga. Resultados - Observou-se redução significativa da freqüência cardíaca, da dispersão do QT e da dispersão do QTc, assim como um aumento no intervalo PR e no intervalo QT, após o uso de propranolol numa dose média de 100mg/dia. Conclusão - A diminuição da dispersão do QT nos pacientes com insuficiência cardíaca em uso de propranolol pode explicar a redução do risco de morte súbita elétrica com a terapia beta-bloqueadora neste grupo específico de pacientes.
Subject(s)
Female , Humans , Adult , Middle Aged , Adrenergic beta-Agonists/pharmacology , Electrocardiography/drug effects , Heart Failure/drug therapy , Heart Rate/drug effects , Propranolol/pharmacology , Adrenergic beta-Agonists/therapeutic use , Electrophysiology , Heart Failure/physiopathology , Propranolol/therapeutic use , Prospective StudiesABSTRACT
The purpose of this study is to describe two infants that were diagnosed with Walker-Warburg syndrome (WWS), a rare form of congenital muscular dystrophy (CMD). They were studied in their clinical, laboratory, and neuroradiologic features. The index case had a brain magnetic resonance imaging (MRI) and the second patient had a head computerized tomography (CT). In addition, a literature review was performed to describe the main forms of CMD. The index case fulfilled all criteria for WWS. A brain MRI performed at age 4 months served to corroborate the clinical diagnosis, showing severe hydrocephalus, type II lissencephaly, cerebellar vermian aplasia, and a hypoplastic brain stem. The authors were able to establish a retrospective diagnosis of WWS in the index cases's older sister, based upon her clinical picture and head CT report.