Efetividade do Trastuzumabe adjuvante em mulheres com câncer de mama HER-2+ no SUS / Effectiveness of adjuvant trastuzumab in women with HER-2+ breast cancer in the SUS

Resumo O objetivo deste artigo é avaliar a efetividade em estudo de vida real do trastuzumabe adjuvante em mulheres com câncer de mama inicial HER-2 positivo na sobrevida global e livre de recidiva. Foi realizado um estudo de coorte retrospectiva em mulheres com câncer de mama inicial HER-2 positivo atendidas no SUS, desde a incorporação da medicação. Trata-se de uma coorte retrospectiva com mulheres com câncer de mama HER-2 positivo, que foram tratadas entre julho de 2012 e maio de 2017 com seguimento até julho de 2021. A taxa de incidência de óbito foi de 2,62 por 100 pessoa/ano e a de recidiva foi de 7,52 por 100 pessoa/ano. A probabilidade de sobrevida em 8,7 anos foi 85,9%, enquanto a probabilidade de sobrevida livre de doença no mesmo período foi 62,8%. O uso de trastuzumabe se mostrou efetivo no tratamento adjuvante do câncer de mama em um serviço público de saúde no Sul do Brasil. Fatores prognósticos associados com pior sobrevida ou recidiva não influenciaram na história natural da doença, exceto doença localmente avançada no início do tratamento. Os dados apresentados podem vir a ser úteis em auxiliar na tomada de decisão sobre a manutenção ou não do uso do trastuzumabe no tratamento do câncer de mama inicial ou localmente avançado no serviço público de saúde brasileiro.

Abstract The aim of this study was to evaluate the effectiveness in a real-world study of adjuvant trastuzumab in women with HER-2+ initial breast cancer in overall survival and recurrence-free survival. A retrospective cohort study was conducted with women who had HER-2+ breast cancer treated with trastuzumab from July 2012 to May 2017 and followed up until July 2021. The death rate was 2.62 per 100 persons/year, and the incidence rate of recurrence was 7.52 per 100 persons/year. The probability of survival at 8.7 years was 85.9%, while the probability of recurrence-free survival in the same period was 62.8%. The use of trastuzumab proved to be effective in the adjuvant treatment of breast cancer in a public health service in southern Brazil. Prognostic factors associated with worse overall survival or relapse did not influence the natural history of the disease, except locally advanced disease at the beginning of treatment. The data presented may prove to be useful in helping to make decisions about whether to use trastuzumab in the treatment of initial or locally advanced breast cancer in the Brazilian SUS.

Effectiveness of adjuvant trastuzumab in women with HER-2+ breast cancer in the SUS. / Efetividade do Trastuzumabe adjuvante em mulheres com câncer de mama HER-2+ no SUS.

The aim of this study was to evaluate the effectiveness in a real-world study of adjuvant trastuzumab in women with HER-2+ initial breast cancer in overall survival and recurrence-free survival. A retrospective cohort study was conducted with women who had HER-2+ breast cancer treated with trastuzumab from July 2012 to May 2017 and followed up until July 2021. The death rate was 2.62 per 100 persons/year, and the incidence rate of recurrence was 7.52 per 100 persons/year. The probability of survival at 8.7 years was 85.9%, while the probability of recurrence-free survival in the same period was 62.8%. The use of trastuzumab proved to be effective in the adjuvant treatment of breast cancer in a public health service in southern Brazil. Prognostic factors associated with worse overall survival or relapse did not influence the natural history of the disease, except locally advanced disease at the beginning of treatment. The data presented may prove to be useful in helping to make decisions about whether to use trastuzumab in the treatment of initial or locally advanced breast cancer in the Brazilian SUS.

O objetivo deste artigo é avaliar a efetividade em estudo de vida real do trastuzumabe adjuvante em mulheres com câncer de mama inicial HER-2 positivo na sobrevida global e livre de recidiva. Foi realizado um estudo de coorte retrospectiva em mulheres com câncer de mama inicial HER-2 positivo atendidas no SUS, desde a incorporação da medicação. Trata-se de uma coorte retrospectiva com mulheres com câncer de mama HER-2 positivo, que foram tratadas entre julho de 2012 e maio de 2017 com seguimento até julho de 2021. A taxa de incidência de óbito foi de 2,62 por 100 pessoa/ano e a de recidiva foi de 7,52 por 100 pessoa/ano. A probabilidade de sobrevida em 8,7 anos foi 85,9%, enquanto a probabilidade de sobrevida livre de doença no mesmo período foi 62,8%. O uso de trastuzumabe se mostrou efetivo no tratamento adjuvante do câncer de mama em um serviço público de saúde no Sul do Brasil. Fatores prognósticos associados com pior sobrevida ou recidiva não influenciaram na história natural da doença, exceto doença localmente avançada no início do tratamento. Os dados apresentados podem vir a ser úteis em auxiliar na tomada de decisão sobre a manutenção ou não do uso do trastuzumabe no tratamento do câncer de mama inicial ou localmente avançado no serviço público de saúde brasileiro.

Low-Risk Antenatal Care Enhanced by Telemedicine: A Practical Guideline Model / Atenção ao pré-natal de baixo risco potencializada por telemedicina: Diretriz clínica prática

Abstract Objective To develop a protocol for hybrid low-risk prenatal care adapted to Brazilian guidelines, merging reduced face-to-face consultations and remote monitoring. Methods The PubMed, Embase, and Cochrane Library databases were systematically searched on telemedicine and antenatal care perspectives and adaptation of the low-risk prenatal care protocols recommended by the Ministry of Health and by the Brazilian Federation of Gynecology and Obstetrics Associations. Results Five relevant articles and three manuals were included in the review, for presented criteria to develop this clinical guideline. We identified, in these studies, that the schedule of consultations is unevenly distributed among the gestational trimesters, and ranges from 7 to 14 appointments. In general, the authors propose one to two appointments in the first trimester, two to three appointments in the second trimester, and two to six appointments in the third trimester. Only three studies included puerperal evaluations. The routine exams recommended show minimal variations among authors. To date, there are no validated Brazilian protocols for prenatal care by telemedicine. The included studies showed that pregnant women were satisfied with this form of care, and the outcomes of interest, except for hypertensive diseases, were similar between the groups exposed to traditional and hybrid prenatal care. Conclusion The presented guideline comprises the Ministry of Health recommendations for low-risk prenatal care and reduces exposure to the hospital environment and care costs. A randomized clinical trial, to be developed by this group, will provide real-world data on safety, effectiveness, satisfaction, and costs.

Resumo Objetivo Desenvolver uma diretriz clínica híbrida para atendimento pré-natal de baixo risco, mesclando consultas presenciais e remotas por telemedicina, adapta às recomendações brasileiras. Métodos Revisão sistemática da literatura nas bases de dados PubMed, Embase e Cochrane e adaptação dos protocolos de atenção ao pré-natal de baixo risco preconizados pelo Ministério da Saúde e pela Federação Brasileira das Associações de Ginecologia e Obstetrícia. Resultados Cinco artigos relevantes e três manuais foram incluídos na revisão por preencherem critérios para o desenvolvimento desta diretriz clínica. Nos estudos incluídos, identificou-se que o cronograma de consultas se distribui de forma desigual entre os trimestres gestacionais, variando entre 07 e 14 encontros. De forma geral, os autores propõem uma a duas consultas no primeiro trimestre, duas a três consultas no segundo trimestre e duas a seis consultas no terceiro trimestre. Somente três estudos incluíram avaliações puerperais. A rotina de exames preconizada apresenta mínimas variações entre os autores. Até o momento, não existem protocolos brasileiros validados para atendimento pré-natal por telemedicina. Os estudos incluídos evidenciaram a satisfação das gestantes em relação a esta forma de atendimento, e os desfechos de interesse, excetuando doenças hipertensivas, foi semelhante entre os grupos expostos ao pré-natal tradicional e ao pré-natal híbrido. Conclusão A diretriz apresentada contempla as recomendações do Ministério da Saúde para atendimento pré-natal de gestantes de baixo risco, reduz a exposição ao ambiente hospitalar e os custos de atendimento. Seu emprego em um ensaio clínico randomizado, a ser desenvolvido por este grupo, proporcionará dados de mundo real, relativos à segurança, efetividade, satisfação e custos.

Low-Risk Antenatal Care Enhanced by Telemedicine: A Practical Guideline Model.

OBJECTIVE: To develop a protocol for hybrid low-risk prenatal care adapted to Brazilian guidelines, merging reduced face-to-face consultations and remote monitoring. METHODS: The PubMed, Embase, and Cochrane Library databases were systematically searched on telemedicine and antenatal care perspectives and adaptation of the low-risk prenatal care protocols recommended by the Ministry of Health and by the Brazilian Federation of Gynecology and Obstetrics Associations. RESULTS: Five relevant articles and three manuals were included in the review, for presented criteria to develop this clinical guideline. We identified, in these studies, that the schedule of consultations is unevenly distributed among the gestational trimesters, and ranges from 7 to 14 appointments. In general, the authors propose one to two appointments in the first trimester, two to three appointments in the second trimester, and two to six appointments in the third trimester. Only three studies included puerperal evaluations. The routine exams recommended show minimal variations among authors. To date, there are no validated Brazilian protocols for prenatal care by telemedicine. The included studies showed that pregnant women were satisfied with this form of care, and the outcomes of interest, except for hypertensive diseases, were similar between the groups exposed to traditional and hybrid prenatal care. CONCLUSION: The presented guideline comprises the Ministry of Health recommendations for low-risk prenatal care and reduces exposure to the hospital environment and care costs. A randomized clinical trial, to be developed by this group, will provide real-world data on safety, effectiveness, satisfaction, and costs.

OBJETIVO: Desenvolver uma diretriz clínica híbrida para atendimento pré-natal de baixo risco, mesclando consultas presenciais e remotas por telemedicina, adapta às recomendações brasileiras. MéTODOS: Revisão sistemática da literatura nas bases de dados PubMed, Embase e Cochrane e adaptação dos protocolos de atenção ao pré-natal de baixo risco preconizados pelo Ministério da Saúde e pela Federação Brasileira das Associações de Ginecologia e Obstetrícia. RESULTADOS: Cinco artigos relevantes e três manuais foram incluídos na revisão por preencherem critérios para o desenvolvimento desta diretriz clínica. Nos estudos incluídos, identificou-se que o cronograma de consultas se distribui de forma desigual entre os trimestres gestacionais, variando entre 07 e 14 encontros. De forma geral, os autores propõem uma a duas consultas no primeiro trimestre, duas a três consultas no segundo trimestre e duas a seis consultas no terceiro trimestre. Somente três estudos incluíram avaliações puerperais. A rotina de exames preconizada apresenta mínimas variações entre os autores. Até o momento, não existem protocolos brasileiros validados para atendimento pré-natal por telemedicina. Os estudos incluídos evidenciaram a satisfação das gestantes em relação a esta forma de atendimento, e os desfechos de interesse, excetuando doenças hipertensivas, foi semelhante entre os grupos expostos ao pré-natal tradicional e ao pré-natal híbrido. CONCLUSãO: A diretriz apresentada contempla as recomendações do Ministério da Saúde para atendimento pré-natal de gestantes de baixo risco, reduz a exposição ao ambiente hospitalar e os custos de atendimento. Seu emprego em um ensaio clínico randomizado, a ser desenvolvido por este grupo, proporcionará dados de mundo real, relativos à segurança, efetividade, satisfação e custos.

Hematological ratios as prognostic indicators in patients with triple-negative breast cancer in southern Brazil

Introduction: The heterogeneous nature and intrinsically aggressive tumor pathology of the triple negative breast cancer subtype results in an unfavorable prognosis and limited clinical success. The use of hematological components of the systemic inflammatory response for patients with triple-negative breast cancer can add important prognostic information to the criteria traditionally used for cancer patients, since inflammation can promote tumor progression support by affecting the stages of tumorigenesis. Objectives: The aim of this study was to evaluate the hematological parameters neutrophil/lymphocyte, monocyte/lymphocyte and platelet/lymphocyte ratios as prognostic indicators in patients with triple-negative breast cancer. Methods: This was a singlecenter retrospective observational study in an oncology referral hospital in the South region of Brazil. Electronic medical records of patients diagnosed with triple-negative breast cancer from 2012 to 2016 were reviewed and analyzed using SPSS. Results: The low blood cell ratio groups had significantly higher overall survival than the high blood cell ratio groups. Univariate analysis also confirmed the correlation of patients in the high blood cell ratio groups with unfavorable results. Conclusions: Hematological components of the systemic inflammatory response are promising prognostic indicators. More studies on the subject should be carried out to assist in future medical decision-making so these parameters of easy assessment and low cost can be introduced in clinical practice.

Molecular markers associated with the outcome of tamoxifen treatment in estrogen receptor-positive breast cancer patients: scoping review and in silico analysis.

Tamoxifen (TMX) is used as adjuvant therapy for estrogen receptor-positive (ER+) breast cancer cases due to its affinity and inhibitory effects. However, about 30% of cases show drug resistance, resulting in recurrence and metastasis, the leading causes of death. A literature review can help to elucidate the main cellular processes involved in TMX resistance. A scoping review was performed to find clinical studies investigating the association of expression of molecular markers profiles with long-term outcomes in ER+ patients treated with TMX. In silico analysis was performed to assess the interrelationship among the selected markers, evaluating the joint involvement with the biological processes. Forty-five studies were selected according to the inclusion and exclusion criteria. After clustering and gene ontology analysis, 23 molecular markers were significantly associated, forming three clusters of strong correlation with cell cycle regulation, signal transduction of proliferative stimuli, and hormone response involved in morphogenesis and differentiation of mammary gland. Also, it was found that overexpression of markers in selected clusters is a significant indicator of poor overall survival. The proposed review offered a better understanding of independent data from the literature, revealing an integrative network of markers involved in cellular processes that could modulate the response of TMX. Analysis of these mechanisms and their molecular components could improve the effectiveness of TMX.

Proportional weight loss in six months as a risk factor for mortality in stage IV non-small cell lung cancer / Perda de peso proporcional em seis meses como fator de risco para mortalidade no câncer de pulmão de células não pequenas estádio IV

ABSTRACT Objective: To evaluate different weight loss (WL) cut-off points as prognostic markers of 3-month survival after diagnosis of stage IV non-small cell lung cancer (NSCLC). Methods: This was a prospective study involving 104 patients with metastatic (stage IV) NSCLC who were admitted to a cancer treatment center in southern Brazil between January of 2014 and November of 2016. We evaluated total WL and WL per month, as well as WL and WL per month in the 6 months preceding the diagnosis. The patients were followed for 3 months after diagnosis. A Cox proportional hazards regression model and Kaplan-Meier curves were used in order to evaluate 3-month survival. Results: The median WL in the 6 months preceding the diagnosis was 6% (interquartile range, 0.0-12.9%). Patients with WL ≥ 5% had a median survival of 78 days, compared with 85 days for those with WL < 5% (p = 0.047). Survival at 3 months was 72% for the patients with WL ≥ 5% (p = 0.047), 61% for those with WL ≥ 10% (p < 0.001), and 45% for those with WL ≥ 15% (p < 0.001). In the multivariate analysis, the hazard ratio for risk of death was 4.51 (95% CI: 1.32-15.39) for the patients with WL ≥ 5%, 6.34 (95% CI: 2.31-17.40) for those with WL ≥ 10%, and 14.17 (95% CI: 5.06-39.65) for those with WL ≥ 15%. Conclusions: WL in the 6 months preceding the diagnosis of NSCLC is a relevant prognostic factor and appears to be directly proportional to the rate of survival at 3 months.

RESUMO Objetivo: Avaliar diferentes pontos de corte da perda de peso (PP) como marcadores prognósticos de sobrevida em 3 meses após o diagnóstico de câncer de pulmão de células não pequenas estádio IV (CPCNP). Métodos: Estudo prospectivo envolvendo 104 pacientes com CPCNP metastático (estádio IV) que foram internados em um centro de tratamento de câncer no sul do Brasil entre janeiro de 2014 e novembro de 2016. Avaliamos a PP total e PP por mês, bem como PP e PP por mês nos 6 meses anteriores ao diagnóstico. Os pacientes foram acompanhados por 3 meses após o diagnóstico. Um modelo de regressão de riscos proporcionais de Cox e curvas de Kaplan-Meier foram utilizados para avaliar a sobrevida em 3 meses. Resultados: A mediana da PP nos 6 meses anteriores ao diagnóstico foi de 6% (intervalo interquartil, 0,0-12,9%). Pacientes com PP ≥ 5% tiveram uma sobrevida mediana de 78 dias, comparados a 85 dias para aqueles com PP < 5% (p = 0,047). A sobrevida em 3 meses foi de 72% para os pacientes com PP ≥ 5% (p = 0,047), 61% para aqueles com PP ≥ 10% (p < 0,001) e 45% para aqueles com PP ≥ 15% (p < 0,001). Na análise multivariada, a taxa de risco para óbito foi de 4,51 (IC95%: 1,32-15,39) para os pacientes com PP ≥ 5%, 6,34 (IC95%: 2,31-17,40) para aqueles com PP ≥ 10%, e 14,17 (IC95%: 5,06-39,65) para aqueles com PP ≥ 15%. Conclusões: A PP nos 6 meses anteriores ao diagnóstico de CPCNP é um fator prognóstico relevante e parece ser diretamente proporcional à taxa de sobrevida em 3 meses.

Análise de custo-efetividade da abiraterona para câncer de próstata metastático resistente à castração em pacientes com uso prévio de quimioterapia / Cost-effectiveness analysis of abiraterone for metastatic, castrateresistant prostate cancer following previous chemotherapy

Objetivo: Avaliar a custo-utilidade e o impacto orçamentário (IO) da abiraterona para o tratamento de câncer de próstata resistente à castração, em pacientes previamente tratados com docetaxel. Métodos: Foi construído um modelo de Markov com ciclos mensais sob a perspectiva do Sistema Único de Saúde (SUS), em um horizonte temporal de cinco anos e taxa de desconto de 5%. A estimativa de efetividade foi oriunda do principal ensaio clínico dessa condição de saúde. Para dados de utilidade, aplicaram-se estimativas internacionais, enquanto para custos se utilizaram tabelas de remuneração do SUS. Para o IO, a população-alvo foi estimada com base em dados do Departamento de Informática do SUS (DATASUS). Resultados: A abiraterona ocasionou ganho de 1,045 ano de vida ajustado para qualidade (QALY) e 1,609 ano de vida ganho (AVG), enquanto para o placebo esses valores foram de 0,763 e 1,299, respectivamente. O custo total na estratégia abiraterona foi de R$ 83.295 e para o placebo, de R$ 2.895. A relação de custo-efetividade incremental (RCEI) foi de R$ 284.416 por QALY ganho. Em nenhuma das análises de sensibilidade os valores ficaram abaixo de R$ 100.000 por QALY. Mesmo quando variados simultaneamente seis parâmetros, todos no seu limite mais favorável à abiraterona, os resultados seguiram elevados, com RCEI de R$ 98.330 por QALY. O IO foi de R$ 270 milhões em cinco anos no cenário mais conservador (tempo médio de tratamento de 7,4 meses e 10% de novos casos/ano). Conclusão: A abiraterona se mostrou pouco custo-efetiva nesta situação clínica, com RCEI superior a nove vezes o PIB per capita por QALY, sendo os resultados robustos em análise de sensibilidade.

Objective: To evaluate the cost-utility and the budget impact (BI) of abiraterone in patients with castration-resistant prostate cancer previously treated with docetaxel. Methods: A Markov model was constructed, with monthly cycles, under the perspective of the Brazilian Public Healthcare System (SUS), in a 5-year time horizon, and with a 5% discount rate. The effectiveness estimate was obtained from the pivotal clinical trial for abiraterone in this health condition. For utility data, international estimates were applied; while for costs, SUS reimbursement information were used. In the BI analysis, the target population was estimated with claims data from DATASUS. Results: Abiraterone resulted in a gain of 1.045 quality-adjusted life years (QALY) and 1.609 life years gained (LYG), while for placebo these values were 0.763 and 1.299, respectively. The total cost for the abiraterone strategy was BRL 83,295, and for placebo, BRL 2,895. The incremental cost-effectiveness ratio (ICER) was BRL 284,416 per QALY gained. None of the estimates from the sensitivity analysis was below BRL 100,000 per QALY. Even when six parameters were variated simultaneously in the range more favorable to abiraterone, the results were still elevated, with an ICER of BRL 98,330 per QALY. The BI was BRL 270 million in 5 years in the most conservative scenario (average time of the treatment of 7.4 months and 10% of the new cases/year). Conclusion: Abiraterone shows unfavorable cost-effective results for this clinical condition in Brazil, with an ICER above 9 times the per capita per QALY. Results were robust in sensitivity analysis.

Proportional weight loss in six months as a risk factor for mortality in stage IV non-small cell lung cancer.

OBJECTIVE: To evaluate different weight loss (WL) cut-off points as prognostic markers of 3-month survival after diagnosis of stage IV non-small cell lung cancer (NSCLC). METHODS: This was a prospective study involving 104 patients with metastatic (stage IV) NSCLC who were admitted to a cancer treatment center in southern Brazil between January of 2014 and November of 2016. We evaluated total WL and WL per month, as well as WL and WL per month in the 6 months preceding the diagnosis. The patients were followed for 3 months after diagnosis. A Cox proportional hazards regression model and Kaplan-Meier curves were used in order to evaluate 3-month survival. RESULTS: The median WL in the 6 months preceding the diagnosis was 6% (interquartile range, 0.0-12.9%). Patients with WL ≥ 5% had a median survival of 78 days, compared with 85 days for those with WL < 5% (p = 0.047). Survival at 3 months was 72% for the patients with WL ≥ 5% (p = 0.047), 61% for those with WL ≥ 10% (p < 0.001), and 45% for those with WL ≥ 15% (p < 0.001). In the multivariate analysis, the hazard ratio for risk of death was 4.51 (95% CI: 1.32-15.39) for the patients with WL ≥ 5%, 6.34 (95% CI: 2.31-17.40) for those with WL ≥ 10%, and 14.17 (95% CI: 5.06-39.65) for those with WL ≥ 15%. CONCLUSIONS: WL in the 6 months preceding the diagnosis of NSCLC is a relevant prognostic factor and appears to be directly proportional to the rate of survival at 3 months.

A prototype single-port device for pressurized intraperitoneal aerosol chemotherapy. Technical feasibility and local drug distribution

Abstract Purpose: To evaluate the technical feasibility and homogeneity of drug distribution of pressurized intraperitoneal aerosol chemotherapy (PIPAC) based on a novel process of intraperitoneal drug application (multidirectional aerosolization). Methods: This was an in vivo experimental study in pigs. A single-port device was manufactured at the smallest diameter possible for multidirectional aerosolization of the chemotherapeutic drug under positive intraperitoneal pressure. Four domestic pigs were used in the study, one control animal that received multidirectional microjets of 9 mL/sec for 30 min and three animals that received multidirectional aerosolization (pig 02: 9 mL/sec for 30 min; pigs 03 and 04: 3 mL/sec for 15 min). Aerosolized silver nitrate solution was applied for anatomopathological evaluation of intraperitoneal drug distribution. Results: Injection time was able to maintain the pneumoperitoneum pressure below 20 mmHg. The rate of moderate silver nitrate staining was 45.4% for pig 01, 36.3% for pig 02, 36.3% for pig 03, and 72.7% for pig 04. Conclusions: Intra-abdominal drug distribution had a broad pattern, especially in animals exposed to the drug for 30 min. Our sample of only four animals was not large enough to demonstrate an association between aerosolization and a higher silver nitrate concentration in the stained abdominal regions.

A prototype single-port device for pressurized intraperitoneal aerosol chemotherapy. Technical feasibility and local drug distribution.

PURPOSE: To evaluate the technical feasibility and homogeneity of drug distribution of pressurized intraperitoneal aerosol chemotherapy (PIPAC) based on a novel process of intraperitoneal drug application (multidirectional aerosolization). METHODS: This was an in vivo experimental study in pigs. A single-port device was manufactured at the smallest diameter possible for multidirectional aerosolization of the chemotherapeutic drug under positive intraperitoneal pressure. Four domestic pigs were used in the study, one control animal that received multidirectional microjets of 9 mL/sec for 30 min and three animals that received multidirectional aerosolization (pig 02: 9 mL/sec for 30 min; pigs 03 and 04: 3 mL/sec for 15 min). Aerosolized silver nitrate solution was applied for anatomopathological evaluation of intraperitoneal drug distribution. RESULTS: Injection time was able to maintain the pneumoperitoneum pressure below 20 mmHg. The rate of moderate silver nitrate staining was 45.4% for pig 01, 36.3% for pig 02, 36.3% for pig 03, and 72.7% for pig 04. CONCLUSIONS: Intra-abdominal drug distribution had a broad pattern, especially in animals exposed to the drug for 30 min. Our sample of only four animals was not large enough to demonstrate an association between aerosolization and a higher silver nitrate concentration in the stained abdominal regions.

A case of late-onset oligomeganephronia / Um caso de oligomeganefronia de início tardio

A 33-year old caucasian man was investigated for pain in the right flank, proteinuria, hemathuria and an elevated serum creatinine level. He also presented an abnormal ultrasonography, which revealed asymmetric kidneys. Through renal biopsy, the diagnosis of oligomeganephronia (OMN) was confirmed. OMN is a very rare form of renal hypoplasia, and late-onset in adulthood is even rarer. In the pediatric population, OMN leads to end-stage-renal-failure(ESRF) in a few years. This is the sixth case related in the literature of a late-onset OMN who have not yet developed ESRF.

Paciente do sexo masculino, 33 anos de idade, foi investigado por apresentar um quadro de dor abdominal em flanco direito, proteinúria, hematúria e níveis elevados de creatinina sérica. A ultrassonografia evidenciou rins de tamanhos assimétricos, e a biópsia renal confirmou o diagnóstico de oligomeganefronia (OMN). OMN é uma forma muito rara de hipoplasia renal, e ainda mais infrequente na faixa etária adulta. Na população pediátrica, OMN culmina com insuficiência renal terminal em poucos anos. Este é o sexto caso de oligomeganefronia de início tardio relatado na literatura, que ainda não teve evolução para insuficiência renal crônica.

A case of late-onset oligomeganephronia.

A 33-year old caucasian man was investigated for pain in the right flank, proteinuria, hemathuria and an elevated serum creatinine level. He also presented an abnormal ultrasonography, which revealed asymmetric kidneys. Through renal biopsy, the diagnosis of oligomeganephronia (OMN) was confirmed. OMN is a very rare form of renal hypoplasia, and late-onset in adulthood is even rarer. In the pediatric population, OMN leads to end-stage-renal-failure(ESRF) in a few years. This is the sixth case related in the literature of a late-onset OMN who have not yet developed ESRF.

Icterícia como causa de internação neonatal: a experiência em um serviço terciário de Porto Alegre, RS / Jaundice in healthy term newborns treated at a tertiary center in Porto Alegre, RS

Introdução: Cerca de 60-80% dos recém-nascidos (RN) tornam-se ictéricos durante os primeiros dias de vida. Apesar de geralmente representar um fenômeno transitório, alguns pacientes necessitam de tratamento hospitalar. O objetivo deste estudo foi determinar a causa principal de icterícia neonatal em recém-nascidos saudáveis internados no Hospital Luterano e possíveis associações com diversas variáveis clínicas. Metodologia: Estudo retrospectivo em que foram estudados todos os casos de RN com icterícia neonatal internados para tratamento de hiperbilirrubinemia na UTI Neonatal do Hospital Luterano da ULBRA, no período de abril de 2007 a dezembro de 2008. Os resultados foram expressos em estatística descritiva e foi utilizado o teste exato de Fischer e o teste Qui-quadrado. O limite alfa considerado foi de 5%, com nível de significância de 0,05. Resultados: Dentre os RNs estudados (74), 52,7% eram do sexo masculino e 45,9% eram do sexo feminino. 14,8% dos pacientes nasceram de parto vaginal, enquanto que 85,1% nasceram de cesárea. A maioria dos recém-nascidos estudados (74,3%) foi considerada a termo. O diagnóstico mais frequente (37,8%) de icterícia dos pacientes internados para tratamento no serviço foi o de baixo aporte. Os pacientes do sexo masculino necessitaram de maior tempo de fototerapia do que as pacientes do sexo feminino (p=0,056). Conclusão: O diagnóstico de baixo aporte recebido pelos pacientes foi a causa mais frequente de icterícia. Os meninos necessitaram de um tempo significativamente maior de fototerapia para o tratamento da icterícia do que as meninas; também houve associação positiva da hiperbilirrubinemia com a baixa idade.

Introduction: About 60-80% of the newborns (NB) experience jaundice in the first days of life. Although jaundice is often a transitory phenomenon, some infants require hospital care. The aim of this study was to determine the main cause of neonatal jaundice among healthy newborns admitted to the Hospital Luterano and the possible associations with a number of clinical variables. Methods: A retrospective study in which all cases of NB with neonatal jaundice admitted for treatment of hyperbilirubinemia at the Neonatal ICU of the Hospital Luterano of ULBRA were studied, from Apr 2007 to Dec 2008. The results were expressed as descriptive statistics, and Fisher’s exact test and the Chi-square test were applied. The alpha limit considered was 5%, with level of significance at 0.05. Results: Among the 74 NB studied, 52.7% were males and 45.9% were females. 14.8% of the infants had a vaginal birth, while 85.1% had a cesarean delivery. Most of the studied infants (74.3%) were born full term. The most frequent cause for (37.8%) jaundice among these patients was inadequate intake. The male patients needed to stay longer on phototherapy than female patients (p=0.056). Conclusion: Low intake by the patient was the most frequent cause of jaundice in this series. The boys needed significantly more time on phototherapy than females, and there was a positive association of hyperbilirubinemia with low age.

Antidepressant behavioral effects of duloxetine and amitriptyline in the rat forced swimming test / Efeitos antidepressivos da duloxetina e da amitriptilina no teste do nado forçado em ratos

PURPOSE: To compare the effects of the antidepressant drugs duloxetine and amitriptyline on depressive behaviors in rats. METHODS: Fifteen male Wistar rats were given systemic injections of duloxetine, amitriptyline or saline prior to a Forced Swimming Test (FST). Immobility and number of stops were measured. Data were analyzed by one-way ANOVA and Kruskall-Wallis. RESULTS: Rats given injections of duloxetine displayed fewer stops than the amitriptyline and control group (p< 0.05). The control group and Amitriptyline showed no difference (p=0.8). CONCLUSION: Duloxetine reduced depressive behaviors in the Forced Swimming Test been more effective than amitriptyline.

OBJETIVO: Comparar o efeito antidepressivo da droga cloridrato de duloxetina com a amitriptilina. MÉTODOS: O teste do nado forçado, teste comportamental que avalia a atividade antidepressiva em ratos, foi utilizado em 15 ratos Wistar, machos adultos, divididos em três grupos iguais: duloxetina, amitriptilina e controle. Os dados foram analisados pelo teste One-way ANOVA e Kruskall-Wallis. RESULTADOS: Houve diferença significativa entre o número de paradas (p <0,05) entre os grupos duloxetina e amitriptilina e o grupo controle. Grupo amitriptilina e controle não apresentaram diferença (p=0,8). CONCLUSÃO: A duloxetina reduziu o comportamento depressivo sendo mais efetiva do que a amitriptilina.

Antidepressant behavioral effects of duloxetine and amitriptyline in the rat forced swimming test.

PURPOSE: To compare the effects of the antidepressant drugs duloxetine and amitriptyline on depressive behaviors in rats. METHODS: Fifteen male Wistar rats were given systemic injections of duloxetine, amitriptyline or saline prior to a Forced Swimming Test (FST). Immobility and number of stops were measured. Data were analyzed by one-way ANOVA and Kruskall-Wallis. RESULTS: Rats given injections of duloxetine displayed fewer stops than the amitriptyline and control group (p< 0.05). The control group and Amitriptyline showed no difference (p=0.8). CONCLUSION: Duloxetine reduced depressive behaviors in the Forced Swimming Test been more effective than amitriptyline.

The evaluation of maté (Ilex paraguariensis) genetic toxicity in human lymphocytes by the cytokinesis-block in the micronucleus assay.

The present study evaluates the clastogenic and/or aneugenic potential of maté (Ilex paraguariensis) - previously tested for the presence of 48 organophosphorous pesticides - in the culture of human lymphocytes in the absence of exogenous metabolic activation. Peripheral blood was obtained once from three healthy female donors for lymphocyte cell cultures. The cultures were treated with maté infusion (filtered in sterilized sartorius filter with a 0.22 mm pore membrane), distilled water (negative control), and 6 microg/ml bleomycin (positive control). For each experimental person, 3000 binucleated cells (BN) from two independent cultures (1000 cells from replicate cultures) were scored for the presence of micronuclei (MN). No statistical differences between maté infusion concentrations were observed: 1400 microg/ml (0.001+/-0.002), 700 microg/ml (0.0006+/-0.0015), 350 microg/ml (0.002+/-0.002), 175 microg/ml (0.002+/-0.003) and negative control (0.001+/-0.001). The present findings show that there is no clastogenic or/and aneugenic basis underlying maté action in the CBMN assay.

Eventos adversos da vacina contra influenza em uma amostra de idosos de Porto Alegre/RS / Adverse effects of the influenza vaccine in elderly patients

Introdução: Há poucos dados sistematizados sobre eventos adversos da vacina contra influenza no Brasil. Objetivos: Estimar a freqüência de eventos adversos da vacina contra influenza, além de analisar queixas pós-vacinais na população-alvo da campanha. Materiais e métodos: Coorte contemporânea montada com 240 pacientes durante a Campanha Nacional de Vacinação do Idoso, em Porto Alegre. A coleta dos dados iniciou durante a vacinação e foi concluída depois de decorridos 15 dias da vacinação. As variáveis foram inicialmente analisadas com estatística descritiva. A associação bivariada entre variáveis qualitativas foi analisada pelo teste do qui-quadrado e com variáveis quantitativas, através do teste t de Student. Uma análise multivariada por meio de regressão logística foi realizada para testar a associação de pelo menos um efeito adverso da vacina com sexo, idade e presença de morbidades prévias. Foi adotado intervalo de confiança de 95%. Resultados: De 240 idosos, 22,08% (n=53) referiram pelo menos um sintoma pós-vacinal. Dos 53 idosos que apresentaram eventos adversos, 10,80% relataram apenas um sintoma, seguido de 5,40% com dois ou mais sintomas. A dor no local da injeção foi evento mais freqüente (12,50%), seguido de sintomas respiratórios (6,66%). Conclusões: A aná- lise multivariada não encontrou associação de efeitos adversos com as variáveis sexo, idade, trabalho, aposentadoria, morbidades pré-existentes e serviço de saúde. A vacina contra a gripe se mostrou pouco reatogênica quando aplicada em idosos (AU)

Background: Influenza immunization has been recommended for mature individuals over sixty-years old. At this time the unfavorable endorsements of the vaccine and the lack of documentation in the medical field in Brazil is changing. Purpose: The purpose of this survey was to identify and document various complaints by the elder patients after taking the vaccine. Methods: The survey was conducted by the Community Health Center Jardim Leopoldina in Porto Alegre, Brasil where we tested a total of two-hundred and forty (240) elderly patients, age 60 and above. Adverse events and complaints of influenza immunization were assessed. Statistical analyses admitted a confidence level of 95%, p < 0.05. Results: Fifty-three patients (22.08%) reported at least one occurrence after vaccine. Twenty-five patients (10.80%) had one incident; thirteen patients (5.40%) had two or more events. The two most common and frequent complaints were: localized pain (N=30 or 12.5%) & Upper respiratory illness (n=16 or 6.66%). Conclusions: It is our findings that gender, age, performance, type of work the patient does, & health condition were not related to the results. The influenza vaccine was well-tolerated by the patients over sixty with no vaccine associated to severe adverse effects (AU)

Antidepressant behavioral effects of duloxetine and fluoxetine in the rat forced swimming test.

PURPOSE: To compare the effects of the antidepressant drugs duloxetine and fluoxetine on depressive behaviors in rodents. METHODS: Eighteen male Wistar rats were given systemic injections of duloxetine, fluoxetine, or saline prior to a Forced Swimming Test (FST). Immobility and number of stops were measured. RESULTS: Rats given injections of fluoxetine displayed significantly less immobility (p = 0.02) and fewer stops than the control group (p = 0.003). Duloxetine significantly reduced the number of stops (p = 0.003), but did not effect immobility (p = 0.48). CONCLUSION: Duloxetine and fluoxetine reduced depressive behaviors in the Forced FST. However, our findings suggest that fluoxetine is more effective than duloxetine.

Antidepressant behavioral effects of duloxetine and fluoxetine in the rat forced swimming test

PURPOSE: To compare the effects of the antidepressant drugs duloxetine and fluoxetine on depressive behaviors in rodents. METHODS: Eighteen male Wistar rats were given systemic injections of duloxetine, fluoxetine, or saline prior to a Forced Swimming Test (FST). Immobility and number of stops were measured. RESULTS: Rats given injections of fluoxetine displayed significantly less immobility (p = 0.02) and fewer stops than the control group (p = 0.003). Duloxetine significanlty reduced the number of stops (p = 0.003), but did not effect immobility (p = 0.48). CONCLUSION: Duloxetine and fluoxetine reduced depressive behaviors in the Forced FST. However, our findings suggest that fluoxetine is more effective than duloxetine.

OBJETIVO: Comparar o efeito antidepressivo da droga cloridrato de duloxetina com a fluoxetina. MÉTODOS: O teste do nado forçado, teste comportamental que avalia a atividade antidepressiva em ratos, foi utilizado em 18 ratos Wistar, machos adultos, divididos em três grupos iguais: duloxetina, fluoxetina e controle. RESULTADOS: Os dados do teste do nado forçado foram analisados pelo teste One-way ANOVA, Mann Whitney e Kruskall-Wallis.Houve diferença significativa (p = 0,003) entre o número de paradas dos grupos duloxetina e fluoxetina e o grupo controle. CONCLUSÃO: A duloxetina e a fluoxetina tiveram frequência de paradas similares. A fluoxetina mostrou ser mais efetiva que a duloxetina no teste do nado forçado em ratos.