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1.
Artigo em Inglês | MEDLINE | ID: mdl-32376758

RESUMO

OBJECTIVES: Opioid-induced constipation (OIC) can affect up to 63% of all patients with cancer. The objectives of this study were to assess quality of life as well as efficacy and safety of naloxegol, in patients with cancer with OIC. METHODS: An observational study was made of a cohort of patients with cancer and with OIC exhibiting an inadequate response to laxatives and treated with naloxegol. The sample consisted of adult outpatients with a Karnofsky performance status score ≥50. The Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL) and the Patient Assessment of Constipation Symptoms (PAC-SYM) were applied for 3 months. RESULTS: A total of 126 patients (58.2% males) with a mean age of 61.3 years (range 34-89) were included. Clinically relevant improvements (>0.5 points) were recorded in the PAC-QOL and PAC-SYM questionnaires (p<0.0001) from 15 days of treatment. The number of days a week with complete spontaneous bowel movements increased significantly (p<0.0001) from 2.4 to 4.6 on day 15, 4.7 after 1 month and 5 after 3 months. Pain control significantly improved (p<0.0001) during follow-up. A total of 13.5% of the patients (17/126) presented some gastrointestinal adverse reaction, mostly of mild (62.5%) or moderate intensity (25%). CONCLUSIONS: Clinically relevant improvements in OIC-related quality of life, number of bowel movements and constipation-related symptoms were recorded as early as after 15 days of treatment with naloxegol in patients with cancer and OIC, with a good safety profile.

2.
Cureus ; 11(9): e5640, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31700743

RESUMO

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare disorder that is commonly underdiagnosed. In 2015, it was recognized by the World Health Organization (WHO) classification of lung tumors as a premalignant lesion. DIPNECH syndrome is characterized by cough, exertional dyspnea, wheezing, and, less frequently, hemoptysis. We report the clinical and histological features and imaging findings in four cases of DIPNECH from our institution (Torrejon University Hospital, Madrid, Spain) between the years 2012 and 2019. DIPNECH represents a rare and poorly understood pulmonary disorder. Our limited single-center experience shows the slow and stable evolution of the disease. However, some exceptional cases may progress poorly if distant metastases occur.

4.
Breast J ; 25(5): 967-970, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31155832

RESUMO

Advanced triple negative breast cancer (TNBC) is an aggressive disease (high probability of visceral metastasis) with poor outcome. Triple negative breast cancer is characterized by lack of expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2), high histologic grade, and high mitotic rate. Chemotherapy remains the primary systemic treatment, with international guidelines supporting the use of single-agent taxanes (with or without bevacizumab) or anthracyclines as first-line therapy, with a median overall survival of approximately 18 months or less. Given the suboptimal outcomes with chemotherapy, new targeted therapies for advanced TNBC are urgently needed. This review summarizes the current status of treatment, and future challenges of using new treatment options for advanced TNBC, such as poly-adenosine-diphosphate-ribose-polymerase inhibitors (olaparib and talazoparib) and immune checkpoint inhibitors (eg atezolizumab) as monotherapy or in combination with chemotherapy.

5.
J Geriatr Oncol ; 10(4): 643-652, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31036463

RESUMO

OBJECTIVES: We aimed to generate expert-based recommendations on the management of breakthrough cancer pain (BTcP) in older patients with cancer. MATERIAL AND METHODS: A two-round multidisciplinary Delphi study. Specialists rated their agreement with a set of statements using a nine-point Likert scale (one = totally disagree and nine = totally agree). Statements were classified as appropriate (median ranged from seven to nine), irrelevant (median ranged from four to six) or inappropriate (median ranged from one to three). Consensus was established when at least two thirds of the panel scored within any of the ranges. RESULTS: A total of 64 specialists from pain units (44.4%), palliative care units (25.4%), medical oncology (19.1%), geriatric medicine (7.9%) and others (3.2%), participated in two consultation rounds. Specialists agreed that effective coordination between the different specialties and levels of care is essential for proper management of BTcP. Most participants (81.3%) supported the assessment of frailty and resolved (96.8%) that frailty status is a better indicator of patient needs than biological age. Participants agreed (75.8%) in the application of the Davies algorithm for diagnosis of BTcP in older patients. A strong consensus was achieved regarding which pharmacological treatment (transmucosal fentanyl) and dosing method (start low and go slow) are the most suitable for the older population. No agreement was reached on how interventionist techniques should be integrated into the therapeutic strategy for BTcP. CONCLUSIONS: The present Delphi has generated a set of recommendations that will help healthcare professionals in the management of BTcP in older patients.

7.
J Palliat Med ; 22(4): 413-419, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30452307

RESUMO

BACKGROUND: Episodic dyspnea is an increasingly recognized phenomenon that occurs frequently in patients with cancer. Although numerous definitions have been proposed to describe episodic dyspnea, to date, no common widely accepted definition in Spanish has yet emerged. Without a clear well-accepted definition, it is difficult to design rigorous clinical trials to evaluate candidate treatments for this emerging entity and to compare outcomes among studies. OBJECTIVE: The aim of the study was to reach a consensus definition of episodic dyspnea in the Spanish language based on professional criteria in cancer patients. DESIGN: A two-round Delphi study. SETTING/SUBJECTS: Sixty-one Spanish specialists in medical oncology, radiation oncology, pneumology, palliative care, and pain management participated in the study. MEASUREMENTS: Sixteen different questions on dyspnea-related terminology, including the definition of episodic dyspnea, were assessed. RESULTS: The panel of experts reached a consensus on 75% of the 16 assessments proposed: 56.25% in agreement and 18.75% in disagreement. The term that most panelists considered most appropriate to define dyspnea exacerbation was dyspnea crisis. The panelists disagreed that dyspnea exacerbation is equivalent to dyspnea at effort and that the presence of dyspnea at rest is required for exacerbation to occur. However, there was wide agreement that exacerbation may or may not be predictable and can be triggered by comorbidities as well as emotional, environmental, or effort factors. CONCLUSIONS: The broad consensus reached in this study is a necessary first step to design high-quality methodological studies to better understand episodic dyspnea and improve treatment.

8.
Cureus ; 10(7): e2982, 2018 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-30237943

RESUMO

Thymic carcinomas are the most aggressive histological subtype of thymic tumors with limited data to guide correct management. No standard treatments are available for patients with advanced thymic carcinoma after progressing while on platinum-based chemotherapy. We present a case of a patient with metastatic thymic carcinoma with an unusual response and favorable evolution after receiving treatment with sunitinib, obtaining a progression-free survival of 23 months, much higher than reported to date. We review the literature on the efficacy of sunitinib in metastatic thymic carcinoma after progression to first-line treatment with platinum combinations.

9.
Medwave ; 18(3): e7211, 2018 Jun 12.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-29920510

RESUMO

INTRODUCTION: Although breakthrough dyspnea is very frequent in cancer patients, there are no precise recommendations for treating it. The main objective of this study was to analyze what treatments are used in clinical practice for the management of breakthrough dyspnea in cancer patients in Spain and the secondary objectives were to describe the characteristics of cancer patients with breakthrough dyspnea and the attributes of the disorder. METHODS: Cancer patients over 18 years of age, with breakthrough dyspnea and a Karnofsky performance score of ≥30, who were treated at departments of oncology in institutes across Spain were included in this cross-sectional observational study. The characteristics of breakthrough dyspnea, history of treatment, anthropometric variables, Mahler dyspnea index, Borg scale, Edmonton Symptoms Assessment Scale, and patient satisfaction with current breakthrough dyspnea treatment were assessed. RESULTS: The mean age of the 149 included patients was 66 years (95% confidence interval: 64.3 to 67.9), and 53 were females (35.6%). The mean breakthrough dyspnea intensity was 5.85 (95% confidence interval 5.48 to 6.22, Borg scale). A total of 55.1% of the first-choice treatments consisted of opioids, followed by oxygen (17.3%). A total of 119 patients (79.9%) received monotherapy for breakthrough dyspnea. Patients presenting with basal dyspnea received oxygen in a greater proportion of cases (21.1% vs 7.4%; p = 0.07). Patients with predictable dyspnea received a greater proportion of opioids (70.9% vs 44.4%; p = 0.01). CONCLUSIONS: Opioids constitute first-line therapy for breakthrough dyspnea in routine clinical practice, though the scientific evidence supporting their use is scarce. Further information derived from controlled clinical trials is needed regarding the comparative efficacy of the different treatments in order to justify their use.


Assuntos
Analgésicos Opioides/administração & dosagem , Dispneia/tratamento farmacológico , Neoplasias/complicações , Oxigênio/administração & dosagem , Idoso , Estudos Transversais , Dispneia/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espanha
10.
Asia Pac J Clin Oncol ; 14(1): 32-39, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28815913

RESUMO

Triple negative breast cancer (TNBC) is a heterogeneous disease, not only on the molecular level, but also on the pathologic and clinical levels. It also has a distinct epidemiology. TNBCs are frequently of high histologic grade, typically more aggressive and difficult to treat than hormone receptor-positive tumors, and they are associated with a higher risk of early relapse with visceral metastasis after surgery, chemotherapy and/or radiotherapy. The lack of estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 expression precludes the use of targeted therapies in advanced stages, and the only approved systemic treatment option is chemotherapy with or without bevacizumab. In patients with advanced TNBC, responses to chemotherapy occur, but are often of short duration and it is associated with poor prognosis. The median overall survival for patients with metastatic TNBC is about 9-12 months with conventional cytotoxic agents. Given the suboptimal outcomes with chemotherapy, new targeted therapies for TNBC are urgently needed. This review summarizes the clinical efficacy, perspectives and future challenges of using new treatment options for metastatic TNBC, such as poly-ADP-ribose-polymerase inhibitors, antiandrogen therapies and immune checkpoint inhibitors (antiprogrammed death receptor-1/PD-L1 monoclonal antibodies).


Assuntos
Neoplasias de Mama Triplo Negativas/terapia , Feminino , Humanos , Neoplasias de Mama Triplo Negativas/metabolismo , Neoplasias de Mama Triplo Negativas/patologia
11.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 52(5): 271-277, sept.-oct. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-165608

RESUMO

El dolor irruptivo se define como una exacerbación aguda del dolor de rápida aparición, corta duración y de intensidad moderada o elevada, que ocurre de forma espontánea o en relación con un evento predecible o no predecible a pesar de existir un dolor basal estabilizado y controlado. Sin embargo, existen dudas sobre la definición, terminología, epidemiología y valoración del dolor irruptivo sin una clara contestación y consenso, especialmente en la población anciana. En esta revisión no sistematizada se intentarán sintetizar y resumir los aspectos más relevantes del dolor irruptivo en los ancianos en base a las escasas publicaciones existentes en dicho grupo poblacional (AU)


Breakthrough pain is defined as an acute exacerbation of pain with rapid onset, short duration and moderate or high intensity, which occurs spontaneously or in connection with a predictable or unpredictable event despite there being stabilised and controlled baseline pain. However, there are doubts about the definition, terminology, epidemiology, and assessment of breakthrough pain, with no clear answers or consensus, especially in the elderly population. This non-systematic review summarises the most important aspects of breakthrough pain in the elderly, based on the limited publications there are in that population group (AU)


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Dor/epidemiologia , Manejo da Dor/métodos , Dor Crônica/terapia , Erros de Medicação/efeitos adversos , Erros de Medicação/prevenção & controle , Neoplasias/tratamento farmacológico , Espanha/epidemiologia , Prognóstico , Analgésicos/administração & dosagem
12.
Medwave ; 17(6): e7007, 2017 Jul 31.
Artigo em Espanhol | MEDLINE | ID: mdl-28777782

RESUMO

There are no approved therapeutic regimes for adrenal carcinoma following progression to a first line of chemotherapy/mitotane although a high percentage of patients are candidates to receive them. In the present article we review the possible therapeutic alternatives after the progression to a first line of treatment in patients with adrenal carcinoma and we report a case in which a prolonged overall survival is achieved, much higher than expected, probably in relation to the multidisciplinary management of the case and the use of most of the therapeutic arsenal available.


Assuntos
Neoplasias do Córtex Suprarrenal/tratamento farmacológico , Carcinoma Adrenocortical/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Córtex Suprarrenal/patologia , Carcinoma Adrenocortical/patologia , Adulto , Humanos , Masculino , Mitotano/administração & dosagem , Cuidados Paliativos/métodos , Equipe de Assistência ao Paciente/organização & administração , Taxa de Sobrevida
13.
Rev Esp Geriatr Gerontol ; 52(5): 271-277, 2017.
Artigo em Espanhol | MEDLINE | ID: mdl-27979661

RESUMO

Breakthrough pain is defined as an acute exacerbation of pain with rapid onset, short duration and moderate or high intensity, which occurs spontaneously or in connection with a predictable or unpredictable event despite there being stabilised and controlled baseline pain. However, there are doubts about the definition, terminology, epidemiology, and assessment of breakthrough pain, with no clear answers or consensus, especially in the elderly population. This non-systematic review summarises the most important aspects of breakthrough pain in the elderly, based on the limited publications there are in that population group.


Assuntos
Dor do Câncer , Idoso , Algoritmos , Dor do Câncer/diagnóstico , Dor do Câncer/terapia , Progressão da Doença , Humanos , Manejo da Dor , Medição da Dor
14.
Support Care Cancer ; 24(9): 4045-55, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27334130

RESUMO

BACKGROUND: Episodic breathlessness (EB) or dyspnea is a common symptom with a very negative impact on the quality of life of patients with cancer and with non-oncological advanced diseases, mainly cardiorespiratory and neurological. OBJECTIVE: The purpose of this non-systematic review is to ascertain the role played by opioids in the management of episodic breathlessness. METHODS: A non-systematic literature review was done in the databases MEDLINE, COCHRANE, and DATABASE, and articles of greater scientific rigor, mainly reviews or prospective studies/randomized clinical trials published to date (August 2015), were selected. Terms used in the search included episodic breathlessness, acute breathlessness, episodic dyspnea, opioids, morphine, fentanyl, oxycodone, and breakthrough dyspnea. CONCLUSIONS: Although the pathophysiology and mechanism of action of opioids for management of breathlessness, and specifically EB, are not fully known, there is scientific evidence, and particularly great clinical evidence, of the benefit of this drug class for dyspnea management. It is important to differentiate hospitalized patients from outpatients because venous or subcutaneous access is easier in hospitalized patients, but use of transmucosal fentanyl, especially in faster formulations like intranasal application, opens up new possibilities to manage outpatients due to its fast onset of action. The main problem is the lack of data available and the multitude of unanswered questions about opioid type, administration route, safety, and dose titration.


Assuntos
Analgésicos Opioides/uso terapêutico , Dispneia/tratamento farmacológico , Neoplasias/fisiopatologia , Humanos , Neoplasias/tratamento farmacológico , Estudos Prospectivos , Qualidade de Vida
15.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 51(3): 159-163, mayo-jun. 2016. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-152828

RESUMO

Es muy difícil estimar la prevalencia del dolor neuropático ya que la mayoría de los estudios que evalúan el dolor crónico no diferencian el nociceptivo del neuropático. Aún más complicado es obtener información de estudios que aborden específicamente el dolor neuropático en ancianos y más concretamente en población oncológica. En esta revisión no sistemática se analizan los artículos más relevantes acerca de la prevalencia y etiopatogenia del dolor oncológico neuropático en el anciano (AU)


The prevalence of neuropathic pain is difficult to estimate as most studies evaluating chronic pain do not differentiate neuropathic from nociceptive pain. There are only a few studies of neuropathic pain in the elderly, specifically in the oncology population. This article is a non-systematic review of the relevant evidence on the prevalence and aetiopathogenesis of neuropathic cancer pain in the elderly (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Polineuropatia Paraneoplásica/epidemiologia , Polineuropatia Paraneoplásica/etiologia , Polineuropatia Paraneoplásica/patologia , Dor/epidemiologia , Dor/etiologia , Dor/patologia , Citotoxinas/uso terapêutico , Neuralgia/tratamento farmacológico , Dor Crônica/etiologia , Dor Crônica/patologia , Propriocepção , Algoritmos
16.
Rev Esp Geriatr Gerontol ; 51(3): 159-63, 2016.
Artigo em Espanhol | MEDLINE | ID: mdl-26318582

RESUMO

The prevalence of neuropathic pain is difficult to estimate as most studies evaluating chronic pain do not differentiate neuropathic from nociceptive pain. There are only a few studies of neuropathic pain in the elderly, specifically in the oncology population. This article is a non-systematic review of the relevant evidence on the prevalence and aetiopathogenesis of neuropathic cancer pain in the elderly.


Assuntos
Neoplasias/complicações , Neuralgia/epidemiologia , Idoso , Humanos , Medição da Dor , Prevalência
17.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 50(6): 289-297, nov.-dic. 2015. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-143501

RESUMO

El dolor es un síntoma muy prevalente en los pacientes geriátricos oncológicos, apareciendo hasta en el 90% en las fases finales de la enfermedad. Requiere de un manejo multidimensional, con un alto porcentaje de valoración y tratamiento inadecuado. El dolor no reconocido o tratado deficientemente en la población geriátrica, y especialmente en los pacientes oncológicos, conlleva la aparición de síntomas invalidantes como depresión, ansiedad, aislamiento, alteraciones del sueño y del apetito, y muy especialmente pérdida de la capacidad funcional y de la calidad de vida. En esta revisión pretendemos analizar los estudios más relevantes sobre el diagnóstico y manejo del dolor en población de edad avanzada con patología oncológica (AU)


Pain is a prevalent symptom in cancer geriatric patients, appearing in up to 90% of patients with terminal cancer. This requires a multidimensional approach, as there is a high percentage of inappropriate assessments and treatments. Unrecognized or poorly treated pain in the geriatric population, especially in cancer patients, leads to the development of disabling symptoms such as depression, anxiety, isolation, sleep disturbances, and appetite, and very especially, loss of functional capacity and quality of life. In this review an analysis is made on the most relevant studies on the diagnosis and management of cancer pain in the geriatric population (AU)


Assuntos
Idoso de 80 Anos ou mais , Idoso , Feminino , Humanos , Masculino , Neoplasias/complicações , Dor/epidemiologia , Manejo da Dor/métodos , Manejo da Dor , Ansiedade/complicações , Ansiedade/terapia , Doença Crônica/tratamento farmacológico , Doença Crônica/epidemiologia , Doença Crônica/prevenção & controle , Analgésicos/uso terapêutico , Manejo da Dor/normas , Manejo da Dor/tendências , Depressão/complicações , Dor/prevenção & controle , Depressão/epidemiologia , Sociedades Médicas/ética , Sociedades Médicas/organização & administração , Sociedades Médicas/normas , Comissão de Ética/organização & administração , Comissão de Ética/normas
18.
Med. paliat ; 22(supl.1): 57-61, mayo 2015. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-143191

RESUMO

A pesar del tratamiento adecuado del dolor basal crónico con opioides mayores, determinados pacientes sufren exacerbaciones transitorias e intensas de inicio rápido, corta duración y gran intensidad denominadas dolor irruptivo. Este tipo de dolor requiere un tratamiento específico con analgésicos capaces de mimetizar las características del episodio de dolor irruptivo. Entre esos analgésicos destaca la formulación de fentanilo de absorción transmucosa nasal a base de pectina (PecFent®), cuyo desarrollo clínico se resume brevemente en este artículo


Despite adequate control of chronic cancer pain with major opioids, some patients experience transitory and intense exacerbations. These exacerbations, known as breakthrough pain, are characterized by rapid onset, short duration and strong intensity. Episodes of breakthrough pain require specific treatment with analgesics tailored to relieve this type of pain. Notable among these analgesics is a transmucosal nasal fentanyl formulation in a pectin-based gel (PecFent®), whose clinical development is summarized in this article


Assuntos
Humanos , Fentanila/administração & dosagem , Dor Irruptiva/tratamento farmacológico , Manejo da Dor/métodos , Neoplasias/complicações , Cuidados Paliativos/métodos , Analgésicos Opioides/uso terapêutico , Administração Intranasal , Pectinas/uso terapêutico , Fentanila/farmacologia
19.
Med. paliat ; 22(supl.1): 71-80, mayo 2015. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-143193

RESUMO

El dolor oncológico es un problema complejo y de gran importancia en la práctica clínica diaria. Aunque el cáncer suele ser indoloro en las primeras fases de su desarrollo, la prevalencia de dolor crónico maligno es del 30-50% en pacientes oncológicos que están en tratamiento activo y del 70-90% en los pacientes con enfermedad avanzada. La prevalencia real del dolor irruptivo oncológico no está clara y es muy variable en función de los estudios, con un abanico que abarca del 19 al 93%. La disnea es un síntoma muy frecuente y común a muchas enfermedades, lo que traduce su origen multisistémico, y se puede presentar tanto en patología respiratoria como en enfermedades no respiratorias. Está presente hasta en el 78% de los pacientes con cáncer de pulmón. Se presentan 2 casos clínicos en los que se utilizó fentanilo intranasal con pectina, tanto para el manejo del dolor irruptivo oncológico como para las crisis de disnea, obteniendo en ambos casos un gran alivio sintomático


Cancer pain is a complex and highly important problem in daily clinical practice. Although cancer is usually painless in the early phases of its development, the prevalence of chronic pain is 30%-50% in cancer patients undergoing active treatment and 79%-90% in patients with advanced disease. The true prevalence of breakthrough cancer pain is unclear and varies widely across studies, ranging from 19% to 93%. Dyspnea is a highly frequent symptom that is common to many diseases, indicating its multisystemic origin. This symptom can occur in respiratory and non-respiratory diseases. Dyspnea is present in up to 78% of patients with lung cancer. We describe two clinical cases in which fentanyl pectin nasal spray was used in the management of both breakthrough cancer pain and dyspnea exacerbations, providing strong symptomatic relief in both patients


Assuntos
Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Fentanila/administração & dosagem , Dor Irruptiva/tratamento farmacológico , Manejo da Dor/métodos , Neoplasias/complicações , Administração Intranasal , Pectinas/uso terapêutico , Resultado do Tratamento , Segurança do Paciente , Dispneia/tratamento farmacológico
20.
Rev Esp Geriatr Gerontol ; 50(6): 289-97, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-25777946

RESUMO

Pain is a prevalent symptom in cancer geriatric patients, appearing in up to 90% of patients with terminal cancer. This requires a multidimensional approach, as there is a high percentage of inappropriate assessments and treatments. Unrecognized or poorly treated pain in the geriatric population, especially in cancer patients, leads to the development of disabling symptoms such as depression, anxiety, isolation, sleep disturbances, and appetite, and very especially, loss of functional capacity and quality of life. In this review an analysis is made on the most relevant studies on the diagnosis and management of cancer pain in the geriatric population.


Assuntos
Dor do Câncer/diagnóstico , Dor do Câncer/tratamento farmacológico , Idoso , Humanos , Manejo da Dor/normas , Guias de Prática Clínica como Assunto
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