Impacto na qualidade de vida em pacientes usuários de medicação retroviral e submetidos à gluteoplastia: estudo de coorte histórica / Gluteal contour restoration in antiretroviral users and its quality-of-life related impacts: a historical cohort study

INTRODUÇÃO: Desde a introdução do tratamento do HIV com uso da terapia antirretroviral altamente ativa, a mortalidade por essa doença foi reduzida drasticamente em todo o mundo. Um dos parefeitos relacionados à utilização desses fármacos é a lipodistrofia glútea. O objetivo deste trabalho é verificar o impacto da correção dessa deformidade na qualidade de vida de pacientes com HIV. MÉTODOS: Foi conduzido um estudo de coorte histórica com 23 pacientes submetidos à gluteoplastia com implante intramuscular, entre janeiro de 2010 e dezembro de 2014, avaliando a qualidade de vida por meio do em Nottingham Health Profile em. As informações foram coletadas de julho a agosto de 2015. A análise estatística foi feita utilizando-se o em Related-Samples McNemar Test em. RESULTADOS: strong Houve diferença significativa entre o pré-operatório e pós-operatório em 19 das 38 perguntas. CONCLUSÃO: É possível afirmar que a reconstrução glútea melhora a qualidade de vida de pacientes HIV positivos acometidos por lipodistrofia glútea relacionada a antirretrovirais.

INTRODUCTION: Since the introduction of highly active antiretroviral therapy for the treatment of human immunodeficiency virus (HIV), disease mortality has been dramatically reduced worldwide. One related side effect from the use of these drugs is gluteal lipodystrophy. The aim of this study is to assess the quality-of-life impact of correcting this deformity in HIV patients. METHODS: A historical cohort study was conducted between January 2010 and December 2014 with 23 patients, assessing the quality of their lives using the Nottingham Health Profile. A statistical analysis was performed using the McNemar test for related samples. RESULTS: There was a significant difference between preoperative and postoperative response in 19 of the 38 questions. CONCLUSION: We may say that gluteal reconstruction plays a role in improving quality of life for HIV patients who have been affected by antiretroviral related gluteal lipodystrophy.

From vagueness in medical thought to the foundations of fuzzy reasoning in medical diagnosis.

OBJECTIVE: This article delineates a relatively unknown path in the history of medical philosophy and medical diagnosis. It is concerned with the phenomenon of vagueness in the physician's "style of thinking" and with the use of fuzzy sets, systems, and relations with a view to create a model of such reasoning when physicians make a diagnosis. It represents specific features of medical ways of thinking that were mentioned by the Polish physician and philosopher Ludwik Fleck in 1926. The paper links Lotfi Zadeh's work on system theory before the age of fuzzy sets with system-theory concepts in medical philosophy that were introduced by the philosopher Mario Bunge, and with the fuzzy-theoretical analysis of the notions of health, illness, and disease by the Iranian-German physician and philosopher Kazem Sadegh-Zadeh. MATERIAL: Some proposals to apply fuzzy sets in medicine were based on a suggestion made by Zadeh: symptoms and diseases are fuzzy in nature and fuzzy sets are feasible to represent these entity classes of medical knowledge. Yet other attempts to use fuzzy sets in medicine were self-contained. The use of this approach contributed to medical decision-making and the development of computer-assisted diagnosis in medicine. CONCLUSION: With regard to medical philosophy, decision-making, and diagnosis; the framework of fuzzy sets, systems, and relations is very useful to deal with the absence of sharp boundaries of the sets of symptoms, diagnoses, and phenomena of diseases. The foundations of reasoning and computer assistance in medicine were the result of a rapid accumulation of data from medical research. This explosion of knowledge in medicine gave rise to the speculation that computers could be used for the medical diagnosis. Medicine became, to a certain extent, a quantitative science. In the second half of the 20th century medical knowledge started to be stored in computer systems. To assist physicians in medical decision-making and patient care, medical expert systems using the theory of fuzzy sets and relations (such as the Viennese "fuzzy version" of the Computer-Assisted Diagnostic System, CADIAG, which was developed at the end of the 1970s) were constructed. The development of fuzzy relations in medicine and their application in computer-assisted diagnosis show that this fuzzy approach is a framework to deal with the "fuzzy mode of thinking" in medicine.

The crime of saving lives. The FDA, John Najarian, and Minnesota ALG.

The indictment of John Najarian, MD, and Richard Condie at Minneapolis, Minn, on April 10, 1995, was a defining episode in the prolonged agony that has ensued since August 1992, when the federal Food and Drug Administration (FDA) placed Minnesota Anti-Lymphocyte Globulin (MALG) on clinical hold, bringing to an end its use as an immunosuppressive agent for patients undergoing transplantation. The principal charge in the indictment is that from about 1968 until 1992--the whole period of the development and use of MALG--Dr Najarian and Mr Condie conspired to defraud the United States by impeding the FDA in its oversight of biological drugs and that they did so for the purpose of financial gain. If the charges can be considered seriously, they mean that Dr Najarian's purpose in the development and manufacture of MALG was to make money, presumably for himself, and that the possible benefit of MALG to the patients was of secondary concern to him. Several difficulties arise immediately. In 1968, MALG offered a promising new approach to immunosuppression. In a relatively crude form, it had been used at the University of Colorado with striking improvement in the survival of patients undergoing transplantation and transplanted organs, but it was painful to administer by intramuscular injections and, in addition to other side effects, produced muscular spasms. Dr Najarian and his colleagues succeeded in purifying MALG so that the pure globulin could be injected into a central vein. The process of purification was complicated and expensive, so it was hardly practical for each transplant center to produce MALG for itself. Thus, in 1969, when Dr Najarian submitted an investigational new drug application (IND) to the FDA, he stated that his purpose was to manufacture MALG not only for patients at the University of Minnesota Hospital but also for patients at other transplant centers, which were not in a position to make it for themselves. He asked the FDA to approve recovery of the cost of providing MALG to other institutions. The FDA approved Dr Najarian's IND application early in 1970 but did not respond to his request for cost recovery--then, or for the next 15 years. Dr Najarian was free to manufacture MALG and to distribute it to other transplant centers for investigational use, but as for paying for it, that was his problem. The FDA offered no suggestion.