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1.
Rev. bras. cir. plást ; 35(2): 243-248, apr.-jun. 2020. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1103839

RESUMO

A pele de tilápia possui microbiota não infecciosa e estrutura morfológica semelhante à pele humana. Estudos clínicos fase II, ainda não publicados, mostraram resultados promissores na sua utilização para tratamento de queimaduras. Nos protocolos destes estudos, pacientes com lesões em áreas de dobras de pele, como genitais e região inguinal, foram excluídos, pois achava-se que o biomaterial não aderiria apropriadamente, resultando em um grau de cicatrização inferior. Relato de caso de paciente do sexo feminino, 18 anos, sem comorbidades, com queimaduras de segundo grau profundo em abdômen, região inguinal, parte da genitália e metade superior de ambas as coxas, envolvendo 13,5% da área total da superfície corporal. A pele de tilápia foi aplicada nas lesões levando a uma reepitelização completa com 16 dias de tratamento. Não foram observados efeitos colaterais. A pele de tilápia traz, portanto, a promessa de um produto inovador, de fácil aplicação e alta disponibilidade, que pode se tornar a primeira pele animal nacionalmente estudada e registrada pela Agência Nacional de Vigilância Sanitária, para uso no tratamento de queimaduras. Este relato de caso contribui para reduzir as limitações em relação às áreas anatômicas apropriadas para a aplicação da pele de tilápia, uma vez que, mesmo com a necessidade de reposição de pele, foram obtidos bons resultados com aplicação na genitália e região inguinal.


Tilapia skin has a non-infectious microbiota and a morphological structure similar to human skin. Phase II clinical studies, not yet published, have shown promising results in their use for the treatment of burns. In the protocols of these studies, patients with lesions in areas of skin folds, such as genitals and inguinal regions, were excluded, as it was thought that the biomaterial would not adhere properly, resulting in a lower degree of healing. Case report of a female patient, 18 years old, without comorbidities, with deep second-degree burns in the abdomen, inguinal region, part of the genitalia and upper half of both thighs, involving 13.5% of the total body surface area. Tilapia skin was applied to the lesions leading to a complete re-epithelialization with 16 days of treatment. No side effects were observed. Tilapia skin, therefore, brings the promise of an innovative product, easy to apply, and highly available, which can become the first animal skin nationally studied and registered by the Agência Nacional de Vigilância Sanitária, for use in the treatment of burns. This case report contributes to reduce the limitations concerning the anatomical areas appropriate for the application of tilapia skin, since, even with the need for skin replacement, good results were obtained with application to the genitalia and inguinal region.


Assuntos
Humanos , Feminino , Adolescente , História do Século XXI , Terapêutica , Transplante Autólogo , Curativos Biológicos , Queimaduras , Relatos de Casos , Condutas Terapêuticas , Tilápia , Ciclídeos , Abdome , Estudo Clínico , Genitália , Quadril , Terapêutica/métodos , Transplante Autólogo/métodos , Transplante Autólogo/reabilitação , Curativos Biológicos/normas , Queimaduras/terapia , Condutas Terapêuticas/efeitos adversos , Condutas Terapêuticas/normas , Tilápia/anatomia & histologia , Ciclídeos/anatomia & histologia , Genitália/anatomia & histologia , Abdome/anatomia & histologia , Quadril/anatomia & histologia
2.
Farm. hosp ; 44(3): 109-113, mayo-jun. 2020.
Artigo em Espanhol | IBECS | ID: ibc-192343

RESUMO

Existen dimensiones relevantes desde una perspectiva de género relaciona-das con el esfuerzo terapéutico. Se pretende ilustrar y traer a debate posibles sesgos de género relacionados con los medicamentos, mediante el análisis del consumo en las mujeres, la prescripción de fármacos biológicos según sexo, la potencial desigualdad de género en las reacciones adversas a los medicamentos y la investigación con ensayos clínicos, así como las decisiones de las instituciones internacionales en la comercialización de medicamentos. mSe observa una mayor tendencia a prescribir analgésicos, con independencia del dolor, y fármacos para síntomas depresivos de baja intensidad en mujeres que en hombres. Lo contrario sucede en la prescripción de estatinas y dosis adecuadas, y con la mayor probabilidad de prescripción de antifactor de necrosis tumoral en hombres que en mujeres con espondilitis anquilosante, pese a la similar carga de la enfermedad. Las reacciones adversas a los medicamentos se observan con más frecuencia en mujeres que en hombres, donde determinantes como el peso corporal están influyendo poco en la dosificación. En la actualidad se considera escasamente en la prescripción que las mujeres presentan diferencias en la actividad de las enzimas del citocromo CYPP450, que puede afectar a la velocidad del metabolismo hepático. Incluso hay efectos inmunológicos, genéticos y epigenéticos (por la herencia y la dosificación desigual de los genes ubicados en los cromosomas X e Y) que pueden influir en estas diferencias por sexo. Por último, mediante los casos de ensayos clínicos de la terapia hormonal, un fármaco para el deseo sexual inhibido de las mujeres y un anticonceptivo para hombres, se muestran sesgos y estereotipos de género que influyen en una potencial generación de desigualdades, especialmente en las reacciones adversas a los medicamentos en perjuicio de las mujeres. Concluyendo, los profesionales sanitarios atribuyen con frecuencia a la emocionalidad de las mujeres lo que son síntomas físicos, influyendo en la mayor prescripción de fármacos sintomáticos en ellas. Debe analizarse si la misma razón influye en la menor prescripción de fármacos terapéuticos en mujeres que en hombres. Existen determinantes biológicos a considerar por su influencia en una mayor toxicidad farmacológica en las mujeres. Los ensayos clínicos deben mejorar atendiendo a las recomendaciones de género de la Food and Drug Administration


There are relevant dimensions from a gender perspective related to the-rapeutic effort. To illustrate and discuss possible gender bias related to medicines, through the consumption analysis in women, the prescription of biological drugs according to sex, the potential gender inequality in adverse drug reactions, and research with clinical trials, as well as the decisions of international institutions in the marketing of medicinal products.There is greater tendency to prescribe pain relievers, regardless of pain, and drugs for low intensity depressive symptoms in women than in men. The opposite occurs in the prescription of statins and adequate doses, and with the greater probability of prescribing anti-tumor necrosis factor in men than in women with ankylosing spondylitis, despite a similar disease burden. Adverse drug reactions are observed more frequently in women than in men, where determinants such as body weight are having little influence on the dosage. It is currently scarcely considered in the prescrip-tion that women have differences in the activity of cytochrome CYPP450 enzymes, which can affect the liver's metabolism rate. There are even immunological, genetic and epigenetic effects (due to heredity and une-ven gene dosing located in the X and Y chromosomes) that can influence these differences by sex. Finally, through cases of hormonal therapy clini-cal trials, a drug for women's inhibited sexual desire and a contraceptive for men, gender bias and stereotypes are shown to influence a potential generation of inequalities, especially in adverse drug reactions to the de-triment of women. In conclusion, health professionals frequently attribute physical symptoms to women's emotionality, influencing their greater prescription of sympto-matic drugs. Whether the same reason influences the lower prescription of therapeutic drugs in women than in men should be analyzed. There are biological determinants to consider due to their influence on a greater pharmacological toxicity in women. Clinical trials should improve accor-ding to the gender recommendations by the Food and Drugs Administration


Assuntos
Humanos , Iniquidade de Gênero , Pesquisa Biomédica , Terapêutica/métodos , Ensaios Clínicos como Assunto/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde , Preconceito , Estereotipagem de Gênero , Prescrições de Medicamentos
3.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-47243

RESUMO

O Ministério da Saúde tem apoiado instituições e monitorado diariamente pesquisas que objetivam identificar um tratamento efetivo para a COVID-19. Entre elas, em especial um consórcio de estudos que utilizará o plasma sanguíneo convalescente de pacientes recuperados da doença


Assuntos
Plasma/virologia , Terapêutica/métodos , Coronavirus , Transfusão de Sangue , Monitoramento
4.
Fertil Steril ; 113(3): 489-499, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32192588

RESUMO

Globally, male factor infertility accounts for 20%-70% of couples struggling to conceive. Certain male pediatric developmental conditions, such as cryptorchidism, hypospadias, testicular and other childhood cancers, infections, and pediatric varicocele have been associated with future infertility. Early fertility preservation, especially in those with pending chemotherapy or genetic conditions such as Klinefelter syndrome, should be strongly considered in patients expected to experience testicular loss. Although optimal treatment timing may be unknown owing to a paucity of long-term prospective studies, early diagnosis and targeted treatment may optimize fertility potential in adulthood.


Assuntos
Preservação da Fertilidade/normas , Infertilidade Masculina/prevenção & controle , Pediatria/métodos , Saúde Reprodutiva/normas , Calibragem , Criança , Fertilidade/fisiologia , Preservação da Fertilidade/métodos , Preservação da Fertilidade/tendências , Humanos , Masculino , Pediatria/tendências , Medicina Reprodutiva/normas , Terapêutica/métodos , Terapêutica/normas , Terapêutica/tendências , Resultado do Tratamento
6.
Clin Chim Acta ; 503: 90-98, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31968211

RESUMO

Fecal microbiota transplantation (FMT) is the introduction (transplantation) of gut microbiota obtained from the faeces of a healthy donor into the patient's gastrointestinal tract. Most often, such therapy is used the treatment of gastrointestinal diseases caused by the activity of pathogenic or conditionally pathogenic microorganisms, however, recently an increasing number of studies have reported the use of fecal microbiota transplantation for the treatment of diseases such as metabolic syndrome, diabetes, cancer and Parkinson's disease. This review article presents the results of studies concerning the impact of FMT on weight gain, immunological response and the treatment of neurological and gastrointestinal diseases and cancer. The procedure of fecal microbiota transplantation and possible side effects that may appear in FMT recipients are also described.


Assuntos
Transplante de Microbiota Fecal/métodos , Terapêutica/métodos , Transplante de Microbiota Fecal/efeitos adversos , Gastroenteropatias/terapia , Humanos , Síndrome Metabólica/terapia , Neoplasias/terapia , Doenças do Sistema Nervoso/terapia , Doença de Parkinson/terapia , Terapêutica/efeitos adversos
7.
Araguaína - TO; [S.n]; 2020. 90 p.
Não convencional em Português | LILACS, Coleciona SUS, CONASS, SES-TO | ID: biblio-1123405

RESUMO

Orienta na campanha para ações de combate ao Coronavírus (Covid-19) no município de Araguaína no Tocantins. Defini responsabilidades e prioridades na esfera municipal e local, assim como também ajuda organizar o fluxograma de resposta às emergências em saúde pública. Defini fluxos de referência para atendimento aos casos suspeitos com sintomas respiratórios leves, moderados e graves. Traz parâmetros para ajudar a detectar, identificar e notificar todos os casos suspeitos de coronavírus (COVID-19). Orienta no fluxo de vigilância epidemiológica para o diagnóstico dos casos suspeitos. Busca orientar e recomendar medidas de controle e prevenção da doença, de forma ativa, imediata e oportuna. Tenta estabelecer cuidados para redução do risco geral de contaminação pelo COVID-19 aos profissionais envolvidos nos atendimentos e protocolos relacionados. Promove ações de educação em saúde e orienta na divulgação das informações.


He guides in the campaign for actions to combat the Coronavirus (Covid-19) in the municipality of Araguaína in Tocantins. I defined responsibilities and priorities at the municipal and local level, as well as helping to organize the flowchart for responding to public health emergencies. I defined reference flows to care for suspected cases with mild, moderate and severe respiratory symptoms. It provides parameters to help detect, identify and report all suspected cases of coronavirus (COVID-19). Guides in the flow of epidemiological surveillance for the diagnosis of suspected cases. It seeks to guide and recommend disease control and prevention measures, in an active, immediate and timely manner. Attempts to establish care to reduce the general risk of contamination by COVID-19 to the professionals involved in the services and related protocols. It promotes health education actions and guides the dissemination of information.


Orienta en la campaña de acciones de combate al Coronavirus (Covid-19) en el municipio de Araguaína en Tocantins. Definí responsabilidades y prioridades a nivel municipal y local, además de ayudar a organizar el diagrama de flujo para responder a emergencias de salud pública. Definí flujos de referencia para la atención de casos sospechosos con sintomatología respiratoria leve, moderada y grave. Proporciona parámetros para ayudar a detectar, identificar y notificar todos los casos sospechosos de coronavirus (COVID-19). Guías en el flujo de vigilancia epidemiológica para el diagnóstico de casos sospechosos. Busca orientar y recomendar medidas de control y prevención de enfermedades, de manera activa, inmediata y oportuna. Intentos de establecer cuidados para reducir el riesgo general de contaminación por COVID-19 a los profesionales involucrados en los servicios y protocolos relacionados. Promueve acciones de educación para la salud y orienta la difusión de información.


Il guide dans la campagne d'actions de lutte contre le Coronavirus (Covid-19) dans la municipalité d'Araguaína à Tocantins. J'ai défini les responsabilités et les priorités aux niveaux municipal et local, ainsi que d'aider à organiser l'organigramme pour répondre aux urgences de santé publique. J'ai défini des flux de référence pour prendre en charge les cas suspects présentant des symptômes respiratoires légers, modérés et sévères. Il fournit des paramètres pour aider à détecter, identifier et signaler tous les cas suspects de coronavirus (COVID-19). Guides dans le flux de la surveillance épidémiologique pour le diagnostic des cas suspects. Il cherche à guider et à recommander des mesures de contrôle et de prévention des maladies, de manière active, immédiate et opportune. Tentative de mise en place de soins pour réduire le risque général de contamination par COVID-19 pour les professionnels impliqués dans les services et les protocoles associés. Il promeut les actions d'éducation sanitaire et guide la diffusion de l'information.


Assuntos
Humanos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Planos de Contingência , Manejo de Espécimes/métodos , Terapêutica/métodos , Administração dos Cuidados ao Paciente/normas , Testes Sorológicos/métodos , Desinfecção/métodos , Precauções Universais/métodos , Telemedicina/organização & administração
8.
Rev. bras. cir. plást ; 34(4): 497-503, oct.-dec. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047912

RESUMO

Introdução: A úlcera plantar por hanseníase é uma lesão no pé resultante da falta de sensibilidade plantar. O objetivo é descrever o tratamento realizado em portadores de úlceras plantares por hanseníase. Métodos: Estudo de prontuários de portadores de úlcera plantar atendidos no Hospital Sarah em Brasília, de 2006 a 2016, quanto ao sexo, idade, etiologia, localização e tratamento. Resultados: Foram atendidos 27 pacientes, 17(62,96%) homens e 10 (37,04%) mulheres, procedentes de Goiás e DF, na faixa etária de 41 a 60 anos (40,74%). Todos necessitaram de um ou mais procedimentos cirúrgicos. Conclusão: Observou-se maior frequência no sexo masculino, grau avançado, localizadas no primeiro artelho. Todos necessitaram de procedimentos cirúrgicos e não cirúrgicos, evoluindo com cicatrização completa da ferida, amputação transtibial em um caso e de artelhos em sete casos, e 90% dos casos apresentaram recorrência da úlcera após um ano.


Introduction: Leprosy-induced plantar ulcers result from a lack of plantar sensitivity. Objective: This study aimed to describe the treatment provided to patients with leprosy-induced plantar ulcers. Methods: We retrospectively reviewed the medical records of patients with plantar ulcers treated at Sarah Hospital in Brasilia from 2006 to 2016 and collected information about sex, age, etiology, location, and treatment. Results: A total of 27 patients (17 [62.96%] men, 10 [37.04%] women; 40.74% were aged 41­60 years) were treated from Goiás and the Federal District. All required ≥1 surgical procedure. Conclusion: A higher frequency of advanced grade was observed in men, primarily on the first toe. All needed surgical and non-surgical procedures and achieved complete wound healing. Transtibial amputation was required in 1 case and toe amputation in 7 cases; 90% patients developed ulcer recurrence after 1 year.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , História do Século XXI , Reabilitação , Terapêutica , Tratamento Terciário , Registros Médicos , Úlcera do Pé , Hanseníase , Reabilitação/métodos , Reabilitação/estatística & dados numéricos , Terapêutica/métodos , Terapêutica/estatística & dados numéricos , Tratamento Terciário/métodos , Tratamento Terciário/estatística & dados numéricos , Registros Médicos/normas , Registros Médicos/estatística & dados numéricos , Úlcera do Pé/cirurgia , Úlcera do Pé/complicações , Úlcera do Pé/terapia , Hanseníase/cirurgia , Hanseníase/complicações , Hanseníase/terapia
9.
Rev. bras. cir. plást ; 34(3): 391-398, jul.-sep. 2019. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1047162

RESUMO

Introdução: Queloides surgem de resposta excessiva à lesão da derme, resultando em proliferação de fibroblastos, produção exagerada de colágeno e comprometimento da pele sadia adjacente. O diagnóstico é clínico e muitos métodos conservadores e cirúrgicos já foram utilizados para tratamento. Porém, dados da eficácia desses tratamentos são limitados e não há consenso na literatura quanto a melhor técnica a ser empregada, permanecendo uma lacuna que necessita ser preenchida, a fim de que seus usos sejam indicados com maior confiabilidade, em um modelo de medicina baseada em evidências. Métodos: Revisão não sistemática da literatura sobre "queloides" nas bases de dados PubMed, Scielo, MEDLINE, UptoDate e livros-texto das áreas de Dermatologia e Cirurgia Dermatológica. Revisão de Literatura: Foram enumeradas e abordadas as principais informações sobre técnicas cirúrgicas e adjuvantes empregadas para essas lesões, que são: excisão, injeções intralesionais, crioterapia, laserterapia, revestimento com gel de silicone, radioterapia e pressoterapia. Torna-se relevante o levantamento dessas informações, tendo em vista que, além de poder causar dor, prurido e restrição de movimento, o principal motivo da procura de assistência médica para queloide é devido ao aspecto cosmético/estético, e as taxas de reincidência e falha terapêutica ainda são altas, sendo necessário conscientizar o paciente sobre o procedimento e seus efeitos. Conclusão: São muitos os tratamentos disponíveis para o queloide, sejam cirúrgicos ou não, todavia não há consenso sobre uma abordagem universalmente aceita. São necessários mais estudos, com a finalidade de definir a melhor conduta e atingir melhores resultados, visto a qualidade mediana das evidências apresentadas nos estudos.


Introduction: Keloids are characterized by an abnormal response to dermal trauma, resulting in fibroblast proliferation, excessive collagen production, and impairment of adjacent healthy tissue. The diagnosis is clinical, and many conservative and surgical methods can be used as treatments. However, data on the efficacy of these treatments are limited, and there is no consensus regarding the best treatment option. This gap needs to be filled by developing comprehensive evidence-based therapies. Methods: A non-systematic literature review of keloid scars was carried out using PubMed, Scielo, MEDLINE, UptoDate, and dermatology and dermatological surgery textbooks. Literature review: The search retrieved relevant information on surgical and adjuvant therapies used for keloids, including excision, intralesional injections, cryotherapy, laser therapy, silicone gel sheeting, radiation therapy, and pressure therapy. These data are crucial because, in addition to complaints of pain, itching, and restriction of movement, the main reason for seeking treatment for keloids is for cosmetic and aesthetic improvement, and the rates of recurrence and treatment failure are high, emphasizing the importance of creating awareness regarding the available procedures and their effectiveness. Conclusion: Many surgical and adjuvant therapies for keloids are available. Nonetheless, there is no consensus on a universally accepted treatment. Therefore, additional high-quality studies are needed to identify the most effective therapeutic approaches to achieve better results.


Assuntos
Humanos , História do Século XXI , Recidiva , Cirurgia Plástica , Terapêutica , Fator 1 de Crescimento de Fibroblastos , Fibroblastos , Procedimentos Cirúrgicos Dermatológicos , Queloide , Cirurgia Plástica/efeitos adversos , Cirurgia Plástica/métodos , Terapêutica/métodos , Ferimentos e Lesões , Ferimentos e Lesões/cirurgia , Ferimentos e Lesões/terapia , Fator 1 de Crescimento de Fibroblastos/análise , Fator 1 de Crescimento de Fibroblastos/efeitos adversos , Cicatriz , Cicatriz/complicações , Procedimentos Cirúrgicos Dermatológicos/métodos , Queloide/cirurgia
12.
J Clin Apher ; 34(3): 171-354, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31180581

RESUMO

The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating and categorizing indications for the evidence-based use of therapeutic apheresis (TA) in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Eighth Edition of the JCA Special Issue continues to maintain this methodology and rigor in order to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Eighth Edition, like its predecessor, continues to apply the category and grading system definitions in fact sheets. The general layout and concept of a fact sheet that was introduced in the Fourth Edition, has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of TA in a specific disease entity or medical condition. The Eighth Edition comprises 84 fact sheets for relevant diseases and medical conditions, with 157 graded and categorized indications and/or TA modalities. The Eighth Edition of the JCA Special Issue seeks to continue to serve as a key resource that guides the utilization of TA in the treatment of human disease.


Assuntos
Remoção de Componentes Sanguíneos/métodos , Medicina Baseada em Evidências/normas , Humanos , Terapêutica/métodos , Estados Unidos , Redação
14.
Value Health ; 22(6): 648-655, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31198181

RESUMO

OBJECTIVES: Recent regulatory approvals of potentially curative but high-cost treatments have made these therapies a focus of health policy discussions. Cures present new challenges to healthcare payers because they have high upfront costs but have life-long health benefits. The objectives of this study are to understand how healthcare payers define and manage cures. We investigated payers' views on key features of curative treatments and the affordability and value challenges they present. METHODS: We conducted semistructured interviews in 2016 with key informants in US payer organizations. Interviewees were directly involved in coverage determination for highly effective and curative therapies. RESULTS: We contacted 24 individuals and 18 participated. When asked what aspects of cures were important for coverage determination, an equal percentage of respondents (61% each) mentioned clinical and economic factors. In defining a cure, half of respondents included an economic element such as no downstream costs associated with the disease. When asked about challenges, 72% of respondents mentioned uncertainty regarding long-term outcomes and 56% mentioned membership churn and competition. CONCLUSIONS: Payers expressed a novel definition of a cure-which we call a "healthcare cost cure"-that captures both the clinical and economic consequences of treatment. This definition may be more pertinent in fragmentary financing systems that unevenly distribute cure costs and benefits across payers. Overall findings indicate that decision makers desire evidence to ensure that the long-term real-world consequences of covering cures match the expected benefits. Future policies need to balance upfront acquisition costs with downstream financial benefits.


Assuntos
Custos de Cuidados de Saúde/normas , Política de Saúde/tendências , Terapêutica/economia , Adulto , Idoso , Tomada de Decisões , Feminino , Custos de Cuidados de Saúde/tendências , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Terapêutica/métodos , Terapêutica/tendências
15.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(2): 133-136, abr.-jun. 2019.
Artigo em Português | LILACS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1009419

RESUMO

As doenças cardiovasculares, principalmente as decorrentes de casos de acidente vascular cerebral e infarto agudo do miocárdio, têm importante impacto na mortalidade global e nas internações hospitalares em todo o mundo. A despeito do vasto conhecimento dos diversos fatores de risco implicados na gênese da doença cardiovascular, o número de eventos ainda se mantém elevado e a instituição de medidas de prevenção primária e secundária são essenciais e complementares. Nos últimos anos, importantes avanços no campo do tratamento farmacológico de aterosclerose e insuficiência cardíaca, predominantemente em decorrência de cardiopatia isquêmica, foram publicados e seus principais resultados são destacados no presente artigo


Cardiovascular diseases, particularly those arising from cases of stroke and acute myocardial infarction, have a significant impact on global mortality and hospital admissions around the world. Despite the vast knowledge of the various risk factors involved in the genesis of cardiovascular disease, the number of events remains high and institution of primary and secondary prevention measures is essential and complementary. In recent years, important advances in the field of pharmacological treatment of atherosclerosis and heart failure, particularly those arising from ischemic heart disease, have been published. The main results are highlighted in this article


Assuntos
Humanos , Masculino , Feminino , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Prevenção Secundária/métodos , Terapêutica/métodos , Fatores de Risco , Diabetes Mellitus , Aterosclerose , Canagliflozina/uso terapêutico , Rivaroxabana/uso terapêutico , Valsartana/uso terapêutico , Insuficiência Cardíaca , Anti-Inflamatórios/uso terapêutico , Atividade Motora
16.
Nurs Philos ; 20(2): e12236, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30891891

RESUMO

In this paper, I will explore the concept that healing activities shape the objects of therapy and seek to construct those objects through therapeutic activities. Objects of therapy are the persons, patients, human bodies, diseases, physiological processes and personal suffering-that which clinical medicine constructs through its distinctive formative processes, practices and knowledge. The rationale for choice of philosophical sources namely, Cassirer, Foucault, the anthropological perspective of Good and the sociological account of Frank will be discussed. The claim articulated by Good will be examined and its relationship to culture, illness, medical knowledge, practice, truth, and science. I then focus on Frank's concepts of the patient and the body and how medical knowledge and practices affects it. The concept that the medicalization of the illness narrative silences the patient's voice requiring an ethic of listening will be emphasized, described and further supported by Charon's (2006, Narrative medicine: Honoring the stories of illness. New York, NY: Oxford University Press) and Cassell's (2015, The nature of suffering and the goals of medicine. New York, NY: Oxford University Press) thoughts on narrative of illness in clinical medicine. My position concludes that healing activities construct the objects of therapy: as the medical culture's way of seeking truth; as medicine's way of mediating and organizing forms of reality through culture and symbolic forms; and, as medicine's way of entering the body and constructing the disease. Lastly, I suggest that in spite of the remarkable progress in the control of disease, the failure to address the interpretation of illness meanings is a fundamental flaw in the work of "doctoring." The experience and meanings of illness are at the centre of clinical practice and is a moral, political, ethical and professional obligation. The person is a cultural construct, a complex and culturally shaped way of experiencing self and other, and cultural "work" is required to constitute the person who is the object of medical attention and it also necessitates the ethic of listening.


Assuntos
Ética em Enfermagem , Filosofia em Enfermagem , Terapêutica/métodos , Humanos , Comportamento de Doença , Terapêutica/normas , Terapêutica/tendências
17.
Blood Cells Mol Dis ; 76: 53-58, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30792169

RESUMO

Thalassemia is a common inherited monogenic disease. It is characterized by chronic hemolysis, ineffective erythropoiesis (IE) and iron overload. Despite advances in transfusion practices and chelation therapy, still many limitations in delivering these standard therapies exist. Challenges of currently available standard care and advances in understanding the underlying pathophysiological mechanisms in thalassemia stimulated research towards development of novel therapeutic targets. Agents reducing IE as Jak 2 inhibitors and Activin II receptor traps are promising and are currently in clinical trials. Other approaches targeting iron dysregulation as mini-hepcidins, exogenous transferrin and erythroferrone inhibitors are in preclinical studies. Gene therapy, a rapidly evolving field, has exhibited remarkable progress in recent years. Studies have focused on ß or γ-globin addition, over expression of endogenous γ-globin-activating transcription factors, silencing of γ-globin repressors and genome editing of ß-globin mutations or γ-globin repressors. In this article we provide an overview of emerging recent trends in treatment of thalassemia targeting IE, iron dysregulation and novel curative treatments as gene therapy and gene editing.


Assuntos
Talassemia/terapia , Terapêutica/tendências , Eritropoese , Edição de Genes , Terapia Genética , Humanos , Sobrecarga de Ferro , Talassemia/complicações , Terapêutica/métodos
18.
Blood ; 133(16): 1762-1765, 2019 04 18.
Artigo em Inglês | MEDLINE | ID: mdl-30723079

RESUMO

Serum soluble chemokines/cytokines produced by Hodgkin cells and the tumor microenvironment might be of value as biomarkers in classic Hodgkin lymphoma (cHL). We assessed serum thymus and activation-related chemokine (TARC), macrophage-derived chemokine (MDC), interleukin-10 (IL-10), and soluble CD163 (sCD163) levels at baseline, time of interim fluorodeoxyglucose positron emission tomography (PET), and after therapy in cHL patients treated on S0816, an intergroup phase 2 response-adapted study evaluating escalated therapy for interim PET (PET2)-positive patients (www.clinicaltrials.gov #NCT00822120). Epstein-Barr virus (EBV) status was assessed, and 559 serum samples were evaluated for TARC, MDC, IL-10, and sCD163 by immunoassay. EBV positivity correlated with higher sCD163 and IL-10 levels but lower TARC levels. While baseline biomarker levels were not associated with outcome, sCD163 levels at the time of PET2 were associated with favorable progression-free survival (PFS), adjusting for PET2 status. After therapy TARC, MDC, and IL-10 correlated with PFS and overall survival (OS) on univariable analysis, which remained significant adjusting for international prognostic score. When also adjusting for end-of-therapy PET results, TARC and IL-10 remained significantly associated with shorter PFS and OS. Exploratory analysis in PET2-negative patients showed that elevated posttherapy TARC and IL-10 levels were associated with PFS. Serum cytokine levels correlate with outcome in cHL and should be investigated further in risk-adapted cHL trials.


Assuntos
Quimiocinas/sangue , Doença de Hodgkin/sangue , Adulto , Antígenos CD/sangue , Antígenos de Diferenciação Mielomonocítica/sangue , Quimiocina CCL17/sangue , Quimiocina CCL22/sangue , Feminino , Doença de Hodgkin/diagnóstico , Doença de Hodgkin/mortalidade , Doença de Hodgkin/terapia , Humanos , Interleucina-10 , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons/métodos , Prognóstico , Receptores de Superfície Celular/sangue , Análise de Sobrevida , Terapêutica/métodos
20.
Dev Dyn ; 248(1): 21-33, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30016584

RESUMO

Astrocytes exhibit dynamic and complex reactions to various insults. Recently, investigations into the transitions that occur during cellular specification, differentiation, maturation, and disease responses have provided insights into understanding the mechanisms that underlie these altered states of reactivity and function. Here we summarize current concepts in how astrocyte state transitions, termed astroplasticity, are regulated, as well as how this affects neural circuit function through extracellular signaling. We postulate that a promising future approach toward enhancing functional repair after injury and disease would be to steer astrocytes away from an inhibitory response and toward one that is beneficial to neuroplasticity and neuroregeneration. Toward this goal, we discuss emerging biotechnological advancements, with a focus on human pluripotent stem cell bioengineering, which has high potential for effective manipulation and control of astroplasticity. Highlights include innovations in cellular transdifferentiation techniques, nanomedicine, organoid and three-dimensional (3D) spheroid microcircuit development, and the use of biomaterials to influence the extracellular environment. Current barriers and future applications are also summarized in order to augment the design of future preclinical trials aimed toward astrocyte-targeted neuroregeneration with a concept termed astrocellular therapeutics. Developmental Dynamics 248:21-33, 2019. © 2018 Wiley Periodicals, Inc.


Assuntos
Astrócitos/citologia , Bioengenharia/tendências , Plasticidade Celular , Regeneração Nervosa , Animais , Bioengenharia/métodos , Transdiferenciação Celular , Humanos , Células-Tronco Pluripotentes , Terapêutica/métodos , Terapêutica/tendências
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