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1.
Stud Health Technol Inform ; 264: 1702-1703, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438301

RESUMO

Medication processes are consisted with multiple steps by professionals and consumers. Physicians prescribe drugs to patient with conformance, but sometimes they were changed to other drugs. We designed concept models to capture medication workflow process records by openEHR archetype models, and four templates were determined with each step of the medication process. We will show the detail of clinical modeling about medication workflow in this article.


Assuntos
Registros Eletrônicos de Saúde , Fluxo de Trabalho , Assistência à Saúde , Tratamento Farmacológico , Humanos
2.
Mem. Inst. Invest. Cienc. Salud (Impr.) ; 17(2): 86-101, ago. 2019. ilus, tab
Artigo em Espanhol | LILACS, BDNPAR | ID: biblio-1008711

RESUMO

La fibrilación auricular (FA) es la arritmia sostenida más frecuente que puede presentarse en una amplia variedad de condiciones clínicas. A pesar de los progresos en el tratamiento de los pacientes con FA, esta arritmia sigue siendo una de las más importantes causas de accidente cerebrovascular, insuficiencia cardiaca, muerte súbita y morbilidad cardiovascular en todo el mundo. El objetivo del tratamiento con fármacos antiarrítmicos es mejorar los síntomas relacionados con la FA, y buscar un equilibrio entre la carga sintomática, la posibilidad de reacciones farmacológicas adversas y las preferencias del paciente. El control de la frecuencia cardiaca a corto y largo plazo se puede lograr con bloqueadores beta, digoxina, bloqueadores de los canales del calcio o tratamiento combinado. Si bien otros fármacos antiarrítmicos de clase III también tienen un efecto limitador de la frecuencia, solo deben emplearse para el control del ritmo cardiaco. Restaurar y mantener el ritmo sinusal también es una parte integral del tratamiento de la FA. Los fármacos antiarrítmicos de clase III duplican la tasa de pacientes en ritmo sinusal. El tratamiento para el control del ritmo está indicado para mejorar los síntomas de los pacientes con FA que siguen sintomáticos a pesar del tratamiento adecuado para el control de la frecuencia cardiaca. La combinación de antiarrítmicos que prolongan el intervalo QT no se debe emplear para el control del ritmo cardiaco en la FA(AU)


Atrial fibrillation (AF) is the most frequent sustained arrhythmia that can occur in a wide variety of clinical conditions. Despite progress in the treatment of patients with AF, this arrhythmia remains one of the most important causes of stroke, heart failure, sudden death and cardiovascular morbidity worldwide. The aim of treatment with antiarrhythmic drugs is to improve the symptoms related to AF, and to look for a balance between the symptomatic load, the possibility of adverse pharmacological reactions and the patient preferences. The short and long term heart rate control can be achieved with beta blockers, digoxin, calcium channel blockers or combination therapy. Although other class III antiarrhythmic drugs also have a frequency-limiting effect, they should only be used for the control of heart rhythm. Restoring and maintaining sinus rhythm is also an integral part of the treatment of AF. Class III antiarrhythmic drugs double the rate of patients who maintain their sinus rhythm. Treatment for rhythm control is indicated to improve the symptoms of patients with AF who remain symptomatic despite adequate treatment for heart rate control. The combination of antiarrhythmics that prolong the QT interval should not be used to control heart rhythm in AF(AU)


Assuntos
Arritmias Cardíacas , Fibrilação Atrial , Tratamento Farmacológico
3.
Int. j. cardiovasc. sci. (Impr.) ; 32(4): 418-427, July-Aug. 2019. tab, ilus
Artigo em Inglês | LILACS | ID: biblio-1012337

RESUMO

Erectile dysfunction (ED) is a highly prevalent problem that affects the quality of life, prognosis and survival of patients with heart failure (HF). In the management of ED, physical exercise is a therapeutic strategy that reduces disease-related symptoms and optimizes drug use. However, the repercussions of physical exercise on ED in individuals with HF still need to be elucidated. In this sense, the objective of this study was to evaluate the effects of physical exercise on erectile function (EF) in HF patients. This was a systematic review conducted according to PRISMA guidelines. Patients with HF, male and ejection fraction ≤ 45% were submitted to physical exercise of different modalities. The search for scientific articles was conducted in the electronic databases (PubMed, LILACS, Cochrane-Library, Science Direct) from the inception until October 2018, according to the MeSH dictionary descriptors, which were suitable for all databases. Results: Three studies were analyzed, includinng 99 male subjects, age ranging from 53 years (± 7.48) to 58 years (± 12). Seventy subjects were submitted to a physical exercise program and 29 were in the control group. In all studies, physical exercise showed positive results in the management of ED regardless of erectile dysfunction (ED) classification status and intensity of exercise used. It was concluded that physical exercise of different intensities was considered an effective therapeutic intervention to improve EF in individuals with HF and ED


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Exercício , Insuficiência Cardíaca/fisiopatologia , Disfunção Erétil , Qualidade de Vida , Volume Sistólico , Idoso , Doenças Cardiovasculares , Aptidão Física , Tratamento Farmacológico
4.
Chem Commun (Camb) ; 55(61): 9015-9018, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31290867
5.
Recurso educacional aberto em Português | CVSP - Brasil | ID: cfc-389090

RESUMO

Se você apresenta tosse seca por mais de três semanas, febre ao final da tarde, suor noturno, emagrecimento e muito cansaço, cuidado! Pode ser tuberculose! A doença, considerada uma das mais perigosas no mundo, atinge cerca de 30 pessoas por dia e chega a matar, diariamente 4.500 pessoas, segundo dados da Organização Mundial da Saúde ­ OMS. Para alertar a população sobre os riscos da tuberculose, a OMS e a União Internacional contra a Tuberculose e Doenças Pulmonares estabeleceram 24 de março como Dia Mundial de Combate à Tuberculose. Neste dia, em 1882, o dr. Roberto Koch conseguiu identificar a bactéria causadora da doença ­ bacilo de Koch ­ abrindo o caminho para o diagnóstico e a cura a doença. Para alertar a população sobre o tema, o projeto Fiocruz no Ar produziu dois podcasts sobre a tuberculose, com a participação da pesquisadora da Fiocruz Bahia, Theolis Bessa, e da médica pneumologista Maria do Carmo Corbaxo. Antibióticos e tuberculose Um dos problemas encontrados no tratamento da tuberculose em todo o mundo é a resistência bacteriana, uma vez que o uso indiscriminado de antibióticos pode levar a uma resistência maior do organismo aos medicamentos que combatem à doença. Em 2017, 82% das pessoas com tuberculose apresentavam resistência aos antibióticos comumente usados para tratar a doença, segundo dados da OMS.


Assuntos
Tuberculose , Diagnóstico , Tratamento Farmacológico , Tuberculose Resistente a Múltiplos Medicamentos
6.
Medicine (Baltimore) ; 98(24): e15662, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192909

RESUMO

Primary adrenal lymphoma (PAL) is a rare entity of lymphoma with dismal prognosis using systemic chemotherapy. More clinical reports are needed to guide the treatment for PAL.We performed a retrospective analysis of 20 patients diagnosed with PAL who presented to our center between January 2005 and January 2014.Median age at presentation was 48 years (range: 27-73) with a male-to-female ratio of 7:3. Bilateral and right-sided adrenal involvement were seen in 11 of 20 and 7 of 20 patients, respectively. Adrenal insufficiency (AI) was seen in 6 of 10 evaluated patients. Diffuse large B cell lymphoma (DLBCL) was the most common immunophenotype (85.0%). Two patients died due to rapid disease progression before treatment. Two patients received autologous stem cell transplantation as consolidation therapy. All patients received prophylactic intrathecal chemotherapy. The estimated 5-year overall survival (OS) and progression-free survival (PFS) were 52.5% [95% confidence interval (95% CI: 28.2-72.0)] and 53.2% (95% CI: 29.0-72.5), respectively.These findings suggest that PAL should always be considered in differential diagnosis of adrenal mass with AI. Despite the contrasting previous reports, long-term prognosis of PAL is not necessarily inferior to that of non-Hodgkin lymphoma in general.


Assuntos
Neoplasias das Glândulas Suprarrenais/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Transplante de Células-Tronco Hematopoéticas/métodos , Linfoma Difuso de Grandes Células B/terapia , Neoplasias das Glândulas Suprarrenais/mortalidade , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Citarabina/administração & dosagem , Citarabina/uso terapêutico , Dexametasona/administração & dosagem , Dexametasona/uso terapêutico , Progressão da Doença , Esquema de Medicação , Tratamento Farmacológico , Feminino , Humanos , Injeções Espinhais , Linfoma Difuso de Grandes Células B/mortalidade , Masculino , Metotrexato/administração & dosagem , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Mortalidade , Estudos Retrospectivos , Análise de Sobrevida , Transplante Autólogo , Resultado do Tratamento
7.
Medicine (Baltimore) ; 98(24): e15912, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192927

RESUMO

RATIONALE: The differential diagnosis of conditions manifesting as bone and joint pain is complex. Although many individuals with acute leukemia experience bone pain, lumbosacral pain as an early feature of acute lymphoblastic leukemia (ALL) is rare. PATIENT CONCERNS: Here we report a case of an adult who presented with a 7-month history of persistent lumbosacral pain which had become more severe during the previous month. DIAGNOSES: Prior to referral, his full blood count revealed no abnormalities, and a computerized tomography scan revealed mild bone hyperplasia of his lumbar vertebrae, with disc herniations of L3-S1. His blood biochemistry and urinary test results had been normal. After referral to our clinic, tests of the morphology, immunology, cytogenetics, and molecular biology of his bone marrow led to a diagnosis of MLL-AF4 fusion positive B-cell ALL. INTERVENTIONS: Prior to his referral, he had been treated with painkillers by local doctors. The painkillers initially provided pain relief, but their effect wore off over time. After diagnosis, he was started on an adult ALL chemotherapy protocol. OUTCOMES: His symptoms resolved within a week of starting chemotherapy. At his most recent assessment, 10 months after diagnosis, he was on maintenance chemotherapy and in remission. LESSONS: This case illustrates that prolonged lumbosacral pain may be a symptom of a life-threatening condition, rather than only attributable to chronic inflammation or disk herniations. Therefore, clinicians need to pay attention to subtle differences in the clinical presentation of patients with lumbosacral pain.


Assuntos
Deslocamento do Disco Intervertebral/diagnóstico por imagem , Dor Lombar/etiologia , Região Lombossacral/diagnóstico por imagem , Leucemia-Linfoma Linfoblástico de Células Precursoras B/diagnóstico , Adulto , Diagnóstico Diferencial , Tratamento Farmacológico , Humanos , Deslocamento do Disco Intervertebral/etiologia , Masculino , Proteína de Leucina Linfoide-Mieloide/genética , Proteínas de Fusão Oncogênica/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras B/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras B/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras B/genética , Resultado do Tratamento
8.
Anticancer Res ; 39(6): 2699-2710, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177104

RESUMO

BACKGROUND/AIM: Adrenal glands are one of the most common sites of cancer metastasis. The treatment options include either surgery or chemotherapy and/or radiotherapy while certain diagnosis is made via percutaneous biopsy or fine needle aspiration (FNA), guided by CT scan. This review aimed to present the current practice regarding the diagnosis and treatment of adrenal cancer metastasis. MATERIALS AND METHODS: A PRISMA-compliant systematic search of the PubMed, Cochrane, EMBASE, AMED, CINAHL, WoS, BIOSIS, LILACS, ASSIA, SCEH, SCIRUS databases, and JIT medical feed sources was performed through November 5th, 2018. RESULTS: A total of 87 original studies including 660 patients with adrenal metastasis were analyzed. Most preferred treatment was excision of the gland in 76.58% of the cases, while most of adrenal metastases were found at autopsy (43.88%) followed by computed tomography guided biopsy (33.09%). CONCLUSION: Adrenalectomy following metastatic disease to the adrenals should be performed when the lesion is isolated in the gland and the site of primary cancer has or can be resected.


Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/secundário , Neoplasias das Glândulas Suprarrenais/terapia , Glândulas Suprarrenais/patologia , Adrenalectomia , Biópsia por Agulha Fina , Tratamento Farmacológico , Feminino , Humanos , Biópsia Guiada por Imagem/métodos , Masculino , Radioterapia , Análise de Sobrevida , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
Medicine (Baltimore) ; 98(25): e16075, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232946

RESUMO

RATIONALE: Gastric cancer is still one of the most common cancer in East Asia. More than 70% gastric cancer patients are diagnosed at an advanced stage in China. Moreover, about 10% cases are unresectable which usually suffer a poor prognosis with a median survival time of 5 to 12 months. In recent years, some clinical studies found that many unresectable gastric cancer cases could get opportunity for surgery after treatment that improve prognosis significantly PATIENT CONCERNS:: 64-year-old male patient was admitted with upper abdominal pain. Upper gastrointestinal endoscopy showed a large ulcerated tumor located from the cardia to the anterior wall of the upper gastric body. Histopathological examination showed it was moderately differentiated adenocarcinoma. Computed tomography (CT) scan image showed a large bulging mass with internal ulcer at the lesser curvature wall, left gastric artery and coeliac trunk were surrounded by fused lymph nodes. DIAGNOSES: Based on the histopathological examination and imaging findings, patient was diagnosed advanced gastric cancer and hardly to resect radically. INTERVENTION: Oral chemotherapy combined with trans-arterial chemotherapy and embolization (TACE) was initiated. Eight weeks after initial therapy, radical laparoscopy-assisted total gastrectomy with D2 lymph node dissection and Roux-en-Y anastomosis were performed successfully. OUTCOMES: Patient was discharged on postoperative day 11 without complications. Histological analysis of the specimen and resected 31 lymph nodes revealed no malignancy. The patient experienced a pathological complete response (pCR). LESSONS: In this case, oral chemotherapy combined with TACE which was rarely reported in the treatment of unresectable gastric cancer achieves a great therapeutic benefit. Although further clinical studies will be needed to establish, it may be a potent strategy for degrading stage and supplying a new chance for surgery.


Assuntos
Quimioembolização Terapêutica/métodos , Tratamento Farmacológico/métodos , Neoplasias Gástricas/tratamento farmacológico , Administração Oral , China , Gastrectomia/métodos , Humanos , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Neoplasias Gástricas/cirurgia , Tomografia Computadorizada por Raios X/métodos
10.
Int J Mol Sci ; 20(9)2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31075828

RESUMO

Despite the different antineoplastic mechanisms of action, peripheral neurotoxicity induced by all chemotherapy drugs (anti-tubulin agents, platinum compounds, proteasome inhibitors, thalidomide) is associated with neuron morphological changes ascribable to cytoskeleton modifications. The "dying back" degeneration of distal terminals (sensory nerves) of dorsal root ganglia sensory neurons, observed in animal models, in in vitro cultures and biopsies of patients is the most evident hallmark of the perturbation of the cytoskeleton. On the other hand, in highly polarized cells like neurons, the cytoskeleton carries out its role not only in axons but also has a fundamental role in dendrite plasticity and in the organization of soma. In the literature, there are many studies focused on the antineoplastic-induced alteration of microtubule organization (and consequently, fast axonal transport defects) while very few studies have investigated the effect of the different classes of drugs on microfilaments, intermediate filaments and associated proteins. Therefore, in this review, we will focus on: (1) Highlighting the fundamental role of the crosstalk among the three filamentous subsystems and (2) investigating pivotal cytoskeleton-associated proteins.


Assuntos
Citoesqueleto/patologia , Tratamento Farmacológico , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Doenças do Sistema Nervoso Periférico/patologia , Animais , Modelos Animais de Doenças , Humanos , Filamentos Intermediários/patologia , Neurônios/patologia
11.
BMC Cancer ; 19(1): 414, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046719

RESUMO

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) can affect functional performance and quality of life considerably. Since balance training has proven to enhance physical function, it might be a promising strategy to manage CIPN-induced functional impairments. METHODS: Fifty cancer survivors with persisting CIPN after finishing their treatment were randomly allocated to an intervention (IG) or active control group (CG). The IG did endurance plus balance training, the CG only endurance training (twice weekly over 12 weeks). Pre- and post-assessments included functional performance, cardiorespiratory fitness, vibration sense, and self-reported CIPN symptoms (EORTC QLQ-CIPN20). RESULTS: Intention-to-treat analyses (n = 41) did not reveal a significant group difference (CG minus IG) for sway path in semi-tandem stance after intervention (primary endpoint), adjusted for baseline. However, our per-protocol analysis of 37 patients with training compliance ≥70% revealed: the IG reduced their sway path during semi-tandem stance (- 76 mm, 95% CI -141 - -17; CG: -6 mm, 95% CI -52 - 50), improved the duration standing on one leg on instable surface (11 s, 95% CI 8-17; CG: 0 s, 95%CI 0-5) and reported decreased motor symptoms (-8points, 95% CI -18 - 0; CG: -2points 95% CI -6 - 2). Both groups reported reduced overall- (IG: -10points, 95% CI -17 - -4; CG: -6points, 95% CI -11 - -1) and sensory symptoms (IG: -7points, 95% CI -15 - 0; CG: -7points, 95% CI -15 - 0), while only the CG exhibited objectively better vibration sense (knuckle: 0.8points, 95% CI 0.3-1.3; IG: 0.0points, 95% CI -1.1 - 0.9; patella: 1.0points, 95% CI 0.4-1.6: IG: -0.8points, 95% CI -0.2 - 0.0). Furthermore, maximum power output during cardiopulmonary exercise test increased in both groups (IG and CG: 0.1 W/kg, 95% CI 0.0-0.2), but only the CG improved their jump height (2 cm, 95% CI 0.5-3.5; IG: 1 cm, 95% CI -0.4 - 3.2). CONCLUSION: We suppose that endurance training induced a reduction in sensory symptoms in both groups, while balance training additionally improved patients' functional status. This additional functional effect might reflect the IG's superiority in the CIPN20 motor score. Both exercises provide a clear and relevant benefit for patients with CIPN. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) number: DRKS00005419 , prospectively registered on November 19, 2013.


Assuntos
Antineoplásicos/efeitos adversos , Sobreviventes de Câncer/psicologia , Doenças do Sistema Nervoso Periférico/reabilitação , Adulto , Idoso , Idoso de 80 Anos ou mais , Aptidão Cardiorrespiratória , Tratamento Farmacológico , Treino Aeróbico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Doenças do Sistema Nervoso Periférico/fisiopatologia , Doenças do Sistema Nervoso Periférico/psicologia , Qualidade de Vida , Resultado do Tratamento
12.
Praxis (Bern 1994) ; 108(6): 419-423, 2019 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-31039701

RESUMO

Safety of Pharmacotherapy in Emergencies Abstract. Emergency pharmacotherapy is one of the most commonly used medical procedures. At the same time, pharmacotherapy in an emergency is always a potentially dangerous action. Medication errors are even among the most frequently registered errors in medicine. Due to the special circumstances in emergency medicine, special precautions are required to ensure the safety of drug therapy. In addition to the important background information, this article presents procedures that are recognized and applicable in daily routine to increase safety in pharmacotherapy.


Assuntos
Tratamento Farmacológico , Medicina de Emergência , Serviços Médicos de Emergência , Humanos , Erros de Medicação
13.
Medicine (Baltimore) ; 98(20): e15731, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096532

RESUMO

BACKGROUND: Programmed death 1 protein (PD-1) and programmed death-ligand 1 (PD-L1) inhibitors are promising cancer immunotherapy. Their dermatologic safety profiles are still poorly understood. The purpose of this article is to evaluate the incidence of selected dermatologic and mucosal adverse effects (AEs) and determine the risk of developing these adverse events associated with PD-1/PD-L1 inhibitors, compared with chemotherapy or ipilimumab. METHODS: PubMed was searched for eligible studies (up to February 21, 2019). Only phase II and phase III randomized controlled trials (RCTs) compared with chemotherapy or ipilimumab monotherapy were included in this meta-analysis. RESULTS: A total 11,465 patients from 18 clinical trials were included in this meta-analysis. Rash and pruritus were the most frequently reported dermatologic AE, with incidence 11.8% and 12.2% respectively. Compared with patients receiving chemotherapy, PD-1/PD-L1 inhibitor treated patients had higher risk of developing rash (RR = 1.84), pruritus (RR = 3.74) and vitiligo (RR = 9.54), and also lower risk in developing mucosal inflammation (RR = 0.26), stomatitis (RR = 0.26), and alopecia (RR = 0.03). Additionally, anti-PD1/PD-L1 drugs had similar risk of developing rash and lower risk of inducing pruritus compared to ipilimumab. In the subgroup analysis, PD-L1 inhibitor demonstrated better safety than PD-1 inhibitor in developing rash, with RR = 1.38 and RR = 2.11, respectively. CONCLUSION: Our meta-analysis concluded that anti PD-1/PD-L1 drugs have different dermatological and mucosal safety profile compared to conventional therapy, and differences of dermatological toxicity between PD-1 and PD-L1 inhibitor warrant further investigation.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Antígeno B7-H1/antagonistas & inibidores , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Ipilimumab/efeitos adversos , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Alopecia/induzido quimicamente , Tratamento Farmacológico , Exantema/induzido quimicamente , Humanos , Incidência , Mucosite/induzido quimicamente , Prurido/induzido quimicamente , Ensaios Clínicos Controlados Aleatórios como Assunto , Estomatite/induzido quimicamente , Vitiligo/induzido quimicamente
14.
J Agric Food Chem ; 67(18): 5053-5071, 2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-30986058

RESUMO

Mushroom consumption is a global tradition that is still gaining popularity. However, foraging for wild mushrooms and accidental ingestion of toxic mushrooms can result in serious illness and even death. The early diagnosis and treatment of mushroom poisoning are quite difficult, as the symptoms are similar to those caused by common diseases. Chemically, mushroom poisoning is related to very powerful toxins, suggesting that the isolation and identification of toxins have great research value, especially in determining the lethal components of toxic mushrooms. In contrast, most of these toxins have remarkable physiological properties that could promote advances in chemistry, biochemistry, physiology, and pharmacology. Although more than 100 toxins have been elucidated, there are a number of lethal mushrooms that have not been fully investigated. This review provides information on the chemistry (including chemical structures, total synthesis, and biosynthesis) and the toxicology of these toxins, hoping to inspire further research in this area.


Assuntos
Agaricales/química , Micotoxinas/química , Micotoxinas/toxicidade , Bioprospecção , Tratamento Farmacológico , Humanos
15.
Indian J Pathol Microbiol ; 62(2): 266-269, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30971552

RESUMO

Post chemotherapy Wilms Tumour (PCWT) is a diagnostic conundrum both for the clinician and the pathologist, in view of its morphological similarity with ectopic immature renal tissue (EIRT). However, due to their varying prognoses and different lines of management, it is important to distinguish between the two. Here, we discuss clinical presentation and pathology of a case of PCWT, arising in a horse shoe deformity of the kidney in a 5 year old girl. The discussion focuses on the pathogenesis of Extra Renal Wilms Tumour (ERWT) as well as its distinguishing morphological features and chemotherapy induced changes in Wilms tumour.


Assuntos
Neoplasias Renais/diagnóstico , Rim/efeitos dos fármacos , Tumor de Wilms/diagnóstico , Tumor de Wilms/patologia , Antineoplásicos/uso terapêutico , Pré-Escolar , Tratamento Farmacológico , Feminino , Humanos , Rim/diagnóstico por imagem , Neoplasias Renais/patologia , Nefrectomia , Prognóstico , Tomografia Computadorizada por Raios X , Tumor de Wilms/tratamento farmacológico
16.
Indian J Pathol Microbiol ; 62(2): 303-305, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30971562

RESUMO

Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is a rare entity and a novel variant of inflammatory myofibroblastic tumor (IMT), usually seen in children and nonsmoking young adults. Their occurrence in a posttransplant setting is still rare. These tumors are characterized by prominent epithelioid morphology, large histiocytoid "Reed Sternberg"-like cell, unique pattern of ALK immuno-reactivity, and aggressive clinical behavior. Their etiology and metastatic potential is controversial. In a post-transplant setting, many factors such as trauma, infections with EBV, HIV, Hepatitis C, mycobacteria, fungus, and chemotherapy-induced immunosuppression have been implicated in their etiology. We present the case of a 2-year-old female child who developed multiple omental and mesenteric tumor nodules, 8 months post liver transplant for progressive familial intrahepatic cholestasis (PFIC). Following a histopathological diagnosis of "mesenchymal neoplasm of possible malignant nature" on a trucut biopsy and frozen section, tumor debulking was performed. A final histological diagnosis of EMIS was made on the completely resected tumor. The patient remains in remission nearly 7 months after presentation, without any follow-up systemic chemotherapy. IMT after a solid organ transplant is rare, only 5 cases have been reported in the literature until now. Similar phenomenon has also been noted with hematopoietic stem cell transplant. However, to our knowledge, this case of EMIS in a post liver transplant patient is first of its kind.


Assuntos
Miofibroblastos/patologia , Miosite/diagnóstico , Sarcoma/diagnóstico , Biomarcadores Tumorais , Biópsia , Pré-Escolar , Tratamento Farmacológico , Feminino , Técnicas Histológicas , Humanos , Hibridização in Situ Fluorescente , Fígado/patologia , Transplante de Fígado/efeitos adversos , Sarcoma/tratamento farmacológico , Sarcoma/cirurgia
17.
Indian J Pathol Microbiol ; 62(2): 306-309, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30971563

RESUMO

Primary tumors of the paratesticular region are rare, with sarcomas constituting a major proportion, particularly in the old age. The paratesticular region consists of mesothelial, various epithelial, and mesenchymal cells and may therefore give rise to a variety of tumors. Epithelioid sarcoma usually occurs at the distal extremities of young adults. The proximal-type variant is characterized by a more aggressive course and resistance to treatment. We herein report a case of 32 years male with scrotal swelling diagnosed as proximal-type epithelioid sarcoma of paratesticular region after histopathological examination and immunohistochemistry. To the best of our knowledge, this is only the second case of proximal epithelioid sarcoma of paratesticular region in the English literature. As these tumors are rare, it has been difficult to establish their optimal treatment. Also, these can be easily misdiagnosed as other epithelioid lesions.


Assuntos
Sarcoma/diagnóstico , Neoplasias de Tecidos Moles/diagnóstico , Neoplasias Testiculares/diagnóstico , Adulto , Biomarcadores Tumorais , Diagnóstico Diferencial , Tratamento Farmacológico , Evolução Fatal , Humanos , Imuno-Histoquímica , Masculino , Sarcoma/tratamento farmacológico , Sarcoma/patologia , Escroto/patologia , Escroto/cirurgia , Neoplasias de Tecidos Moles/patologia , Neoplasias Testiculares/patologia , Testículo/patologia
18.
ACS Appl Mater Interfaces ; 11(18): 16391-16401, 2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31002492

RESUMO

Nanomedicine has emerged as a promising strategy for effective cancer treatment. A useful approach is to develop carrier-free nanodrugs via a facile supramolecular self-assembly process. To achieve high therapeutic effect, integrating photodynamic therapy with chemotherapy has been sought after. In this work, we designed a nanocarrier (PEG-Por-CD: oxliPt(IV)-ada) assembled with oxaliplatin prodrug (oxliPt(IV)-ada) and porphyrin photosensitizer (PEG-Por-CD) through host-guest interaction to achieve stimulus-responsive combination therapy. Contributed by excellent spatial control of the binding ratio between host and guest molecules, porphyrin and oxaliplatin were separately modified with ß-cyclodextrin and adamantane to prepare the amphiphilic host-guest complex for subsequent self-assembly into therapeutic nanoparticles. The obtained PEG-Por-CD: oxliPt(IV)-ada nanoparticles exhibited good colloidal stability with an average hydrodynamic size of 164 nm while undergoing the disassembly under reductive environment to release active therapeutic species. Confocal imaging demonstrated the ability of PEG-Por-CD: oxliPt(IV)-ada to effectively accumulate in the cells and produce reactive oxygen species in vitro upon 630 nm light irradiation. As compared with the monotherapy, the PEG-Por-CD: oxliPt(IV)-ada nanoparticles exhibited 3-fold enhanced cytotoxicity and 2-fold increase in the apoptosis. In vivo experiments using 4T1 tumor-bearing mice confirmed that the nanoparticles were efficient in suppressing the tumor growth without eliciting systemic toxicity. The present self-delivery nanosystem constructed from the self-assembly approach not only allows precise control over the drug and photosensitizer loading ratio but also eliminates systemic toxicity concern of the drug carriers, providing a solution for further development of combinational cancer treatment.


Assuntos
Sistemas de Liberação de Medicamentos , Nanopartículas/administração & dosagem , Neoplasias/terapia , Oxaliplatina/administração & dosagem , Apoptose/efeitos dos fármacos , Terapia Combinada , Portadores de Fármacos/administração & dosagem , Portadores de Fármacos/química , Liberação Controlada de Fármacos , Tratamento Farmacológico , Humanos , Células MCF-7 , Nanopartículas/química , Neoplasias/patologia , Oxaliplatina/química , Fotoquimioterapia , Pró-Fármacos/administração & dosagem , Pró-Fármacos/química , Espécies Reativas de Oxigênio/química , Nanomedicina Teranóstica/tendências
19.
Artigo em Alemão | MEDLINE | ID: mdl-30999352

RESUMO

In 2018, no new active pharmaceutical ingredients were released on the German market for horses or food-producing animals. One established veterinary active pharmaceutical ingredient became available for an additional species: the inhalant anesthetic Isoflurane (Isofluran Baxter® vet) from the group of halogenated hydrocarbon compounds was additionally authorized for pigs (piglets). With Acepromazine, Mepivacaine and Oxyclozanide, three temporarily non-available active ingredients were reapproved in new drugs. Additionally, one drug with a new combination of active ingredients and one drug with a new pharmaceutical form were launched on the market for horses and food-producing animals.


Assuntos
Animais Domésticos , Tratamento Farmacológico/veterinária , Cavalos , Drogas Veterinárias , Acepromazina , Anestésicos Inalatórios , Anestésicos Locais , Animais , Antibacterianos , Anti-Inflamatórios não Esteroides , Antiplatelmínticos , Abelhas , Antagonistas de Dopamina , Tratamento Farmacológico/tendências , Alemanha , Isoflurano , Meloxicam , Mepivacaína , Ácido Oxálico , Oxiclozanida , Suínos , Tianfenicol/análogos & derivados
20.
Expert Opin Pharmacother ; 20(9): 1153-1160, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30958725

RESUMO

INTRODUCTION: Standard treatment for diabetic foot ulcers (DFUs) includes off-loading, debridement, moisture balance, management of infection and peripheral arterial disease (PAD) as well as adequate glycemic control. The outcomes so far are unsatisfactory. AREAS COVERED: Herein, the authors provide an outline of newer pharmacological agents for the management of DFUs and give their expert perspectives on future treatment strategies. EXPERT OPINION: Evidence-based healthcare calls for high quality evidence from large RCTs before the implementation of new guidelines for the management of DFUs. Empagliflozin and liraglutide can be recommended for glucose control in patients with DFUs and PAD, while intensive lipid lowering therapy with evolocumab when primary cholesterol goals are not met could be offered to patients with DFUs. Further clinical studies are warranted to develop a structured algorithm for the treatment of DFUs that fail to heal after four weeks of current standard of care. Sucrose octasulfate dressings, becaplermin gel, and platelet-rich plasma (PRP) could also be considered as advanced treatment options for the management of hard to heal DFUs.


Assuntos
Pé Diabético/tratamento farmacológico , Tratamento Farmacológico/métodos , Cicatrização/efeitos dos fármacos , Pé Diabético/patologia , Humanos
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