Uso de fitoterápicos no controle das alterações bucais pós-tratamento oncológico: novas alternativas na odontologia / Use of herbal medicines to control oral changes post-oncological treatment: new alternatives in dentistry

O tratamento oncológico pode ocasionar diversas alterações orais durante e após o processo que podem acarretar déficit de mastigação, fonação, deglutição, além de dor e nutrição deficiente. Nesse contexto, ainda existe uma busca na comprovação do uso de fitoterápicos na oncologia com presença de lesões na cavidade oral ocasionadas pela oncoterapia, para tratamento destas. Assim, o trabalho em questão se trata de uma revisão de literatura, com objetivo de relatar, a partir da análise de periódicos, a observação de efeitos favoráveis para o tratamento das lesões orais por consequência da quimioterapia e radioterapia, através do uso dos fitoterápicos: Camomila (Matricaria chamomilla), Romã (Punica granatum) e extrato de Própolis (Apis mellifera L.). Realizou-se busca eletrônica de dados através do Scholar Google e PubMed, utilizando os Descritores em Ciências da Saúde (Medicamentos Fitoterápicos, Neoplasias, Protocolos Antineoplásicos). Os estudos apresentados neste trabalho evidenciam que o uso destes fitoterápicos pode auxiliar no tratamento das lesões decorrentes da quimioterapia e radioterapia, por possuírem diversas ações anti-inflamatórias, antimicrobianos, antitumorais, entre outras. Por fim, os fitoterápicos apresentados podem ser considerados como uma nova alternativa sendo assim uma escolha favorável de tratamento em relação aos medicamentos convencionais (alopatia), tanto pelo fato de serem naturais e não reduzirem mais ainda a imunidade do paciente, como também pelo seu baixo custo.

The cancer treatment can cause several oral changes during and after the process that can lead to deficits in chewing, phonation, swallowing, in addition to pain and poor nutrition. In this context, there is still a search to prove the use of herbal medicines in oncology with lesions in the oral cavity caused by oncotherapy. Thus, the work in question is a literature review, with the objective of reporting, from the analysis of journals, the observation of favorable effects for the treatment of oral lesions as a result of chemotherapy and radiotherapy, through the use of herbal medicines: Chamomile (Matricaria chamomilla), Pomegranate (Punica granatum) and Propolis extract (Apis mellifera L.). Electronic data search was carried out through Scholar Google and PubMed, using the Health Sciences Descriptors (Phytotherapic Drugs, Neoplasms, Antineoplastic Protocols). The studies presented in this work show that the use of these herbal medicines can help in the treatment of injuries resulting from chemotherapy and radiotherapy, as they have several anti-inflammatory, antimicrobial and anti-tumor actions, among others. Finally, the herbal medicines presented can be considered as a new alternative, thus being a favorable treatment choice in relation to conventional medicines (allopathy), both because they are natural and do not further reduce the patient's immunity, but also because of their low cost.

Actualizaciones clave sobre el tratamiento de la tuberculosis farmacorresistente. Comunicación rápida

Esta es una comunicación rápida que se publica antes de la actualización de las directrices consolidadas de la Organización Mundial de la Salud (OMS) prevista para principios del 2025, con el fin de informar a los programas nacionales de tuberculosis (TB) y a otras partes interesadas de los cambios clave en el tratamiento de la DR-TB y permitir una transición y una planificación rápidas a nivel nacional. Las directrices basadas en la evidencia más recientes sobre el tratamiento de la TB y la TB farmacorresistente, incluida la TB-RR/MDR y la TB pre-XDR, fueron publicadas por la OMS en mayo del 2022 (Directrices unificadas de la OMS sobre la tuberculosis). Es necesario el acceso a los esquemas de tratamiento y a los medicamentos más eficaces para optimizar los resultados del tratamiento al tiempo que se reducen al mínimo los eventos adversos, se mejora la tolerabilidad y la calidad de vida, y se previene la aparición de nuevas farmacorresistencias. En los últimos años han aparecido varios medicamentos nuevos y esquemas acortados (de 4 o 6 meses) que la OMS recomienda para el tratamiento de la TB y la TB-DR. En los últimos años, los investigadores han estado probando combinaciones y duraciones del uso de medicamentos para tratar la TB-RR/MDR que aún no han sido evaluadas por un grupo de elaboración de directrices de la OMS. Entre estos tratamientos se encuentra un nuevo esquema de 6 meses con bedaquilina (B), delamanid (D) y linezolid (L) en combinación con levofloxacina (Lfx), clofazimina (C) o ambos (ensayo clínico BEAT sobre la TB en Sudáfrica, NCT04062201) y un grupo de esquemas de 9 meses para el tratamiento de personas con TB-RR/MDR sin resistencia a las fluoroquinolonas (ensayo clínico endTB, NCT02754765). La evidencia obtenida en estos ensayos se ha notificado a la OMS, y se convocó un grupo de elaboración de directrices para examinar esta nueva evidencia sobre el tratamiento de la TB-RR/MDR y la TB pre XDR, con el fin de garantizar el acceso de las personas que reúnen los criterios para las opciones de tratamiento más recientes. Estas actualizaciones incluyen un nuevo régimen de 6 meses basado en bedaquilina (B), delamanida (D) y linezolid (L), en combinación con levofloxacino (Lfx) o clofazimina (C), o ambos, y un grupo de regímenes de 9 meses para el tratamiento de pacientes con TB-MDR/RR sin resistencia a las fluoroquinolonas.

Monitoring and management of adverse events during mass drug administration

Preventive Chemotherapy (PC) refers to the use of medications, either individually or in combination, as a key public health tool aimed at controlling and eliminating neglected infectious diseases (NIDs). These diseases disproportionately affect vulnerable populations in low-income areas. By administering medications regularly, PC helps reduce the occurrence, transmission, and severity of NIDs, as well as the long-term complications associated with them. Enuring the safety of medications used in PC is not only a crucial technical consideration but also an ethical responsibility. It ensures that while providing health benefits to eligible populations, no harm is caused to individuals. This aligns with the fundamental principle of "do no harm" in medical practice. Furthermore, medication safety is essential for public health programs to succeed, as public trust in the safety and efficacy of these interventions is critical. From manufacturing, where medicines must meet strict quality standards, to the logistics of distribution within the supply chain, and finally, to their administration and the monitoring of any adverse effects, safety must be guaranteed at every stage. To support national NID programs in ensuring the safe administration of medications, organizations like PAHO and WHO, in partnership with strategic stakeholders, have developed a range of practical guidelines, training materials, and tools. These resources are designed to assist in the planning, preparation, and monitoring processes that ensure medication safety. This publication outlines how to access these resources online and is further supplemented by a detailed section of frequently asked questions and their corresponding answers, specifically focused on safety considerations during the implementation of PC.

Regional workshop on the safety of preventive chemotherapy for the elimination of neglected infectious diseases in the Region of the Americas. 1–3 June and 30 June 2022. Workshop report

The "Regional workshop on the safety of preventive chemotherapy for the elimination of neglected infectious diseases in the the Region of the Americas " was a significant event organized by the Pan American Health Organization (PAHO) to enhance the safety of neglected infectious disease (NID) programs that use preventive chemotherapy (PC). Despite the generally safe administration of PC, the workshop addressed several areas needing improvement, including the reporting and investigation of serious adverse events (SAEs), coordination between NID programs and national pharmacovigilance agencies, safety training for community drug distributors, and crisis communication, especially concerning SAEs and rumors. Supported by the IZUMI Foundation and the Fred Hollows Foundation, the workshop aimed to provide additional guidance and support to national NID programs in the Americas. Participants from Colombia, the Dominican Republic, Guyana, Honduras, Nicaragua, and Paraguay, along with facilitators from PAHO and observers from various NGOs, focused on key issues in NID safety. The workshop was structured into two parts: the first three days concentrated on sharing experiences, successes, and challenges in NID safety across different countries. After a brief hiatus, participants reconvened to present their analyses and propose steps to address identified challenges. Innovative approaches in this workshop, such as the use of pre-workshop questionnaires, facilitated breakout groups, and the separation of the main workshop from the "country report" session, proved effective in identifying gaps and developing strategies to strengthen NID safety. The workshop's recommendations include incorporating these innovations into future regional and national NID safety workshops, using the pre-workshop survey as a baseline safety assessment tool, and creating an online repository of safety resources for national NID programs. The workshop underscored the importance of safety in NID programs and the need for ongoing improvements in training, supervision, and practice at all levels. By integrating these safety measures more deeply into national health systems, the workshop participants took important steps toward ensuring the safe and effective elimination of NIDs in the Americas.

Mapa de evidências sobre tratamento da chikungunya / Evidence map of chikungunya treatments / Mapa de la evidencia sobre el tratamiento del chikunguña

[RESUMO]. Objetivo. A partir de revisão da literatura, elaborar um mapa das evidências disponíveis sobre as formas de tratamento da chikungunya. Métodos. Em maio de 2022, realizou-se uma busca bibliográfica sobre chikungunya nas bases de dados PubMed e Biblioteca Virtual em Saúde. Para elaboração do mapa de evidências, os estudos que faziam menção à febre chikungunya foram selecionados e caracterizados quanto ao tipo de intervenção, ao desfecho e à direção do efeito (positivo, negativo, potencial positivo ou potencial negativo, inconclusivo, sem efeito), conforme metodologia preconizada pelo Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde (BIREME). Resultados. Foram incluídos 15 estudos (revisões sistemáticas, ensaios clínicos controlados e revisões narrativas) com intervenções farmacológicas e não farmacológicas. Todas as intervenções tiveram foco na mitigação dos sintomas; nenhum estudo investigou especificamente o combate ao vírus. Apenas um estudo de intervenções farmacológicas relatou efeito positivo, com monoterapia de hidroxicloroquina e terapia combinada de metotrexato mais sulfassalazina e hidroxicloroquina para redução e alívio da dor ocasionada pela artrite pós-chikungunya. O único estudo a relatar efeito negativo descreveu o uso de cloroquina para artralgia pós-chikungunya. Entre as intervenções não farmacológicas, registraram-se efeitos positivos para estimulação transcraniana por corrente contínua, exercícios com bandas elásticas e método Pilates, principalmente para alívio da dor e melhora da função articular. Conclusão. Embora a revisão não tenha identificado nenhum tratamento que combata o vírus diretamente após a instalação da doença, o mapa de evidências sugere que é possível tratar os sintomas e as sequelas da chikungunya com terapias farmacológicas e não farmacológicas.

[ABSTRACT]. Objective. Based on a review of the literature, to create a map of the available evidence on the treatment methods for chikungunya. Method. In May 2022, a literature search on chikungunya was conducted using the PubMed and Virtual Health Library platforms. To create the evidence map, studies that mentioned chikungunya fever were selected and characterized based on the type of intervention, outcome, and direction of the effect (positive, negative, potentially positive or potentially negative, inconclusive, or no effect), following the methodology recommended by the Latin American and Caribbean Center on Health Sciences Information (BIREME). Results. Fifteen studies (systematic reviews, controlled clinical trials, and narrative reviews) with both pharmacological and non-pharmacological interventions were included. All interventions focused on symptom mitigation; no study specifically investigated ways to combat the virus itself. Only one study on pharmacological interventions reported a positive effect, involving monotherapy with hydroxychloroquine and combined therapy with methotrexate plus sulfasalazine and hydroxychloroquine for reducing and relieving pain caused by post-chikungunya arthritis. The only study to report a negative effect described the use of chloroquine for post-chikungunya arthralgia. Among non-pharmacological interventions, positive effects were noted for transcranial direct current stimulation, elastic band exercises, and the Pilates method, particularly for pain relief and improvement of joint function. Conclusion. Although the review did not identify any treatments that act directly on the virus after the onset of the disease, the evidence map suggests that it is possible to treat the symptoms and sequelae of chikungunya with both pharmacological and non-pharmacological therapies.

[RESUMEN]. Objetivo. A partir de una revisión bibliográfica, elaborar un mapa de la evidencia existente sobre las formas de tratar el chikunguña. Métodos. En mayo del 2022, se realizó una búsqueda bibliográfica sobre el chikunguña en las bases de datos PubMed y Biblioteca Virtual en Salud. Para elaborar el mapa de la evidencia, se seleccionaron los estudios en los que se mencionaba el chikunguña y se caracterizaron por lo que respecta al tipo de intervención, el resultado y la clasificación del efecto (positivo, negativo, posiblemente positivo o posiblemente negativo, no concluyente, ausencia de efecto), según la metodología recomendada por el Centro Latinoamericano y del Caribe de Información en Ciencias de la Salud (BIREME). Resultados. Se incluyeron 15 estudios (revisiones sistemáticas, ensayos clínicos comparativos y revisiones narrativas) con intervenciones farmacológicas y no farmacológicas. Todas las intervenciones se centraron en la mitigación de los síntomas. En ningún estudio se ha investigado específicamente la lucha contra el virus. Solo en un estudio de intervenciones farmacológicas se observó un efecto positivo, con la hidroxicloroquina en monoterapia y con el tratamiento combinado de metotrexato más sulfasalazina e hidroxicloroquina, para reducir y aliviar el dolor causado por la artritis tras el chikunguña. En el único estudio en el que se informó de un efecto negativo se describió el uso de cloroquina para la artralgia tras el chikunguña. En lo que respecta a las intervenciones no farmacológicas, se registraron efectos positivos con la estimulación transcraneal por corriente continua, los ejercicios con bandas elásticas y el método Pilates, principalmente para el alivio del dolor y la mejora de la función articular. Conclusión. Aunque en la revisión no se señaló ningún tratamiento que permita combatir el virus directamente tras la aparición de la enfermedad, el mapa de la evidencia sugiere que es posible tratar los síntomas y las secuelas del chikunguña con intervenciones farmacológicas y no farmacológicas.

Monitoreo y manejo de eventos adversos durante la administración masiva de medicamentos / Monitoring and management of adverse events during mass drug administration

La presente publicación describe una serie de directrices, manuales y materiales educativos disponibles en línea. Estos recursos están diseñados para apoyar a los programas nacionales de enfermedades infecciosas desatendidas, en la planificación, preparación y vigilancia de la administración segura de medicamentos. El documento en cuestión complementa estos recursos, ofreciendo soporte específico para el monitoreo de la seguridad de los medicamentos y el manejo de eventos adversos. En resumen, la quimioterapia preventiva es una estrategia fundamental en la lucha contra las EID, y su éxito depende en gran medida de la seguridad y confianza en los medicamentos utilizados. A través de directrices claras, capacitación y monitoreo riguroso, la OPS y la OMS aseguran que estos programas no solo sean efectivos, sino también seguros y confiables para todas las comunidades involucradas.

Bevacizumab-induced hypertension in patients with glioblastoma: a systematic review and meta-analysis

BACKGROUND: Bevacizumab is a monoclonal antibody medication used as standard treatment for different types of cancers, one of them is glioblastoma, which is the most common primary brain tumor. PURPOSE: We aimed to assess bevacizumab and its effects on inducing hypertension in patients with glioblastoma. METHODS: PubMed, Embase and Cochrane databases were searched until February 13th, 2024 for randomized control trials (RCTs) comparing bevacizumab alone with control or bevacizumab in combination with other chemotherapies in patients with glioblastoma. Data was examined using the Mantel-Haenszel method and we computed risk ratio (RRs) for binary endpoints and 95% confidence intervals (Cls). Heterogeneity was assessed using I² statistics. Meta-regression analysis was conducted to evaluate a possible link between the occurrence of hypertension and mortality or progression-free survival. R software version 4.2.3 was used for statistical analysis. RESULTS: 5 RCTs and 1 non-randomized study were included with a total of 1402 patients, of whom 608 (43,36%) were assigned to the bevacizumab and 794(56,64%) composed the control group. Compared with bevacizumab, the control achieved statistically significant lower rates of hypertension occurrence (RR 6,31; CI: 2,13 - 18,65; p=0.000872; I²=54%). Subgroup analysis of bevacizumab alone versus bevacizumab in combination with other chemotherapies tended towards the combination group(RR 2,24; CI: 1,19 - 4,21; p= 0.012497; I² = 68%). Mortality was significantly higher in the bevacizumab group (OR 1,60; CI: 1,02 - 2,52; p=0,040443; I²= 0%). Progression-free survival did not reach a statistically significant difference between groups (OR 1,07; CI: 0,33 - 3,43; p= 0,907923; I²= 45%) and meta-regression analysis showed no significant link between hypertension and mortality or progression-free survival. CONCLUSION: Concerning the treatment of glioblastoma, our results showed that induced hypertension is more likely to happen in patients treated with bevacizumab. Significant statistical difference in the mortality was observed between the use of bevacizumab and control. However, the current data is insufficient to determine a link between hypertension and prognostic value through meta-regression analysis.

Nova opção no tratamento percutâneo da cardiomiopatia hipertrófica obstrutiva / New option in the percutaneous treatment of obstructive hypertrophic cardiomyopathy

INTRODUÇÃO: A obstrução da via de saída do ventrículo esquerdo (VSVE) ocorre em cerca de 70% dos pacientes com Cardiomiopatia Hipertrófica (CMH), conferindo elevada morbidade e risco de morte súbita. A miectomia cirúrgica e a alcoolização septal são estratégias invasivas já estabelecidas para pacientes refratários à terapia medicamentosa, mas possuem resultados variados e taxas não desprezíveis de complicações. A ablação endocárdica por cateter de radiofrequência (RF) tem se mostrado uma alternativa a essas abordagens. DESCRIÇÃO DO CASO: Mulher, 50 anos de idade, portadora de Cardiomiopatia Hipertrófica Obstrutiva (CMHO) refratária a tratamento medicamentoso, classe funcional NYHA III, hipertensão arterial pulmonar grave tipo II e elevado risco cirúrgico avaliado por "Heart Team". Foi optado pela ablação septal por RF como terapia. O procedimento foi realizado sob anestesia geral, com inserção de cateter "pigtail" no ventrículo esquerdo (VE), que mostrou gradiente máximo na via de saída do VE (VSVE) de 113 mmHg, além de cateteres decapolar em His, quadripolar em átrio direito e ablador 8 mm por via retroaórtica no VE. Areconstrução do volume eletroanatômico do VE evidenciou concavidade ao nível do trato de saída coincidente com o septo alto. Realizou-se extensa ablação guiada pelo ecocardiograma transesofágico (ETE) na área de maior obstrução septal, com controle de temperatura em 60º e potência de 70W. Após a ablação, houve nova mensuração do gradiente máximo na VSVE de 100mmHg (redução aproximada de 13mmHg). Não houve comprometimento do sistema de condução ou outras complicações peri-procedimento. Dois meses após a abordagem, a paciente apresentava Classe Funcional NYHAI e ecocardiograma transtorácico com gradiente máximo na VSVE de 53 mmHg. CONCLUSÃO: A ablação por RF é um procedimento seguro, capaz de diminuir o gradiente da VSVE e melhorar o status funcional em pacientes portadores de CMH com obstrução grave. O uso do ETE permite uma otimização no posicionamento do cateter de ablação, minimizando o risco de complicações.

The decreased left ventricular ejection fraction in patients using trastuzumab deruxtecan for her2-positive breast cancer: a systematic review and meta-analysis

Breast Cancer (BC) is one of the most common cancers diagnosed in population femmale and it has several subtypes, one of them being theexpressing human epidermal growth factor receptor 2 positive (HER2 +), one of the treatments for HER2+ breast cancer consists of chemotherapy plus trastuzumab deruxtecan. Several clinical trials have shown the effectiveness and safety of trastuzumabe deruxtecano in cancer patients, however, several Adverse Events (AEs) have been described and the decrease in left ventricular ejection has been singled out for more prominent analysis. Objective: We conducted a systematic review and meta-analysis to investigate the cardiovascular effects of Trastuzumab Deruxtecano and whether it can influence the appearance of reduced left ventricular ejection fraction.. METHODS: We performed a systematic search in Embase, PubMed and Cochrane databases for randomized controlled trials (RCTs) showed a decrease in left ventricular ejection fraction in patients using trastuzumab deruxtecan against Her-2-positive breast cancer compared to patients to used another's treatments against this disease. Mean difference (MD) with 95% confidence intervals (CI) were calculated using a random effects model. The heterogeneity was examined in the I2 statistic. P-values > 0.05 were considered statistically significant. The statistical analysis was carried out using R software version 4.2.3. RESULTS: A total of 3 RCTs were included, with a total of 1656 patients evaluated, 928 patients randomized to the use of Trastuzumab Deruxtecan and 728 patients to the use of other treatments according to medical choice, follow-up ranged from 10 to 38 months. There was a visible in the decrease in left ventricular ejection fraction, with a higher incidence in the group that used trastuzumab compared to the placebo group (RR: 5.73%; 95% CI 1.51 - 21.78; I2 33% ; P= 0.010466). Another important point is the discontinuation of treatment due to grade 2 adverse events, classified as reduced LVEF, where a higher incidence is seen in the group that used Trastuzumab Deruxtecan compared to the placebo group (RR 2.11%; 95% CI 1.54 - 2.89; P = 0.000003),7. CONCLUSION: In this meta-analysis, Trastuzumab Deruxtecan showed a relationship with a decrease in left ventricular ejection fraction, displaying the need for more studies to evaluate the cardiotoxicity of trastuzumab and its effects as a whole on the cardiovascular system.

Cardio-protective effects of statins in patients with breast cancer undergoing anthracycline-based chemotherapy: a metaanalysis of randomized controlled trials

BACKGROUND: Contemporary understanding characterizes cardiotoxicity as a reduction in left ventricular ejection fraction (LVEF) by at least 10%, resulting in a final value below 53% in successive assessments. Nevertheless, breast cancer therapy can impact the cardiovascular system through various avenues. Cardiotoxicity is a known side effect of anthracycline chemotherapy, and the effectiveness of concomitant statin use in mitigating this risk is still unclear. PURPOSE: We aimed to evaluate the potential cardioprotective effects of statin exposure during anthracycline treatment. Our hypothesis posited that patients receiving statins during their treatment would experience a lesser decline in left ventricular ejection fraction (LVEF), lower levels of cholesterol and a reduced occurrence of cardiotoxicity compared to those not exposed to statins. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing statin versus placebo in patients undergoing anthracycline therapy. We searched PubMed, Embase and Cochrane for eligible trials. Mean differences (MDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was examined with I2 statistics. P values of < 0.05 were considered statistically significant. Statistical analysis were performed using R software version 4.2.3. RESULTS: A total of 4 RCTs comprising 580 patients were included, of whom 281 were randomized to statins and 299 to placebo. The follow up period ranged from 2.5 to 24 months, with participant ages varying between 36 to 68.9 in the intervention group and 37.9 to 72 in the control group. Compared with placebo, statins were significantly associated with a higher left ventricular ejection fraction (MD 2.57%; 95% CI 1.05-4.08; p<0.001; I2=0%), reduction in left ventricular systolic end-volume (MD -4.5 mL; 95% CI -7.57 to -1.44; p<0.004; I2=0%) and diastolic end-volume (MD -6.08 mL; 95% CI -11.27 to -0.9; p<0.021; I2=0%), with a low heterogeneity value. Statins also showed important reduction of total cholesterol (MD -46.28 mg/dL; 95% CI -71.3 to -21.25; p<0.001; I2=89%) and LDL-C (MD -39.45 mg/dL; 95% CI -52.27 to -26.64; p<0.001; I2=84%). CONCLUSIONS: In this metaanalysis of RCTs, the use of statins showed a correlation with improved cardiovascular parameters, indicating their effectiveness in minimizing cardiotoxicity in breast cancer patients undergoing anthracycline chemotherapy

Hipertensão arterial sistêmica: evidências do tratamento farmacológico de pessoas negras / Systemic arterial hypertension: evidence of pharmacological treatment of black people

Pergunta - Qual é o melhor protocolo terapêutico farmacológico para o controle da hipertensão arterial em pessoas negras brasileiras? Métodos - As buscas por Guias de Prática Clínica (GPC) e revisões sistemáticas (RS) foram realizadas em junho de 2024 nas bases de dados LILACS - Literatura Latino-Americana e do Caribe em Ciências da Saúde, Pubmed, Embase, BIGG - Base Internacional de Guias GRADE, GIN - Guidelines International Network e Epistemonikos. Nesta revisão rápida, a seleção dos estudos e a avaliação da qualidade metodológica foram realizadas em duplicidade e de modo independente. Resultados - De 130 registros recuperados nas buscas, 3 RS e 1 GPC foram incluídos. Todas as RS abordam exclusivamente a população negra, enquanto o GPC refere-se à população com HAS em geral. A qualidade metodológica do GPC foi considerada baixa e das RS foi criticamente baixa. Os achados foram categorizados segundo as recomendações do GPC e as evidências das RS. Em síntese, os estudos relataram que para o tratamento da HAS na população negra os diuréticos e BCC são mais eficazes e apresentam menor risco de eventos adversos graves. No entanto, é importante considerar que a qualidade metodológica do GPC foi considerada baixa e das revisões sistemáticas criticamente baixa.

Question - What is the best pharmacological therapeutic protocol for controlling high blood pressure in black Brazilians? Methods - Searches for Clinical Practice Guidelines (CPG) and systematic reviews (SR) were conducted in June 2024 in the databases LILACS - Latin American and Caribbean Literature in Health Sciences, Pubmed, Embase, BIGG - International Database of GRADE Guidelines, GIN - Guidelines International Network and Epistemonikos. In this rapid review, the selection of studies and the assessment of methodological quality were performed in duplicate and independently. Results - Of 130 records retrieved in the searches, 3 SR and 1 CPG were included. All SR address exclusively the black population, while the CPG refers to the population with hypertension in general. The methodological quality of the CGP was considered low and that of the SR was critically low. The findings were categorized according to the CPG recommendations and the evidence from the SR. In summary, the studies reported that for the treatment of hypertension in the black population, diuretics and CCBs are more effective and present a lower risk of serious adverse events. However, it is important to consider that the methodological quality of the CPG was considered low and that of the systematic reviews was critically low.

Hipertensão arterial sistêmica: recomendações para o tratamento inicial em adultos / Systemic arterial hypertension: recommendations for initial treatment in adults

Pergunta - Quais são as evidências sobre o uso de monoterapia ou terapia combinada no tratamento farmacológico inicial da HAS? Métodos - As buscas de Guias de Prática Clínica (GPC) foram realizadas em junho de 2024 nas bases de dados LILACS - Literatura Latino-Americana e do Caribe em Ciências da Saúde, Pubmed, Embase, BIGG - Base Internacional de Guias GRADE e GIN - Guidelines International Network. Nesta revisão rápida, a seleção de GPC e a avaliação da qualidade metodológica foram realizadas em duplicidade e de modo independente. Resultados - De 3.671 registros recuperados nas buscas, cinco GPC foram incluídos. Quatro GPC foram conduzidos na Argentina, El Salvador, Irã, Tailândia, e um foi produzido pela Organização Mundial da Saúde (OMS). A qualidade geral metodológica dos GPC foi considerada baixa. Os achados foram categorizados segundo o esquema terapêutico analisado. Todas as classes de anti-hipertensivos são recomendadas para a monoterapia da HAS. Há evidências de melhores resultados da terapia combinada no controle da HAS inicial e menos eventos adversos. Porém, ainda faltam evidências robustas. Deve-se considerar também que a qualidade metodológica dos GPC foi considerada baixa.

Question - What is the evidence on the use of monotherapy or combination therapy in the initial pharmacological treatment of hypertension? Methods - Searches for Clinical Practice Guidelines (CGP) were conducted in June 2024 in the databases LILACS - Latin American and Caribbean Literature in Health Sciences, Pubmed, Embase, BIGG - International Database of GRADE Guidelines and GIN - Guidelines International Network. In this rapid review, CGP selection and methodological quality assessment were performed in duplicate and independently. Results - Of 3,671 records retrieved in the searches, five CGPs were included. Four CGPs were conducted in Argentina, El Salvador, Iran, Thailand, and one was produced by the World Health Organization (WHO). The overall methodological quality of the CGPs was considered low. The findings were categorized according to the therapeutic regimen analyzed. All classes of antihypertensives are recommended for monotherapy of hypertension. There is evidence of better results of combined therapy in controlling initial hypertension and fewer adverse events. However, robust evidence is still lacking. It should also be considered that the methodological quality of the GPC was considered low.

Monitoreo y manejo de eventos adversos durante la administración masiva de medicamentos

La Quimioterapia Preventiva (QP) es una herramienta vital en la salud pública, utilizada para controlar y eliminar enfermedades infecciosas desatendidas (EID) mediante la administración regular de medicamentos. Este enfoque reduce la incidencia y la propagación de estas enfermedades y mitiga la gravedad de sus secuelas a largo plazo. Al tratar a las poblaciones elegibles, la QP brinda beneficios significativos para la salud, pero también conlleva la responsabilidad ética de garantizar la seguridad de estos medicamentos, adhiriéndose al principio fundamental de "no hacer daño". La seguridad en la administración de medicamentos es crucial para el éxito de cualquier programa de salud pública. La población debe confiar en la seguridad y efectividad de los medicamentos para participar de manera efectiva en estos programas. Esta confianza se logra asegurando que cada etapa del proceso, desde la fabricación de los medicamentos cumpliendo con estrictos estándares de calidad, hasta su envío, gestión en la cadena de suministro, administración y monitoreo de eventos adversos, se realice con la máxima diligencia. Para proporcionar guías prácticas, materiales de capacitación y herramientas de apoyo, la Organización Panamericana de la Salud (OPS) y la Organización Mundial de la Salud (OMS) han desarrollado, en colaboración con socios estratégicos, una serie de directrices, manuales y materiales educativos disponibles en línea. Estos recursos están diseñados para apoyar a los programas nacionales de EID en la planificación, preparación y vigilancia de la administración segura de medicamentos. El documento en cuestión complementa estos recursos, ofreciendo soporte específico para el monitoreo de la seguridad de los medicamentos y el manejo de eventos adversos. A través de respuestas a preguntas frecuentes y mensajes clave, se proporciona una guía esencial para el personal que participa en la administración de medicamentos para EID, así como para la comunidad en general. Este enfoque asegura que todos los involucrados estén informados y preparados para manejar cualquier eventualidad, fortaleciendo así la confianza y la efectividad del programa. En resumen, la Quimioterapia Preventiva es una estrategia fundamental en la lucha contra las EID, y su éxito depende en gran medida de la seguridad y confianza en los medicamentos utilizados. A través de directrices claras, capacitación y monitoreo riguroso, la OPS y la OMS aseguran que estos programas no solo sean efectivos, sino también seguros y confiables para todas las comunidades involucradas.

Dental and maxillofacial outcomes in childhood head and neck cancer survivors: a retrospective study and dental care considerations

Cancer treatment during childhood, including head and neck radiotherapy and chemotherapy, can cause persistent dental and maxillofacial changes, which may lead to long-term complications in dental care and oral rehabilitation. Objective: The aim of this study was to evaluate dental and maxillofacial alterations resulting from childhood head and neck cancer treatment and discuss considerations regarding dental care for these patients. Methods: This retrospective study utilized a Cancer Center database, including patients referred to the Stomatology Department from 2004 to 2018. Results: The sample comprised 12 patients (7 males and 5 females) with a mean age of 5 years at diagnosis, who underwent oncological treatment in the head and neck region. Half exhibited facial bone hypoplasia, predominantly mandibular (33.33%) over maxillary (16.67%). Nearly all patients showed dental abnormalities, including agenesis (50%), supernumerary teeth (16.67%), and root formation anomalies (66%). Conclusion: This study underscores the importance of understanding these treatment-related alterations to ensure appropriate dental care for these patients. The involvement of a dental surgeon is crucial to providing comprehensive care and effectively monitoring any dental and maxillofacial complications. (AU)

Cardiac tumors: review

Cardiac tumors are rare and encompass a variety of presentations. Clinica symptoms are usually nonspecific, but they can present as obstructive, embolic, or constitutional symptoms. Treatment options and prognosis vary highly depending on the subtype, tumor size, and location. Surgical resection is usually the first-line therapy, except for cardiac lymphomas, and provides favorable long-term prognosis in most benign tumors. Cardiac sarcomas, however, are usually diagnosed in advanced stages, and the treatment relies on a multimodal approach with chemotherapy and radiotherapy. Metastatic cardiac tumors are usually related to advanced disease and carry an overall poor prognosis.

Liposarcoma gigante mediastinal. Cirugía radical con abordaje Clamshell y manejo en la Unidad de Cuidados Críticos / Giant Mediastinal Liposarcoma. Radical Surgery with Clamshell Approach and Management in Critical Care Unit

Se presenta a un paciente con liposarcoma mediastinal gigante con dolor torácico, disnea, cuyos estudios por imágenes revelaban la presencia de una gran tumoración de 42 cm en su diámetro mayor que abarcaba todo el mediastino, comprometía ambas cavidades torácicas, rechazaba los pulmones, corazón y grandes vasos. La biopsia con aguja cortante bajo guía ecográfica fue informada como liposarcoma. El paciente tuvo resección completa del tumor mediante la incisión Clamshell. En el post operatorio inmediato, presentó shock circulatorio más disfunción multiorgánica (DOMS): plaquetopenia, insuficiencia renal aguda con necesidad de soporte dialítico, injuria hepática. El soporte y monitoreo especializado en la Unidad de Cuidados Intensivos (UCI) permitió mejoría clínica y buena evolución. Salió de alta en buenas condiciones.

We present a patient with giant mediastinal liposarcoma with chest pain, dyspnea, whose imaging studies revealed the presence of a large tumor measuring 42 cm in its greatest diameter that covered the entire mediastinum, involved both thoracic cavities, rejected the lungs, heart and big glasses. The sharp needle biopsy under ultrasound guidance was reported as liposarcoma. The patient had complete resection of the tumor through the Clamshell incision. In the immediate postoperative period, he presented circulatory shock plus multiple organ dysfunction (DOMS): plateletopenia, acute renal failure with the need for dialytic support, liver injury. Specialized support and monitoring in the Intensive Care Unit (ICU) allowed clinical improvement and good evolution. He was discharged in good condition.

Conhecimento e uso de práticas integrativas e complementares por pacientes submetidos a tratamento quimioterápico / Knowledge and use of integrative and complementary practices by patients undergoing chemotherapy treatment / Conocimiento y uso de prácticas integrativas y complementarias por pacientes sometidos a tratamiento de quimioterapia

Objetivo:avaliar o conhecimento e o uso das práticas integrativas e complementares por pacientes adultos com câncer durante a quimioterapia. Método:estudo quantitativo do tipo descritivo, realizado em uma unidade de quimioterapia de Minas Gerais entre outubro de 2022 e março de 2023. Foram entrevistados pacientes adultos com câncer de ambos os sexos, excluindo aqueles com déficit de compreensão. Aplicado questionário sociodemográfico e clínico-terapêutico, com análise pelosoftware Statistical Package forthe Social Sciences®. Resultados:foram entrevistados 93 pacientes, a maioria era homens, com média de idade 60,32 anos, brancos, casados e com baixa escolaridade. Os cânceres mais prevalentes foram colorretal, pulmão e mama. Quanto às práticas integrativas, 73 pacientes possuíam conhecimento, porém somente 33 realizavam alguma terapia, sendo as mais utilizadas a musicoterapia e a acupuntura. Conclusões:houve maior nível de conhecimento do que de utilização. Para evitar essa discrepância, o enfermeiro precisa realizar orientação e supervisão dessas práticas.

Objective:to evaluate the knowledge and the use of integrative and complementary practices by adult cancer patients during chemotherapy. Method:quantitative descriptive study, carried out in a chemotherapy unit in Minas Gerais between October 2022 and March 2023. Adult cancer patients of both sexes were interviewed, excluding those with comprehension deficits. A sociodemographic and clinical-therapeutic questionnaire was applied and analysis using the software Statistical Package for the Social Sciences®. Results:93 patients were interviewed, the majority were men, average age of 60.32 years, white, married and with a low level of education. The most prevalent cancers were colorectal, lung, and breast. Regarding integrative and complementary practices, 73 patients had knowledge, but only 33 performed some therapy, the most used being music therapy and acupuncture. Conclusions:there was a higher level of knowledge than use. To avoid this discrepancy, nurse need to provide guidance and supervision of these practices.

Objetivo:evaluar el conocimiento y uso de prácticas integrativas y complementarias por parte de pacientes adultos con cáncer durante la quimioterapia. Método:estudio descriptivo cuantitativo, realizado en unidad de quimioterapia de Minas Gerais entre octubre/2022 y marzo/2023. Se entrevistaron pacientes adultos con cáncer de ambos sexos, excluidos aquellos con déficit de comprensión. Se aplicó cuestionario sociodemográfico y clínico-terapéutico, con análisis mediante el software Statistical Package for the Social Sciences®. Resultados:se entrevistaron 93 pacientes, la mayoría eran hombres, edad promedio 60,32 años, blancos, casados y con bajo nivel educativo. Los cánceres más prevalentes fueron el colorrectal, de pulmón y de mama. En cuanto las prácticas integradoras y complementarias,73 pacientes tenían conocimientos, pero solo 33 realizaban alguna terapia, siendo las más utilizadas la musicoterapia y la acupuntura. Conclusiones:hubo mayor nivel de conocimiento que de uso. Para evitar esta discrepancia,la enfermera debe proporcionar orientación y supervisión de estas prácticas.

Cardiovascular benefits of statin plus ezetimibe combination therapy versus statin monotherapy in acute coronary syndrome: a meta-analysis of randomized controlled trials

BACKGROUND: The efficacy of adding ezetimibe to statin therapy for event reduction in patients with acute coronary syndromes (ACS) remains a topic of ongoing debate. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing ezetimibe plus statin versus statin monotherapy in patients with ACS. We searched PubMed, Embase, and Cochrane for eligible trials. Random-effects model was used to calculate the risk ratios (RRs), with 95% confidence intervals (CIs). Statistical analyses were performed using RStudio version 4.2.3. RESULTS: Six RCTs comprising 20,574 patients with ACS were included, of whom 10,259 (49.9%) were prescribed ezetimibe plus statin. The patient population had an average age of 63.8 years and 75.1% were male. Compared with statin monotherapy, ezetimibe plus statin significantly reduced major adverse cardiovascular events (MACE) (RR 0.93; 95% CI 0.90-0.97; p<0.01) and non-fatal myocardial infarction (RR 0.88; 95% CI 0.81-0.95; p<0.01). There was no significant difference between groups for revascularization (RR 0.94; 95% CI 0.88-1.01; p=0.07), all-cause death (RR 0.87; 95% CI 0.63-1.21; p=0.42), or unstable angina (RR 1.05; 95% CI 0.86-1.27; p=0.64). CONCLUSION: In this meta-analysis of patients with ACS, the combination of ezetimibe plus statin was associated with a reduction in MACE and non-fatal myocardial infarction, compared with statin monotherapy.

Metabolic syndrome in women with breast cancer: scope review / Síndrome metabólica em mulheres com câncer de mama: revisão de escopo

Objective: To synthesize evidence involving pathophysiological and clinical-epidemiological linking mechanisms in women with breast cancer and metabolic syndrome. Method: This is a structured scoping review according to the Joanna Briggs Institute and was conducted in the PubMed, BDENF, LILACS, IBECS, CUMED, WPRIM, BINACIS, and Embase databases. This review is registered in the Open Science Framework. Result: Regarding the level of evidence of the included studies, moderate and strong evidence levels were predominant. There were no weak evidence findings in this research. The chronic inflammatory state of breast adipose tissue in patients with obesity can worsen the negative impact on cancer cells, directly affecting survival and recurrence. Unexplained weight gain or loss is associated with shorter survival in women with breast cancer, highlighting the need for specific guidance during treatment. Conclusion: Metabolic syndrome is associated with the risk of breast cancer; however, massive weight loss during active disease can be associated with a worse prognosis and should therefore be prevented. Patients should be advised to maintain a stable weight during chemotherapy and to receive guidance on adequate nutrition and physical activity to increase muscle mass

Objetivo: Sintetizar as principais evidências envolvendo os mecanismos de ligação fisiopatológico e clínico-epidemiológico em mulheres com câncer de mama e a síndrome metabólica. Método: Trata-se de uma revisão de escopo estruturada conforme o Instituto Joanna Briggs, realizado nas bases de dados PubMed, BDENF, LILACS, IBECS, CUMED, WPRIM, BINACIS e Embase. Esta revisão encontra-se protocolada no Open Science Framework. Resultado: Com relação ao nível de evidência dos estudos inclusos, houve predominância para níveis fortes de evidência. Não houve achados de evidência fraca nesta pesquisa. O estado inflamatório crônico do tecido adiposo mamário em casos de obesidade pode agravar o impacto negativo nas células cancerígenas, afetando diretamente a sobrevida e recorrência. Ganho ou perda de peso inexplicável estão associados a uma menor sobrevida em mulheres com câncer de mama, sublinhando a necessidade de orientações específicas durante o tratamento. Conclusão: A síndrome metabólica esta associada ao risco de câncer de mama, entretanto, a perda maciça de peso durante a doença ativa pode ser um fator de pior prognóstico, devendo assim, ser realizada de forma preventiva. Os pacientes devem ser orientados a manter um peso estável durante a quimioterapia e receber orientações sobre alimentação adequada e atividade física em busca de aumento de massa muscular

Informe de estimación de la demanda de Fulvestrant en el contexto de las drogas oncológicas de alto costo: desafíos, limitaciones y perspectivas: documento metodológico / Fulvestrant demand estimation report in the context of high-cost oncology drugs: challenges, limitations and prospects: Methodological document

ANTECEDENTES Y OBJETIVO El aumento del presupuesto para Drogas Oncológicas de Alto Costo (DAC) ha generado una mayor disponibilidad de fármacos como el fulvestrant. La demanda de este medicamento, utilizado en el tratamiento del cáncer de mama avanzado, ha mostrado variaciones que requieren de un análisis preciso. El objetivo de este estudio es estimar la demanda de fulvestrant para el año 2024. METODOLOGÍA Se empleó un enfoque de modelado de series temporales para pronosticar la demanda de fulvestrant, utilizando datos históricos de pacientes aprobados entre 2019 y 2024. La metodología incluyó la depuración y homogenización de los registros de pacientes, con un enfoque en la diferenciación entre pacientes incidentes y en régimen. Posteriormente, se aplicaron modelos lineales, particularmente el ARIMA (0,1,1), para predecir la demanda mensual y anual del medicamento. Los modelos fueron evaluados utilizando criterios de información y ajustados según las limitaciones de tiempo y datos. RESULTADOS Los resultados indicaron que la demanda de fulvestrant para 2024 podría variar entre un mínimo de 1.944 cajas y un máximo de 4.201, con una estimación más probable de 3.073 cajas. Este pronóstico se basa en el comportamiento histórico de la demanda, el número de pacientes y las fluctuaciones observadas, como caídas y aumentos atípicos en el consumo. La estimación del modelo ARIMA mostró un crecimiento progresivo en el consumo, aunque con alta volatilidad. Se observó que los datos de pacientes incidentes y en régimen eran cruciales para una predicción más precisa, ya que reflejan las fluctuaciones en los registros administrativos. Sin embargo, las variaciones en el número de pacientes y los tiempos de tratamiento sugieren que estos modelos deben ser considerados con cautela. En términos de planificación de recursos y adquisición, los resultados ofrecen una base para tomar decisiones informadas sobre la distribución y el acceso al medicamento, destacando la necesidad de mejorar la calidad y la consistencia de los datos disponibles para obtener estimaciones más precisas.