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1.
ABCS health sci ; 44(3): 209-212, 20 dez 2019. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1047756

RESUMO

INTRODUÇÃO: O tratamento do câncer vem evoluindo a cada dia. Entretanto, efeitos adversos como alterações dermatológicas apresentam um grande impacto psicossocial ao paciente oncológico. Uma dessas alterações dermatológicas é a alopecia, caracterizada pela perda dos fios da sobrancelha e do couro cabeludo. RELATO DE CASO: Foram referidos dois casos de pacientes em tratamento quimioterápico com alopecia parcial e total. Ambas receberam tratamento por meio do Minoxidil, de uso tópico, havendo repilação completa após três meses. Não foram observados efeitos adversos. CONCLUSÃO: A loção tópica de Minoxidil mostrou-se um método efetivo e seguro para tratar a alopecia parcial e total em pacientes que ainda estão em tratamento oncológico.


INTRODUCTION: The treatment of cancer has been evolving every day. However, adverse effects such as dermatological changes have a great psychosocial impact on cancer patients. One dermatological change is alopecia, characterized by loss of eyebrow and scalp strands. CASE REPORT: Two cases of patients undergoing chemotherapy with partial and total alopecia were reported. Both were treated with Minoxidil, which was topically used, with complete repilation after three months. No adverse effects observed. CONCLUSION: Minoxidil topical lotion has proven to be an effective and safe method to treat partial and total alopecia in patients still undergoing cancer treatment.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Relatos de Casos , Dermatologia , Alopecia/tratamento farmacológico , Oncologia Integrativa , Minoxidil/uso terapêutico , Tratamento Farmacológico
2.
Medicine (Baltimore) ; 98(45): e17827, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702637

RESUMO

This study was designed to analyze the clinical characteristics and prognostic value of c-MYC and BCL-2 proteins expression in patients with primary central nervous system diffuse large B-cell lymphoma (PCNS-DLBCL).82 patients newly diagnosed with PCNS-DLBCL, from January 2008 to November 2018, were enrolled in this study. Clinical characteristics, immunohistochemical features, laboratory examinations, and treatment outcome were analyzed among these patients.Among these 82 cases, 45 were males (54.9%) and 37 were females (45.1%). Age ranged from 16 to 78 years old, and 29 patients (35.4%) were elder than 60 years old, with median age at 57 years old. According to Hans classification, 25 were accounted for origin of germinal center B-cell (GCB) subtype (30.5%) and 49 were accounted for non-GCB subtype (59.8%), respectively. Eight patients were unclassified due to lack of detailed pathological results. The median survival of these 82 patients was 30 months, and 1-year, 3-year, and 5-year overall survival (OS) rate was 59.7%, 44.6%, and 34.1%, respectively. Patients treated with sequential HD-MTX based chemotherapies showed a superior prognosis than those without. In combination with rituximab, the outcome was further improved. The median OS was 55 months in HD-MTX + R group, 27 months in HD-MTX group, and 9 months in other groups, respectively. Univariate analysis identified age ≥60, ECOG score ≥ 2 points, and overexpression of BCL-2 protein (≥85%) were adverse prognostic factors for OS. Co-expression of c-MYC (≥40%) and BCL-2 (≥50%) proteins was associated with poor ECOG score, high Ki-67 expression, and trended towards an inferior outcome. Gender, lesion location, number of lesions, lactic dehydrogenase (LDH), cell of origin, BCL-6 protein expression, expression of c-MYC protein alone and Ki-67 ≥85% had no significant impact on OS.In patients with PCNS-DLBCL, age ≥60 years old, ECOG score ≥2 points, and overexpression of BCL-2 protein (≥85%) were associated with a poor survival. HD-MTX based chemotherapies in combination with rituximab could improve the prognosis.


Assuntos
Biomarcadores Tumorais/metabolismo , Neoplasias do Sistema Nervoso Central/mortalidade , Linfoma Difuso de Grandes Células B/mortalidade , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Regulação para Cima , Adolescente , Adulto , Idoso , Neoplasias do Sistema Nervoso Central/tratamento farmacológico , Neoplasias do Sistema Nervoso Central/metabolismo , Tratamento Farmacológico , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/metabolismo , Masculino , Pessoa de Meia-Idade , Prognóstico , Proteínas Proto-Oncogênicas c-myc/metabolismo , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
3.
Nurs Clin North Am ; 54(4): 561-567, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31703781

RESUMO

Postpartum depression (PPD) affects10% to 20% of women within the first year after birth and 25% beyond the first year. PPD, despite advances in diagnosis and treatment, remains underdiagnosed and misunderstood. Women do not always display signs of PPD while in care for delivery of the infant and may not discuss mood changes to their primary care provider at discharge and first post-delivery appointment. Identifying screening and treatment options for non-mental health providers was the purpose of this article.


Assuntos
Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/terapia , Programas de Rastreamento , Papel do Profissional de Enfermagem/psicologia , Depressão Pós-Parto/epidemiologia , Tratamento Farmacológico , Feminino , Humanos , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Fatores de Risco
4.
Zhonghua Zhong Liu Za Zhi ; 41(11): 859-864, 2019 Nov 23.
Artigo em Chinês | MEDLINE | ID: mdl-31770855

RESUMO

Objective: This study aimed to evaluate the role of extended involved-field intensity modulated radiation therapy (IMRT) for patients with early stage extranodal nasal-type NK/T-cell lymphoma (NKTCL) in a single center, and to explore the long-term effect of risk-adaptive therapy. Methods: Among 238 patients with early stage NKTCL, there were 191 in high-risk group [any risk factor of age > 60, elevated serum lactate dehydrogenase (LDH), Eastern Cooperative Oncology Group (ECOG) score≥2, primary tumor invasion, or Ann Arbor stage Ⅱ] and 47 in low-risk group (no risk factor). A total of 204 patients received radiotherapy combined with chemotherapy, 15 received radiotherapy alone and 19 received chemotherapy alone. One-hundred and eighty-six patients had radiotherapy at a dose ≥50 Gy and 159 patients received chemotherapy with asparaginase-based regimen. Results: The 5-year overall survival (OS) rate and progression- free survival (PFS)rate of all patients were 66.2% and 57.5%. Five-year OS and PFS rates in low-risk group were 91.8% and 88.0%, while 59.3% and 49.3% in high-risk group. The survival of patients in low-risk group were better than those in high-risk group (both P<0.001). The five-year OS rate in combined therapy group, radiotherapy group and chemotherapy group were 71.7%, 52.3% and 20.7%, respectively (P<0.001). The five-year PFS rate were 63.5%, 23.3% and 24.1%, respectively (P<0.001). Among 219 patients receiving radiotherapy, the 5-year OS and PFS rate of patients with primary site radiotherapy dose ≥ 50 Gy were 72.6% and 66.1%, higher than those of patients with a dose <50 Gy (57.3% and 30.9%, respectively; P=0.031, P<0.001). In the high-risk group, the 5-year OS and PFS rate of the patients who received radiotherapy combined with more than 4 cycles of chemotherapy were 66.5% and 62.6%, higher than those of patients received less than 4 cycles of chemotherapy (56.7% and 46.4%, P=0.045 and 0.020, respectively). Cox multivariate analysis showed that ECOG score (HR=2.208, P=0.001), primary site (HR=4.887, P<0.001), primary tumor invasion (HR=3.265, P=0.001) and radiation dose (HR=1.895, P=0.011) were independent factors of OS in early NKTCL patients. Conclusion: Extended-involved field IMRT with radiation dose more than 50 Gy was the main treatment for patients with early stage NKTCL. Radiotherapy combined with adequate cycle chemotherapy significantly improved prognosis of high-risk patients.


Assuntos
Linfoma Extranodal de Células T-NK/radioterapia , Radioterapia de Intensidade Modulada , Terapia Combinada , Intervalo Livre de Doença , Tratamento Farmacológico , Humanos , Linfoma Extranodal de Células T-NK/diagnóstico , Linfoma Extranodal de Células T-NK/tratamento farmacológico , Estadiamento de Neoplasias , Prognóstico , Fatores de Risco , Taxa de Sobrevida
5.
Ciudad Autónoma de Buenos Aires; Argentina. Ministerio de Salud y Desarrollo Social. Secretaria de Gobierno de Salud. Comisión Nacional de Evaluación de Tecnologías Sanitarias; 2019 Noviembre. 100 p. tabs.
Monografia em Espanhol | BINACIS, ARGMSAL | ID: biblio-1046385

RESUMO

El objetivo del presente informe es evaluar la eficacia, seguridad y costos de todos los tratamientos para DMT2. La evidencia incluida demostró que existe un beneficio menor entre los tratamientos, con diferencias poco importantes para mortalidad por cualquier causa o de origen cardiovascular, eventos adversos serios y complicaciones macrovasculares. El análisis de impacto presupuestario de elaboración propia demostró que el impacto sería no favorable a la incorporación de todos tratamientos evaluados. El impacto en la equidad es probablemente positivo para las sulfonilureas y tiazolidinedionas, sin impacto para los inhibidores de la enzima dipeptidil-peptidasa 4 e inhibidores del cotransportador-2 de sodio-glucosa y probablemente negativo para los agonistas del receptor del péptido-1 símil glucagón, insulinas y análogos de insulina. El impacto en la salud pública se consideró que no tendría impacto para las sulfonilureas y tiazolidinedionas, y que sería probablemente negativo para el resto


Assuntos
Epidemiologia , Diabetes Mellitus , Diabetes Mellitus/tratamento farmacológico , Tratamento Farmacológico , Avaliação da Tecnologia Biomédica
6.
Rinsho Ketsueki ; 60(9): 1331-1336, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31597860

RESUMO

Chronic active EBV infection (CAEBV) is one of the EBV-associated T/NK lymphoproliferative diseases. The prognosis of CAEBV is very poor, and without curative therapy, almost half of patients will die within five years of onset. The results of a 3-step treatment regimen consisting of step 1 (immunochemotherapy), step 2 (multi-drug chemotherapy), and step 3 (hematopoietic cell transplantation, HCT) are excellent. HCT is the only cure for CAEBV, and reduced-intensity conditioning (RIC) is superior to myeloablative conditioning (MAC). The overall survival rate is typically more than 90% following bone marrow transplantation and cord blood transplantation.


Assuntos
Infecções por Vírus Epstein-Barr/terapia , Transplante de Células-Tronco Hematopoéticas , Transtornos Linfoproliferativos/terapia , Tratamento Farmacológico , Humanos , Transtornos Linfoproliferativos/virologia , Prognóstico , Taxa de Sobrevida , Condicionamento Pré-Transplante
7.
Einstein (Sao Paulo) ; 18: eAO4871, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31664324

RESUMO

OBJECTIVE: To analyze, from the pharmacotherapy perspective, the factors associated to visits of older adults to the emergency department within 30 days after discharge. METHODS: A cross-sectional study carried out in a general public hospital with older adults. Emergency department visit was defined as the stay of the older adult in this service for up to 24 hours. The complexity of drug therapy was determined using the Medication Regimen Complexity Index. Potentially inappropriate drugs for use in older adults were classified according to the American Geriatric Society/Beers criteria of 2015. The outcome investigated was the frequency of visits to the emergency department within 30 days of discharge. Multivariate logistic regression was performed to identify the factors associated with the emergency department visit. RESULTS: A total of 255 elderly in the study, and 67 (26.3%) visited emergency department within 30 days of discharge. Polypharmacy and potentially inappropriate medications for older adults did not present a statistically significant association. The diagnosis of heart failure and Medication Regimen Complexity Index >16.5 were positively associated with emergency department visits (OR=2.3; 95%CI: 1.04-4.94; p=0.048; and OR=2.1; 95%CI: 1.11-4.02; p=0.011), respectively. Furthermore, the diagnosis of diabetes mellitus and chronic kidney disease were protection factors for the outcome (OR=0.4; 95%CI: 0.20-0.73; p=0.004; and OR=0.3; 95%CI: 0.13-0.86; p=0.023). CONCLUSION: The diagnosis of heart failure and Medication Regimen Complexity Index >16.5 were positively associated with the occurrence of an emergency department visit within 30 days of discharge.


Assuntos
Prescrições de Medicamentos/estatística & dados numéricos , Tratamento Farmacológico/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Polimedicação , Fatores de Tempo
8.
Prensa méd. argent ; 105(9 especial): 501-508, oct 2019. tab
Artigo em Inglês | LILACS, BINACIS | ID: biblio-1046263

RESUMO

The aim of the study is to increase the effectiveness of diseases treatment in elderly patients. The work is based on the study of the nature and the role of compliance disorders, optimizing the effectiveness with the use of therapeutic complex of pharmacotherapy associated with psychotherapeutic component. As a result of the analysis of morbidity in elderly age and the nature of compliance in elderly patients, an optimal therapeutic complex was proposed, which consists of rational pharmacological load and psychotherapeutic intervention, aimed at informing a patient about the disease, methods of its treatment, as well as at creating an effective therapeutic alliance which provides proper medical care and prevents self-treatment in such patients.


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Pacientes , Terapêutica , Saúde do Idoso , Inquéritos de Morbidade , Resultado do Tratamento , Tratamento Farmacológico , Múltiplas Afecções Crônicas/tratamento farmacológico , Geriatria
9.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(4 (Supl)): 383-386, out.-dez. 2019. tab
Artigo em Português | LILACS | ID: biblio-1047316

RESUMO

Objetivo: Determinar a prevalência da disfunção erétil (DE) em pacientes com hipertensão arterial (HA) primária em tratamento medicamentoso e sua relação e análise do impacto psicossocial. Métodos: O estudo abordou homens hipertensos em tratamento medicamentoso e idade superior a 40 anos que foram avaliados segundo o Índice Internacional de Função Erétil (IIFE- 5), Escala de Ansiedade e Depressão e um questionário sobre sua opinião quanto à relação da DE com as medicações anti-hipertensivas. A dosagem da testosterona sérica foi usada para exclusão de causas orgânicas da DE. Os dados foram analisados visando identificar o coeficiente de correlação entre as varáveis. Resultados: Foi observada prevalência de DE em 74% dos pacientes e, destes, 43% referiram piora do desempenho sexual após uso crônico da medicação anti-hipertensiva. Não foi possível provar uma correlação direta entre o uso de anti-hipertensivos e a DE, entretanto observou-se aumento do coeficiente de correlação em função da progressão da idade dos pacientes. Os betabloqueadores mostraram maior coeficiente de correlação com a DE (25%), seguido dos inibidores da enzima conversora de angiotensina (19%). Dos pacientes, 43% foram classificados com provável diagnóstico de ansiedade ou depressão e 35% com possível diagnóstico. Conclusão: Foi possível inferir, mas não afirmar uma correlação entre DE, HA e o uso de anti-hipertensivos


Objective: To determine the prevalence of erectile dysfunction (ED) in patients with primary arterial hypertension (AH) undergoing drug treatment and its relationship and analysis of psychosocial impact. Methods: The study addressed hypertensive men on drug treatment and over 40 years of age who were evaluated according to the International Index of Erectile Function (IIFE-5), Anxiety and Depression Scale, and a questionnaire about their opinion regarding the relationship between ED and antihypertensive medications. Serum testosterone dosage was used to rule out the organic causes of ED. Data were analyzed to identify the correlation coefficient between variables. Results: Prevalence of ED was observed in 74% of patients and, of these, 43% reported worsened sexual performance after chronic use of antihypertensive medications. It was not possible to prove any direct correlation between the use of antihypertensive drugs and ED, however an increase in the correlation coefficient was observed as a function of patients' age progression. Beta-blockers showed higher correlation coefficient with ED (25%), followed by angiotensin-converting enzyme inhibitors (19%). 43% of patients were classified with probable diagnosis of anxiety or depression and 35% with possible diagnosis. Conclusion: It was possible to infer but not to affirm a correlation between DE, HA and the use of antihypertensive drugs


Assuntos
Hipertensão/terapia , Disfunção Erétil , Anti-Hipertensivos , Ansiedade , Doenças Cardiovasculares , Doença Crônica , Prevalência , Estudos Prospectivos , Inquéritos e Questionários , Fatores de Risco , Depressão , Tratamento Farmacológico
11.
Medicine (Baltimore) ; 98(37): e17109, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517844

RESUMO

BACKGROUND: Patients suffering from chemotherapy-induced nausea and vomiting (CINV) might have negative adherence of treatment. Acupoint therapies, including acupuncture, acupressure, acupoints injection, massage, and moxibustion, are safe medical procedures with minimal side effects for CINV, but studies about overall safety and effectiveness of acupoint therapies have not been scientifically and methodically evaluated in recent years. Evaluating the overall safety and effectiveness of acupoint therapies in patients with CINV is the purpose of this review. METHODS AND ANALYSIS: Relevant randomized controlled trials (RCTSs) are being searched in the following electronic databases: PubMed, Cochrane Library, Web of Science, EMBASE, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP database), Wanfang Data Knowledge Service Platform, and Chinese Biomedical Literature Database (CBM). We will also attempt to obtain the unpublished academic data by contacting the colleague, professor, or Institute of Traditional Chinese Medicine. The RCTs of the acupoint therapies for CINV patients will be searched in the databases from inception to July 2019. The primary outcomes are defined as severity, duration and frequency of nausea or vomiting, or both. The secondary outcomes are defined as any adverse events and quality of life. Performing the meta-analysis by using RevMan version 5 software. Mean difference (MD) or standardized mean difference (SMD) will express the continuous variables, while relative risk (RR) will express the categorical variables. RESULTS: The results of this review will provide a high-quality synthesis to evaluate the effectiveness and safety of acupoint therapies for CINV. CONCLUSION: This review will provide evidence to estimate whether acupoint therapies are effective interventions for CINV. DISSEMINATION: Evidence whether acupoint therapies are effective interventions for CINV will be provided by this systematic review. This knowledge will recommend better acupoint therapies and selections of acupoints which might be helpful in treating CINV. The findings of this systematic review will be disseminated via various forms of presentation and publication of the data in a journal or electronic databases. PROSPERO REGISTRATION NUMBER: CRD42019125538.


Assuntos
Terapia por Acupuntura/normas , Tratamento Farmacológico/métodos , Náusea/etiologia , Vômito/etiologia , Terapia por Acupuntura/métodos , Antineoplásicos/efeitos adversos , Humanos , Náusea/prevenção & controle , Náusea/terapia , Vômito/prevenção & controle , Vômito/terapia
12.
BMC Med Genet ; 20(1): 157, 2019 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-31510946

RESUMO

BACKGROUND: X-linked agammaglobulinemia (XLA) is a primary immunodeficiency disorder caused by germline mutations in the Bruton tyrosine kinase (BTK) gene on X chromosome. These mutations disturb B-cell development, decrease immunoglobulin levels, increase susceptibility to infection or neoplasms, and increase the risk of developing colorectal cancer (CRC). For occasional cases of CRC have been reported in XLA patients, low levels of B lymphocytes and immunoglobulins induced by congenital immune disorder make them more susceptible to drug-related toxicities (DRT). Therefore, gene sequencing, therapeutic drug monitoring and any possible measurement to predict DRT should be considered before determining the course of chemotherapy for XLA patients with CRC. CASE PRESENTATION: In this study, we reported a 21-year-old male who developed metastatic CRC in the context of XLA. Since the whole exome sequencing and therapeutic drug monitoring did not reveal any predictive markers of DRT, we applied standard first-line chemotherapy to the patient. However, progressive disease occurred after the fifth treatment cycle. Therefore, the administration of oxaliplatin was changed to irinotecan as second-line therapy. After that, the patient firstly suffered from severe hypocalcemia and eventually died due to metastatic CRC after the eighth treatment cycle. The overall survival time was 7.5 months. CONCLUSIONS: This study reported the first written record of a Chinese XLA patient with metastatic CRC and severe hypocalcemia. Whole exome sequencing and bioinformatic analysis indicated the somatic mutations in ABCA6, C6 and PAX3 genes might contribute to the early-onset and metastasis CRC. Besides, a number of germline mutations in genes related to calcium metabolism (CACNA2D4, CD36, etc.) and the administration of irinotecan were speculated to be the causes of severe hypocalcemia. We therefore suggested that in order to avoid severe DRT, clinicians should take genetic background and therapeutic drug monitoring into consideration while planning chemotherapy treatment for XLA patients with CRC.


Assuntos
Tirosina Quinase da Agamaglobulinemia/genética , Agamaglobulinemia/genética , Neoplasias Colorretais/genética , Doenças Genéticas Ligadas ao Cromossomo X/genética , Predisposição Genética para Doença/genética , Hipocalcemia/complicações , Irinotecano/administração & dosagem , Transportadores de Cassetes de Ligação de ATP/genética , Adulto , Agamaglobulinemia/diagnóstico por imagem , Grupo com Ancestrais do Continente Asiático , Linfócitos B , Canais de Cálcio Tipo L/genética , Capecitabina/administração & dosagem , Capecitabina/uso terapêutico , Neoplasias Colorretais/tratamento farmacológico , Complemento C6/genética , Monitoramento de Medicamentos , Tratamento Farmacológico , Estudos de Associação Genética , Doenças Genéticas Ligadas ao Cromossomo X/diagnóstico por imagem , Humanos , Hipocalcemia/induzido quimicamente , Imunoglobulinas , Irinotecano/uso terapêutico , Masculino , Mutação , Oxaliplatina/uso terapêutico , Fator de Transcrição PAX3/genética , Sequenciamento Completo do Exoma , Adulto Jovem
14.
Diagn. tratamento ; 24(3): [106-110], jul - set. 2019.
Artigo em Português | LILACS | ID: biblio-1026698

RESUMO

As parafilias, antes conhecidas como perversões sexuais, foram, ao longo da história, ora consideradas patologias ora não. Em 2013, o Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-5) estabeleceu a distinção entre parafilias e transtornos parafílicos (TP), a partir da qual somente os últimos passaram a ser considerados doenças e, portanto, passíveis de tratamento. A presença de comorbidades e a farmacologia das medicações utilizadas são de fundamental importância na escolha da abordagem dos TP. Drogas que inibem a atividade sexual (como antidopaminérgicos, serotoninérgicos, antiandrógenos e outras) podem ser prescritas conforme comorbidades sexuais, psiquiátricas ou sistêmicas. Tratar um transtorno exibicionista associado à doença de Wilson e a uma psicose orgânica é diferente de tratar este mesmo TP associado a hipotireoidismo e depressão, por exemplo. É recomendado que o comportamento parafílico seja inibido sem impedir que o sujeito mantenha a função sexual. No entanto, quando o risco de agressão sexual é maior, muitos autores indicam inibição mais intensa, por meio de antiandrógenos potentes, a chamada "castração química", a qual não está autorizada no Brasil.


Assuntos
Transtornos Parafílicos , Comorbidade , Sexualidade , Tratamento Farmacológico , Ética
15.
Rev. Cient. CRO-RJ (Online) ; 4(2): 52-55, May-Aug. 2019.
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-1024932

RESUMO

Introduction: Rhabdomyosarcoma is an aggressive malignant soft tissue neoplasm of immature mesenchymal cells treated with surgery and chemoradiotherapy. The effects of chemoradiotherapy in head induce a series of sequelae on oral cavity and growth development. Objectives: Report the case of a child undergoing treatment for rhabdomyosarcoma whose effects on the dento-maxillofacial development were cared for in order to safe guard the patient's quality of life. Case report: Describes a case of severe dento-maxillofacial defects resulting from chemoradiation therapy for embryonal rhabdomyosarcoma in a child as well as the dental management performed. Clinically, the patient had gingivitis, severe mobility of permanent teeth, hyposalivation, mucositis and severe trismus. The radiologic exams showed interruption of root formation of all permanent teeth and over-retention of primary teeth. Cephalometric analyses revealed mandibular and maxillary hypoplasia. Results: Was made extraction of the overretained primary teeth associated with a prophylactic program and use of artificial saliva due to hyposalivation in order to improve the quality of life of the patient. After 6 years of dental and phonoaudiologic follow-up her oral opening has increased and chewing and swallowing difficulties have decreased, there is no gingivitis or mucositis and she has remained free of recurrent or metastatic diseases 11 years after the initial diagnosis. Conclusion: Our report emphasizes the importance of dental treatment with a program of prevention and follow-up for patients undergoing anticancer therapies.


Introdução: O rabdomiossarcoma é uma neoplasia maligna agressiva de tecido mole de células mesenquimais imaturas tratadas com cirurgia e quimioradioterapia. Os efeitos da quimioradioterapia na cabeça induzem uma série de sequelas na cavidade oral e no desenvolvimento do crescimento. Objetivo: Relatar o caso de uma criança em tratamento de rabdomiossarcoma cujos efeitos no desenvolvimento dento-maxilofacial foram cuidados a fim de salvaguardar a qualidade de vida do paciente. Relato de caso: Descreve um caso de defeitos dento-maxilo-faciais graves resultante de quimioradioterapia para rabdomiossarcoma embrionário em uma criança, bem como o manejo realizado. Clinicamente, a paciente apresentava gengivite, severa mobilidade dos dentes permanentes, hipossalivação, mucosite e trismo severo. Os exames radiográficos mostraram interrupção da formação radicular de todos os dentes permanentes e retenção dos dentes decíduos. Análises cefalométricas revelaram hipoplasia mandibular e maxilar. Resultados: Foi realizada a extração dos dentes decíduos retidos associado a um programa profilático e uso de saliva artificial devido à hipossalivação, a fim de melhorar a qualidade de vida do paciente. Após 6 anos de acompanhamento odontológico e fonoaudiológico, sua abertura bucal aumentou e as dificuldades de mastigação e deglutição diminuíram, não há gengivite ou mucosite e ela permaneceu livre de doenças recorrentes ou metastáticas 11 anos após o diagnóstico inicial. Conclusão: Nosso relato enfatiza a importância do tratamento odontológico com um programa de prevenção e acompanhamento para pacientes submetidos a terapias antineoplásicas.


Assuntos
Rabdomiossarcoma , Criança , Tratamento Farmacológico , Neoplasias
16.
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
17.
Medicine (Baltimore) ; 98(35): e16742, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464903

RESUMO

RATIONALE: Cases of coexistence of 2 cancers, such as colorectal cancer and diffuse large B-cell lymphoma (DLBCL), colorectal cancer and myelodysplastic syndrome (MDS), and DLBCL with MDS, have been reported, whereas the coexistence of 3 different cancers in a patient is extremely rare. Here we report a case of co-occurrence of colon adenocarcinoma, DLBCL, and MDS in a 78-year-old Chinese man. PATIENT CONCERNS: He presented to our hospital with palpable lumps in the abdomen without any of the following symptoms including abdominal pain, fever, contact pain, tenesmus, changes in bowel habits and shape, nausea, and vomiting. DIAGNOSES: The patient was first diagnosed with sigmoid colon adenocarcinoma and DLBCL in the right ascending colon using enhanced computed tomography, colonoscopy, and immunohistochemistry. After resection of the sigmoid adenocarcinoma and DLBCL, MDS was diagnosed according to the results of routine blood tests, bone marrow aspiration smear, and flow cytometry. INTERVENTIONS: Overall, the patient was treated with surgical resection of the sigmoid adenocarcinoma and DLBCL of the colon, combined with 4 cycles of chemotherapies targeting MDS. OUTCOMES: Blood test results and follow-up indicated that the treatment regimen showed promising outcomes. LESSONS: In conclusion, a case of synchronous existence of colon cancer, DLBCL, and MDS is reported, which suggests that careful attention should be paid clinically to checking the state of bone marrow for elderly cancer patients. Efforts are also needed to establish an effective system for distinguishing the origin of multi-existent cancers and to develop effective therapeutic regimens for multi-existent cancers with fewer side effects.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Colo Ascendente/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Síndromes Mielodisplásicas/diagnóstico , Neoplasias do Colo Sigmoide/diagnóstico por imagem , Adenocarcinoma/cirurgia , Idoso , Biópsia , Medula Óssea , China , Colo Ascendente/patologia , Colonoscopia , Tratamento Farmacológico , Humanos , Linfoma Difuso de Grandes Células B/cirurgia , Masculino , Síndromes Mielodisplásicas/tratamento farmacológico , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/terapia , Neoplasias do Colo Sigmoide/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
Rev. chil. nutr ; 46(4): 375-383, ago. 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-1013801

RESUMO

RESUMEN La sarcopenia se caracteriza por la tríada de reducción de masa muscular en asociación con reducción de la fuerza muscular y/o desempeño físico. Entre las enfermedades crónicas, el cáncer se configura como una condición relacionada al desarrollo de la sarcopenia, debido a la condición inflamatoria, al catabolismo proteico y a la inapetencia alimentaria atribuida a los diversos efectos colaterales del tratamiento de quimioterapia. Objetivo: Describir la prevalencia de sarcopenia en pacientes oncológicos en tratamiento quimioterapéutico. Método: Estudio transversal realizado con pacientes de ambos sexos, en un hospital universitario del nordeste brasileño. Se determinó la sarcopenia a través de la circunferencia muscular del brazo (percentil <10); fuerza de prensión palmar: <20 kg/f y < 30 kg/f para mujeres y hombres ancianos respectivamente, menor tercil: <28,7kg/f y <15,6 kg/f para hombres y mujeres adultas respectivamente y velocidad de marcha (<0.8 m/s). Se evaluaron las variables de asociación, como datos sociodemográficos, estilo de vida, clínico y antropométrico. Resultados: La muestra fue compuesta por 117 pacientes, con edad promedio 60,5 ±13,2 años con prevalencia del sexo femenino (el 59,8%). Se verificó una prevalencia de sarcopenia del 27,4%, y se observó que el 53,1% tenían sarcopenia severa. Los ancianos fueron los más sarcopénicos (p= 0,003). Se encontró también una asociación positiva con el estado nutricional (p<0,001). Conclusión: La prevalencia de la sarcopenia fue significativa y semejante a otros estados, siendo más prevalentes en los pacientes desnutridos y ancianos.


ABSTRACT Sarcopenia is characterized by the triad of reduced muscle mass in association with reduced muscle strength and / or physical performance. Among chronic diseases, cancer is a condition related to the development of sarcopenia because of, among other factors, inflammation, protein catabolism and loss of appetite attributed to the side effects of chemotherapy treatment. Objective: To describe the prevalence of sarcopenia in cancer patients undergoing chemotherapy. Method: A cross-sectional study was carried out with patients of both sexes, in a university hospital in Northeastern Brazil. Sarcopenia was determined by arm circumference (percentile <10); hand grip strength (<20 kg/f and <30 kg/f for women and men, respectively; lowest tertile: <28.7 kg/f and <15.6 kg/f for men and women, respectively) and gait velocity (<0.8 m/s). Sociodemographic, lifestyle, clinical and anthropometric variables were also evaluated. Results: The sample consisted of 117 patients (59.8% female), with a mean age of 60.5 ± 13.2 years. There was a prevalence of sarcopenia of 27.4% and 53.1% had severe sarcopenia. Sarcopenia was more common in older participants (p= 0.003). There was also a positive association with nutritional status (p<0.001). Conclusion: The prevalence of sarcopenia was significant and similar to other studies, being more prevalent in undernourished and elderly participants.


Assuntos
Humanos , Pacientes , Brasil , Tratamento Farmacológico , Força Muscular , Sarcopenia , Neoplasias
19.
Rev. chil. nutr ; 46(4): 384-391, ago. 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-1013802

RESUMO

RESUMEN Los ancianos están más expuestos al desarrollo del cáncer, pues el envejecimiento deja las células más susceptibles a la transformación maligna. Identificar la fragilidad puede contribuir a mejorar resultados en el tratamiento antineoplásico. El objetivo de este estudio fue identificar la prevalencia y grado de fragilidad en ancianos oncológicos en tratamiento con quimioterapia e investigar factores asociados al síndrome. Se incluyeron pacientes ≥60 años en nivel ambulatorio. La fragilidad se evaluó a partir del fenotipo desarrollado en la Universidad Johns Hopkins. El nivel de significancia adoptado para todas las pruebas fue menor que p<0,05. De la muestra de 60 individuos, el 55,0% era hombres, con promedio de edad 69,8±7,6. Entre los pacientes evaluados, el 66,7% presentaron fragilidad y el 33,3% pre-fragilidad. Las mujeres fueron más frágiles (81,5% vs 54,5%; p= 0,028) y la fragilidad tendió a ser mayor entre los caquécticos (81,8% vs 57,9%; p= 0,051). Concluimos que hubo un porcentaje elevado de pacientes frágiles y pre-frágiles. El sexo femenino y el sedentarismo se presentaron como factores asociados.


ABSTRACT The elderly are more at risk for developing cancer, as aging leaves cells more susceptible to malignant transformations. Identifying frailty can contribute to improved outcomes in antineoplastic treatment. The purpose of this study was to identify the prevalence and degree of frailty in elderly cancer patients undergoing chemotherapy treatment and investigate factors associated with this syndrome. Ambulatory patients> 60 years were included. Frailty was assessed from the phenotype developed by Johns Hopkins University. The significance level adopted for all tests was p<0.05. From the sample of 60 individuals, 55.0% were men, with mean age 69.8 ± 7.6. Among the patients evaluated, 66.7% presented frailty, and 33.3% pre-frailty. Women were more frail (81.5% vs 54.5%; p= 0.028) and frailty tended to be higher among cachectic patients (81.8% vs 57.9%; p= 0.051). We concluded that there was an elevated percentage of frail and pre-frail patients. Female sex and sedentarism were associated factors.


Assuntos
Humanos , Brasil , Idoso , Perda de Peso , Nível de Saúde , Idoso Fragilizado , Tratamento Farmacológico , Força Muscular , Fadiga , Velocidade de Caminhada , Neoplasias/tratamento farmacológico
20.
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
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