Early breast cancer: concept and therapeutic review

SUMMARY OBJECTIVE: Breast cancer treatment has evolved significantly over the years, both in terms of local and systemic approaches. Halsted's radical mastectomy gave way to modified mastectomies and to conservative surgeries, along with breast reconstruction and repair. Although the use of new drugs has directly increased the survival of patients submitted to adjuvant or neoadjuvant systemic therapies, the de-escalation of drugs may also be beneficial in numerous cases. Therefore, breast cancer treatment must be increasingly customized and assessed using a multidisciplinary approach. This study aimed to review the concept and therapy of early breast cancer. METHODS: A narrative review of the literature was carried out in the PubMed database in December 2022, where the keywords for the searches were as follows: early breast cancer, surgical treatment of breast cancer, systemic treatment of breast cancer, neoadjuvant chemotherapy in breast cancer, adjuvant treatment of luminal breast cancer, early triple negative tumor, and early positive Her-2 tumor. Articles that were historically important in the treatment of breast cancer and articles that impacted management with scientific relevance were selected for this review. DISCUSSION: As new evidence continues to update existing knowledge, breast cancer treatment is becoming increasingly personalized and must now take into account the different tumor variants and their clinical stages, the age of patients and relevant comorbidities, as well as personal expectations and desires. CONCLUSION: This literature review of current studies shows that the primary therapy for patients with early breast cancer continues to be surgery, although a customized and multidisciplinary approach is now required.

Clinical outcomes of patients undergoing correction of neuromuscular scoliosis with a controlled hospital protocol - preliminar outcomes / Desfechos hospitalares de pacientes submetidos à correção cirúrgica de escoliose neuromuscular com um protocolo hospitalar gerenciado - resultados preliminares / Resultados hospitalarios en pacientes sometidos a corrección quirúrgica de escoliosis neuromuscular con un protocolo hospitalario gestionado - resultados preliminares

ABSTRACT Objectives: To identify the main hospital outcomes of patients undergoing surgical correction of neuromuscular scoliosis and to assess complication rates and achievement of mobility goals after the use of a managed protocol. Methods: This is a longitudinal, retrospective study, with data obtained six months after the application of a protocol in 103 patients of both sexes submitted to surgical correction of neuromuscular scoliosis, at a tertiary level hospital in São Paulo, between June and December 2018 (pre-protocol) and between May and September 2019 (post-protocol). Data from patients who had previously undergone other orthopedic spine surgeries were excluded. In addition to the data for epidemiological characterization of the underlying diseases, the clinical characteristics and complications were analyzed. Results: Of the 103 patients evaluated, there was a predominance of females (53.4%) and a mean age of 14.9 years. The most frequent diagnosis was cerebral palsy, the mean angle of curvature was 75°, and the most frequently observed comorbidities were lung diseases (25%). The protocol was partially adhered to by professionals and after its implementation, there was a significant decrease in pain and the systemic inflammatory response syndrome (SIRS), prevention of immobility and a low rate of infection. Conclusions: The use of a protocol focused on patients undergoing correction of neuromuscular scoliosis led to reduced complications of SIRS and reduced pain; kept the surgical site infection rate low, and prevented short-term immobility. Level of evidence III; Retrospective study.

RESUMO Objetivos: Identificar os principais desfechos hospitalares dos pacientes submetidos à correção cirúrgica de escoliose neuromuscular, avaliar as taxas de complicação e o cumprimento de metas de mobilidade depois do uso de um protocolo gerenciado. Métodos: Trata-se de um estudo longitudinal e retrospectivo, com dados obtidos seis meses depois da aplicação do protocolo em 103 pacientes de ambos os sexos submetidos à correção cirúrgica de escoliose neuromuscular, em um hospital de nível terciário em São Paulo, nos períodos de junho a dezembro de 2018 (pré-protocolo) e entre maio e setembro de 2019 (pós-protocolo). Foram excluídos os dados dos pacientes submetidos a outras cirurgias ortopédicas de coluna previamente. Além dos dados para caracterização epidemiológica das doenças de base, foram analisadas as características clínicas e complicações. Resultados: Dos 103 pacientes avaliados, 53,4% eram do sexo feminino, média de idade de 14,9 anos, o diagnóstico mais frequente paralisia cerebral, ângulo médio da curvatura de 75° e as comorbidades mais observadas foram doenças pulmonares (25%). O protocolo atingiu adesão parcial dos profissionais, e depois da implementação, observou-se diminuição significativa da dor e da síndrome da resposta inflamatória sistêmica (SIRS), prevenção da imobilidade e baixa taxa de infecção. Conclusões: O uso de um protocolo com foco em pacientes submetidos à correção de escoliose neuromuscular, reduziu as complicações por SIRS e dor, manteve a taxa de infecção de sítio cirúrgico baixa e preveniu a imobilidade a curto prazo. Nível de evidência III; Estudo Retrospectivo.

RESUMEN Objetivos: Identificar a los principales resultados hospitalarios de los pacientes sometidos a corrección quirúrgico de escoliosis neuromuscular, evaluar las tasas de complicación y el cumplimiento de metas de movilidad tras la implementación de un protocolo gestionado. Métodos: Se trata de un estudio longitudinal y retrospectivo, con dados obtenidos después de 6 meses de la aplicación de un protocolo en 103 pacientes de ambos sexos, sometidos a corrección quirúrgica de escoliosis neuromuscular, en un hospital de nivel terciario en São Paulo, en los periodos de junio a diciembre de 2018 (pre-protocolo) y mayo a septiembre de 2019 (postprotocolo). Se excluyeron los datos de los pacientes que se habían sometido previamente a otras cirugías ortopédicas de la columna vertebral Además de los dados para la caracterización epidemiológica de las enfermedades de base, se analizaron las características clínicas y las complicaciones. Resultados: De los 103 pacientes evaluados, el 53,4% eran mujeres, con una media de edad de 14,9 años, el diagnóstico más frecuente fue parálisis cerebral, el ángulo de curvatura promedio de 75° y las comorbilidades más observadas fueron las enfermedades pulmonares (25%). El protocolo logró una adhesión parcial de los profesionales, y tras su implementación, se observó una disminución significativa del dolor y del síndrome de respuesta inflamatoria sistémica (SRIS), prevención de la inmovilidad y una baja tasa de infección. Conclusiones: El uso de un protocolo centrado en pacientes sometidos a corrección de escoliosis neuromuscular redujo las complicaciones por SIRS y dolor, mantuvo baja la tasa de infección del sitio quirúrgico y previno la inmovilidad a corto plazo. Nivel de evidencia III; Estudio Retrospectivo.

A Retrospective Study of Histopathology and Clinical Correlation of Renal Cell Carcinoma in a Tertiary Medical College, India

Background: The study was conducted to understand the clinical solution of renal cell carcinoma. Correlation was done by clinical presentation with radiological features and histopathology of renal cell carcinoma. The stress upon to understand the necessity for a team-approach between Clinician, Radiologist and Pathologist and vice versa is emphasized. Aim: Histopathology and Clinical Correlation of Renal cell carcinoma. Methods: The total number of renal tumours studied during the 8 years period was 45 cases among which 25 cases were diagnosed by histopathology as various types of renal cell carcinoma conclusively. This is a retrospective study of renal tumours, diagnosed by histopathology as various types of renal cell carcinoma. All the relevant clinical data of the patients were searched from the ward records. The various Radiological features were collected. Results: The total number of renal tumours studied during the 8 years period was 45 cases among which 25 cases were diagnosed by histopathology as various types of renal cell carcinoma conclusively. MRI provides molecular information with regard to renal cell carcinoma and potentially aid in biopsy planning. The total cases reported in the department is twenty five vases out of which sixteen cases are attending follow up after 3 years. Conclusion: The Fuhrman grading of renal cell carcinoma correlated grading of renal cell carcinoma. Preoperative radiological classification can be used as a supplement to the histopathological grading. Renal cell carcinoma needs correlation between Radiologist, Pathologist and Clinician.

Application of damage control orthopedics for the treatment of severe multiple fractures / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the application effect of damage control orthopedics for the treatment of severe multiple fractures.</p><p><b>METHODS</b>From January 2014 to December 2016, 23 patients with severe multiple fractures were treated with the damage control orthopedics (DCO), included 14 males and 9 females with an average age of (41.57±8.29) years old ranging from 28 to 60 years old; the NISS averaged(27.70±5.44) points ranging from 18 to 40 points. As the control group, 27 patients with severe multiple fractures were treated by the early total care(ETC) technology from Jan. 2007 to Dec. 2019, included 16 males and 11 females with an average age of (38.33±9.99) years old ranging from 19 to 55 years old, the NISS averaged (31.07±6.46) points ranging from 20 to 43 points. The ICU recovery time, blood transfusion, total operation time, mortality, complication and length of hospital stay were observed and compared between two groups.</p><p><b>RESULTS</b>In the DCO group, there were 22 cases surviving and 1 case death, 3 cases of postoperative complication contained 2 cases of adult respiratory distress syndrome, 1 case pin of infection in external fixation. In ETC group, there were 25 cases surviving and 2 cases death, 10 cases of postoperative complication contained 4 cases of adult respiratory distress syndrome and 3 cases of pin infection in external fixation, 1 case of wound infection and 2 cases of multiple organ failure. There was statistically significant difference between two groups in blood transfusion in operation, the ICU recovery time, and complications(<0.05). There was no statistically significant difference in total operation time, length of hospital stay and mortality between two groups(>0.05).</p><p><b>CONCLUSIONS</b>For patients with severe multiple fractures, application of damage control orthopedics can significantly reduce the postoperative complications, ICU recovery time and intraoperative blood transfusion, provide a certain basis for clinical treatment of such patients.</p>

Osteonecrose dos Maxilares Associada ao uso de Bisfosfonatos / Osteonecrosis of the Jaws Associated with the use of Bisphosphonates

Os bifosfonatos são uma classe de medicamentos, que têm por função a inibição da atividade dos osteoclastos, interferindo na remodelação e no turnover ósseo. São indicados para retardar a metástase óssea em algumas condições malignas, como em mielomas múltiplos, câncer de mama e próstata, e outras condições benignas, como no tratamento da doença de Paget e da osteoporose. Desde 2003, estudos têm associado a osteonecrose avascular dos ossos maxilares ao uso dos bifosfonatos. Dentre os mecanismos de ação dos bifosfonatos, podemos citar a sua atividade antiosteoclástica e antiangiogênica, que altera o metabolismo ósseo, inibindo a reabsorção óssea e diminuindo o turnover ósseo. As exposições ósseas maxilo-mandibulares ocorrem após procedimentos cirúrgicos odontológicos ou, menos comumente, após o uso de próteses apoiadas na fina mucosa de revestimento ósseo da cavidade bucal. O tratamento da osteonecrose associada aos bifosfonatos (OAB) é bastante variado, controverso e desafiador, visto que nenhum tratamento efetivo tem sido proposto até o momento. O objetivo desse relato de caso é descrever a ocorrência de áreas de exposição óssea mandibular em um paciente que fez uso do ácido zolendrônico (Zometa®) bem como apresentar a abordagem terapêutica realizada que resultou em completo recobrimento mucoso das áreas ósseas expostas... (AU)

Biphosphonates are a class of drugs whose function is the inhibition of osteoclast activity, interfering in remodeling and bone turnover. They are indicated to delay bone metastases in some malignancies such as multiple myeloma, prostate cancer and other benign conditions such as in the treatment of Paget's disease and osteoporosis. Since 2003, studies associate avascular osteonecrosis of the jaws to the use of bisphosphonates, especially intra venous. Among the mechanisms of action of bisphosphonates are their osteoclastic and antiangionenic activity which alters bone metabolism, inhibiting bone resorption and reducing bone turnover. Maxillo-mandibular bone exposures occur after surgical dental procedures or less commonly after the use of prostheses supported on thin bone lining mucosa of the buccal cavity. The treatment of osteonecrosis associated with biphosphonates (OAB) is quite varied, controversial and challenging, since no effective treatment has been proposed until this moment. The purpose of this case report is to describe the occurrence of areas of mandibular bone exposure in a patient with history of use of Zolendronic Acid (Zometa) and present the therapeutic approach undertaken which resulted in full mucous covering of the exposed bony áreas... (AU)

Heat Treatment of Pre-hydrolyzed Silane Increases Adhesion of Phosphate Monomer-based Resin Cement to Glass Ceramic

This study evaluated the influence of different forms of heat treatment on a pre-hydrolyzed silane to improve the adhesion of phosphate monomer-based (MDP) resin cement to glass ceramic. Resin and feldspathic ceramic blocks (n=48, n=6 for bond test, n=2 for microscopy) were randomly divided into 6 groups and subject to surface treatments: G1: Hydrofluoric acid (HF) 9.6% for 20 s + Silane + MDP resin cement (Panavia F); G2: HF 9.6% for 20 s + Silane + Heat Treatment (oven) + Panavia F; G3: Silane + Heat Treatment (oven) + Panavia F; G4: HF 9.6% for 20 s + Silane + Heat Treatment (hot air) + Panavia F; G5: Silane + Heat Treatment (hot air) + Panavia F; G6: Silane + Panavia F. Microtensile bond strength (MTBS) test was performed using a universal testing machine (1 mm/min). After debonding, the substrate and adherent surfaces were analyzed using stereomicroscope and scanning electron microscope (SEM) to categorize the failure types. Data were analyzed statistically using two-way test ANOVA and Tukey's test (=0.05). Heat treatment of the silane containing MDP, with prior etching with HF (G2: 13.15±0.89a; G4: 12.58±1.03a) presented significantly higher bond strength values than the control group (G1: 9.16±0.64b). The groups without prior etching (G3: 10.47±0.70b; G5: 9.47±0.32b) showed statistically similar bond strength values between them and the control group (G1). The silane application without prior etching and heat treatment resulted in the lowest mean bond strength (G6: 8.05±0.37c). SEM analysis showed predominantly adhesive failures and EDS analysis showed common elements of spectra (Si, Na, Al, K, O, C) characterizing the microstructure of the glass-ceramic studied. Heat treatment of the pre-hydrolyzed silane containing MDP in an oven at 100 °C for 2 min or with hot air application at 50±5 ºC for 1 min, was effective in increasing the bond strength values between the ceramic and resin cement containing MDP.

Este estudo avaliou o efeito de diferentes formas de tratamento térmico de um silano pré-hidrolisado na adesão de um cimento resinoso à base de monómeros fosfatados (MDP) à uma cerâmica vítrea. Blocos em resina e cerâmica feldspática (n=48, n=6 para teste de união, n=2 para microscopia) foram divididos aleatoriamente em 4 grupos e submetidos a tratamentos de superfície: G1-ácido fluorídrico (HF) 9,6% por 20 s + Silano + cimento resinoso com MDP (Panavia F) ; G2-HF 9,6% por 20 s + Silano + Tratamento Térmico (forno) + Panavia F; G3-Silano + Tratamento Térmico (forno) + Panavia F; G4-HF 9,6% por 20 s + Silano + Tratamento Térmico (ar quente) + Panavia F; G5-Silano + Tratamento Térmico (ar quente) + Panavia F; G6-Silano + Panavia F. Teste de microtração (MTBS) foi realizado utilizando máquina de ensaios universal (1 mm/min). Após o descolamento, substrato e superfícies aderentes foram analisadas utilizando estereoscópico e microscópio eletrônica de varredura (MEV) para classificação dos tipos de falha. Os dados foram analisados estatisticamente utilizando o teste ANOVA dois fatores e o teste de Tukey (=0,05). O tratamento térmico do silano contendo MDP, com condicionamento prévio com HF (G2:13,15±0,89a e G4:12,58±1,03a) resultou em valores de resistência de união significativamente superiores aos do grupo controle (G1:9,16±0,64b). Os grupos sem condicionamento prévio (G3:10,47±0,70b e G5:9,47±0,32b), apresentaram valores de resistência de união estatisticamente semelhantes entre eles e ao controle (G1). O silano utilizado sem condicionamento prévio e tratamento térmico apresentou os menores valores de resistência de união (G6:8,05±0,37c). As análises em MEV mostraram predominância de falhas adesivas e as análises em EDS demonstraram espectros com elementos semelhantes (Si, Na, Al, K, O, C) caracterizando a microsestrutura da vitro-cerâmica estudada. O tratamento térmico do silano pré-hidrolisado contendo MDP, realizado em forno a 100 °C durante 2 min ou com ar quente a 50±5 °C durante 1 min, foi eficaz no aumento dos valores de união entre cimento resinoso contendo MDP e cerâmica.

Preventive and therapeutic strategies of doxorubicin cardiotoxicity:research advances / 国际药学研究杂志

The utilization of d oxorubicin (DOX) is compromised by potential lethal cardiotoxicity in clinical application. Improving DOX efficacy in cancer cells while minimizing DOX-associated cardiotoxicity is in the forefront of research. Available methods at present include cardioprotective agents, DOX derivates and dosage schedules. This paper proposes new ideas on potential drug targets aiming at enhancing cancer therapy and cardioprotection simultaneously.

Preventive and therapeutic strategies of doxorubicin cardiotoxicity: Research advances / 国际药学研究杂志

The utilization of doxorubicin (DOX) is compromised by potential lethal cardiotoxicity in clinical application. Improving DOX efficacy in cancer cells while minimizing DOX-associated cardiotoxicity is in the forefront of research. Available methods at present include cardioprotective agents, DOX derivates and dosage schedules. This paper proposes new ideas on potential drug targets aiming at enhancing cancer therapy and cardioprotection simultaneously.

Efficiency of Class I and Class II malocclusion treatment with four premolar extractions

Four premolar extractions is a successful protocol to treat Class I malocclusion, but it is a less efficient way when compared with other Class II treatment protocols. Objective: The objective of this study was to evaluate the influence of anteroposterior discrepancy on the success of four premolar extractions protocol. For that, treatment efficiency of Class I and complete Class II malocclusions, treated with four premolar extractions were compared. Methods: A sample of 107 records from 75 Class I (mean age of 13.98 years - group 1) and 32 Class II (mean age of 13.19 years - group 2) malocclusion patients treated with four premolar extractions was selected. The initial and final occlusal status of each patient was evaluated on dental casts with the PAR index. The treatment time was calculated based on the clinical charts, and the treatment efficiency was obtained by the ratio between the percentage of PAR reduction and treatment time. The PAR index and its components, the treatment time and the treatment efficiency of the groups were statistically compared with t tests and Mann-Whitney U-test. Results: The Class II malocclusion patients had a greater final PAR index than Class I malocclusion patients, and similar duration (Class I - 28.95 mo. and Class II - 28.10 mo.) and treatment efficiency. Conclusion: The treatment of the complete Class II malocclusion with four premolar extractions presented worse occlusal results than Class I malocclusion owing to incomplete molar relationship correction. .

Changing paradigms of anti-VEGF in the Indian scenario.

Anti-vascular endothelial growth factors (VEGF) agents have revolutionized the treatment of retinal diseases. Use of anti-VEGF agents in the Indian Scenario present some unique challenges considering the absence of compounding pharmacies, poor penetrance of health insurance and limited aff ordability of the citizens of a developing economy. To study the changing paradigms of anti-VEGF use in the Indian scenario, all articles published by Indian authors, data from web-based surveys amongst Indian vitreo-retinal specialists were reviewed. In the paucity of compounding pharmacies in India, fractionation and injection techniques diff er from those of developed countries. Frequent anti-VEGF monotherapy off ers the best anatomical and visual results, but economics of scale do not allow the same in the Indian scenario, resulting in PRN dosing and combination of anti-VEGF with laser photocoagulation, being the commonly employed treatment protocols.

Effect of initial treatment protocol on prognosis of pneumonia in the kidney transplant recipients / 中华器官移植杂志

Objective To explore the effects of different initial treatment protocols on the prognosis of pneumonia in the kidney transplant recipients. Methods Sixty-seven cases of pneumonia following kidney transplantation were divided into case group (34 cases) and control group (33 cases).The patients in case group were treated with Imipenem and Cilastatin, SMX/TMP and ganciclovir,and those in control group received routine treatments. Mortality and length of stay in hospital (LOS)were analyzed. Results Mortality (5.9 % ) and LOS (15 days) in case group were reduced as compared with those in control group ( 18. 2 %, 23 days, respectively) (P＜ 0. 05). Among the patients without severe pneumonia, the mortality and incidence of LOS beyond 21 days in case group (3. 4 %, 1/29; 3. 4 %, 1/29) were lower than those in control group (17. 2 %, 5/29; 37. 9 %, 11/29, respectively) (P＜0. 05). Whether the patients were admitted to hospital sooner or later, the incidence of LOS beyond 21 days in case group was lower than that in control group (P＜0. 05).Whether the etiologies were determined or undetermined, the incidence of LOS beyond 21 days in case group was lower than that in control group (P＜0. 05). The incidence of LOS beyond 21 days in case group was lower than that in control group among the patients with cardiopulmonary disease (P＜0. 05). Conclusion The initial appropriate treatment would improve the prognosis of pneumonia in the kidney transplant recipients.

Diagnosis and treatment of cervical cancer during pregnancy / Diagnóstico e tratamento do câncer do colo uterino durante a gestação

CONTEXT AND OBJECTIVE: One third of all cervical carcinomas occur during the reproductive period. Cervical carcinoma is the second greatest cause of death due to cancer during this phase. The estimated frequency of cervical cancer during pregnancy is one case for every 1,000 to 5,000 pregnancies. The aim here was to provide information about the difficulties in diagnosing and managing cervical neoplasia during pregnancy. MATERIALS: A systematic review of the literature was undertaken through the PubMed, Cochrane, Excerpta Medica (Embase), Literatura Latino Americana e do Caribe em Ciências da Saúde (Lilacs) and Scientific Electronic Library Online (SciELO) databases, using the following words: pregnancy, cervical cancer, diagnosis and management. RESULTS: There was a consensus in the literature regarding diagnosis of cervical carcinoma and management of preneoplastic lesions during pregnancy. However, for management of invasive carcinoma, there was great divergence regarding the gestational age taken as the limit for observation rather than immediate treatment. CONCLUSION: All patients with cytological abnormalities should undergo colposcopy, which will indicate and guide biopsy. Conization is reserved for patients with suspected invasion. High-grade lesions should be monitored during pregnancy and reevaluated after delivery. In cases of invasive carcinoma detected up to the 12th week of pregnancy, patient treatment is prioritized. Regarding diagnoses made during the second trimester, fetal pulmonary maturity can be awaited, and the use of chemotherapy to stabilize the disease until the time of delivery appears to be viable.

CONTEXTO E OBJETIVO: Um terço dos carcinomas de colo ocorrem no período reprodutivo, sendo que esta é a segunda causa de morte por câncer nessa fase. A freqüência estimada do carcinoma de colo uterino na gravidez é de um caso para cada 1.000 a 5.000 gestações. O objetivo foi informar sobre as dificuldades frente ao diagnóstico e manejo da neoplasia cervical durante a gravidez. MATERIAIS E MÉTODOS: Revisão sistemática da literatura foi realizada no PubMed, Cochrane, Excerpta Medica (Embase), Literatura Latino Americana e do Caribe em Ciências da Saúde (Lilacs) and Scientific Electronic Library Online (SciELO), usando as seguintes palavras: gestação, câncer cervical, diagnóstico e manejo. RESULTADOS: A literatura apresenta consenso quanto ao diagnóstico do carcinoma cervical e a conduta das lesões pré-neoplásicas durante a gestação. No manejo do carcinoma invasor há grande divergência quanto à idade gestacional considerada como limite para a adoção da observação em vez do tratamento imediato. CONCLUSÃO: Toda paciente com citologia alterada deve realizar colposcopia, a qual indicará e a biópsia. A conização é reservada para pacientes com suspeita de invasão. As lesões de alto grau devem ser acompanhadas durante a gestação e reavaliadas após o parto. Em casos de carcinoma invasor em gestantes com até 12 semanas o tratamento da paciente é priorizado. Nos diagnósticos ocorridos no segundo trimestre, pode-se aguardar a maturidade pulmonar fetal e o uso da quimioterapia para estabilizar a doença até o momento do parto parece ser viável.

Toxoplasmose na gestação: diagnóstico, tratamento e importância de protocolo clínico / Toxoplasmosis in pregnancy: diagnosis, treatment and the importance of clinical protocol

OBJETIVOS: comparar aspectos laboratoriais, terapêuticos e gastos com toxoplasmose em gestantes, em época prévia à implantação de protocolo clínico, a uma situação hipotética de aplicação de um protocolo. MÉTODOS: coorte histórica com gestantes inscritas no pré-natal de unidades básicas de saúde de Londrina, Paraná, que realizaram exames laboratoriais de rotina de pré-natal, incluindo sorologia para toxoplasmose aguda, no período de janeiro a novembro de 2004. Os dados foram obtidos na Secretaria Municipal de Saúde e no Hospital Universitário. A realização de exame confirmatório, tratamento e respectivos gastos foram comparados com dados provenientes de uma situação hipotética de implantação de um protocolo clínico. RESULTADOS: na situação real, em 75 por cento das gestantes com IgM reagente para toxoplasmose não houve diagnóstico definitivo e, entre as que realizaram exame confirmatório, o tempo médio decorrido entre os dois exames foi de 23 semanas; 28,5 por cento foram tratadas sem confirmação e no único caso confirmado não houve tratamento. Na comparação com a situação hipotética, a realização do exame confirmatório na mesma amostra de sangue possibilitaria diagnóstico definitivo a todas. Os menores gastos com medicamentos compensariam o aumento de custos com exames confirmatórios. CONCLUSÕES: os resultados demonstram a importância da implantação de protocolos clínicos de forma adequada, quer seja sob o ponto de vista de proteção à saúde, ou de economia.

OBJECTIVES: to compare therapeutic and laboratory aspects of toxoplasmosis in pregnant women as well as its cost in a real situation and in a hypothetical situation employing a clinical protocol.METHODS: a time-series cohort study was carried out with pregnant women taking part between January and November 2004 in the prenatal program at the Primary Health Units in Londrina, Paraná, Brazil, whose prenatal routine laboratory tests included serology for acute toxoplasmosis. Data were obtained at the city's Department of Health and the University Hospital. Additional tests, treatment and corresponding expenses were compared with data from a hypothetical situation employing a clinical protocol. RESULTS: in the real situation, there was no definitive diagnosis for 75 percent of the pregnant women with reactive IgM for toxoplasmosis, and among those who underwent an additional test, the median time period between the two tests was 23 weeks; 28.5 percent of the women were treated without confirmation and a single confirmed case was not treated. Compared with the hypothetical situation, if an additional test had been carried out with the same blood sample it would have been possible to arrive at a definitive diagnosis of all cases. Lower expenditure on medicines would compensate for extra expenses related to additional tests. CONCLUSIONS: the results show the importance of an appropriate clinical protocol both for health protection and cost reduction.

Malária não complicada por Plasmodium vivax e P. falciparum no Brasil: evidências sobre fármacos isolados e associações medicamentosas empregados em esquemas terapêuticos recomendados pelo protocolo terapêutico oficial / Uncomplicated Plasmodium vivax and P. falciparum malaria in Brazil: evidence on single and combined drug treatments recommended by official guidelines

A malária é a endemia parasitária mais importante no mundo. No Brasil, 60 por cento do território são favoráveis à transmissão, com cerca de 500 mil casos por ano. A doença não se distribui geograficamente de forma homogênea, fato que pode explicar diferenças na eficácia e efetividade dos tratamentos. Para identificar as evidências que poderiam ter embasado os tratamentos recomendados pelo Manual de Terapêutica da Malária 2001, foi realizada uma revisão dos estudos que abordassem tratamentos com antimaláricos no Brasil entre 1980 e 2005. Foram encontrados poucos estudos, e com baixa qualidade metodológica, nenhum deles capaz de gerar recomendações para protocolos baseados em evidência. Os artigos publicados após 2001 apresentaram nível de evidência maior, segundo classificação utilizada para definição de níveis de evidência farmacológico-clínicos. Espera-se que tais estudos também orientem conduta na próxima revisão do manual, prevista para o ano de 2007. Constatou-se que as referências do manual, utilizadas como base para recomendação dos tratamentos, são publicações desatualizadas e possivelmente consideradas clássicas, mas com pouca especificidade para região geográfica, população e/ou tipo de malária.

Malaria is the most important endemic parasitic disease in the world. Conditions are favorable for transmission of the disease in 60 percent of Brazil's territory. Over 500,000 cases per year are recorded in the country. However, the geographic distribution is uneven, which may explain differences in the efficacy and effectiveness of antimalarial drugs. We conducted an extensive literature review of antimalarial treatment in Brazil from 1980 to 2005 in order to identify evidence that might have been available for the 2001 Edition of the Malaria Treatment Manual, the official Ministry of Health guidelines. Only a few studies, of low methodological quality, were identified by the search. None of the studies would have been capable of generating evidence-based guidelines according to the current classification of levels of pharmacological and clinical evidence. Studies published after 2001 drew on more evidence and are expected to provide the basis for the next edition of the manual, due in 2007. References in the 2001 Edition were outdated, possibly perceived as traditional references in the field, but lacking in specificity for region, population, and/or type of malaria.

Role of Clinical Pharmacists of Traditional Chinese Medicine in Rational Drug Use / 中国药房

OBJECTIVE:To discuss the role of clinical pharmacists of TCM in rational use of traditional Chinese drugs. METHODS:The role of clinical pharmacist of Chinese medicine in rational drug use was analyzed based on the brief introduction of rational use of Chinese traditional drugs and responsibility of clinical pharmacists of TCM.RESULTS:Clinical pharmacists of TCM play an important role in rational use of drugs and they can promote rational use of traditional Chinese medicines. CONCLUSION:To play an active role in the rational drug use,clinical pharmacists of TCM have to enhance their own quality in clinical practice.

Diagnosis and treatment of congenital esophageal stenosis / 中华胸心血管外科杂志

Objective Base on the local pathology, the early diagnosis and a reasonable treatment for congenital esophageal stenosis (CES) were discussed. Methods Forty two cases of congenital esophageal stenosis during 1980～2000 were reviewed retrospectively, including age, vomitus and frequency, nutrition and development, diagnostic method used and operative pathological findings, time of normal feeding and time of nutritional restoration. Results According to local pathology, there were 26 cases of tracheobronchial remnant, 11 fibromuscular stenosis, 3 membranous diaphragm, and 2 ectopic gastric mucosa. Membranous diaphragm excision gave the best result without postoperative dilatation. The patients were followed up for 4～10 years, Normal feeding was restored in 1 month in 78 6%, 9 5% in 6 months, and 11 9% in 1 year. Conclusion Persistent vomiting of undigested food and failure in gaining weight are the chief complaints of congenital esophageal stenosis. The confirmatory diagnosis depends on barium swallowing and esophagoscopy. A good result can be achieved by follows local resection and necessary postoperative dilatation.