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1.
Esc. Anna Nery Rev. Enferm ; 26: e20210246, 2022. graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1360442

ABSTRACT

RESUMO Objetivo descrever as necessidades de aprendizagem de familiares de crianças e adolescentes com câncer quanto ao tratamento com quimioterápicos antineoplásicos orais. Método pesquisa qualitativa descritiva desenvolvida em um hospital federal do Rio de Janeiro, Brasil. Os dados foram coletados nos meses de julho a setembro de 2020 a partir de entrevistas semiestruturadas com vinte e três familiares de crianças e adolescentes com câncer em quimioterapia antineoplásica oral. Os dados foram processados no software Interface de R pour Analyses Multidimensionnelles de Textes et de Questionnaires pela Classificação Hierárquica Descendente. Resultados dentre os temas que demandam aprendizagem pelos familiares estão administração oral, armazenamento e manipulação dos quimioterápicos orais, além dos efeitos adversos e emergências que demandam atendimento hospitalar. Conclusão e implicações para a prática no tratamento com quimioterápicos orais, as necessidades de aprendizagem dos familiares de crianças e adolescentes precisam ser problematizadas em práticas educativas dialógicas para, assim, favorecer a segurança, a adesão e a eficácia do tratamento.


RESUMEN Objetivo describir las necesidades de aprendizaje de familiares de niños y adolescentes con cáncer en cuanto al tratamiento con quimioterápicos antineoplásicos orales. Método investigación cualitativa descriptiva desarrollada en un hospital federal de Río de Janeiro, Brasil. Los datos fueron recogidos en los meses de julio a septiembre de 2020 a partir de entrevistas semiestructuradas con veintitrés familiares de niños y adolescentes con cáncer en quimioterapia antineoplásica oral. Los datos fueron procesados en el software Interface de R pour Analyses Multidimensionnelles de Textes et de Questionnaires por la Clasificación Jerárquica Descendente. Resultados entre los temas que demandan aprendizaje por los familiares están administración oral, almacenamiento y manipulación de los quimioterápicos orales, además de los efectos adversos y emergencias que demandan atención hospitalaria. Conclusión e implicaciones para la práctica en el tratamiento con quimioterápicos orales, las necesidades de aprendizaje de los familiares de niños y adolescentes necesitan ser problematizadas en prácticas educativas dialógicas para, así, favorecer la seguridad, la adhesión y la eficacia del tratamiento.


ABSTRACT Objective to describe the learning needs of family members of children and adolescents with cancer regarding treatment with oral antineoplastic chemotherapies. Method a descriptive qualitative research developed in a federal hospital in Rio de Janeiro, Brazil. Data were collected in the months from July to September 2020 from semi-structured interviews with twenty-three family members of children and adolescents with cancer undergoing oral antineoplastic chemotherapy. Data was processed in the software Interface de R pour Analyses Multidimensionnelles de Textes et de Questionnaires by the Descending Hierarchical Classification. Results among the themes that demand learning by the family members are oral administration, storage and handling of oral antineoplastic drugs, as well as adverse effects and emergencies that require hospital care. Conclusion and implications for practice in oral antineoplastic treatment, the learning needs of family members of children and adolescents need to be problematized in dialogic educational practices in order to favor the safety, adherence, and efficacy of the treatment.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Health Education , Caregivers/education , Neoplasms/therapy , Antineoplastic Agents/therapeutic use , Child Care , Methotrexate/therapeutic use , Administration, Oral , Qualitative Research , Drug Storage , Temozolomide/therapeutic use , Mercaptopurine/therapeutic use , Antineoplastic Agents/administration & dosage
2.
Rev. cuba. oftalmol ; 34(3): e1075, 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1352028

ABSTRACT

Objetivo: Caracterizar las uveítis asociadas a la artritis idiopática juvenil. Métodos: Se realizó un estudio observacional, descriptivo, de corte transversal, donde se evaluaron las variables edad, raza, sexo, lateralidad de la uveítis, clasificación anatómica, agudeza visual mejor corregida, presencia de complicaciones y tratamiento. Resultados: Predominaron los mayores de seis años, el sexo femenino y la raza blanca. En cuanto a la lateralidad hubo mayor predominio de las bilaterales, con localización anatómica anterior. En los resultados visuales sobresalieron los que presentaban una agudeza visual mejor corregida ≥ 0,5. Las complicaciones más frecuentes fueron: la pérdida visual, la hipertensión ocular y la queratopatía en banda. Con respecto al tratamiento, la mayoría de los pacientes tenían asociado metotrexate al tratamiento tópico y oral con esteroides. Conclusión: La uveítis asociada a la artritis idiopática juvenil sigue siendo un problema importante de salud en la infancia a pesar de los avances en los programas de atención a esta enfermedad; por tanto, el diagnóstico precoz, el seguimiento estricto y el tratamiento adecuado son los pilares para una mejor evolución(AU)


Objective: Characterize uveitis associated to juvenile idiopathic arthritis. Methods: A cross-sectional observational descriptive study was conducted based on evaluation of the following variables: age, race, sex, laterality of uveitis, anatomical classification, best corrected visual acuity, presence of complications and treatment. Results: A predominance was observed of patients aged over six years, female sex and white race. Bilateral uveitis prevailed, with anterior anatomical location. Patients with a best corrected visual acuity ≥ 0.5 stood out for their visual results. The most common complications were visual loss, ocular hypertension and band keratopathy. Most patients had methotrexate associated to topical and oral treatment with steroids. Conclusion: Uveitis associated to juvenile idiopathic arthritis continues to be an important health problem in childhood, despite the progress in the care of this condition. Therefore, early diagnosis, strict follow-up and appropriate treatment are the pillars of a better evolution(AU)


Subject(s)
Humans , Female , Child , Arthritis, Juvenile/etiology , Uveitis/diagnosis , Methotrexate/therapeutic use , Ocular Hypertension/complications , Early Diagnosis , Epidemiology, Descriptive , Cross-Sectional Studies , Observational Studies as Topic
3.
Rev. bras. ginecol. obstet ; 43(4): 311-316, Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1280049

ABSTRACT

Abstract A cesarean scar pregnancy (CSP) is a scary and life-threatening complication of cesarean section (CS). Nevertheless, the incidence of CS is constantly growing. The CSP incidence is 0,15% of pregnancies after CS which represents 6,1% of all ectopic pregnancies in women with condition after CS. Therefore, it should be more present in the clinical daily routine. From mild nonspecific symptoms to hypovolemic shock, diagnosis and therapy must be performed quickly. With the progressive growth of the scar pregnancy, a uterine rupture involves the risk of severe bleeding, and an emergency hysterectomy could be necessary. Prolongation of pregnancy has been successful only in a few cases.We report 11 cases from our hospital in the past 10 years. In the discussion, treatment options of this complication with an increasing incidence, which is associated with serious morbidity and mortality, are presented based on the current literature. Treatment options include drug therapy, but also surgical or combined procedures with radiological intervention.


Subject(s)
Humans , Female , Pregnancy , Adult , Young Adult , Pregnancy, Ectopic/diagnosis , Pregnancy, Ectopic/therapy , Cesarean Section/adverse effects , Cicatrix/complications , Uterine Hemorrhage/etiology , Uterine Rupture/etiology , Abortifacient Agents, Nonsteroidal/therapeutic use , Methotrexate/therapeutic use , Risk Factors , Pregnancy, High-Risk , Dilatation and Curettage , Hysterectomy
4.
Rev. bras. ginecol. obstet ; 43(4): 323-328, Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1280047

ABSTRACT

Abstract Complete hydatidiform mole (CHM) is a rare type of pregnancy, in which 15 to 20% of the cases may develop into gestational trophoblastic neoplasia (GTN). The diagnostic of GTN must be done as early as possible through weekly surveillance of serum hCG after uterine evacuation.We report the case of 23-year-old primigravida, with CHM but without surveillance of hCG after uterine evacuation. Two months later, the patient presented to the emergency with vaginal bleeding and was referred to the Centro de Doenças Trofoblásticas do Hospital São Paulo. She was diagnosed with high risk GTN stage/score III:7 as per The International Federation of Gynecology and Obstetrics/World Health Organization (FIGO/WHO). The sonographic examination revealed enlarged uterus with a heterogeneous mass constituted of multiple large vessels invading and causing disarrangement of the myometrium. The patient evolved with progressive worsening of vaginal bleeding after chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO) regimen. She underwent blood transfusion and embolization of uterine arteries due to severe vaginal hemorrhage episodes, with complete control of bleeding. The hCG reached a negative value after the third cycle, and there was a complete regression of the anomalous vascularization of the uterus as well as full recovery of the uterine anatomy. The treatment in a reference center was essential for the appropriate management, especially regarding the uterine arteries embolization trough percutaneous femoral


Resumo Mola hidatiforme completa (MHC) é um tipo raro de gravidez, na qual 15 a 20% dos casos podem desenvolver neoplasia trofoblástica gestacional (NTG). O diagnóstico de NTG deve ser feito o mais cedo possível, pelo monitoramento semanal do hCG sérico após esvaziamento uterino. Relatamos o caso de uma paciente primigesta, de 23 anos de idade, com MHC, sem vigilância de hCG após esvaziamento uterino. Dois meses depois, a paciente compareceu na emergência com sangramento vaginal, sendo encaminhada ao Centro de Doenças Trofoblásticas do Hospital São Paulo, onde foi diagnosticada com NTG de alto risco, estádio e score de risco III:7 de acordo com a The International Federation of Gynecology and Obstetrics/Organização Mundial de Saúde (FIGO/OMS). O exame ultrassonográfico revelou útero aumentado com uma massa heterogênea constituída pormúltiplos vasos volumosos invadindo e desestruturando o miométrio. A paciente evoluiu com piora progressiva do sangramento vaginal após quimioterapia com o regime etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO). Ela foi submetida a transfusão de sangue e embolização das artérias uterinas devido aos episódios graves de hemorragia vaginal, com completo controle do sangramento. O hCG atingiu valor negativo após o terceiro ciclo, havendo regressão completa da vascularização uterina anômala, assim como recuperação da anatomia uterina. O tratamento em um centro de referência permitiu o manejo adequado, principalmente no que se refere à embolização das artérias uterinas através da punção percutânea da artéria femoral, que foi crucial para evitar a histerectomia, permitindo a cura da NTG e a manutenção da vida reprodutiva.


Subject(s)
Humans , Female , Pregnancy , Young Adult , Arteriovenous Malformations/complications , Uterine Hemorrhage/therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Gestational Trophoblastic Disease/complications , Gestational Trophoblastic Disease/drug therapy , Embolization, Therapeutic , Uterine Hemorrhage/etiology , Uterine Hemorrhage/diagnostic imaging , Vincristine/therapeutic use , Methotrexate/therapeutic use , Ultrasonography, Prenatal , Pregnancy, High-Risk , Cyclophosphamide/therapeutic use , Dactinomycin/therapeutic use , Gestational Trophoblastic Disease/diagnostic imaging , Etoposide/therapeutic use , Uterine Artery
5.
Rev. méd. Urug ; 37(1): e201, mar. 2021. tab
Article in Spanish | LILACS, BNUY | ID: biblio-1180958

ABSTRACT

Resumen: Introducción: en los últimos años se viene presentando un fenómeno de disminución en las defunciones vinculadas al embarazo ectópico gracias a los avances en el diagnóstico precoz, lo que a su vez abrió las puertas al tratamiento médico con metotrexate en pacientes seleccionadas. El objetivo del presente trabajo es reportar la experiencia del tratamiento con metotrexate en el departamento de Paysandú y determinar secundariamente la satisfacción de las usuarias frente a éste y su fertilidad posterior. Método: se presenta un estudio retrospectivo, observacional, de los embarazos ectópicos tubarios tratados con metotrexate en Paysandú, durante el período del 1º de enero de 2014 al 31 de diciembre de 2017, comprendiendo cuatro años. Se consideró fracaso del tratamiento médico cuando fue necesario tratamiento quirúrgico y se definió como fertilidad futura al tiempo que transcurrió hasta lograr una gestación intrauterina espontánea. Resultados: se registraron 67 embarazos ectópicos en cuatro años, 13 recibieron metotrexate intramuscular con un porcentaje de éxito de 69,2%. Se determinó una fertilidad posterior de 25%. Conclusiones: el uso de metotrexate en el embarazo ectópico se practica en Paysandú desde hace casi una década con buenos resultados y una buena aceptación por parte de las usuarias.


Summary: Introduction : In recent years there has been a decrease in deaths related to ectopic pregnancy, thanks to progress made in early diagnosis, which in turn allowed for medical treatment with methotrexate in selected patients. The study's first objective is to report the experience of methotrexate treatment in the Department of Paysandú and its secondary objective is to determine users' satisfaction towards this treatment and find about their subsequent fertility. Method: a retrospective, observational study is presented of tubal ectopic pregnancies treated with methotrexate in Paysandú, from January 1, 2014 to December 31, 2017, during a 4-year period. Failure of medical treatment was defined as the cases requiring surgical treatment and subsequent fertility was defined as the time it took to achieve a spontaneous intrauterine gestation. Results: 67 ectopic pregnancies were recorded in four years, 13 of which received intramuscular methotrexate with a success rate of 69.2%. Subsequent fertility was found to be 25%. Conclusions: methotrexate has been used to treat ectopic pregnancies in Paysandú for almost a decade, with good results and acceptable rates of user satisfaction.


Resumo: Introdução: nos últimos anos, observou-se uma diminuição dos óbitos relacionados à gravidez ectópica, graças aos avanços no diagnóstico precoce, que por sua vez abriram as portas para o tratamento médico com metotrexato em pacientes selecionadas. Objetivo: o objetivo deste trabalho é relatar a experiência do tratamento com metotrexato no Departamento de Paysandú e determinar secundariamente a satisfação das usuárias com o mesmo e sua consequente fertilidade. Métodos: apresenta-se um estudo retrospectivo e observacional de gestações ectópicas tubárias tratadas com metotrexato em Paysandú, durante o período de 1º de janeiro de 2014 a 31 de dezembro de 2017. Considerou-se como falha do tratamento médico quando o tratamento cirúrgico foi necessário e definiu-se fertilidade futura como o tempo decorrido até a obtenção de uma gravidez intrauterina espontânea. Resultados: foram registradas 67 gestações ectópicas em quatro anos, 13 receberam metotrexato intramuscular com taxa de sucesso de 69,2%. Uma fertilidade subsequente de 25% foi determinada. Conclusões: o uso do metotrexato na gravidez ectópica é praticado em Paysandú há quase uma década com bons resultados e boa aceitação pelas usuárias.


Subject(s)
Pregnancy, Ectopic/therapy , Methotrexate/therapeutic use , Retrospective Studies , Fertility , Observational Study
6.
Rev. chil. endocrinol. diabetes ; 14(1): 14-16, 2021. tab
Article in Spanish | LILACS | ID: biblio-1146466

ABSTRACT

La enfermedad trofoblástica gestacional (ETG) es una complicación del embarazo poco común. Corresponde a un espectro de lesiones proliferativas del tejido trofoblástico: Mola Hidatiforme (MH) en sus formas parcial y completa, Coriocarcinoma, Tumor Trofoblástico y Tumor Trofoblástico Epiteloide. Los distintos tipos de ETG presentan en común la hipersecreción de gonadotrofina coriónica humana (hCG). La hCG es una hormona glicoproteica con una estructura muy similar a la TSH, por lo cual puede estimular la función tiroidea en condiciones fisiológicas y en algunas condiciones patológicas. La ETG puede cursar con hipertiroidismo, el cual puede variar en intensidad, desde una presentación asintomática con alteración leve de hormonas tiroideas a un cuadro de hipertiroidismo manifiesto. Se presentan 3 casos clínicos de pacientes con ETG, específicamente MH que evolucionaron con tirotoxicosis transitoria. Los casos presentaron un cuadro leve de hipertiroidismo con pocos síntomas asociados. La taquicardia fue el único síntoma en la mayoría de los casos. En todas las pacientes las hormonas tiroideas se normalizaron después del tratamiento de la ETG. Conclusión: Se debe tener presente la posibilidad de hipertiroidismo en toda paciente con ETG. Un alto nivel de sospecha permitirá identificar a aquellas pacientes que cursen con hipertiroidismo, permitiendo así un diagnóstico y tratamiento oportuno.


Gestational trophoblastic disease (GTD) is a rare complication of pregnancy. GTD includes a group of proliferative lesions of trophoblastic tissue: partial and complete hydatidiform mole, choriocarcinoma, epithelioid trophoblastic tumor, and placental site trophoblastic tumor. The different types of GTD have in common the hypersecretion of human chorionic gonadotropin (hCG). HCG is a glycoprotein hormone with a similar structure to TSH. In physiological and pathological conditions hCG can stimulate thyroid function. GTD can present with hyperthyroidism, which can vary in intensity, from an asymptomatic presentation with mild alteration of thyroid hormones to a manifest hyperthyroidism. We present 3 clinical cases of patients with GTD thyrotoxicosis. All cases presented mild hyperthyroidism. Tachycardia was the only symptom in most cases. In all patients thyroid hormones return to normal after treatment of GTD. Conclusion: In patients with GTD the possibility of hyperthyroidism should be kept in mind. A high level of suspicion will allow to identifying patients with hyperthyroidism.


Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Young Adult , Gestational Trophoblastic Disease/complications , Gestational Trophoblastic Disease/diagnosis , Hyperthyroidism/etiology , Propranolol/therapeutic use , Tachycardia , Thyrotoxicosis/etiology , Hydatidiform Mole , Methotrexate/therapeutic use , Gestational Trophoblastic Disease/drug therapy
7.
Adv Rheumatol ; 61: 17, 2021. tab, graf
Article in English | LILACS | ID: biblio-1152736

ABSTRACT

Abstract Background: Hyperhomocysteinemia is associated with autoimmune diseases such as ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA). Current findings regarding plasma/serum homocysteine (HCY) levels in AS patients are inconsistent. This study aims to systematically evaluate the association between circulating HCY levels and AS. Methods: Online electronic databases (PubMed, Web of Science, Embase, ScienceDirect, China National Knowledge Infrastructure (CNKI), and Wanfang data) were used to retrieve all relevant articles published up to May 7, 2020. The pooled standardized mean difference (SMD) with 95% confidence interval (CI) was calculated using the random-effect model, Stata16 software. Results: Nine articles containing 778 AS patients and 522 controls were included in this meta-analysis. No significant differences in HCY levels were found between AS and control groups (pooled SMD = 0.46, 95% CI = − 0.30 to 1.23, P = 0.23). However, subgroup analysis suggested that HCY levels were significantly higher (P < 0.05) in the AS group treated with methotrexate (MTX) compared with the control group. In contrast, HCY levels were significantly (P < 0.05) lower in the AS group receiving anti-TNF-α treatment compared with the control group. No significant differences were detected between HCY levels and disease activity scores (Bath AS disease activity index, BASDAI), and methylenetetrahydrofolate reductase (MTHFR) C677T genotype. Conclusion: This meta-analysis indicates that HCY levels are similar between AS and controls, and do not correlate with disease activity. However, different medical treatments cause fluctuations of circulating HCY levels in AS patients. Further and larger-scale studies are needed to confirm these findings. Trial registration: This study was registered at international prospective register of systematic reviews (PROSPERO), registration number: CRD42020184426.(AU)


Subject(s)
Humans , Spondylitis, Ankylosing/etiology , Homocysteine/analysis , Case-Control Studies , Methotrexate/therapeutic use , Tumor Necrosis Factor-alpha/therapeutic use
8.
Journal of Experimental Hematology ; (6): 1175-1180, 2021.
Article in Chinese | WPRIM | ID: wpr-888535

ABSTRACT

OBJECTIVE@#To investigate the clinical efficacy of high dose methotrexate (HD-MTX), temozolomide (TMZ), and rituximab (R) in the treatment of patients with primary central nervous system lymphoma (PCNSL).@*METHODS@#Clinical data of patients with PCNSL diagnosed and treated in Guangdong Provincial People's Hospital from February 2010 to May 2017 were collected. First, patients were given 6-8 cycles of MTX (3.5 g/m@*RESULTS@#There were 42 patients enrolled in the study, 17 cases in HD-MTX+TMZ group and 25 cases in HD-MTX+TMZ+R group. The median PFS and OS times in HD-MTX+TMZ+R group were 56.7 months and N/A, respectively, while, 7.3 months and 34.7 months in HD-MTX+TMZ group, respectively. In addition, there was no significant difference in median survival between patients who received TMZ maintenance therapy and those who were only actively monitored. During the induction period, all the patients had grade 1-2 nausea and vomiting, while in the consolidation treatment period, no grade 3/4 toxicity was observed.@*CONCLUSION@#The combination of HD-MTX+TMZ+R in the treatment of PCNSL patients shows a definite short-term effect, which can increase the survival rate of the patients. The side effects are mild, and the patients can generally tolerate.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols , Central Nervous System , Central Nervous System Neoplasms/drug therapy , Humans , Lymphoma, Non-Hodgkin/drug therapy , Methotrexate/therapeutic use , Retrospective Studies , Rituximab/therapeutic use , Temozolomide/therapeutic use , Treatment Outcome
9.
Chinese Medical Journal ; (24): 1457-1464, 2021.
Article in English | WPRIM | ID: wpr-878178

ABSTRACT

BACKGROUND@#Clinical observational studies revealed that 99Tc-methylene diphosphonate (99Tc-MDP) could reduce joint pain and swollenness in rheumatoid arthritis (RA) patients. This multicenter, randomized, double-blind, double-dummy study aimed to evaluate the effects of 99Tc-MDP plus methotrexate (MTX) vs. MTX alone or 99Tc-MDP alone on disease activity and structural damage in MTX-naïve Chinese patients with moderate to severe RA.@*METHODS@#Eligible patients with moderate to severely active RA were randomized to receive 99Tc-MDP plus MTX (n = 59) vs. MTX (n = 59) alone or 99Tc-MDP (n = 59) alone for 48 weeks from six study sites across four provinces in China. The primary outcomes were the American College of Rheumatology 20% improvement (ACR20) response rates at week 24 and changes in modified total Sharp score at week 48.@*RESULTS@#At week 24, the proportion of participants achieving ACR20 was significantly higher in the MTX + 99Tc-MDP combination group (69.5%) than that in the MTX group (50.8%) or 99Tc-MDP group (47.5%) (P = 0.03 for MTX + 99Tc-MDP vs. MTX, and MTX + 99Tc-MDP vs.99Tc-MDP, respectively). The participants in the MTX + 99Tc-MDP group and the 99Tc-MDP group had significantly less important radiographic progression than the participants in the MTX group over the 48 weeks (MTX + 99Tc-MDP vs. MTX: P = 0.03, 99Tc-MDP vs. MTX: P = 0.03, respectively). There was no significant difference in terms of adverse events (AEs) among the groups. No serious AEs were observed.@*CONCLUSIONS@#This study demonstrated that the combination of 99Tc-MDP with MTX inhibited structural damage and improved disease activity in RA patients compared with MTX and 99Tc-MDP monotherapies, without increasing the rate of AEs. Additional clinical studies of 99Tc-MDP therapy in patients with RA are warranted.@*TRIAL REGISTRATION@#Chictr.org, ChiCTR-IPR-14005684; http://www.chictr.org.cn/showproj.aspx?proj=10088.


Subject(s)
Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/drug therapy , China , Diphosphonates , Double-Blind Method , Drug Therapy, Combination , Humans , Methotrexate/therapeutic use , Technetium/therapeutic use , Treatment Outcome
10.
Rev. cuba. reumatol ; 22(3): e856,
Article in Spanish | LILACS, CUMED | ID: biblio-1144533

ABSTRACT

El diagnóstico y el tratamiento de la artritis reumatoide temprana en el curso de la enfermedad proporcionan alivio de los síntomas y también previene el daño estructural a largo plazo y el deterioro funcional, con una mejora concomitante en la calidad de vida. El propósito de este estudio es exponer algunos enfoques de la artritis reumatoide en cuanto al tratamiento y comportamiento de la actividad de la enfermedad. El reconocimiento de los pacientes de que su enfermedad progresa rápidamente es fundamental para identificar candidatos en los cuales la terapia intensiva puede tener el mayor impacto, en términos de prevenir la progresión de la enfermedad. Los datos acumulados muestran que las estrategias de tratamiento intensivo con agentes biológicos, especialmente los inhibidores del factor de necrosis tumoral, son más eficaces que la monoterapia secuencial o la terapia de combinación progresiva. Estos muestran una eficacia sustancial en combinación con el metotrexato, ya que proporcionan beneficios y mejoras rápidas y sustanciales a los pacientes(AU)


The diagnosis and treatment of rheumatoid arthritis early in the course of the disease provides relief of symptoms and also prevents long-term structural damage and functional deterioration, with a concomitant improvement in quality of life. To expose approaches to rheumatoid arthritis in terms of the treatment and behavior of the activity of said disease. Recognition of patients with rapidly progressing disease is essential to identify candidates in whom intensive therapy can have the greatest impact, in terms of preventing disease progression. The accumulated data shows that intensive treatment strategies with biological agents, especially TNF inhibitors, are more effective than sequential monotherapy or progressive combination therapy. These show substantial efficacy in combination with methotrexate, providing rapid and substantial benefits and improvements in patient outcomes(AU)


Subject(s)
Humans , Male , Female , Arthritis, Rheumatoid/diagnosis , Methotrexate/therapeutic use , Disease Progression , Early Diagnosis , Arthritis, Rheumatoid/drug therapy , Quality of Life
12.
Rev. bras. ginecol. obstet ; 42(12): 800-804, Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1156064

ABSTRACT

Abstract Objective In recent years, there has been an increase in the incidence of ectopic pregnancies; therefore, it is important for tertiary centers to report their approaches and outcomes to expand and improve treatment modalities. The aim of the present study was to evaluate the general characteristics, treatment and outcomes of cases diagnosed with ectopic pregnancy. Methods In total, 432 patients treated for ectopic pregnancy between February 2016 and June 2019 were retrospectively evaluated. Results Overall, 370 patients had tubal pregnancy, 32 had cesarean scar pregnancy, 18 had pregnancy of unknown location, 6 had cervical pregnancy, and 6 had interstitial pregnancy. The most important risk factors were advanced age (> 35 years; prevalence: 31.2%) and smoking (prevalence: 27.1%). Thirty patients who did not have any symptoms of rupture and whose human chorionic gonadotropin (β-hCG) levels were ≤ 200 mIU/ml were followed-up with expectant management, while 316 patients whose β-hCG levels were between 1,500 mIU/ml and 5,000 mIU/ml did not have an intrauterine gestational sac on the transvaginal or abdominal ultrasound, did not demonstrate findings of rupture, and were treated with a systemic multi-dose methotrexate treatment protocol. In total, 24 patients who did not respond to the medical treatment, 20 patients whose β-hCG levels were > 5,000 mIU/ml, 16 patients who had shown symptoms of rupture at the initial presentation, and 6 patients diagnosed with interstitial pregnancy underwent surgery. Patients with cervical and scar pregnancies underwent ultrasound-guided curettage, and no additional treatment was needed. Conclusion The fertility status of the patients, the clinical and laboratory findings, and the levels of β-hCG are the factors that must be considered in planning the appropriate treatment.


Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Young Adult , Pregnancy, Ectopic/epidemiology , Ultrasonography, Prenatal , Pregnancy, Ectopic/etiology , Pregnancy, Ectopic/therapy , Pregnancy, Ectopic/diagnostic imaging , Brazil/epidemiology , Abortifacient Agents, Nonsteroidal/therapeutic use , Methotrexate/therapeutic use , Retrospective Studies , Risk Factors , Treatment Outcome , Curettage , Tertiary Care Centers , Middle Aged
13.
Brasília; s.n; 5 ago 2020.
Non-conventional in Portuguese | PIE, LILACS, BRISA, PIE | ID: biblio-1117760

ABSTRACT

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referentes ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 11 artigos e 6 protocolos.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Betacoronavirus/drug effects , Antiviral Agents/therapeutic use , Technology Assessment, Biomedical , Immunoglobulins/therapeutic use , Methylprednisolone/therapeutic use , Colchicine/therapeutic use , Methotrexate/therapeutic use , Cohort Studies , Interferons/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Azithromycin/therapeutic use , Oseltamivir/therapeutic use , Mesenchymal Stem Cells , Interferon alpha-2/therapeutic use , Glucocorticoids/therapeutic use , Hydroxychloroquine/therapeutic use , Immunosuppressive Agents/therapeutic use , Anti-Bacterial Agents/therapeutic use , Antibodies, Monoclonal/therapeutic use
14.
Brasília; s.n; 7 jul. 2020.
Non-conventional in Portuguese | PIE, LILACS, BRISA, PIE | ID: biblio-1117630

ABSTRACT

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referente ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 17 artigos.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Betacoronavirus/drug effects , Steroids/therapeutic use , Technology Assessment, Biomedical , Vitamin D/therapeutic use , Warfarin/therapeutic use , Ivermectin/therapeutic use , Ceftriaxone/therapeutic use , Chloroquine/therapeutic use , Methotrexate/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Azithromycin/therapeutic use , Ritonavir/therapeutic use , Oseltamivir/therapeutic use , Interleukin 1 Receptor Antagonist Protein/therapeutic use , Lopinavir/therapeutic use , Infliximab/therapeutic use , Leflunomide/therapeutic use , Amoxicillin/therapeutic use , Hydroxychloroquine/therapeutic use , Mycophenolic Acid/therapeutic use
15.
Brasília; s.n; 21 maio 2020.
Non-conventional in Portuguese | PIE, LILACS, BRISA, PIE | ID: biblio-1097387

ABSTRACT

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referente ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 21 artigos.


Subject(s)
Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Disease Progression , Betacoronavirus/drug effects , Azathioprine/therapeutic use , Zinc/therapeutic use , Methylprednisolone/therapeutic use , Methotrexate/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Azithromycin/therapeutic use , Heparin, Low-Molecular-Weight/therapeutic use , Ritonavir/therapeutic use , Drug Combinations , Oseltamivir/therapeutic use , Lopinavir/therapeutic use , Tumor Necrosis Factor Inhibitors/therapeutic use , Hydroxychloroquine/therapeutic use , Mercaptopurine/therapeutic use
18.
An. bras. dermatol ; 95(1): 63-66, Jan.-Feb. 2020. graf
Article in English | LILACS | ID: biblio-1088728

ABSTRACT

Abstract Topical use of immune response modifiers, such as imiquimod, has increased in dermatology. Although its topical use is well tolerated, it may be associated with exacerbations of generalized cutaneous inflammatory diseases, possibly through the systemic circulation of pro-inflammatory cytokines. This report describes a case of development of pityriasis rubra pilaris, a rare erythematous-papulosquamous dermatosis, in a woman aged 60 years during treatment with imiquimod 5% cream for actinic keratosis. It evolved with erythrodermic conditions and palmoplantar keratoderma, presenting progressive clinical resolution after the introduction of methotrexate. The authors emphasize the importance of recognizing possible systemic reactions associated with the topical use of imiquimod.


Subject(s)
Humans , Female , Pityriasis Rubra Pilaris/chemically induced , Pityriasis Rubra Pilaris/pathology , Keratosis, Actinic/drug therapy , Imiquimod/adverse effects , Antineoplastic Agents/adverse effects , Pityriasis Rubra Pilaris/drug therapy , Biopsy , Methotrexate/therapeutic use , Treatment Outcome , Adrenal Cortex Hormones/therapeutic use , Dermatologic Agents/therapeutic use , Middle Aged
20.
Dermatol. argent ; 26(1): 11-16, 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1146357

ABSTRACT

Introducción: La hemiatrofia facial progresiva (HFP) o síndrome de Parry-Romberg y la morfea en golpe de sable (MGS) forman parte de las morfeas lineales cefálicas. Son enfermedades inflamatorias crónicas de la piel y tejidos subyacentes, que se caracterizan por esclerosis y atrofia cutánea. Objetivos: Describir las características clínicas, manifestaciones asociadas, histología, laboratorio, estudios complementarios y tratamientos instaurados. Diseño: Estudio retrospectivo descriptivo. Materiales y métodos: Se revisaron las historias clínicas de pacientes con morfea evaluados en el Sector Colagenopatías desde julio de 2010 hasta diciembre de 2016. Resultados: De 56 pacientes, 11 cumplieron con los criterios de inclusión, 7 con diagnóstico de HFP, 2 con MGS y 2 con ambas patologías. El 64% fueron mujeres. Las manifestaciones extracutáneas se presentaron en el 64% de los casos. El tratamiento utilizado en todos los pacientes fue el metotrexato, asociado o no, al uso de corticosteroides sistémicos. Conclusiones: La mayoría de nuestros resultados concuerdan con la bibliografía consultada, excepto las manifestaciones asociadas. Destacamos el tratamiento asociado de metotrexato y pulsos de corticosteroides intravenosos con resultados satisfactorios y bien tolerado. (AU)


Introduction: Progressive facial hemiatrophy (PFH) or Parry-Romberg Syndrome and morphea en coup de sabre are cephalic linear morpheas. They are chronics inflammatories diseases of the skin and underlying tissues, characterized by cutaneous atrophy and sclerosis. Objectives: To describe clinical features, associated extracutaneous manifestations, histological and laboratory findings, imaging and diagnostic modalities and treatments established in patients with diagnosis of HFP, MGS, or both, evaluated in our Department. Design: Retrospective descriptive study. Materials and methods: We included medical histories of patients diagnosed with morphea evaluated in Collagenopathy Sector from July 2010 up to December 2016. Results: Of 56 patients, 11 met the inclusion criteria, 7 with diagnosis of PFH, 2 with morphea en coup de sabre and 2 with both pathologies. 64% were women. 64% showed extracutaneous manifestations. The treatment used in all of the patients was methotrexate, associated or not, with the use of systemic corticosteroids. Conclusions: Most of our results agree with the bibliography consulted, with the exception of the associated manifestations. We emphasize the associated treatment of methotrexate and intravenous corticosteroid pulses with satisfactory results and well tolerated. (AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Scleroderma, Localized/diagnosis , Facial Hemiatrophy/diagnosis , Scleroderma, Localized/complications , Scleroderma, Localized/drug therapy , Methotrexate/therapeutic use , Retrospective Studies , Adrenal Cortex Hormones/therapeutic use , Dermatologic Agents/therapeutic use , Facial Hemiatrophy/complications , Facial Hemiatrophy/drug therapy
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