Percepção do enfermeiro sobre os cuidados relacionados ao extravasamento de drogas antineoplásicas / Percepción de profesionales de enfermería sobre los cuidados relacionados con la extravasación de medicamentos antineoplásicos / Perception of the nursing professional about the care related to extravasation of antineoplastic drugs

Introdução: O uso de quimioterapias antineoplásicas atuando a nível celular com objetivo de tratar as neoplasias malignas, pode levar ao surgimento da toxicidade dermatológica, ocasionada pelo extravasamento, que consiste em um dano tecidual decorrente da infiltração, por via endovenosa, dos quimioterápicos aos tecidos circunvizinhos do local puncionado, necessitando de uma atuação profissional rápida e efetiva para evitar desfechos desfavoráveis para o paciente. Objetivo: Compreender a percepção do enfermeiro sobre os cuidados relacionados ao extravasamento de drogas antineoplásicas. Método: Trata-se de um estudo de campo, descritivo-exploratório com abordagem qualitativa, realizado com quinze enfermeiros que atuam no ambulatório e enfermarias da oncologia adulto de uma instituição hospitalar filantrópica localizada em Recife/Pernambuco, Brasil. Os dados foram coletados entre janeiro e dezembro de 2020 através de entrevista e passaram por análise de conteúdo temática-categorial. Resultados: Emergiram duas categorias. Cuidados preventivos: da identificação dos fatores de riscos à educação do paciente e equipe de saúde; Cuidados diretos: da identificação da ocorrência ao gerenciamento institucional do evento. Conclusão: Compreendeu-se que a percepção do enfermeiro destaca a importância do planejamento da assistência, incluindo a intervenção imediata, o registro do evento e o acompanhamento do paciente após o extravasamento, como forma de realizar um cuidado especializado e com maior segurança.

Introducción: El uso de quimioterapias antineoplásicas que actúan a nivel celular con el objetivo de tratar neoplasias malignas puede conducir a la aparición de toxicidad dermatológica. Esta es causada por extravasación, que consiste en daño tisular producto de la infiltración, por vía endovenosa, de los agentes quimioterápicos a los tejidos circundantes del sitio de punción. Lo anterior, requiere una actuación profesional rápida y eficaz para evitar resultados desfavorables para la persona. Objetivo: Comprender la percepción de profesionales de enfermería sobre el cuidado relacionado con la extravasación de fármacos antineoplásicos. Método: Se trata de un estudio de campo descriptivo-exploratorio con abordaje cualitativo, realizado con quince personas enfermeras que actúan en las salas de oncología de población adulta y ambulatoria de un hospital filantrópico ubicado en Recife/Pernambuco, Brasil. Los datos fueron recolectados entre enero y diciembre de 2020, a través de entrevistas y fueron sometidos a análisis de contenido por categorías temáticas. Resultados: Emergieron dos categorías: atención preventiva (desde la identificación de factores de riesgo hasta la educación de la persona y del equipo de salud) y atención directa (desde la identificación de la ocurrencia hasta la gestión institucional del evento). Conclusión: Se entendió que la percepción de la persona profesional de enfermería destaca la importancia de la planificación del cuidado, incluyendo la intervención inmediata, el registro de eventos y el seguimiento después de la extravasación, como forma de realizar cuidados especializados y con mayor seguridad.

Introduction: The use of antineoplastic chemotherapies acting at the cellular level with the aim of treating malignant neoplasms can lead to the emergence of dermatological toxicity caused by extravasation. This toxicity consists of tissue damage resulting from the infiltration, by intravenous route, of the chemotherapeutic agents to the surrounding tissues, requiring quick and effective professional action to avoid unfavorable outcomes for the patient. Objective: To understand the nurses' perception of care related to extravasation of antineoplastic drugs. Method: This is a descriptive-exploratory field study with a qualitative approach; it was carried out with fifteen nurses who work in the outpatient and adult oncology wards of a philanthropic hospital located in Recife/Pernambuco, Brazil. Data were collected between January and December 2020 through interviews and underwent thematic-category content analysis. Results: Two categories emerged: Preventive Care: from the identification of risk factors to the patient and health team education; and Direct Care: from the identification of the occurrence to the institutional management of the event. Conclusion: It was understood that the nurse's perception highlights the importance of care planning, including immediate intervention, event registration, and patient follow-up after extravasation, to perform specialized care and with greater safety.

Safety of levofloxacin as an antibiotic prophylaxis in the induction phase of children newly diagnosed with acute lymphoblastic leukemia: an interim analysis of a randomized, open-label trial in Brazil

ABSTRACT Background: Despite high cure rates, treatment-related mortality in children with acute lymphoblastic leukemia (ALL) remains significant. About 4% of patients die during remission induction therapy and approximately two-thirds of treatment-related deaths are due to infectious complications. Methods: From May 2021 to June 2022, children aged one through 18 years, with a recent diagnosis of ALL, admitted to three pediatric oncology centers in Brazil, were enrolled in this multicenter, open-label, randomized, phase 3 clinical trial. Eligible patients were randomly divided into two groups, based on a 1:1 allocation ratio, to receive, or not, levofloxacin as a prophylactic agent during the induction phase. All patients were treated according to the IC-BFM 2009 chemotherapy protocol. Primary endpoints were carbapenemase-producing Enterobacteriaceae (CPE) colonization, Clostridioides difficile diarrhea, and other adverse events related to the use of levofloxacin. The secondary endpoint was febrile neutropenia during induction. The median follow-up was 289 days. Results: Twenty patients were included in this trial, 10 in each group (control and levofloxacin). Mild adverse reactions related to levofloxacin were observed in three patients (30%). Three patients had Clostridioides difficile diarrhea, two in the levofloxacin group and one in the control group (p > 0.99). Only one patient presented colonization by CPE. This patient belonged to the levofloxacin group (p > 0.99). Nine patients presented febrile neutropenia, five in the control group and four in the levofloxacin intervention group (p > 0.99), one patient died due to febrile neutropenia. Conclusion: The use of levofloxacin was shown to be safe in the induction phase in children with de novo ALL. The use of this medication did not increase the rate of colonization by CPE nor the rate of diarrhea by C. difficile. All adverse reactions were mild and remitted either spontaneously or after switching medicine administration from oral to intravenous route.

Comparative studies on protective efficacy of gentisic acid and 2-pyrocatechuic acid against 5-fluorouracil induced nephrotoxicity in Wistar rats

Nephrotoxicity is a frequent and severe side effect of 5-fluorouracil (5-FU) chemotherapy which limits its use clinically regardless of being one of the most promising chemotherapeutic agents. Here, we assessed the nephroprotective activity of two structurally related phenolic acids 2-pyrocatechuic acid (2,3 dihyroxybenzoic acid) and gentisic acid (2,5 dihyroxybenzoic acid) against 5-FU induced nephrotoxicity in Wistar rats. Intraperitoneal administration of 5-FU at a dose of 20 mg/kg once a day for 5 days produced a significant elevation in serum parameters of the kidney such as uric acid, urea, creatinine, sodium and potassium levels along with severe histopathological changes in renal tissues of rats indicating severe nephrotoxicity. Administration of 2-pyrocatechuic acid (2-PCA) at 10, 30 and 100 by oral route for 9 days and additional 5 days with 5-FU resulted in an amelioration of altered serum parameters in a dose-dependent manner. Moreover, 2-PCA attenuated the renal damage produced by 5-FU demonstrating its efficacy as a nephroprotective agent for the prevention as well as amelioration of 5-FU induced nephrotoxicity. None of the doses of gentisic acid (GA) were found to be effective in this posology when given orally.

Planejamento, síntese e avaliação biológica de candidatos a fármacos: busca de inibidores epigenéticos da Sirtuína 2 Sir2 / Design, synthesis and biological evaluation of drug candidates: search for Sirtuin 2 (Sir 2) epigenetic inhibitors

As doenças negligenciadas são causadas por agentes infecciosos e parasitários, como vírus, bactérias, protozoários e helmintos. Essas doenças são prevalentes em populações de baixa renda que vivem em países em desenvolvimento e são responsáveis por incapacitar e levar milhares de pessoas à morte. Este nome se dá pois, apesar de sua grande relevância médica, recebem pouca atenção dos governos e indústrias farmacêuticas. Dentre essas doenças podemos destacar a Doença de Chagas, doença infecciosa causada pelo parasita hemoflagelado Trypanosoma cruzi. Endêmica em 21 países, com 6 a 7 milhões de pessoas infectadas resultando em 7500 mortes por ano. A quimioterapia disponível contra essa parasitose é baseada em apenas dois medicamentos, o benznidazol e o nifurtimox, ativos principalmente na fase aguda da doença e com efeitos adversos graves que comprometem a adesão ao tratamento e, além disso, apesar dos enormes esforços na pesquisa de novos agentes antichagásicos em nível nacional e internacional, na maioria realizada academicamente, ainda não foram encontradas alternativas terapêuticas para a doença, persistindo, assim, a necessidade de descoberta e desenvolvimento de novos fármacos. O início de um planejamento de um novo fármaco se dá pela definição de um alvo bioquímico a ser utilizado na busca de moléculas que possam exercer a função de inibidores ou moduladores, conforme a atividade biológica desejada. Neste sentido, as sirtuínas 2 (Sir2) são enzimas que se mostraram essenciais para o crescimento in vitro do T. cruzi em suas formas amastigota e epimastigota. No caso de tripanossomatídeos, em geral, a superexpressão de Sir2 está relacionada à sobrevivência de formas amastigotas. Assim, essas evidências indicam que a Sir2 de tripanosomatídeos tem grande potencial como alvo biológico na busca e desenvolvimento de novos fármacos antichagásicos. O objetivo principal deste projeto foi identificar moléculas que apresentaram atividade inibitória para a sirtuína 2 de T. cruzi por meio da utilização da estratégia de Planejamento de Fármacos Baseada no Ligante - Ligand Based Drug Design (LBDD) e o desenvolvimento de análogos dos inibidores da Sir2. A modificação molecular está entre algumas das técnicas tradicionais usadas no desenvolvimento racional de um fármaco, e é usada principalmente no desenvolvimento de análogos, e busca melhorar as propriedades farmacocinéticas e/ou farmacodinâmicas de um protótipo, obter propriedades de interação semelhantes ao alvo e, em alguns casos, revelar uma atividade biológica. Com este intuito, análogos do sirtinol e da salermida foram sintetizados e uma nova rota sintética utilizando o microrreator em fluxo contínuo foi desenvolvida e apresentou rendimento superior quando comparado à síntese em bancada. A partir desta metodologia foram obtidos 20 compostos. Os ensaios in vitro contra formas amastigotas do T. cruzi indicaram que 8 compostos inibiram a atividade parasitária em mais de 50%, na dose de 10 µM, sendo que alguns destes apresentaram maior inibição parasitária quando comparados ao benznidazol, o fármaco de referência e único disponível no Brasil. Com estes resultados preliminares, novos ensaios estão sendo realizados para identificar potência e mecanismo de ação destes candidatos a agentes tripanomicidas

Neglected diseases are caused by infectious and parasitic agents such as viruses, bacteria, protozoa and helminths. These diseases are prevalent in low-income populations living in developing countries and are responsible for disabling and killing thousands of people. They get this name because, despite their great medical relevance, they end up receiving little attention from governments and pharmaceutical industries. Among these diseases, we can highlight Chagas disease, an infectious endemic disease caused by the hemoflagellate parasite Trypanosoma cruzi. This disease is endemic in 21 countries, with 6 to 7 million people infected resulting in 7,500 deaths per year. Chemotherapy is based on just two drugs, benznidazole and nifurtimox, which are mainly active in the acute phase of the disease. These drugs have adverse effects that compromise adherence, even more, considering that they are not effective from the point of view of the chronic phase of the disease. Despite the enormous efforts in researching new anti-chagasic agents at the national and international level, and mostly carried out academically, therapeutic alternatives for the disease have not yet been found, thus, the need for the discovery and development of new drugs persists. Sirtuins 2 (Sir2) are enzymes that have been shown to be essential for the in vitro growth of T. cruzi in its amastigote and epimastigote forms. In the case of trypanosomatids in general, Sir2 overexpression is related to the survival of amastigote forms. Sir2 inhibitors, such as sirtinol, have shown efficacy in leishmanicides. Thus, these evidences indicate that Sir2 from trypanosomatids can be considered as a biological target in the search and development of new anti-chagasic drugs. The beginning of a new drug planning study is the definition of a biochemical target to be used in the search for molecules that can play the role of inhibitors or modulators, according to the desired biological activity. The main objective of this project was to identify molecules that presented inhibitory activity to sirtuin 2 of T. cruzi using the Ligand Based Drug Design (LBDD) strategy of planning and the development of analogues of Sir2 inhibitors. Molecular modification is a traditional technique used in the rational development of a drug, as well as the use of natural products, combinatorial chemistry, high-throughput screening (HTS), among others. Mainly used in the development of analogues, molecular modification is applied for different purposes, among them, it seeks to improve the pharmacokinetic and/or pharmacodynamic properties of a prototype, obtain target-like interaction properties and, in some cases, reveal an activity biological. For this purpose, analogues of sirtinol and salermide were synthesized and a new synthetic route using the microreactor in continuous flow was developed and presented superior yield when compared to benchtop synthesis. From this methodology, 20 compounds were obtained. in vitro assays against amastigote forms of T. cruzi indicated that 8 compounds inhibited parasitic activity by more than 50% at a dose of 10 µM, and some of these showed greater parasitic inhibition when compared to benznidazole, the reference drug, and only available in Brazil. With these preliminary results, new assays are being carried out to identify the potency and mechanism of action of these candidate trypanocidal agents

Risk factors for esophagogastric anastomotic leakage after esophageal cancer surgery: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective    To systematically review risk factors for esophagogastric anastomotic leakage (EGAL) after  esophageal cancer surgery for adults to provide theoretical basis for clinical prevention and treatment. Methods    PubMed, Web of Science, The Cochrane Library, WanFang Data, VIP, CNKI and CBM were searched from inception to January 2020 to collect case control studies and cohort studies about risk factors for EGAL after esophageal cancer surgery. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, and then, meta-analysis was performed by using RevMan 5.3 software. Results    A total of 33 studies were included, including 19 case-control studies and 14 cohort studies, all of which had a Newcastle-Ottawa Scale (NOS)≥6. There were 26 636 patients, including 20 283 males and 6 353 females, and there were 9 587 patients in China and 17 049 patients abroad. The results of meta-analysis showed that the following factors could increase the risk for EGAL (P≤0.05), including patient factors (18): age, sex, body mass index (BMI), smoking history, smoking index (≥400), alcohol history, digestive tract ulcer, respiratory disease, lower ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC), chronic obstructive pulmonary disease (COPD), coronary atherosclerosis, peripheral vascular disease, arrhythmia, diabetes, hypertension, cerebrovascular disease, celiac trunk calcification and descending aortic calcification; preoperative factors (6): abnormal liver function, renal insufficiency, American Society of Anesthesiologists (ASA) grading, neoadjuvant radiotherapy and preoperative albumin<35 g/L, preoperative lower albumin; intraoperative factors (7): retrosternal route, cervical anastomosis, thoracoscopic surgery, operation time≥4.5 h, tubular stomach, upper segment tumor, splenectomy; postoperative factors (5): respiratory failure, postoperative arrhythmia, use of fiberoptic bronchoscopy, pulmonary infection, deep venous thrombosis. Neoadjuvant chemotherapy could reduce the risk for postoperative EGAL (P<0.05). However, age≥60 years, upper gastrointestinal inflammation, diffusing capacity for carbon monoxide (DLCO%), thoracic surgery history, abdominal surgery history, glucocorticoid drugs history, neoadjuvant chemoradiotherapy, anastomotic embedding, end-to-end anastomosis, hand anastomosis, intraoperative blood loss and other factors were not significantly correlated with EGAL. Conclusion    Current evidence suggests that the risk factors for postoperative EGAL include age, sex, BMI, smoking index, alcohol history, peptic ulcer, FEV1/FVC, COPD, diabetes, ASA grading, neoadjuvant radiotherapy, preoperative albumin<35 g/L, cervical anastomosis, thoracoscopic surgery, operation time≥4.5 h, tubular stomach, upper segment tumor, intraoperative splenectomy, postoperative respiratory failure, postoperative arrhythmia and other risk factors. Neoadjuvant chemotherapy may be the protection factor for EGAL. Due to limited study quality, more high quality studies are needed to verify the conclusion.

Síndrome de Behçet ou úlcera de Lipschütz: desafio diagnóstico / Behçet's syndrome or Lipschütz ulcer: diagnostic challenge

A ocorrência de úlceras genitais em adolescentes e mulheres jovens tem impacto emocional para as pacientes e seus familiares, pela frequente associação com uma possível etiologia de transmissão sexual. Porém, úlcera de Lipschütz e síndrome de Behçet não têm etiologia infecciosa e devem ser lembradas como possíveis diagnósticos diferenciais. O diagnóstico dessas duas patologias é clínico e pode ser desafiador. Dessa forma, foi realizada uma revisão na literatura com o objetivo de comparar as duas entidades. A úlcera de Lipschütz é causada por uma vasculite local e caracteriza-se pelo surgimento súbito de úlceras na vulva ou vagina inferior. Já a doença de Behçet é causada por vasculite sistêmica, com episódios de remissão e exacerbação, que pode envolver quase todos os sistemas orgânicos. Em ambos os casos, é essencial o referenciamento para reumatologia. O tratamento objetiva suprimir exacerbações, controlar a dor e prevenir infecção secundária.(AU)

The occurrence of genital ulcers in adolescents and young women have an emotional impact for the patient and their families, due to the frequent association of its etiology with a sexually transmitted disease. However, Lipschütz ulcer and Behçet's syndrome do not have an infectious etiology and should be remembered as a possible differential diagnoses. As the diagnosis of these two pathologies is clinical and can be challenging, a review of literature was carried out. The objective of this review of literature was to compare both diseases. Lipschütz ulcer is caused by local vasculitis and is characterized by the sudden appearance of ulcers in the vulva or lower vagina. Behçet's syndrome is caused by systemic vasculitis, with episodes of remission and exacerbation, which can affect almost all organ systems. In both cases, referral to rheumatology is essential. Treatment aims to suppress exacerbations, control pain and prevent secondary infection.(AU)

Avaliação da pentoxifilina e do sulfato ferroso no tratamento da úlcera varicosa dos membros inferiores / Evaluation of pentoxifylline and ferrous sulfate for treatment of lower limb venous ulcers

Resumo Contexto A úlcera varicosa (UV) é o estágio mais avançado da doença venosa crônica (DVC) dos membros inferiores (MMII), frequentemente associada a episódios de hemorragia que podem provocar anemia crônica (AC) e retardar a sua cicatrização. Não há, na literatura, trabalhos que avaliem a prevalência da AC nos portadores de UV dos MMII, e poucos trabalhos analisam o uso da pentoxifilina no tratamento das UV dos MMII. Objetivos Avaliar a prevalência da AC nos pacientes portadores de UV de MMII e a resposta terapêutica ao sulfato ferroso (SF) e a associação da pentoxifilina com SF no tratamento adjuvante das UV dos MMII. Métodos Foram avaliados 67 pacientes portadores de UV de MMII atendidos no ambulatório de Cirurgia Vascular do Hospital das Clínicas, Recife, PE. Após as avaliações clínica e laboratorial iniciais, os pacientes diagnosticados com AC foram randomizados em dois grupos: o grupo controle, que recebeu SF (900 mg/dia via oral), e o grupo de estudo, tratado com SF (900 mg/dia via oral) e pentoxifilina (1.200 mg/dia). Todos foram reavaliados após 90 dias. Resultados Entre os pacientes avaliados, 27 (40%) apresentavam AC. Após o tratamento, foram observados aumento dos níveis de hemoglobina e de hematócrito e melhora das taxas da cinética do ferro, assim como a diminuição da profundidade e da área das UV em ambos os grupos, sem diferença estatística. Conclusões Foi encontrada alta prevalência de anemia na população estudada. A associação do SF com a pentoxifilina não se mostrou mais eficaz do que o emprego isolado do SF no tratamento adjuvante da UV dos MMII.

Abstract Background Venous ulcers (VU) are the most advanced stage of chronic venous disease (CVD) of the lower limbs. They are frequently associated with episodes of hemorrhage that can provoke chronic anemia (CA), delaying healing. There are no studies in the literature analyzing the prevalence of CA among patients with VU of the lower limbs and few studies have analyzed use of pentoxifylline to treat VU of the lower limbs. Objectives To evaluate the prevalence of CA in patients with lower limb VU and responses to treatment with ferrous sulfate (SF) compared with a combination of SF plus pentoxifylline as adjuvant treatment for VU of the lower limbs. Methods A total of 67 patients with lower limb VU were recruited from a Lymphedema and Angiodysplasia Clinic at the Hospital das Clínicas, Recife, PE, Brazil. After initial clinical and laboratory assessments, patients diagnosed with CA were randomized into one of two groups: a control group, given SF (900 mg/day oral route), or a study group, treated with SF (900 mg/day oral route) and pentoxifylline (1,200 mg/day). All were reassessed after 90 days. Results Twenty-seven patients (40%) had CA. After treatment, increases were observed in hemoglobin and hematocrit levels, iron kinetics had improved, and both depth and area of VU had reduced in both groups, without statistically significant differences. Conclusions A high prevalence of anemia was detected in the study population. The combination of SF and pentoxifylline was not more effective than SF alone for adjuvant treatment of VU of the lower limbs.

Validação clínica do diagnóstico de enfermagem risco de reações adversas a medicamentos: estudo de caso controle / Clinical validation of the nursing diagnosis risk of adverse drug reactions: case-control study

Introdução: As causas e a natureza das reações adversas a medicamentos são complexas e multifatoriais. O enfermeiro, diretamente envolvido com a administração segura de medicamentos, deve avaliar cada paciente, a fim de identificar fatores predisponentes e hipóteses diagnósticas, com ênfase em resultados e intervenções que mitiguem ou evitem reações adversas. Recentemente foi desenvolvido o diagnóstico de enfermagem Risco de reações adversas a medicamentos, contudo, critérios de nível de evidência mais elevados da NANDA-I incluem a validação clínica, que aproxima a teoria da evidência e certifica sua aplicação precisa. Objetivo: Realizar a validação clínica do diagnóstico de enfermagem Risco de reações adversas a medicamentos. Método: Estudo de caso-controle, conduzido no Centro de Pesquisa Clínica de um hospital público universitário, entre maio de 2019 e julho de 2020. Incluíram-se 288 adultos e crianças que participaram de protocolo de pesquisa com medicamentos, independente da fase e via de administração, com participação finalizada no estudo e registro de reação adversa com confirmação de relação de causa e efeito com o(s) medicamento(s) em estudo ou de ausência de relação. Excluíram-se participantes com informações incompletas ou ausentes que comprometessem os dados. A coleta de dados foi realizada no prontuário eletrônico, de modo que participantes com reações adversas foram alocados no grupo caso e participantes sem reações no grupo controle. Elaborou-se um instrumento contendo variáveis sociodemográficas e clínicas, informações das reações adversas e 64 componentes do diagnóstico em estudo, divididos em fatores de risco, populações em risco e condições associadas. As associações entre os fatores predisponentes do diagnóstico foram realizadas pelo Teste Qui-quadrado de Pearson ou Teste Exato de Fisher, com valor de P bicaudal < 0,05 considerado estatisticamente significativo. Odds ratios foram calculados para medir o efeito da exposição entre os grupos caso e controle. Este projeto foi aprovado por Comitê de Ética em Pesquisa sob Certificado de Apresentação de Apreciação Ética 88812718.0.0000.5327. Resultados: A média de idade dos participantes foi de 57±15 anos, predominantes do sexo masculino e com escolaridade até o ensino fundamental. A comorbidade com maior prevalência foi doença oncológica (50%) e quimioterápicos os medicamentos mais utilizados (42%). Participantes com reações adversas tiveram significativamente mais chances de apresentar os fatores de risco consumo de álcool (p=0,001), tabagismo (p=0,005) e uso inapropriado do medicamento (p=0,013); de estarem nas populações em risco residir em área rural (p<0,001), história de reação adversa ou alergia (p=0,049), uso de múltiplos medicamentos (p=0,003); e possuírem as condições associadas uso de medicamentos recentemente comercializados (p<0,001), neoplasia (p<0,001), uso de quimioterápico (p<0,001), corticosteroide (p<0,001), analgésico e/ou opioide (p<0,001), anti-inflamatório não esteroide (p<0,001), imunoglobulina (p<0,001), imunossupressor (p=0,004), antibiótico (p=0,001) e antiemético (p<0,001). Conclusões: Na amostra estudada, foram considerados validados três fatores de risco, três populações em risco e 10 condições associadas, o que auxiliará os enfermeiros na avaliação de pacientes suscetíveis. Como ponto forte deste estudo, destaca-se a conceptualização e identificação de fatores específicos e validados clinicamente, o que contribui para o avanço da ciência da enfermagem e da prática baseada em evidências.

Introduction: The causes and nature of adverse reactions to medications are complex and multifactorial. The nurse professional, directly involved in the safe administration of medications, must evaluate each patient to identify predisposing factors and diagnostic hypotheses, with an emphasis on results and interventions that mitigate or help avoid adverse reactions. The nursing diagnosis, Risk for Adverse Reactions to Medications, was recently developed, to describe an accurate appraisal of a patient's risk of adverse reactions. However, NANDA-I's higher evidence level criteria includes a clinical validation, which approximates the theory of evidence and certifies its accurate application. Purpose: To conduct the clinical validation of the nursing diagnosis Risk for Adverse Reactions to Medications. Method: Case-control study, conducted at the Clinical Research Center of a public university hospital, between May 2019 and July 2020. Two hundred and twenty-eight adults and children who participated in a clinical research protocol with medications were included, regardless of the phase and route of medication administration. After completing participation in the clinical study, the registry of participants was divided into two groups: those who experienced an adverse reaction with confirmation of cause-and-effect relationship with the study medications and those with no reaction. Participants with incomplete or missing information that compromised the quality of the data were excluded. Data collection was performed on the electronic medical records, so that participants with adverse reactions were allocated to the case group and participants without reactions to the control group. An instrument was developed containing sociodemographic and clinical variables, information on adverse reactions and 64 components of the diagnosis under study, divided into risk factors, populations at risk and associated conditions. Associations between the predisposing factors of the nursing diagnosis were performed using the Pearson's Chi-square test or Fisher's exact test, with a two-tailed P value <0.05 considered statistically significant. Odds ratios were calculated to measure the effect of exposure between the case and control groups. This project was approved by the Research Ethics Committee under the Certificate of Presentation of Ethical Appreciation 88812718.0.0000.5327. Results: The average age of the participants was 57±15 years old, predominantly male and with education up to elementary school. The most prevalent comorbidity was cancer (50%), and chemotherapy was the most frequently used medication (42%). Participants with adverse reactions were significantly more likely to present the risk factors alcohol consumption (p=0.001), smoking (p=0.005) and inappropriate medication use (p=0.013); to present the at risk populations living in a rural area (p<0.001), history of adverse reaction or allergy (p=0.049), use of multiple medications (p=0.003); and to present the associated conditions use of recently marketed drugs (p<0.001), cancer (p<0.001), use of chemotherapy (p<0.001), corticosteroid (p<0.001), analgesic and/or opioid (p<0.001), non-steroidal anti-inflammatory drugs (p <0.001), immunoglobulin (p<0.001), immunosuppressant (p=0.004), antibiotic (p=0.001) and antiemetic (p<0.001). Conclusion: In the studied sample, three risk factors, three at risk populations and 10 associated conditions were considered validated, which will assist nurses in the assessment of vulnerable patients. As a strong point of this study, the conceptualization and identification of specific and clinically validated factors of stands out, which contributes to the advancement of nursing science and evidence-based practice.

Antimicrobial stewardship in the outpatient parenteral antimicrobial therapy (OPAT) setting: the impact of prescription assessment by an infectious diseases specialist

ABSTRACT Objective: In recent years, the use of outpatient parenteral antimicrobial therapy (OPAT) has increased, resulting in the need to ensure its rational and adequate utilization. This article describes the implementation of an antimicrobial stewardship program in the OPAT setting by a Health Maintenance Organization (HMO) and its results. Method: An infectious disease (ID) physician made routine assessments of all home care parenteral antimicrobial requests from February to December 2019. Information on diagnosis, renal function, weight, previous antimicrobials, and microbiology were gathered during remote evaluations. Prescription changes recommended by the ID specialist were not mandatory, but implemented by the primary provider as accepted. Antibiotic consumption data was analyzed from January 2018 to December 2019. An active screening was conducted for treatment failures: two or more treatment course requirements, or death within 15 days of the evaluation were reexamined. Results: A total of 506 antimicrobial requests were assessed. The most frequent diagnoses were urinary tract infection, pneumonia, and orthopedic surgical site infection. Six percent of evaluations were not completed due to insufficient information and 12% were requests by the primary physician for initial antimicrobial guidance. Of the 416 completed prescriptions evaluations, 58% had suggested changes, including different antimicrobials (40%), treatment duration (25%), and route of administration (23%). There was an increase in use of teicoplanin and meropenem, and a decrease in ceftriaxone, ertapenem, cefepime, amikacin and daptomycin use. The HMO's overall parenteral antimicrobial outpatient consumption, which had shown an upward trend over the previous year, decreased after program initiation. No major adverse results were detected in patients' clinical outcomes; two treatment failures were detected and promptly corrected; no deaths attributed to antibiotic changes were detected. Conclusion: Outpatient antimicrobial stewardship, through remote assessment by an ID specialist, was effective and safe in the OPAT setting.

Eficácia e segurança da milrinona no tratamento do vasoespasmo cerebral após hemorragia subaracnóidea: uma revisão sistemática / Efficacy and safety of milrinone in the treatment of cerebral vasospasm after subarachnoid hemorrhage: a systematic review

RESUMO Objetivo: Revisar sistematicamente a evidência atual da eficácia de milrinona no tratamento do vasoespasmo cerebral após hemorragia subaracnóidea. Métodos: Triaram-se as bases de dados Pubmed®, Cochrane e Embase quanto a artigos publicados entre abril de 2001 e fevereiro de 2019. Dois revisores independentes realizaram uma triagem metodológica da qualidade e a extração dos dados dos estudos. Resultados: Encontraram-se 22 estudos considerados relevantes, sendo que apenas um deles era um ensaio randomizado controlado. Os estudos demonstraram acentuada heterogeneidade e debilidade de seus critérios metodológicos. A maioria dos pacientes apresentava vasoespasmo moderado a grave. O principal método para diagnóstico do vasoespasmo foi a angiografia. Em três estudos, realizou-se administração de milrinona por via intra-arterial; em nove estudos, a administração foi endovenosa, e, em seis estudos, utilizaram-se ambas as vias de administração. A via intratecal foi utilizada em dois estudos, em um estudo, a administração foi realizada via cisterna e, em um estudo, a via de administração foi a endovascular. Os efeitos colaterais de milrinona foram descritos em seis estudos. Vinte e um estudos indicaram a resolução do vasoespasmo. Conclusão: A evidência atual indica que o uso de milrinona teve um papel no tratamento do vasoespasmo após hemorragia subaracnóidea aneurismática. Contudo, só foi realizado um ensaio randomizado controlado, com baixo nível de qualidade. Nossos achados indicam a necessidade de futuros estudos randomizados controlados com desfechos centrados no paciente, com o fim de proporcionar recomendações definitivas.

ABSTRACT Objective: To systematically review the current evidence on the efficacy of milrinone in the treatment of cerebral vasospasm after subarachnoid hemorrhage. Methods: The Pubmed®, Cochrane and Embase databases were screened for articles published from April 2001 to February 2019. Two independent reviewers performed the methodological quality screening and data extraction of the studies. Results: Twenty-two studies were found to be relevant, and only one of these was a randomized control trial. Studies showed marked heterogeneity and weaknesses in key methodological criteria. Most patients presented with moderate to severe vasospasm. Angiography was the main method of diagnosing vasospasm. Intra-arterial administration of milrinone was performed in three studies, intravenous administration was performed in nine studies, and both routes of administration in six studies; the intrathecal route was used in two studies, the cisternal route in one study and endovascular administration in one study. The side effects of milrinone were described in six studies. Twenty-one studies indicated resolution of vasospasm. Conclusion: The current evidence indicates that milrinone may have a role in treatment of vasospasm after aneurysmal subarachnoid hemorrhage. However, only one randomized control trial was performed, with a low quality level. Our findings indicate the need for future randomized control trials with patient-centered outcomes to provide definitive recommendations.

Body composition, but not insulin resistance, influences postprandial lipemia in patients with Turner's syndrome

ABSTRACT Objective: The aim of the present study was to examine the influence of body composition and insulin resistance on the magnitude of postprandial lipemia in patients with Turner's syndrome receiving oral versus transdermal estrogen replacement. Subjects and methods: Twenty-five patients with Turner's syndrome receiving oral or transdermal estrogen replacement were evaluated for body mass index, waist-to-hip and waist-to-height ratios, fasting glycemia, insulin, body composition (dual-energy X-ray absorptiometry), and postprandial lipid metabolism. For statistical analysis, we used parametric tests to compare numeric variables between the two subgroups. Results: We observed no difference in postprandial triglyceride levels between patients receiving oral versus transdermal hormone replacement therapy. The postprandial triglycerides increment correlated positively with the percentage of total fat mass (p=0.02) and android fat mass (p=0.02) in the transdermal group. In the oral estrogen group, a positive correlation was observed between the increment in postprandial triglycerides and waist-to-hip (p=0.15) and waist-to-height (p=0.009) ratios. No association was observed between the estrogen replacement route and insulin resistance evaluated by the homeostatic model assessment-insulin resistance (HOMA-IR) index (p=0.19 and p=0.65 for the oral and transdermal groups, respectively). Conclusion: We concluded that body composition and anthropometric characteristics possibly affect the extent of postprandial lipemia independently from the route of estrogen replacement.

Sarcoma sinovial da laringe: Relato de caso sob a perspectiva da deglutição, voz e qualidade de vida / Synovial Sarcoma of the Larynx: Case report from the perspective of swallowing, voice and quality of life / Sarcoma de laringe sinovial: reporte de un caso desde la perspectiva de la deglución, la voz y la calidad de vida

Introdução: O sarcoma sinovial é um tumor agressivo comumente encontrado nos membros inferiores e raramente descrito na laringe. A literatura recomenda tratamento multimodal com radioterapia, quimioterapia e laringectomia total. Objetivo: Descrever os impactos funcionais e de qualidade de vida em voz e deglutição de um adolescente que desenvolveu um sarcoma sinovial monofásico da laringe. Método: Adolescente de 16 anos que desenvolveu um sarcoma sinovial monofásico da laringe na infância, submetido a uma aritenoidectomia extendida por acesso laringofaríngeo associado à radioquimioterapia aos 11 anos de idade. O tratamento oncológico menos agressivo foi adequado para o controle oncológico e resultados funcionais do caso aqui descrito, apresentando voz com qualidade satisfatória e via oral exclusiva. A avaliação endoscópica demonstrou uma laringe com proporções infantis, revelando a interrupção do crescimento no momento do tratamento. O paciente apresenta sobrevida de 5 anos e 6 meses, superior à sobrevida média de dois anos descrita na literatura, referindo boa qualidade de vida. Conclusão: O adolescente apresenta controle oncológico e resultados funcionais de voz e deglutição satisfatórios, sem grandes interferências em sua qualidade de vida. O suporte familiar e atendimento multiprofissional especializado demonstraram-se primordiais.

Introduction: Synovial sarcoma is an aggressive tumor commonly found in the lower limbs and rarely described in the larynx. The literature recommends multimodal treatment with radiotherapy, chemotherapy and total laryngectomy. Purpose: To describe the functional and quality of life impacts on voice and swallowing of an adolescent who developed a monophasic synovial sarcoma of the larynx. Method: A 16-year-old adolescent who developed a monophasic synovial sarcoma of the larynx in childhood, who underwent an extended arytenoidectomy due to laryngopharyngeal access associated with radiotherapy at the age of 11. The less aggressive cancer treatment was adequate for cancer control and functional results of the case described here, presenting a voice with satisfactory quality and exclusive oral route. The endoscopic evaluation showed a larynx with infantile proportions, revealing growth interruption at the time of treatment. The patient has a 5-year and 6-month survival rate, higher than the average two-year survival rate described in the literature, referring to a good quality of life. Conclusion: The adolescent has oncological control and satisfactory functional results of voice and swallowing, without major interferences in his quality of life. Family support and specialized multidisciplinary care proved to be paramount.

Introducción: El sarcoma sinovial es un tumor agresivo que se encuentra comúnmente en las extremidades inferiores y rara vez se describe en la laringe. La literatura recomienda el tratamiento multimodal con radioterapia, quimioterapia y laringectomía total. Propósito: Describir los impactos funcionales y de calidad de vida en la voz y la deglución de un adolescente que desarrolló un sarcoma sinovial monofásico de la laringe. Método: Un adolescente de 16 años que desarrolló un sarcoma sinovial monofásico de la laringe en la infancia, que se sometió a una aritenoidectomía prolongada debido al acceso laringofaríngeo asociado con radioterapia a la edad de 11 años. El tratamiento contra el cáncer menos agresivo fue adecuado para el control del cáncer y los resultados funcionales del caso descrito aquí, presentando una voz con calidad satisfactoria y una vía oral exclusiva. La evaluación endoscópica mostró una laringe con proporciones infantiles, revelando la interrupción del crecimiento en el momento del tratamiento. El paciente tiene una tasa de supervivencia a 5 y 6 meses, superior a la tasa de supervivencia promedio de dos años descrita en la literatura, que se refiere a una buena calidad de vida. Conclusión: El adolescente tiene control oncológico y resultados funcionales satisfactorios de voz y deglución, sin grandes interferencias en su calidad de vida. El apoyo familiar y la atención multidisciplinaria especializada resultaron ser primordiales.

Osteomielitis cervical asociada a otitis crónica. Presentación de un caso / Cervical osteomyelitis associated with chronic otitis. A case report

Introducción : La osteomielitis es la infección de estructuras óseas ya sea por inoculación directa a través de heridas, por vía hematógena a través de focos distantes o por contigüidad con estructuras vecinas como los oídos. Objetivo: Reportar un caso que demuestra la necesidad de seguimiento de las otitis medias con vistas a evitar recurrencias y complicaciones. Presentación del Caso: Paciente femenina, de 62 años de edad, tez blanca y ama de casa de la localidad de Baracoa, provincia Guantánamo, Cuba. Con antecedentes de otitis de un año de evolución que desarrolló osteomielitis crónica cervical y un cuadro neurológico caracterizado por cuadriparesia y dificultad para la acción asociado a la osteomielitis cervical. Se trató con vancomicina y levofloxacino durante 6 semanas y oxigenación hiperbárica con lo cual egresó totalmente rehabilitada. Conclusiones: El manejo inadecuado de la otitis puede desencadenar complicaciones graves y poco frecuentes como la osteomielitis cervical tal y como se presenta en este caso(AU)

Introduction: Osteomyelitis is the infection of the osseous structures associated with the direct inoculation of microorganisms through wounds, hematogenous route from distant focus of infection or the contiguity with neighboring structures like the ears. Objective: The aim of this paper is to demonstrate the need for medical follow-up of otitis media in order to avoid recurrence and complications of this disease. Case presentation: Sixty-two-year-old white woman, housewife, from Baracoa, Guantanamo Province, Cuba. The patient had antecedents of one-year history of otitis media. She developed cervical chronic osteomyelitis and a neurological picture that was characterized by quadriparesis and difficulty to carry out actions, which was associated with cervical osteomyelitis. She was treated with Vancomycin and Levofloxacin during 6 months and hyperbaric oxygenation that helped her to be totally recovered after discharge from hospital. Conclusions: Inadequate treatment of otitis can cause very serious and less frequent complications such as cervical osteomyelitis, as it is presented in this case(AU)

Itinerário terapêutico de mulheres com câncer de mama em município de fronteira / Therapeutic itinerary of women with breast cancer in a border municipality

Esta pesquisa teve como objetivo compreender o Itinerário Terapêutico de mulheres com câncer de mama, usuárias do Sistema Único de Saúde, do diagnóstico ao início do tratamento, em município de fronteira, na perspectiva delas. Este estudo é qualitativo, interpretado sob a perspectiva do Paradigma da Complexidade de Edgard Morin. Realizado a partir de dois encontros com 13 mulheres selecionadas de forma aleatória, maiores de 18 anos, com diagnóstico de câncer de mama em tratamento ambulatorial, usuárias do Sistema Único de Saúde, residentes no município de Foz do Iguaçu-PR; foram excluídas aquelas com diagnóstico de problemas de saúde mental, registrado em prontuário. O primeiro encontro aconteceu no Centro de Oncologia para caracterizar as mulheres; a seguir, visita domiciliar realizada após sete dias. A análise de conteúdo proposta por Bardin, foi eleita para análise dos dados. A coleta de dados ocorreu em Foz do Iguaçu- PR entre março a junho/2018. Responderam à questão norteadora: "Conte-me como foi o caminho percorrido desde a descoberta do câncer de mama até o início do tratamento?". Emergiram sete categorias de análise: Traçando o itinerário terapêutico - da descoberta do nódulo ao início do tratamento; O acesso em serviços de atenção primária em busca de atendimento para o câncer de mama: facilidades e dificuldades; (Des)construindo a longitudinalidade na atenção à mulher com câncer de mama; A integralidade na atenção à saúde da mulher com câncer de mama; A coordenação na atenção primária à saúde: perspectivas no cuidado à mulher com câncer de mama; O cuidado à mulher com câncer de mama no contexto familiar e comunitário e Construindo serviços de saúde para a atenção ao câncer de mama: perspectivas da usuária. A idade média foi de 49,92 anos. Em relação à raça/cor, religião e escolaridade, 53,85% eram brancas, católicas e cursaram ensino médio completo. O itinerário de cuidado e cura se configurou pela busca de atenção nos serviços públicos de saúde, serviços privados e além das fronteiras do Brasil, no Paraguai. A análise da presença e extensão dos atributos da Atenção Primária à Saúde mostrou incongruências. As dificuldades para o acesso, vínculo, coordenação e desprovimento do cuidado integral, colaboraram para a não resolutividade dos agravos de saúde da mulher com câncer de mama, na concepção das usuárias. Espera-se que os dados obtidos possam subsidiar reflexões, e orientar as decisões de gestores, a fim de investirem na capacitação dos profissionais de saúde e formulação e implementação de políticas públicas direcionadas para a garantia da qualidade da assistência prestada e maior resolutividade da ABS, tendo como base os atributos da APS. Essas ações poderiam contribuir no atendimento às necessidades de saúde das mulheres acometidas por neoplasia mamária, no contexto da atenção primária, em regiões de fronteira.

This research had as objective understanding the therapeutic itinerary of women with breast cancer, users of the Sistema Único de Saúde (Unique Health System), from the diagnosis to the beginning of treatment, in a border municipality, in their perspective. This study is qualitative and interpreted under the perspective of the Complexity Paradigm from Edgard Morin. The study started from two meetings with 13 random selected women, all of them over 18 years old, with a diagnosis of breast cancer in ambulatorial treatment, users of the Sistema Único de Saúde (Unique Health System), who reside in the city of Foz do Iguaçu-PR; the ones with a diagnostic of mental health problems were excluded, according to their registers. The first meeting took place in the Centro de Oncologia (Center of Oncology) to characterize the women; next, a home visit was made after seven days. The content analysis proposed by Bardin was chosen for the data analysis. The data collection occurred in Foz do Iguaçu-PR between March and June/2018. They answered the main question: "Describe the route from the discovery of your breast cancer until the beginning of the treatment". Seven analysis categories emerged: Tracing the therapeutic itinerary - from the discovery of a nodule to the beginning of treatment; The access to primary attention services in search of attendance for breast cancer: facilities and difficulties; (Des)constructing longitudinal aspects of the attention to the women with breast cancer; Integrality in the attention to the health of women with breast cancer; the care to the women with breast cancer in a familiar and community context; constructing health services for breast cancer attention: user perspectives. The average age was 49,92 years old. Regarding race/color, religion and education, 53.85% were white, catholic and attended high school. The itinerary of care and cure was configured by the search of attention in the public health services, private services and beyond the borders of Brazil, in Paraguay. The analysis of the presence and extension of the attributes of Primary Health Attention showed incongruities. The difficulties of access, bonding, coordination and lack of full health care all contributed to the no resolution of women with breast cancer health grievances, in the view of the users. It is expected that the data obtained can support reflections and guide the decisions of management agents, in order to invest in the training of health professionals and formulating the implementation of public policies directed towards reassuring the quality of attendance and better resolution of Basic Health Attention, having as basis the attributes of the Primary Health Attention. Those actions could contribute to the attendance of the health necessities of women with mammary neoplasia, in the context of primary attention in border regions.

Progress in interferon: A treatment of Behcet syndrome / 北京大学学报(医学版)

Behcet syndrome (BS) is a chronic systemic inflammatory disorder involving vessels of all sizes, characterized by relapsing episodes of oral and/or genital ulcers, as well as skin lesions. Ocular, vascular, gastrointestinal, neurological system involvement can cause significant morbidity and mortality. Glucocorticoids and immunosuppressants are the cornerstones for the management of BS. Biologic agents has been recommended for severe and/or refractory BS. Interferon-α (IFN-α) had multiple biological effects, such as antiviral and antiproliferative, that could regulate both innate and adaptive immunity in BS. Growing evidence showed the efficacy of IFN-α in severe and/or refractory BS. Many studies have demonstrated that IFN-α has comparable effectiveness and tolerance profiles as anti-tumor necrosis factor (TNF) agents for Behcet's uveitis with a much lower cost and steroid-and immunosuppressant-sparing effects. IFN-α has been recommended as second-line therapy for ocular involvement of BS in EULAR (The European League Against Rheumatism) 2018. IFN-α also improves mucocutaneous lesions in BS with the dosage from 3 to 9-12 million IU three times per week. A few cases indicated the therapeutic potential of IFN-α in intestinal BS. As a new trial of IFN-α in vascular BS (VBS), a recent study revealed the lower relapse rate and higher recanalization rate with IFN-α in lower extremity deep vein thrombosis (DVT). Another two case reports presented the efficacy of IFN-α in pulmonary artery involvement in BS. Also, case reports have shown successful treatment in refractory neurological involvement. There are two subtypes of IFN-α commonly used in autoimmune diseases, named IFN-α2a and IFN-α2b. IFN-α2a seemed more effective than IFN-α2b, especially in ocular and mucocutaneous involvement of BS. Side effects of IFN-α are dose-dependent and not severe. The most frequent side effects are flu-like syndrome, mild leukopenia and alopecia. Considering the potential risk of tuberculosis (TB) and hepatitis B virus (HBV) reactivation of TNF-α inhibitors, IFN-α is safe due to its anti-HBV effect and protective effect on TB. In conclusion, IFN-α is a promising choice for severe and/or refractory BS patients, especially for those who are intolerant or contraindicant to other biological agents, such as TNF inhibitors. Further prospective controlled studies are warranted to confirm the efficacy and safety of IFN-α in BS.

Clinical analysis of golimumab in the treatment of severe/refractory cardiovascular involvement in Behcet syndrome / 北京大学学报(医学版)

OBJECTIVE@#To explore the effectiveness and safety of golimumab in the treatment of severe/refractory cardiovascular Behcet syndrome (BS).@*METHODS@#We retrospectively analyzed the clinical data of nine patients diagnosed with severe/refractory cardiovascular BS and treated with golimumab from February 2018 to July 2020 in Peking Union Medical College Hospital. We analyzed levels of erythrocyte sedimentation rate (ESR) and high-sensitivity C-reactive protein (hsCRP), imaging findings, and the doses of glucocorticoids and immunosuppressive agents during the period of combined treatment with golimumab.@*RESULTS@#Nine patients were enrolled, including 8 males and 1 female, with a mean age and median course of (37.0±8.6) years and 120 (60, 132) months, respectively. Seven patients presented with severe aortic regurgitation combined with other cardiovascular involvement secondary to BS. Two patients presented with large vessel involvement, including multiple aneurysms and vein thrombosis. Prior to golimumab treatment, seven patients were treated with glucocorticoids and multiple immunosuppres-sants [with a median number of 3 (1, 3) types] while still experienced disease progression or elevated inflammation biomarkers during postoperative period. Eight patients with disease progression, uncontrolled inflammation and history of severe postoperative complications required effective and fast control of inflammation during perioperative period. One patient had adverse reaction with tocilizumab and switched to golimumab during perioperative period. The patients were treated with golimumab 50 mg every 4 weeks, along with concomitant treatment of glucocorticoid and immunosuppressants. After a median follow-up of (16.3±5.6) months, all the patients achieved clinical improvement. Vascular lesions were radiologically stable and no vascular progressive or newly-onset of vascular lesions was observed. The eight patients who experienced cardiac or vascular operations showed no evidence of postoperative complications. The ESR and hsCRP levels decreased significantly [16.5 (6.8, 52.5) mm/h vs. 4 (2, 7) mm/h, and 21.24 (0.93, 32.51) mg/L vs. 0.58 (0.37, 1.79) mg/L (P < 0.05), respectively]. The dose of prednisone was tapered from 35 (15, 60) mg/d to 10.0 (10.0, 12.5) mg/d. No prominent adverse reactions were observed.@*CONCLUSION@#Our study suggests that golimumab is effective in the treatment of severe/refractory cardiovascular BS. Combination immunosuppression therapy with golimumab contributes to control of inflammation, reduction of postoperative complications and tapering the dose of glucocorticoids or immunosuppressants.

Ozonoterapia paravertebral en la patología de la columna vertebral lumbar / Terapia ozônio paravertebral na patologia da coluna lombar / Paravertebral ozone therapy in the pathology of the lumbar spine

Introducción: la búsqueda de alternativas terapéuticas para la atención al paciente con patología de la columna vertebral es una exigencia social, para lo cual se promueve el uso de la ozonoterapia. Objetivo: caracterizar la respuesta clínica de los pacientes con patología de la columna vertebral tratados con ozonoterapia paravertebral en el Hospital General Docente Dr Agostinho Neto de Guantánamo durante el período comprendido entre los meses de septiembre de 2017 y agosto de 2018. Método: se realizó un estudio observacional, prospectivo y transversal en el servicio de Neurocirugía en 78 pacientes con enfermedades de la columna vertebral, seleccionados intencionalmente y que participaron conscientemente en un preexperimento que consistió en la aplicación de un ciclo de diez sesiones de ozonoterapia por vía paravertebral durante un periodo de dos semanas. Se controlaron las siguientes variables: intensidad del dolor lumbar medida mediante la escala de evaluación analógica; incapacidad funcional evaluada mediante la escala de Oswestry. Resultados. la mayoría de los pacientes transitó a una categoría de dolor inferior y el 80,7 % se evaluó en la categoría leve­moderado después de la ozonoterapia. Esta posibilitó que en el mayor porcentaje disminuyera el grado de incapacidad funcional y la proporción con un grado mínimo de incapacidad función se incrementara en un 46,0 %. Conclusiones: la ozonoterapia paravertebral constituye una alternativa que puede ayudar en el tratamiento conservador del paciente con patología vertebral(AU)

Introduction: the search for therapeutic alternatives for patient care with pathology of the spine is a social requirement, for which the use of ozone therapy is promoted. Objective: to characterize the clinical response of patients with spinal pathologies treated with paravertebral ozone therapy at the Dr Agostinho Neto Guantanamo General Teaching Hospital during the period between September 2017 and August 2018. Method: a observational, prospective and cross-sectional study in the Neurosurgery service in 78 patients with diseases of the spine, intentionally selected and consciously involved in a preexperiment that consisted in the application of a cycle of ten sessions of ozone therapy by paravertebral route, during a period two weeks The following variables were controlled: lumbar pain intensity measured by the analogical evaluation scale; functional disability assessed by the Oswestry scale. Results: the majority of patients went to a lower pain category and 80.7% were evaluated in the mild-moderate category after ozone therapy. This made it possible for the highest percentage to decrease the degree of functional disability and the proportion with a minimum degree of disability function increased by 46.0%. Conclusions: Paravertebral ozone therapy is an alternative that can help in the conservative treatment of patients with vertebral pathology(AU)

Introdução: a busca de alternativas terapêuticas para o cuidado do paciente com patologia da coluna vertebral é uma exigência social, para a qual o uso da ozonioterapia é promovido. Objectivo: para caracterizar a resposta clínica de pacientes com patologia vertebral tratados com terapia de ozono paravertebral no Agostinho Neto Geral Teaching Hospital Dr Guantánamo durante o período de setembro 2017 a Agosto de 2018. Método: foi realizado um estudo de observação, em perspectiva e em corte transversal, no departamento de neurocirurgia em 78 pacientes com doenças da coluna vertebral, seleccionados intencionalmente e conscientemente participaram num preexperimento que consistia na aplicação de um ciclo de dez sessões de terapia de ozono através paravertebral, ao longo de um período duas semanas As seguintes variáveis foram controladas: intensidade da dor lombar medida pela escala de avaliação analógica; incapacidade funcional avaliada pela escala de Oswestry. Resultados: a maioria dos pacientes foi para uma categoria de dor mais baixa e 80,7% foram avaliados na categoria leve-moderada após a terapia com ozônio. Isso permitiu que o maior percentual diminuísse o grau de incapacidade funcional e a proporção com um grau mínimo de incapacidade aumentasse 46,0%. Conclusões: A terapia com ozônio paravertebral é uma alternativa que pode ajudar no tratamento conservador de pacientes com patologia vertebral(AU)

Excisão total de mesorreto transanal combinada à dissecção laparoscópica: resultados perioperatórios e avaliação da qualidade do mesorreto / Transanal total mesorectal excision combined with laparoscopic dissection: perioperative results and assessment of the mesorectal quality

RESUMO Objetivo: avaliar os resultados perioperatórios e pós-operatórios relacionados à excisão total do mesorreto transanal, bem como, qualidade dos espécimes obtidos pela excisão total do mesorreto transanal através da análise histopatológica da qualidade do mesorreto, acometimento das margens proximal e distal e positividade da margem circunferencial. Métodos: estudo prospectivo, descritivo, em pacientes consecutivos portadores de adenocarcinoma de reto localizados até 10cm da borda anal, sem metástase à distância, submetidos ou não à quimioterapia e radioterapia neoadjuvantes. Foram avaliados a presença de dificuldades técnicas, índice de conversão para via abdominal, tempo cirúrgico e intercorrências intra e pós-operatórias. A qualidade do mesorreto foi classificada em ressecção completa, parcialmente completa ou incompleta. Resultados: entre dezembro de 2016 e maio de 2019, 41 pacientes foram submetidos à excisão total do mesorreto transanal, dos quais 75% foram classificados como estágio clínico III, 13% estágio clínico II e 12% estágio clínico I. A média de distância entre borda anal e borda inferior do tumor foi de 6,2cm. Quarenta por cento dos tumores encontravam-se na parede retal anterior e 17% foram classificados como circunferenciais. A média de tempo operatório foi de 189 minutos. A média de internação hospitalar foi de 4,6 dias. Não houve óbitos intra-hospitalares. Oitenta e dois por cento dos espécimes foram classificados como ressecção completa. Conclusão: a excisão total do mesorreto transanal demonstra adequada qualidade do mesorreto e adequadas margens cirúrgicas, estando associada a baixos índices de complicações perioperatórias, tempo cirúrgico aceitável e curto tempo de hospitalização.

ABSTRACT Objective: to assess the perioperative and postoperative results of transanal total mesorectal excision, as well as the quality of the specimens obtained by this technique. Methods: we conducted a prospective, descriptive study in consecutive patients with rectal adenocarcinoma located up to 10cm from the anal verge, without distant metastasis, subjected or not to neoadjuvant chemoradiotherapy. We evaluated the presence of technical difficulties, conversion to open abdominal route, surgical time and intra and postoperative complications. Through histopathological analysis, we assessed the quality of the mesorectum, involvement of the proximal and distal margins and positivity of the circumferential, classifying quality of the mesorectum as complete, partially complete or incomplete resection. Results: between December 2016 and May 2019, 41 patients underwent transanal total mesorectal excision, of which 75% were classified as clinical stage III, 13% clinical stage II and 12% clinical stage I. The average distance between the anal verge and the lower border of the tumor was 6.2cm. Forty percent of the tumors were in the anterior rectal wall and 17% were circumferential. The average operative time was 189 minutes. The average hospital stay was 4.6 days. There were no in-hospital deaths. Eighty-two percent of the specimens were classified as complete resection. Conclusion: transanal total mesorectal excision demonstrates adequate specimen quality and surgical margins, being associated with lower rates of perioperative complications, acceptable surgical time and short hospitalization.

A randomized, open-label clinical trial comparing the long-term effects of miltefosine and meglumine antimoniate for mucosal leishmaniasis

Abstract INTRODUCTION: The treatment of mucosal leishmaniasis (ML) is difficult due to the toxicity and route of administration of standard drugs. Miltefosine is an oral agent used for leishmaniasis treatment; however, no data exist regarding its use for ML in Brazil. In this study, we aimed to evaluate the efficacy of miltefosine for ML treatment compared to that of pentavalent antimonial in a pilot study. METHODS: We performed a randomized clinical trial with two parallel groups. The tested intervention consisted of miltefosine 1.3-2 mg/kg/day (two capsules) for 28 days or intravenous 20 mg SbV/kg/day of meglumine antimoniate (N-MA) for 30 days. The final endpoint was defined as complete healing of the lesion four years after treatment. We also analyzed an early endpoint at 90 days after treatment. RESULTS: Forty patients were included in this study: each experimental group comprised 20 patients. Applying a multivariate model in an intention-to-treat analysis, we observed that patients treated with miltefosine had a cure probability 2.08 times greater (95% confidence interval [CI] = 1.03-4.18) than those treated with N-MA at 90 days after treatment. At the final endpoint, we observed no differences in cure probability between miltefosine and N-MA (relative risk = 0.66; 95% CI = 0.33-1.32). With respect to adverse reactions, significant differences between groups were related to gastrointestinal effects, which were more frequent in the miltefosine group. CONCLUSIONS: Miltefosine may be an interesting alternative for treating ML because of its oral administration and cure rate after long-term follow-up.

Manejo da dor em crianças queimadas: Revisão integrativa / Management of pain in burned children: An integrative review / Manejo del dolor en niños quemados: Revisión integrativa

A dor e o sofrimento estão associados com queimaduras, trazem efeitos fisiológicos e emocionais adversos, principalmente em crianças. O controle adequado da dor é um fator importante na melhora dos resultados clínicos. Este estudo tem como objetivo identificar na literatura os princípios ativos mais utilizados para a analgesia em crianças vítimas de queimaduras. Foi realizada uma revisão com um período de busca entre 2008 e 2018, consultando as bases de dados LILACS, Scielo e Medline/PubMed. Duzentas e vinte e cinco publicações foram encontradas e, após a aplicação dos critérios de inclusão e exclusão, 12 artigos relatavam os princípios ativos medicamentosos utilizados para analgesia em crianças queimadas. Os medicamentos mais encontrados foram paracetamol, morfina, ketamina, propofol, AINEs e fentanil. Os profissionais de saúde precisam reconhecer o significado da dor relacionada às crianças queimadas e estar atualizados sobre as várias opções farmacológicas disponíveis. Assim, ter aprofundamento sobre dosagem e via de administração, bem como o conhecimento com queimaduras pediátricas, pode romper barreiras para beneficiar o paciente com o início precoce da administração de analgésicos.

Pain and suffering are associated with burns, they bring adverse physiological and emotional effects mainly on children. Adequate pain control is an important factor in improving clinical outcomes. This study aims to identify in the literature the active principles most used for analgesia in children victims of burns. A review was conducted with a search period between 2008 and 2018, consulting the LILACS, Scielo and Medline / PubMed databases. Two hundred and twenty five publications were found and, after the application of the inclusion and exclusion criteria, 12 articles reported the active drug principles used for analgesia in burned children. The most commonly found drugs were paracetamol, morphine, ketamine, propofol, NSAIDs and fentanyl. Health professionals need to recognize the meaning of pain related to burned children and be up to date on the various pharmacological options available. Thus, having in-depth dosing and route of administration as well as knowledge with pediatric burns can break down barriers to benefit the patient with the early onset of analgesic administration.

El dolor y el sufrimiento están asociados con quemaduras, traen efectos fisiológicos y emocionales adversos principalmente en los niños. El control adecuado del dolor es un factor importante en la mejora de los resultados clínicos. Este estudio tiene como objetivo identificar en la literatura los principios activos más utilizados para la analgesia en niños víctimas de quemaduras. Se realizó una revisión con un período de búsqueda entre 2008 y 2018, consultando las bases de datos LILACS, Scielo y Medline / PubMed. Se encontraron doscientas veinticinco publicaciones y, después de la aplicación de los criterios de inclusión y exclusión, 12 artículos relataban los principios activos medicamentosos utilizados para la analgesia en niños quemados. Los medicamentos más encontrados fueron paracetamol, morfina, ketamina, propofol, AINES y fentanil. Los profesionales de la salud deben reconocer el significado del dolor relacionado con los niños quemados y estar al día sobre las diversas opciones farmacológicas disponibles. Así, tener profundización sobre dosificación y vía de administración, así como el conocimiento con quemaduras pediátricas pueden romper barreras para beneficiar al paciente con el inicio precoz de la administración de analgésicos.