Survival of NSCLC Patients Treated with Cimavax-EGF as Switch Maintenance in the Real-World Scenario.

Introduction: In Cuba, lung cancer represents the first cause of mortality for both sexes. Non-small cell lung cancer (NSCLC) is the most prevalent histology. Overall, 75-85% of NSCLC overexpress EGFR and its ligands. EGFR overexpression has been implicated in the malignant transformation by promoting cell proliferation and survival. CIMAvax-EGF is a therapeutic vaccine composed of recombinant-human EGF conjugated to a carrier protein and Montanide as an adjuvant. CIMAvax-EGF is intended to induce antibodies against self-EGF that block the EGF-EGFR interaction. Objectives: To characterize the efficacy and safety of CIMAvax-EGF as maintenance in NSCLC patients treated in the real-world setting. Results: 106 patients diagnosed with advanced NSCLC at the National Institute of Oncology and Radiobiology, who had at least stable disease after first-line therapy, were enrolled in the study. The initial four CIMAvax-EGF doses were administered every 2 weeks and then, patients received monthly re-immunizations. Globally, 52.8% of the patients were 65 years or older, 77.4% had an ECOG 1 and 62.3% had an adenocarcinoma. The median survival time (MST) was 14.6 months. Patients younger than 65 years had a MST of 16.7 months and subjects with ECOG 0 survived for 29 months. The median progression-free survival was 8.16 months. Overall, 36.8% and 19.8% of patients maintained disease control at 6 and 12 months, respectively. The most frequent adverse events were pain (27.3%) or induration (7.3%) at the injection site and local erythema (10.9%). Conclusion: CIMAvax-EGF, as an EGF depleting immunotherapy used as switch-maintenance was safe and effective in patients with NSCLC.

Adverse outcomes during pregnancy and major congenital malformations in infants of patients with bipolar and schizoaffective disorders treated with antiepileptic drugs: A systematic review. / Dzialania niepozadane w czasie ciazy i powazne wrodzone wady rozwojowe u niemowlat pacjentek z zaburzeniami afektywnymi dwubiegunowymi i zaburzeniami schizoafektywnymi leczonych lekami przeciwpadaczkowymi: przeglad systematyczny.

OBJECTIVES: Antiepileptic drugs (AEDs), which are commonly used as a treatment for acute phases and prevention of relapses in bipolar disorder (BD) and schizoaffective disorder (SAD), have been often associated to adverse outcomes in pregnancy and major congenital malformations (MCM). We aimed to summarize available evidence assessing these outcomes when AEDs are used in pregnant women with BD and/or SAD. METHODS: We searched four databases from inception to 18 January, 2019. We included peer-reviewed observational studies on the use of AEDs in pregnant women with BD or SAD. We excluded studies not reporting data on BD or SAD, not specifying the AED or not assessing pregnancy outcomes or MCM. RESULTS: The pooled records amounted to 2,861. After duplicate removal and inclusion/exclusion criteria application, we included 9 observational studies assessing patients with BD and SAD. The AEDs evaluated were lamotrigine (LTG), valproate (VPA), carbamazepine (CBZ), oxcarbazepine (OXC), topiramate (TPR) and gabapentin (GBP). VPA and CBZ were the AED most commonly associated to MCM. LTG showed the best safety profile. Higher rates of complications during pregnancy were observed in treated and untreated women with BD compared to healthy controls. CONCLUSIONS: AEDs may produce adverse outcomes in pregnancy and MCM in children of pregnant women with BD or SAD, showing higher risks at higher doses. LTG could be considered in this type of patients, given the low rate of adverse events. VPA and CBZ use should be avoided during pregnancy.

Human rickettsialpox, southeastern Mexico.

The detection of Rickettsia akari in 2 human patients increased the diversity of rickettsioses affecting the public health in the southeast of Mexico. Rickettsialpox should be considered in the differential diagnosis with other febrile illnesses for the correct diagnosis and accurate treatment of this potential threat to human health.

Percepções de professores da primeira e segunda fase do curso de graduação em medicina sobre o novo currículo da Universidade Federal de Santa Catarina / Perceptions of teachers of first and second semester of medicine course about the new resume of the Santa Catarina Federalãs University

As discussões visando a mudança curricular na Universidade Federal de Santa Catarina resultaram na elaboração de um projeto cuja implantação foi iniciada noprimeiro semestre de 2003. O objetivo deste trabalho foi conhecer as percepções de professores que participam da primeira e segunda fase do novo currículo do curso de medicina, sobre o processo de mudança curricular. Método: pesquisa qualitativa, tipo estudo de casos, coma técnica de entrevista semi-estruturada. Do universo de quarenta e sete professores foram sorteados dez. Aanálise de conteúdo foi realizada pela técnica de Análise-Reflexão-Síntese. Resultados: entre as vantagens do novo currículo, foram citadas: estímulo à busca de conhecimento pelo professor e aluno, caráter globalizante, maior compromisso social, ênfase em valores ético-humanísticos e integração básico/profissionalizante e entre os professores. Entre as limitações foram apontadas: barreiras administrativas, econômicas e políticas da universidade pública, falta de infra-estrutura física (salas e equipamentos), despreparo dos professores para novas abordagens pedagógicas, sobrecarga de trabalho e resistência de professores às mudanças. Conclusões: apesar dos professores perceberem vantagens no novocurrículo, há necessidade de maior comprometimento da instituição, engajamento dos professores em cursos de aprimoramento didático-pedagógico e envolvimento de todos os professores do curso de medicina nesse processo, fatores esses importantes para alicerçar a implantação do projeto de mudança...

Análise radiológica da veia cava caudal em ratos Wistar / Radiologic analyses of caudal vein in Wistar rats

OBJETIVO: Apresentar um método de estudo angiográfico da veia cava caudal em ratos. MÉTODOS: Foram utilizados 24 ratos Wistar machos, com peso entre 300 a 350 gramas. Os animais foram operados com anestesia geral, utilizando-se injeção intraperiotoneal da solução de Cloridrato Ketamina e Cloridrato de 2-(2,6- xilidino) -5,6- dihidro-4H-1,3-tiazina. O contraste iodado foi injetado na veia dorsal do pênis do rato, utilizando uma agulha de calibre 21 acoplada ao sistema Butterfly® de infusão. O método de cavografia foi testado, no 15º dia de pós-operatório, em três grupos de 6 animais. O Grupo I foi o controle. Nos grupos II e III os animais foram submetidos respectivamente à ligadura da veia cava caudal acima e abaixo da desembocadura das veias íleo-lombares. No grupo IV à ligadura da veia ilíaca direita. RESULTADOS: Os exames flebográficos realizados permitiram observar a anatomia e a perviedade das veias que formam o sistema cava, e a circulação colateral desenvolvida, de todos os animais estudados. CONCLUSAO: A cavografia por via peniana, permite a visibilidade das vias ilíacas e cava caudal, bem como a circulação colateral desenvolvida, em ratos machos.

Neuropsychological performance in HIV/AIDS intravenous drug users.

It is known that HIV can directly infect the CNS and, as a result of such infection, neuropsychological alterations with cognitive, behavioural and motor manifestations can be developed. In this study we seek to determine whether seropositivity is associated with a poor neuropsychological performance in patients with a history of intravenous drug consumption (n=90). For this purpose we carried out an extensive neuropsychological evaluation and compared their performance with that of two seronegative control groups, one comprised of subjects with no history of drug abuse (n=22), which allowed us to obtain a reference of normal neuropsychological performance, and the other of seronegative subjects with a history of drug abuse (n=48), which allowed us to differentiate whether the performance of the seropositive subjects derives from their history of drug abuse. The results reveal that HIV infection in drug users is associated with deficits in attention, verbal and visual memory, verbal skills, concept formation and reasoning, visual-constructive skills, manual dexterity, and perceptive-motor speed, which cannot be attributed to a history of drug abuse. However, the seronegative drug users also showed some of these alterations, which suggests that seropositivity is not only associated with a decrease in performance in these tasks, but also adds to the alterations seen in seronegative subjects as a consequence of drug abuse.

[Influence of factors not related with HIV infection on neuropsychological performance of HIV-seropositive patients]. / Influencia de factores no relacionados con la infeccion en el rendimiento neuropsicológico de seropositivos al VIH.

INTRODUCTION: The presence of neuropsychological impairment related to HIV infection has generated abundant literature whose results are disparate. Keeping in mind that it has been suggested that neuropsychological impairment could be associated to the presence of certain factors that would coexist with the own HIV, it is necessary to determine factors which contribute to transform a seropositive into a subject more neuropsychologically vulnerable. DEVELOPMENT: In this work we present a revision of those factors related with HIV infection that can influence neuropsychological performance of the patients as the antecedents of neurological and psychiatric pathology, depressed mood, drugs abuse, and cognitive reserve. CONCLUSIONS: The study of the influence of these factors can not only contribute to clarify the controversy on the presence of neuropsychological deficits, but also to understand why some seropositive patients are more neuropsychologically vulnerable than others, and ultimately to better understand the neuropsychological implications derived of HIV infection.

Influencia de factores no relacionados con la infecciónen el rendimiento neuropsicológico de seropositivos al VIH / Hiv infection no related factors influence on neuropsychological performance of seropositives

Introducción. La presencia de alteraciones neuropsicológicas (ANP) asociadas a la infección por VIH ha generado abundante literatura, cuyos resultados son dispares. Si tenemos en cuenta la sugerencia de que la afectación neuropsicológica que pueden llegar a desarrollar los seropositivos podría asociarse a la presencia de determinados factores que coexisten con el propio VIH, se necesita determinar qué factores contribuyen a convertir a un seropositivo en un sujeto más vulnerable neuropsicológicamente. Desarrollo. En este trabajo presentamos una revisión de aquellos factores no relacionados con la infección por VIH que pueden influir en el funcionamiento neuropsicológico de los pacientes, como los antecedentes de patología neurológica y psiquiátrica, el estado de ánimo, el consumo de drogas y la reserva cognitiva. Conclusiones. El estudio de la influencia de estos factores puede contribuir no sólo a clarificar la controversia sobre la presencia de ANP, sino también a comprender porqué algunos pacientes seropositivos son más vulnerables neuropsicológicamente que otros, y, en última instancia, a profundizar y comprender mejor las implicaciones neuropsicológicas derivadas de la infección por el VIH (AU)

[Influence of infection related factors on neuropsychological performance of HIV seropositive subjects]. / Influencia de factores relacionados con la infección en el rendimiento neuropsicológico de seropositivos al VIH.

There are no definitive risk factors which predict the development of neuropsychological deficits associated to HIV infection, and, taking into account that neuropsychological impairment is a risk factor of early death in all stages of HIV infection, there is a pressing need to determine those factors, either related or foreign to HIV, which help to explain the existing intragroup differences and that may also be associated with the development and progression of the dysfunction. The aim of this work is to revise those factors related with the infection that can influence neuropsychological functioning of the seropositive patients, such as antiretroviral treatments, immunological impairment, viral load and the advance of the infection. Identification of these risk factors will help us to outline characteristics of the seropositive subjects who are neuropsychologically more vulnerable, in order to detect them early with a view to preventing the manifestation of neuropsychological disturbances, and offer quick, suitable treatment.

Influencia de factores relacionados con la infección en el rendimiento neuropsicológico de seropositivos al VIH / Influence of infection related factors on neuropsychological performance of HIV seropositive subjects

Todavía no se dispone de factores de riesgo definitivos que indiquen el desarrollo de las alteraciones neuropsicológicas asociadas a la infección por el virus de la inmunodeficiencia humana (VIH) y, teniendo en cuenta que la presencia de trastornos cognitivos constituye un factor de riesgo de muerte precoz en todos los estadios de la infección, urge determinar aquellos factores, extraños o relacionados con el propio VIH, que ayuden a explicar las diferencias intragrupo que existen y que también pueden estar asociadas con el desarrollo y la progresión de la disfunción. En este trabajo planteamos revisar aquellos factores relacionados con la infección que pueden influir en el funcionamiento neuropsicológico de los pacientes seropositivos, como los tratamientos antirretrovirales, el deterioro inmunológico que sufre el paciente, la carga viral y el avance de la infección, considerados factores que pueden influir en el funcionamiento neuropsicológico del seropositivo. El estudio de la influencia de estos factores va a contribuir no sólo a clarificar la controversia sobre la presencia de alteraciones neuropsicológicas, sino también a que podamos perfilar las características de los seropositivos neuropsicológicamente más vulnerables, para detectarlos de manera precoz a efectos de prevenir o paliar las consecuencias de estas alteraciones neuropsicológicas, ofreciéndoles un tratamiento rápido y adecuado. (AU)

Uma proposta para o ensino da Pediatria preventiva e social / A proposal for preventive and social Pediatrics teaching

O ensino da pediatria nas escolas médicas tem como meta principal a transmissão do conceito de assistência global à criança, salientando a importância do atendimento integral, nos aspectos bio-psicossociais e do relacionamento equipe de saúde-criança-família. É objetivo deste artigo elaborar uma proposta curricular para o ensino da pediatria preventiva e social no curso de graduação em medicina. A metodologia propõe um conteúdo programático integrando as áreas cognitiva, psicomotora e afetiva, obedecendo ao critério de uma aula teórica para três aulas práticas. O conteúdo compõe-se de ações básicas de saúde, indicadores de saúde, medidas de proteção e promoção da saúde e aspectos de bioética, ética e humanização da saúde. A avaliação aborda os domínios cognitivo, psicomotor e afetivo do discente e do processo ensino/aprendizagem...

Contribuição ao estudo da anatomia da veia porta hepática do cão Beagle / Contribution to the research of the anatomy of the portal hepatic vein of Beagle dog

A moderna pesquisa experimental para sua validação necessita de animais de pesquisa padronizados. Dentro do projeto de caracterização morfo-fisológica do cão Beagle, como animal de experimentação e obtenção de seu registro junto à Research Beagle Breeding Association, objetivou-se determinar o padrão de formação da Veia Porta Hepática. Delineamento: estudo descritivo Amostra: Foram utilizados 21 fígados de cães adultos, criadose procedentes do Biotério Central/UFSc. Procedimentos: 1. Identificação. 2. Anestesia endovenosa. 3. Laparotomia mediana de aproximadamente 20cm. 4. Após inventário da cavidade, observando-se principalmente a Veia Porta Hepática, essa e seus afluentes foram dissecados, com posterior esquematização e fotografia. Local: Laboratório de Técnica Operatória e Cirurgia Experimental, em cooperação com o Laboratório de Anatomia da UFSC. Resultados/Conclusões: Nesse estudo, a Veia Porta Hepática foi formada pela confluência de duas raízes principais: as Veias Mesentérica Cranial e Esplênica, numa configuração do tipo bi-radicular em todos os casos. A Veia Mesentérica Caudal drenou seu conteúdo na veia Mesentérica Cranial e a Veia Gástrica Esquerda drenou seu conteúdo na Veia Esplênica. A Veia Porta Hepática teve comprimento médio de 6,2cm (6,0 a 6,5) e diâmetro médio de O,6cm (0,4 a 0,8)...

Breastfeeding pattern in a population with different levels of poverty in Southern Brazil.

A cross-sectional study was conducted on 477 poor children aged 12-59 months in order to investigate their breastfeeding pattern, taking into account the poverty level of their families. Although the population living in extreme poverty had the same pattern of breastfeeding as the rest of the poor population, the former group should still have priority in breastfeeding promotion programs, since they are the population who benefit most with breastfeeding.

Poverty levels and children's health status: study of risk factors in an urban population of low socioeconomic level.

To test the hypothesis that the low socioeconomic population living in shanty towns in Porto Alegre presents different levels of poverty which are reflected on its health status, a cross-sectional study was designed involving 477 families living in Vila Grande Cruzeiro, Porto Alegre, Brazil. The poverty level of the families was measured by using an instrument specifically designed for poor urban populations. Children from families living in extreme poverty (poorest quartile) were found to have higher infant mortality rate, lower birth weights, more hospitalizations, and higher malnutrition rates, in addition to belonging to more numerous families. Thus, the shanty town population of Porto Alegre is not homogeneous, and priority should be given to the more vulnerable subgroups.

[Effect of the treatment with amlodipine on left ventricular hypertrophy in hypertensive patients]. / Efecto del tratamiento con amlodipino sobre la hipertrofia ventricular izquierda en pacientes hipertensos.

BACKGROUND: Left ventricular hypertrophy (LVH) is one of the physiopathological effects of hypertension and one of the main risk factors for sudden death, myocardial infarction and congestive heart failure. Drugs to treat hypertension must not only reduce blood pressure, but also modify the facts which lead to ventricular hypertrophy. This study has been designed to assess the effect of amlodipine, a calcium-antagonist, on LVH in hypertensive patients. METHODS: 20 hypertensive patients (mild to moderate, both sexes, mean age 45.0 yr) were included in a single-blind study. After an initial, four weeks placebo period, active treatment was given (amlodipine 5 mg a day). Dose titration was made after 4-8 weeks to 10 mg a day if necessary and continued until the end of the study. Systolic (SBP) and diastolic blood pressure (DBP), as well as pulse rate (PR) and adverse events were recorded at every visit. Blood and urine analysis, catecholamine, plasmatic renin activity and Mode M echocardiography were made at the beginning and the end of the study. RESULTS: Only one patient was excluded. SBP and DBP showed a significantly fall (p < 0.001). In 80% of patients DBP fell under 90 mm Hg. Every echocardiographic parameter, but left ventricular diastolic dimension, showed significantly reductions at the end of the study: septum thickness (p = 0.001), posterior wall thickness (p = 0.001), left ventricular systolic dimension (p = 0.014), wall relative thickness (p = 0.015), shortening fraction (p = 0.009), left ventricular mass (p = 0.001) and corrected left ventricular mass (p = 0.001). Blood parameters did not modify. CONCLUSIONS: Amlodipine has a beneficial effect on LVH and also is an effective and safe drug to treat mild to moderate hypertension.

Analise experimental do tamponamento com balao inflavel em traumatismos hepaticos transfixantes / Experimental analysis of hemostasis with inflable ballon in transfixing lesions of the liver

Este estudo, objetivou avaliar experimentalmente, a eficacia do balao inflavel de temponamento em traumas hepaticos transfixantes, bem como, as complicacoes precoces decorrentes do seu uso. Foram utilizados 16 caes sem raca ou sexo definido, compesos rigorosamente entre 16 e 25kg, os quais foram submetidos, apos laparotomia, a traumatismo hepatico transfixante produzido com instrumento cilindrico de 1,0 cm de diametro. Dois grupos de 8 animais foram compostos: grupo A, controle, no qual nao foi realizado tratamento da lesao hepatica e; grupo B no qual foi utilizado o balao de tamponamento, colocado atraves do ferimento e insuflado ate obter hemostasia. Na confeccao do balao, foram utilizados 2 drenos concentricos: um liminar maliavel de borracha externamente, e outro, tubular de plastico, internamente. O balao inflavel de tamponamento mostrou efetivamente na interrupcao da hemorragia imediatamente apos sua insuflacao, em todos os animais deste grupo, apresentando boa evolucao pos-operatoria, o que nao pode ser observado no grupo controle

Fistula venoesofagica por corpo estranho / Esophageal-vein fistula by foreign body

Relato de caso de paciente com 34 anos, sexo feminino, com fistula da veia pulmonar direita para o esofago por corpo estranho que evoluiu para a morte por exsanguinacao e alteracoes da coagulabilidade. Na tentativa de parar o sangramento durante a laparatomia utilizou-se como forma de tamponamento temporario o balao de Sangstaken-Blackmore, enquanto se realizava a toracotomia a direita. E dado enfoque ao diagnostico pela valorizacao da historia, sinais e sintomas premonitorios, "TRIADE DE CHIARI" capazes de indicar a intervencao precoce e evitar o evento cataclismico de volumosa hematemese e morte.

Endobronchial lipomas.

We report 2 cases of endobronchial lipomas diagnosed by biopsy through a fiberoptic bronchoscope. Its endoscopic differences with bronchial adenomas are analyzed. Computerized tomography contribution to differential diagnosis with other pulmonary tumors is reported. Early diagnosis is advised and the endoscopic removal, before pulmonary complications are observed, is thought preferable to surgery.

[Mediastinal tuberculosis as a cause of fever of unknown origin]. / Tuberculosis mediastínica como causa de fiebre de origen desconocido.

Tuberculosis is the most frequent cause of fever from unknown etiology. On the other hand, mediastinal tuberculous adenopathy (TBM), without associated pulmonary affection is a rare form of presentation among adults, generally evolving with sustained fever until a thoracic radiology is performed showing mediastinal enlargement. We present a case which started as fever from unknown etiology (FUE), given that, according to the thoracic radiology performed one month after the onset of fever, no mediastinal affection was observed.