Systematic review: coxibs, non-steroidal anti-inflammatory drugs or no cyclooxygenase inhibitors in gastroenterological high-risk patients?

Selective cyclooxygenase-2 inhibitors have been marketed as alternatives of conventional, non-steroidal anti-inflammatory drugs with the purpose of reducing/eliminating the risk of ulcer complications. Unexpectedly, randomized-controlled trials revealed that long-term use of coxibs, such as rofecoxib, significantly increased the risk of myocardial infarction and stroke, while the use of valdecoxib was associated with potentially life-threatening skin reactions. Subsequently, rofecoxib and valdecoxib were withdrawn from the market. Although more strict precautions for other coxibs, such as celecoxib, etoricoxib, lumiracoxib and parecoxib, may be accepted/recommended by regulatory agencies, a critical review of published data suggests that their use may not be justified - even in high-risk patients - taking benefits, costs and risks into consideration. Clinicians should, therefore, never prescribe coxibs to patients with cardiovascular risk factors, and should only reluctantly prescribe coxibs to patients with a history of ulcer disease or dyspepsia to overcome persistent pain due to, e.g. rheumatoid arthritis or osteoarthritis. Instead, they should consider using conventional non-steroidal anti-inflammatory drugs in combination with a proton pump inhibitor or a prostaglandin analogue, especially for patients with increased cardiovascular risks, i.e. established ischaemic heart disease, cerebrovascular disease and/or peripheral arterial disease, or alternatively acetaminophen. An evidence-based algorithm for treatment of a chronic arthritis patient with one or more gastrointestinal risk factors is presented.

Sex education is key to combatting AIDS in Brazil.

PIP: About 60,000 children in Brazil were born from an AIDS-affected mother, and 16,000 were orphaned by AIDS. These stark figures were released by the Global Orphan Project and the Instituto Promundo at the EducAids conference. About 90% of childhood AIDS cases were a result of perinatal exposure, and the other 10% from unknown exposure. In response to these prevalences, the EducAids initiative, which aims to promote AIDS education in schools, was considering sex education for preschool children. The coordinator of the government's AIDS prevention program, Pedro Chequer, believes sex education for children as young as 4 years old would reduce AIDS among teenagers and help avoid unwanted pregnancies. The Minister of Health supported this concept. Jose Serra, the Minister of Health declared that it was not the aim of the ministry to avoid teenage pregnancy but to prevent early sexual intercourse. In 1997 the number of deliveries by girls aged 15-19 years had risen to 25.27%, from 21.41% in 1993. However, the number of deliveries for women over age 20 are falling. Pedro Chequer, EducAids coordinator, stated that despite these facts, campaigns for sex education would be opposed by the Roman Catholic Church.^ieng

[The physician-scientist: from academy to partnership]. / O pesquisador-médico: da academia às parcerias.

OBJECTIVES: To illustrate the changes in academy and in industry that are reshaping the profile of the physician-scientist. METHODS AND RESULTS: Data were extracted from the literature and from primary sources as well as from the authors' own experiences. CONCLUSIONS: Within an academy-industry relationship, the market demands a physician-scientist best suited to orient research activities towards patient-oriented and disease-oriented goals.

O pesquidador-médico: da academia às parcerias / The physician-scientist: from academy to partnership

Objetivo. Ilustrar as mudanças na academia e na indústria que estao levando a uma transformaçao no perfil do pesquisador-médico. Método e Resultados. Foram pesquisados dados de literatura, fontes primárias e experiência dos próprios autores. Conclusao. O mercado de trabalho passa a procurar curar um pesquisador-médico mais adequado a orientar as pesquisas em funçao de objetivos centrados nos pacientes e em doenças num relacionamento universidade-indústria.