RESUMO
The COVID-19 pandemic caused a change in our society and put health systems in crisis worldwide. Different risk factors and comorbidities have been found that increase the risk of mortality when acquiring this infection. The use of alternative devices to the cigarette like the electronic cigarettes, the vapers have been studied widely and generators of great controversy since it has been discovered that they also produce different pulmonary affections. When developing the SARS-CoV2 infection, different theories have been generated about the greater predisposition to a worse prognosis of people who use electronic cigarettes; however, the information on this continues in discovery. A group of experts made up of oncologists, infectologists, pulmonologists, and epidemiologists met to review the literature and then generate theories about the impact of electronic cigarettes on SARS-CoV2 infection.
Assuntos
COVID-19/patologia , Sistemas Eletrônicos de Liberação de Nicotina , Vaping/efeitos adversos , COVID-19/epidemiologia , Suscetibilidade a Doenças , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Humanos , Macrófagos/metabolismo , Alvéolos Pulmonares/imunologia , Alvéolos Pulmonares/patologia , Risco , SARS-CoV-2 , Vaping/epidemiologia , Adulto JovemRESUMO
PURPOSE: Patients with recurrent glioblastoma (rGBM) have a poor prognosis, with survival ranging from 25 to 40 weeks. Antiangiogenic agents are widely used, showing a variable response. In this study, we explored the efficacy of carmustine plus bevacizumab (BCNU/Bev) for treating rGBM. METHODS/PATIENTS: In this study, we assessed 59 adult patients with histologically confirmed rGBM who were treated with BCNU/Bev as second-line regimen. The response rate (RR), progression-free survival (PFS) and overall survival (OS) were evaluated according to their molecular expression profile, including CD133 mRNA expression, MGMT methylation (pMGMT), PDGFR amplification, YKL40 mRNA expression, IDH1/2 condition, p53 and EGFRvIII mutation status. RESULTS: Median follow-up was 18.6 months, overall RR to the combination was 56.3%, and median PFS was 9.0 months (95% CI 8.0-9.9). OS from time of diagnosis was 21.0 months (95% CI 13.2-28.7) and from starting BCNU/Bev it was 10.7 months (95% CI 9.5-11.8). IDH1/2 mutations were found in 30.5% of the patients, pMGMT in 55.9% and high CD133 mRNA expression in 57.6%. Factors which positively affected PFS included performance status (p = 0.015), IDH+ (p = 0.05), CD133 mRNA expression (p = 0.009) and pMGMT+ (p = 0.007). OS was positively affected by pMGMT+ (p = 0.05). Meanwhile, YKL40 negatively affected PFS (p = 0.01) and OS (p = 0.0001). Grade ≥ 3 toxicities included hypertension (22%) and fatigue (12%). CONCLUSIONS: BCNU/Bev is a safe and tolerable treatment for rGBM. Patients with MGMT+/IDH+ derive the greatest benefit from the treatment combination in the second-line setting. Nonetheless, high YKL40 expression discourages the use of antiangiogenic therapy.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Neoplasias Encefálicas/tratamento farmacológico , Carmustina/uso terapêutico , Glioblastoma/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Antígeno AC133/genética , Antígeno AC133/metabolismo , Adulto , Idoso , Inibidores da Angiogênese/efeitos adversos , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Bevacizumab/efeitos adversos , Neoplasias Encefálicas/irrigação sanguínea , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/mortalidade , Carmustina/efeitos adversos , Proteína 1 Semelhante à Quitinase-3/genética , Colômbia , Metilases de Modificação do DNA/metabolismo , Enzimas Reparadoras do DNA/metabolismo , Esquema de Medicação , Feminino , Genes erbB-1 , Genes p53 , Glioblastoma/irrigação sanguínea , Glioblastoma/genética , Glioblastoma/mortalidade , Humanos , Isocitrato Desidrogenase/genética , Masculino , Metilação , Pessoa de Meia-Idade , Mutação , Recidiva Local de Neoplasia/irrigação sanguínea , Recidiva Local de Neoplasia/genética , Recidiva Local de Neoplasia/mortalidade , Intervalo Livre de Progressão , RNA Mensageiro/metabolismo , Receptores do Fator de Crescimento Derivado de Plaquetas/genética , Análise de Sobrevida , Proteínas Supressoras de Tumor/metabolismo , Adulto JovemRESUMO
BACKGROUND: The procedure of radical peritonectomy followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is considered the standard treatment for peritoneal cancers. AIMS: To evaluate various outcomes in a cohort of patients with peritoneal tumors treated with HIPEC. METHODS: Twenty-four patients consecutively treated with radical peritonectomy plus HIPEC within the time frame of November 2007 to July 2010 were enrolled; 15 (62%) had tumors of appendicular origin, 4 (16.7%) had primary peritoneal tumors, 2 had ovarian carcinomas and there was one case of colon cancer, one carcinosarcoma and one hemangioendothelioma. Mean age was 53 years (range: 26-68) and median follow-up was 14.2 months (range: 1-32). Demographic data, histology, peritoneal cancer index (PCI), surgical procedure characteristics, recurrence-free survival (RFS), and overall survival (OS) were all evaluated. Short-term morbidity and mortality were also determined. RESULTS: Complete cytoreduction was achieved in 18 patients (75%). Mean PCI was 15 (<10: 41% and >10: 58%), and the median (range) for surgery duration, length of stay in the Intensive Care Unit, parenteral nutritional support, and hospital stay were 12,5 (7-20) hours, 11,4 (2-74) days, 13,8 (12-65) days, and 29,1 (10-90) days, respectively. One patient (4%) died 6 months after the procedure, due to multiple associated complications. Considerable morbidity was seen in 52% of cases, including thromboembolic events (41%), catheter-related bacteremia (29%), fistulas (29%), and nephrotoxicity (25%). Six patients (25%) recurred after a median of 21 months of RFS. CONCLUSIONS: Cytoreductive surgery plus HIPEC in well-selected patients presenting with tumors that affect the peritoneum is a procedure that can be carried out in Colombia with an adequate safety and effectiveness profile. Mortality was similar to that reported in the international literature.
Assuntos
Antineoplásicos/uso terapêutico , Hipertermia Induzida , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Peritoneais/cirurgia , Adulto , Terapia Combinada , Feminino , Hospitais de Ensino , Humanos , Tempo de Internação , Masculino , Neoplasias Peritoneais/mortalidade , Análise de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: Acute laryngitis is a common illness worldwide. Diagnosis is often made by case history alone and treatment is often directed towards controlling symptoms. OBJECTIVES: The aim of this review was to assess the effectiveness of different antibiotic therapies in adults suffering acute laryngitis. A secondary objective was to report the rates of adverse events associated with these treatments. SEARCH STRATEGY: We systematically screened the following electronic databases: the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2006); MEDLINE (January 1966 to December Week 2 2006); and EMBASE (1974 to June 2006), LILACS (from 1982 to December 2006 ) and BIOSIS (1980 to June 2002). Other strategies included hand searching relevant journals, searching ongoing trial databases and general databases such as Google scholar. SELECTION CRITERIA: Randomized controlled trials comparing any antibiotic therapy with placebo in acute laryngitis. The main outcome measurement was objective voice scores. DATA COLLECTION AND ANALYSIS: Data were independently extracted by two review authors and then descriptively synthesized. MAIN RESULTS: Only two trials met study inclusion criteria after extensive literature searches. One hundred participants were randomly selected to receive either penicillin V (800 mg twice a day for five days), or an identical placebo, in a study of penicillin V in acute laryngitis in adults. A tape recording of each patient reading a standardized text was obtained during the first visit, subsequently during re-examination after one and two weeks, and at follow up after two to six months. No significant differences were found between the groups. The trial also measured symptoms reported by participants and found no significant differences. The second trial investigated erythromycin for treating acute laryngitis in 106 adults. The mean objective voice scores measured at the first visit, at re-examination after one and two weeks, and at follow up after two to six months did not significantly differ between control and intervention groups. At one week there were significant beneficial differences in the severity of reported vocal symptoms as judged by the participants (P = 0.042). Comparing the erythromycin and placebo groups on subjective voice scores the a priori relative risk (RR) was 0.7 (95% confidence interval (CI) 0.51 to 0.96, P = 0.034) and the number needed to treat (NNT) was 4.5. AUTHORS' CONCLUSIONS: Antibiotics appear to have no benefit in treating acute laryngitis. Erythromycin could reduce voice disturbance at one week and cough at two weeks when measured subjectively. We consider that these outcomes are not relevant in clinical practice. The implications for practice are that prescribing antibiotics should not be done in the first instance as they will not objectively improve symptoms.
Assuntos
Antibacterianos/uso terapêutico , Laringite/tratamento farmacológico , Doença Aguda , Adulto , Eritromicina/uso terapêutico , Humanos , Penicilina V/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Acute laryngitis is a common illness worldwide. Diagnosis is often made by case history alone and treatment is often directed towards controlling symptoms. OBJECTIVES: The aim of this review was to assess the effectiveness of different antibiotic therapies in adults suffering acute laryngitis. A secondary objective was to report the rates of adverse events associated with these treatments. SEARCH STRATEGY: We systematically screened the following electronic databases: the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004); MEDLINE (January 1966 to June Week 3 2004); and EMBASE (1974 to June 2004), LILACS (from 1982 to the 40th edition) and BIOSIS (1980 to June 2002). Other strategies included hand searching relevant journals, searching ongoing trial databases and general databases such as Alta Vista. SELECTION CRITERIA: Randomized controlled trials comparing any antibiotic therapy with placebo in acute laryngitis. The main outcome measurement was objective voice scores. DATA COLLECTION AND ANALYSIS: Data were independently extracted by two people and then descriptively synthesised. MAIN RESULTS: Only two trials met study inclusion criteria after extensive literature searches. One hundred patients were randomly selected to receive either penicillin V (800 mg twice a day for five days), or an identical placebo, in a study of penicillin V in acute laryngitis in adults. A tape recording of each patient reading a standardised text was obtained during the first visit, subsequently during re-examination after one and two weeks, and at follow up after two to six months. No significant differences were found between the groups. The trial also measured symptoms reported by patients and found no significant differences. The second trial investigated erythromycin for treating acute laryngitis in 106 adults. The mean objective voice scores measured at the first visit, at re-examination after one and two weeks, and at follow up after two to six months did not significantly differ between control and intervention groups. At one week there were significant beneficial differences in the severity of reported vocal symptoms as judged by the patients (p = 0.042). Comparing the erythromycin and placebo groups on subjective voice scores the a priori relative risk (RR) was 0.7 (95% confidence interval (CI) 0.51 to 0.96, p = 0.034) and the number needed to treat (NNT) was 4.5. AUTHORS' CONCLUSIONS: Antibiotics appear to have no benefit in treating acute laryngitis. Erythromycin could reduce voice disturbance at one week and cough at two weeks when measured subjectively. We consider that these outcomes are not relevant in clinical practice. The implications for practice are that prescribing antibiotics should not be done in the first instance as they will not objectively improve symptoms.
Assuntos
Antibacterianos/uso terapêutico , Laringite/tratamento farmacológico , Doença Aguda , Adulto , Eritromicina/uso terapêutico , Humanos , Penicilina V/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Es bien conocido que tanto los experimentos clínicos aleatorizados así como las revisiones sistemáticas de la literatura y los meta análisis bien conducidos, ofrecen la evidencia más confiable y de mejor calidad, sobre el efecto de las intervenciones en salud. Los autores de revisiones sistemáticas, así como de otros estudios integrativos entre los que se encuentran guías de práctica clínica basadas en evidencia, y análisis económicos, deben tratar de encontrar toda la evidencia relevante en un intento para minimizar el riesgo del sesgo de publicación, que corresponde al hecho que los resultados negativos, es decir aquellos que no encuentran diferencias entre los grupos de intervención, es menos probable que lleguen a la publicación, tardan más tiempo en ser publicados cuando lo hacen y tienden a publicarse más frecuentemente en el idioma nativo del autor cuando no es el inglés; todo esto podría conducir a una distorsión de la evidencia disponible para la toma de decisiones en la práctica clínica. Adicionalmente, algunos resultados de experimentos no son fácilmente recuperados en búsquedas de la literatura porque nunca han sido publicados o lo han hecho en revistas biomédicas no indexadas en las grandes bases de datos1 y 3. Desde mucho tiempo atrás se ha reconocido la importancia de registrar de manera sistemática y prospectiva los experimentos clínicos aleatorizados. Sin embargo, existen varias barreras que han impedido el desarrollo de un registro comprehensivo para los experimentos clínicos a saber: resistencia de la industria farmacéutica y tecnológica, recursos insuficientes para hacer sostenible la empresa del registro a largo plazo, dificultades para forzar a los investigadores a registrar su ensayo y carencia de conocimiento acerca de los problemas de no registrar los experimentos4...
Assuntos
Indústria Farmacêutica , Epidemiologia , Metanálise , Pesquisa , Tecnologia FarmacêuticaRESUMO
BACKGROUND: Migraine is a common and disabling health problem among young and middle aged adults. Flunarizine have been used as a prophylactic medication in its management for more than two decades. OBJECTIVE: The aim of the study is to systematically review the evidence obtained from randomized controlled trials about the efficacy and security of flunarizine versus placebo for the prevention of migraine in adults. MATERIALS AND METHODS: Electronic search were performed using the databases MEDLINE, EMBASE, Biosis, the Cochrane Library, Lilacs and others. Reference lists of retrieved studies, reviews and conference abstracts were used to found another articles. Additionally, the authors performed a handsearched in recognized journals related to migraine and neurological topics. Randomized, placebo controlled, double blind trials assessing the efficacy of flunarizine for preventing migraine were included. We evaluated the frequency of the attacks by comparing the mean frequency before and after the intervention for each group of treatment and then the two groups were compared. To evaluate the security of flunarizine we used included and excluded studies and open trials. RESULTS: Nine studies were obtained but only four met the inclusion criteria. The fixed effects model reported a reduction in the frequency of attacks by using flunarizine. The monthly difference was 0.55 attacks (CI 95%= 0.215 0.895; p= 0.002). Somnolence was the most frequent adverse effect in 20.5% of the subjects (n= 1,987). CONCLUSIONS: Based on a small number of trials, flunarizine, at a daily dose of 10 mg lightly reduces the frequency of migraine attacks.