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OBJECTIVE: assess pain and opioid consumption in patients undergoing anesthetic techniques of spinal erector plane block and local anesthetic block in video-assisted thoracic surgery in the immediate postoperative period. METHODS: ninety-two patients undergoing video assisted thoracic surgery were randomized to receive ESPB or BAL before starting the surgical procedure. Using the numerical verbal scale, the primary outcome assessed was the patient's pain in the immediate postoperative period (POI). The secondary outcome comprises the assessment of opioid consumption in the IPP by quantifying the medication used in an equianalgesic dose of morphine expressed in milligrams, in the immediate post-anesthetic recovery period, 6h, 12h, and 24h after surgery. RESULTS: the EVN scores in the LBA and ESPB group in the POI had a mean of 0,8 (±1,89) vs 0,58 (±2,02) in the post-anesthesia care room (REPAI), 1,06 (±2,00) vs 1,30 (±2,30) in 6 hours of POI, 0,84 (±1,74) vs 1,19 (±2,01) within 12 hours of POI and 0,95 (±1,88) vs 1 ( ±1,66) within 24 hours of POI, all with p>0.05. Mean opioid consumption in the BAL and ESPB groups in the POI was 12.9 (± 10.4) mg vs 14.9 (±10.2) mg, respectively, with p = 0.416. Sixteen participants in the ESPB group and seventeen in the BAL group did not use opioids during the first 24 hours of the PO analyzed. CONCLUSION: local anesthesic block and ESP block techniques showed similar results in terms of low pain scores and opioid consumption during the period evaluated.
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Analgésicos Opioides , Bloqueio Nervoso , Analgésicos Opioides/uso terapêutico , Anestésicos Locais , Humanos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Cirurgia Torácica Vídeoassistida , Ultrassonografia de IntervençãoRESUMO
Sertraline hydrochloride is a first-line antidepressant with potential antineoplastic properties because of its structural similarity with other drugs capable to inhibit the translation-controlled tumor protein (TCTP), a biomolecule involved in cell proliferation. Recent studies suggest it could be repositioned for cancer treatment. In this review, we systematically map the findings that repurpose sertraline as an antitumoral agent, including the mechanisms of action that support this hypotesis. From experimental in vivo and in vitro tumor models of thirteen different types of neoplasms, three mechanisms of action are proposed: apoptosis, autophagy, and drug synergism. The antidepressant is able to inhibit TCTP, modulate chemotherapeutical resistance and exhibit proper cytotoxicity, resulting in reduced cell counting (in vitro) and shrunken tumor masses (in vivo). A mathematical equation determined possible doses to be used in human beings, supporting that sertraline could be explored in clinical trials as a TCTP-inhibitor.
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ABSTRACT Objective: assess pain and opioid consumption in patients undergoing anesthetic techniques of spinal erector plane block and local anesthetic block in video-assisted thoracic surgery in the immediate postoperative period. Methods: ninety-two patients undergoing video assisted thoracic surgery were randomized to receive ESPB or BAL before starting the surgical procedure. Using the numerical verbal scale, the primary outcome assessed was the patient's pain in the immediate postoperative period (POI). The secondary outcome comprises the assessment of opioid consumption in the IPP by quantifying the medication used in an equianalgesic dose of morphine expressed in milligrams, in the immediate post-anesthetic recovery period, 6h, 12h, and 24h after surgery. Results: the EVN scores in the LBA and ESPB group in the POI had a mean of 0,8 (±1,89) vs 0,58 (±2,02) in the post-anesthesia care room (REPAI), 1,06 (±2,00) vs 1,30 (±2,30) in 6 hours of POI, 0,84 (±1,74) vs 1,19 (±2,01) within 12 hours of POI and 0,95 (±1,88) vs 1 ( ±1,66) within 24 hours of POI, all with p>0.05. Mean opioid consumption in the BAL and ESPB groups in the POI was 12.9 (± 10.4) mg vs 14.9 (±10.2) mg, respectively, with p = 0.416. Sixteen participants in the ESPB group and seventeen in the BAL group did not use opioids during the first 24 hours of the PO analyzed. Conclusion: local anesthesic block and ESP block techniques showed similar results in terms of low pain scores and opioid consumption during the period evaluated.
RESUMO Objetivo: avaliar a dor e o consumo de opioides dos pacientes submetidos a técnicas anestésicas de bloqueio do plano eretor da espinha (ESPB) e bloqueio anestésico local (LBA) em cirurgia torácica vídeo assistida no período pós-operatório imediato (POI). Métodos: noventa e dois pacientes submetidos a cirurgia torácica videotoracoscópica foram randomizados aleatoriamente para receberem ESPB ou LBA antes do início do procedimento cirúrgico. O desfecho primário avaliado foi a dor do paciente no POI através da escala verbal numérica. O desfecho secundário avaliou o consumo de opioides através da quantificação da medicação usada em dose equianalgésica de morfina expressa em miligramas, no período de recuperação pós-anestésica imediata, 6h, 12h e 24h após a cirurgia. Resultados: os escores da Escala Verbal Numérica de dor (EVN) no grupo LBA e ESPB no POI, respectivamente, tiveram média de 0,8 (±1,89) vs 0,58 (±2,02) na sala de recuperação pós anestesia (REPAI), 1,06 (±2,00) vs 1,30 (±2,30) em 6 horas do POI, 0,84 (±1,74) vs 1,19 (±2,01) em 12 horas do POI e 0,95 (±1,88) vs 1 ( ±1,66) em 24 horas do POI, todos com p>0,05. O consumo médio de opioides no grupo LBA e ESPB foi de 12,9 (±10,4) mg vs 14,9 (±10.2) mg, respectivamente, com p=0.416. Dezesseis participantes do grupo ESPB e dezessete do grupo LBA não utilizaram opioides durante as primeiras 24 horas do PO. Conclusões: as técnicas de bloqueio LBA e ESPB apresentaram resultados semelhantes em termos de baixos escores de dor e consumo de opioides durante o período avaliado.
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This study analyzed the effect of thermal stress on erythrocytes of Notothenia rossii and Notothenia coriiceps, abundant notothenioids in Admiralty Bay, Antarctic Peninsula. In both species, the antioxidant defense system enzymes, superoxide dismutase, catalase, glutathione peroxidase, glutathione-S transferase, glutathione reductase were punctually altered (8°C for 1, 3 and 6 days) in erythrocytes, indicating that these markers are not ideal for termal stress. However, under the influence of thermal stress, morphological changes in Notothenia coriiceps erythrocytes were observed at all exposure times (1, 3 and 6 days at 8°C), and in Notothenia rossii occurred in 6 days. These results suggest that Notothenia corriceps presents a lower tolerance to thermal stress at 8°C for up to 6 days, since the cellular and nuclear alterations recorded are pathological and may be deleterious to the cells. Among the morphological markers analyzed in this work, we believe that the shape change and nuclear bubble formation may be good stress biomarkers in erythrocytes of Notothenia rossii and Notothenia coriiceps.
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Antioxidantes , Resposta ao Choque Térmico , Animais , Regiões Antárticas , Eritrócitos , PeixesRESUMO
Este estudo teve por objetivo analisar o desempenho de médicos atuantes na atenção primária frente ao reconhecimento de lesões suspeitas de câncer de pele. Trata-se de um estudo de campo exploratório descritivo com abordagem quantitativa. Médicos generalistas, médicos de família e residentes em Medicina de Família e Comunidade atuantes nas 66 unidades de saúde de Curitiba-PR, foram entrevistados. O conhecimento em dermatologia foi considerado mínimo para 61,5% dos participantes. A sensibilidade média (S) no reconhecimento das lesões suspeitas foi de 63,92% (IC95% 60,5-67,34). O desempenho foi considerado satisfatório na identificação do melanoma cutâneo (S=83%) e do carcinoma espinocelular (S=97%) e insatisfatório nos casos de ceratose actínica (S=54%), nevo melanocítico displásico (S=51%) e carcinoma basocelular (S=32%). Lesões de pele prevalentes podem estar sendo diagnosticadas tardiamente ou subdiagnosticadas. Salienta-se a importância de atualizações e treinamentos profissionais para aprimoramento da percepção e capacidade de reconhecimento precoce na atenção primária. (AU)
The aim of this study was to analyze the performance of primary care doctors in recognizing suspected skin cancer lesions. This is an exploratory-descriptive field study with a quantitative approach. General practitioners, family doctors, and family and community medicine residents working in the 66 health units in Curitiba-PR were interviewed. Knowledge in dermatology was considered basic for 61.5% of the participants. The mean sensitivity (S) in recognizing suspected lesions was 63.92% (CI95% 60.5-67.34). The performance was considered satisfactory in the identification of cutaneous melanoma (S=83%) and squamous cell carcinoma (S=97%) and unsatisfactory in cases of actinic keratosis (S=54%), dysplastic melanocytic nevus (S=51%) and basal cell carcinoma (S=32%). Prevalent skin lesions may be diagnosed late or underdiagnosed. The importance of professional updates and training is emphasized to improve perception and the ability to recognize early in primary care. (AU)
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Atenção Primária à Saúde , Neoplasias Cutâneas , Médicos de Família , Diagnóstico Precoce , Nevo PigmentadoRESUMO
This study aimed to analyze the efficacy of the monoclonal antibodies ipilimumab, nivolumab, and pembrolizumab when compared with conventional chemotherapy in the treatment of advanced melanoma. Three authors made the search independently and five articles matched the eligibility criteria. A fourth expert confirmed their quality (κâ¯=â¯1). The meta-analysis for overall survival and 12-month overall survival was impaired due to remarkably high heterogeneity (I2â¯=â¯91 % and 86 %, respectively). However, chemotherapy showed benefits on 24-months overall survival (RRâ¯=â¯1.60; IC95 %: 1.29, 1.98; pâ¯<â¯0.0001). The interruption by toxicity outcome showed no significant differences between therapies. Some studies used monoclonal antibodies in monotherapy or in combination and some groups of participants showed heterogeneity, which made the analysis difficult. Given the exorbitant costs of monoclonal antibodies in low and middle-income countries, the evidence of its benefits is limited when considering the replacement of conventional therapy with immunotherapy in public health systems.
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Antineoplásicos Imunológicos , Melanoma , Antineoplásicos Imunológicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica , Humanos , Imunoterapia , Ipilimumab/uso terapêutico , Melanoma/tratamento farmacológico , Nivolumabe/uso terapêuticoRESUMO
A violência sexual infantil configura-se como um fenômeno sociocultural, pautado em relações hierárquicas e desigualdades de gênero, étnico-raciais e geracionais. Nesta pesquisa, investigouse os determinantes da violência sexual infantil a partir dos casos notificados pelo SINAN no estado do Paraná entre 2011 e 2014, disponibilizados pelo DATASUS, por estudo descritivo, de base documental e abordagem quantitativa. No Paraná, totalizaram 2.446 casos no período. A Regional de Saúde com maior prevalência foi a de Foz do Iguaçu. Prevalece a faixa etária de 5 a 9 anos, meninas, raça negra e indígenas. Na tipologia, predominaram estupro e assédio sexual, por meio de força corporal. Os casos prevalentemente ocorreram na residência e o provável agressor era próximo da criança. Reconhecer os determinantes da violência sexual infantil é essencial para a implementação de ações de cuidado integral às vítimas.
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Comportamento Social , Abuso Sexual na InfânciaRESUMO
The thermal stability of the Antarctic Ocean raises questions concerning the metabolic plasticity of Antarctic notothenioids to changes in the environmental temperature. In this study, Notothenia rossii survived 90 days at 8 °C, and their condition factor level was maintained. However, their hepatosomatic (0.29×) index decreased, indicating a decrease in nutrient storage as a result of changes in the energy demands to support survival. At 8 °C, the plasma calcium, magnesium, cholesterol, and triglyceride concentrations decreased, whereas the glucose (1.91×) and albumin (1.26×) concentrations increased. The main energy substrate of the fish changed from lipids to glucose due to a marked increase in lactate dehydrogenase activity, as demonstrated by an increase in anaerobic metabolism. Moreover, malate dehydrogenase activity increased in all tissues, suggesting that fish acclimated at 8 °C exhibit enhanced gluconeogenesis. The aerobic demand increased only in the liver due to an increase (2.23×) in citrate synthase activity. Decreases in the activities of superoxide dismutase, catalase, and glutathione-S-transferase to levels that are most likely sufficient at 8 °C were observed, establishing a new physiological activity range for antioxidant defense. Our findings indicate that N. rossii has some compensatory mechanisms that enabled its long-term survival at 8 °C.
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Aclimatação/fisiologia , Perciformes/metabolismo , Temperatura , Albuminas/metabolismo , Animais , Regiões Antárticas , Catalase/metabolismo , Metabolismo Energético , Feminino , Proteínas de Peixes/metabolismo , Glucose/metabolismo , Glutationa Transferase/metabolismo , Glicogênio/metabolismo , L-Lactato Desidrogenase/metabolismo , Metabolismo dos Lipídeos , Fígado/metabolismo , Malato Desidrogenase/metabolismo , Masculino , Músculos/metabolismo , Perciformes/sangue , Superóxido Dismutase/metabolismoRESUMO
Antarctic Nototheniidae is an attractive group for studying metabolic and physiological responses at high temperatures. The present work investigated the metabolic responses of the carbohydrate metabolism and antioxidant system to thermal stress at 8⯰C (for 2-144â¯h) in the brains of Notothenia rossii and Notothenia coriiceps. In N. coriiceps, glycogenolysis was essential in the first hours of exposure (2â¯h) at 8⯰C and, in addition to inhibiting glucose-6-phosphatase activity, was important for activating the pentose phosphate pathway. In N. rossii, anaerobic metabolism was reduced in the first hours of exposure (2 and 6â¯h) at 8⯰C, followed by reduced hexokinase activity, suggesting energy regulation between neurons and astrocytes. The antioxidant system results indicated the importance of the actions of the glutathione-dependent antioxidant enzymes glutathione-S-transferase and glutathione peroxidase as well as those of catalase in N. coriiceps and the action of glutathione-S-transferase, glutathione peroxidase and glutathione reductase in N. rossii, especially during the first 12â¯h of thermal stress exposure. These results indicate tissue-specific patterns and species-specific responses to this stress.
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Encéfalo/metabolismo , Resposta ao Choque Térmico/fisiologia , Perciformes/metabolismo , Animais , Regiões Antárticas , Antioxidantes/metabolismo , Metabolismo dos Carboidratos/fisiologia , Catalase/metabolismo , Glutationa Peroxidase/metabolismo , Glutationa Redutase/metabolismo , Glutationa Transferase/metabolismo , Fígado/metabolismo , Estresse Oxidativo/fisiologiaRESUMO
The objective of the present study was to assess the effect of short-term (2-144 h) heat stress (8 °C) on energy production processes and antioxidant defense systems in the kidneys and gills of Notothenia rossii and Notothenia coriiceps. Heat stress affected energy metabolism and oxidative stress parameters in a time-, tissue-, and species-dependent manner, and gills were more sensitive than kidneys to heat stress. N. rossii kidneys were able to stabilize carbohydrate metabolism after 12 h of heat stress, whereas the glycogen levels in N. coriiceps kidneys fluctuated in response to varying glucose-6-phosphatase (G6Pase) levels. The gills of N. rossii were able to stabilize their energy demand and aerobic metabolism under heat stress, whereas in the gills of N. coriiceps, changes in carbohydrate metabolic pathways depended on the exposure time: initially, anaerobiosis was activated after 6 h; the energy demand, characterized by glycogen consumption, increased after 72 h, and aerobic metabolism was activated within 144 h. With regard to the antioxidant defenses of the N. rossii kidney, it was found that levels of antioxidant enzymes were reduced during the first hours of heat stress, contributing to increased lipid peroxidation, whereas N. coriiceps kidneys did not show signs of oxidative damage. The gills of N. rossii exhibited more pronounced oxidative damage in response to heat stress than those of N. coriiceps despite the presence of increasing levels of antioxidants, likely due to tissue hypoxia.