RESUMEN

BACKGROUND: Medicaid expansion (ME) has contributed to transforming the United States healthcare system. However, its effect on palliative care of primary liver cancers remains unknown. This study aimed to evaluate the association between ME and the receipt of palliative treatment in advanced-stage liver cancer. METHODS: Patients diagnosed with stage IV hepatocellular carcinoma or intrahepatic cholangiocarcinoma were identified from the National Cancer Database and divided into pre-expansion (2010-2013) and postexpansion (2015-2019) cohorts. Logistic regression identified predictors of palliative treatment. Difference-in-difference (DID) analysis assessed changes in palliative care use between patients living in ME states and patients living in non-ME states. RESULTS: Among 12,516 patients, 4582 (36.6%) were diagnosed before expansion, and 7934 (63.6%) were diagnosed after expansion. Overall, rates of palliative treatment increased after ME (18.1% [pre-expansion] vs 22.3% [postexpansion]; P < .001) and are more pronounced among ME states. Before expansion, only cancer type and education attainment were associated with the receipt of palliative treatment. Conversely, after expansion, race, insurance, location, cancer type, and ME status (odds ratio [OR], 1.23; 95% CI, 1.06-1.44; P = .018) were all associated with palliative care. Interestingly, the odds were higher if treatment involved receipt of pain management (OR, 2.05; 95% CI, 1.23-2.43; P = .006). Adjusted DID analysis confirmed increased rates of palliative treatment among patients living in ME states relative to non-ME states (DID, 4.4%; 95% CI, 1.2-7.7; P = .008); however, racial disparities persist (White, 5.6; 95% CI, 1.4-9.8; P = .009; minority, 2.6; 95% CI, -2.5 to 7.6; P = .333). CONCLUSION: The implementation of ME contributed to increased rates of palliative treatment for patients residing in ME states after expansion. However, racial disparities persist even after ME, resulting in inequitable access to palliative care.

Asunto(s)

RESUMEN

Within the de Broglie-Bohm theory, we numerically study a generic two-dimensional anharmonic oscillator including cubic and quartic interactions in addition to a bilinear coupling term. Our analysis of the quantum velocity fields and trajectories reveals the emergence of dynamical vortices. In their vicinity, fingerprints of chaotic behavior such as unpredictability and sensitivity to initial conditions are detected. The simultaneous presence of the off-diagonal -kxy and nonlinear terms leads to robust quantum chaos very analogous to its classical version.

RESUMEN

BACKGROUND: Metastatic disease in the regional lymph nodes (LNs) is a strong indicator of worse outcomes among patients after curative-intent resection of ampullary cancer (AC). This study aimed to ascertain the threshold number of examined LNs (ELNs) for AC to compare the prognosis accuracy of various nodal classification schemes relative to long-term prognosis. METHODS: Patients who underwent pancreatoduodenectomy (PD) for AC (2004-2019) were identified using the National Cancer Database. Locally weighted regression scatter plot smoothing (LOWESS) curves were used to ascertain the optimal cut point for ELNs. The accuracy of the American Joint Committee on Cancer N classification, LN ratio, and log odds transformation (LODDS) ratio to stratify patients relative to survival was examined. RESULTS: Among 8127 patients with AC, 67% were male with a median age of 67 years (IQR, 59-74). Tumors were most frequently classified as T3 (34.9%), followed by T2 (30.6%); T1 (12.9%) and T4 (17.6%) were less common. LN metastasis was identified in 4606 patients (56.7%). Among patients with nodal disease, 37.0% and 19.7% had N1 and N2 disease, respectively. The LOWESS curves identified an inflection cutoff point in the hazard of survival at 20 ELNs. The survival benefit of 20 ELNs was more pronounced among patients without LN metastasis vs patients with N1 disease (median overall survival [OS]: 54.1 months [IQR, 45.9-62.1] in ≥20 ELNs vs 39.0 months [IQR, 35.8-42.2] in <20 ELNs; P < .001) or N2 disease (median OS: 22.5 months [IQR, 18.9-26.2] in ≥20 ELNs vs 25.4 months [IQR, 23.3-27.6] in <20 ELNs; P < .001). When comparing the 4 different N classification schemes, the LODDS classification scheme yielded the highest predictive ability. CONCLUSIONS: Evaluation of a minimum of 20 LNs was needed to stratify patients with AC relative to the prognosis and to minimize stage migration. The LODDS nodal classification scheme had the highest prognostic accuracy to differentiate survival among patients after PD for AC.

Asunto(s)

RESUMEN

The chemiluminescence (CL) reaction of eight different 2-(4-hydroxyphenyl)-4,5-dihydrothiazole-4-carboxylate esters with an organic superbase and oxygen was investigated through a kinetic and computational study. These esters are all analogues to the luciferin substrate involved in efficient firefly bioluminescence. The kinetic data obtained from CL emission and light absorption assays were used in the context of linear free energy relationships (LFER); we obtained the Hammett reaction constant ρ = +1.62 ± 0.09 and the Brønsted constant ßlg = -0.39 ± 0.04. These observations from LFER, together with activation parameters obtained from Arrhenius plots, suggest that the formation of the high-energy intermediate (HEI) 1,2-dioxetanone occurs via a concerted mechanism during the rate-determining step of the reaction. Calculations performed using density functional theory support a late transition state for HEI formation within the reaction mechanism pathway, which was described considering geometric parameters, Wiberg bond indices from natural bond order analysis, and the atomic charges derived from the electrostatic potential.

RESUMEN

The brain is a complex system whose understanding enables potentially deeper approaches to mental phenomena. Dynamics of wide classes of complex systems have been satisfactorily described within q-statistics, a current generalization of Boltzmann-Gibbs (BG) statistics. Here, we study human electroencephalograms of typical human adults (EEG), very specifically their inter-occurrence times across an arbitrarily chosen threshold of the signal (observed, for instance, at the midparietal location in scalp). The distributions of these inter-occurrence times differ from those usually emerging within BG statistical mechanics. They are instead well approached within the q-statistical theory, based on non-additive entropies characterized by the index q. The present method points towards a suitable tool for quantitatively accessing brain complexity, thus potentially opening useful studies of the properties of both typical and altered brain physiology.

Asunto(s)

RESUMEN

BACKGROUND: Socioeconomic status can often dictate access to timely surgical care and postoperative outcomes. We sought to analyze the impact of county-level poverty duration on hepatopancreaticobiliary cancer outcomes. METHODS: Patients diagnosed with hepatopancreaticobiliary cancer were identified from the Surveillance, Epidemiology, and End Results-Medicare 2010 to 2015 database linked with county-level poverty from the American Community Survey and the US Department of Agriculture between 1980 to 2010. Counties were categorized as never high-poverty, intermittent high-poverty, and persistent poverty. Hierarchical generalized linear models and accelerated failure time models with Weibull distribution were used to assess diagnosis, treatment, textbook outcomes, and survival. RESULTS: Among 41,077 patients, 1,758 (4.3%) lived in persistent poverty. Counties exposed to greater durations of poverty had increased proportions of non-Hispanic Black patients (never high-poverty: 7.6%, intermittent high-poverty: 20.4%, persistent poverty: 23.2%), uninsured patients (never high-poverty: 0.5%, intermittent high-poverty: 0.5%, persistent poverty: 0.9%), and patients with a rural residence (never high-poverty: 0.6%, intermittent high-poverty: 2.4%, persistent poverty: 11.5%). Individuals residing in persistent poverty had lower odds of undergoing resection (odds ratio 0.82, 95% confidence interval 0.66-0.98), achieving textbook outcomes (odds ratio 0.54, 95% confidence interval 0.34-0.84), and increased cancer-specific mortality (hazard ratio 1.07, 95% CI 1.00-1.15) (all P < .05). Non-Hispanic Black patients were less likely to present with early-stage disease (odds ratio 0.86, 95% confidence interval 0.79-0.95) and undergo surgical treatment (odds ratio 0.58, 95% confidence interval 0.52-0.66) compared to non-Hispanic White patients (both P < .01). Notably, non-Hispanic White patients in persistent poverty were more likely to present with early-stage disease (odds ratio 1.30, 95% confidence interval 1.12-1.52) and undergo surgery for localized disease (odds ratio 1.36, 95% confidence interval 1.06-1.74) compared to non-Hispanic Black patients in never high-poverty (both P < .05). CONCLUSION: Duration of poverty was associated with lower odds of receipt of surgical treatment, achievement of textbook outcomes, and worse cancer-specific survival. Non-Hispanic Black patients were at particular risk of suboptimal outcomes, highlighting the impact of structural racism independent of socioeconomic status.

Asunto(s)

RESUMEN

BACKGROUND: Defining patterns and risk of recurrence can help inform surveillance strategies and patient counselling. We sought to characterize peak hazard rates (pHR) and peak time of recurrence among patients who underwent resection of hepatocellular carcinoma (HCC). METHODS: 1434 patients who underwent curative-intent resection of HCC were identified from a multi-institutional database. Hazard, patterns, and peak rates of recurrence were characterized. RESULTS: The overall hazard of recurrence peaked at 2.4 months (pHR: 0.0384), yet varied markedly. The incidence of recurrence increased with Barcelona Clinic Liver Cancer (BCLC) stage 0 (29%), A (54%), and B (64%). While the hazard function curve for BCLC 0 patients was relatively flat (pHR: <0.0177), BCLC A patients recurred with a peak at 2.4 months (pHR: 0.0365). Patients with BCLC B had a bimodal recurrence with a peak rate at 4.2 months (pHR: 0.0565) and another at 22.8 months. The incidence of recurrence also varied according to AFP level (≤400 ng/mL: 52.6% vs. >400 ng/mL: 36.3%) and Tumor Burden Score (low: 73.7% vs. medium: 50.6% vs. high: 24.2%) (both p < 0.001). CONCLUSION: Recurrence hazard rates for HCC varied substantially relative to both time and intensity/peak rates. TBS and AFP markedly impacted patterns of hazard risk of recurrence.

Asunto(s)

RESUMEN

The thermal conductance of a one-dimensional classical inertial Heisenberg model of linear size L is computed, considering the first and last particles in thermal contact with heat baths at higher and lower temperatures, Th and Tl (Th>Tl), respectively. These particles at the extremities of the chain are subjected to standard Langevin dynamics, whereas all remaining rotators (i=2,⋯,L-1) interact by means of nearest-neighbor ferromagnetic couplings and evolve in time following their own equations of motion, being investigated numerically through molecular-dynamics numerical simulations. Fourier's law for the heat flux is verified numerically, with the thermal conductivity becoming independent of the lattice size in the limit L→∞, scaling with the temperature, as κ(T)∼T-2.25, where T=(Th+Tl)/2. Moreover, the thermal conductance, σ(L,T)≡κ(T)/L, is well-fitted by a function, which is typical of nonextensive statistical mechanics, according to σ(L,T)=Aexpq(-Bxη), where A and B are constants, x=L0.475T, q=2.28±0.04, and η=2.88±0.04.

RESUMEN

BACKGROUND: The conventional treatment of inflammatory bowel disease (IBD) is based on drug therapy, but different studies have shown a progressive increase in the use of complementary and alternative medicine (CAM). The most used CAM comprises of acupuncture, traditional Chinese medicine, Ayurvedic medicine, homeopathy, and herbal medicine, as well as more modern practices, including aromatherapy and reflexology. Data from CAM use in Brazil has previously been scarce and there are no studies among Brazilian patients with IBD. OBJECTIVE: The aim of the study was to evaluate the frequency of, and factors associated with the use of CAM among IBD patients in Brazil, in addition to estimating the satisfaction with CAM use. METHODS: A cross-sectional study was performed in adult IBD outpatients from two Southeastern Brazilian referral centers, with a total a sample of 227 individuals. A semi-structured questionnaire was used containing CAM products - tea, probiotics, omega 3 or glutamine, homeopathy, and herbal therapy, and factors associated with CAM use and patient satisfaction. We used descriptive statistics, association tests (P<0.05) and logistic regression for statistical analyses. RESULTS: In total, 126 patients with Crohn's disease and 101 with ulcerative colitis were included. The mean age was 41.19±14.49 years and 57.27% were female. The time since diagnosis was 10.58±7.5 years, and most patients were in clinical remission. Twenty-nine patients (12.8%) reported having used CAM for IBD treatment, such as tea (5.29%), probiotics (5.29%), omega-3 or glutamine (1.76%), homeopathy (0.88%), and herbal therapies (0.44%). Despite the low frequency, patients were satisfied (>50%). There was no difference between CAM use in Crohn's disease as compared to ulcerative colitis patients (P=0.1171). The factors associated with the use of CAM were regular or poor quality of life (odds ratio 2.084; 95% confidence interval 1.147-3.786, P=0.0159) and a shorter time since diagnosis (odds ratio 0.956; 95% confidence interval 0.918-0.995; P=0.0260). CONCLUSION: The prevalence of CAM use was low, but satisfactory among Brazilian IBD patients. The application of CAM has been associated with poor quality of life and shorter disease duration compared to patients with no use of CAM.

Asunto(s)

RESUMEN

ABSTRACT Background: The conventional treatment of inflammatory bowel disease (IBD) is based on drug therapy, but different studies have shown a progressive increase in the use of complementary and alternative medicine (CAM). The most used CAM comprises of acupuncture, traditional Chinese medicine, Ayurvedic medicine, homeopathy, and herbal medicine, as well as more modern practices, including aromatherapy and reflexology. Data from CAM use in Brazil has previously been scarce and there are no studies among Brazilian patients with IBD. Objective: The aim of the study was to evaluate the frequency of, and factors associated with the use of CAM among IBD patients in Brazil, in addition to estimating the satisfaction with CAM use. Methods: A cross-sectional study was performed in adult IBD outpatients from two Southeastern Brazilian referral centers, with a total a sample of 227 individuals. A semi-structured questionnaire was used containing CAM products - tea, probiotics, omega 3 or glutamine, homeopathy, and herbal therapy, and factors associated with CAM use and patient satisfaction. We used descriptive statistics, association tests (P<0.05) and logistic regression for statistical analyses. Results: In total, 126 patients with Crohn's disease and 101 with ulcerative colitis were included. The mean age was 41.19±14.49 years and 57.27% were female. The time since diagnosis was 10.58±7.5 years, and most patients were in clinical remission. Twenty-nine patients (12.8%) reported having used CAM for IBD treatment, such as tea (5.29%), probiotics (5.29%), omega-3 or glutamine (1.76%), homeopathy (0.88%), and herbal therapies (0.44%). Despite the low frequency, patients were satisfied (>50%). There was no difference between CAM use in Crohn's disease as compared to ulcerative colitis patients (P=0.1171). The factors associated with the use of CAM were regular or poor quality of life (odds ratio 2.084; 95% confidence interval 1.147-3.786, P=0.0159) and a shorter time since diagnosis (odds ratio 0.956; 95% confidence interval 0.918-0.995; P=0.0260). Conclusion: The prevalence of CAM use was low, but satisfactory among Brazilian IBD patients. The application of CAM has been associated with poor quality of life and shorter disease duration compared to patients with no use of CAM.

RESUMO Contexto: O tratamento convencional da doença inflamatória intestinal (DII) é baseado na terapia medicamentosa, mas diferentes estudos têm mostrado aumento progressivo do uso de medicina complementar e alternativa (MCA) na abordagem dos pacientes. As modalidades de MCA mais usadas compreendem: acupuntura, medicina tradicional chinesa, medicina ayurvédica, homeopatia e fitoterapia, bem como práticas mais modernas, como aromaterapia e reflexologia. Os dados do uso de MCA no Brasil são escassos e não há estudos entre pacientes brasileiros com DII. Objetivo: O objetivo do estudo foi avaliar a frequência e os fatores associados com o uso de MCA entre pacientes com DII, além de estimar a satisfação com o uso de MCA. Métodos: Foi realizado estudo transversal em pacientes adultos ambulatoriais com DII oriundos de dois centros de referência no sudeste do Brasil, com amostra de 227 indivíduos. Foi aplicado questionário semiestruturado contendo produtos como - chá, probióticos, ômega 3 ou glutamina, homeopatia e fitoterapia, além de fatores associados ao uso de MCA e a satisfação do paciente. Utilizamos estatística descritiva, testes de associação (P<0,05) e regressão logística para análise estatística. Resultados: No total, 126 pacientes com doença de Crohn e 101 com retocolite ulcerativa foram incluídos. A média de idade foi 41,19±14,49 anos e 57,27% eram do sexo feminino. O tempo desde o diagnóstico foi de 10,58±7,5 anos, e a maioria dos pacientes estava em remissão clínica. Vinte e nove pacientes (12,8%) relataram ter usado MCA para o tratamento de DII, como chá (5,29%), probióticos (5,29%), ômega-3 ou glutamina (1,76%), homeopatia (0,88%) e fitoterápicos (0,44%). Apesar da baixa frequência, os pacientes ficaram satisfeitos com o uso (>50%). Não houve diferença entre o uso de MCA entre os pacientes com doença de Crohn em comparação com pacientes com retocolite ulcerativa (P=0,1171). Os fatores associados com o uso de MCA foram qualidade de vida regular ou ruim (Odds ratio 2,084; intervalo de confiança de 95% 1,147-3,786, P=0,0159) e menor tempo desde o diagnóstico (Odds ratio 0,956; intervalo de confiança de 95% 0,918-0,995; P=0,0260). Conclusão: A prevalência do uso de MCA foi baixa, mas satisfatória entre os pacientes com DII. O uso de MCA tem sido associada a baixa qualidade de vida e menor duração da doença.

RESUMEN

Search for new pharmacological alternatives for obesity is based on the design and development of compounds that can aid in weight loss so that they can be used safely and effectively over a long period while maintaining their function. The endocannabinoid system is related to obesity by increasing orexigenic signals and reducing satiety signals. Cannabis sativa is a medicinal plant of polypharmaceutical potential that has been widely studied for various medicinal purposes. The in silico evaluation of their natural cannabinoids (also called phytocannabinoids) for anti-obesity purpose stems from the existence of synthetic cannabinoid compounds that have already presented this result, but which did not guarantee patient safety. In order to find new molecules from C. sativa phytocannabinoids, with the potential to interact peripherally with the pharmacological target cannabinoid receptor 1, a pharmacophore-based virtual screening was performed, including the evaluation of physicochemical, pharmacokinetic, toxicological predictions and molecular docking. The results obtained from the ZINC12 database pointed to Zinc 69 (ZINC33053402) and Zinc 70 (ZINC19084698) molecules as promising anti-obesity agents. Molecular dynamics (MD) studies disclose that both complexes were stable by analyzing the RMSD (root mean square deviation) values, and the binding free energy values demonstrate that the selected structures can interact and inhibit their catalytic activity.

Asunto(s)

RESUMEN

Kefiran is a polysaccharide present in kefir grains that have been widely explored due to its potential health benefits. The objective of this work was to characterize and quantify the components present in the ethanolic extract of milk kefir grains; to study its pharmacokinetic and toxicological properties in silico and evaluate the acute toxicity of the kefiran in zebrafish. The prediction of pharmacokinetic properties was performed by QikProp software. In silico toxicity assessment was performed using the DEREK (deductive estimate of risk from existing knowledge) software. In the chromatographic, kefiran was identified as the major component. Results showed that the kefiran had low human oral absorption and intestinal absorption its due poor solubility profile; low logP value, indicating its lipophilicity and the low MDCK and Caco-2 cells permability, and unable to cross the blood-brain barrier. Kefiran did not present any structural warning for in silico toxicity. In zebrafish, the dose of 2,000 mg/kg of kefiran produced nonsignificant alterations in the analyzed organs. It can be said then that kefiran has an acceptable degree of safety for use in the development of drugs or functional foods. Further research such as in vivo testing to confirm its pharmacological potential is currently underway.

RESUMEN

BACKGROUND: Alzheimer's disease (AD) is a neurodegenerative condition and the most common type of dementia among the elderly. The enzymes acetylcholinesterase (AChE) and nitric oxide synthase (NOS) have a pivotal role in the pathophysiology of this disease. OBJECTIVE: This study aimed to select medicinal plant-derived molecules with reported inhibition of AChE and design optimized molecules that could inhibit not only AChE, but also NOS, potentially increasing its efficacy against AD. METHODS: 24 compounds were selected from the literature based on their known AChE inhibitory activity. Then, we performed molecular orbital calculations, maps of electrostatic potential, molecular docking study, identification of the pharmacophoric pattern, evaluation of pharmacokinetic and toxicological properties of these molecules. Next, ten analogs were generated for each molecule to optimize their effect where the best molecules of natural products had failed. RESULTS: The most relevant correlation was between HOMO and GAP in the correlation matrix of the molecules' descriptors. The pharmacophoric group's derivation found the following pharmacophoric features: two hydrogen bond acceptors and one aromatic ring. The studied molecules interacted with the active site of AChE through hydrophobic and hydrogen bonds and with NOS through hydrogen interactions only but in a meaningful manner. In the pharmacokinetic and toxicological prediction, the compounds showed satisfactory results. CONCLUSION: The design of natural products analogs demonstrated good affinities with the pharmacological targets AChE and NOS, with satisfactory pharmacokinetics and toxicology profiles. Thus, the results could identify promising molecules for treating Alzheimer's disease.

Asunto(s)

RESUMEN

We obtain height estimates and half-space theorems concerning a wide class of hypersurfaces immersed into a product space ℝ × M n , the so-called generalized linear Weingarten hypersurfaces, which extends that one having some constant higher order mean curvature.

RESUMEN

Hancornia speciosa Gomes is a tree native to Brazil and has therapeutic potential for several diseases. Ethnopharmacological surveys have reported that the plant is used as a hypoglycemic agent and to lose weight. This study aimed to evaluate the effects of the aqueous extract from H. speciosa latex (LxHs) in a zebrafish model of diabetes. The extract was evaluated through high-performance thin-layer chromatography (HTPLC), nuclear magnetic resonance (NMR), and Fourier-transform infrared spectroscopy (FT-IR). We then tested treatments with LxHs (500, 1000, and 1500 mg/kg) by assessing blood glucose levels in alloxan-induced diabetic animals, and metformin was used as a control. The toxicity was evaluated through histopathology of the pancreas and biochemical assessment of serum levels of AST, ALT, creatinine, and urea. The extract was also assessed for acute toxicity through several parameters in embryos and adult animals. Finally, we performed in silico analysis through the SEA server and docking using the software GOLD. The phytochemical study showed the compounds cornoside, dihydrocornoide, and 1-O-methyl-myoinositol (bornesitol). The treatment with all doses of LxHs significantly decreased alloxan-induced hyperglycemia without any significant histological or biochemical abnormalities. No significant frequency of teratogenesis was observed in the embryos exposed to the extract, and no significant behavioral changes or deaths were observed in adult animals. In silico, the results showed a potential interaction between inositol and enzymes involved in carbohydrates' metabolism. Overall, the results show a hypoglycemic activity of the extract in vivo, with no apparent toxicity. The computational studies suggest this could be at least partially due to the presence of bornesitol, since inositols can interact with carbohydrates' enzymes.

RESUMEN

The q-exponential form eqx≡[1+(1-q)x]1/(1-q)(e1x=ex) is obtained by optimizing the nonadditive entropy Sq≡k1-∑ipiqq-1 (with S1=SBG≡-k∑ipilnpi, where BG stands for Boltzmann-Gibbs) under simple constraints, and emerges in wide classes of natural, artificial and social complex systems. However, in experiments, observations and numerical calculations, it rarely appears in its pure mathematical form. It appears instead exhibiting crossovers to, or mixed with, other similar forms. We first discuss departures from q-exponentials within crossover statistics, or by linearly combining them, or by linearly combining the corresponding q-entropies. Then, we discuss departures originated by double-index nonadditive entropies containing Sq as particular case.

RESUMEN

ABSTRACT BACKGROUND AND OBJECTIVES: The importance of interdisciplinary action has been increasingly recognized in the area of health due to the global effect that has on the various symptoms of the patient. Interdisciplinarity is possible when professionals allow the exchange of knowledge through clinical meetings and jointly follow-up of the case. The objective of this study was to document the interdisciplinary care of patients with orofacial pain symptoms and comorbidities. CASE REPORT: Female patient, 48 years old, diagnosed with muscular temporomandibular disorder and oral opening limitation, labyrinthine cervicalgia, tinnitus, sleep disorder, eating disorders and anxiety after evaluation with an odontologist, otorhinolaryngologist, physiotherapist, acupuncturist, psychologist and nutritionist. The 1-year follow-up with monthly visits with the dentist and nutritionist, and biweekly visits with a psychologist, physiotherapist, and acupuncturist showed symptoms control with total remission of the orofacial pain, cervicalgia, labyrinthitis. Tinnitus did not improve in the sense of frequency that remained constant, but according to the patient, there was an improvement in the adaptation to tinnitus in places with excessive noise, thus allowing a better social interaction. Nutrition and psychology made a great contribution to self-esteem and social routine as well as to seek for a better quality of life. CONCLUSION: The interdisciplinary work promoted a global approach to the patient's symptoms.

RESUMO JUSTIFICATIVA E OBJETIVOS: A importância da ação interdisciplinar tem sido cada vez mais reconhecida na área da saúde, pelo efeito global que exerce sobre os diversos sintomas da paciente. A interdisciplinaridade é possível quando os profissionais permitem a troca do conhecimento através de reuniões clínicas e acompanhamento em conjunto do caso. O objetivo deste estudo foi documentar o atendimento interdisciplinar de paciente que apresentava sintoma da dor orofacial e comorbidades. RELATO DO CASO: Paciente do sexo feminino, 48 anos, diagnosticada com disfunção temporomandibular muscular e limitação de abertura bucal, cervicalgia labirintite, zumbido, distúrbio do sono, distúrbios alimentares e ansiedade após avaliação com odontólogo, otorrinolaringologista, fisioterapeuta, acupunturista, psicólogo e nutricionista. O acompanhamento de 1 ano com consultas mensais na área da odontologia e nutrição e consultas quinzenais na área de fisioterapia, acupuntura e psicologia demonstrou controle dos sintomas com remissão total da dor orofacial, cervicalgia, labirintite. O zumbido não teve melhora no sentido de frequência que permaneceu constante, mas segundo a paciente houve melhora na adaptação ao zumbido em lugares com excesso de barulho, permitindo assim melhor interação social. A nutrição e a psicologia tiveram uma grande contribuição na autoestima e rotina social bem como na busca por melhor qualidade de vida. CONCLUSÃO: O trabalho interdisciplinar promoveu uma abordagem global dos sintomas da paciente.

RESUMEN

Este estudo teve como objetivo analisar os métodos de esterilização utilizados pelos cirurgiões dentistas, observando se fazem o uso de indicadores que verificam a eficácia da esterilização, quais indicadores são empregados e com que frequência. Cinquenta cirurgiões dentistas participaram da pesquisa, respondendo a um questionário com perguntas abordando aspectos sobre a forma de esterilização realizada no local onde o profissional atua. O método de esterilização mais utilizado foi a autoclave. Apenas 44,9% dos entrevistados souberam responder a correta relação tempo/temperatura da autoclave, e metade dos que utilizavam estufa respondeu de forma errônea. 96% dos profissionais fazem uso de algum indicador de verificação de eficácia de esterilização. O indicador mais utilizado foi a fita adesiva externa, empregada diariamente. O meio biológico é pouco utilizado e numa frequência inadequada. A maioria dos entrevistados faz descontaminação do instrumental com lavagem com água e detergente e acondicionamento em papel grau cirúrgico. As respostas obtidas nesta pesquisa indicam que há necessidade de maior conscientização por parte dos profissionais em relação à sua responsabilidade no controle de infecção, sendo necessária uma busca maior por conhecimento em relação às formas de esterilização e o uso de indicadores para verificação de eficácia (AU).

The aim of this study was to analyze the sterilization methods used by dentists, observing if they use indicators that verify the effectiveness of sterilization, which are the indicators and how often are they used. Fifty dentists participated of the survey, answering a questionnaire with questions about aspects of form of sterilization carried out at the place where the professional woks. The most widely used sterilization method was the autoclave. Only 44.9% of those interviewed could answer the correct relation of autoclave time/temperature and half of those that used ovens answered wrongly. 96% of professionals make use of some sterilization effectiveness check indicator. The most widely used indicator was the external tape used daily. The biological indicator is underutilized and in an inadequate frequency. Most of the dentists interviewed perform decontamination of instruments washing with water and detergent and packaging in surgical grade paper. The answers obtained in this study indicate that there is need of greater awareness from professionals in relation to their responsibility to control infection, requiring a greater search of knowledge about ways of sterilization and the use of indicators for efficacy verification (AU).

Asunto(s)

RESUMEN

OBJECTIVE: to evaluate the expression of the epithelial growth factor receptor (EGFR) by immunohistochemistry, and to verify its association with prognostic factors and survival of patients operated by cholangiocarcinoma. METHODS: we verified the immunohistochemical expression of EGFR in 35 surgical specimens of cholangiocarcinoma (CCA). We obtained survival curves with the Kaplan-Meier method. RESULTS: we found significant EGFR expression in ten (28.6%) of the 35 CCAs, eight with score 3 and two with score 2. Advanced stages (III and IV) presented higher EGFR expression (p=0.07). The clinical characteristics that were most associated with positive EGFR expression were female gender (p=0.06) and absence of comorbidities (p=0.06). Overall survival at 12, 24, 36 and 48 months was 100%, 82.5%, 59% and 44.2%, respectively. The survival of EGFR positive patients at 12, 24, 36 and 48 months was 100%, 75%, 50% and 0%, whereas for negative EGFR patients it was 100%, 87.5%, 65.6% and 65.6%, respectively. CONCLUSION: EGFR expression occurred in 28.6% of the cases studied and was associated with lower survival.

Asunto(s)

RESUMEN

ABSTRACT Objective: to evaluate the expression of the epithelial growth factor receptor (EGFR) by immunohistochemistry, and to verify its association with prognostic factors and survival of patients operated by cholangiocarcinoma. Methods: we verified the immunohistochemical expression of EGFR in 35 surgical specimens of cholangiocarcinoma (CCA). We obtained survival curves with the Kaplan-Meier method. Results: we found significant EGFR expression in ten (28.6%) of the 35 CCAs, eight with score 3 and two with score 2. Advanced stages (III and IV) presented higher EGFR expression (p=0.07). The clinical characteristics that were most associated with positive EGFR expression were female gender (p=0.06) and absence of comorbidities (p=0.06). Overall survival at 12, 24, 36 and 48 months was 100%, 82.5%, 59% and 44.2%, respectively. The survival of EGFR positive patients at 12, 24, 36 and 48 months was 100%, 75%, 50% and 0%, whereas for negative EGFR patients it was 100%, 87.5%, 65.6% and 65.6%, respectively. Conclusion: EGFR expression occurred in 28.6% of the cases studied and was associated with lower survival.

RESUMO Objetivo: avaliar a expressão do receptor do fator de crescimento epitelial (EGFR) por meio de imuno-histoquímica, e verificar sua associação com fatores prognósticos e com a sobrevida dos pacientes operados por colangiocarcinoma. Métodos: a expressão imuno-histoquímica de EGFR foi verificada em 35 peças cirúrgicas de colangiocarcinomas (CCA). Curvas de sobrevida foram obtidas pelo método de Kaplan-Meier. Resultados: expressão significativa de EGFR foi encontrada em dez (28,6%) de 35 CCA, oito com escore 3 e dois com escore 2. Estágios avançados (III e IV) apresentaram maior expressão de EGFR (p=0,07). As características clínicas que mais estiveram associadas com a expressão positiva de EGFR foram o sexo feminino (p=0,06) e ausência de comorbidades (p=0,06). A sobrevida global aos 12, 24, 36 e 48 meses foi de 100%, 82,5%, 59% e 44,2%, respectivamente. A sobrevida de pacientes EGFR positivos aos 12, 24, 36 e 48 meses foi de 100%, 75%, 50% e 0%, enquanto que para EGFR negativos foi de 100%, 87,5%, 65,6% e 65,6%, respectivamente. Conclusão: a expressão do EGFR ocorreu em 28,6% dos casos estudados e esteve associada a menor sobrevida.

Asunto(s)