Asthma and pregnancy : a comprehensive approach.

A asma e doenca inflamatoria cronica caracterizada pela hiper-reatividade br?nquica a varios estimulos, culminando com crises de broncoespasmo. Na gravidez a asma mal controlada pode ocasionar hipoxia e consequente aumento da letalidade materna e perinatal, prematuridade e retardo no crescimento fetal, hiperemese e pre-eclampsia. O curso da asma, durante a gravidez, nao e previsivel, podendo ocorrer melhora, piora ou estabilizacao do quadro. O tratamento da asma na gravidez apresenta-se similar ao tratamento habitual. Os objetivos principais do tratamento sao: controlar sintomas evitando hipoxia fetal, orientar a gestante sobre sintomas e como evitar fatores desencadeantes, tratamento da crise e de manutencao para manter a funcao pulmonar normal ou proxima do normal. O monitoramento da asma na gestacao devera ser mensal, com realizacao de espirometria na primeira consulta de pre-natal e avaliacao de pico de fluxo (peak-flow) nas consultas subsequentes. Os medicamentos utilizados para asma sao divididos em duas categorias: medicamentos para melhora da crise (sintomas agudos) e medicamentos de manuten??o (evitar exacerbacoes ? controle de sintomas). A ultrassonografia deve ser realizada precocemente para adequada datacao da gravidez, possibilitando acompanhamento adequado do crescimento fetal. Exames seriados no 2o e 3o trimestres sao essenciais se a gestante apresenta asma moderada ou grave ou se ha suspeita de restricao no crescimento fetal. A amamentacao no pos-parto deve ser incentivada e as medicacoes antiasmaticas mantidas.Asthma is a chronic inflammatory disease characterized by bronchial hyper-reactivity to various stimuli, culminating with bronchospasm crises. Poorly controlled asthma during pregnancy can lead to hypoxia and the consequent increase in maternal and perinatal mortality, prematurity and fetal growth retardation, hyperemesis, and preeclampsia. The course of asthma during pregnancy is not predictable and improvements, worsening, or stabilization of the framework can occur. The treatment of asthma during pregnancy is similar to the usual treatment. The main objectives of treatment are: to control symptoms by avoiding fetal hypoxia, guide the pregnant women about symptoms and how to avoid triggering factors, treatment of crises and maintenance of a normal or near-normal lung function. Asthma during pregnancy should be monitored monthly, with spirometry in the first prenatal consultation and evaluation of peak flow (peak-flow) in subsequent consultations. The medicines used for asthma are divided into two categories: medications for improving a crisis (acute symptoms) and maintenance medications (avoiding exacerbations-controlling symptoms). The ultrasound should be performed early for adequate pregnancy dating enabling appropriate follow-up of fetal growth. Serial exams on the 2nd and 3rd trimesters are essential if the pregnant woman has moderate or severe asthma or if there is suspicion of fetal growth restriction. Breastfeeding in postpartum should be encouraged, and anti-asthmatic medications maintaine

Time trend of breast cancer mortality in BRAZILIAN men: 10-year data analysis from 2005 to 2015

Abstract Background Male Breast Cancer (MBC) is rare, which makes its understanding and treatment be extrapolated from what is known about the occurrence in women, with few epidemiological studies. Therefore, the aim of the present paper was to study breast cancer mortality in adult males in Brazil and its administrative regions between 2005 and 2015. Methods Ecological study with data on MBC mortality in adults between 2005 and 2015. Data were obtained from the Mortality Information System of the Department of Informatics of SUS (the Unified Health System of the country). Descriptive statistics were used for MBC mortality and linear regression to analyze the relationship between mortality and the country’s administrative regions. Percentage Change (PC) and Annual Percentage Change (APC) were the trend measures used for MBC mortality for the period. Results Between 2005 and 2015, there were 1521 deaths due to MBC in adults in Brazil. Regarding mortality by region, there was great oscillation in the rates of the country as a whole (PC = 113,87; β = 0,009 (IC95% 0,000 – 0,018); r2 = 0,381; P = 0,043). The highest increase in MBC mortality occurred in patients aged 80 years or older (PC = 161,04; β = 0,201 (IC95% 0,640 - 0,339); r2 = 0,550; P = 0,009) and there was significant increase in deaths for the 50–54-year age group (PC = 224,01; β = 0,135 (CI95% 0,052; 0,218); r2 = 0,601; P = 0,005). Conclusion Mortality in adults due to MBC increased in Brazil during the study period with the highest percentage increase occurring for individuals aged 80 years or older