Epithelioid Angiosarcoma of the Small Intestine After Occupational Exposure to Radiation and Polyvinyl Chloride: A case Report and Review of Literature

Angiosarcomas represent 1–2% of soft tissue sarcomas and most frequently occur in the subcutis. They may affect internal organs, such as the heart, liver, and spleen, and only rarely do they emerge in the gastrointestinal tract. The association between angiosarcomas and certain toxic chemical substances or previous external-beam radiation therapy is well documented

Desenvolvimento de um modelo experimental de hemorragia subependim?ria-intraventricular em ratos rec?m-nascidos

Made available in DSpace on 2015-04-14T13:32:39Z (GMT). No. of bitstreams: 1 411483.pdf: 9511623 bytes, checksum: 6e96dbea5095542343d03d019de7bb7c (MD5) Previous issue date: 2009-03-02Introdu??o: A hemorragia subependim?ria-intraventricular, tamb?m chamada de hemorragia da matriz germinativa, ocorre, em pr?-termos com menos de 34 semanas e/ou abaixo de 1500 gramas. O desenvolvimento de modelos para entender a evolu??o da les?o cerebral antes e depois da hemorragia ? importante para determinar estrat?gias de tratamento da doen?a. Objetivo: desenvolver um modelo experimental neonatal de hemorragia subependim?ria-intraventricular em ratos rec?m-nascidos, atrav?s da colagenase tipo VII e avaliar os desfechos da les?o atrav?s de testes neuromotores, cognitivos e avalia??o macrosc?pica e microsc?pica dos subgrupos: controle negativo, grupo salina e colagenase. M?todo: Ratos Wistar no P6 foram submetidos ? hemorragia pela t?cnica da m?o livre (freehand) atrav?s de uma inje??o intracraniana com colaganese tipo VII. Num grupo foi provocada hemorragia unilateral, e, em outro, hemorragia bilateral. Os mesmos foram avaliados com testes neuromotores e cognitivos (P7, P11, P15 e P30). Ap?s os testes neuromotores e cognitivos, foram realizadas as avalia??es macrosc?picas e histol?gicas. Um grupo de animais tamb?m foi avaliado histologicamente no P7 ap?s a les?o hemorr?gica. Resultados: Foi poss?vel provocar les?o na matriz germinativa com colagenase tipo VII, sendo f?cil de reproduzir. As altera??es neuromotoras, como ambula??o, geotaxia negativa, reflexo de endireitamento e o teste de preens?o das patas anteriores apresentaram valores significativos na fase aguda. J? o teste do cilindro e o reconhecimento de objeto n?o foram estatisticamente significativos. O teste do campo aberto foi significativo para o grupo com hemorragia bilateral. Encontramos diminui??o do volume do enc?falo e les?o da matriz germinativa na avalia??o histol?gica. Conclus?o: O modelo de hemorragia subependim?ria-intraventricular em ratos Wistar rec?m-nascidos (P6) foi estabelecida utilizando a colagenase tipo VII, sendo de f?cil execu??o. N?o houve diferen?a significativa na avalia??o cognitiva e as altera??es neuromotoras s?o not?veis na fase aguda. A avalia??o histol?gica evidenciou altera??es semelhantes ?s do humano. Houve redu??o do volume do enc?falo na regi?o do hemisf?rio correspondente ? les?o

Feasibility and effectiveness of an evidence-based asthma service in Australian community pharmacies: a pragmatic cluster randomised trial

Objective: To test the feasibility, effectiveness and sustainability of a pharmacy asthma service in primary care. Methods: A pragmatic cluster randomised trial in community pharmacies in four Australian states/territories in 2009. Specially trained pharmacists were randomised to deliver an asthma service in two groups, providing 3 or 4 consultations over 6 months. People with poorly-controlled asthma or no recent asthma review were included. Follow-up for 12 months after service completion occurred in 30% of randomly-selected completing patients. Outcomes included change in asthma control (poor, fair/good) and Asthma Control Questionnaire (ACQ) score, inhaler technique, quality of life, perceived control, adherence, asthma knowledge and asthma action plan ownership. Objective: To test the feasibility, effectiveness and sustainability of a pharmacy asthma service in primary care. Methods: A pragmatic cluster randomised trial in community pharmacies in four Australian states/territories in 2009. Specially trained pharmacists were randomised to deliver an asthma service in two groups, providing 3 or 4 consultations over 6 months. People with poorly-controlled asthma or no recent asthma review were included. Follow-up for 12 months after service completion occurred in 30% of randomly-selected completing patients. Outcomes included change in asthma control (poor, fair/good) and Asthma Control Questionnaire (ACQ) score, inhaler technique, quality of life, perceived control, adherence, asthma knowledge and asthma action plan ownership. Conclusions: The pharmacy asthma service delivered clinically important improvements in both a 3-visit and 4-visit service. Pharmacists were able to recruit and deliver the service with minimal intervention suggesting it is practical to implement in practice. The 3-visit service would be feasible and effective to implement, with a review at 12 months

Using the community pharmacy to identify patients at risk of poor asthma control and factors which contribute to this poor control

Background. Although asthma can be well controlled by appropriate medication delivered in an appropriate way at an appropriate time, there is evidence that management is often suboptimal. This results in poor asthma control, poor quality of life, and significant morbidity. Methods. The objective of this study was to describe a population recruited in community pharmacy identified by trained community pharmacists as being at risk for poor asthma outcomes and to identify factors associated with poor asthma control. It used a cross-sectional design in 96 pharmacies in metropolitan and regional New South Wales, Victoria, Queensland, and Australian Capital Territory in Australia. Community pharmacists with specialized asthma training enrolled 570 patients aged ≥18 years with doctor-diagnosed asthma who were considered at risk of poor asthma outcomes and then conducted a comprehensive asthma assessment. In this assessment, asthma control was classified using a symptom and activity tool based on self-reported frequency of symptoms during the previous month and categorized as poor, fair, or good. Asthma history was discussed, and lung function and inhaler technique were also assessed by the pharmacist. Medication use/adherence was recorded from both pharmacy records and the Brief Medication Questionnaire (BMQ). Results. The symptom and activity tool identified that 437 (77%%) recruited patients had poor asthma control. Of the 570 patients, 117 (21%%) smoked, 108 (19%%) had an action plan, 372 (69%%) used combination of inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA) medications, and only 17-28%% (depending on device) used their inhaler device correctly. In terms of adherence, 90% had their ICS or ICS/LABA dispensed <6 times in the previous 6 months, which is inconsistent with regular use; this low adherence was confirmed from the BMQ scores. A logistic regression model showed that patients who smoked had incorrect inhaler technique or low adherence (assessed by either dispensing history or BMQ) and were more likely to have poor control. Conclusion. Community pharmacists were able to identify patients with asthma at risk of suboptimal control, and factors that contributed to this were elicited. This poorly controlled group that was identified may not be visible or accessible to other health-care professionals. There is an opportunity within pharmacies to target poorly controlled asthma and provide timely and tailored interventions