Tratamento da dor oncológica: uma revisão sobre desafios, necessidades e tendências para o futuro

A dor crônica no paciente oncológico é um grande desafio ao manejo terapêutico. Diversas são as linhas de tratamento especializado, perfazendo abordagens farmacológicas e não farmacológicas. Objetivou-se avaliar, por meio de uma revisão narrativa de literatura, as principais condutas associadas à cronicidade da dor oncológica. Marcada pela complexidade, a dor crônica é um dos sintomas mais prevalentes em pessoas com câncer. Com o aumento da taxa de sobrevida dos pacientes portadores de neoplasias, surge a necessidade de estabelecer estratégias especializadas, em detrimento da antagônica postura generalizada, que vigora em quase metade dos casos no país. Considerando as principais opções de tratamento analisadas, destaca-se, sobretudo, a utilização demasiada de opioides, os quais, além dos benefícios para a dor, trazem consigo diversos efeitos colaterais. Nessa perspectiva, percebeu-se que o mais adequado é a abordagem multidisciplinar e multiprofissional do paciente, associando diferentes terapêuticas. Entretanto, no que concerne às terapias alternativas existentes, carece-se de estudos para solidificar seu embasamento científico e sua efetividade para complementar e ampliar a terapêutica tradicional, no intuito de melhorar a qualidade e a efetividade do tratamento oferecido aos pacientes

COVID19: alocação de recursos e escolhas estratégicas na pandemia / COVID19: resource allocation and strategic choices strategic choices in the pandemic

Atualmente vivemos em um cenário de pandemia causada pelo “CORONAVIRÚS”.Esse vírus foi isolado pela primeira vez em seres humanos em 1937, entretanto foi em 1965 que ele foi descrito pela primeira vez após análise microscópica. A condição atual é causada pelo SARS-COV-2 e teve seu primeiro caso confirmado no Brasil em 26 de fevereiro de 2020 e foi reconhecida pela Organização Mundial da Saúde (OMS) no dia 11 de março de 2020. (1

Prevenção e manejo do delirium pós-operatório em pacientes idosos

O artigo buscou abordar o Delirium Pós-Operatório (DPO) na população idosa, bem como sua prevenção e manejo. O delirium é considerado um distúrbio neurocognitivo secundário à neuroinflamação por múltiplas causas. Clinicamente, caracteriza-se por alterações psicomotoras heterogêneas, o que permite classificá-lo nos subtipos hipoativo, hiperativo ou misto, sendo que a majoritária parcela dos pacientes manifesta o primeiro subtipo e cursa com pior prognóstico. Nesse sentido, a incidência de DPO chega a acometer 70% dos pacientes com mais de 60 anos submetidos a grandes cirurgias e está associada a resultados adversos, incluindo aumento na morbimortalidade em 30 dias, declínio cognitivo persistente com diminuição da qualidade de vida, maior demanda de cuidados intensivos e maior tempo de internação hospitalar. Nota-se que o quadro clínico perioperatório é autolimitado e passível de tratamento medicamentoso, embora também possa persistir ou surgir após o período pós-operatório, acentuando os impactos psicológicos nos pacientes. Mesmo que muito já se tenha descoberto sobre essa patologia, ainda são necessários mais estudos para melhor caracterizar seu processo fisiopatológico, a fim de fornecer mais evidências para auxiliar a conduta médica

Dermatologists' attitude towards psoriasis treatment during the COVID-19 pandemic

Publisher Copyright: Copyright © 2021 Torres T, Pereira M, Paiva Lopes MJ, Rebelo C, Pedro Andrade P, Henrique M, Oliveira H, Ferreira P, Marques Pinto G, Menezes Brandão F, Rozeira J, Filipe P, Tavares Bello R. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.Background: The COVID-19 pandemic introduced new challenges in several dimensions in healthcare services. Herein, we describe the real-life strategies and therapeutic options adopted by dermatologists regarding their patients with psoriasis being treated with or with an indication for systemic therapy during the first COVID-19 lockdown period in Portugal. Methods: The study involves a web-based survey on the clinical management of systemic therapy for psoriasis during the COVID-19 pandemic administered to Portuguese dermatologists. The survey consisted of 55 questions (4 openended questions; 51 closed-ended questions), grouped into 6 sections. Results: A total of 60 dermatologists voluntarily participated in this survey. Nearly 63% of the participants opted for suspending biologics during the COVID-19 lockdown period and 23.3% increased the time between drug administrations. Eighty percent of the participants agreed that biologics did not change the probability of acquiring COVID-19 and 58.4% believed that these drugs decreased or did not change the severity of the disease. Approximately one-third of the participants opted not to prescribe a biological agent in patients despite clinical indication over the duration of the pandemic. Nearly 25% of the participants opted for suspending traditional immunosuppressant administration. Virtual appointments were an option for 93.3% of the participants. Conclusion: The COVID-19 pandemic has significantly affected the management of patients with psoriasis being treated with or with an indication for systemic therapy. Some of the decisions made during the first lockdown period were contrary to what we know today. These decisions might have had a significant impact on patients' quality of life and on future therapeutic success. An adequate interpretation and analysis of the available data will be extremely important to an insightful adaptation of the clinical practice in future confinement or restrictive scenarios.publishersversionpublishe

Abordagem anestésica no parto cesáreo e controle da dor no pós-operatório: Anesthetic approach in cesarean section and postoperative pain control

Este artigo analisou a produção científica sobre a abordagem anestésica no parto cesáreo e controle da dor no pós-operatório, de forma a entender os benefícios e os malefícios de cada técnica utilizada. Percebeu-se que o uso da raquianestesia utilizando combinação de fármacos pode tanto ser uma abordagem segura e confiável quanto promover também analgesia prolongada no pós-operatório. A anestesia combinada raqui-peridural permite um melhor ajuste de dose, diminui os efeitos adversos, possibilita um menor tempo de permanência, mas pode ter problemas com relação à técnica e ao cateter em si. Já a anestesia peridural, apesar de ter algumas contraindicações, como a sepse, a mielopatia e a hipovolemia, por exemplo, possibilita a participação consciente da mãe durante o parto, além de manter os reflexos protetores de vias aéreas superiores intacto. Por fim, a anestesia geral não deve ser a técnica de escolha na cesariana, exceto em algumas situações específicas, como a instabilidade hemodinâmica e a hipertensão intracraniana, por conta de seus inúmeros efeitos adversos. Não há, portanto, uma técnica ideal, sendo necessário o conhecimento de todas para proporcionar uma melhor anestesia para a mãe e seu concepto

A utilização das técnicas opioid-free e opioid-sparing na prática Anestésica

O presente artigo teve como objetivo apresentar, a partir de uma revisão narrativa de literatura, os prós e contras das Técnicas Opioid-Free (TOF) e Opioid-Sparing (TOS) no manejo da prática anestésica. Sabe-se que os opioides apresentam propriedades analgésicas que os tornam componentes importante da anestesia; porém, apresentam riscos indesejáveis, como dependência e hiperalgesia. Desse modo, a utilização de novas modalidades anestésicas é uma alternativa para um intra e pós-operatório mais seguros, visando minimizar os efeitos adversos do uso opioides. Entre as novas técnicas, a TOF é caracterizada pela não utilização de opioides, mas sim anti-inflamatórios não esteroidais, técnicas analgésicas regionais e adjuvantes não farmacológicos. Tem-se também a TOS, em que se administra a quantidade mínima possível de opioide no ambiente cirúrgico capaz de produzir efeitos analgésicos e prolongar a sedação. Contudo, ainda não há estudos suficientes que consolidem as técnicas alternativas em detrimento ao uso convencional de opioide na prática anestésica, tornando necessárias novas pesquisas que esclareçam suas vantagens e indicações

Efeitos colaterais do uso de reversores de bloqueadores neuromusculares na prática anestésica

O presente artigo trata-se dos efeitos colaterais do uso de reversores de bloqueadores neuromusculares, com o objetivo de aprofundar o reconhecimento dos medicamentos, suas principais complicações, e o manejo de recuperação pós-anestésica. O uso desses reversores pode trazer impactos adversos, como por exemplo, cardiovasculares, trato gastrointestinal, respiratórios, mas ao associar-se com os anticolinesterásicos na decorrência do término da cirurgia, essa faixa de complicação é reduzida. Para ter um manejo apropriado dos BNM’s, é necessário monitorizar as funções neuromusculares, para isso, têm-se os monitores qualitativos e os quantitativos. E durante uma operação cirúrgica, são utilizados os estimuladores de nervo periféricos, que serão explicados no decorrer do artigo

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Diminishing benefits of urban living for children and adolescents’ growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income&nbsp;countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was &lt;1.1 kg m–2 in the vast majority of&nbsp;countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified