A Randomised, Double Blind, Placebo-Controlled Pilot Study of Oral Artesunate Therapy for Colorectal Cancer.

BACKGROUND: Artesunate is an antimalarial agent with broad anti-cancer activity in in vitro and animal experiments and case reports. Artesunate has not been studied in rigorous clinical trials for anticancer effects. AIM: To determine the anticancer effect and tolerability of oral artesunate in colorectal cancer (CRC). METHODS: This was a single centre, randomised, double-blind, placebo-controlled trial. Patients planned for curative resection of biopsy confirmed single primary site CRC were randomised (n = 23) by computer-generated code supplied in opaque envelopes to receive preoperatively either 14 daily doses of oral artesunate (200 mg; n = 12) or placebo (n = 11). The primary outcome measure was the proportion of tumour cells undergoing apoptosis (significant if > 7% showed Tunel staining). Secondary immunohistochemical outcomes assessed these tumour markers: VEGF, EGFR, c-MYC, CD31, Ki67 and p53, and clinical responses. FINDINGS: 20 patients (artesunate = 9, placebo = 11) completed the trial per protocol. Randomization groups were comparable clinically and for tumour characteristics. Apoptosis in > 7% of cells was seen in 67% and 55% of patients in artesunate and placebo groups, respectively. Using Bayesian analysis, the probabilities of an artesunate treatment effect reducing Ki67 and increasing CD31 expression were 0.89 and 0.79, respectively. During a median follow up of 42 months 1 patient in the artesunate and 6 patients in the placebo group developed recurrent CRC. INTERPRETATION: Artesunate has anti-proliferative properties in CRC and is generally well tolerated

Client with epilepsy in a work Brazilian rehabilitation center Cliente com epilepsia em um centro de reabilitação profissional brasileiro

INTRODUCTION: People with epilepsy (PWE) may have problems in obtaining or maintaining regular employment because of restrictions related to their handicap, social prejudices and also high rates of unemployment of the population. The main aim of this pilot study was to know the vocational rehabilitation problems involving PWE sent to a vocational rehabilitation center (VRC) in Rio de Janeiro. METHOD: Fifteen PWE were selected unbiased from those seen at the VCR. It was reviewed their records in the search of sociodemographic, health care, employment suitability and work rehabilitation data. RESULTS: Only one person was eligible for the training program, four were ineligible, six were temporarily ineligible, and the other four do not necessitate the rehabilitation, but as the majority, the better seizures control. CONCLUSIONS: The studied sample of selected PWE, but representative of the studied population, do not show any important successful in the vocational rehabilitation carried out at the VRC.<br>INTRODUÇÃO: A pessoa com epilepsia (PCE) pode ter problemas para obter ou manter emprego regular por conta de restrições relacionadas à sua deficiência, preconceitos sociais ou altas taxas de desemprego na população. O principal objetivo deste estudo piloto é o reconhecimento dos problemas de reabilitação profissional de PCE enviadas para um Centro de Reabilitação Profissional (CRP) no Rio de Janeiro. MÉTODO: Quinze PCE foram selecionadas sem viés de um CRP. Foram revistos seus prontuários na procura de dados sociodemográficos, de cuidados de saúde, além de capacidade de emprego segundo a análise de função e infortunística. RESULTADOS: Apenas uma pessoa foi elegível para o programa de treinamento, quatro inelegíveis, seis temporariamente inelegíveis, e os outros quatro não necessitam da reabilitação profissional, mas como a maioria, o melhor controle das crises epilépticas. CONCLUSÕES: A amostra estudada e selecionada de PCE mas representativa da população estudada, não revelou nenhum sucesso importante na reabilitação promovida pela CRP