Diagnóstico e manejo do Tumor de Wilms na população infantil

O tumor de Wilms (nefroblastoma) é uma alteração embrionária maligna da linhagem mesodérmica, predominantemente identificado ao longo da infância. A apresentação clínica inicial mais comum é sutil e cursa com o surgimento de uma massa abdominal assintomática. Objetivo: Analisar a abordagem de diagnóstico e tratamento do Tumor de Wilms em crianças. Método: Trata-se de uma revisão integrativa realizada nas bases de dados Portal Periódicos CAPES, Medline, Lilacs e Scopus, através dos descritores “Tumor de Wilms”, “Nefroblastoma”, “Detecção Precoce de Câncer”, “Tratamento”, no período de 01 e 15 de março, 2022. Filtros de busca adotados: publicações dos últimos 5 anos, em português, inglês e espanhol. Ao fim foram selecionados 19 artigos para serem incluídos na redação final da discussão. Resultados e discussão: Do total de artigos selecionados, 52,63% são procedentes da CAPES, 26,31% encontrados na Medline, Lilacs correspondendo a 10,53% e Scopus, significando 10,53%. Os autores estão em consonância quanto a adoção de protocolos como o International Society of Paediatric Oncology e as diretrizes do Grupo de Oncologia Infantil para a definição do diagnóstico de modo seguro e eficaz. O prognóstico segue sendo positivo na maioria dos casos, no entanto algumas variáveis podem influenciar a evolução, como o tipo histológico do tumor e período de início do tratamento. Conclusão: a atenção da equipe multidisciplinar no processo de diagnóstico precoce influi diretamente na qualidade do tratamento prestado para o paciente, sendo o resultado de exames de imagem e a avaliação imunohistológica essenciais para o estadiamento e adequação terapêutica

Aplicação do processo de enfermagem ao indivíduo com diabetes mellitus baseado na teoria de callista roy / Application of the nursing process to individuals with diabetes mellitus based on the theory of callista roy

O Diabetes Mellitus se constitui o grupo das doenças metabólicas crônicas não transmissíveis caracterizada por apresentar níveis elevados da glicose (hiperglicemia) e está associada as complicações, disfunções e insuficiência de diversos órgãos. Nesse sentindo, o processo de enfermagem é um instrumento metodológico que orienta o cuidado dos profissionais de enfermagem e a documentação da prática profissional Os elementos do processo de enfermagem idealizados por Callista Roy incluem: investigação do comportamento, investigação de estímulos, diagnóstico de enfermagem, estabelecimento de metas, intervenção e avaliação. Objetivou-se aplicar o processo de enfermagem implementado à luz da Teoria da Adaptação de Callista Roy a um paciente diagnosticado com diabetes mellitus. Trata-se de um estudo de caso, do tipo descritivo-exploratória com abordagem qualitativa, resultante da aplicação do processo de enfermagem mediado pela teoria de Adaptação de Callista Roy a um paciente diabético. Evidenciaram-se seis diagnósticos de enfermagem elencados com base na taxonomia da Nanda International nursing diagnoses: definitions and classification (2018-2020), para estabelecer as intervenções de enfermagem utilizou-se a Classificação das Intervenções de Enfermagem e para os resultados de enfermagem a Classificação dos Resultados de Enfermagem. Neste estudo evidenciou-se que aplicação do processo de enfermagem ao indivíduo com diabetes mellitus baseado na teoria de Callista Roy, contribuiu com o cuidado efetivo de enfermagem ao dar importância aos estímulos que desencadeiam respostas às quais exigem a adaptação do paciente. Portanto, destaca-se a necessidade de um maior compromisso dos familiares mediante o plano terapêutico proposto ao paciente

A importância do acolhimento e classificação de risco nas urgências/emergências obstétricas: revisão de literatura / The importance of reception and risk classification in obstetric emergencies/emergencies: literature review

A gestação constitui um fenômeno natural e fisiológico do ciclo vital feminino, que na maioria das vezes evolui sem intercorrências e complicações clínicas e obstétricas é um fenômeno natural e fisiológico, que na maioria das vezes evolui sem intercorrências. Quando ocorrem alguma intercorrência obstétrica, essa necessita de atendimento em unidades de urgência, bem como as de emergência, sendo necessário que os profissionais de saúde acolham e realizem a classificação de risco obstétrico. Objetivou-se, mediante a literatura científica, evidenciar a importância do acolhimento e classificação de risco nas urgências e emergências obstétricas. Trata-se de revisão narrativa da literatura, desenvolvida entre os meses de fevereiro a maio de 2019 nas bases de dados LILACS; MEDLINE e BDENF indexadas na Biblioteca Virtual em Saúde (BVS). Utilizou-se a seguinte estratégia de busca: “Enfermagem em urgência e emergência” AND “Assistência pré-hospitalar” AND “Urgência e Emergência obstétrica” AND “Mortalidade Materna”. Após aplicação dos critérios de elegibilidade foram selecionados 06 artigos para compor amostra final. Realizou-se a leitura na íntegra e extração das informações de identificação dos artigos selecionados. Os dados obtidos foram discutidos mediante a literatura científica pertinente à temática em estudo. Mediante análise dos artigos selecionados, constatou-se que o perfil obstétrico de mulheres atendidas na classificação de risco obstétrico nos serviços maternos infantis atingiu os objetivos propostos quanto a implementação dos protocolos de acolhimento e classificação de riscos nos atendimentos obstétricos, tendo sido evidenciados as principais queixas obstétricas que delimitam um perfil de mulheres gestantes. Ademais, os estudos analisados sugerem o desenvolvimento de pesquisas científicas posteriores, que busquem evidenciar a importância do acolhimento com classificação de risco nos serviços obstétricos, visando a integralidade, a resolutividade e qualidade da assistência obstétrica ofertada, assim como as repercussões sobre os resultados maternos e perinatais

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

Consistent improvement with eculizumab across muscle groups in myasthenia gravis

Objective: To assess whether eculizumab, a terminal complement inhibitor, improves patient- and physician-reported outcomes (evaluated using the myasthenia gravis activities of daily living profile and the quantitative myasthenia gravis scale, respectively) in patients with refractory anti-acetylcholine receptor antibody-positive generalized myasthenia gravis across four domains, representing ocular, bulbar, respiratory, and limb/gross motor muscle groups. Methods: Patients with refractory anti-acetylcholine receptor antibody-positive generalized myasthenia gravis were randomized 1:1 to receive either placebo or eculizumab during the REGAIN study (NCT01997229). Patients who completed REGAIN were eligible to continue into the open-label extension trial (NCT02301624) for up to 4 years. The four domain scores of each of the myasthenia gravis activities of daily living profile and the quantitative myasthenia gravis scale recorded throughout REGAIN and through 130 weeks of the open-label extension were analyzed. Results: Of the 125 patients who participated in REGAIN, 117 enrolled in the open-label extension; 61 had received placebo and 56 had received eculizumab during REGAIN. Patients experienced rapid improvements in total scores and all four domain scores of both the myasthenia gravis activities of daily living profile and the quantitative myasthenia gravis scale with eculizumab treatment. These improvements were sustained through 130 weeks of the open-label extension. Interpretation: Eculizumab treatment elicits rapid and sustained improvements in muscle strength across ocular, bulbar, respiratory, and limb/gross motor muscle groups and in associated daily activities in patients with refractory anti-acetylcholine receptor antibody-positive generalized myasthenia gravis

Long-term safety and efficacy of eculizumab in generalized myasthenia gravis

Introduction: Eculizumab is effective and well tolerated in patients with antiacetylcholine receptor antibody-positive refractory generalized myasthenia gravis (gMG; REGAIN; NCT01997229). We report an interim analysis of an open-label extension of REGAIN, evaluating eculizumab's long-term safety and efficacy. Methods: Eculizumab (1,200 mg every 2 weeks for 22.7 months [median]) was administered to 117 patients. Results: The safety profile of eculizumab was consistent with REGAIN; no cases of meningococcal infection were reported during the interim analysis period. Myasthenia gravis exacerbation rate was reduced by 75% from the year before REGAIN (P < 0.0001). Improvements with eculizumab in activities of daily living, muscle strength, functional ability, and quality of life in REGAIN were maintained through 3 years; 56% of patients achieved minimal manifestations or pharmacological remission. Patients who had received placebo during REGAIN experienced rapid and sustained improvements during open-label eculizumab (P < 0.0001). Discussion: These findings provide evidence for the long-term safety and sustained efficacy of eculizumab for refractory gMG. Muscle Nerve 2019

Long-term efficacy and safety of eculizumab in Japanese patients with generalized myasthenia gravis: A subgroup analysis of the REGAIN open-label extension study

The terminal complement inhibitor eculizumab was shown to improve myasthenia gravis-related symptoms in the 26-week, phase 3, randomized, double-blind, placebo-controlled REGAIN study (NCT01997229). In this 52-week sub-analysis of the open-label extension of REGAIN (NCT02301624), eculizumab's efficacy and safety were assessed in 11 Japanese and 88 Caucasian patients with anti-acetylcholine receptor antibody-positive refractory generalized myasthenia gravis. For patients who had received placebo during REGAIN, treatment with open-label eculizumab resulted in generally similar outcomes in the Japanese and Caucasian populations. Rapid improvements were maintained for 52 weeks, assessed by change in score from open-label extension baseline to week 52 (mean [standard error]) using the following scales (in Japanese and Caucasian patients, respectively): Myasthenia Gravis Activities of Daily Living (−2.4 [1.34] and − 3.3 [0.65]); Quantitative Myasthenia Gravis (−2.9 [1.98] and − 4.3 [0.79]); Myasthenia Gravis Composite (−4.5 [2.63] and − 4.9 [1.19]); and Myasthenia Gravis Quality of Life 15-item questionnaire (−8.6 [5.68] and − 6.5 [1.93]). Overall, the safety of eculizumab was consistent with its known safety profile. In this interim sub-analysis, the efficacy and safety of eculizumab in Japanese and Caucasian patients were generally similar, and consistent with the overall REGAIN population

Correction to: Eculizumab improves fatigue in refractory generalized myasthenia gravis (Quality of Life Research, (2019), 28, 8, (2247-2254), 10.1007/s11136-019-02148-2)

The article “Eculizumab improves fatigue in refractory generalized myasthenia gravis”, written by “Henning Andersen, Renato Mantegazza, Jing Jing Wang, Fanny O’Brien, Kaushik Patra, James F. Howard Jr. and The REGAIN Study Group” was originally published electronically on the publisher’s internet portal (currently SpringerLink) on 23 March 2019 without open access

Eculizumab in refractory generalized myasthenia gravis previously treated with rituximab: subgroup analysis of REGAIN and its extension study

Introduction/Aims Individuals with refractory generalized myasthenia gravis (gMG) who have a history of rituximab use and experience persistent symptoms represent a population with unmet treatment needs. The aim of this analysis was to evaluate the efficacy and safety of eculizumab in patients with refractory anti‐acetylcholine receptor antibody‐positive (AChR+) gMG previously treated with rituximab. Methods This post hoc subgroup analysis of the phase 3 REGAIN study (NCT01997229) and its open‐label extension (OLE; NCT02301624) compared baseline characteristics, safety, and response to eculizumab in participants who had previously received rituximab with those who had not. Rituximab use was not permitted within the 6 months before screening or during REGAIN/OLE. Results Of 125 REGAIN participants, 14 had received rituximab previously (7 received placebo and 7 received eculizumab). In the previous‐rituximab group, 57% had used at least four other immunosuppressants compared with 16% in the no‐previous‐rituximab group. Myasthenia Gravis Activities of Daily Living total scores from eculizumab baseline to week 130 of eculizumab treatment improved in both the previous‐rituximab and no‐previous‐rituximab groups (least‐squares mean −4.4, standard error of the mean [SEM] 1.0 [n = 9] and least‐squares mean −4.6, SEM 0.3 [n = 67], respectively; difference = 0.2, 95% confidence interval −1.88 to 2.22). In addition, in both groups, most patients who were treated with eculizumab for 130 weeks achieved a Myasthenia Gravis Foundation of America post‐intervention status of minimal manifestations (66.7% and 65.0%, respectively). The eculizumab safety profile was similar between groups and consistent with its established profile. Discussion Eculizumab is an effective therapy for patients with refractory AChR+ gMG, irrespective of whether they had received rituximab treatment previously