Therapeutic phlebotomy

A sangria terapêutica é método paliativo de controle de sintomas, simples e antigo, que se mostra eficaz também a longo prazo, melhorando a expectativa e a qualidade de vida. Suas indicações ampliaram-se atualmente e pode ser combinada com outras modalidades terapêuticas. Pode ser utilizada no controle da hiperviscosidade sangüínea nas eritrocitoses, e para a remoção de produto metabólico ou de depósito, tóxicos ao organismo. No Hemocentro, em Ribeirão Preto, as retiradas por eritrocitose representam a grande maioria, sendo 42% póstransplante renal, 30% por doenças cardíacas e pulmonares e 15% por Policitemia Vera. As retiradas por produtos metabólicos e/ou tóxicos acumulados foram 9% na hemocromatose e 4% nas porfirias. Não foram notados efeitos colaterais e os valores alvo do hematócrito foram considerados adequados nas eritrocitoses. As retiradas periódicas levaram a bom controle sintomático dos pacientes. São feitas sugestões de estratégias de condutas, consideradas adequadas.Therapeutic phlebotomy is an old and simple way to relieve sintoms but can raize life spectancy and bring better quality of life. It is incrisingly indicated nowadays, alone or in combination with others therapeutic tools. It can be used to control high blood viscosity in polycythemias or washout of toxic metabolic products or iron in parenquimal cells. At Hemocentro, in Ribeirão Preto, polycythemias were the most common indication for bloodletting, 42% after kidney transplants, 30% by lung and heart diseases, and 15% by polycythemia vera. Toxic metabolic products motivated bloodletting in 9% by iron overload and 4% by porphyria. No adverse efects were noted, target hematocrits were considered adequate in polycythemias and periodic bloodletting exerced an effective control of symptoms. Sugestions were made for better medical practices

Delayed colorectal cancer care during covid-19 pandemic (decor-19). Global perspective from an international survey

Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care