Importância do estado de saúde oral na nutrição dos idosos

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

Giardiose: realidade em Portugal e no mundo

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

Substâncias psicoativas de venda legal em smart shops: princípios ativos e formas de deteção

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

Infeções humanas por aeromonas

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

Intraperitoneal bevacizumab for control of malignant ascites due to advanced-stage gastrointestinal cancers: A multicentre double-blind, placebo-controlled phase II study - AIO SUP-0108

PURPOSE: Malignant ascites is debilitating for patients with advanced cancer. As shown previously, tumour cell production of vascular endothelial growth factor might be a major cause of the formation of malignant ascites. Intraperitoneal bevacizumab could therefore be an option for symptom control in refractory ascites. PATIENTS AND METHODS: Patients with advanced gastrointestinal cancer and malignant ascites who had undergone paracentesis at least twice within the past 4 weeks were randomly assigned in a 2:1 ratio to intraperitoneal bevacizumab (400 mg absolute) or placebo after paracentesis. During the 8-week treatment period, a minimum interval of 14 d was kept between the applications of the study drug. Primary end-point was paracentesis-free survival (ParFS). RESULTS: Fifty-three patients (median age 63 years) were randomised. Forty-nine patients received at least one study drug application and qualified for the main analysis. The proportion of patients with at least one common toxicity criteria grade III-V event was similar with 20/33 (61%) on bevacizumab and 11/16 (69%) on placebo. Median ParFS was 14 d (95% confidence interval [CI]: 11-17) in the bevacizumab arm and 10.5 d (95% CI: 7-21) on placebo (hazard ratio 0.74, 95% CI: 0.40-1.37; P = 0.16). The longest paracentesis-free period was 19 d on bevacizumab (range 6-66 d) and 17.5 d in the placebo arm (range 4-42) (P = 0.85). Median overall survival was 64 d (95% CI: 45-103) on bevacizumab compared to 31.5 d (95% CI: 20-117) on placebo (P = 0.31). CONCLUSION: Intraperitoneal bevacizumab was well tolerated. Overall, treatment did not result in a significantly better symptom control of malignant ascites. However, patients defined by specific immune characteristics may benefit.

Second St. Gallen European Organisation for Research and Treatment of Cancer Gastrointestinal Cancer Conference: consensus recommendations on controversial issues in the primary treatment of rectal cancer

Primary treatment of rectal cancer was the focus of the second St. Gallen European Organisation for Research and Treatment of Cancer (EORTC) Gastrointestinal Cancer Conference. In the context of the conference, a multidisciplinary international expert panel discussed and voted on controversial issues which could not be easily answered using published evidence. Main topics included optimal pretherapeutic imaging, indication and type of neoadjuvant treatment, and the treatment strategies in advanced tumours. Here we report the key recommendations and summarise the related evidence. The treatment strategy for localised rectal cancer varies from local excision in early tumours to neoadjuvant radiochemotherapy (RCT) in combination with extended surgery in locally advanced disease. Optimal pretherapeutic staging is a key to any treatment decision. The panel recommended magnetic resonance imaging (MRI) or MRI + endoscopic ultrasonography (EUS) as mandatory staging modalities, except for early T1 cancers with an option for local excision, where EUS in addition to MRI was considered to be most important because of its superior near-field resolution. Primary surgery with total mesorectal excision was recommended by most panellists for some early tumours with limited risk of recurrence (i.e. cT1-2 or cT3a N0 with clear mesorectal fascia on MRI and clearly above the levator muscles), whereas all other stages were considered for multimodal treatment. The consensus panel recommended long-course RCT over short-course radiotherapy for most clinical situations where neoadjuvant treatment is indicated, with the exception of T3a/b N0 tumours where short-course radiotherapy or even no neoadjuvant therapy were regarded to be an option. In patients with potentially resectable tumours and synchronous liver metastases, most panel members did not see an indication to start with classical fluoropyrimidine-based RCT but rather favoured preoperative short-course radiotherapy with systemic combination chemotherapy or alternatively a liver-first resection approach in resectable metastases, which both allow optimal systemic therapy for the metastatic disease. In general, proper patient selection and discussion in an experienced multidisciplinary team was considered as crucial component of care.

Treatment approach in patients with hyperbilirubinemia secondary to liver metastases in gastrointestinal malignancies: a case series and review of literature

BACKGROUND: Treatment of patients with severe liver dysfunction including hyperbilirubinemia secondary to liver metastases of gastrointestinal (GI) cancer is challenging. Regimen of oxaliplatin and fluoropyrimidine (FP)/folinic acid (FA) ± a monoclonal antibody (moAb), represents a feasible option considering the pharmacokinetics. Clinical data on the respective dosage and tolerability are limited and no recommendations are available. METHODS: Consecutive patients with severe hyperbilirubinemia [>2 × upper limit of the normal range (ULN) and >2.4 mg/dl] due to liver metastases of GI cancer without options for drainage receiving oxaliplatin, FP/FA ± moAb were analyzed. To collect further data a review of the literature was performed. RESULTS: A total of 12 patients were identified between 2011 and 2015. At treatment start, median bilirubin level was 6.1 mg/dl (>5 × ULN, range 2.7-13.6). The majority of patients (n = 11) received dose-reduced regimen with oxaliplatin (60-76%) and FP/FA (0-77%), rapidly escalating to full dose regimen. During treatment, bilirubin levels dropped more than 50% within 8 weeks or normalized within 12 weeks in 6 patients (responders). Median overall survival was 5.75 months (range 1.0-16.0 months) but was significantly prolonged in responders compared to nonresponders [9.7 and 3.0 months, p = 0.026 (two-sided test); 95% confidence interval (CI): 1.10-10.22]. In addition, case reports or series comprising a further 26 patients could be identified. Based on the obtained data a treatment algorithm was developed. CONCLUSION: Treatment with oxaliplatin, FP/FA ± moAb is feasible and may derive relevant benefits in patients with severe liver dysfunction caused by GI cancer liver metastases without further options of drainage.

Produtos farmacêuticos para animais de companhia - Estudo de Caso: As opções de compra em lares do concelho de Oeiras

A presença dos animais de companhia nos lares Portugueses é uma realidade cada vez mais significativa e que carece de uma maior consciencialização, sobre a pro-blemática dos parasitas externos e suas formas de controlo. A prevenção é a chave principal e a maneira mais fácil de diminuir a hipótese das infestações e transmissão de doenças. O aumento das temperaturas, o aumento do número de animais de companhia e o acréscimo na mobilidade dos cidadãos, são factores que todos os dias potenciam a proliferação de parasitas externos, que comprometem o bem-estar e a saúde de animais e de seres humanos. Esta dissertação de Mestrado investiga e concentra-se nos parasitas externos dos animais de companhia, nas práticas utilizadas e no processo de decisão de compra dos desparasitantes externos para o cão. O levantamento de dados foi realizado através de questionário estruturado construído para o efeito, e alvo de tratamento estatístico adequado. Tendo em consideração a informação recolhida juntos dos proprietários dos animais de companhia – cão, no Concelho de Oeiras, maioritariamente são Mulheres (58,64%), com habilitações ao nível da licenciatura, com idades compreendidas en-tre 45-54 anos. Sobre o animal de companhia – cão, destaca-se a faixa etária de 3-5 anos, sendo privilegiada a raça de porte médio (48%). Confirma-se que existe uma maior preocupação com a desparasitação externa (84%), face à desparasitação in-terna (76%). A maior influência na decisão de compra dos desparasitantes externos é dos Veterinários (53%) seguida do efeito da confiança na utilização do produto (13%) e do efeito de passa-palavra (11%). O local preferencial de compra é a Clíni-ca Veterinária (40%), seguida das Farmácias (31%), Pet-Shop (19%) e Grandes Su-perfícies (10%). Verificou-se a necessidade de implementação de um sistema de gestão de informa-ção para o mercado da Saúde Animal, à semelhança dos sistemas já existentes na saúde humana, face à pertinência do tema e seus impactos tanto económicos como na Saúde Publica.

Doença, inflamatória pélvica: o que o radiologista precisa saber?

O diagnóstico da doença inflamatória pélvica é clínico, baseando-se numa combinação de sintomas e sinais, que incluem dor pélvica e febre. A referenciação ao médico radiologista ocorre na fase aguda da doença, quando é necessário excluir diagnósticos diferenciais (ginecológicos, gastrointestinais ou urinários) ou em doentes que tiveram um episódio agudo prévio, por vezes assintomático, que recorrem ao médico assistente por complicações, como dor pélvica crónica, gravidez ectópica e infertilidade. Neste contexto, é fundamental que o médico radiologista reconheça as manifestações radiológicas dos diferentes estádios da doença inflamatória pélvica, com especial ênfase para o abcesso tuboovárico, cujas características radiológicas colocam diagnóstico diferencial com carcinoma do ovário.