Long-Term Anticoagulant Therapy of Patients with Venous Thromboembolism. What Are the Practices?

Current guidelines of antithrombotic therapy suggest early initiation of vitamin K antagonists (VKA) in non-cancer patients with venous thromboembolism (VTE), and long-term therapy with low-molecular weight heparin (LMWH) for those with cancer. We used data from RIETE (international registry of patients with VTE) to report the use of long-term anticoagulant therapy over time and to identify predictors of anticoagulant choice (regarding international guidelines) in patients with- and without cancer. Among 35,280 patients without cancer, 82% received long-term VKA (but 17% started after the first week). Among 4,378 patients with cancer, 66% received long term LMWH as monotherapy. In patients without cancer, recent bleeding (odds ratio [OR] 2.70, 95% CI 2.26-3.23), age >70 years (OR 1.15, 95% CI 1.06-1.24), immobility (OR 2.06, 95% CI 1.93-2.19), renal insufficiency (OR 2.42, 95% CI 2.15-2.71) and anemia (OR 1.75, 95% CI 1.65-1.87) predicted poor adherence to guidelines. In those with cancer, anemia (OR 1.83, 95% CI 1.64-2.06), immobility (OR 1.51, 95% CI 1.30-1.76) and metastases (OR 3.22, 95% CI 2.87-3.61) predicted long-term LMWH therapy. In conclusion, we report practices of VTE therapy in real life and found that a significant proportion of patients did not receive the recommended treatment. The perceived increased risk for bleeding has an impact on anticoagulant treatment decision.

Valor da PET/CT na abordagem do câncer de cabeça e pescoço

OBJETIVO: Avaliar a PET/CT na abordagem de pacientes com câncer de cabeça e pescoço. MATERIAIS E MÉTODOS: Estudo retrospectivo de 63 prontuários e exames de PET/CT de pacientes com câncer de cabeça e pescoço. RESULTADOS: Foram encontradas alterações em 76% dos exames. Destes, 7 (11%) foram considerados falso-positivos, com SUV < 5,0. A PET/CT mostrou-se negativa em 15 situações (24%). Dos 14 casos nos quais se utilizou o exame para estadiamento, em 3 (22%) houve aumento no estadiamento. CONCLUSÃO: A PET/CT mostra-se como exame de potencial valor na rotina de avaliação de pacientes com câncer de cabeça e pescoço, entretanto, necessitamos de maior número de casos para definirmos protocolo de uso.

Hardcopy quality parameters to ensure structures detection at digital mammography

Objective To develop procedures to ensure consistency of printing quality of digital images, by means of hardcopy quantitative analysis based on a standard image. Materials and Methods Characteristics of mammography DI-ML and general purpose DI-HL films were studied through the QC-Test utilizing different processing techniques in a FujiFilm®-DryPix4000 printer. A software was developed for sensitometric evaluation, generating a digital image including a gray scale and a bar pattern to evaluate contrast and spatial resolution. Results Mammography films showed maximum optical density of 4.11 and general purpose films, 3.22. The digital image was developed with a 33-step wedge scale and a high-contrast bar pattern (1 to 30 lp/cm) for spatial resolution evaluation. Conclusion Mammographic films presented higher values for maximum optical density and contrast resolution as compared with general purpose films. The utilized digital processing technique could only change the image pixels matrix values and did not affect the printing standard. The proposed digital image standard allows greater control of the relationship between pixels values and optical density obtained in the analysis of films quality and printing systems.

Acción antimicrobiana in vitro de distintas medicaciones sobre Enterococcus faecalis y Actinomyces israelii

Objetivo: Se comparó in vitro la acción antimicrobiana de diversas medicaciones intraconducto frente a Enterococcus faecalis y Actinomyces israelii. Material y métodos: para evaluar las zonas de inhibición microbiana se utilizó el test de difusión en agar frente a diversas pastas, incluyendo una pasta con base de metronidazol (Grinazole ®), una pasta con base de dexametasona, tiretrocina, polimixana y neomicina (Septomixine forte ®) y otra de hidróxido de calciio (Calcipulpe ®) y paroclorofenol alcanforado (KRI-3 ®), frente a E. faecalis y A. israelii. Resultados: La acción inhibitoria frente a E. faecalis fue significativamente mayor (p< 0,05) con Septomixine forte ® (30,7 mm) seguido de KRI- 3 ® (22,5 mm), Calcipulpe ® (16,6 mm) y Grinazole ® (11,4 mm). La inhibición microbiana frente a E. israelii fue significativamente mejor con Septomixine forte ® (p< 0,05) (40,1 mm) seguido de KRI-3 ® (36,6 mm), Grinazole ® (7,6 mm) y Calcipulpe ® (6 mm). Conclusión: Septomixine forte ® fue la pasta antibiótica más efectiva frente a E. faecalis y A. israelii comunmente hallados en las infecciones endodóncicas.

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