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[PMID]:28922781
[Au] Autor:Goldvaser H; Barnes TA; Seruga B; Cescon DW; Ocaña A; Ribnikar D; Amir E
[Ad] Endereço:Division of Medical Oncology, University of Toronto and Princess Margaret Cancer Centre, Toronto, Canada; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Research Unit, Albacete University Hospi
[Ti] Título:Toxicity of Extended Adjuvant Therapy With Aromatase Inhibitors in Early Breast Cancer: A Systematic Review and Meta-analysis.
[So] Source:J Natl Cancer Inst;110(1), 2018 Jan 01.
[Is] ISSN:1460-2105
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Background: A number of randomized controlled trials (RCTs) have reported improvement in breast cancer outcomes from extending treatment with aromatase inhibitors (AIs) beyond the initial five years after diagnosis. However, the toxicity profile of extended AIs is uncertain. Methods: We identified RCTs that compared extended AIs to placebo or no treatment using MEDLINE and a review of abstracts from key conferences between 2013 and 2016. Odds ratios (ORs), 95% confidence intervals (CIs), absolute risks, and the number needed to harm (NNH) were computed for prespecified safety and tolerability outcomes including cardiovascular events, bone fractures, second cancers (excluding new breast cancer), treatment discontinuation for adverse events, and death without recurrence. All statistical tests were two-sided. Results: Seven trials comprising 16 349 patients met the inclusion criteria. Longer treatment with AIs was associated with increased odds of cardiovascular events (OR = 1.18, 95% CI = 1.00 to 1.40, P = .05, NNH = 122), bone fractures (OR = 1.34, 95% CI = 1.16 to 1.55, P < .001, NNH = 72), and treatment discontinuation for adverse events (OR = 1.45, 95% CI = 1.25 to 1.68, P < .001, NNH = 21). Longer treatment with AIs did not influence the odds of either second malignancy (OR = 0.93, 95% CI = 0.73 to 1.18, P = .56) or deaths without breast cancer recurrence (OR = 1.11, 95% CI = 0.90 to 1.36, P = .34). Conclusions: Extended treatment with AIs is associated with an increased risk of cardiovascular events and bone fractures. There is no statistically significant increase in deaths without breast cancer recurrence among patients receiving longer treatment with AIs. These data should be taken into account when considering extended adjuvant AIs.
[Mh] Termos MeSH primário: Inibidores da Aromatase/efeitos adversos
Neoplasias da Mama/tratamento farmacológico
Doenças Cardiovasculares/epidemiologia
Quimioterapia Adjuvante/efeitos adversos
Fraturas Ósseas/epidemiologia
Segunda Neoplasia Primária/epidemiologia
[Mh] Termos MeSH secundário: Inibidores da Aromatase/administração & dosagem
Neoplasias da Mama/cirurgia
Quimioterapia Adjuvante/métodos
Feminino
Seres Humanos
Mortalidade
Ensaios Clínicos Controlados Aleatórios como Assunto
Fatores de Tempo
Suspensão de Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Aromatase Inhibitors)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170920
[St] Status:MEDLINE
[do] DOI:10.1093/jnci/djx141


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[PMID]:29292905
[Au] Autor:Henriksson R; Falkenius J; Norin S; Öhman D; Abrahamsson M; Lindquist M; Lööv SÅ
[Ad] Endereço:Onkologi & Patologi - Regionalt Cancercentrum STOCKHOLM, Sweden Onkologi & Patologi - Regionalt Cancercentrum STOCKHOLM, Sweden.
[Ti] Título:Register för nya läkemedel i cancervården ger värdefull hjälp - Visar en bra bild av hur läkemedlen används ­ patienten kan följas i den kliniska vardagen..
[So] Source:Lakartidningen;114, 2017 Nov 06.
[Is] ISSN:1652-7518
[Cp] País de publicação:Sweden
[La] Idioma:swe
[Ab] Resumo:Register for new drugs in cancer care provides a picture of how the drugs are used in the daily clinical practice Today, an increasing number of cancer drugs are approved before traditional well-controlled phase 3 studies have been conducted and in many registration studies there is no participation of Swedish departments. This article describes the general experience of a caregiver initiated systematic follow-up of new cancer drugs that shows the possibility of obtaining a picture of the drug's use in routine care. From the register "New Pharmaceuticals in Cancer care", registrations from Stockholm-Gotland region are reported. The structure of the registry can be used with advantage in other therapeutic areas than cancer and can be supplemented with data from national and regional registers as well as quality registers including patient experiences. The knowledge is important to many actors in health care and can contribute to an evidence based, patient-safe and equal healthcare in accordance with current guidelines.
[Mh] Termos MeSH primário: Antineoplásicos
Neoplasias/tratamento farmacológico
Sistema de Registros
[Mh] Termos MeSH secundário: Androstenos/uso terapêutico
Antineoplásicos/administração & dosagem
Antineoplásicos/uso terapêutico
Bevacizumab/uso terapêutico
Neoplasias da Mama/tratamento farmacológico
Neoplasias da Mama/mortalidade
Neoplasias Colorretais/tratamento farmacológico
Neoplasias Colorretais/mortalidade
Uso de Medicamentos
Seres Humanos
Ipilimumab/uso terapêutico
Masculino
Melanoma/tratamento farmacológico
Melanoma/mortalidade
Neoplasias/mortalidade
Cuidados Paliativos/métodos
Feniltioidantoína/análogos & derivados
Feniltioidantoína/uso terapêutico
Projetos Piloto
Neoplasias da Próstata/tratamento farmacológico
Neoplasias da Próstata/mortalidade
Rádio (Elemento)/uso terapêutico
Taxa de Sobrevida
Suécia/epidemiologia
Suspensão de Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Androstenes); 0 (Antineoplastic Agents); 0 (Ipilimumab); 0 (MDV 3100); 0 (Radium-223); 2010-15-3 (Phenylthiohydantoin); 2S9ZZM9Q9V (Bevacizumab); G819A456D0 (abiraterone); W90AYD6R3Q (Radium)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180103
[St] Status:MEDLINE


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[PMID]:29341071
[Au] Autor:Bergman H; Soares-Weiser K
[Ad] Endereço:Cochrane Response, Cochrane, St Albans House, 57-59 Haymarket, London, UK, SW1Y 4QX.
[Ti] Título:Anticholinergic medication for antipsychotic-induced tardive dyskinesia.
[So] Source:Cochrane Database Syst Rev;1:CD000204, 2018 01 17.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Antipsychotic (neuroleptic) medication is used extensively to treat people with serious mental illnesses. However, it is associated with a wide range of adverse effects, including movement disorders. Because of this, many people treated with antipsychotic medication also receive anticholinergic drugs in order to reduce some of the associated movement side-effects. However, there is also a suggestion from animal experiments that the chronic administration of anticholinergics could cause tardive dyskinesia. OBJECTIVES: To determine whether the use or the withdrawal of anticholinergic drugs (benzhexol, benztropine, biperiden, orphenadrine, procyclidine, scopolamine, or trihexylphenidyl) are clinically effective for the treatment of people with both antipsychotic-induced tardive dyskinesia and schizophrenia or other chronic mental illnesses. SEARCH METHODS: We retrieved 712 references from searching the Cochrane Schizophrenia Group's Study-Based Register of Trials including the registries of clinical trials (16 July 2015 and 26 April 2017). We also inspected references of all identified studies for further trials and contacted authors of trials for additional information. SELECTION CRITERIA: We included reports identified in the search if they were controlled trials dealing with people with antipsychotic-induced tardive dyskinesia and schizophrenia or other chronic mental illness who had been randomly allocated to (a) anticholinergic medication versus placebo (or no intervention), (b) anticholinergic medication versus any other intervention for the treatment of tardive dyskinesia, or (c) withdrawal of anticholinergic medication versus continuation of anticholinergic medication. DATA COLLECTION AND ANALYSIS: We independently extracted data from included trials and we estimated risk ratios (RR) with 95% confidence intervals (CIs). We assumed that people who left early had no improvement. We assessed risk of bias and created a 'Summary of findings' table using GRADE. MAIN RESULTS: The previous version of this review included no trials. We identified two trials that could be included from the 2015 and 2017 searches. They randomised 30 in- and outpatients with schizophrenia in the USA and Germany. Overall, the risk of bias was unclear, mainly due to poor reporting: allocation concealment was not described; generation of the sequence was not explicit; studies were not clearly blinded; and outcome data were not fully reported.Findings were sparse. One study reported on the primary outcomes and found that significantly more participants allocated to procyclidine (anticholinergic) had not improved to a clinically important extent compared with those allocated to isocarboxazid (MAO-inhibitor) after 40 weeks' treatment (1 RCT, n = 20; RR 4.20, 95% CI 1.40 to 12.58; very low quality evidence); that there was no evidence of a difference in the incidence of any adverse effects (1 RCT, n = 20; RR 0.33, 95% CI 0.02 to 7.32; very low quality evidence); or acceptability of treatment (measured by participants leaving the study early) (1 RCT, n = 20; RR 0.33, 95% CI 0.02 to 7.32; very low quality evidence). The other trial compared anticholinergic withdrawal with anticholinergic continuation and found no evidence of a difference in the incidence of acceptability of treatment (measured by participants leaving the study early) (1 RCT, n = 10; RR 2.14, 95% CI 0.11 to 42.52; very low quality evidence).No trials reported on social confidence, social inclusion, social networks, or personalised quality of life - outcomes designated important to patients. No studies comparing either i. anticholinergics with placebo or no treatment, or ii. studies of anticholinergic withdrawal, were found that reported on the primary outcome 'no clinically important improvement in TD symptoms and adverse events'. AUTHORS' CONCLUSIONS: Based on currently available evidence, no confident statement can be made about the effectiveness of anticholinergics to treat people with antipsychotic-induced tardive dyskinesia. The same applies for the withdrawal of such medications. Whether the withdrawal of anticholinergics may benefit people with antipsychotic-induced TD should be evaluated in a parallel-group, placebo-controlled randomised trial, with adequate sample size and at least 6 weeks of follow-up.
[Mh] Termos MeSH primário: Antipsicóticos/efeitos adversos
Antagonistas Colinérgicos/uso terapêutico
Discinesia Induzida por Medicamentos/tratamento farmacológico
[Mh] Termos MeSH secundário: Biperideno/efeitos adversos
Biperideno/uso terapêutico
Antagonistas Colinérgicos/efeitos adversos
Discinesia Induzida por Medicamentos/etiologia
Seres Humanos
Isocarboxazida/efeitos adversos
Isocarboxazida/uso terapêutico
Prociclidina/efeitos adversos
Prociclidina/uso terapêutico
Ensaios Clínicos Controlados Aleatórios como Assunto
Esquizofrenia/tratamento farmacológico
Suspensão de Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Antipsychotic Agents); 0 (Cholinergic Antagonists); 0FRP6G56LD (Biperiden); 34237V843T (Isocarboxazid); C6QE1Q1TKR (Procyclidine)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180118
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD000204.pub2


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[PMID]:29367529
[Au] Autor:Tamura M; Kitano M; Azuma K; Tsuboi K; Abe T; Ogita C; Yokoyama Y; Furukawa T; Yoshikawa T; Saito A; Nishioka A; Sekiguchi M; Azuma N; Tsunoda S; Hosono Y; Nakashima R; Ohmura K; Matsui K; Mimori T; Sano H
[Ad] Endereço:Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine.
[Ti] Título:[A case of anti-PL-7 antibody positive polymyositis with thrombotic microangiopathy].
[So] Source:Nihon Rinsho Meneki Gakkai Kaishi;40(6):450-455, 2017.
[Is] ISSN:1349-7413
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Ab] Resumo:  A 65-year-old woman with a 17-year history of polymyositis and 8-year history of rheumatoid arthritis who was treated with a low dose of prednisolone and tacrolimus (Tac) was admitted to our hospital because of general malaise and hypertension. Blood tests showed thrombocytopenia, hemolytic anemia with fragmented erythrocytes, and hypercreatinemia. Based on these clinical features, she was diagnosed with thrombotic micro-angiopathy (TMA). Thrombocytopenia and hemolytic anemia with fragmented erythrocytes improved with the discontinuation of Tac and plasma exchange; however, hypertension and renal dysfunction persisted. TMA due to calcineurin inhibitor (CNI) nephropathy was suspected based on the histopathological findings of renal biopsy. However, the condition was atypical of a CNI nephropathy because the trough level of Tac was lower than that reported previously and renal dysfunction persisted after drug discontinuation. She had mild sclerodactylia and Raynaud's symptoms, although the diagnostic criteria for systemic sclerosis (SSc) were not satisfied. Moreover, the patient tested positive for anti PL-7 antibody. The relationship between anti PL-7 antibody and pathogenesis of SSc has been reported. In this case, it was suspected that CNI nephropathy worsened because of the potential basic factors of SSc. These findings indicate that TMA may occur in patients testing positive for anti PL-7 antibody who are treated with Tac.
[Mh] Termos MeSH primário: Aminoacil-tRNA Sintetases/imunologia
Autoanticorpos/sangue
Polimiosite/complicações
Microangiopatias Trombóticas/etiologia
[Mh] Termos MeSH secundário: Idoso
Artrite Reumatoide/complicações
Artrite Reumatoide/terapia
Biomarcadores/sangue
Inibidores de Calcineurina/administração & dosagem
Inibidores de Calcineurina/efeitos adversos
Feminino
Seres Humanos
Troca Plasmática
Polimiosite/diagnóstico
Polimiosite/terapia
Tacrolimo/administração & dosagem
Tacrolimo/efeitos adversos
Microangiopatias Trombóticas/diagnóstico
Suspensão de Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Autoantibodies); 0 (Biomarkers); 0 (Calcineurin Inhibitors); EC 6.1.1.- (Amino Acyl-tRNA Synthetases); WM0HAQ4WNM (Tacrolimus)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180126
[St] Status:MEDLINE
[do] DOI:10.2177/jsci.40.450


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[PMID]:29299751
[Au] Autor:Honecker F; Wedding U; Kallischnigg G; Schroeder A; Klier J; Frangenheim T; Weißbach L
[Ad] Endereço:Tumor and Breast Center ZeTuP St Gallen, Rorschacher Str 150, 9006, St Gallen, Switzerland.
[Ti] Título:Risk factors for unplanned discontinuation of scheduled treatment in elderly patients with castration-resistant prostate cancer: results of the IBuTu study.
[So] Source:J Cancer Res Clin Oncol;144(3):571-577, 2018 Mar.
[Is] ISSN:1432-1335
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To gain knowledge about the factors associated with discontinuation of scheduled treatment in elderly men with castration-resistant prostate cancer (CRPC). METHODS: Patients ≥ 70 years with CRPC starting a new line of treatment were included in a prospective cohort study. A geriatric assessment (CGA) was performed at baseline, including comorbidity, mobility, functional/mental/nutritional status, as well as depression. Furthermore, pain intensity, quality of life, ECOG-performance status, and physicians' and patients' perception of health were documented. Reasons for and factors associated with discontinuation of scheduled treatment were analysed by univariate and multivariate analysis. RESULTS: After inclusion of 177 of 300 planned patients, the study was closed due to slow recruitment. 160 patients were eligible for final analysis. Median age was 77.5 years. 46% received chemotherapy, and 54% hormonal treatment. Discontinuation of scheduled treatment occurred in 91 patients (57.6%). The main reasons were progressive disease/death in 63%, adverse events/toxicity in 22%, and withdrawal of consent in 8%. In bivariate analyses, factors associated with discontinuation of treatment were age ≥ 80 years, ECOG PS ≥ 2, compromised/poor health status (physicians'/patients' assessment), and compromised functional or nutritional status. In multivariate analysis, the only remaining factor independently associated with discontinuation of scheduled treatment was impairment of activities of daily living (ADL < 100 points) (OR = 4.2 for discontinuation; p < 0.05). CONCLUSION: Despite limitations due to early termination of the study, our results demonstrate that discontinuation of scheduled treatment was common, and that compromised ADL seems to be a significant risk factor for treatment failure in elderly patients with CRPC.
[Mh] Termos MeSH primário: Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico
Neoplasias de Próstata Resistentes à Castração/epidemiologia
Suspensão de Tratamento
[Mh] Termos MeSH secundário: Atividades Cotidianas
Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Estudos de Coortes
Comorbidade
Esquema de Medicação
Avaliação Geriátrica
Nível de Saúde
Seres Humanos
Masculino
Qualidade de Vida
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180105
[St] Status:MEDLINE
[do] DOI:10.1007/s00432-017-2577-1


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[PMID]:29292983
[Au] Autor:Wlodaver CG; May C
[Ti] Título:Antibiotic Stewardship for Non-Infectious Disease Physicians: Focusing on When to Withhold, Modify and Discontinue Antibiotics.
[So] Source:J Okla State Med Assoc;110(1):8-12, 2017 01.
[Is] ISSN:0030-1876
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The multiple drug resistant organism (MDRO) and Clostridium difficile infection (CDI) epidemics are progressing relentlessly. Antibiotic stewardship (ABS) has evolved to confront these scourges. The Joint Commission has formulated a standard for its implementation and this should promote its use where others have failed. However, precisely how to intervene needs definition. Healthcare workers need practicable guidelines. The article discusses clinical scenarios where antibiotics should be withheld (Table 1), how they should be modified (Table 2) and when they should be discontinued (Table 3), three focal points of ABS.
[Mh] Termos MeSH primário: Gestão de Antimicrobianos
Doenças não Transmissíveis/tratamento farmacológico
Suspensão de Tratamento
[Mh] Termos MeSH secundário: Gestão de Antimicrobianos/normas
Seres Humanos
Guias de Prática Clínica como Assunto
Padrões de Prática Médica
Suspensão de Tratamento/normas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180103
[St] Status:MEDLINE


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[PMID]:29189896
[Au] Autor:Kuykendall AT; Shah S; Talati C; Al Ali N; Sweet K; Padron E; Sallman DA; Lancet JE; List AF; Zuckerman KS; Komrokji RS
[Ad] Endereço:University of South Florida Morsani College of Medicine at H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, MCC-GME, Tampa, FL, 33612, USA. Andrew.Kuykendall@moffitt.org.
[Ti] Título:Between a rux and a hard place: evaluating salvage treatment and outcomes in myelofibrosis after ruxolitinib discontinuation.
[So] Source:Ann Hematol;97(3):435-441, 2018 Mar.
[Is] ISSN:1432-0584
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:Ruxolitinib is a JAK1/2 inhibitor that is effective in managing symptoms and splenomegaly related to myelofibrosis (MF). Unfortunately, many patients must discontinue ruxolitinib, at which time treatment options are not well defined. In this study, we investigated salvage treatment options and clinical outcomes among MF patients who received and discontinued ruxolitinib outside the context of a clinical trial. Among 145 patients who received ruxolitinib, 23 died while on treatment, 58 remained on treatment at time of analysis, leaving 64 people available for analysis. Development of cytopenias was the most common reason for discontinuation (38%) after median treatment time of 3.8 months (mo). The majority of patients received some form of salvage therapy after ruxolitinib discontinuation (n = 42; 66%), with allogeneic hematopoietic stem cell transplant (alloHSCT) (n = 17), being most commonly employed. Lenalidomide, thalidomide, hydroxyurea, interferon, and danazol were used with similar frequency. The response rate to salvage treatment was 26% (8 responses) and responses were most often seen with lenalidomide or thalidomide. Improved outcomes were observed in patients who underwent alloHSCT or received salvage therapy compared to those who did not receive additional therapy. Median overall survival (OS) after ruxolitinib discontinuation was 13 months. These findings show that salvage therapy can provide clinical responses after ruxolitinib discontinuation; however, these responses are rare and outcomes in this patient population are poor. This represents an area of unmet clinical need in MF.
[Mh] Termos MeSH primário: Mielofibrose Primária/tratamento farmacológico
Pirazóis/uso terapêutico
Suspensão de Tratamento
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Transplante de Células-Tronco Hematopoéticas
Seres Humanos
Masculino
Meia-Idade
Cuidados Paliativos
Mielofibrose Primária/complicações
Mielofibrose Primária/mortalidade
Mielofibrose Primária/terapia
Estudos Retrospectivos
Terapia de Salvação
Esplenomegalia/tratamento farmacológico
Esplenomegalia/etiologia
Esplenomegalia/mortalidade
Análise de Sobrevida
Transplante Homólogo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (INCB018424); 0 (Pyrazoles)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.1007/s00277-017-3194-4


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[PMID]:29239457
[Au] Autor:Bonilla-García JL; Cortiñas-Sáenz M; Pozo-Gavilán ED
[Ad] Endereço:FEA Anestesiología y Reanimación, Complejo Hospitalario Universitario de Huelva, Huelva, Spain.
[Ti] Título:Opioids and immunosupression in oncological postoperative patients.
[So] Source:Rev Assoc Med Bras (1992);63(9):753-763, 2017 Sep.
[Is] ISSN:1806-9282
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Recent animal studies demonstrated immunosuppressive effects of opioid withdrawal resulting in a higher risk of infection. The aim of this study was to determine the impact of remifentanil discontinuation on Post-Anesthesia Care Unit (PACU)-acquired infection after a schedule of sedoanalgesia of at least 6 days. METHOD: All patients over 18 years of age with a unit admission of more than 4 days were consecutively selected. The study population was the one affected by surgical pathology of any origin where sedation was based on any hypnotic and the opioid remifentanil was used as analgesic for at least 96 hours in continuous perfusion. Patients who died during admission to the unit and those with combined analgesia (peripheral or neuroaxial blocks) were excluded. Bivariate analysis was performed to determine risk factors for infection acquired in the unit. A comparative study between periods of 6 days before and after the cessation of remifentanil was performed. Paired samples test and McNemar test was used for quantitative and categorical variables, respectively. RESULTS: There were 1,789 patients admitted to the PACU during the study and the population eligible was constituted for 102 patients. The incidence rate of PACU-acquired infection was 38 per 1,000 PACU days. Ventilator-associated pneumonia was the most frequently diagnosed PACU-acquired infection. Pseudomona aeruginosa was the most frequently isolated microorganism. Hospital mortality was 36.27%. No statistically significant differences were seen in the incidence of HAI in cancer patients in relation to discontinuation of remifentanil (p=0.068). CONCLUSION: The baseline state of immunosuppression of cancer patients does not imply a higher incidence of HAI in relation to the interruption of remifentanil. It would be of interest to carry out a multicenter PACU study that included immunological patterns.
[Mh] Termos MeSH primário: Analgésicos Opioides/administração & dosagem
Infecção Hospitalar/etiologia
Imunossupressores/administração & dosagem
Neoplasias/cirurgia
Dor Pós-Operatória/tratamento farmacológico
Suspensão de Tratamento
[Mh] Termos MeSH secundário: Idoso
Infecção Hospitalar/prevenção & controle
Feminino
Seres Humanos
Masculino
Midazolam/administração & dosagem
Meia-Idade
Piperidinas/administração & dosagem
Propofol/administração & dosagem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Analgesics, Opioid); 0 (Immunosuppressive Agents); 0 (Piperidines); P10582JYYK (remifentanil); R60L0SM5BC (Midazolam); YI7VU623SF (Propofol)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180123
[Lr] Data última revisão:
180123
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171215
[St] Status:MEDLINE


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[PMID]:27775997
[Au] Autor:Roshanov PS; Rochwerg B; Patel A; Salehian O; Duceppe E; Belley-Côté EP; Guyatt GH; Sessler DI; Le Manach Y; Borges FK; Tandon V; Worster A; Thompson A; Koshy M; Devereaux B; Spencer FA; Sanders RD; Sloan EN; Morley EE; Paul J; Raymer KE; Punthakee Z; Devereaux PJ
[Ad] Endereço:From the London Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada (P.S.R.); Departments of Medicine (B.R., A.P., O.S., E.D., E.P.B.-C., G.H.G., F.K.B., V.T., A.W., F.A.S., Z.P., P.J.D.), Clinical Epidemiology and Biostatistics (B.R., E.D., E.P.B.-C., G.H.G., Y.L.M., A.W., P.J.D.), and Anesthesiology (Y.L.M., J.P., K.E.R.), McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada (E.D., E.P.B.-C., Y.L.M., F.K.B., A.T., M.K., B.D., P.J.D.); Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (D.I.S.); Department of Anesthesiology, University of Wisconsin, Madison, Wisconsin (R.D.S.); and Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (E.N.S., E.E.M.).
[Ti] Título:Withholding versus Continuing Angiotensin-converting Enzyme Inhibitors or Angiotensin II Receptor Blockers before Noncardiac Surgery: An Analysis of the Vascular events In noncardiac Surgery patIents cOhort evaluatioN Prospective Cohort.
[So] Source:Anesthesiology;126(1):16-27, 2017 01.
[Is] ISSN:1528-1175
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The effect on cardiovascular outcomes of withholding angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in chronic users before noncardiac surgery is unknown. METHODS: In this international prospective cohort study, the authors analyzed data from 14,687 patients (including 4,802 angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker users) at least 45 yr old who had in-patient noncardiac surgery from 2007 to 2011. Using multivariable regression models, the authors studied the relationship between withholding angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers and a primary composite outcome of all-cause death, stroke, or myocardial injury after noncardiac surgery at 30 days, with intraoperative and postoperative clinically important hypotension as secondary outcomes. RESULTS: Compared to patients who continued their angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, the 1,245 (26%) angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker users who withheld their angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers in the 24 h before surgery were less likely to suffer the primary composite outcome of all-cause death, stroke, or myocardial injury (150/1,245 [12.0%] vs. 459/3,557 [12.9%]; adjusted relative risk, 0.82; 95% CI, 0.70 to 0.96; P = 0.01) and intraoperative hypotension (adjusted relative risk, 0.80; 95% CI, 0.72 to 0.93; P < 0.001). The risk of postoperative hypotension was similar between the two groups (adjusted relative risk, 0.92; 95% CI, 0.77 to 1.10; P = 0.36). Results were consistent across the range of preoperative blood pressures. The practice of withholding angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers was only modestly correlated with patient characteristics and the type and timing of surgery. CONCLUSIONS: Withholding angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers before major noncardiac surgery was associated with a lower risk of death and postoperative vascular events. A large randomized trial is needed to confirm this finding. In the interim, clinicians should consider recommending that patients withhold angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers 24 h before surgery.
[Mh] Termos MeSH primário: Antagonistas de Receptores de Angiotensina/administração & dosagem
Inibidores da Enzima Conversora de Angiotensina/administração & dosagem
Complicações Intraoperatórias/epidemiologia
Complicações Pós-Operatórias/epidemiologia
Procedimentos Cirúrgicos Operatórios
Suspensão de Tratamento/estatística & dados numéricos
[Mh] Termos MeSH secundário: Idoso
Estudos de Coortes
Feminino
Seres Humanos
Hipotensão/epidemiologia
Internacionalidade
Masculino
Meia-Idade
Estudos Prospectivos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Angiotensin Receptor Antagonists); 0 (Angiotensin-Converting Enzyme Inhibitors)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:180102
[Lr] Data última revisão:
180102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:29224638
[Au] Autor:Clark NP; Douketis JD; Hasselblad V; Schulman S; Kindzelski AL; Ortel TL; BRIDGE Investigators
[Ad] Endereço:Kaiser Permanente Colorado, Aurora, CO. Electronic address: nathan.clark@Kp.org.
[Ti] Título:Predictors of perioperative major bleeding in patients who interrupt warfarin for an elective surgery or procedure: Analysis of the BRIDGE trial.
[So] Source:Am Heart J;195:108-114, 2018 Jan.
[Is] ISSN:1097-6744
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The use of low-molecular weight heparin bridge therapy during warfarin interruption for elective surgery/procedures increases bleeding. Other predictors of bleeding in this setting are not well described. METHODS: BRIDGE was a randomized, double-blind, placebo-controlled trial of bridge therapy with dalteparin 100 IU/kg twice daily in patients with atrial fibrillation requiring warfarin interruption. Bleeding outcomes were documented from the time of warfarin interruption until up to 37 days postprocedure. Multiple logistic regression and time-dependent hazard models were used to identify major bleeding predictors. RESULTS: We analyzed 1,813 patients of whom 895 received bridging and 918 received placebo. Median patient age was 72.6 years, and 73.3% were male. Forty-one major bleeding events occurred at a median time of 7.0 days (interquartile range, 4.0-18.0 days) postprocedure. Bridge therapy was a baseline predictor of major bleeding (odds ratio [OR]=2.4, 95% CI: 1.2-4.8), as were a history of renal disease (OR=2.9, 95% CI: 1.4-6.0), and high-bleeding risk procedures (vs low-bleeding risk procedures) (OR=2.9, 95% CI: 1.4-5.9). Perioperative aspirin use (OR=3.6, 95% CI: 1.1-11.9) and postprocedure international normalized ratio >3.0 (OR=2.1, 95% CI: 1.5-3.1) were time-dependent predictors of major bleeding. Major bleeding was most common in the first 10 days compared with 11-37 days postprocedure (OR=3.5, 95% CI: 1.8-6.9). CONCLUSIONS: In addition to bridge therapy, perioperative aspirin use, postprocedure international normalized ratio >3.0, a history of renal failure, and having a high-bleeding risk procedure increase the risk of major bleeding around the time of an elective surgery/procedure requiring warfarin interruption.
[Mh] Termos MeSH primário: Fibrilação Atrial/tratamento farmacológico
Dalteparina/efeitos adversos
Procedimentos Cirúrgicos Eletivos/efeitos adversos
Hemorragia Pós-Operatória/etiologia
Acidente Vascular Cerebral/prevenção & controle
Varfarina/farmacologia
Suspensão de Tratamento
[Mh] Termos MeSH secundário: Idoso
Anticoagulantes/efeitos adversos
Anticoagulantes/uso terapêutico
Fibrilação Atrial/complicações
Dalteparina/uso terapêutico
Método Duplo-Cego
Feminino
Seres Humanos
Incidência
Injeções Subcutâneas
Masculino
North Carolina/epidemiologia
Hemorragia Pós-Operatória/epidemiologia
Acidente Vascular Cerebral/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anticoagulants); 5Q7ZVV76EI (Warfarin); S79O08V79F (Dalteparin)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171220
[Lr] Data última revisão:
171220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171212
[St] Status:MEDLINE



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