Revista da Associa??o Médica Brasileira (English Edition)最新文献

This study aimed to establish the safety of chemotherapy use in pregnant women with breast cancer, and to find possible effects in the fetus. A search of MEDLINE/PubMed, LILACS, SciELO, Cochrane, UpToDate, and Google Scholar databases was performed to identify publications., 86 articles published from 2001 to 2012 were retrieved and evaluated by two readers in accordance predetermined exclusion and inclusion criteria; 39 articles were selected. All the chemotherapy drugs used to treat breast cancer during pregnancy belonged to class D, and consisted of 5-fluorouracil (F), doxorubicin (A) or epirubicin (E) and cyclophosphamide (C), or the combination doxorubicin and cyclophosphamide (AC), a safe regimen when used after the first trimester of pregnancy. Few studies evaluated the use of taxanes (T), such as docetaxel (D) and paclitaxel (P), with no increase in the occurrence of fetal defects and other maternal complications when used in the second and third trimesters of pregnancy. The use of trastuzumab in pregnant women is associated with oligohydramnios and anhydramnios; thus, it is not recommended during pregnancy. As almost all studies were observational and retrospective, new prospective studies on the subject are needed.

Objective

The occurrence of psychiatric comorbidity among individuals with crack or inhalant dependence is frequently observed. The objective of this study was to investigate anxiety symptoms among crack cocaine and inhalant users in southern Brazil.

Methods

The study investigated two groups of volunteers of equal size (n = 50): one group consisted of crack cocaine users, and the othergroup consisted of inhalant users. Research volunteers completed the Portuguese versions of the State-Trait Anxiety Inventory (STAI), Hamilton Anxiety Rating Scale (HAM-A), and Self-Report Questionnaire (SRQ).

Results

Both crack and inhalant users experience significant symptoms of anxiety. Inhalant users presented significantly more anxiety symptoms than crack users according to the HAM-A questionnaire only. In contrast to the results of the HAM-A, the STAI failed to demonstrate a significant difference between the two groups of substance users. SRQscores revealed that crack and inhalants users had significant degrees of morbidity.

Conclusion

A significant difference regarding anxiety symptomatology, especially state anxiety, was observed among inhalant and crack users. Anxiety and overall mental psychopathology were significantly correlated in this sample. The results indicate that screening initiatives to detect anxiety and additional psychiatric comorbidities among crack and inhalant users are feasible and relevant.

Objective

To analyze the features of preventable adverse events (AEs) in hospitals inpatient in the state of Rio de Janeiro, in Brazil, in order to identify elements to serve as a substrate for priority actions aimed at improving patient safety.

Methods

Analysis of data from a baseline retrospective cohort study to assess the incidence of AEs in a sample of records in three teaching hospitals in the State of Rio de Janeiro to describe the features of preventable AEs.

Results

In a sample of 1,103 patients, were identified 65 preventable AEs of 56 patients who suffered preventable AEs. The healthcare associated infections (HAI) accounted for 24.6% of preventable AEs; surgical complications and/or anesthetic, 20.0%; damages arising from delay or failure in diagnosis and/or treatment, 18.4%; pressure ulcers, 18.4%; damage from complications of venipuncture, 7.7%; damage due to falls, 6.2%; damage as a result of the use of drugs, 4.6%. The preventable AEs were responsible for additional 373 days of hospital stay.

Conclusion

The HAI is the major preventable AE, as observed in other developing countries. Despite the limitations of the study, the characterization of preventable AEs indicates that known and effective actions available to reduce HAI, such as hand hygiene, to prevent pressure ulcers, to encourage adherence to protocol and clinical guidelines and to create continuing education programs for health professionals, should compose the list of priorities of hospital managers and health professionals involved in the care of hospitalized patients.

Objective

To analyze the clinical and autonomic profile of patients with Alzheimer's disease or mixed dementia (MD).

Methods

Fifty-four patients with indication for cholinesterase inhibitors use were evaluated through clinical examination, rest electrocardiogram, and spectral analysis of heart rate (HR) variability through digital Holter system recordings.

Results

Overall, 61.1% of patients were females and were, on average, 77.1 years of age, had 3.3 years of schooling, and scored 16.4 points on the Mini Mental State Examination. The gap between symptom onset and diagnosis was 26.2 months. Almost all patients (90.7%) presented at least one clinical comorbidity, and each patient took, on average, 3.7 drugs to control them. Thirty-one patients had some alteration on the electrocardiogram, and nine (16.6%) had orthostatic hypotension (OH). The latter was associated with the diagnosis of MD (p = 0.001), with lower values of low (LF) and high (HF) frequency components of the spectral analysis in the supine position (p = 0.000 and p = 0.017, respectively), and with lower values of LF in the orthostatic position (p = 0.006). Diagnosis of MD was associated with lower values of LF in both positions (p = 0.003 and p = 0.007).

Conclusion

This sample of patients had frequent comorbidities, which resulted in the prescription of multiple drugs. Signs of autonomic dysfunction resulting in OH were found mainly in those with MD.

Viral pneumonia is a prevalent cause of respiratory infection in immunocompetent adults. It has varied presentation, from mild to severe respiratory failure, requiring mechanical ventilation. However, in Brazil, there have been few studies on the clinical presentation and diagnosis of this infection. Thus, the authors of the present article intend to review the main viral agents that cause community-acquired pneumonia and to discuss the currently available diagnostic and therapeutic methods.