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São Paulo, Brazil

Epelman S.,Santa Marcelina Hospital | Epelman S.,A+ Network
Current Oncology Reports | Year: 2013

The management of adolescents and young adults with brain tumors, which consist of many different histologic subtypes, continues to be a challenge. Better outcome with a decrease of the side effects of the disease and therapy and improvement of quality of life has been demonstrated in recent decades for some tumors. Significant differences in survival and cure are also observed between adult and pediatric tumors of the same histologic grade. Genetic, developmental, and environmental factors likely influence the type of tumor and response observed, even though no clear pathologic features differentiate these lesions among children, adolescents, and adults. Similarly, treatment strategies are not identical among these populations; most patients receive surgery, followed by radiation therapy and multiagent chemotherapy. Advances in understanding the biology underlying the distribution of tumors in adolescents and young adults may influence the development of prospective trials. A more individualized view of these tumors will likely influence stratification of patients in future studies as well as selection for targeted agents. Accordingly, outcomes may improve and long-term morbidities may decrease. © 2013 Springer Science+Business Media New York.

Epelman C.L.,Santa Marcelina Hospital
Current Oncology Reports | Year: 2012

Pediatric palliative care at the end-of-life is focused on ensuring the best possible quality of life for patients with life-threatening illness and their families. To achieve this goal, important needs include: engaging with patients and families; improving communication and relationships; relieving pain and other symptoms, whether physical, psychosocial, or spiritual; establishing continuity and consistency of care across different settings; considering patients and families in the decision-making process about services and treatment choices to the fullest possible and desired degree; being sensitive to culturally diverse beliefs and values about death and dying; and responding to suffering, bereavement, and providing staff support. Any effort to improve quality of palliative and endof- life care in pediatric oncology must be accompanied by an educational strategy to enhance the level of competence among health care professionals with regard to palliative care and end-of-life management skills as well as understanding of individualized care planning and coordination processes. © 2012 Springer Science+Business Media, LLC.

Barnett A.G.,Queensland University of Technology | Graves N.,Queensland University of Technology | Rosenthal V.D.,International Nosocomial Infection Control Consortium | Salomao R.,Santa Marcelina Hospital | Rangel-Frausto M.S.,Specialties IMSS Hospital
Infection Control and Hospital Epidemiology | Year: 2010

OBJECTIVE. To estimate the excess length of stay in an intensive care unit (ICU) due to a central line-associated bloodstream infection (CLABSI), using a multistate model that accounts for the timing of infection. DESIGN. A cohort of 3,560 patients followed up for 36,806 days in ICUs. SETTING. Eleven ICUs in 3 Latin American countries: Argentina, Brazil, and Mexico. PATIENTS. All patients admitted to the ICU during a defined time period with a central line in place for more than 24 hours. RESULTS. The average excess length of stay due to a CLABSI increased in 10 of 11 ICUs and varied from -1.23 days to 4.69 days. A reduction in length of stay in Mexico was probably caused by an increased risk of death due to CLABSI, leading to shorter times to death. Adjusting for patient age and Average Severity of Illness Score tended to increase the estimated excess length of stays due to CLABSI. CONCLUSIONS. CLABSIs are associated with an excess length of ICU stay. The average excess length of stay varies between ICUs, most likely because of the case-mix of admissions and differences in the ways that hospitals deal with infections. © 2010 by The Society for Healthcare Epidemiology of America. All rights reserved.

Asevedo E.,Linc Inc | Mendes A.C.,Santa Marcelina Hospital | Berk M.,Deakin University | Berk M.,University of Melbourne | Brietzke E.,Linc Inc
Revista Brasileira de Psiquiatria | Year: 2014

Objective: To conduct the first systematic literature review of clinical trials of N-acetylcysteine (NAC) for the treatment of substance abuse disorders and addictive behaviors. Methods: A search of the MEDLINE, Embase and PsycINFO databases was conducted. The inclusion criteria for the review were clinical trials that used NAC in the treatment of a disorder related to substance use and/or addictive behaviors, limited to texts in English, Spanish, or French. The selected studies were evaluated with respect to type of trial, sample size, diagnostic input, intervention, length of follow-up, outcome variables, and results. Results: Nine studies analyzing a total of 165 patients met the eligibility criteria and were included in qualitative analysis. These studies evaluated the role of NAC in cocaine dependence (three studies), cannabis dependence (two studies), nicotine dependence (two studies), methamphetamine addiction (one study), and pathological gambling (one study). Five of these trials were double-blind, randomized, and placebo-controlled. Conclusions: The studies analyzed suggest a potential role for NAC in the treatment of addiction, especially of cocaine and cannabis dependence. These results are concordant with the hypothesis of the involvement of glutamatergic pathways in the pathophysiology of addiction. © 2014 Associação Brasileira de Psiquiatria.

Lima T.O.,Federal University of Sao Paulo | de Araujo T.F.,Santa Marcelina Hospital | Soares L.C.A.,Unifesp | Testa J.R.G.,Unifesp | Testa J.R.G.,Federal University of Sao Paulo
Brazilian Journal of Otorhinolaryngology | Year: 2013

Recurrent cholesteatoma is relatively uncommon. Residual middle ear cholesteatomas account for most of the cases of recurrent disease. The limited role of microscopy in the visualization of tridimensional anatomic alterations of the temporal bone led to the use of endoscopic examination as an additional tool in the realm of ear surgery. Endoscopy has significantly aided in the management of chronic cholesteatomatous otitis media and in the prevention of recurrent disease. Objective: To review the literature and assess the relevance of endoscopy in the surgical treatment of cholesteatomas and in the prevention of relapsing lesions. Method: Searches on databases MedLine and LILACS were carried out between March and June of 2011 to select studies in which endoscopy was used in the management of cholesteatomas. Results: Three studies comparing surgery aided by endoscopy and surgery performed with the aid of a microscope met the inclusion criteria. Conclusion: Endoscopy has positively impacted the management of cholesteatomas and should be used in cholesteatoma surgery.

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