Spontaneous Pneumomediastinum,Pneumopericardium and Pneumorrhachis as potential complications of 2009 pandemic influenza A (H1N1) virus infection in healthy children

We report on two cases of spontaneous pneumomediastinum and pneumopericardium, in one case associated with pneumorrhachis, occurring in two children suffering from the novel influenza H1N1 virus infection. At the admission both children presented with fever, violent dry cough, dyspnea and tachypnea. Radiological studies showed sizeable pneumomediastinum and pneumopericardium in both patients. One of the patients also a pneumorrachis. Children were initially treated by intravenous broad-spectrum antibiotics, antipyretics and a cough sedative. Oral Oseltamivir (60 mg twice daily for 5 days) was administered after the diagnosis of influenza A (H1N1) virus infection. Patients’ clinical condition quickly improved and children were discharged with a partial resolution of their radiological findings. Although these conditions are usually self-limiting and without respiratory or systemic consequences, their prompt recognition in children with H1N1 influenza virus infection is essential to establish fast and adequate therapy mainly related to the control of cough and the commencement of antiviral treatment.     

Access to cancer care: mapping hospital admissions and high-complexity outpatient care flows. The case of breast cancer

This study analyzes the flow of patients with breast cancer treated in Brazil's Unified National Health System (SUS) by type of treatment (surgery, radiotherapy, and chemotherapy). Hospital and outpatient services networks were identified based on data from the National Information System for Inpatient Care (SIH), and the National Information System for Outpatient Cancer Care, for 2005-2006, using TabWin and TerraView. Health services networks reach most of the country, and few municipalities are not connected to a network. However, treatment is highly concentrated in the largest cities, and even the latter show evidence of service shortages. Furthermore, a large proportion of patients live more than 150 km from the respective service. Network identification is important for planning and improving services distribution, since geographic access is a relevant issue for treatment outcome. Reduction of morbidity and mortality requires early identification, and appropriate and prompt treatment can reduce the impacts of the disease.     

Estimates of thyroid cancer incidence in Brazil: an approach using polynomial models

This study aimed to estimate thyroid cancer incidence in Brazil in 2006 using polynomial models that take age and birth cohort effects into account in the estimation process. Estimates were based on new cases of thyroid cancer in nine Brazilian cities (Manaus, Palmas, Natal, Recife, Cuiabá, Belo Horizonte, S?o Paulo, Porto Alegre, and Curitiba) and the Federal District from 1997 to 2001. We estimated 6,066 new cases, of which 1,065 in men and 5,001 in women. The incidence rates were, respectively, 1.16 and 5.27 per 100,000 inhabitants. Rates increased with age in both genders, especially after 30 years. The size and profile of rates according to age and gender indicate that the method yields plausible estimates.     

How to avoid discontinuation of antihypertensive treatment: The experience in São Paulo, Brazil

OBJECTIVES:

To evaluate the importance of providing guidelines to patients via active telephone calls for blood pressure control and for preventing the discontinuation of treatment among hypertensive patients.

INTRODUCTION:

Many reasons exist for non-adherence to medical regimens, and one of the strategies employed to improve treatment compliance is the use of active telephone calls.

METHODS:

Hypertensive patients (n = 354) who could receive telephone calls to remind them of their medical appointments and receive instruction about hypertension were distributed into two groups: a) “uncomplicated” – hypertensive patients with no other concurrent diseases and b) “complicated” - severe hypertensive patients (mean diastolic ≥110 mmHg with or without medication) or patients with comorbidities. All patients, except those excluded (n = 44), were open-block randomized to follow two treatment regimens (“traditional” or “current”) and to receive or not receive telephone calls (“phone calls” and “no phone calls” groups, respectively).

RESULTS:

Significantly fewer patients in the “phone calls” group discontinued treatment compared to those in the “no phone calls” group (4 vs. 30; p<0.0094). There was no difference in the percentage of patients with controlled blood pressure in the “phone calls” group and “no phone calls” group or in the “traditional” and “current” groups. The percentage of patients with controlled blood pressure (<140/90 mmHg) was increased at the end of the treatment (74%), reaching 80% in the “uncomplicated” group and 67% in the “complicated” group (p<0.000001).

CONCLUSION:

Guidance to patients via active telephone calls is an efficient strategy for preventing the discontinuation of antihypertensive treatment.     

Phase II nonrandomized study of the efficacy and safety of COX-2 inhibitor celecoxib on patients with cancer cachexia

Chronic inflammation is one of the main features of cancer cachexia. Experimental and clinical studies showed that cyclooxygenase-2 inhibitors, such as celecoxib, may be beneficial in counteracting major symptoms of this devastating syndrome. We carried out a prospective phase II clinical trial to test the safety and effectiveness of an intervention with the COX-2 inhibitor celecoxib (300 mg/day for 4 months) on key variables of cachexia (lean body mass, resting energy expenditure, serum levels of proinflammatory cytokines, and fatigue) in patients with advanced cancer at different sites. A sample of 24 patients was enrolled from January to December 2008 and all were deemed assessable. A significant increase of lean body mass and a significant decrease of TNF-α were observed. Moreover, an improvement of grip strength, quality of life, performance status, and Glasgow prognostic score was shown. There were no grade 3/4 toxicities. Patient compliance was very good; no patient had to reduce the celecoxib dosage nor interrupt treatment. Our results showed that the COX-2 selective inhibitor celecoxib is an effective single agent for the treatment of cancer cachexia. Although the treatment of cancer cachexia, a multifactorial syndrome, is more likely to yield success with a multitargeted approach; in the present study, we were able to show that a treatment, such as celecoxib, addressing a single target, albeit very important as chronic inflammation, could have positive effects. Therefore, phase III clinical trials are warranted to test the efficacy and safety of celecoxib.     

Physico-chemical characterization and biocompatibility evaluation of hydroxyapatites

The aim of this study was to evaluate the physico-chemical and biocompatibility characteristics of two different hydroxyapatites. Physical and chemical properties were analyzed using granulometric analysis, scanning electron microscopy (SEM), X-ray energy-dispersion (EDX), X-ray fuorescence (XRF) and X-ray diffraction (XRD). Biomaterials were implanted into the subcutaneous tissue on the dorsum of 36 Wistar rats, divided into the following groups: Group 1 - Gen-Ox (natural); Group 2 - HA-U (synthetic) and Group 3 - Control (Sham). After 15 and 30 days, 6 animals/period were sacrificed and the subcutaneous tissue was taken for histological and histometric analysis, giving consideration to inflammatory reaction and granule area. The granulometric test results showed a mean granule diameter of 161.6 microm (min = 19.0 microm; max = 498.0 microm) and 48.7 microm (min = 7.0 microm; max = 256.0 microm) for groups 1 and 2 respectively. Analysis with SEM demonstrated irregular and sharp-edge particles in group 1 (3332.8 +/- 274.3 microm(2)) and irregular and rounded particles in group 2 (1320.8 +/- 83.0 microm(2)) (P < 0.0001; Student's t test). EDX and XRF revealed calcium, carbon, oxygen, sodium and phosphorus in both groups. XRD indicated that both biomaterials were pure and crystalline. There was a statistically significant difference in granule area between the two groups after 15 days (P = 0.022; Student's t-test). After 15 days, an increased inflammatory response was seen in group 2 (P < 0.0001; ANOVA and Tukey's post hoc test) whereas it was more pronounced in group 1 after 30 days (P < 0.0001; ANOVA and Tukey's post hoc test). It was concluded that these biomaterials have similar physical, chemical and biocompatibility characteristics.