O retinoblastoma é a neoplasia intraocular maligna mais comum na infância e, apesar das elevadas taxas de sobrevida alcançadas nas últimas décadas, a preservação do globo ocular e da função visual permanece um importante desafio terapêutico. Objetiva-se analisar as principais abordagens oncológicas integradas empregadas no tratamento do retinoblastoma, com ênfase nas estratégias de salvamento ocular, preservação visual e terapias emergentes. Para tanto, realizou-se uma revisão narrativa da literatura na base PubMed, utilizando os descritores MeSH “Retinoblastoma” e “Therapeutics”, com seleção de estudos em português ou inglês pertinentes à temática. Observou-se que a integração entre quimioterapia intravenosa, intra-arterial e intravítrea e métodos de consolidação focal ampliou significativamente as possibilidades de controle tumoral e preservação ocular. A quimioterapia intravenosa associada à terapia focal apresenta taxas de salvamento ocular de 90% a 100% nos grupos A a C, enquanto a administração intravítrea possibilita taxas de erradicação de sementes vítreas de 90% a 100%. Além disso, terapias moleculares e imunológicas emergentes, incluindo inibidores de histona desacetilases e estratégias direcionadas ao antígeno GD2, apresentam resultados pré-clínicos promissores. Conclui-se que o manejo contemporâneo do retinoblastoma deve integrar controle oncológico, preservação anatômica e reabilitação visual, mediante abordagem individualizada e multidisciplinar, enquanto novas terapias direcionadas apresentam potencial para ampliar a eficácia e reduzir a toxicidade dos tratamentos.
ABSTRACT Purpose: The treatment of kidney stones has undergone continuous evolution. Despite the evolution of retrograde intrarenal surgery, percutaneous nephrolithotomy (PNL) remains the gold standard treatment for large and complex stones. We aimed to evaluate and analyze the temporal evolution of the results of the PNLs conducted at two teaching hospitals. Results: Data from 2660 patients were studied between 2009 and 2022. The rate of complex stones (Guy's 3 and 4) was 55.3%. Supine position was used in 82.1% of the cases. In 74.7% of cases, only 1 puncture was performed. The median surgery time was 120 min (15-240 min). The overall complication rate was 12.2%, the transfusion rate was 4.5%, and the success rate was 59.8%. Regarding temporal evolution, the use of the supine position increased from 73% in 2009 to 100% in 2022 (p < 0.001). The use of nephrostomy dropped from 81.8% to 26.5% (p<0.001), the median duration of surgery dropped from 145 to 130 min, the median time of use of fluoroscopy went from 12 to 8 min, the rate of blood transfusions dropped from 11.5% to 2.8% (p= 0.009), and the complication rate dropped from 18.2% to 12% (p= 0.002), while the average length of stay dropped from 81.8 hours to 50 hours. Conclusions: PNL is an effective surgical option for treating complex kidney stones. The implementation of several technical aspects, along with the standardization of the procedure, led to a significant improvement in most outcomes, reducing complication rates but leaving room for technique improvements in terms of success rates.
The Hodgkin lymphoma International Study for Individual Care (HoLISTIC) Consortium's A-HIPI model, developed in 2022 for advanced-stage classical Hodgkin lymphoma (cHL), predicts survival within 5 years amongst newly diagnosed patients. This study validates its performance in the Brazilian Hodgkin lymphoma registry. By 2022, the Brazilian HL registry included 1357 cHL patients, with a median 5-year follow-up. Probabilities for 5-year progression-free survival (PFS) and overall survival (OS) were calculated using A-HIPI-model equations. Discrimination (Harrell C -statistic/Uno C -statistic) and calibration measures assessed external validation and calibration. Lab values beyond the allowed range were excluded, mirroring the initial A-HIPI analysis. A total of 694 advanced-stage cHL patients met the original inclusion criteria (age 18–65 years, Stage IIB-IV). Median age was 31 years; 46.3% were females. Stage distribution was IIB (33.1%), III (27.4%), IV (39.5%). Bulky disease in 32.6%. Five-year PFS and OS were 68.4% and 86.0%, respectively. Harrell C -statistics were 0.60 for PFS and 0.69 for OS, and Uno C -statistics were 0.63 for PFS and 0.72 for OS. Calibration plots demonstrated well-calibrated predictions with calibration slopes of 0.91 and 1.03 for 5-year OS and PFS, respectively. Despite differing patient, clinical characteristics, and socioeconomic factors, the baseline prediction tool performed well in the Brazilian cohort, demonstrating adequate discrimination and calibration. This supports its reliability in diverse settings.
Introdução: A Justiça Terapêutica (JT) surgiu nos EUA em 1989 para reduzir a população carcerária de crimes ligados às drogas. Focada na reabilitação e tratamento dos infratores, a JT possui um potencial promissor na reincidência e na reintegração social, para aliviar a superlotação dos presídios e reduzir a demanda para o judiciário. No Brasil, começou no Rio Grande do Sul em 2000 e em São Paulo em 2002. Objetivo: Descrever a construção do Projeto JT pelo Ministério Público do Estado de São Paulo e sua parceria com o Ambulatório Médico de Especialidades de Psiquiatria Dra. Jandira Masur (AME Psiquiatria) sob gestão da Associação Paulista para o Desenvolvimento da Medicina (SPDM), fornecendo dados sobre o perfil e desfecho de 150 pacientes encaminhados pela JT para o AME Psiquiatria de março de 2012 a dezembro de 2022. Metodologia: Estudo transversal descritivo com dados de 150 autores de delitos encaminhados pelo Ministério Público ao AME Psiquiatria no Programa da JT entre março de 2012 a dezembro de 2022. Resultados: Dos encaminhados que aceitaram a proposta de transação penal ou suspensão condicional do processo, 59,80% cumpriram integralmente o benefício. A maioria (49%) apresentava transtorno relacionado ao uso de álcool, seguido por transtorno relacionado ao uso de cannabis (17%) e cocaína ou crack (10%). 14% não foram avaliados e 2% não tiveram diagnóstico pela CID-10. Conclusão: A parceria entre o Ministério Público e o AME Psiquiatria na zona norte de São Paulo possibilitou o acesso ao tratamento de infratores com transtornos mentais relacionados ao uso de álcool e outras drogas. A experiência de 10 anos dessa colaboração indica um caminho replicável em outros locais, mesmo com recursos financeiros limitados, demonstrando a sustentabilidade do Programa da JT. Esta descrição prática pode apoiar futuros estudos que demonstrem a eficácia do programa no Brasil.
SUMMARY OBJECTIVE: The aim of this study was to identify predictive factors for complications after percutaneous nephrolithotomy. METHODS: We prospectively analyzed patients who underwent percutaneous nephrolithotomy from June 2011 to October 2018. The association of preoperative and intraoperative factors with the presence of complications was assessed using univariate and multivariate analyses. The significance level was set at p<0.05. RESULTS: A total of 1,066 surgeries were evaluated, and the overall complication rate was 14.9%. In all, 105 (9.8%) surgeries were performed in the prone position, and 961 (90.2%) were performed in the supine position. Univariate analysis demonstrated that surgical position, upper pole puncture, surgical time, number of tracts, and Guys Stone Score were associated with complications. In multivariate analyses, prone position (odds ratio [OR] 2.10; p=0.003), surgical time ≥90 min (OR 1.76; p=0.014), upper pole puncture (OR 2.48; p<0.001), and Guys Stone Score 3 or 4 (OR 1.90; p=0.033) were independent predictive factors for complications after percutaneous nephrolithotomy. CONCLUSION: Performing percutaneous nephrolithotomy in the supine position, in under 90 min, and avoiding upper pole punctures may reduce complications during the treatment of large kidney stones.
