In the face of new diseases, medicine needs to reinvent itself in order to contain and control epidemics, such as the one we have recently faced, COVID-19, a disease with a wide spectrum of clinical severity. A new mo...In the face of new diseases, medicine needs to reinvent itself in order to contain and control epidemics, such as the one we have recently faced, COVID-19, a disease with a wide spectrum of clinical severity. A new moment has been established, since the application of well-known, effective and safe medications for other diseases, has shown high success rates in the treatment of COVID-19. Thereunto, studies with early intervention are needed, which can change the unfavorable outcome of patients. In this article, we report the successful experience using an oral strategy during the collapse of Belem (Para, Brazil) Health System. Two hundred and ten patients were diagnosed with respiratory failure due to COVID-19, with no option of hospital treatment due to lack of beds and resources. These patients were then started on therapeutic regimen consisting of 40 mg prednisolone, 40 mg enoxaparin and macrolides (500 mg clarithromycin, 500 mg axetylcefuroxime) associated and followed in outpatient facilities. Two hundred and eight patients had an excellent therapeutic response and there were only two fatalities. These results push research boundaries, valuing outpatient treatment with early use of prednisolone in the initial pulmonary phase, preventing severe COVID-19 pneumonitis. Adoption of the proposed treatment intends to reduce the need for hospitalization, as well as lethality, with social robust benefits and incalculable economic savings since involves the use of accessible, safe and not expensive medications.展开更多
Melanoma is a malignant neoplasm that affects the melanocytes. Its treatment is based on cancer staging. In immunotherapy, it can be pointed out the ipilimumab, used in the systemic therapy for unresectable and/or met...Melanoma is a malignant neoplasm that affects the melanocytes. Its treatment is based on cancer staging. In immunotherapy, it can be pointed out the ipilimumab, used in the systemic therapy for unresectable and/or metastatic melanoma in the first or the second line treatment with increased survival. However, limiting toxicity and the low complete response discourage its use in the elderly patients. The aim of this study is to report the case of an 83-year-old man, white, with scalp melanoma measuring 3.5 cm in its major axis. After two resections was verified that the deep margin was involved, making the lesions unresectable. The evaluation of distant metastasis, by skull, chest and abdomen CT-scan （computed tomography-scan）, was performed and did not detect the presence of any metastatic loci. The patient underwent the first cycle of chemotherapy with DTIC （dacarbazine） protocol. After the first cycle, the medication was discontinued due to significant myelotoxicity and Grade 3 thrombocytopenia. Underwent second line treatment with ipilimumab by four cycles. After this, the patient follow with complete local response, asymptomatic, with no signs of local recurrence or distant metastasis site, and no limiting toxicity during and after a year of treatment with ipilimumab. Thus, it is possible to suggest that the use of ipilimumab isolatedly as a second line treatment may have a good response even in elderly patients.展开更多
文摘In the face of new diseases, medicine needs to reinvent itself in order to contain and control epidemics, such as the one we have recently faced, COVID-19, a disease with a wide spectrum of clinical severity. A new moment has been established, since the application of well-known, effective and safe medications for other diseases, has shown high success rates in the treatment of COVID-19. Thereunto, studies with early intervention are needed, which can change the unfavorable outcome of patients. In this article, we report the successful experience using an oral strategy during the collapse of Belem (Para, Brazil) Health System. Two hundred and ten patients were diagnosed with respiratory failure due to COVID-19, with no option of hospital treatment due to lack of beds and resources. These patients were then started on therapeutic regimen consisting of 40 mg prednisolone, 40 mg enoxaparin and macrolides (500 mg clarithromycin, 500 mg axetylcefuroxime) associated and followed in outpatient facilities. Two hundred and eight patients had an excellent therapeutic response and there were only two fatalities. These results push research boundaries, valuing outpatient treatment with early use of prednisolone in the initial pulmonary phase, preventing severe COVID-19 pneumonitis. Adoption of the proposed treatment intends to reduce the need for hospitalization, as well as lethality, with social robust benefits and incalculable economic savings since involves the use of accessible, safe and not expensive medications.
文摘Melanoma is a malignant neoplasm that affects the melanocytes. Its treatment is based on cancer staging. In immunotherapy, it can be pointed out the ipilimumab, used in the systemic therapy for unresectable and/or metastatic melanoma in the first or the second line treatment with increased survival. However, limiting toxicity and the low complete response discourage its use in the elderly patients. The aim of this study is to report the case of an 83-year-old man, white, with scalp melanoma measuring 3.5 cm in its major axis. After two resections was verified that the deep margin was involved, making the lesions unresectable. The evaluation of distant metastasis, by skull, chest and abdomen CT-scan （computed tomography-scan）, was performed and did not detect the presence of any metastatic loci. The patient underwent the first cycle of chemotherapy with DTIC （dacarbazine） protocol. After the first cycle, the medication was discontinued due to significant myelotoxicity and Grade 3 thrombocytopenia. Underwent second line treatment with ipilimumab by four cycles. After this, the patient follow with complete local response, asymptomatic, with no signs of local recurrence or distant metastasis site, and no limiting toxicity during and after a year of treatment with ipilimumab. Thus, it is possible to suggest that the use of ipilimumab isolatedly as a second line treatment may have a good response even in elderly patients.
