Marcelo Cunio Machado Fonseca

Validação do questionário de qualidade de vida (King's Health Questionnaire) em mulheres brasileiras com incontinência urinária

Universidade Federal de Sao Paulo (UNIFESP) Escola Paulista de Medicina Ambulatorio de Uroginecologia e Mioma

Consenso brasileiro do tratamento da fibromialgia

Recebido em 06/10/2009. Aprovado, apos revisao, em 24/11/2009. Roberto Ezequiel Heymann e Eduardo dos Santos Paiva declaram ter recebido honorarios da Lilly, Janssen-Cilag, Boehringer, Apsen e Pfizer para palestras e consultoria; Milton Helfenstein Junior recebeu honorarios da Pfizer e Merck Sharp para palestras e consultoria; Daniel Feldman Pollak recebeu honorarios da Lilly, Pfizer e Merck Sharp; Jose Eduardo Martinez recebeu honorarios da Sanofi Aventis para palestras e da Pfizer para palestras e consultoria; Jose Roberto Provenza recebeu honorarios dos laboratorios Roche, Bristol, Ache e Pfizer para participar de pesquisas clinicas com novos farmacos na PUC-Campinas; Marcelo Cruz Rezende declara ter recebido honorarios da Lilly-Boehringer para a participacao em simposios e da Pfizer para ser palestrante e participar de simposios; valerio valim Cristo declara recebimento de honorarios por apresentacao, conferencia ou palestra pela Roche, alem de financiamento para a realizacao de pesquisa, organizacao de atividade de ensino ou comparecimento a simposios pela Lilly, Genzyme, Schering-Plough. os demais autores declararam nao haver conflitos de interesse.1. Coordenador do Ambulatorio de Fibromialgia da UNiFESP e assistente doutor da Disciplina de Reumatologia da UNiFESP2. Professor Assistente da Disciplina de Reumatologia, UFPR. Chefe do ambulatorio de fibromialgia do HC-UFPR3. Assistente doutor da Disciplina de Reumatologia da UNiFESP4. Professor Adjunto da Disciplina de Reumatologia da UNiFESP e chefe do Setor de reumatismos de partes moles da UNiFESP5. Professor titular do Departamento de Medicina da PUC-SP, doutor em Reumatologia pela UNiFESP e diretor da Faculdade de Medicina da PUC-SP6. Professor titular de Reumatologia da PUC-Campinas e chefe do Servico de Reumatologia do Hospital Universitario da PUC-Campinas7. Professora orientadora da pos-graduacao da Faculdade de Ciencias da Saude da UnB e chefe do centro de ambulatorios do Hospital Universitario de Brasilia8. Membro da Sociedade Brasileira de Reumatologia9. Mestre em Medicina pelo instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte, coordenador do Programa de Residencia Medica em Reumatologia e do Ambulatorio de Fibromialgia da Santa Casa de Belo Horizonte10. Ex-presidente da Sociedade Brasileira de Reumatologia, bienio 2007-200811. Professora colaboradora da Faculdade de Medicina da USP, assistente doutora do Servico de Reumatologia e responsavel pelo ambulatorio de Fibromialgia do Servico de Reumatologia do HC-FMUSP12. Responsavel pelo Setor de Reumatologia e Preceptor do programa de Residencia em Clinica Medica da Santa Casa de Campo Grande. Ex-presidente da Sociedade de Reumatologia do Mato Grosso do Sul13. Professor assistente de Reumatologia da Universidade Federal de Ciencias da Saude de Porto Alegre (UFCSPA) e mestre em Clinica Medica pela UFGRS14. Reumatologista com especializacao em Medicina Esportiva do setor de reabilitacao, procedimentos e coluna vertebral pela UNiFESP15. Ex-fellow da Universidade da virginia (EUA), mestre em Educacao e Ciencia e professora da UNiSUL16. Professora adjunto do Departamento de Clinica Medica, chefe do ambulatorio de fibromialgia e chefe do servico de Reumatologia do Hospital Universi-tario da Universidade Federal do Espirito Santo17. Doutora em Reumatologia pela UNiFESP, membro da Sociedade Brasileira de Reumatologia e da Sociedade Brasileira de Clinica Medica18. Membro da Sociedade Brasileira para o Estudo da Dor19. Presidente da Associacao Brasileira de Medicina Fisica e Reabilitacao, professora colaboradora da Faculdade de Medicina da Universidade de Sao Paulo e doutora em Medicina pela FMUSP20. Membro da Associacao Brasileira de Medicina Fisica e Reabilitacao21. Professor titular de Neurologia da Universidade Federal Fluminense (UFF), coordenador do Departamento de Dor da Academia Brasileira de Neurologia (ABN) e do Subcomite de Dor da European Neurological Society (ENS). Membro da Peripheral Nerve Society22. Doutor em ortopedia e Traumatologia pela Faculdade de Medicina da USP, medico Assistente do Grupo de Mao e professor colaborador da FMUSP23. Membro da Sociedade Brasileira de ortopedia e Traumatologia24. Membro da Consultoria Axia.Bio farmacoeconomia e pesquisa em saude25. Diretor executivo do Nucleo de Gestao de Pesquisas da UNiFESP, mestre em Ciencias pela UNiFESP e socio-pesquisador da Axia.Bio

Unplanned Extubation in the Neonatal ICU: A Systematic Review, Critical Appraisal, and Evidence-Based Recommendations

OBJECTIVE: To update the state of knowledge on unplanned extubations (UEs) in neonatal ICUs. This review focuses on the following topics: incidence, risk factors, reintubation after UE, outcomes, and prevention. METHODS: The MEDLINE, EMBASE, CINAHL, Scielo, Lilacs, and Cochrane databases were searched for relevant publications from January 1, 1950, through January 30, 2012. Fifteen articles were selected for data abstraction. The search strategy included the following key words: “unplanned extubation,” “accidental extubation,” “self extubation,” “unintentional extubation,” “unexpected extubation,” “inadvertent extubation,” “unintended extubation,” “spontaneous extubation,” “treatment interference,” and “airway accident.” Study quality was assessed using the Newcastle-Ottawa scale. Grades of recommendation were assessed according to the Oxford Centre for Evidence-Based Medicines levels of evidence system. Studies with Newcastle-Ottawa scale score ≥ 5 that included appropriate statistical analysis were deemed of high methodological quality. RESULTS: The overall mean Newcastle-Ottawa scale score was 3.5. UE rates ranged from 0.14 to 5.3 UEs/100 intubation days, or 1% to 80.8%. Risk factors included restlessness/agitation (13–89%), poor fixation of endotracheal tube (8.5–31%), tube manipulation at the time of UE (17–30%), and performance of a patient procedure at bedside (27.5–51%). One study showed that every day on mechanical ventilation increased the UE risk 3% (relative risk 1.03, P < .001). The association between birth weight/gestational age and UE is controversial. Reintubation rates ranged from 8.3% to 100%. There is still a gap of information about strategies addressed to reduce the incidence of UE. The best method of endotracheal tube securement remains a controversial issue. CONCLUSIONS: Despite numerous publications on UE, there are few studies assessing preventive strategies for adverse events and there is a lack of randomized clinical trials. Recommendations are proposed based on the current available literature.

Bronquiolite aguda, uma revisão atualizada

Acute bronchiolitis (AB) is a frequent cause of hospitalization among children and its main etiological agent is respiratory syncytial virus (RSV). It occurs epidemically during autumn and winter. Some populations of children such as premature newborns, infants with congenital heart disease and those with chronic lung disease, immunocompromised, undernourished, among others, present increased morbidity and mortality risk. The virus multiplies in epithelial ciliated cells while inflammation and cellular debris cause obstruction of the airways, hyperinflation, atelectasis, and wheezing and gas exchange imbalance. Definitive evidence still does not exist about treatment of this disease, Treatment includes oxygen therapy, hydration, inhaled beta-2 agonists, racemic epinephrine, recombinant DNase and respirotherapy, among others. Prophylactic measures include administration of monoclonal antibodies. The majority of children with AB, independent of disease severity, recover without sequels. The natural course of this disease usually varies, from seven to ten days ,however some children may not recover for weeks.

Cost effectiveness of peginterferon alfa-2B combined with ribavirin for the treatment of chronic hepatitis C in Brazil

The treatment of chronic hepatitis C (CHC) with peginterferon alpha-2b/ribavirin (PegIFN + Rib) produced larger sustained viral response (SVR) compared to the conventional (non-pegylated) interferon/ribavirin (IFN + Rib), but its cost-effectiveness was not assessed in Brazil. We developed a Markov model to mirror the natural disease history and cohorts of patients with hepatitis C virus (HCV), that received PegIFN + Rib or IFN + Rib treatment for 48 or 24 weeks, according to viral genotype and liver histology. The SVRs for the treatments PegIFN + Rib and IFN + Rib were respectively 48% and 34% (genotype 1), and 88% and 80% (genotype non-1). Three Delphi panels were conducted with hepatologists and intensivists, and another one with oncologists. The costs are expressed in 2006 Brazilian Reais (R

Cost-effectiveness of anastrozole, in comparison with tamoxifen, in the adjuvant treatment of early breast cancer in Brazil

) and the benefits were discounted at 3%. In genotype 1 HCV patients, PegIFN + Rib increases the life expectancy (LE) in 0.51 year, and the quality-adjusted life years (QALY) in 0.78, as compared to IFN + Rib. In genotype non-1 HCV patients, PegIFN + Rib increases the LE in 0.29 years and the QALY in 0.44 years, as compared to IFN + Rib. The incremental cost-effectiveness rate, considering all the genotypes, was of R

Uterine Artery Embolization and Surgical Methods for the Treatment of Symptomatic Uterine Leiomyomas: A Systemic Review and Meta-analysis Followed by Indirect Treatment Comparison

19,848.34 per QALY. Peginterferon alpha-2b with ribavirin is a cost-effective therapy for the treatment of naïve CHC adult patients compared to the interferon alpha-2b and ribavirin regime, irrespective of the viral genotype.

Value of clinical pulmonary infection score in critically ill children as a surrogate for diagnosis of ventilator-associated pneumonia☆

OBJECTIVE Breast cancer, a leading type of cancer in many developing countries, is the most frequent non-cutaneous tumor in Brazil. Hormone therapy is the standard of care in the adjuvant treatment of early-stage, hormone-receptor-positive disease, and both tamoxifen and third-generation aromatase inhibitors are options in postmenopausal women. The comparative cost-effectiveness of different treatment strategies is of considerable interest in societies facing limited resources. METHODS In an attempt to compare cost-effectiveness of upfront treatment with tamoxifen or anastrozole, the medical and economic results in a hypothetical cohort of 64-year-old postmenopausal women, was analyzed considering the Brazilian healthcare system in 2005, the primary perspective of the private sector, and a lifetime horizon. Data from the ATAC Trial, Markov modeling, a modified Delphi panel, and microcosting (in Brazilian R

Costs of hospitalization in preterm infants: impact of antenatal steroid therapy

) were used to estimate costs and effectiveness of the two upfront strategies. RESULTS The model estimated a gain of 0.55 discounted life-years for patients receiving anastrozole, relative to those treated with tamoxifen. With an incremental cost of R

Repercussões cardiorrespiratórias da diálise peritoneal em crianças graves

15,141.15, the model estimated that the cost-effectiveness of anastrozole, in relation to tamoxifen, was R