O tratamento dos gliomas de alto grau no Hospital de Clínicas da Unicamp

Abstract

Introduction:The general management of high-grade gliomas is based on surgery plus radiotherapy and chemotherapy. However, in developing countries, the lack of financial resources may delay the treatment, and probably affect patients' outcome. Based on this, the aim of this study is to review the clinical data of high-grade glioma patients treated in a brazilian referral public hospital. Methods: We retrospectively analyzed the clinical data with emphasis on the management options (surgery, radiotherapy and chemotherapy) of high grade glioma patients from 2007 to 2014 at the University of Campinas (Unicamp) hospital. Results: A total of 135 patients (27% of all brain tumors) had the diagnosis of high-grade glioma and were included. The mean age of high-grade glioma patients at the time of diagnosis was 57 years and 2 months. There were 90 men (67%) and 44 women (33%). The outpatient referral system was responsible for only 15 (11%) admissions with 120 (89%) patients being admitted through the emergency unit. Headache was the main complaint and 90.3% of the patients had been symptomatic for over 2 weeks and 14,8% for over 12 weeks. After surgery 56% were treated with chemotherapy and radiotherapy.Radiotherapy was the single therapy for 25% of the cases. Another 19% were referred to supportive care. After surgery patients took a median 6.71 weeks to the first radiotherapy consultation, 6.28 weeks to the first clinical oncology consultation and a median 12.57 weeks to start radiation. Only 12% started radiation in less than 6 weeks. Tumor progression requiring a second surgery was observed in 27 patients in the delayed therapy group (> 6weeks) compared with no patients in the early therapy (< 6 weeks) group (P=.002). Glioblastoma Multiforme patients overall survival was 7.8x months. Conclusion: Although surgery, radiation and temozolamide were available at our institution only 56% of the patients received all these treatments and only 12% started radiation in less than 6 weeks. These numbers fail in comparison to many studies published in developed countries but are similar to others published in developing nations. The same applies to the overall survival calculated for glioblastoma patients. This study supports that financial constrictions in public health care in developing countries have a negative impact on high-grade glioma treatment.

Design and Implementation of an SGX Based Electricity Information Collection and Management System

“…They can adjust their electricity consumption plans and peak shaving and valley filling based on the global information feedback from the control center, thereby achieving energy conservation and emission reduction. However, once an attacker takes advantage of the lack of security authentication and access control mechanisms in smart home devices with embedded wireless communication modules, stealing communication data between smart meters and smart homes, and even controlling the operation of smart home devices, not only will it harm the economic interests of users, but once the attack range is large enough, it will also affect the overall operational efficiency of the power grid [19][20][21] . A large number of research results have emerged both domestically and internationally, proposing various methods from different perspectives, aiming to improve the security of smart grids and ensure that the privacy of users in the grid is not compromised [22] .…”