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1.
Clin. transl. oncol. (Print) ; 25(3): 633-642, mar. 2023.
Artigo em Inglês | IBECS | ID: ibc-216422

RESUMO

New treatments have increased the life expectancy of pediatric patients diagnosed with malignant hematological diseases, often at the cost of protracting their immunocompromised state in the form of prolonged neutropenia. This neutropenic state favors the development of bacterial and fungal infections. Moreover, recent years have seen a series of changes in the epidemiology of fungal and Clostridium infections. These changes necessitate adaptations to the management of pediatric patients with febrile neutropenia, who are at risk of further increases in already high rates of morbidity and mortality. This article discusses the current bases for the management of febrile neutropenia and associated emerging fungal infections, as well as the epidemiology, diagnosis, and treatment of Clostridioides difficile in pediatric patients diagnosed with malignant hematological diseases (AU)


Assuntos
Humanos , Neutropenia Febril/etiologia , Neutropenia Febril/tratamento farmacológico , Leucopenia , Micoses , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/microbiologia , Antibacterianos/uso terapêutico
3.
Psiquiatr. biol. (Internet) ; 28(1): 38-42, Enero - Abril 2021. tab
Artigo em Espanhol | IBECS | ID: ibc-224410

RESUMO

La clozapina es un fármaco de referencia en el tratamiento de la esquizofrenia refractaria. El temor a la aparición y el manejo de efectos secundarios graves, especialmente agranulocitosis, hace que los profesionales se retraigan a la hora de usarlo.En este artículo se describe un caso de inicio de tratamiento con múltiples complicaciones médicas tras la aparición de neutropenia y un caso de reexposición al fármaco tras un primer intento frustrado por agranulocitosis. En ambos hubo que retirar definitivamente el tratamiento con clozapina, pero los pacientes se recuperaron sin secuelas.Consideramos que la aportación de casos en los que se apreciaron problemas puede enriquecer la formación e inspirar más confianza entre los psiquiatras y residentes en el manejo de casos similares. (AU)


Clozapine is a gold standard in the treatment of refractory schizophrenia. The fear of the appearance and management of serious side effects, especially agranulocytosis, causes professionals not to use it frequently.This article describes a case of initiation of treatment with multiple clinical complications after the onset of neutropenia and a case of drug reexposure after a first attempt frustrated by agranulocytosis. In both cases, clozapine treatment had to be definitively withdrawn, but the patients full recovered.We believe that the presentation of cases in which relevant problems appeared c ould enrich the formation and inspire confidence among psychiatrist and residents in the management of similar cases. (AU)


Assuntos
Humanos , Masculino , Adulto , Agranulocitose/diagnóstico , Agranulocitose/terapia , Clozapina/administração & dosagem , Clozapina/uso terapêutico , Esquizofrenia/terapia , Leucopenia , Neutropenia
5.
Gastroenterol. hepatol. (Ed. impr.) ; 43(8): 457-463, oct. 2020. graf
Artigo em Espanhol | IBECS | ID: ibc-196902

RESUMO

La infección por el virus SARS-CoV-2 ha producido una pandemia con graves consecuencias sobre nuestro sistema sanitario. Aunque el colectivo de pacientes trasplantados hepáticos representa solo una minoría de la población, los hepatólogos que seguimos a estos pacientes hemos intentado coordinar esfuerzos para protocolizar el manejo de la inmunosupresión durante la infección por SARS-CoV-2. Aunque no hay estudios sólidos que avalen recomendaciones generales, las experiencias con otras infecciones víricas (hepatitis C, citomegalovirus) sugieren que el manejo de la inmunosupresión sin micofenolato mofetilo ni inhibidores m-Tor (fármacos que además se asocian a leucopenia y linfopenia) puede resultar beneficiosa. Es importante además prestar atención a las posibles interacciones farmacológicas, especialmente en el caso de tacrolimus, con algunos de los tratamientos con efecto antiviral que se administran en el contexto de la covid-19 (lopinavir/ritonavir, azitromicina). Finalmente, deberá tenerse en cuenta el efecto inmunosupresor de fármacos inmunomoduladores (tocilizumab y similares) que se administran en pacientes con enfermedad pulmonar severa. En el artículo se revisan los mecanismos de actuación de los diferentes fármacos inmunosupresores, su potencial efecto sobre la infección por SARS-CoV-2 y se sugieren unas pautas en el manejo de la inmunosupresión


SARS-CoV-2 infection has produced a pandemic with serious consequences for our health care system. Although liver transplant patients represent only a minority of the population, the hepatologists who follow these patients have tried to coordinate efforts to produce a protocol the management of immunosuppression during SARS-CoV-2 infection. Although there are no solid studies to support general recommendations, experiences with other viral infections (hepatitis C, cytomegalovirus) suggest that management of immunosuppression without mycophenolate mofetil or m-Tor inhibitors (drugs that are also associated with leukopenia and lymphopenia) may be beneficial. It is also important to pay attention to possible drug interactions, especially in the case of tacrolimus, with some of the treatments with antiviral effect given in the context of COVID 19 (lopinavir/ritonavir, azithromycin). Finally, the immunosuppressive effect of immunomodulating drugs (tocilizumab and similar) administered to patients with severe lung disease should be taken into account. The mechanisms of action of the different immunosuppressive drugs are reviewed in this article, as well as their potential effect on SARS-CoV-2 infection, and suggests guidelines for the management of immunosuppression


Assuntos
Humanos , Terapia de Imunossupressão/métodos , Transplante de Fígado/métodos , Infecções por Coronavirus/imunologia , Pandemias/prevenção & controle , Pneumonia Viral/imunologia , Leucopenia/complicações , Linfopenia/complicações , Tacrolimo/uso terapêutico , Fatores Imunológicos/uso terapêutico , Glucocorticoides/antagonistas & inibidores , Inibidores de Calcineurina/uso terapêutico , Serina-Treonina Quinases TOR/uso terapêutico
6.
Fontilles, Rev. leprol ; 31(5): 349-359, mayo-ago. 2018. graf
Artigo em Espanhol | IBECS | ID: ibc-175729

RESUMO

Introducción: La Organización Mundial de la Salud (OMS) recomendó el uso de la poliquimioterapia (PQT) desde 1981, y desde 1998 esta pauta de tratamiento fue introducida en Paraguay. Desde ese entonces y hasta la actualidad el esquema Multibacilar (MB) comprende tres drogas: rifampicina, clofazimina y dapsona, y, el esquema Paucibacilar (PB), dos drogas: rifampicina y dapsona. Todas ellas relacionadas en mayor o menor medida a efectos colaterales. A pesar de ello, hay pocos estudios a nivel mundial, y ningún estudio en el Paraguay. Métodos: Estudio retrospectivo, observacional, de corte transversal con componente analítico, llevado a cabo en la Cátedra de Dermatología del Hospital de Clínicas - Universidad Nacional de Asunción, en San Lorenzo, Paraguay. En el periodo de enero de 2013 a octubre de 2017. Resultados: Fueron incluidos en el estudio 58 pacientes con enfermedad de Hansen, de los cuales 45 (78%) presentaron al menos un efecto colateral a la PQT, 3 pacientes presentaron más de un efecto colateral. De los 45, 25 (56%) fueron del sexo masculino y 20 (44%) del sexo femenino. En cuanto a la distribución por rango de edad: Dos (4%) en menores de 18 años, 8 (18%) de 19 a 30 años, 27 (18%) de 31 a 59 años y 8 (18%) 60 y más años. Seis (3%) pacientes de procedencia rural y 39 (87%) de procedencia urbana. Cuarenta y siete (98%) casos de efectos colaterales hematológicos (Anemia: 45; leucopenia: 1 y trombocitopenia: 1) y 1 (2%) caso de efecto colateral gastrointestinal (hepatitis). La conducta en casos de anemia: suplementación con hierro y ácido fólico: 40, suspensión de dapsona: 10 y ninguna conducta: 6 suspensión de la dapsona en 1 caso de leucopenia, suspensión de la dapsona en 1 caso de trombocitopenia y suspensión de la rifampicina en 1 caso de hepatitis. En 26 (58%) pacientes los efectos colaterales se presentaron al mes del inicio de la PQT, en 15 (33%) pacientes entre 2 y 5 meses del inicio y en 4 (9%) pacientes a los 6 y más meses del inicio. En 14 (31%) de los pacientes con efectos colaterales existía comorbilidad y en 31 (69%) casos, eran pacientes sanos. De los 45 pacientes, 41 (91%) estaban en tratamiento MB, 4 (9%) en tratamiento PB. Conclusión: La mayoría de los pacientes incluidos en el estudio presentaron efectos colaterales. Los hombres fueron los más afectados, el rango etario en el cual se presentaron con mayor frecuencia fue entre los 31 y 59 años. La mayoría procedían del medio urbano. Los efectos colaterales más frecuentes fueron los hematológicos y, de entre ellos, la anemia. Ante tal situación la medida más frecuentemente adoptada fue la suplementación con hierro y ácido fólico. En la mayoría de los casos los efectos colaterales aparecieron en el primer mes de recibir la medicación. Aquellos pacientes que recibieron PQT MB presentaron la mayor frecuencia de efectos colaterales


Introduction: The World Health Organization (WHO) recommends the implementation of multidrug (MDT) since 1981, and this régimen was introduced in Paraguay in 1998. The MDT administrate three drugs: rifampicin, clofazimine and dapsone to multibacillary patients (MB) and only two: rifampicina and dapsone to paucibacillary patients (PB). All the drugs have some adverse effects. But very few statistics have been carried out in the world on this matter and none at all in Paraguay. Methods: The work is a retrospective, observational, cross-sectional and analytical study carried out at Catedra de Dermatología del Hospital de Clínicas-Universidad Nacional de Asunción, San Lorenzo, Paraguay between January 2013 and October 2017. Results: Fifty eight leprosy patients were registered in the study and 45 (78%) presented at least one adverse effect to the MDT and 3 patients presented more tan one. 25/45 were men and 20 (44%) women. The age distributions were: Two (4%) less than 18 years old, 8 (18%) between 19-30 years old, 27(18%) 31-59 years old and 8 (18%) 60 and older. Six (3%) lived in rural setting and 39 (87%) urban. Forty seven (98%) presented adverse hematological effects (anemia: 45, leucopenia: 1 and thrombocytopenia:1) and 1 (2%) presented a gastrointestinal effect. Forty patients with anemia received iron and folic acid supplements and 6 cases with no modifications. There was 1 case leucopenia, 1 thrombocytopenia, and 1 hepatitis due to rifampicine. In 26 patients (58%) adverse effects were detected during first month of MDT, in 15 (33%) between 2-5 of treatment and in 4 (9%) patients after 6 or more months of treatment. Fourteen (31%) patients had comorbility and 31 (69%) were healthy patients. Forty one (91%) patients were receiving MB MDT and 4 (9%) PB MDT. Conclusions: The mayority of the patients in the study presented adverse effects. Men were the most affected and the mayority were in the 31-59 years age group and from urban settings. Most of the effects were hematological and among them, anemia the most frequent. These cases were supplemented with iron and folic acid. Most adverse effects appeared during the first month of treatment and MB MDT group was the most affected


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/complicações , Hanseníase/complicações , Quimioterapia Combinada/efeitos adversos , Hanseníase/tratamento farmacológico , Hanseníase/diagnóstico , Estudos Retrospectivos , Estudo Observacional , Estudos Transversais , Leucopenia/complicações , Anemia/complicações
7.
Rev. psiquiatr. salud ment. (Barc., Ed. impr.) ; 11(2): 94-100, abr.-jun. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-174309

RESUMO

Material y métodos. Se estudió una muestra de mujeres ingresadas en nuestra UCPP y en tratamiento con clozapina. Se estudió la variación de los recuentos de leucocitos y neutrófilos durante las primeras 18 semanas de tratamiento, la aparición de leucopenia, neutropenia y agranulocitosis, así como la influencia de los fármacos empleados de forma concomitante. Resultados y conclusiones. Se obtuvo una tasa de incidencia de neutropenia de 1,82% (IC 95%: 0,05-10,13) y ningún caso de leucopenia ni agranulocitosis (0%). En el análisis cuantitativo de leucocitos y neutrófilos durante las 18 semanas de tratamiento, se observó un aumento hasta la semana 3-4, tendiendo después a la estabilización de las cifras alcanzadas, pero manteniendo siempre cifras superiores a las de los valores iniciales. Estas diferencias resultaron estadísticamente significativas para los leucocitos en el ANOVA de medidas repetidas con la corrección de Greenhouse-Geisser F (11,47, 37)=2,114 (p=0,011), ŋ2P=0,038. También resultó significativo para los neutrófilos el ANOVA con la corrección de Greenhouse-Geisser F (10,33, 37)=3,312 (p=0,0002), y el MANOVA F (18, 37)=2,693 (p=0,005), ŋ2P=0,567). La influencia de los fármacos estudiados de forma concomitante (litio, valproico y biperideno) no resultó globalmente significativa (MANOVA) sobre el aumento hallado en los leucocitos y neutrófilos


Introduction. Clozapine is an antipsychotic drug that has shown to be more effective than other antipsychotics in the treatment of schizophrenia, but its use is limited due to its side effects, particularly by the risk of causing agranulocytosis. A study was made on the variations in white cell and neutrophil counts in patients treated with clozapine in a Long-term Psychiatric Unit. Methods. A retrospective observational study was conducted with a sample of women of our long-term psychiatric care unit who had been treated with clozapine. A study was made on the variations in white cell and neutrophil counts during the first 18 weeks of treatment, as well as the onset of leukopenia, neutropenia, agranulocytosis, and the influence of concomitant drugs. Results and conclusions. The study included 55 patients on treatment with clozapine. The incidence rate of neutropenia was 1.82% (95% CI; 0.05-10.13). The incidence rate of leukopenia and agranulocytosis was 0%. An increase in white cell and neutrophil counts from baseline to week 3-4 was observed. Only small variations were observed after this time, but the counts remained higher than the initial values. These changes were statistically significant in the white cell count: One-way repeated ANOVA with Greenhouse-Geisser correction F (11.47, 37) = 2.114 (P= .011); and in neutrophils: One-way repeated ANOVA with Greenhouse-Geisser correction F (10.3, 37)=3.312 (P=.0002), and MANOVA F (18, 37)=2.693 (P=.005), ŋ2P=0.567. The influence of concomitant drugs (lithium, valproic and biperiden) was not significant on the overall increase found in white cells or neutrophils (MANOVA)


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Contagem de Leucócitos/métodos , Transtornos Leucocíticos/tratamento farmacológico , Clozapina/administração & dosagem , Ativação de Neutrófilo , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/complicações , Leucócitos , Neutrófilos , Clozapina/metabolismo , Clozapina/farmacologia , Análise de Variância , Agranulocitose/induzido quimicamente , Intervalos de Confiança , Leucopenia/induzido quimicamente
11.
Prog. obstet. ginecol. (Ed. impr.) ; 60(2): 146-149, mar.-abr. 2017. ilus
Artigo em Espanhol | IBECS | ID: ibc-164057

RESUMO

Introducción: El drenaje quirúrgico de un absceso de Bartholino se trata de una técnica con una baja tasa de complicaciones, siendo la sepsis extremadamente infrecuente. Caso: mujer de 26 años que acude a urgencias con mal estado general asociado a fiebre de hasta 38ºC, con punción de un absceso de Bartholino en horas previas. Presenta signos clínicos y analíticos compatibles con cuadro de shock séptico y a la exploración ginecológica se objetiva un hematoma sobreinfectado secundario a la punción del absceso de Bartholino. Se procede al drenaje del hematoma y marsupialización, con cobertura antibiótica durante 14 días consiguiéndose la resolución del cuadro. Conclusiones: la punción ciega de un absceso de Bartholino puede vehiculizar gérmenes al espacio vascular y provocar una septicemia, por lo que un adecuado control tras el procedimiento resulta fundamental, no siendo necesaria la cobertura antibiótica de rutina (AU)


Introduction: The surgical drainage of a Bartholin abscess is a technique with a low rate of complications, being the sepsis extremely unusual. Case: A 26 year old woman presents to the emergency room with chills and temperature of 38ºC, after punction of a Bartholin abscess a few hours before. She presents clinical and analytical signs compatible with septic shock. During the gynecological examination a infected haematoma is seen, secondary to the previous punction. The drainage of the haematoma and ulterior marsupialization are made, under antibiotic treatment during 14 days, getting to the resolution of the case. Conclusion: The punction of a Bartholin abscess may be a portal of entry for bacteremia causing a sepsis, so a tight control after procedure is essential, while the concomitant antibiotic treatment may be unnecessary (AU)


Assuntos
Humanos , Feminino , Adulto , Choque Séptico/complicações , Choque Séptico/etiologia , Abscesso/tratamento farmacológico , Abscesso/cirurgia , Glândulas Vestibulares Maiores/patologia , Glândulas Vestibulares Maiores/cirurgia , Hematoma/cirurgia , Sucção/métodos , Leucopenia/complicações , Antibacterianos/uso terapêutico , Administração Intravenosa , Biópsia por Agulha/efeitos adversos , Hematoma/tratamento farmacológico
12.
Cir. pediátr ; 30(1): 22-27, ene. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-163329

RESUMO

Objetivos. La trombosis portal extrahepática (TPEH) es la causa más frecuente de hipertensión portal en el niño. El objetivo de este estudio es analizar la utilidad de la técnica quirúrgica que crea un shunt mesoportal para mejorar o revertir las alteraciones causadas por la TPEH. Material y métodos. Revisión retrospectiva de los pacientes con TPEH idiopática sometidos al shunt mesoportal y análisis de los cambios en la cifra de leucocitos, plaquetas, tiempo de protrombina y tamaño del bazo al año de la cirugía. Resultados. De los 12 pacientes intervenidos, 10 tenían leucopenia, 11 plaquetopenia, 9 un tiempo de protrombina alargado y todos presentaban hiperesplenismo. Una paciente sufrió una trombosis postoperatoria del shunt por la que fue reoperada con cambio de la técnica quirúrgica. El resto de pacientes (92%) tienen un shunt funcionante con un seguimiento 4,3 ± 2,5 años y no han sufrido ningún sangrado gastrointestinal. Al año de la cirugía, observamos cambios significativos en el número total de plaquetas, tiempo de protrombina y tamaño del bazo, no siendo estos cambios significativos para la cifra de leucocitos. Sin embargo, el número de pacientes que pasó de estar leucopénico a tener cifras normales de leucocitos, sí fue significativo, hecho que también ocurrió en el caso de las alteraciones en el tiempo de protrombina. Conclusiones. El shunt mesoportal de Rex mejora de manera efectiva las alteraciones asociadas a la hipertensión portal por TPEH, con una alta tasa de éxito, por lo que debería ser la técnica de elección en estos pacientes (AU)


Background. Extrahepatic portal vein obstruction (EPVO) is the principal cause of portal hypertension in children. The objective of this study was to analyze the capacity of the surgical technique that creates a mesoportal shunt to treat changes caused by EPVO. Methods. Retrospective review of patients with idiopathic EPVO who underwent a mesoportal shunt and analysis of the changes in the number of leucocytes, platelets, prothrombin time and spleen size one year after the surgery. Results. Twelve patients underwent surgery, out of which 10 had prior leukopenia, 11 thrombopenia, 9 longer prothrombin times and all had hypersplenism. One patient suffered a postoperative shunt thrombosis, was reoperated and underwent a change in the operative technique. The remaining patients (92%) have functioning shunts 4.3 ± 2.5 years after surgery, and none have suffered any episode of gastrointestinal bleeding. One year after surgery, there were significant changes in the number of platelets, prothrombin time and spleen size, with no significant changes in the number of leukocytes. However, the number of patients who went from a leukopenic to a normal state was significant, as happened with changes in prothrombin time. Conclusions. Mesoportal Rex shunt improves some of the disorders caused by portal hypertension in children suffering EPVO, with a high rate of surgical success. This technique should be of first choice in these patients (AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Trombose Venosa/cirurgia , Hipertensão Portal/fisiopatologia , Derivação Portossistêmica Cirúrgica/métodos , Veia Porta/fisiopatologia , Leucopenia/complicações , Transtornos Plaquetários/complicações , Estudos Retrospectivos
14.
Clin. transl. oncol. (Print) ; 18(2): 138-143, feb. 2016. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-148218

RESUMO

Objective. The aim of this study was to evaluate the efficacy and safety of a consecutive series of elderly patients with primary central nervous system lymphoma (PCNSL) treated with single-agent pemetrexed without radiotherapy or intrathecal chemotherapy. Methods. Twelve histologically confirmed newly diagnosed PCNSL patients older than 65 years were studied between 2008 and 2013. An induction chemotherapy was initially given (pemetrexed 600 mg/m2 on day 1, every 3 weeks). Patients achieving a complete, partial response or stable disease proceeded to a maintenance phase (up to 6 cycles). Patients with progressive/recurrent disease (PD) were treated with whole brain radiotherapy on an individual basis. Results. Four patients presented complete response, six patients showed partial response and two patients presented progressive disease. The median progression-free survival (PFS) was 9.0 months [95 % confidence interval (CI) 2.0-45.3] and the median overall survival was 19.5 months (95 % CI 5.0-45.3). Adverse events included leukocytopenia, anemia, fatigue, rash and vomiting. No neurotoxicity or treatment-related death was observed. The estimated 1-year and 2-year survival rate was 66.7 and 41.7 %, respectively. Conclusions. Our efficacy results demonstrate that the single-agent pemetrexed was feasible, active and well tolerated in elderly patients with PCNSL. Furthermore, this single-agent regimen results in higher response rates and less toxicity comparable with other chemotherapy or radiotherapy regimens. Prospectively, controlled studies are warranted to confirm such results (AU)


No disponible


Assuntos
Humanos , Masculino , Feminino , Idoso , Doenças do Sistema Nervoso Central/complicações , Doenças do Sistema Nervoso Central/patologia , Linfoma/congênito , Linfoma/metabolismo , Leucopenia/sangue , Fadiga/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Estudos Retrospectivos , Doenças do Sistema Nervoso Central/diagnóstico , Doenças do Sistema Nervoso Central/metabolismo , Linfoma/complicações , Linfoma/diagnóstico , Intervalo Livre de Doença , Leucopenia/metabolismo , Fadiga/complicações , Tomografia Computadorizada por Raios X
15.
Rev. lab. clín ; 8(4): 188-191, oct.-dic. 2015. ilus
Artigo em Espanhol | IBECS | ID: ibc-146405

RESUMO

La leishmaniasis es una enfermedad parasitaria ocasionada por protozoos del género Leishmania, cuya forma de transmisión habitual es vectorial. Actualmente está clasificada como enfermedad tropical desatendida. A pesar de esto, se ha visto un aumento de casos en los últimos años en relación con 3 hechos: falta de medidas de control, movimientos de población y presencia de inmunosupresión. A continuación, exponemos el caso de un varón de 26 años sin antecedentes previos, que presentaba un cuadro de 2 meses de evolución inespecífico con predominio de sensación de distermia, astenia, diaforesis e hiperoxia. En la exploración se evidenció hepatoesplenomegalia y en la analítica inicial se objetivó una marcada neutropenia y anemia. Se procedió al estudio citomorfológico de sangre periférica y aspirado de médula ósea donde se evidenció parasitación por Leishmania, a pesar de no presentar ningún factor de inmunosupresión; característica habitual de esta dolencia (AU)


Leishmaniasis is a parasitic disease caused by protozoa of the genus Leishmania. Its usual transmission form is vectorial. It is currently classified as a neglected tropical disease. Despite this, cases have been increasing in recent years due to three factors: lack of control measures, population movements, and presence of immunosuppression. The case is presented of a 26 year-old male with no previous history, who had a clinical profile of two months non-specific evolution with dysthermic feeling, asthenia, diaphoresis and hyperoxia. On physical examination he had hepatosplenomegaly and the initial laboratory results showed a marked anaemia and neutropenia. A cyto-morphological study of peripheral blood and bone marrow aspirate were performed that reported a Leishmania parasite infestation, but no evidence of any immunosuppressive factor, which is a regular feature of this disease (AU)


Assuntos
Adulto , Humanos , Masculino , Leishmaniose Visceral/diagnóstico , Terapia de Imunossupressão/métodos , Neutropenia/diagnóstico , Trombocitopenia/sangue , Trombocitopenia/diagnóstico , Análise Química do Sangue/métodos , Análise Química do Sangue , Testes de Química Clínica , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/isolamento & purificação , Leishmaniose Visceral , Leucopenia/diagnóstico , Bilirrubina/análise , Radiografia Abdominal/métodos , Radiografia Abdominal , Esplenomegalia , Anfotericina B/uso terapêutico
19.
Clin. transl. oncol. (Print) ; 17(5): 371-377, mayo 2015. tab, graf
Artigo em Inglês | IBECS | ID: ibc-141718

RESUMO

Background: The application of newer signaling pathway-targeted agents has become an important addition to chemotherapy in the treatment of advanced non-small cell lung cancer (NSCLC). In this study, we evaluated the efficacy and toxicities of PKC inhibitors combined with chemotherapy versus chemotherapy alone for patients with advanced NSCLC systematically. Patients and materials: Literature retrieval, trials selection and assessment, data collection, and statistic analysis were performed according to the Cochrane Handbook 5.1.0. The outcome measures were tumor response rate, disease control rate, progression-free survival (PFS), overall survival (OS), and adverse effects. Results: Five randomized controlled trials, comprising totally 1,005 patients, were included in this study. Meta-analysis showed significantly decreased response rate (RR 0.79; 95 % CI 0.64–0.99) and disease control rate (RR 0.90; 95 % CI 0.82–0.99) in PKC inhibitors-chemotherapy groups versus chemotherapy groups. There was no significant difference between the two treatment groups regarding progression-free survival (PFS, HR 1.05; 95 % CI 0.91–1.22) and overall survival (OS, HR 1.00; 95 % CI 0.86–1.16). The risk of grade 3/4 neutropenia, leucopenia, and thrombosis/embolism increased significantly in PKC inhibitors combination groups as compared with chemotherapy alone groups. Conclusion: The use of PKC inhibitors in addition to chemotherapy was not a valid alternative for patients with advanced NSCLC


No disponible


Assuntos
Feminino , Humanos , Masculino , Proteína Quinase C/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/diagnóstico , Metástase Neoplásica/tratamento farmacológico , Metástase Neoplásica/fisiopatologia , Neutropenia/complicações , Neutropenia/prevenção & controle , Leucopenia/complicações , Leucopenia/prevenção & controle , Metástase Neoplásica/patologia , Metástase Neoplásica/prevenção & controle
20.
Actas urol. esp ; 38(8): 515-522, oct. 2014. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-128831

RESUMO

Introducción: El docetaxel administrado cada 3 semanas es el tratamiento estandar del cáncer de próstata resistente a la castración (CPRC), pero se asocia con toxicidades limitantes de dosis. Se analizó la eficacia y la tolerabilidad de docetaxel 3 veces a la semana y una vez a la semana en una cohorte turca de pacientes con CPRC, con un énfasis especial en los pacientes de edad avanzada. Materiales y métodos: Se realizó un análisis retrospectivo de 45 pacientes que recibieron docetaxel 3 veces a la semana o una vez a la semana en una única clínica de oncología urológica. Se evaluaron las tasas de respuesta al tratamiento, toxicidad y supervivencia global. Resultados: La edad media de los pacientes fue de 70,0 (± 8,8) años. Se obtuvo respuesta completa o parcial de PSA en el 45% de los pacientes. La mediana de supervivencia global fue de 20,0 meses (SE: 6,46; IC 95%: 7,3-32,6). La ausencia de metástasis, tiempo hasta CPRC > 10 meses, 75 mg/m2 de DP una vez cada 3 semanas y PSA < 50% al final del tercer ciclo se asociaron con una mejor supervivencia global. No hubo diferencia significativa en la supervivencia entre los pacientes de 75 años o más en comparación con los más jóvenes. La toxicidad hematológica más frecuente fue la leucopenia, que fue limitante de la dosis en un solo paciente. Conclusión: La administración de docetaxel estándar 3 veces a la semana está bien tolerada en esta relativamente antigua cohorte de pacientes turcos con CPRC, y la administración semanal puede ser una alternativa razonable en pacientes frágiles, no solo para prolongar la supervivencia, sino también para aliviar los síntomas de la enfermedad


Introduction: Docetaxel administered every 3-weeks is the standard treatment of castration resistant prostate cancer (CRPC) but it is associated with dose limiting toxicities. We analyzed the efficacy and tolerability of 3-weekly and weekly docetaxel in a Turkish cohort of CRPC patients with a special emphasis on the elderly patients. Materials and methods: A retrospective analysis of 45 patients who received either 3-weekly or weekly docetaxel in a single urologic oncology clinic was performed. Response to therapy, toxicity and overall survival rates were evaluated. Results: The mean age of patients was 70.0 (± 8.8) years. Complete or partial PSA response was obtained in 45% of patients. The median overall survival was 20.0 months (SE 6.46; 95% CI 7.3-32.6). Absence of metastasis, time to CRPC >10 months, DP 75 mg/m2 once every 3 weeks and PSA <50% at the end of the third cycle were associated with better overall survival. There was no significant survival difference between the patients aged 75 or older versus younger ones. The most common hematological toxicity was leukopenia which was dose limiting in only one patient. Conclusion: Administration of standard 3-weekly docetaxel is well tolerated in this relatively old cohort of Turkish CRPC patients and weekly administration can be a reasonable alternative in frail patients not only to prolong survival but also to palliate disease symptoms


Assuntos
Humanos , Masculino , Idoso , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/patologia , Castração , Sobrevivência/fisiologia , Leucopenia/sangue , Leucopenia/complicações , Leucopenia/patologia , Geriatria/ética , Geriatria/métodos , Geriatria/organização & administração , Prostatectomia
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