Factors associated with abandonment of therapy by children diagnosed with solid tumors in Peru.

BACKGROUND: Abandonment of treatment is a major cause of treatment failure and poor survival in children with cancer in low- and middle-income countries. The incidence of treatment abandonment in Peru has not been reported. The aim of this study was to examine the prevalence of and factors associated with treatment abandonment by pediatric patients with solid tumors in Peru. METHODS: We retrospectively reviewed the sociodemographic and clinical data of children referred between January 2012 and December 2014 to the two main tertiary centers for childhood cancer in Peru. The definition of treatment abandonment followed the International Society of Paediatric Oncology, Paediatric Oncology in Developing Countries, Abandonment of Treatment recommendation. RESULTS: Data from 1135 children diagnosed with malignant solid tumors were analyzed, of which 209 (18.4%) abandoned treatment. Bivariate logistic regression analysis showed significantly higher abandonment rates in children living outside the capital city, Lima (forest; odds ratio [OR] 3.25; P < 0.001), those living in a rural setting (OR 3.44; P < 0.001), and those whose parent(s) lacked formal employment (OR 4.39; P = 0.001). According to cancer diagnosis, children with retinoblastoma were more likely to abandon treatment compared to children with other solid tumors (OR 1.79; P = 0.02). In multivariate regression analyses, rural origin (OR 2.02; P = 0.001) and lack of formal parental employment (OR 2.88; P = 0.001) were independently predictive of abandonment. CONCLUSION: Treatment abandonment prevalence of solid tumors in Peru is high and closely related to sociodemographical factors. Treatment outcomes could be substantially improved by strategies that help prevent abandonment of therapy based on these results.

Real-World Outcomes of Adolescents and Young Adults with Diffuse Large B-Cell Lymphoma: A Multicenter Retrospective Cohort Study.

Purpose: Patients with diffuse large B-cell lymphoma (DLBCL) are typically treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). However, a standard of care for managing adolescents and young adults (AYAs) with DLBCL is lacking. We examine treatment approaches and outcomes of this population. Methods: We included 90 AYAs (15-39 years) diagnosed with DLBCL between 2008 and 2018 in three tertiary centers in Peru. Overall response rates (ORR) were available for all patients. Overall survival (OS) and progression-free survival (PFS) rates were estimated using the Kaplan-Meier method. Results: The median age at diagnosis was 33 years, 57% were males, 57% had good performance status (Lansky/Karnofsky ≥90), and 61% were diagnosed with early-stage disease (Ann Arbor stages I-II). R-CHOP (n = 69, 77%) was the most frequently used first-line regimen, with an ORR of 91%. With a median follow-up of 83 months, the 5-year OS and PFS among all patients were 79% and 67%, respectively. Among the patients who received R-CHOP, the 5-year OS and PFS were 77% and 66%, respectively. Of the 29 (32%) patients with relapsed/refractory (R/R) disease, 83% received second-line treatment and only 14% underwent consolidation therapy with autologous transplantation. The 3-year OS for R/R DLBCL was 36%. Conclusion: Our data show that AYAs with DLBCL who received conventional therapy had comparable outcomes to those observed in studies conducted among the adult population. However, the prognosis for AYAs with R/R disease was dismal, indicating the unmet need for developing and increasing access to novel treatment modalities in AYAs.

Selective estrogen receptor modulators in chronic renal failure.

BACKGROUND: In addition to renal osteodystrophy, postmenopausal women on dialysis could be at risk of osteoporosis. Hormone replacement therapy (HRT) could have beneficial effects as well as potentially serious risks, especially in uremic women, due to the pharmacokinetics of estradiol in renal failure. Therapeutic alternatives, such as the selective estrogen receptor modulators (SERMs), have shown the benefits of estrogen on bone and serum lipid levels, without its adverse effects on the breast and endometrium, in nonuremic women. METHODS: Recent data on the effect of the SERM raloxifene in bone and lipid metabolism in osteoporotic postmenopausal women on dialysis is reviewed. Since the estrogen receptor (ER) gene has been suggested as a candidate marker for osteoporosis, we investigated whether ER polymorphism could have predicted the BMD response to raloxifene. RESULTS: Hemodialyzed women on raloxifene demonstrated increased trabecular bone mineral density (BMD) and decreased bone resorption markers. Similarly, LDL-cholesterol values dropped significantly. ER gene polymorphism analysis of baseline BMD parameters did not differ between PP/xx or Pp/Xx groups. Nevertheless, patients on raloxifene with PP/xx genotypes, but not those with Pp/Xx, showed a higher trabecular BMD after one year on treatment, suggesting that homozygous women for P or x alleles of the ER have a better BMD response to raloxifene. CONCLUSION: Raloxifene and, most likely, other SERMs, could represent a good alternative to HRT in postmenopausal uremic women.

Transplant coordination program: a useful tool to improve organ donation in Venezuela.

Donor shortage is the single most important limitation for allowing adequate growth of transplant programs. Transplant coordination programs have been shown to provide solutions to this situation worldwide. To evaluate the efficacy of transplant coordination programs in Venezuela, a pilot program was implemented at a 1200-bed teaching hospital. The implementation of this program included an assessment of the hospital's donation practices such as donor identification, maintenance, brain-death diagnosis, family consent for donation, and timely transport and allocation of organs and tissues. A follow-up 1 year after the implementation of the transplant coordination program demonstrated a 7-fold increase in the number of donors compared with the 2 previous years when the program did not exist. During the first year of application, the transplant coordination program resulted in solutions in how to address issues surrounding the procurement process in a hospital with a high potential donor rate; a linkage between the coordinator and the medical staff through educational activities; increased skills of hospital staff; and a methodology that should be applied extensively in hospitals with high donor potential to deal with the organ shortage.

Organ and tissue procurement system: a novel intervention to increase organ donation rates in Venezuela.

The limited number of organs and tissues available for transplantation in Venezuela and the need to improve outcomes for patients with life-threatening end-stage organ failure or inadequate quality of life resulted in the development and implementation of an organ and tissue procurement system by the Venezuelan National Transplant Organization. This procurement system, a 24-hour, nationwide, free phone service for detection of potential organ donors, connects callers with transplant coordinators. The on-call coordinator supervises family approach as well as maintenance, transport, and allocation of the organs and tissues. During a period of 21 months, the phone service received 1191 calls (713 requesting information to become a voluntary donor, 207 requesting information about donation and transplantation, and 271 reporting potential donors). Of the potential donors, 74% were men and 67% were aged between 11 and 40 years, and most came from hospital intensive care units, emergency departments, and trauma shock units. The main causes of death were trauma and stroke. Reasons why donation was not accomplished included early cardiorespiratory arrest and denied consent. In conclusion, establishing the procurement system resulted in an increase in the detection, referral, and maintenance of potential donors; doubling of the number of donors per million population; and an increase in the number of cadaveric transplants.

[Household factors associated with the presence of human hydatid disease in three rural communities of Junin, Peru]. / Factores domiciliarios asociados con la presencia de hidatidosis humana en tres comunidades rurales de Junín, Perú.

INTRODUCTION: Hydatid disease, a zoonosis caused by the larval stage of the parasite Echinococcus granulosus, is a public health problem at national level, especially in those regions dedicated to raising livestock. By now, there are many factors, at individual level, that have been associated to the infection by E. granulosus; nevertheless there is not any previous report that explore the association between household characteristics and the presence of the disease among household members. OBJECTIVE: To explore the association between household characteristics and the presence of hydatid disease among household members. MATERIAL AND METHODS: We performed a cross-sectional study in the households of 3 rural communities located in Junín, we evaluated the association between household characteristics and the presence of hydatid disease by multiple logistic regression (MLR). RESULTS: From 417 evaluated households, 56 (13%) of them had at least one positive case among its members. Multivariate analysis showed that households with three or more members, located in the community with the lowest quintile of poverty, that reported raising livestock, and with evaluation coverage greater than 25% were more likely to have at least one positive case among its members. CONCLUSION: The observed characteristics be taken into account in the preliminary definition of high-risk subgroups, optimizing the use of resources and improving the effectiveness of screening programs.

Discitis hematógena aguda en un adulto / Discite hématogène aiguë chez un adulte / Acute hematogenous discitis in an adult patient

Introducción: la discitis es una de las formas de presentación de los procesos infecciosos en el raquis. La de origen hematógeno es más frecuente en los niños y de modo raro aparece en el adulto asociada a una inmunodepresión, porque en esta edad ocurre generalmente como complicación de un proceder quirúrgico sobre el disco intervertebral. Objetivo: establecer las características clínicas e imaginológicas y el tratamiento de esta afección en el adulto. Descripción: se presentó un paciente masculino de 35 años de edad con antecedentes de salud anterior, que comenzó a presentar dolor en columna lumbar e impotencia funcional absoluta. Se realizaron estudios de laboratorio y de imágenes. Los parámetros hematológicos inclinaban al diagnóstico de un proceso infeccioso y la resonancia magnética nuclear evidenció una discitis. El tratamiento consistió en la administración de antibióticos e inmovilización. Conclusiones: el paciente presentó mejoría de los síntomas a las 72 h, con alivio total del dolor a las 2 semanas. Los resultados hematológicos mejoraron paulatinamente hasta alcanzar la normalidad a los 3 meses. Los estudios de imágenes fueron normales a los 6 meses y el paciente se incorporó a sus actividades habituales. la discitis hematógena en el adulto, aunque infrecuente, debe ser sospechada en todo paciente con síntomas dolorosos del raquis de posible origen infeccioso, que no responde a tratamiento médico y mucho más si concomita con algún grado de inmunodepresión(AU)

Introduction: Discitis is one of the forms of presentation of infectious processes of the spine. Discitis of hematogenous origin is more common in children. In adults it is a rare condition associated to immunosuppression, since it generally occurs as a complication of intervertebral disk surgery. Objective: Determine the clinical and imaging characteristics as well as the treatment of this condition in adults. Description: A male 35-year-old patient with a disease history presents with lumbar pain and total functional impotence. Laboratory and imaging studies were conducted. Hematological parameters pointed to an infectious process, and nuclear magnetic resonance imaging revealed a discitis. Treatment consisted of antibiotics and immobilization. Conclusions: The patient showed symptom improvement at 72 hours, with total pain relief at 2 weeks. There was gradual improvement in hematological results, which reached normal levels at 3 months. Imaging studies were normal at 6 months, and the patient resumed his daily routine. Adult hematogenous discitis, though infrequent, should be suspected in any patient with spinal pain symptoms of possible infectious origin not responding to clinical treatment, particularly when it is concomitant with some degree of immunosuppression(AU)

Introduction: la discite est l'une des formes de présentation caractérisant les processus infectieux au niveau du rachis. L'infection hématogène est la plus fréquente chez les enfants, mais rare chez les adultes si associée à une immunodépression, car à l'âge adulte, elle survient généralement comme une complication d'un geste chirurgical sur un disque intervertébral. Objectif: établir les caractéristiques cliniques et par image, et le traitement de cette affection chez l'adulte. Description: un patient du sexe masculin, âgé de 35 ans, avec une histoire médicale connue, ayant une douleur lombaire et un dysfonctionnement absolu, s'est présenté en consultation. Des examens de laboratoire et d'imagerie ont été réalisés. Les résultats hématologiques ont évoqué une infection, et la résonance magnétique nucléaire a mis en évidence une discite. Le traitement a consisté à l'administration des antibiotiques et à l'immobilisation. Conclusion: les symptômes du patient ont résolu à 72 h, la douleur s'est atténuée à 2 semaines. Les résultats hématologiques ont amélioré peu à peu lors de 3 semaines. Les examens d'imagerie sont revenus à la normale à 6 mois, et le patient s'est réincorporé à sa vie quotidienne. La discite hématogène chez l'adulte, quoique rare, doit être soupçonnée chez tout patient ayant une douleur de possible origine infectieuse au niveau du rachis et ne répondant pas au traitement médical, nettement plus si une certaine immunodépression est concomitante(AU)

Caracterización clínica y serológica de la toxoplasmosis ocular activa / Clinical and serological characterization of active ocular toxoplasmosis

Objetivo: Describir las características clínicas y serológicas de un grupo de pacientes afectados de toxoplasmosis ocular activa. Método: Estudio observacional, descriptivo, de corte transversal realizado en 54 ojos de igual número de pacientes con diagnóstico de toxoplasmosis ocular. Se les realizó un examen oftalmológico completo y se determinó los niveles de anticuerpos Ig G anti-toxoplasma en suero por inmunofluorescencia indirecta. Resultados: Las edades de 16 a 45 años y el sexo masculino predominaron en los pacientes estudiados. El 100 % presentó retinocoroiditis acompañada de vitritis de variable intensidad. Predominaron en 51,9 % las lesiones recurrentes. La afectación visual moderada fue más frecuente (46,3 %), constituyó la zona I de retina el área mayormente afectada (53,7 %). La Ig G fue positiva en el 88,9 % de los pacientes, hubo un predominio de la dilución 1/32 (38,9 %). Las complicaciones más frecuentes fueron: membrana epirretinal (7,41 %), opacidades vítreas (5,56 %) y glaucoma secundario (5,56 %). Conclusiones: Las características epidemiológicas de los pacientes coincidieron con lo descrito en la literatura. El grado de afectación visual estuvo relacionado con la localización de las lesiones. Prevaleció la serpositividad a la Ig G para toxoplasma a diluciones bajas.

Objective: To report the clinical and serological features of active ocular toxoplasmosis in a group of patients. Methods: A cross-sectional observational and descriptive study was conducted in 54 eyes from an equal number of patients, with a diagnosis of active ocular toxoplasmosis. A complete ophthalmologic exam was performed; and indirect immunofluorescence was applied to estimate the anti-toxoplasma IgG antibodies levels in peripheral serum. Results: Male patients and 16-45 y age group prevailed. All of the patients presented with retinochoroiditis along with vitreous haze of variable density. Recurrent lesions prevailed in 51.9% of cases. Mild visual impairment was more common (46.3%,), being the retinal zone I the most compromised(53.7 %). Ig G was positive in 88.9% of patients; 1/32 dilution prevailed (38.9 %). The most frequent ocular complications were epiretinal membrane (7. 41 %), vitreous opacities (5.56 %) and secondary glaucoma (5.56 %). Conclusion: In this study, the epidemiological characteristics of patients were similar to those described in literature. The level of visual impairment was related with the location of lesions, whereas IgG positivity to toxoplasma at low dilutions predominated.

Comportamiento de la toxoplasmosis ocular activa en el Instituto Cubano de Oftalmología Ramón Pando Ferrer / Behavior of the active ocular toxoplasmosis in patients of the Ram¾n Pando Ferrer Cuban Institute of Ophthalmology

OBJETIVO: Describir los hallazgos patológicos en una serie de pacientes con toxoplasmosis ocular. MÉTODOS: Se realizó un estudio observacional descriptivo de serie de casos, con el propósito de describir el comportamiento de la forma activa de la toxoplasmosis ocular en pacientes atendidos en el Instituto Cubano de Oftalmología Ramón Pando Ferrer durante el año 2009. Se examinaron 128 pacientes, a quienes se les efectuó examen oftalmológico completo y de laboratorio. RESULTADOS: La forma de presentación más común fue una retinitis, y el grupo etáreo más afectado fue el de 20 a 29 años, con ligero predominio del sexo femenino. La disminución de la visión y los flotadores fueron los principales síntomas de presentación, y el diagnóstico se realizó en 106 pacientes de forma clínica. La inflamación predominó en la zona I de la retina y dañó principalmente, de manera oderada, la visión de los pacientes en el ojo afectado al momento del diagnóstico. Se instauró tratamiento en 122 de los 128 pacientes y este fue en su mayoría el esquema estándar de pirimetamina, sulfadiazina y prednisona. El 53,1 por ciento de los ojos afectados recuperaron su visión normal, mientras permanecieron con disminución de la visión severa 34 ojos, la mayoría causada por complicaciones como cicatrices maculares, que fueron las más registradas. CONCLUSIONES: Buenos resultados visuales pueden ser obtenidos con una terapia adecuada aunque esta dependerá del área de la retina afectada, el nivel de la inflamación intraocular y el tiempo de duración de la enfermedad

OBJECTIVE: To describe the pathological findings in a series of patients diagnosed with ocular toxoplasmosis. METHODS: A case-series, descriptive and observational study was conducted to describe the behavior of the active way of the ocular toxoplasmosis in patients seen in the Ramón Pando Ferrer Cuban Institute of Ophthalmology over 2009. A total of 128 were examined who underwent a total laboratory and ophthalmologic examination. RESULTS: The commonest presentation way was as a retinitis and the more involved age-group was that of 20-29 years, with a slight predominance of female sex. The vision decrease and the floaters were the main symptoms of presentation, the clinical diagnosis was made in 106 patients. Inflammation predominated in the 1 retinal zone and involved mainly in a moderate way the vision of patients in the involved eye at diagnosis. In 122 of the 128 treatment was applied consisted in most of the standard scheme of pyrimethamine, sulfadiazine and prednisone. The 43.1 percent of involved eyes recovered it normal vision, whereas 34 eyes remained with a severe decrease, most caused by complications including macular scars, which were the more registered. CONCLUSIONS: It is possible to achieve good visual results with an appropriate therapy although it will depend on the involved retinal area, the level of intraocular inflammation and the length of the disease

Maculopatía por cloroquina / Maculopathy from use of chloroquine

La toxicidad de la cloroquina está relacionada con la dosis. Una dosis acumulativa de -100 g de cloroquina o una duración del tratamiento de menos de 1 año raramente se asocia con lesión retiniana. El riesgo de toxicidad aumenta significativamente cuando la dosis acumulativa excede los 300 g (250/día por 3 años). Se presenta un paciente del sexo femenino, con antecedentes de lupus eritematoso sistémico, hace 17 años, para lo cual se le indicó un tratamiento con cloroquina, (1 tableta 250 mg/diaria) durante 15 años. Como síntoma capital presentaba disminución lenta y progresiva de la agudeza visual de 2 años de evolución; se le realizó un examen oftalmológico y otros exámenes complementarios que condujeron al diagnóstico de la enfermedad, y se estableció su tratamiento y su pronóstico. Se realizan recomendaciones.

Chloroquine toxicity depends on the dose. A cumulative dose of under 100 g of chloroquine or a length of treatment for less than one year is rarely associated to any retinal lesion. The toxicity risk significantly increases with the cumulative dose over 300 g (250 g/day for three years). The case of a female patient with a history of lupus erythematosus for 17 years was presented. She was treated with chloroquine (one 250 mg every day) for 15 years. The main symptom was slow and progressive reduction of visual acuity experienced for 2 years; a complete ophthalmologic exam and other supplementary tests were indicated, which led to a diagnosis of maculopathy, and treatment and prognosis were then presented. Recommendations were made.

Estrogen receptor (ER) gene polymorphism may predict the bone mineral density response to raloxifene in postmenopausal women on chronic hemodialysis.

The estrogen receptor (ER) gene has been considered as a candidate genetic marker for osteoporosis, and PvuII and XbaI polymorphisms of the ERalpha gene have been associated with low bone mineral density (BMD). We investigated whether ER polymorphism could predict the response of BMD in 28 postmenopausal women on hemodialysis with marked osteopenia or osteoporosis, randomized to receive raloxifene, a selective estrogen receptor modulator (SERM), or placebo for 1 year. BMD was assessed by dual X-ray absorptiometry and PvuII and XbaI restriction fragment-length polymorphism of the ER gene was determined using polymerase chain reaction. Baseline lumbar spine or femoral neck BMD parameters were not different between patients presenting either homozygous PP or xx when compared with heterozygous Pp or Xx genotypes. After 1 year, patients on raloxifene, presenting with PP or xx genotypes (but not those with Pp or Xx), showed a significantly higher mean lumbar spine BMD (0.942 +/- 0.18 vs. 0.925 +/- 0.17 g/cm2, p < .01) and lower serum pyridinoline (19.7 +/- 9.7 vs. 30.6 +/- 16.5 nmol/L, p < .02) when compared with baseline values. No changes were detected in the placebo-treated patients or in the femur neck sites. In conclusion, after 1 year on raloxifene, postmenopausal osteoporotic women on chronic hemodialysis, homozygous for the P or x (PP or xx) alleles of the ER, exhibited a better lumbar spine BMD response and decreased serum pyridinoline values when compared with heterozygous women (Pp or Xx), suggesting that ERalpha allelic variants may explain, at least in part, the different outcomes after treatment of osteoporosis with SERM.

Factores domiciliarios asociados con la presencia de hidatidosis humana en tres comunidades rurales de Junín, Perú / Household factors associated with the presence of human hydatid disease in three rural communities of Junin, Peru

Introducción. La hidatidosis, zoonosis producida por el estadio larvario de la taenia Echinococcus granulosus, es un problema de salud pública a nivel nacional, en especial en aquellas regiones dedicadas a la crianza de ganado. A la fecha, se han descrito factores, a nivel individual, asociados con la infección por E. granulosus; sin embargo, no se encontró reporte previo que explore la asociación entre características de la vivienda y la presencia de esta enfermedad en alguno de sus miembros. Objetivos. Explorar la asociación entre las características de la vivienda y la presencia de hidatidosis entre las personas que la habitan. Materiales y métodos. Se realizó un estudio transversal en viviendas de tres comunidades rurales de Junín. Se evaluó el grado de asociación entre las características de la vivienda y la presencia de hidatidosis en el hogar mediante un análisis de regresión logística múltiple (RLM). Resultados. De un total de 417 viviendas evaluadas, 56 (13 por ciento) de ellas tenían al menos un caso positivo entre sus miembros; luego del análisis de RLM se observó que aquellas viviendas con más de tres miembros, localizadas en la comunidad con quintil de pobreza más bajo, que refirieron crianza de animales, y con una cobertura de evaluación mayor al 25 por ciento presentaron una mayor probabilidad de tener al menos un caso de positivo entre sus miembros. Conclusión. Las características observadas deben ser tomadas en cuenta para la determinación preliminar de subgrupos de alto riesgo, optimizando así el uso de los recursos y mejorando la eficacia de los programas de despistaje.

Introduction. Hydatid disease, a zoonosis caused by the larval stage of the parasite Echinococcus granulosus, is a public health problem at national level, especially in those regions dedicated to raising livestock. By now, there are many factors, at individual level, that have been associated to the infection by E. granulosus; nevertheless there is not any previous report that explore the association between household characteristics and the presence of the disease among household members. Objective. To explore the association between household characteristics and the presence of hydatid disease among household members. Material and methods. We performed a cross-sectional study in the households of 3 rural communities located in Junín, we evaluated the association between household characteristics and the presence of hydatid disease by multiple logistic regression (MLR). Results. From 417 evaluated households, 56 (13 percent) of them had at least one positive case among its members. Multivariate analysis showed that households with three or more members, located in the community with the lowest quintile of poverty, that reported raising livestock, and with evaluation coverage greater than 25 percent were more likely to have at least one positive case among its members. Conclusion. The observed characteristics be taken into account in the preliminary definition of high-risk subgroups, optimizing the use of resources and improving the effectiveness of screening programs.

Triamcinolona subtenoniana en el edema macular diabético / Subtenon triamcinolone in the diabetic macular edema

INTRODUCCIÓN: La prevalencia de la retinopatía diabética está determinada por el tipo de diabetes mellitus y por el tiempo de evolución de la enfermedad. El edema macular es la principal causa de la disminución de la agudeza visual en el paciente diabético. Un diagnóstico precoz y certero de esta enfermedad, unido al establecimiento de un tratamiento adecuado es crucial en el esfuerzo por reducir la incapacidad visual. El propósito de este trabajo fue determinar la efectividad de la triamcinolona subtenoniana como tratamiento del edema macular en un grupo de pacientes diabéticos. MÉTODOS: Se realizó un estudio descriptivo-prospectivo de caso control. La muestra estuvo formada por 30 pacientes diabéticos que fueron atendidos en el Hospital Clínicoquirúrgico "Dr. Miguel Enríquez, desde enero a junio de 2007, con diagnóstico de edema macular diabético que cumplieron con los criterios de inclusión. RESULTADOS: Predominó el sexo femenino, el grupo de edades más frecuentes fue de 55 a 65 años. Se relacionó el tiempo de evolución con la presencia de edema macular, se evidenció una involución de esta patología, así como una mejoría en la agudeza visual después de aplicado el tratamiento y no se presentaron complicaciones graves. CONCLUSIONES: El tratamiento con acetato de triamcinolona por vía subtenoniana posterior es una alternativa efectiva en el tratamiento de el edema macular.

INTRODUCTION: Prevalence of diabetic retinopathy is determined by type of diabetes mellitus and the length of development of the disease. Macular edema is the main cause of reduction in visual acuity of the diabetic patient. An early exact diagnosis of the disease together with an adequate treatment is essential to decrease visual disability. The objective of this paper was to evaluate the effectiveness of subtenon triamcinolone as therapy for macular edema in a group of diabetics. METHODS: A prospective descriptive case-control study was conducted. The sample was made up of 30 diabetic patients who were seen at "Dr Miguel Enríquez" clinical and surgical hospital from January to June 2007, with diagnosis of diabetic macular edema, and who met the inclusion criteria. RESULTS: Females prevailed and the 55-65 year age group was the most common. Length of development of the disease was associated with the presence of macular edema; it was evident that this pathology declined and that visual acuity improved after the treatment whereas no serious complications occurred. CONCLUSIONS: The use of triamcinolone acetonide through posterior subtenon way of administration is an alternative for the treatment of macular edema.

Effects of raloxifene on bone metabolism and serum lipids in postmenopausal women on chronic hemodialysis.

BACKGROUND: Premature amenorrhea and hypoestrogenism and lack of hormone replacement therapy after menopause have been frequently reported in uremic women on dialysis. Therefore, in addition to renal osteodystrophy, postmenopausal women on dialysis could be at risk of osteoporosis. In addition, these patients are at higher risk for hyperlipidemia, arteriosclerosis, and subsequent coronary heart disease and stroke. Recent evidence has suggested that hormone replacement therapy (HRT) in postmenopausal women could have several beneficial effects as well as potentially serious risks. Great efforts have been made to identify therapeutic alternatives that would have the benefits of estrogen on brain and bone without its adverse effects on breast and endometrium. In the present study, we evaluated the effect of raloxifene, a selective estrogen receptor modulator (SERM), on bone metabolism and serum lipids in postmenopausal women on chronic hemodialysis. METHODS: We performed a prospective, blind, placebo-controlled, and randomized study. Fifty postmenopausal women on chronic hemodialysis with proven severe osteopenia or osteoporosis by bone densitometry were selected. After a written informed consent, patients were randomized into two groups: 25 women on placebo and 25 women on the study drug, raloxifene hydrochloride, at a dose of 60 mg/day. In all patients, we performed a baseline bone mineral density (BMD) analysis and simultaneously evaluated different biochemical parameters, serum lipids (total low-density lipoprotein [LDL] and high-density lipoprotein [HDL] cholesterol and triglycerides) and serum markers of bone resorption (pyridinoline crosslinks). BMD was reassessed after 1 year of therapy. Bone resorption markers were determined every 3 months for 1 year. RESULTS: After 1 year on raloxifene therapy, lumbar spine BMD (trabecular bone) significantly improved, whereas femoral neck BMD (cortical bone) did not change significantly. No changes in BMD were observed at trabecular or cortical sites in the placebo group. Serum pyridinoline levels showed a significant decrease after 6 months on raloxifene that persisted thereafter. Low-density lipoprotein (LDL)-cholesterol decreased significantly in the raloxifene group with no changes in serum triglycerides, total cholesterol, or HDL cholesterol. No significant side effects were observed in the raloxifene group. CONCLUSION: The study demonstrates that after one year on raloxifene, postmenopausal women on hemodialysis have a significant increase in trabecular BMD, decrease in bone resorption markers and LDL-cholesterol values, suggesting that SERMs could constitute a therapeutic alternative to improve bone metabolism and control of hyperlipidemia in these patients. The possible long-term effects of raloxifene remain to be determined.

¿El Boxeo, es el deporte con mayor frecuencia de trauma ocular? / Is Boxing the sports of highest ocular injure frequency?

El trauma ocular lo constituye cualquier lesión causada en el ojo por factores externos que no se relacionan con enfermedades del paciente. Las causas más frecuentes encontradas, son los accidentes domésticos, laborales y la práctica deportiva. En el caso específico del boxeo, existe una polémica en la que algunos afirman que con la medicina moderna, las nuevas reglas de arbitraje y las novedosas técnicas de entrenamiento, este deporte es casi inofensivo al que lo practique. Otros afirman que los traumatismos repetitivos provocan lesiones cerebrales responsables de la decadencia neuropsicológica de un gran número de pugilistas. Se revisaron 24 trabajos internacionales y un nacional (el único publicado hasta el momento). Se refieren estudios comparativos entre varios deportes 20 (80 porciento), entre los cuales se observa que 17 (85 porciento) son deportes donde se refieren una gran cantidad de severos traumatismos oculares (football, hockey y squash); y se mantiene el boxeo en un lugar de baja incidencia con respecto a estos y a otros deportes. A partir de los resultados hasta ahora obtenidos, concluimos que el boxeo tiene una baja incidencia en la ocurrencia de traumatismos oculares.

The ocular injure is any eye lesion caused by external factors that are not related to the patient`s disease. The most common causes are domestic, work accidents and sports practicing. In the particular case of boxing, there is a controversy in which some state that the modern medicine, the new refereeing rules and the novel training techniques, this sports is almost harmless to the individuals practicing it. Other people say that repeated traumas bring about brain injures responsible for neuropsychological decline of a great number of boxers. Twenty four international and one national (the only one so far published) papers were reviewed. Comparative studies among several sports 20 (80 percent) are mentioned; it was observed that 17 (85 percent) are sports where a great deal of severe ocular injures occur ( football, hockey and squash) ; however, boxing keeps low incidence if compared to these sports and others. According to the results achieved so gar, we may conclude that boxing has a low ocular injure incidence rate.

Lesiones traumáticas de los anexos y del segmento anterior del ojo en los boxeadores / Traumatic lesions of the adnexa and of the anterior segment of the eye in fighters

Se realizó un estudio retrospectivo con una muestra de 71 boxeadores a los cuales se les examinaron las estructuras de referencia mediante oftalmoscopia directa y biomicroscopia ocular, antes de las 6 horas posteriores al término de sus peleas; donde se obtuvo como resultado que los anexos afectados fueron los párpados con 5 hematomas, 4 edemas y 1 excoriación; y la conjuntiva con 4 hiperemias y 8 hemorragias. En el segmento anterior del ojo sólo se afectó la córnea con 13 lesiones en total, divididas en 10 excoriaciones superficiales y 3 profundas. Las lesiones traumáticas predominantes en los anexos del ojo son las de los párpados y las de la conjuntiva y las del segmento anterior del ojo, las de la córnea. El ojo más afectado fue el izquierdo y las lesiones más frecuentes fueron en las categorías de 13 y 14, 17 y 18 y 19 y 34 años las corneales, las conjuntivales y la de los párpados, respectivamente