Programmed cell death in a patient with hepatocellular carcinoma treated with yttrium-90 and doxorubicin-loaded beads.

Molecular analysis of apoptosis and autophagy pathways was performed from a single hepatocellular carcinoma treated with yttrium-90 and doxorubicin-loaded beads before resection and compared with normal liver tissue from the margins. Both bead formulations activated apoptosis-associated mechanisms and increased autophagy pathway protein levels. Increased DNA fragmentation and autophagy markers were seen in tumor treated with drug-eluting beads compared with yttrium-90-treated tumor. These results suggest that both microembolic therapies activate cell death signaling, although differences in apoptosis and autophagy pathways were seen in this patient. Knowledge of mechanisms of action for each treatment may enhance future therapeutic strategies.

[Clinical practice guideline. Diagnosis and treatment of insomnia in the elderly]. / Guía de práctica clínica. Diagnóstico y tratamiento del insomnio en el adulto mayor.

Insomnia is the difficulty to initiate or to maintain sleep. It also has to do with waking up too early at least for a month. A patient with insomnia has daytime consequences such as fatigue, sleepiness, changes in mood, lose of concentration, as well as changes in his social performance and his family relationships, among others. The relationship between this disorder and physical and mental health is important due to the impact that it has on the quality of life and life expectancy of those who suffer from it. Unfortunately, insomnia usually goes unnoticed or untreated, which contributes to the onset or worsening of psychiatric and medical conditions. This exacerbates the problem of insomnia in the elderly people. In relation to the treatment it is recommended: 1) the search and management of secondary causes of insomnia, 2) a non-drug therapy that includes sleep hygiene measures, 3) pharmacotherapy. It is not recommended to start a treatment with a hypnotic drug without rule out medications or diseases that cause or exacerbate insomnia. It is not recommended the use of narcoleptics, melatonin, antihistamines or long half-life benzodiazepines. The consequences include limitations on activities of daily living, loss of functionality, impaired quality of life, increased morbidity and mortality, as well as the worsening of preexisting chronic conditions.

El insomnio es la dificultad para conciliar o mantener el sueño; también consiste en despertar demasiado temprano al menos durante un mes. Un paciente con insomnio presenta consecuencias diurnas como fatiga, somnolencia, deterioro de la memoria, cambios en el estado de ánimo, en la concentración, así como en su desempeño social o familiar, entre otros. La asociación de este padecimiento con la salud física y mental es importante debido al impacto que tiene en la calidad y la esperanza de vida de los que lo padecen. Desafortunadamente, el insomnio suele pasar desapercibido o no tratarse, lo cual contribuye al empeoramiento de condiciones médicas y psiquiátricas. Esto se acentúa más en los adultos mayores, grupo por demás vulnerable. En relación con el tratamiento se recomienda aplicar la siguiente combinación: 1) la búsqueda y el manejo de causas secundarias de insomnio, 2) alguna terapia no farmacológica que incluya medidas de higiene del sueño, 3) tratamiento farmacológico. No es recomendable comenzar el tratamiento con un hipnótico sin haber descartado fármacos o enfermedades que provoquen o exacerben este padecimiento. Tampoco se recomienda el uso de neurolépticos, melatonina, antihistamínicos o benzodiacepinas de vida media larga. Las consecuencias incluyen limitación en las actividades de la vida diaria, pérdida de la funcionalidad, deterioro en la calidad de vida, incremento en la morbimortalidad, además del empeoramiento de las condiciones crónicas prexistentes.