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BACKGROUND AND OBJECTIVE: Androgen deprivation therapy (ADT) with salvage radiation therapy (RT) improves survival for patients with prostate-specific antigen (PSA) recurrence after radical prostatectomy (RP) for prostate cancer (PC), but many patients suffer further relapse. This study aims to determine the benefit of the combination of ADT, apalutamide, salvage RT, and docetaxel for high-risk PSA recurrent PC. METHODS: STARTAR is a multicenter, investigator-initiated phase 2 trial of men with PSA recurrent PC after RP. The key inclusion criteria included M0 by computed tomography/bone scan, Gleason 7 with either T3/positive margin/N1 disease or Gleason 8-10 prostate adenocarcinoma, PSA relapse (0.2-4 ng/ml) <4 yr after RP, and fewer than four positive resected lymph nodes. Patients received ADT with apalutamide for 9 mo, RT starting week 8, and then six cycles of docetaxel. The primary endpoint was 36-mo progression-free survival (PFS) with testosterone recovery and compared against the prior STREAM trial. KEY FINDINGS AND LIMITATIONS: We enrolled 39 men, including those with Gleason 8-10 (46%), pN1 (23%); the median PSA was 0.58 ng/ml. The median follow-up was 37 mo. All patients achieved undetectable PSA nadir. At 24 and 36 mo, PFS rates were 84% and 71%, respectively, which improved significantly over 3-yr 47% historic PFS and 54% enzalutamide/ADT/RT (STREAM) PFS rates (p = 0.004 and p = 0.039, respectively). Common any-grade adverse events included 98% hot flashes, 88% fatigue, 77% alopecia, 53% rash (10% G3), and 5% febrile neutropenia. CONCLUSIONS AND CLINICAL IMPLICATIONS: In this phase 2 trial of ADT, apalutamide, salvage RT, and six cycles of docetaxel for high-risk PSA recurrence, the 3-yr PFS rate improved to 71%, indicating feasible and efficacious treatment intensification, with durable remissions beyond historic data. PATIENT SUMMARY: Prostate cancer recurrence after surgical removal of the tumor occurs often, and current treatment options to limit recurrence after surgery are only partially effective. In this study, we found that the addition of an androgen receptor inhibitor and docetaxel chemotherapy to standard postsurgery radiation therapy and androgen deprivation therapy significantly improved progression-free survival at 3 yr after treatment. These results suggest that intensification of treatment after surgery can provide long-term benefit to a subset of patients with high-risk prostate cancer.
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Retail stores maintain fresh rice noodles (FRNs) at room temperature because refrigeration negatively impacts FRNs' texture. The room temperature and high water activity of FRNs help spore-forming Bacillus cereus to grow and produce toxins. In this study, the effect of steam cooking on survival and different storage temperatures on the growth and enterotoxins production of B. cereus in FRNs were investigated. White rice flour was used to make FRNs. Three treatments of FRNs were used in this study; uninoculated, inoculated (with 4.0 log CFU/ml of B. cereus spores), and autoclaved as a negative control. A slurry of rice flour, cornstarch, and water was steam cooked for 4 min at 90°C and incubated for 168 h at 4°C, and for 72 h at 22 and 32°C. Incubated FRNs were tested for pH, B. cereus growth, and enterotoxins production. Steam cooking reduced the total number of B. cereus spores by 0.7 ± 0.3 log CFU/g. Surviving B. cereus spores in inoculated and uninoculated FRNs germinated over 72 h of storage. No B. cereus was detected in negative controls. An interaction was observed across storage temperatures and time (p < 0.05). The B. cereus population in uninoculated FRNs increased by more than 7.0 log CFU/g at 22 and 32°C over 72 h, while inoculated FRNs showed a 5.0 log bacterial increase at these storage temperatures. No growth was observed at 4°C in both inoculated and uninoculated FRNs. The pH of inoculated FRNs was reduced from 6.9 ± 0.1 to 5.7 ± 0.0 at 32°C and to 6.2 ± 0.1 at 22°C, and the pH of uninoculated FRNs was reduced from 7.0 ± 0.1 to 5.8 ± 0.2 at 32°C and to 6.5 ± 0.0 at 22°C, indicative of FRNs spoilage. B. cereus in inoculated FRNs produced enterotoxins after 12 h of storage at 32°C, and over 24 h of storage at 22°C, while no toxin was detected at 4°C. Our findings show that storing FRNs at room temperature for 24 h leads to enterotoxin production, emphasizing the importance of proper FRN storage and their potential risk to consumers. Nevertheless, further research should investigate the effect of other foodborne pathogens on these products.
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Contaminação de Alimentos , Oryza , Contaminação de Alimentos/análise , Microbiologia de Alimentos , Bacillus cereus , Oryza/microbiologia , Vapor , Contagem de Colônia Microbiana , Esporos Bacterianos , Culinária , Temperatura , EnterotoxinasRESUMO
El síndrome de Hajdu-Cheney, es una patología infrecuente caracterizada por alteraciones esqueléticas que se manifiestan con acro-osteolisis y osteoporosis generalizada. Su frecuencia es extremadamente rara y existen escasos reportes en la literatura a nivel mundial. Se presenta un caso de un paciente con colapso avanzado del carpo producto de una no unión de escafoides no tratada. Se describen características clínicas y radiográficas del paciente y la resolución del caso con artrodesis total de muñeca.
Hajdu-Cheney syndrome is an uncommon skeletal disorder characterized by acroosteolysis and generalized osteoporosis. It is an extremely rare condition and few reports have been published in worldwide literature. We present a case of a patient with advanced carpal collapse product of a scaphoid non-union with Hajdu-Cheney syndrome. We describe clinical and radiographic characteristics and resolution of the case with total wrist arthrodesis.
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Humanos , Masculino , Adulto Jovem , Artrodese/métodos , Osso Escafoide/cirurgia , Osso Escafoide/lesões , Síndrome de Hajdu-Cheney/complicações , Osteoporose , Punho , Osso Escafoide/diagnóstico por imagem , Acro-OsteóliseRESUMO
La Glucosa-6-fosfato deshidrogenasa (G6PD) mantiene intactos los grupos sulfidrilos y ayuda en la detoxificación de radicales libres y peróxidos, por tanto, el déficit provoca daño oxidativo irreversible y destrucción de los eritrocitos cuando estos son sometidos a sustancias oxidativas y al estrés. La infección por Plasmodium spp., produce anemia como consecuencia de la ruptura del eritrocito por parte de este parásito, misma que puede verse agravada en personas infectadas con deficiencia de G6PD al ser expuestos a drogas. Estudio de campo y descriptivo en que se determinó por pruebas bioquímicas la actividad enzimática de G6PD en una comunidad de indígenas Piaroa del municipio Atures, estado Amazonas. La muestra estuvo conformada por 186 individuos, 100 mujeres y 86 hombres. La concentración promedio de hemoglobina fue de 10,6 g/dL, 88,6% de los sujetos resultaron con anemia moderada y ninguno presento deficiencia de G6PD. Se concluye que la anemia es común en indígenas Piaroas, de tipo moderada y carencial; que por prueba bioquímicas no se detecta deficiencia de G6PD; y que este estudio provee información útil a los organismos del Estado encargados de administrar los cuidados de la salud en Venezuela.
Glucose-6-phosphate dehydrogenase (G6PD) remains intact sulfhydryl groups and assist in the detoxification of free radicals and peroxides, therefore deficit irreversible oxidative damage and destruction of the erythrocyte when these are subjected to oxidative substances and stress. Plasmodium spp. infection causes anemia as a result of the rupture of the erythrocyte by this parasite, it can be aggravated in people infected with G6PD deficiency when exposed to drugs. Descriptive field study in which the enzymatic activity of G6PD in an indigenous community of Piaroa municipality of Atures, Amazonas state, was determined by biochemical tests. The sample consisted of 186 individuals, 100 women and 86 men. The average concentration of hemoglobin was 10.6 g/dL, 88, 6% of the subjects were moderately anemic and none had G6PD deficiency. It is concluded that anemia is common in indigenous Piaroas, moderate and deficiency type; no biochemical test that G6PD deficiency is detected; and that this study provides useful information to state agencies responsible for administering health care in Venezuela information.
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Glucosefosfato Desidrogenase , Povos IndígenasRESUMO
Introducción: La neuromielitis óptica, es un síndrome clínico caracterizado por la asociación de mielitis transversa y neuritis óptica, hoy en día es reconocida como una enfermedad cuya fisiopatología, clínica, hallazgos en imágenes diagnósticas de laboratorio y tratamiento son específicos. Objetivo: describir las características clínicas, métodos diagnósticos y tratamiento de los pacientes con neuromielitis óptica (NMO) en tres centros asistenciales de cuarto nivel de la ciudad de Bogotá. Materiales y métodos: Diseño: se realizó un estudio de tipo serie de casos. Participantes: se incluyeron casos consecutivos de pacientes de cualquier género, entre los 19 y los 48 años, clasificados en dos grupos según los criterios del Consenso Internacional para el Diagnóstico de Neuromielitis óptica 2015, NMOSD con AQP4-IgG positivos, y NMOSD con AQP4-IgG negativos. Los pacientes fueron reclutados en tres centros hospitalarios, desde junio de 2013 a mayo de 2015. Análisis estadístico: la descripción de las variables se realizó por frecuencias absolutas y relativas, los análisis se realizaron en el paquete estadístico STATA 13®. Resultados: participaron 22 pacientes, con una edad mediana de 36 años, la mayoría mujeres, la mediana de inicio de síntomas fue de 31 años (RIC 24-39). La técnica para el diagnóstico más utilizada fue IFI, la clínica más frecuente del evento inicial fue mielitis y de neuritis óptica en las recaídas posteriores, la mitad de los pacientes presentaron dos o menos eventos, ningún paciente cumplió criterios para otra enfermedad sistémica. Se observaron escalas de discapacidad mas altas en el grupo con AQP4 positivos, y mas bajas en los que recibieron corticoide al inicio. Discusión y conclusiones: esta caracterización constituye la primera descripción de esta enfermedad en Colombia, nuestros hallazgos son similares a los obtenidos en otras poblaciones, algunos datos relevantes requieren más estudios.
Introducción: Optic neuromyelitis, a clinical syndrome characterized by the association of transverse myelitis and optic neuritis, is nowadays recognized as a disease whose pathophysiology, clinical features, and diagnostic and laboratory imaging findings are specific. Objective: To describe the clinical characteristics, diagnostic methods and treatment of patients with neuromyelitis Optica (NMO) in three health centers fourth level of the City of Bogota. Materials and method: Design: A case series type was performed. Participants: consecutive cases of patients of either gender were included between 19 and 48 years, divided into two groups according to the International Consensus criteria for the diagnosis of NMO 2015, NMOSD with AQP4-IgG positive, and NMOSD with AQP4- IgG negative. Patients were recruited from three hospitals from June 2013 to May 2015. Statistical analysis: The description of the variables was performed by absolute and relative frequencies, analyzes were performed in STATA statistical package 13®. Results: A total of 22 patients with a median age of 36, mostly women, median onset was 31 years (IQR 24-39). The technique most commonly used for diagnosis was IFI, the most frequent initial clinical event was myelitis and optic neuritis in subsequent relapses, half of the patients had two or fewer events, no patients met criteria for other systemic disease. higher disability scales were observed in the group with positive AQP4, and lower in those receiving corticosteroids at baseline. Discussion and conclusions: This characterization is the first description of this disease in Colombia, our findings are similar to those obtained in other populations, some relevant data require further study.
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La esclerosis múltiple es una enfermedad neurodegenerativa común en poblaciones jóvenes en edad reproductiva; el embarazo ha sido motivo de controversia, dada la necesidad de manejo farmacológico, el riesgo de recaídas y la discapacidad resultante. Los estudios son escasos, aunque la mayoría aporta datos confiables.Objetivos: Ofrecer al médico una adecuada orientación preconcepcional y durante el embarazo en pacientes con esta enfermedad, así como una adecuada información acerca del uso de medicamentos y sus efectos a corto y largo plazo, tanto en la madre como en el feto.Materiales y métodos: Para la revisión de la literatura se estructuró una estrategia de búsqueda utilizando los términos embarazo, esclerosis múltiple, tratamientos inmunomoduladores y efectos teratogénicos (MeSH y no MeSH), los cuales se articularon con operadores booleanos en las siguientes bases de datos: Pubmed, Ebscohost y Embase, filtrando los resultados por artículos de revisión.Discusión: Se analizan el efecto protector del embarazo en esclerosis múltiple y la administración de vitamina D.Conclusión: Aunque no hay evidencia suficiente sobre el efecto nocivo del tratamiento en el recién nacido, se recomienda suspenderlo.
Multiple sclerosis is a neurodegenerative disease commonly affecting young adults of fertile age. Pregnancy has been a subject of controversy given that pharmacological management is required, there is a risk of relapses, and it may be disabling. Studies on the topic are scarce, although most of them report reliable data.Objective: To provide the physician with adequate preconception and pregnancy care guidelines for this disease, as well as, adequate information about medications and their effects in the short and long-term, for the mother and the foetus.Materials and methods: A search strategy was created for reviewing the literature, using the terms, pregnancy, multiple sclerosis, immunomodulatory therapies and teratogenic effects (MeSH and not MeSH), which were articulated with Boolean operators in the following databases: Pubmed, Ebscohost and Embase, filtering the results by review article.Discussion: The protective effects of pregnancy on multiple sclerosis were evaluated, as well as, vitamin D administration.Conclusion: Although there is not enough evidence on the harmful effects of treatment on the newborn, discontinuing the treatment is recommended.
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Humanos , Feminino , Gravidez , Complicações na Gravidez , Esclerose Múltipla , Fatores Imunológicos , Perigo CarcinogênicoRESUMO
El síndrome de apnea hipoapnea obstructiva del sueño es considerado factor de riesgo para accidente cerebrovascular, que es a nivel mundial la segunda causa de muerte y primera de discapacidad. Objetivo: describir la prevalencia de sospecha de SAHOS por escala Epwhort y aumento de circunferencia cervical en pacientes con ACV isquémico en los hospitales de San José e Infantil Universitario de San José, de Bogotá DC, de octubre 2013 a septiembre 30 de 2014. Metodología: estudio descriptivo de corte transversal con población elegida con diagnóstico de ACV isquémico. Resultados: 125 pacientes con edad promedio de 69 años (DE 15.0) y relación hombre/mujer 1:1. Antecedente de SAHOS 1.6% (n: 2). Por Epworth 57% (n: 63/109) tenian sospecha de SAHOS, hombres 60,3%(n: 35). La mediana para Epworth fue 10 (RIQ 7-12). Circunferencia cervical >43 cm en hombres 8,6% (n:5) y en mujeres >40 cm en 28% (n:14). El 30% (19/62) de ACV tenía sospecha de SAHOS por Epworth y circunferencia cervical. Los hombres con Epworth (8-15), tenían circunferencia cervical aumentada 14% (5/35) y las mujeres 51,9% (14/27). La mortalidad intrahospitalaria fue 9,7% (n:12). Conclusión: se encontró que más de la mitad tenía sospecha de SAHOS leve por Epworth. Hubo mayor prevalencia de obesidad cervical en mujeres y una tercera parte tenían sospecha de SAHOS por ambos criterios, lo cual confirma la importancia de explorar de rutina estos indicadores...
Obstructive sleep apnea hypoapnea syndrome is considered a risk factor for cerebrovascular accident which is the second cause of death and leading cause of disability worldwide. Objective: to describe suspicion prevalence of OSAHS estimated by the Epworth score and increase of neck circumference in patients with ischemic CVA at San José and Infantil Universitario de San José hospitals, Bogotá DC, from October 2013 and September 30 2014. Methodology: cross sectional descriptive study including a population diagnosed with ischemic CVA. Results: 125 patients with mean age 69 years (SD 15.0) and male/female ratio of 1:1. History of OSAHS in 1.6% (n: 2). By Epworth score, 57% (n: 63/109) had suspicion of OSAHS, 60.3% (n: 35) corresponded to men. The media for Epworth score was 10 (RIQ 7-12). Neck circumference, >43 cm in men 8.6% (n: 5) and women >40 cm in 28% (n: 14). OSAHS was suspected in 30% of CVAs (19/62) by Epworth score and neck circumference. Men with Epworth score (8-15), had an increased neck circumference 14% (5/35) and women 51.9% (14/27). In-hospital mortality was 9.7% (n: 12). Conclusion: we found that mild SOAHS estimated by Epworth score was suspected in more than half the patients. There was a higher prevalence of neck obesity in women and OSAHS was suspected in one third of them by both criteria, which confirms the importance of routinely exploring these indicators...
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Humanos , Masculino , Feminino , Idoso , Acidente Vascular Cerebral , Apneia , Isquemia , Síndromes da Apneia do SonoRESUMO
La Leucoencefalopatía Multifocal Progresiva (LMP) es una condición grave secundaria a la infección por virusJohn Cunningham (VJC) derivada de la deficiencia de inmunidad celular innata o adquirida. Se presenta el primercaso reportado en Latinoamérica de (LMP) asociada a Natalizumab (NZB) en un paciente con diagnóstico deesclerosis múltiple recaída-remisión, quien ingresa a urgencias con cuadro clínico de deterioro cognoscitivo,comportamental, motor y de lenguaje de curso progresivo. Se realizaron neuroimágenes con resonancia magnéticacerebral sugestivas de LMP, estudios de reacción en cadena de polimerasa en líquido cefalorraquídeopara virus JC, que resultaron negativos en dos oportunidades; el diagnóstico se confirmó mediante la técnica dehibridación in situ en biopsia cerebral. Se realiza este reporte con el fin de resaltar la importancia de la vigilanciaclínica y paraclínica en los pacientes con esclerosis múltiple que reciben NZB...
Progressive Multifocal Leukoencephalopathy (PML) is a serious condition secondary to John Cunninghamvirus (JCV) infection derived from an innate or acquired cellular immunity deficiency. We present the firstreported case in Latin America of PML associated with Natalizumab (NZB) in a patient with a diagnostic ofrelapsing remitting multiple sclerosis, who entered the emergency room with progressive cognitive, behavioral,motor and language impairment. Neuroimaging performed with magnetic resonance imaging was suggestiveof PML. Polymerase chain reactions in cerebrospinal fluid for JC virus were conducted twice with negativeresults. Finally the diagnosis was confirmed by in situ hybridization technique on brain biopsy. This reportis made in order to highlight the importance of clinical and paraclinical monitoring in patients with multiplesclerosis receiving NZB...
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Humanos , Vírus JC , Leucoencefalopatia Multifocal Progressiva , Esclerose MúltiplaRESUMO
Background: Sunlight exposure is the main factor for adequate vitamin D (VitD) nutrition; in extreme latitudes there is an increased riskfor its deficiency. Aim: To study VitD nutritional status in pre-school children living in austral latitudes of Chile. Subjects and Methods: A blood sample was obtained from 60 pre-school healthy children (aged 2 to 5years, 24 males), attending to public day-care centers in Coyhaique (45° 35' S), during March (time 1) and September (time 2). 250HD, parathyroid hormone (PTH), calcium, phosphate and alkaline phosphatases (PA) were measured. Information about weather conditions during three months prior to the sample withdrawal was gathered. Results: Forty nine percent of children had a normal weight and 11% were overweight. Vive children with unreliable 250HD levels were excluded from analysis. At time 1, 250HD levels were 21.6 ± 14.5 ngl mh (7.9-71.1). Sixty four percent of children had valúes < 20 ng/mL (deficiency). At time 2, the figures were 21.5 ± 13.2 ng/mL (9.4-68.5) and 67.3% of children were deficient. PTH, serum calcium, phosphate and PA were normal. Prior to time 1, the UVradiation Índex (UVI) was high to extreme (91.3%), with 3.3 and 73% ofsunny and cloudy days, respectively. Mean minimal and maximal temperatures were 7 and 17.3°C respectively. Prior to time 2 the IUVwas low in 100%) ofdays; with 15.2 and 60.9 ofsunny and cloudy days, respectively. Mean minimal and maximal temperatures were 0.3 and 6.7°C respectively. No association of250HD with the other metabolicparameters was found. Conclusions: Chilean pre-school children living in austral latitudes have a high rate of vitamin D deficiency, throughout theyear, with no association with PTH, calcium, phosphate or PA. Further research is required to study vitamin D deficiency in other latitudes and magnitude of sunlight exposure.
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Pré-Escolar , Feminino , Humanos , Masculino , Estado Nutricional , Luz Solar , Deficiência de Vitamina D/etiologia , Fosfatase Alcalina , Cálcio , Chile , Geografia Médica , Hormônio Paratireóideo , Estações do Ano , Deficiência de Vitamina D/sangue , Vitamina D/sangueRESUMO
Antecedentes. El asma y la rinitis se han convertido en las enfermedades alérgicas más prevalentes en la población infantil en el mundo. Objetivos. Determinar la prevalencia y el comportamiento epidemiológico de las enfermedades alérgicas en preescolares de la ciudad de Cali. Diseño. Estudio de corte transversal. Métodos. Se seleccionó una muestra de 198 niños preescolares menores de 6 años y se aplicó el cuestionario ISAAC. Resultados. La prevalencia de asma fue 20.6/100 y de rinitis alérgica 18.1/100 y su comportamiento diferente, presentándose con más frecuencia el asma en niños de estratos bajos 27/100 vs 13/100 en estratos altos. En cambio, en niños de estrato alto la rinitis fue más prevalente (29.3/100 vs 8.1/100, p=0.0002). El antecedente familiar de alergia fue más frecuente en los niños con asma que con rinitis (40.9/100 vs 9.1, p<0.008). No se encontró asociación entre género, edad o padres fumadores, con alguna de las enfermedades alérgicas
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Pré-Escolar , Asma/epidemiologia , Estudos Epidemiológicos , Rinite Alérgica Perene/epidemiologia , ColômbiaRESUMO
Tan importante como hacer un correcto diagnostico de asma en un nino, es un manejo racional, que se apoye en el conocimiento que hoy se tiene de su fisiopatologia. para esto se revisan las bases y se hace notar que el medico debe aclarar con los padres y con el mismo nino, si es el caso, las alternativas que ofrece su enfermedad. Se plantean estrategias para el control; conocer y evitar los factores de hiperreactividad; el uso de drogas preventivas; el uso de farmacos para las formas leves, moderadas y severas del asma; las indicaciones de la inmunoterapia. Finalmente, se discuten algunas perspectivas actuales en el control de la enfermedad