Alternatives for the administration of oral antineoplastics in patients with swallowing difficulties.

Oncology patients often experience swallowing difficulties, which can compromise adherence to treatment and consequently reduce its effectiveness. Improper handling of these hazardous drugs can lead to the risk of inhalation of particles or other exposures endangering the health of the persons involved such as nurses and pharmacists. The aim of this review is to analyse and update the recommendations for the manipulation of oral antineoplastic drugs in patients with swallowing difficulties. A literature review of articles, websites, guidelines and other documents published up to about the conditions of handling and administration of oral antineoplastic agents in oncology and oncohaematology was carried out. A table of 110 active principles was compiled. The information was grouped according to the name of the drug, instructions for oral and nasogastric tube administration and suggested recommendations. Among the drugs reviewed, 66.4% were suitable for dissolution. Although there is a lot of information in the literature, the nonstop development of new oncological drugs requires continuous updating. Therefore, we have collected the most recent data to provide a consultation tool for healthcare professionals and patients with swallowing difficulties.

This review can be used by all types of healthcare professionals, especially nurses, who handle oncological medicinal drugs. In addition, the safest handling methods for the worker have been recommended.

Short report - Usefulness of point-of-care ultrasound in pediatric SARS-CoV-2 infection.

SARS-CoV-2 infection in children is uncommon compared to adult population. However, some children required hospital and/or PICU admission. The aim of this short communication is to share our experience with Point-of-Care Ultrasound (POCUS) when managing these patients. Remarkably, all cases presented pleural and pericardial effusions, detected by POCUS, despite showing an adequate urinary output and prior to receiving any kind of fluid resuscitation. Effusions have been described as rare among SARS-CoV-2 infection in adult population. By performing portable chest X-Ray they would have gone unnoticed in our patients. Other POCUS findings consisted of all types of consolidations and coalescent B-line patterns. POCUS was also performed in order to optimize PEEP, checking adequate endotracheal intubation positioning (avoiding the risk of contagiousness related to auscultation in this framework), and to assess volemia status, cardiac performance, and brain neuro-monitoring. There was not cross-infection. In pediatric SARS-CoV-19 effusions are frequent but easily unnoticed unless lung and echo POCUS are performed.

[Techniques and complementary techniques. Complementary treatments: nitric oxide, prone positioning and surfactant]. / Técnicas y tratamientos complementarios. Tratamientos complementarios: óxido nítrico, posición en prono y surfactante.

The management of hypoxic respiratory failure is based on oxygen delivery and ventilatory support with lung-protective ventilation strategies. Better understanding of acute lung injury have led to new therapeutic approaches that can modify the outcome of these patients. These adjunctive oxygenation strategies include inhaled nitric oxide and surfactant delivery, and the use of prone positioning. Nitric oxide is a selective pulmonary vasodilator that when inhaled, improves oxygenation in clinical situations such as persistent pulmonary hypertension of the newborn, pulmonary hypertension associated with congenital heart disease, and acute respiratory distress syndrome (ARDS). When applied early in ARDS, prone positioning improves distribution of ventilation and reduces the intrapulmonary shunt. The surfactant has dramatically decreased mortality caused by hyaline membrane disease in premature newborns, although the results have been less successful in ARDS. Greater experience is required to determine whether the combination of these treatments will improve the prognosis of these patients.

Synovial sarcoma of the upper digestive tract: a report of two cases with demonstration of the X;18 translocation by fluorescence in situ hybridization.

Two cases of synovial sarcoma that arose in the upper digestive tract are reported. One case was a polypoid mass that arose at the gastroesophageal junction; the other was a large intramural mass that arose in the wall of the stomach. Both cases had a classic biphasic pattern. In the stomach tumor, the biphasic morphology was focal and there was an abrupt transition to poorly differentiated synovial sarcoma. The tumors had immunohistochemical features that were consistent with synovial sarcoma. Ultrastructural evaluation of the gastroesophageal tumor supported the diagnosis. The diagnostic X;18 translocation was demonstrated by fluorescence in situ hybridization on sections from paraffin-embedded tissue in 86% and 50% of interphase nuclei from the gastroesophageal and gastric tumor, respectively. The translocation was present in equal frequency in the epithelial and spindle cells in the biphasic areas and the poorly differentiated areas of the gastric tumor, indicating that the development of the more aggressive subclone was probably due to genetic mutations not encompassing the SYT-SSX gene fusion product. We are aware of only five reported cases of synovial sarcoma arising in the digestive tract, all in the proximal esophagus. These cases are the first reported arising in the gastroesophageal junction and stomach and the only cases of synovial sarcoma of the digestive tract in which the diagnostic translocation was demonstrated. Sarcomatoid carcinoma (carcinosarcoma) and gastrointestinal stromal tumor are the main differential diagnoses for synovial sarcoma in this site. Synovial sarcoma of the digestive tract may be underdiagnosed, and its recognition may have important clinical implications. Fluorescence in situ hybridization is helpful in making this distinction.

Propagación de tres especies de Atriplex mediante cultivo de tejidos in vitro por Organogénesis / Propagation of three species of atriplex by means of cultivation of you woven in vitro organ genesis

Se evaluó el comportamiento del tipo de explante y la especie en medio Leismaier & Skoog, con diferentes concentraciones de reguladores de crecimiento para las tres fases de propagación in vitro, de tres especies de Atriplex (Atriplex semibaccata, Atriplex halimus y Atriplex canescens). Se utilizaron secciones de tallo con un nudo. Para todas las fases se aplicó un diseño de bloques completamente al azar con arreglo factorial de 2x2 con 10 repeticiones para la fase I, 2x2 con repeticiones para la fase II y 3x2x2 con 10 repeticiones para la fase III. En la fase I, se tomaron en cuenta el N§ de plántulas establecidas, porcentaje de contaminación y altura de la planta como variables de respuesta. En la fase II; el tamaño de las plántulas durante 15 y 30 días y el N§ de yemas o nudos y para la fase III; el peso de la planta completa, peso de las raíces y peso de la parte aérea. Debido a factores de contaminación masiva no se pudo continuar el estudio con la especie A. canescens, por lo que se muestra sólo los resultados de las otras dos especies. En la fase I se observó que la especie A. Semibaccata alcanzó mayor altura en relación a la especie A. hamilus (69.27 mm y 58.63 mm) respectivamente, con una diferencia estadistica altamente significativamente (p 0.0001) entre especies. Con respecto al tipo de explante no se evidenció diferencia estadística significativa (63.83 mm para la parte basal y 64.07 mm para la parte apical). En la fase II, la especie A. semibaccata alcanzó una altura de 51.30 mm y A. halimus 49,65 mm con una diferencia estadística altamente significativa (p. 0.0031). El análisis de varianza muestra que existe una diferencia altamente significativa para tipo de explante muestra mayor crecimiento al cabo de 28 días. El número de nudos es mayor en la especie A. halimus en relación a la otra especie (12.45 y 13.05 nudos). En la Fase III se estableció que la mejor auxina para inducir rizógenésis en las dos especies estudiadas fué el acido indolbutírico (IBA) en una concentración de 2 mg/1; el tipo de explante más apropiado fué el ápice. La especie A. semibaccata tuvo mejor comportamiento alcanzando una altura de 123.05 mm al cabo de 35 días. Por lo que se recomienda la propagación in vitro de estas especies de Atriplex, utilizando segmentos de tallo con un nudo en medio Leismaier & Skoog con adición de IBA

p53 immunostaining of surgical margins as a predictor of local recurrence in squamous cell carcinoma of the oral cavity and oropharynx.

Local and regional recurrence is the principal reason for treatment failure in squamous cell carcinoma (SCC) of the head and neck. The conventional method of evaluating surgical margins for cellular atypia does not always predict risk of local recurrence accurately. Immunostaining of surgical margins for tumor markers may provide a more precise evaluation of risk of local recurrence. Paraffin-embedded tissue blocks of surgical margins from 24 patients with oral cavity and oropharyngeal squamous cell carcinoma were immunostained for p53 protein. Fifty-eight percent of the patients had at least one margin stain positive for p53, including eight of ten patients whose SCC recurred locally. The sample odds ratio test predicted a 5.333 times higher chance of local recurrence with at least one p53 positive surgical margin. The implications of these results for patient management and further investigations will be discussed.

[Low grade disseminated astrocytoma in childhood]. / Astrocitomas de bajo grado diseminados en la infancia.

INTRODUCTION: Leptomeningeal dissemination is a common event in some kinds of cerebral tumours, but in low-grade astrocytomas who classically have been conferred a benign course. However, multifocal affectation is described each time more frequently in these group of tumours. CLINIC CASES: We present three patients aged respectively 8 and 10 months and 10 years, who were diagnosed of low-grade astrocytoma with multicentric spread. They were treated with systemic chemotherapy and controlled with MRI. At the end of the treatment an important reduction in tumours' size was observed in the three cases. DISCUSSION: Biological behaviour of low-grade astrocytoma as been reviewed in last years. By one side, it has been seen that certain histological characteristics are associated with an aggressive behaviour: on the other hand, long-term evolution of these tumours can be complicated with tumoral recurrence, malignization and leptomeningeal dissemination. This last one is observed each time more frequently since the use of MRI in the diagnose of cerebral tumours has become routine. From the therapeutic point of view, chemotherapy represents an effective choice for these patients' management, when surgery is not possible and radiotherapy not advisable, allowing in many cases to stop tumoral growth and sometimes to reduce it's size strongly.

Severe life-threatening cholera associated with blood group O in Peru: implications for the Latin American epidemic.

A household survey in 1991, at the onset of the Latin American cholera epidemic, investigated high attack rates in Trujillo, Peru, and determined the association between blood group O and severe cholera. Of 463 persons in 69 households, 173 (37%) reported diarrhea, 21% required rehydration therapy, and 4% were hospitalized; these treatment requirements greatly exceeded estimates based on other populations. Elevated vibriocidal or antitoxic antibody titers were present in 52% of 321 from whom serum was obtained; 73% were blood group O. Blood group O was strongly associated with severe cholera: Infected persons had more diarrheal stools per day than persons of other blood groups, were more likely to report vomiting and muscle cramps, and were almost eight times more likely to require hospital treatment. Since prevalence of blood group O in Latin America may be the world's highest, estimates of treatment requirements should be increased to prevent unnecessary deaths.

[Allogenic bone marrow transplantation in Wiskott-Aldrich syndrome]. / Trasplante de medula ósea alogénico en el síndrome de Wiskott-Aldrich.

Two males of 3 and 3 1/2 years of age with the Wiskott-Aldrich syndrome who underwent bone marrow transplantation from an HLA compatible brother following conditioning treatment with busulphan and cyclophosphamide are described. In both patients the taking of the graft was proven by study of blood subgroups and correction of the immunodeficiency, normalization of platelet number and function and disappearance of cutaneous eczema were seen. At 3 and 1 year respectively of the transplantation the patients showed no evidence of graft versus host disease and no severe infections or hemorrhagic episodes have seen.

[Infantile asthma within a health area: the population affected and its characteristics]. / Asma infantil en una zona de salud: población afecta y características de la misma.

OBJECTIVE: To discover the prevalence and the characteristics of the population group affected by infantile asthma and attended at a Health Centre. DESIGN: Descriptive crossover study, conducted throughout 1991. SETTING: Primary Care. PATIENTS: Patients between 2 and 14 attending the Health Centre. MEASUREMENTS AND MAIN RESULTS: We identified 349 children suffering from asthma (9.6% of the child population). 206 (59%) were male and 143 (41%), female. 45% of these children had shown symptoms suggesting asthma before their first birthday; 74% before they were 3; and 90% before 7. Family histories of asthma existed in 72%, of allergic rhinitis in 45% and atopic dermatitis in 17%. Out of the asthmatic children, 58% had allergic rhinitis and 20% atopic dermatitis. As to severity, 55% suffered light asthma, 31% moderate asthma and the remaining 14%, severe asthma. 79% had follow-up control of their asthma at the Health Centre. The rest were controlled by professionals outside the Centre (allergologists, pneumologists, hospital paediatricians etc.). 70% of the asthmatic children were passive smokers. CONCLUSIONS: Infantile asthma has 9.6% prevalence among the children attending our Health Centre. These patients are generally cared for in Primary Care. Usually their symptoms have started in very early infancy.

[Allogeneic bone marrow transplantation in children with acute lymphoblastic leukemia]. / Trasplante de medula ósea alogénico en niños con leucemia linfoblástica aguda.

PURPOSE: Long disease-free survival can be achieved with chemotherapy in over 50% of children with acute lymphoblastic leukaemia (ALL). However, those children suffering relapse or presenting with poor-risk features at diagnosis have scarce possibility of doing well with conventional chemotherapy. Bone marrow transplantation (BMT) is a good choice in such cases. MATERIAL AND METHODS: Between July 1985 and January 1992, twenty-four children with ALL underwent BMT in the Service of Pediatrics of the Hospital Ramón y Cajal. In seven patient with poor-risk criteria at diagnosis BMT was performed in the first complete remission (CR) and in seventeen cases it was performed after the second CR. The conditioning for transplantation consisted of cyclophosphamide plus total body irradiation in 21 patients and cyclophosphamide plus busulphan in 3 others. RESULTS: Fifteen patients persist in CR with post-transplant follow-up of 3 to 73 months (median, 31 months). Five patients died due to complications of the transplantation techniques, and four others died upon leukaemic relapse. The probability of disease-free survival for all cases is 61%, a plateau being reached at 13 months (83% and 52% for BMT in first or second CR, respectively). CONCLUSIONS: These findings confirm the efficacy of BMT in the treatment of children with ALL in second CR, or in first CR when there are very poor risk criteria at diagnosis.

Waterborne transmission of epidemic cholera in Trujillo, Peru: lessons for a continent at risk.

The epidemic of cholera that began in Peru in January, 1991, marked the first such epidemic in South America this century. Subsequently, over 533,000 cases and 4700 deaths have been reported from nineteen countries in that hemisphere. We investigated the epidemic in Trujillo, the second largest city in Peru. Trujillo's water supply was unchlorinated and water contamination was common. Suspect cholera cases were defined as persons presenting to a health facility with acute diarrhoea between Feb 1, and March 31, 1991. We studied a cohort of 150 patients who had been admitted to hospital and conducted a matched case-control study with 46 cases and 65 symptom-free and serologically uninfected controls; we also carried out a water quality study. By March 31, 1991, 16,400 cases of suspected cholera (attack rate 2.6%), 6673 hospital admissions, and 71 deaths (case-fatality rate 0.4%) had been reported in the province of Trujillo. 79% of stool cultures of patients with diarrhoea presenting to a single hospital yielded Vibrio cholerae O1. In the case-control study, drinking unboiled water (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.3-7.3), drinking water from a household water storage container in which hands had been introduced into the water (4.2, 1.2-14.9), and going to a fiesta (social event) (3.6, 1.1-11.1) were associated with illness. The water quality study showed progressive contamination during distribution and storage in the home: faecal coliform counts were highest in water from household storage containers and lowest in city well water. V cholerae O1, biotype El Tor, serotype Inaba, was isolated from three city water samples. Cholera control measures in Trujillo should focus on treatment of water and prevention of contamination during distribution and in the home. Trujillo's water and sanitation problems are common in South America; similar control measures are needed throughout the continent to prevent spread of epidemic cholera.

PIP: Researchers conducted various studies simultaneously in Trujillo. Peru (population 626,456) in March 1991 to set up a cholera surveillance system and to determine clinical characteristics of suspect cholera cases, modes of transmission, and municipal water quality during distribution and storage. These studies occurred after the population received information on how to avoid cholera. The cholera attack rate for the 1st 2 months of the epidemic stood at 2.6% (16,400 cases). The case fatality rate was 0.4% (71 deaths). The median hours between onset of symptoms and arrival at Belen hospital were 12 hours. 56% of the patients were treated with oral rehydration solution before coming to the hospital and 13% with homemade rehydration solution. Laboratory personnel isolated toxigenic nonhemolytic Vibrio cholera 01, biotype El Tor, serotype Inaba from the rectal swabs of 79% of cholera patients. None of the hospital patients died. 29% of controls from the case control study claimed to not have witnessed a personal or household attack of diarrhea recently, yet their vibrocidal antibody titers indicated a recent cholera infection. 58% of cases drank unboiled water within 3 days of falling ill compared to only 28% of controls (matched odds ratio [OR] 3.1; p.05). Other significant risk factors (p.05) were drank water from container also used to dip hands (OR 4.2) and attended a fiesta (OR 3.6). There were significantly more total coliforms in water containers than tap water and municipal water (mean 794 vs. 6 and 1 respectively; p.05). The same was true for fecal coliforms (20 vs. 2 and 1 respectively). In conclusion, the drinking water was contaminated with V. cholera. Eventually the city should eliminate cross connections, provide continuous supplies of water at high pressure, and improve the sewage system.

[Bone marrow transplantation in malignant diseases in childhood using reverse isolation technics: evaluation of results]. / Trasplante de médula ósea en enfermedades malignas en la edad pediátrica con aislamiento inverso convencional: valoración de resultados.

Between July 1985 and March 1990, 31 pediatric patients with neoplastic diseases underwent bone marrow transplantation (22 allogenic and 9 autologous). Routine reverse isolation techniques with sterilization of the gastrointestinal tract were used in all cases. Of these patients, 55% had fever and 32% had a documented infection. In allogenic bone marrow transplants, 23% developed graft-versus-host disease, grade I-IV. The incidence of infection and graft-versus-host disease compares favorably with other published reports from centers utilizing laminar air flow rooms during bone marrow transplantation. This suggest that standard reverse isolation techniques may be used without increasing the morbidity and mortality in these patients.

Outbreak of human rabies in the Peruvian jungle.

Transmission of rabies to man by vampire bats has been known for 60 years but there have been few reports of the features of rabies transmitted in this way. These aspects of the disease were investigated during an outbreak in Peru in early 1990. Between Jan 1 and April 30, 1990, 29 (5%) of 636 residents of the two rural communities in the Amazon Jungle in Peru acquired an illness characterised by hydrophobia, fever, and headache and died shortly thereafter. A census in one of the two towns revealed that the proportion affected was significantly higher for 5-14 year olds (17%) than for other age-groups (p less than 10(-5). Interviews conducted with 23 of the patients or their families revealed that 22 (96%) had a history of bat bite, compared with 66 (22%) of 301 community members who remained healthy (p less than 10(-6). A rabies virus strain identical to those isolated from vampire bats (Desmodus rotundus) was isolated from the brain of the only person on whom necropsy could be done. Because of the extreme isolation of this and other communities affected by bat-transmitted rabies, preventive measures should be directed at decreasing the risk of nocturnal exposure to bats by bat proofing dwellings or use of mosquito nets and at prompt wound care. Rabies pre-exposure or postexposure vaccination is clearly indicated, but may not be feasible in these isolated populations.

Investigación epidemiológica del Cólera en el Perú: Lecciones para un Continente en riesgo / Epidemiological investigation of cholera in Perú; Lessons for a continent in risk

Desde el inicio de la epidemia de cólera en el Perú el Programa de entrenamiento en Epidemiología de Campo de la Oficina General de Epidemiología del Ministerio de Salud ha desarrollado diversas investigaciones con el propósito de mejorar la efectividad de las medidas de intervención para el control del problema. A través de la aplicación y diseños metodológicos estandarizados en las áreas más afectadas, se ha encontrado que la seroprevalencia de infección por Vibrio cholerae alcanza a 25-30 de cada 100 habitantes. Los factores de riesgo más significativos incluyen consumo de agua no tratada y de alimentos sanitariamente deficientes. La severidad de cuadro clínico colérico está asociada significativamente con la presencia de grupo sanguíneo "O". La letalidad del cólera está asociada con el tratamiento intradomiciliario del enfermo y la automedicación familiar. El desconocimiento acerca de los modos de contagio, tratamiento y prácticas preventivas incrementa el riesgo de enfermar con cólera. Finalmente, la magnitud del cólera en la población infantil parece ser mayor en el escenario comunitario que en el hospitalario. Los estudios epidemiológicos en el campo pueden ayudar a identificar medidas de control más específicas y más efectivas