RESUMEN
Relatively little is known about the outcomes of multiple myeloma in Latin America, a world region where incorporation of novel agents is generally slow. In the current retrospective-prospective study, we aimed to describe the patterns of care and treatment results in five Latin American countries. Between April 2007 and October 2009, patients who had been diagnosed from January 2005 to December 2007 were registered at 23 institutions from Argentina, Brazil, Chile, Mexico, and Peru. We divided patients into two cohorts, according to transplantation eligibility, and analyzed them with regard to first-line treatment and overall survival (OS). We analyzed a total of 852 patients, 46.9 % of whom were female. The median follow-up was 62 months. Among transplantation-ineligible patients (N = 461), the mean age was 67.4 years, approximately one third of patients received a thalidomide-based treatment in the first line, and the median OS was 43.0 months. Transplantation-eligible patients (N = 391) had a mean age of 54.7 years and a median OS of 73.6 months. Autologous transplantation was performed in 58.6 % of the patients for whom this procedure was initially planned and in only 26.9 % of the overall patients. Our long-term results reflect the contemporary literature for patients with multiple myeloma treated with autologous transplantation and thalidomide-based regimens in clinical trials and observational studies. However, further efforts are needed to approve and incorporate novel agents in Latin American countries, as well as to increase access to transplantation, in order to achieve the expected improvements in patient outcomes.
Asunto(s)
Mieloma Múltiple/diagnóstico , Mieloma Múltiple/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , América Latina/epidemiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios RetrospectivosRESUMEN
BACKGROUND: Acinetobacter baumannii has evolved from an opportunistic pathogen into a common and persistent nosocomial bacterium capable of causing severe infections during endemic and epidemic periods. METHODS: The study period extended from January 1999 to December 2011 and involved patients hospitalized at the Hospital Civil de Guadalajara, Fray Antonio Alcalde, Jalisco, Mexico. From each patient, a single isolate was obtained, and a total of 3,680 unique isolates were collected. Susceptibility tests were performed according to the guidelines of the Clinical and Laboratory Standards Institute. RESULTS: A. baumannii has disseminated throughout the Hospital Civil de Guadalajara, Fray Antonio Alcalde, since 1999. A. baumannii isolates obtained from patients treated in the adult intensive care unit represent the majority of the isolates that have been collected. In addition, A. baumannii was isolated from the adult neurosurgical ward and the adult internal medicine ward, and these isolates were frequently obtained from secretions. A persistent decrease in the susceptibility of A. baumannii isolates to meropenem (92% in 1999 to 12% in 2011), imipenem and amikacin has been observed. CONCLUSIONS: A. baumannii became an endemic nosocomial pathogen during the study period at the Hospital Civil de Guadalajara, Fray Antonio Alcalde, and has exhibited a persistent decrease in susceptibility to all categories of antimicrobial agents over the past 13 years.
Asunto(s)
Infecciones por Acinetobacter/microbiología , Acinetobacter baumannii/aislamiento & purificación , Acinetobacter baumannii/efectos de los fármacos , Amicacina/farmacología , Antibacterianos/farmacología , ADN Bacteriano/análisis , Electroforesis en Gel de Campo Pulsado , Humanos , Imipenem/farmacología , Unidades de Cuidados Intensivos , Meropenem , México , Pruebas de Sensibilidad Microbiana , Atención Terciaria de Salud , Tienamicinas/farmacologíaRESUMEN
We present a case of a twelve year old child with a eosinophilic granuloma of the temporal bone. The eosinophilic granuloma is the most frecuent and most benign form of the histiocytosis of the Langerhans cells. The frecuency of the othological manifestations of this condition varies between 15-60 percent and radiologically, the images are characterized by litho-lesions with sharp edges. The diagnosis is histological and the treatment includes surgical intervention accompanied by inter-lesion corticoid-therapy and/or radiotherapy.
Asunto(s)
Granuloma Eosinófilo , Hueso Temporal , Antiinflamatorios/administración & dosificación , Antiinflamatorios/uso terapéutico , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/uso terapéutico , Biopsia , Niño , Terapia Combinada , Legrado , Granuloma Eosinófilo/diagnóstico por imagen , Granuloma Eosinófilo/patología , Granuloma Eosinófilo/radioterapia , Granuloma Eosinófilo/cirugía , Estudios de Seguimiento , Humanos , Ibuprofeno/administración & dosificación , Ibuprofeno/uso terapéutico , Inyecciones Intralesiones , Masculino , Metilprednisolona/administración & dosificación , Metilprednisolona/uso terapéutico , Dosificación Radioterapéutica , Hueso Temporal/diagnóstico por imagen , Hueso Temporal/patología , Hueso Temporal/cirugía , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
The Papillary carcinoma is the most frequent neoplasic tumour of the thyroid gland. It accounts for 70-75% of all malignant thyroid tumours. In 80-90% of cases it presents as a slow-growing single thyroid node. Nevertheless, in 10-26% of cases, the initial presentation is a lateral neck mass without palpable thyroid mass. We present the case of a 67 year- old patient who attended to the ENT out-patient clinic with a lateral neck mass which had been growing slowly over the course of number of years.
Asunto(s)
Carcinoma Papilar , Neoplasias de la Tiroides , Anciano , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/patología , Carcinoma Papilar/cirugía , Estudios de Seguimiento , Humanos , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Masculino , Estadificación de Neoplasias , Glándula Tiroides/patología , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Factores de TiempoRESUMEN
Angiofibromas are benign tumors, highly vascularized, that affect male adolescents and young men. We present a clinical case of an 11-year-old patient with an angiofibroma of the nasopharynx, reviewing the etiopathogenic theories and current surgical approaches.
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Angiofibroma/diagnóstico por imagen , Angiofibroma/patología , Neoplasias Nasofaríngeas/diagnóstico por imagen , Neoplasias Nasofaríngeas/patología , Angiofibroma/cirugía , Angiografía Cerebral , Niño , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias Nasofaríngeas/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Anisotropic gold nanoparticles and in particular with shapes exhibiting tips are known to present an extremely strong localized electromagnetic field. This field is mostly located at the top of the tips and can be used in various optical applications. Moreover, as a consequence of their anisotropy, they present two plasmon resonance bands corresponding to the transverse and longitudinal resonance modes. Tuning the aspect ratio it becomes possible to display SPR bands near the near infrared region. This was particularly investigated in the case of nanorods and also for bipyramids. In this paper we report a high yield synthesis approach that allows one to precisely control the aspect ratio of bipyramids and to elongate the structure until they adopt a javelin-like aspect. We were able to prepare nano-javelins with surface plasmon resonances up to 1850 nm, opening important perspectives in terms of optical applications in the NIR and IR regions. The synthetic methods are fully reported and the optical properties were correlated with the theoretical approach, taking into consideration not only the aspect ratio but also the truncation of the nano-objects.
RESUMEN
Dietary fish oil has a beneficial effect on heart and some bacterial diseases and apart from other effects, some studies have revealed their ability to modulate the course of inflammatory and autoimmune diseases. The study here reported was designed to evaluate the possible influence of a fish oil supplement on the course of a Trichinella infection. Nutritional, parasitological and immunological parameters were analyzed. Two groups of 20 Wistar rats, one fed a standard diet and the other one a standard diet supplemented with fish oil, were infected with 1000 L1 larvae. Other two uninfected groups served as control. Results were as follows: fish oil diet intake and infection have, respectively, a positive and a negative effect on growth and food utilization. The negative effect is detected later in animals fed the fish oil diet. A reduction of 30.9 and 36.6% in the number of adult worms and L1 larvae, respectively, was observed in the fish oil group as compared to the standard diet group. Production of IFNgamma (Th1 response) and IL4 (Th2) response was measured in stimulated splenic cells. The fish oil diet increased both IFNgamma and IL4 levels. At 6 days after infection both IFNgamma and IL4 responses were detected, but at 36 days after infection only IL4 was detected in the standard group. The level of somatic and cuticular antibodies was not affected by the diet.
Asunto(s)
Ácidos Grasos Insaturados/farmacología , Aceites de Pescado/farmacología , Trichinella spiralis/inmunología , Triquinelosis/parasitología , Alimentación Animal , Fenómenos Fisiológicos Nutricionales de los Animales , Animales , Anticuerpos Antihelmínticos/sangre , Suplementos Dietéticos , Ingestión de Alimentos/efectos de los fármacos , Ácidos Grasos Insaturados/administración & dosificación , Aceites de Pescado/administración & dosificación , Interferón gamma/biosíntesis , Interleucina-4/biosíntesis , Masculino , Distribución Aleatoria , Ratas , Ratas Wistar/crecimiento & desarrollo , Ratas Wistar/inmunología , Trichinella spiralis/aislamiento & purificación , Triquinelosis/inmunologíaRESUMEN
The infections due to herpes-varicella viruses occurring in 191 patients with Hodgkin's disease form the basis of this report. There were overall 41 episodes (26.7%) in 40 patients, distributed as follows: varicella in three cases, atypical herpes-varicella in two cases, and herpes zoster in 36 cases, the latter showing systemic spread in seven instances, one to the central nervous system (myelitis) and six to the skin. The mortality was 2.5% of all infections, and 33% of the varicella cases. Morbidity was apparent as postherpetic neuralgia in seven patients (19.4%), postherpetic paraplegia in one case (2.5%), and severe thrombocytopenia in another case (2.5%). The statistical study of the factors contributing to the development of reactivation episodes demonstrated that neither age, sex, or previous splenectomy were influential. The results obtained in relation to the stage and histologic type of Hodgkin's disease can not be fully evaluated because of the artifact introduced by other variables such as type of therapy and observation time. There was a clear relationship with the aggressiveness of therapy, because 81.7% of the viral episodes occurred in patients submitted to total radiotherapy with or without chemotherapy, or with partial radiotherapy plus chemotherapy. In the patients with systemic spread there was a clear relationship with prior splenectomy (p less than 0.005). The clinical features of these patients are commented upon.
Asunto(s)
Varicela/complicaciones , Herpes Zóster/complicaciones , Enfermedad de Hodgkin/complicaciones , Adolescente , Adulto , Factores de Edad , Anciano , Niño , Femenino , Herpesvirus Humano 3/inmunología , Enfermedad de Hodgkin/terapia , Humanos , Masculino , Persona de Mediana Edad , Factores Sexuales , EsplenectomíaRESUMEN
OBJECTIVE: To study the management of esophageal foreign bodies. MATERIAL AND METHODS: A retrospective study was made of all rigid esophagoscopies performed for suspected foreign bodies in the esophagus by an otolaryngology department for ten years. RESULTS: Rigid esophagoscopy was performed for suspected foreign bodies in 46 patients (27 females, 19 males); age range 22 months to 88 years. In 40 cases an impacted foreign body was found. The most frequent location was the upper third of the esophagus (33/82.5%). The most common type of foreign body was chicken bones in adults (17/42) and coins in children (2/4). Nine patients (all adults) had complications. CONCLUSIONS: Due to its low cost and morbility, flexible endoscopy is the first choice for managing esophageal foreign bodies. Rigid esophagoscopy is still an appropriate technique when flexible endoscopy fails or it is not possible.
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Esófago , Cuerpos Extraños/cirugía , Adolescente , Adulto , Anciano , Niño , Esofagoscopía , Esófago/diagnóstico por imagen , Femenino , Cuerpos Extraños/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Estudios RetrospectivosRESUMEN
A great number of studies focus their interest on the photophysical properties of fluorescent hybrid gold nanoparticles for potential applications in biotechnologies such as imaging and/or treatment. Spherical gold nanoparticles are known to quench a chromophore fluorescent signal, when moieties are located in their close vicinity. The use of a polymer spacer on such a system allowed only partial recovery of the dye emission by controlling the surface to dye distance. Gold-based anisotropic sharp nanostructures appear to exhibit more interesting features due to the strong electric field generated at their edges and tips. In this paper, a complete study of hybrid fluorescent bipyramidal-like gold nanostructures is presented. We describe the chemical synthesis of gold bipyramids functionalized with fluorescent water-soluble polymers and their photophysics both in solution and on a single object. We show that the use of a bipyramidal shape instead of a spherical one leads to total recovery of the fluorescence and even to an enhancement of the emission of the dyes by a factor of 1.4.
RESUMEN
The beneficial effects of n-3 polyunsaturated fatty acids (PUFA) are well known, but their consumption in western countries is chronically insufficient, and so it is recommended that diets should be supplemented with a fat rich in these fatty acids. However, the effect of such diets on the energy expenditure remains a controversial question. Precise data concerning the effect of using under the same metabolizable energy intake, a diet non-supplemented or supplemented with a fat rich in n-3 PUFA are not available. This type of information was obtained using rats at weaning fed a diet supplemented or non-supplemented with 10% of fish oil. Between the 30th and 60th day after starting the experiment, the energy and protein balance was established by means of the comparative slaughter method. The blood levels of different metabolites were also determined. Although total thermogenesis did not vary between the two groups, consumption of the fish oil diet led to a lower level of thermogenesis associated with the oxidation of protein, and a higher one of that associated with the oxidation of fat. We conclude that the thermic effect of feeding is a combination of independent processes. Due to their specific metabolism, n-3 PUFA may be considered essential compounds to maintain the energy balance.
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Grasas Insaturadas en la Dieta/administración & dosificación , Metabolismo Energético/fisiología , Ácidos Grasos Omega-3/administración & dosificación , Termogénesis/efectos de los fármacos , Termogénesis/fisiología , Tejido Adiposo/metabolismo , Animales , Composición Corporal , Dieta , Grasas Insaturadas en la Dieta/metabolismo , Suplementos Dietéticos , Ingestión de Energía/fisiología , Metabolismo Energético/efectos de los fármacos , Ácidos Grasos Omega-3/metabolismo , Masculino , Ratas , Ratas Wistar , DesteteRESUMEN
The validity of a self-administered, computerized version of the National Institute of Mental Health Diagnostic Interview Schedule (DIS) was evaluated with a group of 41 psychiatric inpatients. Each patient was administered the computerized DIS (C-DIS) and a semi-structured clinical interview using the symptom checklist developed by Helzer et al. The concordance between the C-DIS and symptom checklist was comparable to that found in earlier studies of the original DIS. The overall distribution of kappas was also similar to those of previous studies. Overall, the results suggest that computerized administration may be a feasible alternative to face-to-face administration of the DIS.
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Diagnóstico por Computador/instrumentación , Trastornos Mentales/diagnóstico , Escalas de Valoración Psiquiátrica/instrumentación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Trastornos Mentales/clasificación , Trastornos Mentales/psicología , Persona de Mediana Edad , Inventario de Personalidad/estadística & datos numéricos , PsicometríaRESUMEN
Quality controls are becoming an important part of our health care system. A medical audit is one way of evaluating quality of care, and this paper describes the results of an audit conducted to investigate the reasons for a prolonged stay on a psychiatric inpatient unit. The results showed a decrease in the mean length of stay over a five year period, although the figure remained substantially above provincial norms. A review of the hospital charts of a random sample of one in six patients whose hospital stay exceeded 30 days was carried out. It revealed that in 50.0% of cases the reasons were "medically acceptable," in 10.3% the reasons were "medically unacceptable" and in 39.7% the reasons were "social and administrative" and beyond the control of the treating psychiatrist. The implication of these results are discussed.
Asunto(s)
Servicios Comunitarios de Salud Mental , Mal Uso de los Servicios de Salud , Hospitalización , Auditoría Médica , Trastornos Mentales/terapia , Adulto , Enfermedad Crónica , Terapia Combinada , Trastorno Depresivo/psicología , Trastorno Depresivo/terapia , Femenino , Hospitales Generales , Humanos , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Trastornos del Humor/psicología , Trastornos del Humor/terapia , Ontario , Trastornos de la Personalidad/psicología , Trastornos de la Personalidad/terapia , Servicio de Psiquiatría en Hospital , Trastornos Psicóticos/psicología , Trastornos Psicóticos/terapia , Garantía de la Calidad de Atención de SaludAsunto(s)
Anticuerpos Monoclonales/análisis , Inmunoglobulina D/análisis , Cadenas Ligeras de Inmunoglobulina/análisis , Cadenas lambda de Inmunoglobulina/análisis , Mieloma Múltiple/diagnóstico , Proteínas de Mieloma/análisis , Anciano , Femenino , Humanos , Fallo Renal Crónico/etiología , Persona de Mediana Edad , Mieloma Múltiple/complicacionesRESUMEN
Reporte de de un caso de edema pulmonar en el postoperatorio inmediato de uan cirugia laparascópica ginecológica. La etiología del edema pulmonar en este caso no pudo ser determinada con precisión, pero se plantea con precisión, pero se plantearon dos posibles causas que lo explicaran. La primera sería un aumento súbito del retorno venoso luego de la remoción del CO2 de la cavidad peritoneal, lo que a su vez producira una sobre carga de liquidos. La segunda sería un aumento en la permeabilidad capilar pulmonar que podria resultar...