RESUMEN
In recent years, immunotherapy-based regimens have been included into the treatment's algorithm of several cancer types. Programmed death-1 (PD-1) and cytotoxic T lymphocyte antigen-4 (CTLA-4) interact with their ligands found on the surface of antigen presenting cells (APC) or tumor cells (PD-L1/2 and CD80/86). Through these interactions, stimulatory or inhibitory signals are established. Immune checkpoint inhibitors (ICIs), block these interactions, and when administered not only as monotherapy but also as part of combination regimens, have shown to improve survival results in multiple advanced cancers leading to an increasing number of patients treated with ICI and, as a consequence, a rise in the number of patients developing immune-related adverse events (irAEs). Presence of irAEs has been associated with greater benefit from treatment, especially when blocking PD-L1. Recent data suggests that treatment benefit persists after discontinuation of ICIs due to a treatment related adverse event, regardless of the grade. Patients experiencing grade 3-4 irAEs are at risk of toxicity recurrence after reintroducing immunotherapy and therefore, the decision to resume the treatment is challenging. In these cases, a multidisciplinary approach is always needed and several factors should be considered. Management of severe toxicities may require systemic corticosteroids which can impact on T-cell function. Due to their immunosuppressive properties, it is necessary to deeper determine how corticosteroids influence responses. In terms of overall survival (OS), the use of steroids as therapy for irAEs seems not to reduce OS and several studies have reported durable responses in patients experiencing autoimmune toxicities treated with corticosteroids.
RESUMEN
La eficacia analgésica de 100 mg. de tramadol administrado en dosis única I.M. fue evaluada en un estudio abierto con casos control que incluyó a 100 pacientes (50 multíparas y 50 primíparas) en trabajo de parto en el Hospital Escuela de Tegucigalpa, Honduras. El estudio muestra que el tramadol disminuyó el nivel de dolor desde moderado a leve (P<0.05) hasta en un 15// de pacientes. A la dosis administrada el tramadol no tuvo ningún efecto sobre las funciones vitales, frecuencia cardiaca fetal, trabajo de parto y APGAR del recién nacido
Asunto(s)
Humanos , Tramadol/uso terapéutico , Trabajo de Parto , Analgesia Obstétrica/clasificación , HondurasRESUMEN
Se presenta una investigación retrospectiva realizada durante doce meses en 1.146 embarazadas menores de 18 años y con edad gestacional de 20 o mas semanas, extraídas de una población de 32.681 partos. El estudio se llevó a cabo en Honduras con la participación de cinco instituciones; tres correspondieron a Hospitales del Estado y dos al Instituto Hondureño del Seguro Social. Se analizó la frecuencia global y particular de embarazo en la adolescente: partos, gestaciones previas, edad gestacional, control prenatal y formas de terminación del embarazo, particularmente la interrupción quirúrgica