Complementary and alternative medicine in radiation oncology : Survey of patients' attitudes.

BACKGROUND: Complementary and alternative medicine (CAM) are gaining in importance, but objective data are mostly missing. However, in previous trials, methods such as acupuncture showed significant advantages compared to standard therapies. Thus, the aim was to evaluate most frequently used methods, their significance and the general acceptance amongst cancer patients undergoing radiotherapy (RT). METHODS: A questionnaire of 18 questions based on the categorical classification released by the National Centre for Complementary and Integrative Health was developed. From April to September 2015, all patients undergoing RT at the Department of Radiation Oncology, Technical University of Munich, completed the survey. Changes in attitude towards CAM were evaluated using the questionnaire after RT during the first follow-up visit (n = 31). RESULTS: Of 634 patients, 333 answered the questionnaire (52.5%). Of all participants, 26.4% used CAM parallel to RT. Before RT, a total of 39.3% had already used complementary medicine. The most frequently applied methods during therapy were vitamins/minerals, food supplements, physiotherapy/manual medicine, and homeopathy. The majority (71.5%) did not use any complementary treatment, mostly stating that CAM was not offered to them (73.5%). The most common reasons for use were to improve the immune system (48%), to reduce side effects (43.8%), and to not miss an opportunity (37.8%). Treatment integrated into the individual therapy concept, e.g. regular acupuncture, would be used by 63.7% of RT patients. CONCLUSION: In comparison to other studies, usage of CAM parallel to RT in our department is considered to be low. Acceptance amongst patients is present, as treatment integrated into the individual oncology therapy would be used by about two-third of patients.

"Placebo effect is probably what we refer to as patient healing power": A qualitative pilot study examining how Norwegian complementary therapists reflect on their practice.

BACKGROUND: Complementary therapists spend considerable time with their patients, especially in the first consultation. The communication between patients and their therapists is important for raising consciousness and activation of the patient's self-healing power. Thus, the aims in this study were to delineate what complementary therapists regard as essential in patient consultations, their view of the healing process, and how the therapists understand the placebo effect and its position in the healing process. METHODS: Semi-structured individual interviews (n = 4), focus group interview (n = 1) and participant observation were conducted among four different complementary therapists in a Norwegian community. The text data was transcribed verbatim and the analysis of the material was conducted according to conventional and direct content analysis. Some codes were predefined and others were defined during the analysis. RESULTS: The pilot study showed that the implemented methods seems feasible and fit well with the aims of this study. Complementary therapists (chiropractor, naprapath (musculoskeletal therapist), acupuncturist and acupuncturist/homeopath) representing four different complementary modalities participated. A combination of the conversation and examination during the first consultation formed the basis for the therapist's choice of treatment. A successful consultation was characterized by a fruitful relationship between the therapist and the patient. Moreover, the therapist needs to be humble and show the patient respect. Patients' positive beliefs and expectations about the treatment play a significant role in the healing process. The more hope the therapist can bring about, the more easily the patient can start believing that it is possible to get well. CONCLUSION: This was a pilot study. Therefore the findings should be appreciated as limited and preliminary. Therapists' and patients' mutual understanding and treatment goals were essential for a successful consultation. The therapists emphasized their professional skills and therapeutic competence as important when building fruitful relationships with their patients. Exerting authority and making the patient feel confident were essential factors for a successful healing process. The complementary therapists understood the placebo effect as the patient's self-healing power, resulting from establishing trust and belief in the treatment process.

[Complementary and alternative medicine use in surgical patients]. / Nem konvencionális gyógymódok használata sebészeti betegek között.

INTRODUCTION: Due to the rise in use of non-conventional therapies, we may consider the application of those in perioperative setting. AIM: The aims of the authors were to measure the attitude of patients waiting for elective surgery towards naturopathic methods, to determine their use and factors influencing their usage. METHOD: A questionnaire was applied that patients filled in individually and anonymously at the First Department of Surgery of Semmelweis University, between July 1, 2014 and April 30, 2016. RESULTS: 63.6% of the 519 participants (response rate = 21%) were interested in non-conventional therapies, and 26.8% of them applied naturopathy. In this group there were significantly more females (p = 0.022; OR: 1.066-2.3635), patients with university degree (p = 0.000315; OR: 1.3915-3.1132), aged 40-49 (p = 0.012419; OR: 1.1451-3.2405), and patients with hormonal disease (p = 0.039482; OR: 1.0186-5.7242). In terms of lifetime prevalence the most popular methods were traditional Chinese medicine (8.9%), alternative movement and massage therapy (7.5%) and homeopathy (7.3%). Only 12.9% of the patients reported the application of these methods to the physician. CONCLUSION: Surgical patients are interested in naturopathic methods, and one-fourth of them actually use them even in the perioperative period. Orv. Hetil., 2016, 157(37), 1483-1488.

The Value of a Patient-Level Modeling Approach and Need for Better Reporting in Economic Evaluations of Osteoporosis.

DISCLOSURES: No funding was involved in the writing of this letter. Outside of the submitted work, Hiligsmann has received research grants through institution from Amgen, Radius Health, UCB, and Teva/Theramex. Reginster has received research grants and/or consulting fees from Servier, Novartis, Negma, Lilly, Wyeth, Amgen, GlaxoSmithKline, Roche, Merckle, Nycomed-Takeda, NPS, IBSA Genevrier, Theramex, UCB, Asahi Kasei, Endocyte, Merck Sharp and Dohme, Rottapharm, Teijin, Teva, Analis, NovoNordisk, Ebewee Pharma, Zodiac, Danone, Will Pharma, Meda, Bristol Myers Squibb, Pfizer, Organon, Therabel, Boehringer, Chiltern, and Galapagos. Silverman has received grant support from Amgen, Radius, and Lilly; consulting fees from Amgen and Radius; has served on scientific advisory boards for Lilly and Amgen; and has served on speakers bureaus for Amgen, Lilly, and Radius.

Practicing a medicine of the whole person: an opportunity for healing.

Integrative medicine has been defined in several ways. For some it is a discipline that combines such approaches to the resolution of disease as acupuncture and homeopathy, meditation and imagery with more familiar and accepted health practices, such as surgery, pediatrics, and oncology. For others it is about cultivating awareness and sensitivity beyond symptoms to the mental, emotional, and spiritual needs of the patient. But, integrative medicine is more than the weaving together of techniques, or understanding the intimate interaction of the mental, emotional, and spiritual dimensions of human experience. It is about rethinking the task of medicine and the infrastructure of relationships and beliefs that have limited its power to serve all people.

Os desafios na conduta terapêutica em pacientes acometidos com feridas crônicas / Challenges in the therapeutic conduct in patients affected with chronic wounds / Retos en la conducta terapéutica en pacientes afectados de heridas crónicas

Considerado um grave problema em saúde pública, as feridas crônicas são patologias que desafiam o manejo terapêutico e infelizmente acometem milhares de pessoas em todo o mundo. Essa doença apresenta altos índices de morbidade impactando negativamente na qualidade de vida dos seus portadores, além de influenciar negativamente no domínio "bem-estar", principalmente quando associado aos fatores clínicos podendo estar relacionado há anos de tratamento sem cura da ferida. As feridas crônicas são caracterizadas por demora ou dificuldade nos processos de cicatrização e reparação ordenada da integridade anatômica e funcional da pele durante um período de no mínimo três meses. Porém, algumas lesões permanecem por anos e até décadas sem cicatrizar. Objetivo: O escopo dessa revisão é mostrar o limitado arsenal terapêutico bem como a dificuldade no manejo clínico e dessa forma proporcionar uma reflexão sobre sua fisiopatologia e a urgente necessidade de novas opções e condutas terapêuticas que possam auxiliar no tratamento desses pacientes. Metodologia: Trata-se de uma revisão integrativa da literatura sobre feridas crônicas, cujo critérios de inclusão foram artigos publicados no período de janeiro de 2005 a fevereiro de 2023. Conclusão: A problemática acerca dessa patologia é vasta, tratando de uma doença de difícil cura, com uma gama de fatores associados que dificultam a cura da lesão, estendendo essa doença a altos índices de morbidade. Novas condutas terapêuticas e novos fármacos, precisam ser desenvolvidos urgentemente. Destaca-se que o uso de probióticos e o emprego da nanotecnologia tem mostrado um grande potencial inovador no tratamento de pacientes portadores de feridas crônicas.

Considered a serious public health problem, chronic wounds are pathologies that defy therapeutic management and unfortunately affect thousands of people around the world. This disease has high morbidity rates, negatively impacting the quality of life of its patients, in addition to negatively influencing the "well-being" domain, especially when associated with clinical factors, which may be related to years of treatment without healing of the wound. Chronic wounds are characterized by delay or difficulty in healing processes and orderly repair of the anatomical and functional integrity of the skin over a period of at least three months. However, some injuries remain for years and even decades without healing. Objective: The scope of this review is to show the limited therapeutic arsenal as well as the difficulty in clinical management and thus provide a reflection on its pathophysiology and the urgent need for new options and therapeutic approaches that can help in the treatment of these patients. Methodology: This is an integrative review of the literature on chronic wounds, whose inclusion criteria were articles published from January 2005 to February 2023. Conclusion: The problem surrounding this pathology is vast, dealing with a difficult-to-cure disease, with a range of associated factors that make healing of the lesion difficult, extending this disease to high morbidity rates. New therapeutic approaches and new drugs need to be developed urgently. It is noteworthy that the use of probiotics and the use of nanotechnology have shown great innovative potential in the treatment of patients with chronic wounds.

Consideradas un grave problema de salud pública, las heridas crónicas son patologías que desafían el manejo terapéutico y que, lamentablemente, afectan a miles de personas en todo el mundo. Esta enfermedad presenta altas tasas de morbilidad, impactando negativamente en la calidad de vida de sus pacientes, además de influir negativamente en el dominio "bienestar", especialmente cuando se asocia a factores clínicos, que pueden estar relacionados con años de tratamiento sin curación de la herida. Las heridas crónicas se caracterizan por un retraso o dificultad en los procesos de cicatrización y reparación ordenada de la integridad anatómica y funcional de la piel durante un periodo de al menos tres meses. Sin embargo, algunas heridas permanecen durante años e incluso décadas sin cicatrizar. Objetivo: El alcance de esta revisión es mostrar el limitado arsenal terapéutico así como la dificultad en el manejo clínico y así aportar una reflexión sobre su fisiopatología y la urgente necesidad de nuevas opciones y enfoques terapéuticos que puedan ayudar en el tratamiento de estos pacientes. Metodología: Se trata de una revisión integradora de la literatura sobre heridas crónicas, cuyos criterios de inclusión fueron artículos publicados desde enero de 2005 hasta febrero de 2023. Conclusiones: La problemática que rodea a esta patología es amplia, tratándose de una enfermedad de difícil curación, con una serie de factores asociados que dificultan la cicatrización de la lesión, extendiendo esta enfermedad a altas tasas de morbilidad. Es urgente desarrollar nuevos enfoques terapéuticos y nuevos fármacos. Cabe destacar que el uso de probióticos y el empleo de nanotecnología han mostrado un gran potencial innovador en el tratamiento de pacientes con heridas crónicas.

Descripción de los pacientes de 80 o más años intervenidos quirúrgicamente en el laboratorio de electrofisiología en un hospital de tercer nivel / Description of patients aged 80 or older undergoing surgery in the electrophysiology lab of a tertiary care hospital

Resumen Introducción: en una unidad de electrofisiología de un hospital de tercer nivel de Manizales, Caldas, se han atendido pacientes en la cuarta edad; sin embargo, existe poca claridad en la literatura sobre las conductas terapéuticas en este grupo etario. Presentamos nuestra experiencia de atención e intervención en pacientes mayores de 80 años entre el 20 de septiembre de 2017 y 7 de octubre de 2019. Métodos: estudio tipo cohorte longitudinal, se recogió información con base en revisión de historias clínicas. Se realizaron seguimientos telefónicos al tercer y sexto mes del procedimiento. Se incluyeron pacientes mayores de 80 años intervenidos de cualquier procedimiento en la sala de electrofisiología. Se excluyeron los pacientes sin información sobre los datos de seguimiento. Resultados: se recogieron datos de 75 pacientes llevados a procedimiento. El 62.7% de los pacientes fueron hombres, las edades oscilaron entre 80 y 95 años. 32.7%, de pacientes con diagnóstico de disfunción sinusal. La comorbilidad más prevalente fue hipertensión arterial (92%). El procedimiento más realizado fue el implante de marcapaso bicameral. La mediana del tiempo de estancia hospitalaria fue de 1 día. EL 70% de los pacientes tuvieron riesgo medio o bajo según la escala CHA2DS2VASc. En el lapso de seis meses se encontró una incidencia acumulada de complicaciones de 4%, con 8% de reconsultas y una mortalidad de 1.3%. Conclusiones: las complicaciones posquirúrgicas, la necesidad y duración de la hospitalización, la tasa de reconsulta y la mortalidad asociada a los procedimientos en este grupo de edad son similares a las observadas en estudios con población menor de 80 años.

Abstract Introduction: fourth age patients have been cared for in the electrophysiology unit of a tertiary care hospital in Manizales, Caldas; however, there is little clarity in the literature regarding therapeutic conduct in this age group. We present our experience of care and intervention in patients over the age of 80 between September 20, 2017 and October 7, 2019. Methods: a longitudinal cohort study in which data was collected from a chart review. Telephone follow up was performed three and six months after the procedure. Patients over the age of 80 who had undergone any procedure in the electrophysiology lab were included. Patients without follow up information were excluded. Results: data were collected on 75 patients undergoing a procedure: 62.7% of the patients were men, ages ranged from 80 to 95, and 32.7% of the patients had a diagnosis of sinus dysfunction. The most prevalent comorbidity was arterial hypertension (92%). The most frequently performed procedure was dual chamber pacemaker implantation. The median hospital stay was one day. Seventy percent of the patients had a medium or low risk according to the CHA2DS2-VASc scale. Over a six-month period, a 4% cumulative incidence of complications was found, with 8% reconsultation and 1.3% mortality. Conclusions: postsurgical complications, the need for and length of hospitalization, the rate of reconsultation and the mortality associated with procedures in this age group are similar to those seen in studies of populations under 80 years old.

Oral health in the analysis of patients with hearing disabilities / Saúde bucal na análise de pacientes com deficiência auditiva

Objective: To assess the degree of knowledge of deaf and hard of hearing patients about oral health and relate it to clinical and demographic variables. Methods: The target population was schoolchildren from the 6th to the 9th grade of Elementary School and the 1st year of High School. Data collection took place through a structured questionnaire previously validated. The expressed as absolute and percentage frequencies it was analyzed using Fisher's exact test or Pearson's chi-square test (p <0.05). Results: Assessing the relationship between oral health and quality of life, to 53 students, 32.1% of students never reported pain in their teeth, mouth, or jaws, 55.8% never missed school due to problems with their teeth or dental treatments, 71, 2% never avoided smiling or laughing due to problems with teeth or dental treatments, 53.8% never avoided opening their mouths or talking due to problems with teeth or dental treatments. Conclusion: Professional and patient communication should be emphasized with the deaf and hard of hearing to intensify the importance of monitoring with the dental surgeon, carrying out activities to promote, prevent, cure, and rehabilitate oral health.

Objetivo: Avaliar o grau de conhecimento de pacientes portadores de deficiência auditiva sobre a saúde bucal, e relacionar com as variáveis clínicas e demográficas. Métodos: A população alvo foram escolares do 6º ao 9º ano do Ensino Fundamental e do 1º ano do Ensino Médio. A coleta de dados ocorreu de agosto a novembro de 2018, por meio de um questionário estruturado previamente validado. A análise dos dados foi realizada por meio do programa SPSS (Statistical Package of the Social Sciences) e expressos em forma de frequência absoluta e percentual e analisados pelo teste exato de Fisher ou qui-quadrado de Pearson (p<0,05). Resultados: Avaliando a relação da saúde bucal com a qualidade de vida de 53 alunos; 32,1% dos alunos nunca relataram dores nos dentes, na boca, ou nos maxilares, 55,8% nunca faltaram à escola devido problemas com os dentes ou tratamentos dentários, 71,2% nunca evitaram sorrir ou rir devido a problemas com os dentes ou tratamentos dentários, 53,8% nunca evitaram abrir a boca ou falar devido a problemas com os dentes ou tratamentos dentários. Conclusão: A comunicação profissional e paciente deve ser enfatizada com os portadores de deficientes auditivos, com o intuito de intensificar a importância do acompanhamento com o cirurgião dentista, realizando atividades de promoção, prevenção, cura e reabilitação à saúde bucal

Relationship between corticotherapy and increased cardiac risk in patients with rheumatoid arthritis

Rheumatoid arthritis is an autoimmune inflammatory joint disease with global prevalence of 0.4% to 1.0%. Extra-articular manifestations increase its morbidity and severity, and cardiovascular diseases present the greatest risk. Therapeutic approaches have been used to treat rheumatoid arthritis, often involving the use of multiple classes of drugs with different mechanisms and forms of action. Corticosteroid therapy is widely used in this therapeutic combination; however, its use has been widely questioned because of its high toxicity and some negative effects, including the possibility of increased cardiovascular risk, depending on the dosage. Some studies have provided important insights into how glucocorticoids have an impact on cardiac complications in patients with rheumatoid arthritis. Most of these studies have concluded that exposure to these drugs at high or cumulative doses is associated with increased risk of death, as well as possibly being associated with the presence of a positive rheumatoid factor.

Estudio Retrospectivo de Fisuras Labio-Máxilo-Palatina en Chile, 12 Años de Seguimiento / Retrospective Study of Cleft Lip and Palate in Chile, 12-Year Follow Up

Describir el perfil epidemiológico de los pacientes con FLMP no sindrómica de acuerdo a los factores que involucran a la madre. Estudio de tipo observacional, retrospectivo y analítico a partir de los datos de los casos de FLMP no sindrómicos. Se clasifico el tipo de FLMP y las variables que involucran a la madre. Fueron evaluadas 236 fichas completas de pacientes. Un 56,60 % pertenecen al sexo masculino y 43,40 % al sexo femenino. El mayor porcentaje nació el año 2011 (15,57 %), la FLP es la más prevalente (44,92 %), el 26,67 % de las madres tenía entre 21-25 años al momento del parto, un 80,50 % y 87,50 % consumió alcohol y tabaco respectivamente durante primer trimestre del embarazo, y un 41,33 % se desempeñó en rubro agrícola. Pueden ser considerados como factores de riesgo durante el embarazo: estrés post catástrofe natural, enfermedades crónicas, consumo de fármaco, hábito tabáquico y alcohólico y exposición a pesticidas.

The objective of the study was to describe the epidemiologic profile of patients with non-syndromic cleft palate according to factors that involve the mother. Observational, retrospective and analytical study from data obtained of non-syndromic cleft lip palate cases. The type of cleft lip and palate (CLP) and the variables that involve the mother were classified. In this analysis 236 fulfilled clinical records from patients were evaluated; 56,60 % correspond to male and 43,40 % to female. Most births occurred in 2011 (15,57%), cleft palate is the most prevalent (44,92 %), at the moment of birth mothers were 21-25 years old (26,67 %), most of the mothers consumed alcohol or tobacco during the first trimester of pregnancy (80,50 % and 87,50 %, respectively), and 41,33% worked in agriculture related jobs. In conclusion post natural catastrophe stress, chronic diseases, consumption of drugs, smoking and alcohol habits and exposure to pesticides can be considered as a risk factor for having a child with CLP.

Associação entre condições sistêmicas e gravidade da doença periodontal em pacientes atendidos na Clínica-Escola da UFCG / Association between systemic conditions and the gravity of periodontal disease in patients attended at the UFCG School clinic

Introdução: A doença periodontal é uma doença inflamatória crônica dos tecidos de proteção e suporte dos dentes. As doenças ou alterações de ordem sistêmica, como diabetes, alterações cardiovasculares e pulmonares, distúrbios hormonais e outras, não iniciam a doença periodontal, mas podem acelerar uma doença preexistente, aumentando sua progressão e destruição tecidual. Objetivo: O presente estudo teve como objetivo avaliar, por meio de prontuários clínicos, uma possível associação entre as condições sistêmicas e a gravidade da doença periodontal em pacientes atendidos na Clínica-Escola de Odontologia da Universidade Federal de Campina Grande, campus CSTR (UFCG-CSTR). Material e método: Para o estudo, foram avaliados 1.035 prontuários clínicos dos pacientes que procuraram atendimento na Clínica-Escola de Odontologia da UFCG-CSTR durante os anos de 2012 a 2017. Resultado: A população estudada apresentou prevalência do sexo masculino (50,9%) e diagnóstico de doença gengival (63,6%) e periodontal (35,8%). As condições sistêmicas mais prevalentes foram hipertensão (15%), diabetes (7,5%) e cardiopatias (5,8%). Além disso, 20,2% relataram ser fumantes ou ex-fumantes, enquanto o uso de medicação foi observado em 28,3% dos casos. Foi verificada associação estatisticamente significativa entre doença periodontal, sexo masculino, faixa etária mais avançada, hipertensão arterial, tabagismo ou histórico de tabagismo e diabetes. Conclusão: Foi observada uma quantidade de dentes igual ou menor do que 10 com maior frequência entre os pacientes com idade igual ou superior a 60 anos, hipertensos, diabéticos, cardiopatas e fumantes ou ex-fumantes, sugerindo, desse modo, uma maior gravidade da doença periodontal nesses indivíduos.

Introduction: Periodontal disease is a chronic inflammatory disease of the protective and supporting tissues of the teeth. Systemic diseases or changes, such as diabetes, cardiovascular changes, lung changes, hormonal disorders and others, do not start periodontal disease, however they can accelerate a pre-existing disease increasing its progression and tissue destruction. Objective: The present study aimed to evaluated, through clinical records, a possible association between systemic conditions and the severity of periodontal disease in patients seen at the Clinical School of Dentistry, Federal University of Campina Grande, Campus CSTR (UFCG-CSTR). Material and method: The study evaluated 1035 medical records of patients who sought care at the Clinical School of Dentistry of the Federal University of Campina Grande, Campus CSTR during the years 2012 to 2017. Result: The studied population had a prevalence of males (50.9%) and a diagnosis of gingival and periodontal disease of 63.6% and 35.8%, respectively. The most prevalent systemic conditions were hypertension (15.0%), diabetes (7.5%) and heart disease (5.8%). About 20.2% reported being smokers or ex-smokers. The use of medication was observed in 28.3% of the cases. There was a statistically significant association between periodontal disease, male gender, older age group, arterial hypertension, smoking or history of smoking and diabetes. Conclusion: A number of teeth equal to or less than 10 was observed more frequently among patients aged 60 years or more; hypertensive, diabetic, cardiac patients and smokers or ex-smokers, thus suggesting a greater severity of periodontal disease in these individuals.

Anatomía segmentaria del recto. Nuevo enfoque / Anatomy segmentation of the rectal. New approach

RESUMEN Se actualizó la clasificación anatómica del tumor de recto, con la revisión de varios tratados sobre anatomía. El estudio de la morfología interna del recto reconoce la formación de anchos pliegues. La formación de anchos pliegues de mucosas transversales, denominadas válvulas: una válvula inferior a 7 cm del ano, otra a 2 cm. Más arriba con una forma de media luna y la tercera a 11 cm del ano. Como estas válvulas son pliegues mucosos sin localización precisa no pueden ser consideradas como puntos anatómicos para segmentación del recto. De esta manera, la segmentación rectal como el límite entre recto superior e inferior se sitúa en la reflexión peritoneal; en el diagnóstico de tumores rectales la definición de su situación anatómica es importante para la conducta terapéutica, ya que el recto inferior tiene su origen embriológico en el proctodeo (ectoblástica) y puede ser más sensible a las radiaciones y los tumores del recto superior son tumores que se originan de tejido de formación entoblástica, las radiaciones producen lesiones del peritoneo y de otros órganos de la cavidad pelviana. La segmentación rectal es importante para el estadio locorregional del tumor y para la definición de un esquema de tratamiento adecuado. En primer lugar, establece el concepto anatómico de localización de un tumor de recto inferior, se diagnóstica con un tacto rectal, si es tocable es del recto inferior. En segundo lugar, define cuáles son los estudios complementarios para saber el estadio de la enfermedad y establece los parámetros anatómicos necesarios para la indicación del tratamiento neoadyuvante (AU).

SUMMARY To present a recent an anatomic classification of rectal tumor localization. Review of many anatomy treaties. The rectal internal morphology studies recognize the formation of thick folds of transversal mucosa thick folds named valves: a low valve to 7 cm from anus. Another is to 2 cm upper with a half moon form, a third one to 11 cm from anus. As this valves are mucosal folds without a clear localization they can't be consider as anatomical points to the rectum segment. Therefore, the rectal segmentation as the limit between up and low rectum, is located in the peritoneal reflection. In the rectal tumors diagnosis definition of it's anatomic situation is important for the therapeutic behavior, because the low rectum has its embryologic origin in the Proctodeum (ectoblastic). It can be more sensitive to the radiation the up rectum tumors are originated from the formation entoblast tissue (endoblast) the radiations cause peritoneal injuries and other pelvic cavity organs. The rectal segmentation is important for the locate-regional tumor stadium and for the appropriate treatment definition. In first place, establish the anatomic concept of the low rectal tumor localization. In second place defines which are the complementary for the new adjuvant indication (AU).

Denying the incredible: unexplained deaths in a Veterans Administration hospital.

During July and August 1975 a large number of patients at the Ann Arbor Veterans Administration Hospital experienced unexplained respiratory arrests, and there were six deaths. These were later shown to be due to the deliberate injection of pancuronium bromide, a muscle relaxant. A questionnaire survey of the reactions of the hospital patients and staff to the deaths revealed that the patients had more confidence in the hospital and their medical treatment than did the staff, and those patients who were theoretically most vulnerable used denial to cope with the unprecedented and frightening situation.

Research with human subjects.

Ackerman reviews three recent books on moral issues in human research: Who Goes First? The Story of Self-Experimentation in Medicine, by Lawrence K. Altman (Random House; 1987); The Patient as Partner: A Theory of Human-Experimentation Ethics, by Robert M. Veatch (Indiana University Press; 1987); and Ethics and Regulation of Clinical Research, 2d ed., by Robert J. Levine (Urban & Schwarzenberg; 1986).

Un ensayo clínico piloto de la efectividad clínica de dos presentaciones de esomeprazol / Clinical effectiveness of two esomeprazole presentations in a pilot trial

Resumen Introducción: el presente estudio tuvo como fin investigar la efectividad clínica de dos presentaciones de esomeprazol en pacientes con dispepsia de causa no estudiada. Métodos: se realizó un ensayo clínico piloto de dos presentaciones de esomeprazol de 40 mg recibidos diariamente por 28 días. Se eligieron pacientes con diagnóstico de dispepsia no estudiada que asistieron a consulta de gastroenterología en un hospital de referencia. Se evaluaron a los pacientes inicialmente con endoscopia y biopsia, el seguimiento a 2 y 4 semanas con escalas clínicas de síntomas y calidad de vida con cuestionarios validados en español (SODA y QoL-PEI) y eventos adversos. Además, se midieron los niveles de pH gástrico con pH-metrías en 24 horas al día 14 de tratamiento. Se tomaron niveles séricos del medicamento al momento de la evaluación de la pH-metría. Para las escalas clínicas se aplicó un análisis de varianza (ANOVA) de dos factores con medidas repetidas y al encontrar diferencias significativas en los tiempos se realizó una corrección de Bonferroni. Resultados: se aleatorizó un total de 33 pacientes, 16 y 17 pacientes en cada grupo. No hubo diferencias en el porcentaje de inhibición del pH gástrico al día 14 de tratamiento (p = 0,9795). No hubo diferencias en concentraciones de niveles séricos el día 14 (p = 0,2199). No se encontraron diferencias significativas en las escalas de gravedad y calidad de vida en las dos primeras semanas de tratamiento, pero sí en las últimas dos semanas, en las cuales el producto de prueba demostró mayor disminución del dolor (p = 0,0048) y superioridad en conformidad (p = 0,01) en la subescala SODA. No se presentaron eventos adversos serios y no hubo diferencias estadísticas entre la presentación eventos adversos no serios. Conclusiones: los productos de prueba y el de referencia mostraron efectos similares en variables clínicamente relevantes.

Abstract Introduction: This pilot studied the clinical effectiveness of two presentations of esomeprazole in patients with dyspepsia with undiagnosed causes. Methods: We conducted a pilot clinical trial of two 40 mg Esomeprazole presentations. Patients with dyspepsia of unknown cause at a gastroenterology clinic in a referral hospital were included. They received one or the other presentation daily for 28 days. Patients were initially evaluated with endoscopy and biopsy and received follow-up examinations at two and four weeks. Adverse events were recorded, and clinical symptom scales and quality of life questionnaires validated in Spanish (SODA and QoL-PEI) were used. In addition, gastric pH levels were measured continuously for 24 hours on day 14 of treatment. Serum levels of the medication administered were also measured on day 14 of treatment. A two-way repeated measures ANOVA was used to compare mean differences between the two groups. When significant differences in times were found, a Bonferroni correction was made. Results: A total of 33 patients were randomized into two groups: 16 patients in one group and 17 in the other. There were no differences in the percentages of gastric pH inhibition at day 14 of treatment (p = 0.9795). There were no differences in serum level concentrations on day 14 (p = 0.2199). No significant differences were found in severity and quality of life scales in the first two weeks of treatment. However, in the last two weeks of treatment the test product showed a larger decrease in pain (p = 0.0048) and superiority in compliance (p = 0.01) on the SODA subscale. There were no serious adverse events, and there were no statistical differences between the presentations of non-serious adverse events. Conclusions: The Test product and the Reference product showed similar effects on clinically relevant variables.

Early diagnosis and treatment of latent tuberculosis infection / Diagnóstico y tratamiento temprano de la infección de tuberculosis latente

Latent tuberculosis infection is a major health problem worldwide. People with latent tuberculosis infection have a lifetime risk of developing active tuberculosis approximately 5 % to 10%. Patients with latent tuberculosis infection were infected with Mycobacterium tuberculosis. Therefore, early diagnosis and treatment of a latent tuberculosis infection are very important. Patients with latent tuberculosis infection do not have the symptoms, signs, radiographic, and bacteriological evidence of active tuberculosis. Consequently, these patients are not contagious to others. Patients with latent tuberculosis infection usually have a positive tuberculin skin test or interferon-gamma release assays test. Systematic testing is recommended for all patients that are at risk for latent tuberculosis infection. The treatment of latent tuberculosis is recommended for patients that are at increased risk for developing active tuberculosis. The medications recommended to treat latent tuberculosis infection are isoniazid, rifampin, and a combination of isoniazidand rifapentine, and isoniazid and rifampin combination regimens. The most common side effect of these medications is hepatotoxicity. Therefore, patient monitoring during treatment should occur every month to evaluate medications side effects and adherence to medications. Post-treatment patient follow-up is very important, but serial or repeats chest radiography is not recommended.

La infección de tuberculosis latente es un gran problema de salud a nivel mundial. Las personas con infección de tuberculosis latente tienen un riesgo de desarrollar tuberculosis activa en aproximadamente 5 % a 10 % en toda su vida. Pacientes con infección de tuberculosis latente fueron infectados con Mycobacterium tuberculosis, por lo tanto, diagnóstico y tratamiento temprano de la infección de tuberculosis latente es muy importante. Pacientes con infección de tuberculosis latente son asintomáticos, no tienen signos físicos o radiográficos anormales, y no tienen evidencia bacteriológica de tuberculosis activa. Consecuentemente, estos pacientes no son contagiosos a otras personas. Pacientes con infección de tuberculosis latente usualmente son positivos para las pruebas de la tuberculina o Interferon-Gamma Release Assays. Pruebas sistemáticas son recomendadas para todos los pacientes que están en riesgo de presentar infección de tuberculosis latente. El tratamiento de tuberculosis latente es recomendado para los pacientes que tienen un elevado riesgo de desarrollar tuberculosis activa. Los medicamentos recomendados para el tratamiento de la infección de tuberculosis latente son isoniacida, rifampicina, y una combinación de isoniacida y rifapentin, y la combinación de isoniacida y rifampicina. El efecto secundario más común de estos medicamentos es hepatotoxicidad. Por lo tanto, la monitorización de estos pacientes durante el tratamiento debería ser cada mes, para evaluar efectos secundarios de los medicamentos y la adherencia al tratamiento. Es muy importante dar seguimiento después del tratamiento, pero hacer radiografías repetidas de pulmones no es recomendado.

Clinical characteristics and therapeutic response in patients with Burning Mouth Syndrome: accompanying 2 years / Características clínicas e resposta terapêutica em pacientes portadores da Síndrome de Ardência Bucal: acompanhamento de 2 anos

Introduction: Burning Mouth Syndrome (BMS) is a condition characterized by burning symptom of the oral mucosa in the absence of clinical signs. Its etiology is still unknown and, and to date there is no effective treatment. Purpose: The aim of this study was to evaluate patients with BMS profile and the therapies results in a retrospective study. Material and method: Clinical and therapeutic data were collected from records of patients with BMS diagnosed between January 2013 to April 2015 at the Clinic of Stomatology Clinic, Faculdade de Odontologia of Universidade de São Paulo, according to the criteria established by the International Headache Society in 2013. The therapies used for BMS control were also evaluated. Result: Twelve patients were diagnosed with BMS at this period. All of them were women with a mean age of 61.18 years and the apex of the tongue was the most common affected site and the duration of the burning sensation ranged from 6 months to 25 years. Many therapies were prescribed for BMS control, such as topical capsaicin, topical clonazepan, low level laser therapy and homeopathy. Among the established therapies, capsaicin has immediate effect in reducing symptoms. Conclusion: The present study showed that the challenges towards an effective treatment for BMS are varied and are mainly related to the lack knowing of the pathogenesis of this disease. The demographic profile of patients studied here was similar to that described in the available literature, however, the variables represented by secondary symptoms (medical history, anxiety and depression levels) may be modifying factors of therapeutic response and the pathogenesis of the disease itself.

Introdução: A Síndrome de Ardência Bucal (SAB) é uma condição caracterizada pelo sintoma de ardência na mucosa oral na ausência de qualquer sinal clínico. Sua etiologia ainda é desconhecida e, até o momento, não dispõe de tratamento efetivo. Objetivo: Avaliar o perfil do paciente portador de SAB, as terapias instituídas e seus resultados em estudo retrospectivo. Material e método: Foram coletados os dados clínicos e terapêuticos dos prontuários de pacientes diagnosticados com SAB, no período de janeiro de 2013 a abril de 2015, no Ambulatório da Disciplina de Estomatologia Clínica da Faculdade de Odontologia da Universidade de São Paulo. Os critérios para o diagnóstico utilizados se basearam nos estabelecidos pela International Headache Society em 2013 e foram observadas as terapêuticas empregadas e seus resultados. Resultado: Doze pacientes foram diagnosticadas com SAB neste período, todas do sexo feminino, média de idade 61,18 anos, e a principal região acometida pelo sintoma de ardor foi o ápice de língua. O tempo de duração deste sintoma variou de 6 meses a 25 anos. As terapias utilizadas para o controle de sintomas da SAB foram capsaicina, clonazepan tópico, laserterapia e homeopatia. Dentre as terapias instituídas, a capsaicina apresentou efeito imediato na redução dos sintomas. Conclusão: O presente estudo demonstrou que os desafios que circundam a obtenção de um tratamento efetivo para a SAB são diversos e estão principalmente relacionados ao desconhecimento da etiopatogenia da doença. O perfil demográfico dos pacientes aqui estudados foi semelhante ao descrito na literatura disponível, entretanto, as variáveis representadas por sintomas secundários (história médica, níveis de ansiedade e depressão) podem constituir fatores modificadores da resposta terapêutica e da própria etiopatogenia da doença.

Diez años de actuación homeopática en cólicos nefríticos y litiasis renal en Pinar del Río / Ten years of homeopathic operations in renal colic and nephrolithiasis in Pinar del Rio

Introducción: la homeopatía, no escapa a la medicación que puede emplearse en la litiasis renal y sus síntomas dolorosos. Objetivo: incorporar la medicación homeopática al tratamiento sintomático de la litiasis renal. Métodos: se realizó estudio descriptivo, prospectivo y longitudinal en pacientes con diagnóstico de litiasis renal o cólicos nefríticos valorados en la consulta de Medicina Natural y Tradicional, procedentes del Servicio de Urgencia u hospitalizados en el hospital "León Cuervo Rubio" de Pinar del Río, desde enero de 2004 a diciembre de 2014. Se empleó el valor absoluto y porcentual. Resultados: fueron tratados 248 pacientes, obteniéndose el 73 % (181 pacientes) atendidos por cólicos renales y 67 pacientes por litiasis renal, predominó el lado derecho. La combinación homeopática de (Lycopodium 6 CH y Berberis 6 CH fue satisfactoria para el alivio del dolor en 153 pacientes (84,53 %). Se eliminaron los cálculos a 44 pacientes con litiasis renal. De los pacientes que presentaban cálculos de más de un centímetro (65,67 %) disminuyeron de tamaño. Conclusiones: la combinación homeopática utilizada resultó ser eficaz en el tratamiento del cólico nefrítico y la litiasis renal.

Introduction: Homeopathy does notevade being amedication that can be used in the renal nephrolithiasis and its painful symptoms. Objective: To incorporate homeopathic medication to the symptomatic treatment of nephrolithiasis. Methods: A descriptive, longitudinal, prospective studywas carried out,in patients with diagnosis of nephrolithiasisor renal colic, evaluated at the Natural and Traditional Medicine service, coming from the Emergency Room or admitted at the hospital Leon Cuervo Rubioin Pinar del Rio, from January 2004 to December 2014. Absolute values and percentages were determined. Results: 248 patients were treated, obtaining the following main results. 73 % (181 patients) assisted due to renal colics and 67 patients for nephrolithiasis. Prevalence was found on the right side. The homeopathic combination of Lycopodium 6 CH and Berberis 6 CH was satisfactory for the relief of the pain in 153 patients (84.53 %). 44 patients with nephrolithiasiseliminated the stones. The patients who presented lithiasis bigger than a centimeter (65.67 %), diminished its size. Conclusions: The homeopathic combination used seems to be effective in the treatment of the renal colic and nephrolithiasis.