RESUMEN
BACKGROUND: There is a paucity of effective systemic therapy options for patients with advanced, chemotherapy-refractory colorectal cancer. We aimed to evaluate the efficacy and safety of fruquintinib, a highly selective and potent oral inhibitor of vascular endothelial growth factor receptors (VEGFRs) 1, 2, and 3, in patients with heavily pretreated metastatic colorectal cancer. METHODS: We conducted an international, randomised, double-blind, placebo-controlled, phase 3 study (FRESCO-2) at 124 hospitals and cancer centres across 14 countries. We included patients aged 18 years or older (≥20 years in Japan) with histologically or cytologically documented metastatic colorectal adenocarcinoma who had received all current standard approved cytotoxic and targeted therapies and progressed on or were intolerant to trifluridine-tipiracil or regorafenib, or both. Eligible patients were randomly assigned (2:1) to receive fruquintinib (5 mg capsule) or matched placebo orally once daily on days 1-21 in 28-day cycles, plus best supportive care. Stratification factors were previous trifluridine-tipiracil or regorafenib, or both, RAS mutation status, and duration of metastatic disease. Patients, investigators, study site personnel, and sponsors, except for selected sponsor pharmacovigilance personnel, were masked to study group assignments. The primary endpoint was overall survival, defined as the time from randomisation to death from any cause. A non-binding futility analysis was done when approximately one-third of the expected overall survival events had occurred. Final analysis occurred after 480 overall survival events. This study is registered with ClinicalTrials.gov, NCT04322539, and EudraCT, 2020-000158-88, and is ongoing but not recruiting. FINDINGS: Between Aug 12, 2020, and Dec 2, 2021, 934 patients were assessed for eligibility and 691 were enrolled and randomly assigned to receive fruquintinib (n=461) or placebo (n=230). Patients had received a median of 4 lines (IQR 3-6) of previous systemic therapy for metastatic disease, and 502 (73%) of 691 patients had received more than 3 lines. Median overall survival was 7·4 months (95% CI 6·7-8·2) in the fruquintinib group versus 4·8 months (4·0-5·8) in the placebo group (hazard ratio 0·66, 95% CI 0·55-0·80; p<0·0001). Grade 3 or worse adverse events occurred in 286 (63%) of 456 patients who received fruquintinib and 116 (50%) of 230 who received placebo; the most common grade 3 or worse adverse events in the fruquintinib group included hypertension (n=62 [14%]), asthenia (n=35 [8%]), and hand-foot syndrome (n=29 [6%]). There was one treatment-related death in each group (intestinal perforation in the fruquintinib group and cardiac arrest in the placebo group). INTERPRETATION: Fruquintinib treatment resulted in a significant and clinically meaningful benefit in overall survival compared with placebo in patients with refractory metastatic colorectal cancer. These data support the use of fruquintinib as a global treatment option for patients with refractory metastatic colorectal cancer. Ongoing analysis of the quality of life data will further establish the clinical benefit of fruquintinib in this patient population. FUNDING: HUTCHMED.
Asunto(s)
Neoplasias del Colon , Neoplasias Colorrectales , Neoplasias del Recto , Humanos , Trifluridina/efectos adversos , Factor A de Crecimiento Endotelial Vascular , Calidad de Vida , Neoplasias del Recto/tratamiento farmacológico , Método Doble Ciego , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversosRESUMEN
BACKGROUND This study evaluated the effects of milling (CADCAM), 3D printing, preparation taper angles (10-degree and 20-degree), auxiliary retentive features (groove and box), and provisional cement types (conventional and resin-based) on the adhesive failure stress of 3-mm short provisional crowns (PC). The research was motivated by the need to understand how digital dentistry technologies impact the retention and durability of provisional crowns. MATERIAL AND METHODS A total of 160 working models (3D-printed) and PCs [80 milled (CopraTemp)/80 printed (Asiga)] were fabricated from two 10- and 20-degree typodont master models and two 20-degree 3D-printed master models (groove and box), simulating a 3 mm high all-ceramic short PC. After provisional cementation with conventional (Kerr TempBond) and resin-based (ProviTemp) cements, 16 subgroups (n=10 each) underwent thermocycling (10 000 cycles; 5-55°C) and pull-off tests on a universal testing machine. Statistical analysis was performed using one-way ANOVA and post hoc Tukey test. RESULTS Conventional cement failed at lower stress for milled (47.68 to 73.54) and printed (48.40 to 77.91) as compared to resin cement for milled (104.2 to 137.27) and printed (184.85 to 328.84), respectively, with significant differences. Increased taper and groove decreased failure load except for the printed PC/resin cement combination. Use of proximal box preparation increased retention significantly. Except for 20-degree taper cemented with conventional cement, the differences in auxiliary retentive features for milled and printed provisional crowns were statistically significant at P≤0.05. CONCLUSIONS 3D-printed PC, resin-based cement, 10-degree taper, and proximal box preparation were associated with higher retention than milled, conventional cements, 20-degree taper, and vertical groove.
Asunto(s)
Adhesivos , Cementos de Resina , Cementos de Resina/química , Ensayo de Materiales , Coronas , Impresión Tridimensional , Cementos de Ionómero Vítreo , Cementos DentalesRESUMEN
BACKGROUND Several auxiliary features have been proposed to achieve sustainable retention for short-prepared dental crowns; however, achieving retention is challenging. This study aimed to assess the impact of increased total occlusal convergence and auxiliary preparation factors like box and groove on the retention form of short tooth preparations. MATERIAL AND METHODS Eighty resin machine-milled dies with a height of 3 mm and a deep chamfer margin of 1 mm were prepared to mimic the short-prepared molar. Initially, 2 teeth were prepared following the guidelines, and the total occlusal convergence was kept at 10° and 20°, respectively. Auxiliary features such as the proximal box and buccal groove were prepared on separate 20° dies. Eighty dies were prepared with 10 samples each for 10°, 20°, 20° with proximal box and 20° with buccal groove for zirconia (n=40) and metal crowns (n=40). Cementation was done with glass ionomer luting cement, and a pull-off test was conducted. Data were analyzed using one-way analysis of variance and post hoc fisher least significant difference test (P<0.05). RESULTS The highest mean was observed in the proximal box group with the metal crown (14.59), and the lowest in the group with 20° zirconia crowns (9.12). Within groups, the highest retentive values were found for the 20° taper with proximal box preparation; the lowest was for the 20° taper group. CONCLUSIONS Within the study limitations, it could be concluded that incorporating a proximal box or buccal groove in short tooth preparations with an increased total occlusal convergence improved retentive values.
Asunto(s)
Cementos de Ionómero Vítreo , Boca , Circonio , Membrana Celular , CoronasRESUMEN
AIM: This review aimed to evaluate the in vitro studies done with regard to the cytotoxicity associated with mineral trioxide aggregate (MTA)-based root canal sealers. BACKGROUND: Root canal sealers are used during endodontic treatment as fillers to seal the gaps between the canal gutta-percha cone and canal walls. It is necessary to understand the cytotoxicity of these materials on human-derived cells as these materials interact with human cells periapically. REVIEW RESULTS: Six in vitro studies were chosen for review. In these selected studies, along with MTA-based root canal sealers, other sealers were tested for cytotoxicity on human periodontal ligament (PDL) stem cells, human PDL fibroblasts, and human osteoblast cells. Regarding cytotoxicity, the studies were diverse, and most were based on 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl-2H-tetrazolium bromide) (MTT) assay. In general, the studies suggested that root canal sealers cause mild to severe cytotoxic effects and that several factors influence this effect, such as material setting time, concentration, and duration of exposure. CONCLUSION: All studies in the review indicated that MTA. Fillapex must be used cautiously as it exhibited the highest cytotoxic effect compared to other MTA-based and non-MTA-based sealers. CLINICAL SIGNIFICANCE: Endodontic sealers do serve the purpose of bridging the gaps between the gutta-percha cone and the canal wall but knowing its biocompatibility becomes important as the material is extruded beyond the apical foramen where it comes in contact with the surrounding tissues. The effect of sealers on the surrounding tissues affects the healing and prognosis of the treatment.
Asunto(s)
Compuestos de Calcio , Gutapercha , Humanos , Compuestos de Calcio/toxicidad , Gutapercha/toxicidad , Proyectos de InvestigaciónRESUMEN
Background: Over the past decades, Capparis spinosa has been considered a traditional therapy for relieving different illnesses. Mastitis causes a decrease in milk production and is usually treated with injectable and intra-mammary antibiotics. Aim: Investigating the therapeutic effects of C. spinosa root extract on subclinically mastitic ewes. Methods: Totally, 164 lactating ewes were selected randomly from the flocks that existed in some areas belonging to Al-Najaf City (Najaf, Iraq) from September to December (2022). Each study animal was subjected to direct sampling of milk before and once each week for 6 weeks (42 days) post treatment to be tested directly by the California mastitis test (CMT). Results: Concerning phytochemical testing of ethanolic root extract, the findings revealed a significant increase in the concentration of alkaloids, flavonoids, polyphenols, and tannins when compared to other components such as coumarins, saponin, glycosides, amino acids, and steroids. In this study, there were 44.51% infected ewes with subclinical mastitis, involving 25.61%, 13.41%, and 5.49% for scores 1, 2, and 3, respectively. In comparison with pre-treatment week, insignificant alteration was seen in the values of all scores in therapeutic week 1. However, significant differences were initiated in values of score 0 in week 2; score 0 and score 2 in week 3; score 0, score 1, and score 2 in week 4; and values of all scores in weeks 5 and 6. Conclusion: This represents the first Iraqi study aimed at the treatment of subclinical mastitis in sheep using the root extract of C. spinosa. Phytochemical testing of ethanolic extract revealed the presence of variable amounts of chemical compounds that reflect their effects on treated animals by decreasing the number of infected ewes with the disease. Moreover, studies are greatly important to estimate the therapeutic effects of other parts of C. spinosa such as leaves and seeds, on the disease and other animal diseases.
Asunto(s)
Capparis , Mastitis , Extractos Vegetales , Raíces de Plantas , Enfermedades de las Ovejas , Animales , Extractos Vegetales/administración & dosificación , Extractos Vegetales/uso terapéutico , Extractos Vegetales/química , Extractos Vegetales/farmacología , Femenino , Ovinos , Enfermedades de las Ovejas/tratamiento farmacológico , Raíces de Plantas/química , Mastitis/veterinaria , Mastitis/tratamiento farmacológico , Capparis/química , Leche/químicaRESUMEN
Context: Cigarette smoking is a global public health concern, particularly in developing countries. Saudi Arabia has a high prevalence of smoking among young individuals, highlighting the need for interventions to address this issue. Aims: This study aimed to evaluate the awareness, attitude, smoking rates, and perception of health risks among young individuals in the Jazan region of Saudi Arabia. The goal was to identify areas for improvement and develop effective strategies to combat smoking and promote healthier lifestyles. Methods and Materials: A cross-sectional survey was conducted at the out-patient department of the College of Dentistry, Jazan University, over a 3-month period. A questionnaire consisting of 15 open-ended questions was administered to eligible patients. Statistical Analysis Used: Statistical analysis was performed using the Chi-squared test with a P- value of <0.05. Results: Out of 300 participants, the majority were males, university students, and non-smokers. Among smokers, electronic cigarettes were the most used form. Starting smoking with friends was a common trend. Females smoked fewer times per day compared to males. Participants expressed concerns about the damaging effects of smoking on health. Conclusions: Targeted interventions and educational programs are needed to address smoking behaviors among young individuals in the Jazan region. Gender-specific interventions, family involvement, and promoting school connectedness are crucial in reducing smoking rates. Graphic health warnings on cigarette packs have the potential to improve knowledge and quitting intentions. Continued research and surveillance are necessary to inform evidence-based policies and interventions to combat youth smoking.
RESUMEN
The aim of our analysis was to evaluate the efficacy of cabozantinib in patients with metastatic renal cell carcinoma. Cabozantinib therapy initiated between 01/01/2019 and 31/12/2022 was evaluated based on a retrospective review of data from 14 renal centers in Hungary. The starting dose was 60 or 40 mg. Physical examinations and laboratory tests were performed every 4 weeks and imaging studies 3-monthly. Tumor response was assessed according to RECIST 1.1, and toxicity according to NCI CTCAE 4.0. A total of 230 patient records were evaluated, 201 (87.4%) of them had clear cell RCC. Cabozantinib was administered as third, second and first-line treatment in 48.7%, 38.3% and <5% of cases, respectively. Dose reductions occurred in 62.6% and treatment interruption in 6.5%. Duration of therapy was 10.03 months, which was independent of dose reduction. Overall tumor response rate was 39.2% and clinical benefit was 82.8%. The duration of first-, second-, third- and fourth-line treatment was 11.47, 8.03, 11.57 and 10.13 months, respectively. Overall survival from the start of therapy was 22.0 months. Cabozantinib therapy in daily practice was more beneficial than according to registry study results. Dose reduction did not affect efficacy.
Asunto(s)
Carcinoma de Células Renales , Neoplasias Renales , Humanos , Carcinoma de Células Renales/tratamiento farmacológico , Hungría , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
The aim of our analysis was to evaluate the efficacy of cabozantinib in patients with metastatic renal cell carcinoma. Cabozantinib therapy initiated between 01/01/2019 and 31/12/2022 was evaluated based on a retrospective review of data from 14 renal centers in Hungary. The starting dose was 60 or 40 mg. Physical examinations and laboratory tests were performed every 4 weeks and imaging studies 3-monthly. Tumor response was assessed according to RECIST 1.1, and toxicity according to NCI CTCAE 4.0. A total of 230 patient records were evaluated, 201 (87.4%) of them had clear cell RCC. Cabozantinib was administered as third, second and first-line treatment in 48.7%, 38.3% and <5% of cases, respectively. Dose reductions occurred in 62.6% and treatment interruption in 6.5%. Duration of therapy was 10.03 months, which was independent of dose reduction. Overall tumor response rate was 39.2% and clinical benefit was 82.8%. The duration of first-, second-, third- and fourth-line treatment was 11.47, 8.03, 11.57 and 10.13 months, respectively. Overall survival from the start of therapy was 22.0 months. Cabozantinib therapy in daily practice was more beneficial than according to registry study results. Dose reduction did not affect efficacy.
Asunto(s)
Carcinoma de Células Renales , Neoplasias Renales , Humanos , Carcinoma de Células Renales/tratamiento farmacológico , Hungría , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
BACKGROUND: The Biarum species (Kardeh) has been consumed as a traditional functional food and medicine for decades. The current study investigates the phytochemistry, in-vitro and in-vivo bioactivities of methanol extracts of B. bovei. METHODS: The Gas-chromatography mass spectrophotometer (GS/GS-MS) was used to analyze the phytochemical profile of the methanol extracts of B. bovei leaves and corms. The B. bovei extracts (BBE) were also investigated for in-vitro antioxidant, anticancer, and in-vivo acute toxicity (2000 mg/kg) activities. RESULTS: The chemical profiling of BBE revealed mainly fatty acids, phytosterol, alcohols, and hydrocarbon compounds. Namely, Linoleic acid, eliadic acid, palmitic acid, 22,23-dihydro-stigmasterol, and campesterol. The antioxidant activity of BBE ranged between 0.24-3.85 µg TE/mL based on different assays. The extracts also exhibited significant anticancer activity against DU-145 (prostate cancer cells), MCF-7 (human breast adenocarcinoma), and HeLa (human cervical cancer) cell lines with IC50 values ranging between 22.73-44.24 µg/mL. Rats fed on 2000 mg/kg dosage of BBE showed absence of any toxicological sign or serum biochemical changes. CONCLUSION: The detected phytochemicals and bioactivities of BBE scientifically backup the folkloric usage as an important source of nutraceuticals and alternative medicine for oxidative stress-related diseases and carcinogenesis inhibition.
Asunto(s)
Antioxidantes , Extractos Vegetales , Masculino , Ratas , Humanos , Animales , Antioxidantes/farmacología , Antioxidantes/química , Extractos Vegetales/toxicidad , Extractos Vegetales/química , Metanol , Células HeLa , Fitoquímicos/farmacología , Fitoquímicos/análisisRESUMEN
Glioblastoma is a brain tumor with poor prognosis in the therapy of which operation, postoperative temozolomide sensitized radiochemotherapy followed by temozolomide monotherapy offer the best chances. Administration of temozolomide is also recommended in relapse if the patient is naïve to this treatment. In recurrent or progressive glioblastoma following the above therapy, several biological therapeutic agents were tested, out of which the angiogenesis inhibitor bevacizumab has been approved by FDA (and similar authority of several other countries). Bevacizumab monotherapy resulted in objective tumor response in 28.2%, the median of progression-free survival was 4.2 (2.9-5.8) months, the median of overall survival was 9.2 (8.2-10.7) months. When combined with irinotecan, these results were 37.8%, 5.6 (4.4-6.2) and 8.7 (7.8-10.9) months, respectively. Adverse events were known from the use of bevacizumab in other indications, symptoms affecting the central nervous system were mild, i.e. the therapy proved to be not only effective but safe as well. Reduction of edema provided further advantage. In Hungary the product is available for "off-label" use only through a fairness request process.
Asunto(s)
Inhibidores de la Angiogénesis/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Neoplasias Encefálicas/tratamiento farmacológico , Glioblastoma/tratamiento farmacológico , Antineoplásicos Alquilantes/uso terapéutico , Antineoplásicos Fitogénicos/uso terapéutico , Bevacizumab , Neoplasias Encefálicas/patología , Camptotecina/análogos & derivados , Camptotecina/uso terapéutico , Dacarbazina/análogos & derivados , Dacarbazina/uso terapéutico , Progresión de la Enfermedad , Aprobación de Drogas , Europa (Continente) , Glioblastoma/patología , Humanos , Hungría , Irinotecán , Imagen por Resonancia Magnética , Uso Fuera de lo Indicado , Recurrencia , Temozolomida , Resultado del TratamientoRESUMEN
Tremendous changes have been witnessed in the post-COVID-19 world. Global efforts were initiated to reach a successful treatment for this emerging disease. These efforts have focused on developing vaccinations and/or finding therapeutic agents that can be used to combat the virus or reduce its accompanying symptoms. Gulf Cooperation Council (GCC) countries have initiated efforts on many clinical trials to address the efficacy and the safety of several therapeutic agents used for COVID-19 treatment. In this article, we provide an overview of the GCC's clinical trials and associated drugs' discovery process in the pursuit of an effective medication for COVID-19.
Asunto(s)
Tratamiento Farmacológico de COVID-19 , Descubrimiento de Drogas , Ensayos Clínicos como Asunto , HumanosRESUMEN
For the past ten years, the healthcare sector and industry has witnessed a surge in Artificial Intelligence (AI) technologies being used in many different medical specialties. Recently, AI-driven technologies have been utilized in medical care for pregnancy. In this work, we present a scoping review that explores the features of AI-driven technologies used in caring for pregnant patients. This review was conducted using the Preferred Reporting Items for Systematic review and Meta-Analyses extension for Scoping Reviews. Our analysis revealed that AI techniques were used in predicting pregnancy disorders such as preeclampsia and gestational diabetes, along with managing and treating ectopic pregnancies. We also found that AI technologies were used to assess risk factors and safety surveillance of pregnant women. We believe that AI-driven technologies have the potential to improve the healthcare provided to pregnant women.
Asunto(s)
Inteligencia Artificial , Atención a la Salud , Femenino , Instituciones de Salud , Humanos , EmbarazoRESUMEN
In this study, we addressed the alternative medications that have been targeted in the clinical trials (CTs) to be evidenced as an adjuvant treatment against COVID-19. Based on the outcomes from CTs, we found that dietary supplements such as Lactoferrin, and Probiotics (as SivoMixx) can play a role enhancing the immunity thus can be used as prophylactics against COVID-19 infection. Vitamin D was proven as an effective adjuvant treatment against COVID-19, while Vitamin C role is uncertain and needs more investigation. Herbals such as Guduchi Ghan Vati can be used as prophylactic, while Resveratrol can be used to reduce the hospitalization risk of COVID-19 patients. On the contrary, there were no clinical improvements demonstrated when using Cannabidiol. This study is a part of a two-phase research study. In the first phase, we gathered evidence-based information on alternative therapeutics for COVID-19 that are under CT. In the second phase, we plan to build a mobile health application that will provide evidence based alternative therapy information to health consumers.
Asunto(s)
Tratamiento Farmacológico de COVID-19 , Terapias Complementarias , Ácido Ascórbico , Ensayos Clínicos como Asunto , Suplementos Dietéticos , Humanos , Fitoterapia , Resveratrol/uso terapéutico , SARS-CoV-2 , Vitamina D/uso terapéuticoRESUMEN
BACKGROUND Transcranial direct current stimulation (tDCS) is a non-invasive brain modulatory technique that can boost cognitive processes and alter performance in cognitive tasks. The effect of anodal-tDCS on cognitive functions following a single session has been repeatedly reported. However, results are varied, mixed, and confounded by several factors, including differences in tDCS current intensity and sham conditions used. Therefore, we assessed the effect of a single session of anodal-tDCS over the primary motor cortex (M1) on cognitive functions, particularly response inhibitory control and visual recognition memory, in healthy adults. MATERIAL AND METHODS Thirty healthy male subjects participated in a randomized, double-blind, sham-controlled tDCS study (2 mA, for 20 min). In the sham stimulation, subjects received the same intensity (2 mA, for 30 s, ramped up, then ramped down). We assessed the cognitive functions response inhibitory control and visual recognition memory using the stop signal task (SST) and pattern recognition memory (PRM) task before and after the stimulation. RESULTS There was a statistically significant difference in cognitive function as assessed by the stop signal task go trial (SST) (P=0.019) and SST correct response time on go trials (P=0.04) after real stimulation only. There was no significant effect observed in sham condition. CONCLUSIONS The findings suggest that anodal-tDCS applied over M1 improves inhibitory control and visual recognition memory compared to sham stimulation. Thus, application of anodal-tDCS to the M1, as an integral node in inhibitory motor control, might be a promising adjuvant therapeutic intervention for modulation of motor response inhibition.
Asunto(s)
Corteza Motora , Estimulación Transcraneal de Corriente Directa , Adulto , Cognición , Humanos , Masculino , Memoria , Tiempo de ReacciónRESUMEN
Paravasation of cytostatic drugs during peripheral intravenous administration is a well known complication. In the United States of America it occurs in seven percent of cases with different severity and consequences. Although methods to completely avoid this complication are still unavailable, we are able to decrease the risks by identifying the patient- and procedure-related factors. The educated patient is a good indicator of paravasation in case he or she can cooperate and call the nurse. When the patient is unable to cooperate, the risks of extravasation is higher and closer nursing surveillance is indicated. The extent of injury depends mainly on the chemical structure of the extravasant substance (vesicant, irritant or non-vesicant) which may be modified by other factors. There is no strong evidence-based guidance for the management of complication. Abrupt cessation of the infusion and drawing back on the inserted venous catheter as well as elevating and resting the affected limb are necessary measures. In the available literature cooling or warming of the affected area is controversial. Similarly there are still open questions regarding the value of using antidotes as dexrazoxane, dimethylsulfoxide, thiosulfate and hyaluronidase (which is not registered as medicament in Hungary). In the event of extravasation early multidisciplinary dermatological and surgical assessment is essential for definitive diagnosis and setting the optimal management.
Asunto(s)
Antídotos/uso terapéutico , Antineoplásicos/efectos adversos , Citostáticos/efectos adversos , Extravasación de Materiales Terapéuticos y Diagnósticos/diagnóstico , Extravasación de Materiales Terapéuticos y Diagnósticos/terapia , Piel/efectos de los fármacos , Antineoplásicos/administración & dosificación , Catéteres de Permanencia , Crioterapia , Citostáticos/administración & dosificación , Dimetilsulfóxido/uso terapéutico , Extravasación de Materiales Terapéuticos y Diagnósticos/epidemiología , Humanos , Hungría/epidemiología , Hialuronoglucosaminidasa/uso terapéutico , Infusiones Intravenosas , Comunicación Interdisciplinaria , Irritantes/efectos adversos , Razoxano/uso terapéutico , Factores de Riesgo , Tiosulfatos/uso terapéutico , Estados Unidos/epidemiologíaRESUMEN
The risk of venous thromboembolic events (VTE) in cancer patients is higher than in the general population. Treatment may also increase this risk in these patients. Based on the appropriate criteria (of which the most important are the current ministerial guidelines) thrombosis prophylaxis should be started (given that there is no contraindication) on these patients and be continued while they are at risk. In the event of permanent risk thrombosis prophylaxis should be given lifelong. The drug of choice is low-molecular-weight heparin (LMWH) which is safer and more effective than the oral vitamin K antagonists. Platelet aggregation inhibitors have proved unsuccessful in this patient group. The evidence so far suggests that LMWH (during VTE prophylaxis) can have a positive impact on the course of cancer and perhaps it will be registered under the indication section for cancer patients in the future.
Asunto(s)
Anticoagulantes/uso terapéutico , Heparina de Bajo-Peso-Molecular/uso terapéutico , Neoplasias/complicaciones , Tromboembolia Venosa/etiología , Tromboembolia Venosa/prevención & control , Vitamina K/antagonistas & inhibidores , Humanos , Medición de Riesgo , Factores de Riesgo , Tromboembolia/etiología , Tromboembolia/prevención & control , Resultado del Tratamiento , Tromboembolia Venosa/inducido químicamente , Trombosis de la Vena/etiología , Trombosis de la Vena/prevención & controlRESUMEN
Recognition of the commonly encountered colorectal cancer (CRC) generally begins and takes place because of and based on symptoms and signs, due to the unsettled screening of this type of cancer. Sometimes, because of advanced stage cancer urgent surgical intervention could become necessary and, if this is the case, there is no time and possibility for searching for an eventual second tumor and perhaps the patient's status does not permit performing intraoperative investigations either. The incidence of multiple colon cancer is considered to be between 2.5 and 30% according to the literature. That is why one should exclude them even in the absence of pre- and intraoperative investigations and complaints. On the other hand, colonoscopy and perhaps irrigoscopy of seemingly healthy followed-up patients is mandatory. In the case of the presence of complaints/symptoms denoting impaired intestinal passage seen in a followed-up patient or during the adjuvant setting or metastatic/recurrent disease, treatment and even during hospice care we should evaluate the possibility of a second metachronous tumor. Moreover, if there is no urgency, the multidisciplinary team (oncoteam) should recommend the adequate treatment by balancing gain/utility and risk.
Asunto(s)
Biomarcadores de Tumor/análisis , Neoplasias del Colon/diagnóstico , Neoplasias Primarias Múltiples/diagnóstico , Vigilancia de la Población , Neoplasias del Recto/diagnóstico , Adenocarcinoma/diagnóstico , Biomarcadores de Tumor/sangre , Biopsia , Antígeno Carcinoembrionario/sangre , Neoplasias del Colon/epidemiología , Neoplasias del Colon/patología , Neoplasias del Colon/terapia , Colonoscopía , Medios de Contraste , Estudios de Seguimiento , Humanos , Hungría/epidemiología , Imagen por Resonancia Magnética , Estadificación de Neoplasias , Neoplasias Primarias Múltiples/epidemiología , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Múltiples/terapia , Vigilancia de la Población/métodos , Salud Pública , Neoplasias del Recto/epidemiología , Neoplasias del Recto/patología , Neoplasias del Recto/terapia , Sistema de Registros , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
The neuoroendocrine cancer of the bladder is a rare tumor, and from this entity the well-differentiated tumors with favorable prognosis, the paraganglioma with unfavorable prognosis, small and large cell types of tumors should be emphasized. From the methods of the anticancer therapies operation can be eligible by itself in the first group but in the second group should form only the part of the multimodal treatment. Radiotherapy plays a role only in the treatment of the small and large cell tumors and during the treatment of these tumors the administration of the cytostatic drugs is also essential (mainly platina derivates). Somatostatin analogs, immune checkpoint inhibitors could be beneficial in special cases and some tumor agnostic treatment can be useful as well. Moreover, the palliative treatment should represent an important modality even in the early treatment period but it should also be provided when no other treatment options are left.
Asunto(s)
Carcinoma Neuroendocrino , Tumores Neuroendocrinos , Neoplasias de la Vejiga Urinaria , Carcinoma Neuroendocrino/diagnóstico , Carcinoma Neuroendocrino/terapia , Terapia Combinada , Humanos , Tumores Neuroendocrinos/diagnóstico , Tumores Neuroendocrinos/terapia , Pronóstico , Neoplasias de la Vejiga Urinaria/diagnóstico , Neoplasias de la Vejiga Urinaria/terapiaRESUMEN
OBJECTIVES: The aim of this retrospective study was to determine the position of the impacted maxillary canine (IMC) and then to inspect the frequency, location, and extent of the consequent root resorption (RR) of the adjacent teeth by using CBCT. MATERIALS AND METHODS: Forty-one patients aged 12-68 who have 56 IMC detected on CBCT images were retrospectively examined in 3D. The canine position was determined by assessing the side of impaction, buccopalatal location, the distance of the canine cusp tip to the midline and to the occlusal plane, and canine angulation to the midline. RR of adjacent teeth was analyzed by investigating the nearest location of ectopic canine to adjacent teeth in horizontal and vertical dimensions in addition to measuring the degree of RR. RESULTS: Twenty-seven (48.2%) impacted canines were on the right side, and 29 (51.8%) were on the left. Most of these teeth 31 (55.4%) were located palatally, while buccal impaction was seen in only 13 (23.2%) canines and 12 (21.4%) were located centrally. The mean distance of the ectopic canine cusp tip to the occlusal plane was significantly higher in males (14.4 mm) than in females (10.7 mm). RR was seen in 9 central incisors (31.03%) and 21 lateral incisors (41.17%) as well as one case in the first and second premolar. This RR was slight for all the adjacent central incisors and premolars. CONCLUSIONS: IMC is more frequent in females, palatally and apically. When left untreated, it may cause RR of some of the adjacent teeth with various degrees, however, with no gender preference.
Asunto(s)
Tomografía Computarizada de Haz Cónico , Diente Canino/diagnóstico por imagen , Maxilar/diagnóstico por imagen , Resorción Radicular/diagnóstico por imagen , Diente Impactado/diagnóstico por imagen , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
BACKGROUND: Worldwide, mental health is a big problem and Saudi Arabia is not far behind in observing this. It seems that progress in the field of mental health is slow. Interventions in mental health education have resulted in positive results. Participation by family members, sensitization to care and social integration include some of methods believed to target understanding and counter stigma surrounding mental illness. AIM: To assess mental health literacy among female students of secondary schools in Abha city, Kingdom of Saudi Arabia. METHODOLOGY: A descriptive cross-sectional study from May 2019 to 2020 was conducted at the female governmental secondary schools in Abha sector. A total sample of 350 female students from a total of 5000 students were included. Sampled students were selected from secondary schools using probability proportionate to size using two stage cluster sample technique. Data were collected from students directly using pre-structured questionnaire. The researchers created the study questionnaire after extensive literature review and expert consultation. RESULTS: Almost half (48.9%) study participants had good awareness of the signs and indications of anxiety and depression. Loss of confidence and poor self-esteem were identified as signs of depression by 81%, sleep disturbance by 77% and disturbed appetite by 76.2% participants. Parent's education level and occupation, participant's educational performance and family living arrangement were significantly related with their awareness in univariate analysis. Father's education level (ORA = 1.45), maternal engagement with occupation (ORA = 4.18) and participant living with parents (ORA = 5.4) were identified as predictors of mental health awareness. Social media was reported as the most common source of awareness. The approach towards individuals with mental illness were helpful. CONCLUSIONS AND RECOMMENDATIONS: In conclusion, the study revealed that secondary school students had satisfactory awareness level regarding mental health and its impact. They exhibited positive attitude towards friendship with person having mental illness.