Improvement of pure sensory mononeuritis multiplex and IgG1 deficiency with sitagliptin plus Vitamin D3.

INTRODUCTION: Mononeuritis multiplex (MM) is an unusual form of peripheral neuropathy involving at least two noncontiguous peripheral nerve trunks. The pure sensory form of MM occurs rarely. Immunoglobulin (Ig)G subclass deficiency is a clinically and genetically heterogeneous disorder. Up to 50% of adults with selective subnormal IgG1 levels or selective IgG1 deficiency have a concomitant autoimmune disorder. Herein, we report the case of a patient with MM and selective IgG1 deficiency who showed remarkable clinical improvement after 2-year combination therapy with the DPP-4 inhibitor sitagliptin plus vitamin D3. CASE REPORT: A 49-year-old man developed numbness in right hand and forearm. After 6 months, the patient developed left forefoot numbness. Approximately 8 years later, the patient started to develop numbness also in the right forefoot, along with symptoms of evening fatigue and occasional orthostatic hypotension. The patient also reported recurrent candidiasis in glans and intergluteal areas since adolescence. Electromyoneurography of lower and upper limbs revealed the presence of multiple mononeuropathies. Protein electrophoresis showed hypogammaglobulinemia and low serum IgG1 levels. Sural nerve biopsy showed the presence of perineuritis. The patient was diagnosed with MM due to perineuritis probably secondary to IgG1 deficiency. We, then, proposed combination therapy with sitagliptin and vitamin D3 in the attempt to achieve immunomodulation. At the last follow-up visit (2 years), the patient showed persistent clinical improvement, increase in IgG1 levels and normalization of protein electrophoresis. CONCLUSIONS: To the best of our knowledge, this is the first case showing a remarkable clinical improvement of MM and selective IgG1 deficiency achieved through a combination therapy with sitagliptin and vitamin D3.

Inclusion of a pH-responsive amino acid-based amphiphile in methotrexate-loaded chitosan nanoparticles as a delivery strategy in cancer therapy.

The encapsulation of antitumor drugs in nanosized systems with pH-sensitive behavior is a promising approach that may enhance the success of chemotherapy in many cancers. The nanocarrier dependence on pH might trigger an efficient delivery of the encapsulated drug both in the acidic extracellular environment of tumors and, especially, in the intracellular compartments through disruption of endosomal membrane. In this context, here we reported the preparation of chitosan-based nanoparticles encapsulating methotrexate as a model drug (MTX-CS-NPs), which comprises the incorporation of an amino acid-based amphiphile with pH-responsive properties (77KS) on the ionotropic complexation process. The presence of 77KS clearly gives a pH-sensitive behavior to NPs, which allowed accelerated release of MTX with decreasing pH as well as pH-dependent membrane-lytic activity. This latter performance demonstrates the potential of these NPs to facilitate cytosolic delivery of endocytosed materials. Outstandingly, the cytotoxicity of MTX-loaded CS-NPs was higher than free drug to MCF-7 tumor cells and, to a lesser extent, to HeLa cells. Based on the overall results, MTX-CS-NPs modified with the pH-sensitive surfactant 77KS could be potentially useful as a carrier system for intracellular drug delivery and, thus, a promising targeting anticancer chemotherapeutic agent.

PEGylated and poloxamer-modified chitosan nanoparticles incorporating a lysine-based surfactant for pH-triggered doxorubicin release.

The growing demand for efficient chemotherapy in many cancers requires novel approaches in target-delivery technologies. Nanomaterials with pH-responsive behavior appear to have potential ability to selectively release the encapsulated molecules by sensing the acidic tumor microenvironment or the low pH found in endosomes. Likewise, polyethylene glycol (PEG)- and poloxamer-modified nanocarriers have been gaining attention regarding their potential to improve the effectiveness of cancer therapy. In this context, DOX-loaded pH-responsive nanoparticles (NPs) modified with PEG or poloxamer were prepared and the effects of these modifiers were evaluated on the overall characteristics of these nanostructures. Chitosan and tripolyphosphate were selected to form NPs by the interaction of oppositely charged compounds. A pH-sensitive lysine-based amphiphile (77KS) was used as a bioactive adjuvant. The strong dependence of 77KS ionization with pH makes this compound an interesting candidate to be used for the design of pH-sensitive devices. The physicochemical characterization of all NPs has been performed, and it was shown that the presence of 77KS clearly promotes a pH-triggered DOX release. Accelerated and continuous release patterns of DOX from CS-NPs under acidic conditions were observed regardless of the presence of PEG or poloxamer. Moreover, photodegradation studies have indicated that the lyophilization of NPs improved DOX stability under UVA radiation. Finally, cytotoxicity experiments have shown the ability of DOX-loaded CS-NPs to kill HeLa tumor cells. Hence, the overall results suggest that these pH-responsive CS-NPs are highly potent delivery systems to target tumor and intracellular environments, rendering them promising DOX carrier systems for cancer therapy.

The use of radiotherapy for early breast cancer in woman at different ages.

Age is an important feature at the time of early breast cancer diagnosis. Radiotherapy is a mandatory component of treatment for breast-conserving strategies in early disease stages. Breast radiotherapy has rapidly evolved in the last 20 years. A tendency to less treatment volume (partial-breast irradiation) and less treatment time (hypofractionation) is consolidated in modern radiation oncology practice. Age and risk for local recurrence guide the decision-making process to electro-optimal treatment. Radiotherapy technological versatility offers multiple options for individualized (risk-age adapted) recommendations.

Manejo del dolor por parte de la familia de la mujer con cáncer cérvico uterino / Pain management by family of females with uterine cervical cancer

En Chile el cáncer constituye un problema de salud pública importante ya que es la segunda causa de muerte de la población general; en el sexo femenino el cáncer de cuello uterino ocupa el primer lugar como causa de muerte. El dolor es el principal síntoma en este tipo de patología y se relaciona al avanzado estado o curso de la enfermedad oncológica, lo que produce un fuerte impacto tanto en la enfermera como en su familia. Esto nos ha incentivado a conocer como manejan el dolor las familias de la mujer con cáncer cérvico uterino, para cumplir este fin se realizó un estudio descriptivo y transversal con 21 familias, seleccionadas aleatoriamente, en el Servicio de Ginecología del Hospital Dr. Sotero del Río, entre los meses de septiembre y octubre de 1998. A las familias seleccionadas se les realizó una encuesta que mide conocimientos básicos sobre la enfermedad y el manejo que estas tienen del dolor de la paciente. Se observó que el 90 por ciento de las familias son capaces de manejar el dolor de la paciente proporcionándole los cuidados que ésta requiere, en su hogar. Sin embargo, las familias sienten que les falta educación y apoyo para cumplir de mejor forma esta tarea

Latin American Registry of dialysis and renal transplantation: 1993 annual dialysis data report.

BACKGROUND: The Latin American Registry of Dialysis and Transplantation was created in October 1991 and comprises the National Societies of Nephrology from 21 countries with a total population of 468.56 million inhabitants. METHODS: This report includes data from 21,181 patients from Argentina, Brazil, Chile, El Salvador, Panama, Paraguay, Peru, Puerto Rico, Uruguay, and Venezuela who were receiving chronic dialysis treatment during 1993. Data was collected by individual patient questionnaires except from Chile and Brazil where the data was obtained from a local centre questionnaire. RESULTS: The prevalence rate averaged 131.1 per million population. The mean age of the 8972 incident patients was 50.5 years, with 58.2% males. The more frequent causes of renal failure were glomerulopathies (22.6%), vascular nephropathy (20.9%) and diabetes (16.9%). Haemodialysis was the most used treatment (88.3%). Gross mortality was 21.1% and the more frequent causes of death were cardiac complications and infections. The analysis of mortality risk factors using a logistic regression model showed that diabetics patients older than 65 years had the highest probability of death (43.0%) and patients with glomerulonephritis, younger than 65 years had the lowest (8.0%). The adjusted mortality rate was 241 deaths/1000 patient-years at risk when the USRDS 1987-1989 white mortality rate by age groups and primary diseases was used as standard. CONCLUSION: In spite of the economic difficulties, very important efforts have been made to treat ESRD patients and gross mortality statistics in some countries are similar to those reported by other regional registries.

Actitud de médicos cirujanos ante pacientes con SIDA / Surgeonïs attitude with AIDS patients

Se trata de un estudio transversal descriptivo, realizado por 76 médicos cirujanos; es decir, un 60//del total de cirujanos en ejercicio profesional en la ciudad de Santo Domingo y reconocidos como miembros del Colegio de Cirujanos de la República Dominicana. Se determinaron las variables de interés en la investigación, como son: actitud del cirujano ante el paciente VIH positivo y/o SIDA, datos socio-económicos y socio-demográficos, estatus psicológicos, etc. Como resultados importantes el estudio revela: que la edad más frecuente oscila entre 40-49 años para un 46.1//. El sexo más frecuente es el masculino para un 78.9//. Con respecto a la actitud frente al paciente VIH positivo, 30.3//experimentó ansiedad, un 6.6//insomnio, etc. El 82.9//tomó medidas especiales de protección. Recomendamos tratar todos los pacientes como probable VIH positivo, tomando todas las medidas de precaución, ya que existe un período de 3-6 meses en el cual el virus no es detectado por las pruebas inmunológicas, debido a que el individuo no ha creado anticuerpos contra el virus del VIH

Dietary vitamin B12 deficiency in a patient with multiple sclerosis.

The authors present a case of dietary vitamin B12 deficiency in a patient with multiple sclerosis. A simple schemata for evaluating patients for vitamin B12 deficiency is included as a clinical aid for physicians.

Diagnosis of lactose intolerance through the quantification of hydrogen in exhaled air.

Considerations are made on diarrhea secondary to intestinal malabsorption of carbohydrates and on the diagnostic means available in our environment, among which are the reactive strip, the clinitest tablet, tolerance curves and research of intestinal enzymes. The quantification of exhaled hydrogen is mentioned as a diagnostic method, used by several other authors, and a review of the literature on the subject is made. Considerations are made on a hydrogen quantification in the breath of patients with a transitory lactose intolerance. 16 patients were studied, 15 of whom showed an increase in the exhaled H2. 32 children with diarrhea, free from lactose intolerance, were studied. The method used did not show a significant increase in the exhaled hydrogen. 27 patients showed no H2 in their breath. In 4 there was elimination of H2 (false positives). 17 diarrhea-free children were studied. A significant difference was found when comparing the children with diarrhea and lactose intolerance to the other two groups who were free from lactose-intolerance. It is considered that this method can be useful in the diagnosis of intolerance to lactose and other sugars.

[Nutritive quality of ayocote beans (Phaseolus coccineous) supplemented with methionine at different cooking stages]. / Calidad nutritiva del ayocote (Phaseolus coccineous) suplementado con metionina en diferentes etapas de la cocción.

The purpose of the present study was to evaluate the nutritive quality of the Ayocote bean (Phaseolus coccineous) and to determine whether it could be increased by the addition of methionine. Methionine (0.6%) and salt (4%) were added at the beginning of cooking, 30 min before the beans were cooked or at the end when they were cooked, dried and ground. The beans were dried with or without broth. Proximate analysis, amino acids determination, available lysine, in vitro and in vivo digestibility as well as PER were determined in the bean flours. A second experiment was carried out using diets supplemented with increasing amounts of methionine (0.1-1%). The addition of this amino acid improved the chemical score, but methionine continued to be the first limiting amino acid. The beans dried with broth showed lower chemical score values than those dried without broth. The concentration of available lysine was lower in the beans dried with broth; the content of it in the beans was, however, still high. No significant differences were found in the PER's of the beans supplemented with different concentration of methionine. The addition of the amino acid can be effected at any step of cooking, since it was found that the thermic treatment did not reduce the utilization of the methionine added.

Trypsin inhibitors and hemagglutinins in certain edible leguminosae.

All raw legumes contain, in different proportion, several toxic substances that prevent consumption in their natural form. In this study the contents of the two main toxic products and their degree of destruction after thermic treatment similar to home cooking techniques were determined in 13 edible legumes. Proximate chemical analysis was made, and in vitro digestibility, contents of trypsin inhibitors and hemagglutinins in raw and cooked samples were studied. In the cooking treatment the legumes were boiled for two hours at boiling temperature under atmospheric pressure. Protein content in the samples was high, as in most legumes (20 per cent or more). Peas, lentils and broad beans had the lowest content of trypsin inhibitors and hemagglutinins. Cooking destroyed these substances, but did not improve in vitro digestibility, probably because of the reactions between their components when exposed to heat.