Pharmacogenomic study of anthracycline-induced cardiotoxicity in Mexican pediatric patients.

Background: The aim of this study was to evaluate the association between well-defined genetic risk variants in SLC28A3, RARG and UGT1A6 and anthracycline-induced cardiotoxicity in Mexican pediatric patients. Methods: We tested a cohort of 79 children treated with anthracyclines for the presence of SLC28A3-rs7853758, RARG-rs2229774 and UGT1A6-rs17863783. Results: The SLC28A3-rs7853758 variant was more frequent in this cohort, while the UGT1A6-rs17863783 and RARG-rs2229774 variants were present at lower frequencies. A clinically important decrease of fractional shortening was associated with SLC28A3-rs7853758 variant. Conclusion: In this cohort, 39.2% of patients carried the protective SLC28A3 variant. A small number of tested patients have the risk variants of UGT1A6 and RARG. None of the patients shared the two risk variants.

Severe osteoporosis: Principles for pharmacological therapy in Mexico. / Osteoporosis severa: fundamentos para su terapia farmacológica en México.

BACKGROUND: This article presents evidence and recommendations regarding the efficacy and safety of the approved and available therapies in Mexico to treat severe or established osteoporosis with the aim of developing a position regarding therapeutics in this stage of the disease, according to the descriptive cards of the National Drug Formulary of the National General Health Council of Mexico. METHODS: We performed a systematic and narrative review of the evidence of teriparatide and denosumab, from their pharmacological profile, effectiveness, and safety derived from clinical trials, as well as an analysis of the general recommendations of the national and international clinical practice guidelines. RESULTS: The evidence establishes that teriparatide and denosumab belong to different therapeutic classes, with biologically opposed mechanisms of action and indications of use, which are clearly differentiated in their respective national codes, therefore these drugs cannot be substitutable or interchangeable in severe osteoporosis therapy. Both represent the best options currently available for this stage of the disease; being similar in their efficacy in preventing new vertebral fragility fractures, with an RR of .35 (CI 95%; .22-.55) for teriparatide, and .32 (CI 95%: .26-.41) for denosumab. The absolute risk reduction is higher with teriparatide 9.3% (21 months) compared with denosumab at 4.8% (36 months). CONCLUSIONS: Our results agree with the recommendations available in national and international clinical practice guidelines, with both therapies proposed as a sequential, but not a substitute, treatment.

[Anthracycline-induced cardiotoxicity: report of fatal cases]. / Cardiotoxicidad inducida por antraciclinas. Reporte de casos fatales.

BACKGROUND: Anthracyclines are effective drugs in pediatrics cancer treatment. However, anthracycline-induced cardiotoxicity (AIC) is a serious adverse drug reaction that affects the survival in patients treated for childhood cancer. CLINICAL CASES: Case 1: Nine-year-old girl with stage IV Hodgkin lymphoma with 12 epirubicin doses and a cumulative dose of 576 mg/m2. After last chemotherapy dose, the patient was admitted with systemic inflammatory response, asthenia and adinamia. Echocardiography: LVEF of 22%, SF 11% and moderate mitral regurgitation. Patient died 2 days after diagnosed with dilated cardiomyopathy secondary to anthracyclines. Case 2: Fifteen-year-old girl with stage IV Burkitt lymphoma with two epirubicin doses and a cumulative dose of 90 mg/m2. After the last cycle, the patient developed several infectious foci. Echocardiography: LVEF of 49%, SF 20% and dilated left ventricle with septal flattening. Patient died 13 days after diagnosis of dilated cardiomyopathy by anthracyclines. CONCLUSION: AIC is a problem in pediatric patients receiving anthracyclines, monitoring is essential to detect the onset of cardiac damage to provide an intervention to prevent heart failure progress.

Introducción: las antraciclinas son fármacos eficaces en el tratamiento de pacientes pediátricos con cáncer. Sin embargo, la cardiotoxicidad inducida por antraciclinas (CIA) es una reacción adversa grave que afecta la sobrevida de niños y jóvenes. Casos clínicos: el caso 1 estuvo constituido por una paciente de nueve años con linfoma de Hodgkin estadio IV con 12 ciclos de quimioterapia con epirrubicina y una dosis acumulada de 576 mg/m2. Después del último ciclo de quimioterapia, la paciente ingresó con respuesta inflamatoria sistémica, astenia y adinamia. El ecocardiograma reportó una FEVI de 22 %, FA de 11 % e insuficiencia mitral moderada. La paciente falleció dos días después con diagnóstico de cardiomiopatía dilatada secundaria a antraciclinas. El caso 2 fue el de una paciente de 15 años con linfoma no Hodgkin tipo Burkitt estadio IV, con dos ciclos de quimioterapia con epirrubicina y una dosis acumulada de 90 mg/m2. Después del último ciclo, la paciente presentó diversos focos infecciosos. El ecocardiograma reportó una FEVI de 49 %, una FA de 20 % y dilatación del ventrículo izquierdo con aplanamiento septal. La paciente falleció 13 días después del diagnóstico de cardiomiopatía dilatada por antraciclinas. Conclusión: la CIA es un problema en los pacientes pediátricos que reciben antraciclinas. El monitoreo durante y después de la quimioterapia es indispensable para detectar el inicio del daño cardiaco a fin de brindar una intervención oportuna que evite la evolución a una insuficiencia cardiaca.

Qualidade de vida de cuidadoras formais de idosos / Quality of life of formal caregivers of the elderly / Calidad de vida de los cuidadores formales de personas mayores

Pesquisa descritiva e exploratória de abordagem quantitativa realizada em dois serviços de longa permanência para idosos em municípios baianos, com o objetivo de avaliar a qualidade de vida de cuidadores de idosos residentes em Instituições de Longa Permanência. A amostra foi constituída por 18 cuidadores. O instrumento de coleta de dados foi composto por dados sociodemográficos, condições de saúde e o questionário WHOQOL-Bref. Na avaliação da qualidade de vida, constatou-se que os cuidadores de idosos apresentaram menor pontuação no domínio meio ambiente (52,14 pontos) e maior pontuação no domínio psicológico (79,16 pontos). Concluiu-se que a qualidade de vida dos cuidadores formais de idosos avaliados apresenta comprometimento no Domínio Meio Ambiente.

This is a descriptive and exploratory study with a quantitative approach carried out in two long-term care facilities for the elderly in municipalities of Bahia, with the purpose of evaluating the quality of life of the caregivers of the elderly residents in long stay institutions. The sample consisted of 18 caregivers. The data collection instrument consisted of sociodemographic information, health conditions and the WHOQOL-Bref questionnaire. In evaluating the quality of life it was verified that the caregivers had lower scores in the environment domain (52.14 points) and higher scores in the psychological domain (79.16 points). It was concluded that the quality of life of the assessed caregivers demonstrated commitment in the Domain Environment.

Se trata de un estudio descriptivo y exploratorio con enfoque cuantitativo llevado a cabo en dos centros de atención a largo plazo para personas mayores en municipalidades de Bahia, con el objetivo de evaluar la calidad de vida de los cuidadores de ancianos residentes in instituciones de larga estadía. La muestra fue constituida por 18 cuidadores. El instrumento de recolecta de datos consistió en información sociodemográfica, las condiciones de salud y el cuestionario WHOQOL-Bref. En la evaluación de la calidad de vida se encontró que los cuidadores de ancianos tenían puntuaciones más bajas en el campo del medio ambiente (52,14 puntos) y una puntuación más alta en el dominio psicológico (79,16 puntos). Se concluyó que la calidad de vida de los cuidadores formales de ancianos evaluados presenta comprometimiento en el dominio del medio ambiente.