Tratamientos de primera línea para pacientes estadio IV con adenocarcinoma pulmonar de mutación EGFR / First-line treatments for stage IV patients with EGFR-mutated lung adenocarcinoma

Lung cancer is one of the leading causes of death in the world. Current treatments act directly on the signal transduction pathways in cancer cells, mainly. One of the main pathways is associated with the Epidermal Growth Factor (EGFR), whose mutations leads to uncontrolled cell proliferation and a higher rate of cell invasion. Activating mutations in the EGFR gene, which includes deletions in exon 19 and the L858R mutation in exon 21, were detected in most patients with non-small cell lung cancer (NSCLC). Studies of EGFR tyrosine kinase inhibitors (EGFR-TKIs) such as Gefitinib, Erlotinib and Afatinib, compared with platinum-based treatments, showed that EGFR-TKIs produce increased disease-free survival, although only in patients whose cancers harbor activating mutations in the EGFR gene. Clinical trials also demonstrated that EGFR-TKIs are effective as first-line therapies in stage IV pulmonary adenocarcinoma. Here, the main aspects of the activation of the EGFR pathway in NSCLC will be reviewed, highlighting the importance for health professionals of correctly identifying activating mutations in the EGFR gene and acting quickly at the molecular level based on aforementioned treatments. (AU)

Variation in training requirements within general surgery: comparison of 23 countries.

Background: Many differences exist in postgraduate surgical training programmes worldwide. The aim of this study was to provide an overview of the training requirements in general surgery across 23 different countries. Methods: A collaborator affiliated with each country collected data from the country's official training body website, where possible. The information collected included: management, teaching, academic and operative competencies, mandatory courses, years of postgraduate training (inclusive of intern years), working-hours regulations, selection process into training and formal examination. Results: Countries included were Australia, Belgium, Canada, Colombia, Denmark, Germany, Greece, Guatemala, India, Ireland, Italy, Kuwait, the Netherlands, New Zealand, Russia, Saudi Arabia, South Africa, South Korea, Sweden, Switzerland, UK, USA and Zambia. Frameworks for defining the outcomes of surgical training have been defined nationally in some countries, with some similarities to those in the UK and Ireland. However, some training programmes remain heterogeneous with regional variation, including those in many European countries. Some countries outline minimum operative case requirement (range 60-1600), mandatory courses, or operative, academic or management competencies. The length of postgraduate training ranges from 4 to 10 years. The maximum hours worked per week ranges from 38 to 88 h, but with no limit in some countries. Conclusion: Countries have specific and often differing requirements of their medical profession. Equivalence in training is granted on political agreements, not healthcare need or competencies acquired during training.

Antecedentes: Existen muchas diferencias entre los programas de formación quirúrgica de posgrado del mundo. El objetivo de este estudio fue proporcionar una visión general de los requisitos formativos en cirugía general en 23 países diferentes. Métodos: En cada uno de los países participantes, un colaborador recopiló datos de la página web del organismo oficial encargado de la formación, si era posible. La información incluyó: gestión, formación, competencias académicas y operatorias, cursos obligatorios, años de formación de postgrado (que incluía el período de internado), regulaciones sobre las horas de trabajo, proceso de selección para la formación y existencia de un examen final. Resultados: Se incluyeron los datos de Australia, Bélgica, Canadá, Colombia, Dinamarca, Alemania, Grecia, Guatemala, India, Irlanda, Italia, Kuwait, Países Bajos, Nueva Zelanda, Rusia, Arabia Saudita, Sudáfrica, Corea del Sur, Suecia, Suiza, Reino Unido, Estados Unidos de América y Zambia. En algunos países existen los marcos normativos para definir los resultados del programa de formación, con ciertas semejanzas a los del Reino Unido e Irlanda. Sin embargo, algunos programas de formación, incluso en muchos países europeos, son muy heterogéneos con variaciones regionales. Pocos países describen el número mínimo de procedimientos quirúrgicos (rango 60 a 1.600), los cursos obligatorios o competencias quirúrgicas, académicos o de gestión exigidos. La duración de la formación postgraduada osciló de los 4 a los 10 años. El número de horas trabajadas máximas por semana oscilaron entre 38 y 88, sin límite en algunos países. Conclusión: Cada país tiene unos requisitos específicos, a menudo diferentes, para la formación de sus médicos. La convalidación se otorga por acuerdos políticos, más que por las necesidades médicas o por las competencias adquiridas durante la formación.

Estado nutricional de trabajadores bajo turnos rotativos o permanentes / Nutritional state of workers under steady or rotating shifts

Restrictions of sleep predispose to experience, in the long-term, excess malnutrition and non-transmissible chronic diseases. The objective of this research has to study the influence of working shifts on nutritional status lipid profile and fasting blood glucose (FBG). Study of a series of cases considered a total of47 recruited workers from which 31 of them had a rotating shift (day and night) and 16 a steady shift (day). The nutritional assessment involved: BMI (Body Mass index), waist and hip circumference, tricipital, bicipital, sub scapular and supra iliac skin folds. Sleep hours were studied with a weekly record, food intake was studied by means of 24-hours dietary recall. It was determined: total cholesterol, c-HDL, c-LDL, blood triglycerides and fasting blood glucose (FBG). The sample was composed by 87 percent women and 13 percent men, average age of 38,7years [19,0] v/s 44,7[25¿2] (p=0,420) in rotating and steady shifts respectively. The rotating shift did not show any significant differences compared to the steady shift in terms of anthropometric parameters except for sub scapular skin fold that was significantly higher (p=0,032) in relation to the macronutrients intake. Lipid profile and glycerin did not show important differences (p=>0,05). The prevalence of the nutritional status was: rotating shift 35,4 percent normal, 45,1 percent overweight and 19,5 percent obese. On the other hand, the steady shift showed: 43,7 percent normal and 56¿ percent overweight. Seniority only in the rotating shift showed a positive correlation of BMI (r=0,436 p<0,005) body fat (r=0,454 p<0,005) total cholesterol (r= 0,¿94 p<0,005) LDL (r=0,484 p<0,005) and glycerin (r=0,405 p<0,005). We concluded that workers of the rotating and steady shift did not show significant differences among variables studied except for the sub scapular skin fold that was significantly higher in the rotating shift, that can be associated to predominantly central fat distribution.

Restricciones del sueño predisponen a padecer, a largo plazo, malnutrición por exceso y enfermedades crónicas no transmisibles. El objetivo fue estudiar la influencia del turno laboral sobre estado nutricional, perfil lipídico y glicemia en ayuno. Estudio exploratorio del tipo de serie de casos, 47 reclutados; 31 turnos rotativos (día y noche), y 16 turno permanente (día). La evaluación nutricional se efectuó mediante el IMC, la circunferencia cintura-cadera y los pliegues tricipital, bícipital, subescapular y suprailiaco. Se estudió las horas sueño mediante un registro semanal, la ingesta dietética por encuesta de recordatorio de 24 horas. Se determinó el colesterol total, c-HDL, c-LDL, triglicéri-dos séricos y glicemia. La muestra estuvo representada en un 87 por ciento mujeres y 13 por ciento por hombres, cuya mediana de edad fue de 38,7 años [19,0] y 44,7[25,2] (p=0,420) en turno rotativo y permanente, respectivamente. El turno rotativo no mostró diferencias significativas respecto al turno permanente en los parámetros antropométricos a excepción, del pliegue subescapular que fue significativamente superior (p=0,032), respecto a ingesta de macronutrientes, perfil lipídico y glicemia tampoco mostró diferencias significativas (p=> 0,05). La prevalencia del estado nutricional en el turno rotativo fue en 35,4 por ciento normal, en 45,1 por ciento sobrepeso y en 19,5 por ciento obesidad, y turno permanente: 43,7 por ciento normal y 56,3 por ciento sobrepeso. La antigüedad laboral sólo en el turno rotativo se correlacionó positivamente con IMC (r=0,436 p<0,005), grasa corporal (r=0,454 p<0,005), el colesterol total (r= 0,394 p<0,005) el LDL (r=0,484 p<0,005) y la glicemia (r=0,405 p<0,005). En conclusión, los funcionarios del turno rotativo y permanente no mostraron diferencias significativas entre las variables estudiadas, a excepción del pliegue subescapular que fue significativamente mayor en el turno rotativo, lo que podría asociarse a la distribución de la...

Cooperación en ratas: efectos de la experiencia temprana / Cooperative behavior in rats: effects of early experience

Se estudiaron los efectos de la experiencia alimenticia temprana en el desarrollo de conductas cooperativas en una tarea instrumental en ratas. Los sujetos fueron asignados aleatoriamente a dos grupos. En uno, los sujetos tuvieron libre acceso al alimento, condición análoga a un ambiente rico en alimento. En otro, los sujetos fueron expuestos a cantidades limitadas de alimento, representando un hábitat pobre en recursos alimenticios. En la primera fase experimental se expuso a los sujetos a una situación de elección entre respuestas cooperativas e individuales. El refuerzo obtenido por el trabajo compartido proporcionó 4 veces más de lo recibido por el trabajo individual. En la segunda fase, los sujetos obtuvieron 1 refuerzo tanto por sus respuestas individuales, como por sus respuestas compartidas. En la tercera fase, los sujetos recibieron 4 refuerzos por cada respuesta individual y 1 refuerzo por cada respuesta cooperativa. Los sujetos con experiencia temprana de escasez de alimento presentaron tasas de respuestas cooperativas más altas que los sujetos expuestos a condiciones de abundancia de alimento.(AU)

We studied the effects of early experience in the development of cooperative behaviors in an instrumental task in rats. In the first experimental phase, subjects were exposed to a choice between a cooperative and a non cooperative task. By cooperating subjects obtained 4 times more food than working individually. In a second phase, all experimental subjects earned one reinforcement for each type of response. In the third phase, all experimental subjects earned four reinforcement units for responding individually and one unit for responding cooperatively. Subjects with an early experience of food deprivation presented rates of higher cooperative response than subjects early exposed to food abundance. We conclude that early experience of food abundance or deprivation influence the later development of cooperative behavior.(AU)

Conduction failure of action potentials in sensory sural nerves of undernourished rats.

In order to determine possible functional and morphometrical alterations produced by perinatal undernourishment on peripheral nerves, sensory sural nerves from control and undernourished rats of 30 and 90 postnatal days of age were dissected and divided in two segments, one for recording the compound action potential (CAP) and the other for histological examination. Nerves from undernourished animals showed maximal CAP responses of smaller amplitude and area, larger trial-to-trial variability in area, and a significant reduction in axonal myelin sheath thickness than nerves from control animals. It is suggested that perinatal undernourishment produces changes in axonal myelin sheath structure, resulting in severe alterations in the generation and propagation of action potentials (block and/or intermittent conduction) in sensory afferent fibers in the rat.

Correlation of tumor growth index with early treatment response in cervical carcinoma.

Despite the recent progress in the management of cervical carcinoma, treatment failure is quite common and therefore it is necessary to identify predicting factors for tumor response. It is known that both cell proliferation and apoptosis determine the tumor growth index (TGI) which reflects the overall contribution of gene defects. Here we explored whether the TGI index could be a better predictor of response in comparison to cell proliferation or apoptosis as separate phenomena. Twenty-five patients with cervical carcinoma treated with radiation alone or neoadjuvant chemotherapy plus surgery were analyzed. Cell proliferation and apoptosis determined by PCNA immunohistochemical expression and tumor nucleosomes by ELISA, respectively, were used to calculate the TGI, which was analyzed with regard to early tumor response. Our results show that most patients with a negative TGI had early response suggesting increased tumor sensitivity(p = 0.0186). On the other hand, patients with a positive TGI were more resistant to treatment. TGI was not related to age, clinical stage or tumor size. In conclusion, the results of this study show that the determination of the TGI, but no cell proliferation or apoptosis, as separate events, is able to predict an early treatment response to either radiation or chemotherapy in cervical carcinoma.

Effect of perinatal food deficiencies on the compound action potential evoked in sensory nerves of developing rats.

The aim of this study was to analyze the possible alterations produced by inadequate perinatal food intake, in quantity (undernutrition) or quality (malnutrition), on the generation and propagation of the compound action potential (CAP) evoked in sensory sural nerves, during the postnatal development of the rat. Low intensity stimulation (2-3 times the threshold of the most excitable nerve fibers; xT) of the sural nerve evoked an early potential (CAP-A component) which is due to activation of low-threshold, fast-conducting myelinated group A afferent fibers. Meanwhile, at higher stimulus intensity (20-30T) it produced a second, long-lasting potential (CAP-C component) probably due to activation of high-threshold, slow-conducting group Adelta or C afferent fibers. Compared to control nerves, the CAP-A component, but not the CAP-C component of undernourished and malnourished nerves showed significant changes in amplitude, area, electrical threshold and conduction velocity (except absolute refractory period) at several postnatal ages. Our results may suggest that a relative large number of myelinated group A afferent fibers in the sural nerve of undernourished and malnourished animals suffer severe alterations on their electrophysiological properties of generation and propagation of the action potential during the postnatal development of the rat.

Práctica obstétrica en el Hospital Estatal de Baeza (H.E.B) 1989-1993

El Hospital Estatal de Baeza situado en el cantón Quijos, Provincia de Napo, está ubicado en eun lugar estratégico donde existen pacientes de gran parte de la provincia. En el presente estudi se analizaron retrospectivamente 642 historias clínicas de la s pacientes obstétricas hospitalizadas en esta casa de salud entre diciembre de 1989 a marzo de 1993, período en el cual se han atendido 334 partos, es decir, 41,23 por ciento se han realizado 78 (11,96 por ciento legrados; 63 (9.66 por ciento cesáreas, etc. De laevaluación realizada podemos destacar que el H.E.B, asume gran importancia en la atención gineco- obstétrica en esta región y con el presente estudio pretendemos dar a conocer a la comunidad científica ecuatoriana, la labor desplegada en este campo, durante el tiempo de existencia de este Hospital cantonal...