Quimioterapia antineoplásica frente al cáncer de mama en mujeres embarazadas: Prevención de Extravasaciones / Antineoplastic chemotherapy against breast cancer in pregnant women: Extravasation Prevention

El cáncer gestacional se puede definir como el cáncer que ocurre durante el embarazo o durante el primer año posterior al parto. Entre ellos, el cáncer de mama ocupa el primer lugar en frecuencia con una incidencia en aumento y que se sitúa cerca de 1 por cada 3.000 mujeres embarazadas. En la mujer embarazada el diagnóstico de cáncer representa un desafío en términos de manejo clínico, debido a la necesidad de garantizar la seguridad materna y asegurar el estado de gestación. Este tiende a retrasarse y detectarse en estadios más tardíos debido a que los síntomas asociados pueden relacionarse fácilmente con una situación normal de gestación. Las embarazadas diagnosticadas de cáncer deben ser evaluadas por un comité multidisciplinario de tumores, especializado en cáncer durante el embarazo. Uno de los tratamientos utilizados para el abordaje del cáncer de mama es la quimioterapia antineoplásica, que debe ser administrada en un hospital, atendiendo a diferentes factores como son el estado general del paciente, las posibles enfermedades previas, el tipo, estadio y localización del tumor, así como la semana de gestación en la que se encuentra la mujer. A partir de la semana 13-14 de gestación puede iniciarse el tratamiento, siendo los regímenes más utilizados a día de hoy: ciclos de 3 semanas de FAC (5-fluorouracilo, doxorrubicina y ciclofosfamida), FEC (5-fluorouracilo, epirubicina y ciclofosfamida), AC (doxorrubicina y ciclofosfamida) y EC (epirubicina y ciclofosfamida) o epirubicina semanal como monoterapia. Asimismo, destaca el uso de los taxanos (paclitaxel como agente único). La enfermera constituye un pilar fundamental dentro del equipo multidisciplinario de tumores, especializado en cáncer de mama durante el embarazo, que atenderá y acompañará a la embarazada durante todo el proceso de la enfermedad. El cáncer de mama, y más en la embarazada, conlleva una serie de cambios en su vida que requieren diferentes procesos de adaptación física, psicológica y social (AU)

Gestational cancer can be defined as cancer that occurs during pregnancy or within the first year after delivery. Among them, breast cancer occupies the first place in frequency with an increasing incidence that is situated at about 1 per 3.000 pregnant women. In pregnant women, the diagnosis of cancer represents a challenge in terms of clinical management, due to the need to guarantee maternal safety and ensure the state of pregnancy. This tends to be delayed and detected at later stages because the associated symptoms can be easily related to a normal pregnancy situation. Pregnant women diagnosed with cancer should be evaluated by a multidisciplinary tumor team, specialized in cancer during pregnancy. One of the treatments used to address breast cancer is antineoplastic chemotherapy, which must be administered in a hospital, taking into account different factors such as the general condition of the patient, possible previous diseases, the type, stage and location of the tumor, as well as the week of gestation in which the woman is. Treatment can be started from week 13-14 of gestation, the most widely used regimens to date are: 3-week cycles of FAC (5-fluorouracil, doxorubicin and cyclophosphamide), FEC (5-fluorouracil, epirubicin and cyclophosphamide), AC (doxorubicin and cyclophosphamide) and EC (epirubicin and cyclophosphamide) or weekly epirubicin as monotherapy. Likewise, the use of taxanes (paclitaxel as a single agent) stands out. The nurse is a fundamental pillar within the multidisciplinary team of tumors, specialized in breast cancer during pregnancy, who will care for and accompany the pregnant woman throughout the disease process. Breast cancer, and more in pregnant women, entails a series of changes in their lives that require different processes of physical, psychological and social adaptation. (AU)

Face-to-face and online teaching experience on experimental animals and alternative methods with nursing students: a research study.

BACKGROUND: Animal models are increasingly used in Nursing science to study care approaches. Despite the scientific relevance and the ethical debate surrounding the use of experimental animals, there is a scarcity of scholarly literature exploring this topic in Nursing Schools. AIM: To evaluate perceptions and attitudes of nursing students enrolled in a Pharmacology course on the use of experimental animals and implementation of alternative methods, by comparing the experience for two academic years. An interdisciplinary collaboration has also been developed. METHODS: A descriptive cross-sectional, quantitative study was developed. Undergraduate nursing students were enrolled in the Pharmacology subject at the University of Leon (Spain). The study was carried out in the Pharmacology facilities. Students followed a two-session practical class regarding experimental animals and alternative methods in the Pharmacology course (Degree in Nursing) in two different academic years (2019-20/2020-21). At the end of the activity, they answered a questionnaire to assess their opinions on the use of experimental animals and alternative methods in Pharmacology and the 3Rs principle. RESULTS: A comparison of the students' perception with and without direct participation in the evaluation of promazine effects in mice was made. A total of 190 students participated in the teaching experience, providing high scores in all items (4-5 out of 5 points) regarding the teaching experience. Students became also aware of the advantages and disadvantages on the use of experimental animals, as well as the ethical considerations to bear in mind for their use and the need for alternative methods. CONCLUSIONS: In the students' opinion, the total replacement of animals by alternative techniques was very difficult, and they preferred to do the practice face-to-face. The alternative method designed was useful for the students to accept the employment of experimental animals in biomedical research and education, and know the legislation applied in the protection of animals.

Detección de la prescripción inadecuada en personas mayores. Papel de la enfermera / Detection of inappropriate prescription in elderly patients. Role of the nurse

En las últimas décadas se han producido una serie de cambios a nivel sanitario y farmacológico que han aumentado la esperanza de vida de la sociedad, dando lugar a un notable incremento de personas mayores.El envejecimiento progresivo junto con las comorbilidades asociadas, se traduce en un perfil de paciente susceptible de sufrir polimedicación y, por consiguiente, fenómenos tales como prescripción inadecuada, reacciones adversas a medicamentos o interacciones farmacológicas. Esta situación genera la mayor parte de las admisiones hospitalarias en personas de más de 65 años, lo que conlleva un aumento del empleo de los recursos sanitarios y un incremento del gasto farmacéutico.Para poder optimizar las prescripciones en los pacientes mayores pluripatológicos, reduciendo la prescripción potencialmente inadecuada y las reacciones adversas a medicamentos, existen diversas herramientas a nivel mundial. Estas las podemos englobar en dos grandes grupos, por una parte, los métodos implícitos que se basan en juicios críticos y, por otro lado, los métodos explícitos en los cuales se emplean criterios definidos basados en datos científicos y creados por grupos de expertos a través de métodos de generación de consenso, generalmente método Delphi. Los criterios STOPP/START representan el método explícito más adecuado para la detección de prescripción potencialmente inadecuada en comparación con el resto de herramientas disponibles, aunque continúan las investigaciones con el objetivo de optimizarse. (AU)

In the last decades there have been a series of changes at the health and pharmacological level that have increased the life expectancy of society, leading to a notable increase in the number of seniors.Progressive aging with associated comorbidities, translates into a patient profile susceptible to polymedication and therefore, phenomena such as inappropriate prescription, adverse drug reactions or drug interactions. This situation generates the majority of hospital admissions in people over 65 years, which leads to an increase in the use of healthcare resources and an increase in pharmaceutical spending.In order to optimize prescriptions in multipathological senior patients, reducing potentially inappropriate prescription and adverse drug reactions, there are various tools worldwide. These can be grouped into two large groups, on the one hand, the implicit methods that are based on critical judgments, and on the other hand, the explicit methods in which defined criteria based on scientific data and created by groups of experts through consensus-building methods, usually the Delphi. The STOPP / START criteria represent the most appropriate explicit method for the detection of potentially inappropriate prescription compared to the rest of the available tools, although research continues with the aim of optimization. (AU)

Enrofloxacin: pharmacokinetics and metabolism in domestic animal species.

Enrofloxacin is a fluorquinolone exclusively developed for use in veterinary medicine (1980). The kinetics of enrofloxacin are characterized, in general terms, by high bioavailability in most species and rapid absorption after IM, SC or oral administration. However, several studies reported that enrofloxacin showed low bioavailability after oral administration in ruminants. This drug has a broad distribution in the organism, excellent tissue penetration and long serum half-life. Also, enrofloxacin is characterized by a low host toxicity, a broad antibacterial spectrum and high bactericidal activity against major pathogenic bacteria (both Gram-positive and Gram-negative), and intracellular organisms found in diseased animals. The kinetics vary according to the route of administration, formulation, animal species, age, body condition, and physiological status, all of which contribute to differences in drug efficacy. The pharmacokinetic properties of drugs are closely related to their pharmacological efficiency, so it is important to know their behavior in each species that is used. This article reviews the pharmacokinetics of enrofloxacin in several domestic animal species.

Tissue distribution of enrofloxacin after intramammary or simulated systemic administration in isolated perfused sheep udders.

OBJECTIVE: To determine the tissue distribution of enrofloxacin after intramammary or simulated systemic administration in isolated perfused sheep udders by measuring its concentration at various sample collection sites. SAMPLE: 26 udders (obtained following euthanasia) from 26 healthy lactating sheep. PROCEDURES: For each isolated udder, 1 mammary gland was perfused with warmed, gassed Tyrode solution. Enrofloxacin (1 g of enrofloxacin/5 g of ointment) was administered into the perfused gland via the intramammary route or systemically via the perfusion fluid (equivalent to a dose of 5 mg/kg). Samples of the perfusate were obtained every 30 minutes for 180 minutes; glandular tissue samples were obtained at 2, 4, 6, and 8 cm from the teat base after 180 minutes. The enrofloxacin content of the perfusate and tissue samples was analyzed via high-performance liquid chromatography with UV detection. RESULTS: After intramammary administration, maximun perfusate enrofloxacin concentration was detected at 180 minutes and, at this time, mean tissue enrofloxacin concentration was detected and mean tissue enrofloxacin concentration was 123.80, 54.48, 36.72, and 26.42 µg/g of tissue at 2, 4, 6, and 8 cm from the teat base, respectively. Following systemic administration, perfusate enrofloxacin concentration decreased with time and, at 180 minutes, tissue enrofloxacin concentrations ranged from 40.38 to 35.58 µg/g of tissue. CONCLUSIONS AND CLINICAL RELEVANCE: By 180 minutes after administration via the intramammary or systemic route in isolated perfused sheep mammary glands, mean tissue concentration of enrofloxacin was greater than the minimum inhibitory concentration required to inhibit growth of 90% of many common mastitis pathogens in sheep. Use of either route of administration (or in combination) appears suitable for the treatment of acute mastitis in sheep.

La seguridad del paciente en los ensayos clínicos con medicamentos de uso humano / Patient safety in clinical trials with drugs for human use

Un ensayo clínico es un estudio planificado que tiene como objetivo evaluar la eficacia de las intervenciones sanitarias. El primer paso consiste en formular una hipótesis o una pregunta de la que se desea obtener respuesta. Esta pregunta será el principal condicionante de la metodología del ensayo, de los sujetos incluidos, del tipo de ensayo, de la duración, etc. A su vez, para poder realizar trabajos de investigación se requiere una serie de elementos imprescindibles entre los que podemos citar el personal (que debe ser cualificado), una infraestructura adecuada, diferentes fuentes de información contrastadas, medios económicos suficientes y un ambiente de trabajo que motive a los profesionales para su realización. Todo ello, con el fin de incrementar los servicios de calidad y responder a las mayores exigencias en el control y vigilancia de los medicamentos existentes (AU)

A clinical trial is a planned study which aims to evaluate the effectiveness of health interventions. The first step of a clinical trial is to develop a hypothesis or a question which answer is desired. This question will be the main factor of the methodology of the trial, of the included subjects, of the type of trial, duration, etc. In turn, a number of essential elements among which we can mention staff (who must be qualified), adequate infrastructure, various contrasting sources of information, financial means are required to perform research enough and a working environment that will motivate the professionals for its realization. All this, in order to increase the quality services and respond to the most demanding requirements in the control and monitoring of existing drugs (AU)