Parenteral nutrition in cancer patients outside of oncologic treatment: Bioethical perspective.

BACKGROUND AND AIMS: The medical care of a patient with an end-stage disease focus on the pursuit of the patient's quality of life. Many treatments can be used to achieve this goal. In this study, the benefits, and burdens of providing parenteral nutrition to patients diagnosed with end-stage cancer were reviewed and analyzed from a bioethical perspective with the aim of issuing a useful recommendation for decision making. METHODOLOGY: A qualitative convergent study through interviews and a multiple case study was performed. The study is on the decisions to provide parenteral nutrition as an end-of-life treatment for terminal cancer patients treated in Mexico City. Eight physicians specialized in Oncology and Palliative Care were interviewed and 10 clinical records of patients diagnosed with terminal cancer, who were out of oncologic treatment, who received palliative care and were prescribed parenteral nutrition at the end of life were analyzed. RESULTS: The physicians considered parenteral nutrition as an advanced life-sustaining medical treatment and, therefore, susceptible to not being initiated or being withdrawn, according to the patient's clinical situation. Minor complications secondary to parenteral nutrition were found in all the records reviewed, all these patients died in hospital instead of at home. CONCLUSION: When death is certain in the short term and cannot be avoided, the role of feeding and nutrition becomes questionable, especially in cancer patients at the end of life, where parenteral nutrition causes more burden than benefit.

Efficacy of Parainfluenza Virus 5 (PIV5)-vectored Intranasal COVID-19 Vaccine as a Single Dose Vaccine and as a Booster against SARS-CoV-2 Variants.

Immunization with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines has greatly reduced coronavirus disease 2019 (COVID-19)-related deaths and hospitalizations, but waning immunity and the emergence of variants capable of immune escape indicate the need for novel SARS-CoV-2 vaccines. An intranasal parainfluenza virus 5 (PIV5)-vectored COVID-19 vaccine CVXGA1 has been proven efficacious in animal models and blocks contact transmission of SARS-CoV-2 in ferrets. CVXGA1 vaccine is currently in human clinical trials in the United States. This work investigates the immunogenicity and efficacy of CVXGA1 and other PIV5-vectored vaccines expressing additional antigen SARS-CoV-2 nucleoprotein (N) or SARS-CoV-2 variant spike (S) proteins of beta, delta, gamma, and omicron variants against homologous and heterologous challenges in hamsters. A single intranasal dose of CVXGA1 induces neutralizing antibodies against SARS-CoV-2 WA1 (ancestral), delta variant, and omicron variant and protects against both homologous and heterologous virus challenges. Compared to mRNA COVID-19 vaccine, neutralizing antibody titers induced by CVXGA1 were well-maintained over time. When administered as a boost following two doses of a mRNA COVID-19 vaccine, PIV5-vectored vaccines expressing the S protein from WA1 (CVXGA1), delta, or omicron variants generate higher levels of cross-reactive neutralizing antibodies compared to three doses of a mRNA vaccine. In addition to the S protein, the N protein provides added protection as assessed by the highest body weight gain post-challenge infection. Our data indicates that PIV5-vectored COVID-19 vaccines, such as CVXGA1, can serve as booster vaccines against emerging variants.

Battle of Thermopylae: 300 Spartans (natural killer cells plus obinutuzumab) versus the immortal warriors (chronic lymphocytic leukemia cells) of Xerxes' army.

AIM: To analyze the effects of subcutaneous or intravenous rituximab + lymphokine-activated killer cells, obinutuzumab or ibrutinib on natural killer (NK) cell levels in chronic lymphocytic leukemia and follicular lymphoma patients. PATIENTS & METHODS: The distribution of peripheral blood NK cells of 31 patients was analyzed by flow cytometry. RESULTS: We detected a decrease of NK cells in peripheral blood below normal range after obinutuzumab treatment. During maintenance treatment with subcutaneous rituximab, an NK cell reduction was less pronounced than after intravenous rituximab treatment, despite lymphokine-activated killer cell infusions. CONCLUSION: After one dose of obinutuzumab, each NK cell in peripheral blood destroys 25 leukemic cells.

Costos de atención a lesionados por armas de fuego en el Hospital Nacional San Juan de Dios de San Miguel, El Salvador en 2018 / Costs of care for injured by firearms at the San Juan de Dios National Hospital in San Miguel, El Salvador in 2018

OBJETIVO: Estimar los costos de atención a lesionados por armas de fuego en el Hospital Nacional San Juan de Dios de San Miguel, El Salvador, en el año 2018. DISEÑO Metodológico: Descriptivo, transversal, retrospectivo, a partir de bases de datos, expedientes clínicos de 113 lesionados por armas de fuego del Hospital San Juan de Dios de San Miguel de enero a diciembre 2018, con instrumentos acorde a los objetivos, la recolección de datos y análisis de resultados a cargo de la investigadora en febrero de 2019, se utilizó sistemas estadísticos del Ministerio de Salud y Sistema PERC para el cálculo de costos por volumen y actividades de centros de costos. RESULTADOS: Los costos de atención a lesionados por armas de fuego en 2018 fue de USD$125,874.61 dólares del presupuesto asignado para ese año de USD$23653,630.00 dólares, lo cual corresponde al 0.53%. Los lesionados eran jóvenes, (84.1% del sexo masculino, de procedencia rural en (61.1%), ocupación agricultores (51.6%9) y estudiantes (29%), El 80.6% se encontraba en recreación/descanso/jugando, el 3.5% consumió alcohol, 3% pertenecía a maras/pandillas, en 77% la lesión ocurrió en calles/carreteras y el 42.5% fue agredido por desconocido y 1.8% auto infringidas. CONCLUSIONES: La caracterización de lesionados por armas de fuego atendidos en el Hospital Nacional San Juan de Dios en 2018 reveló que son hombres entre los 10 a 39 años, del área rural, agricultores. Las lesiones en su mayoría fueron moderadas, la región anatómica más afectada fue la cabeza, el promedio de días de estancia hospitalaria fue de 7.88 (± 13.63 días), con promedio de 890.4 días cama ocupado., con un costo estimado para la atención a lesionados por armas de fuego alrededor de los ciento veintiséis mil dólares

Participation of COX-1 and COX-2 in the contractile effect of phenylephrine in prepubescent and old rats.

Vascular reactivity can be influenced by the vascular region, animal age, and pathologies present. Prostaglandins (produced by COX-1 and COX-2) play an important role in the contractile response to phenylephrine in the abdominal aorta of young rats. Although these COXs are found in many tissues, their distribution and role in vascular reactivity are not clear. At a vascular level, they take part in the homeostasis functions involved in many physiological and pathologic processes (e.g., arterial pressure and inflammatory processes). The aim of this study was to analyze changes in the contractile response to phenylephrine of thoracic/abdominal aorta and the coronary artery during aging in rats. Three groups of rats were formed and sacrificed at three distinct ages: prepubescent, young and old adult. The results suggest that there is a higher participation of prostanoids in the contractile effect of phenylephrine in pre-pubescent rats, and a lower participation of the same in old rats. Contrarily, there seems to be a higher participation of prostanoids in the contractile response of the coronary artery of older than pre-pubescent rats. Considering that the changes in the expression of COX-2 were similar for the three age groups and the two tissues tested, and that expression of COX-1 is apparently greater in older rats, COX-1 and COX-2 may lose functionality in relation to their corresponding receptors during aging in rats.

Convex Grooves in Staggered Herringbone Mixer Improve Mixing Efficiency of Laminar Flow in Microchannel.

The liquid streams in a microchannel are hardly mixed to form laminar flow, and the mixing issue is well described by a low Reynolds number scheme. The staggered herringbone mixer (SHM) using repeated patterns of grooves in the microchannel have been proved to be an efficient passive micro-mixer. However, only a negative pattern of the staggered herringbone mixer has been used so far after it was first suggested, to the best of our knowledge. In this study, the mixing efficiencies from negative and positive staggered herringbone mixer patterns as well as from opposite flow directions were tested to investigate the effect of the micro-structure geometry on the surrounding laminar flow. The positive herringbone pattern showed better mixing efficiency than the conventionally used negative pattern. Also, generally used forward flow gives better mixing efficiency than reverse flow. The mixing was completed after two cycles of staggered herringbone mixer with both forward and reverse flow in a positive pattern. The traditional negative pattern showed complete mixing after four and five cycles in forward and reverse flow direction, respectively. The mixing effect in all geometries was numerically simulated, and the results confirmed more efficient mixing in the positive pattern than the negative. The results can further enable the design of a more efficient microfluidic mixer, as well as in depth understanding of the phenomena of positive and negative patterns existing in nature with regards to the surrounding fluids.

Clinical and Serologic Response to the 23-valent Polysaccharide Pneumococcal Vaccine in Children and Teens with Recurrent Upper Respiratory Tract Infections and Selective Antibody Deficiency.

We report the clinical and serological response of 72 children and adolescents after immunization with the 23-valent polysaccharide pneumococcal vaccine (PPV23). All had been diagnosed with recurrent upper respiratory tract infections and low antipneumococcal immunity. Forty-five (62%) of these patients had received PCV7, the 7-serotype pneumococcal conjugated vaccine (Prevnar7). After immunization with the polysaccharide vaccine, 69 (96%) patients, including 42 of the 45 who had previously been immunized with the conjugate vaccine, had a positive clinical response including 12 patients (17%) whose serological response to the polysaccharide vaccine was inadequate. Clinical and serological response to PPV23 was assessed at approximately 1, 3 and 6 months after immunization. Our study also confirmed that a small group of patients with recurrent upper respiratory tract infections are unable to develop a normal response to pneumococcal and other bacterial polysaccharides despite vaccination with the newer conjugated vaccines. This immunodeficiency has been named selective antibody deficiency with normal immunoglobulins or impaired polysaccharide responsiveness. These patients did well after administration of intravenous IgG.

A new dic(7;12)(p12.21;p12.2) chromosome aberration in a case of acute myeloid leukemia.

A new dic(7;12)(p12.21;p12.2) chromosome aberration was identified in an acute myeloid leukemia with FAB-M1 morphology and was cloned. Fluorescence in situ hybridization and genomic quantitative polymerase chain reaction mapping experiments revealed the precise localization of the breakpoints, at 7p12, just 5' to the GRB10 gene, and 12p11, within a genomic region containing no known genes. As a result, a new dicentric chromosome is created, dic(7;12), with the consequent deletion of 50 Mb at 7p, from the telomere to the GRB10 region, and of 30 Mb at 12p, from the telomere to p11. Several genes are included in the affected areas.

Numerical abnormalities of chromosomes 17 and 18 in sporadic colorectal cancer: Incidence and correlation with clinical and biological findings and the prognosis of the disease.

BACKGROUND: In recent years important information has accumulated on the genetic alterations present in colorectal tumors. However, thus far few studies have analyzed the impact of numerical abnormalities of chromosomes 17 and 18, which carry the p53 and DCC plus SHAD4/DPC4 genes involved in colorectal cancer, on the clinical and biological behaviors of the disease. METHODS: With the use of interphase fluorescence in situ hybridization (FISH), we analyzed the incidence of numerical abnormalities of chromosomes 17 and 18 in a series of malignant colorectal tumors and explored its potential association with clinicobiological behavior and the prognosis of the disease. For this purpose, 94 consecutive patients newly diagnosed with colorectal cancer were analyzed. In all cases, FISH analyses of the number of copies and nuclei of chromosomes 17 and 18 were performed in interphase nuclei with the use of double stainings. For all patients, information on age, sex, tumor size, Dukes' stage, tumor localization, DNA ploidy status, and the proportion of S-phase tumor cells was recorded. Median follow-up was 38 months. RESULTS: Numerical abnormalities of chromosomes 17 and 18 were present in most patients with colorectal cancer (57% and 52%, respectively). Gains of chromosome 17 and monosomy 18 were found in 51% and 29% of cases, respectively, and they were the most frequent individual abnormalities for each chromosome. The simultaneous analysis of the number of copies of both chromosomes in the same cell showed that, in most cases displaying numerical abnormalities for these chromosomes, two or more different tumor cell clones were present. From a clinical point of view, numerical abnormalities of chromosome 17, especially monosomy 17, were associated with a significantly higher incidence of rectal tumors (P = 0.001) and Dukes' stage D (P = 0.02) and a lower median of disease-free survival among patients who underwent curative surgery (P = 0.05), as compared with diploid cases. In addition, cases with an altered number of copies of chromosome 17 showed a higher incidence of DNA aneuploidy (P = 0.0001) and a greater proportion of S-phase cells (P = 0.001) by flow cytometry. In contrast, no clear association was found between the presence of numerical abnormalities of chromosome 18 and clinicobiological disease characteristics, except for a higher incidence of DNA aneuploidy by flow cytometry (P = 0.001) and a lower median of disease-free survival (P = 0.06). Multivariate analysis showed that numerical abnormalities of chromosome 17, but not of chromosome 18, are an independent prognostic factor for predicting disease-free survival in patients with colorectal cancer. CONCLUSIONS: Numerical abnormalities of chromosomes 17 and 18 were relatively common findings in patients with colorectal cancer, with chromosome 17 being associated with a higher incidence of tumors localized to the rectum and a worse clinical outcome. Cytometry Part B (Clin. Cytometry) 51B:14-20, 2003.

Amethocaine-lidocaine cream, a new topical formulation for preventing venopuncture-induced pain in children.

BACKGROUND AND OBJECTIVES: The aim of this study was to compare the effectiveness of 3 anesthetic creams in relieving venous puncture-related pain in children. METHODS: We performed a double-blind, randomized, prospective study in 300 patients, American Society of Anesthesiologists (ASA) I-II, aged 3 months to 10 years, scheduled for minor elective surgical procedures. These children were distributed into 3 groups, with 100 patients each, according to each type of cream applied to the back of the children's hands before performing the venous puncture: Group I was given EMLA (eutectic 2.5% lidocaine and 2.5% prilocaine mixture), group II received 4% amethocaine (4% AMET), and group III was treated with AMLI (2.5% amethocaine and 2.5% lidocaine), a new anesthetic cream developed at our hospital. Each group was further classified into 5 subgroups, with 20 patients each, according to the time length of the application of the individual cream (group A, < or = 30 minutes; B, 30 minutes to 60 minutes; C, 60 minutes to 90 minutes; D, 90 minutes to 120 minutes; E, > or = 120 minutes). We evaluated pain, movement, and verbalization to puncture, as well as the appearance of adverse effects. RESULTS: Group I (EMLA), subgroup A (< or = 30 minutes), experienced significantly more pain, movement, and verbalization than groups II and III. Patients in group II (4% AMET) exhibited a higher frequency of untoward effects. CONCLUSIONS: All 3 creams proved to be effective in relieving venous puncture pain in children. EMLA presented a longer latency period, 4% amethocaine showed the highest percentage of untoward effects, and AMLI exhibited a shorter latency period than EMLA, while having fewer adverse effects than 4% AMET and EMLA.

Detección de Mycobacterium tuberculosis en niños, con empleo de dos sistemas de cultivo y su confirmación con la reacción en cadena de la polimerasa / Mycobacterium tuberculosis detection in children with two culture systems and its confirmation by polimerasa chain reaction

La tuberculosis ha resurgido hasta el punto de ser considerada una de las principales causas de muerte por enfermedades infecciosas. Su diagnóstico requiere del cultivo del agente causal. Para esto se han empleado diferentes medios de cultivo sintéticos, sistemas manuales, automatizados y semiautomatizados, tendientes a detectar en el menor tiempo, evidencias de desarrollo de Mycobacterium tuberculosis. Este hecho adquiere gran importancia en el paciente pediátrico, si consideramos el tiempo de generación prolongado de las micobacterias y la característica paucibacilar de estos pacientes. El objetivo de este trabajo fue tratar de realizar el aislamiento e identificación de M. tuberculosis en el menor tiempo al requerido por los procedimientos habituales. Se estudiaron 357 muestras clínicas, sometidas a baciloscopías, cultivo en medio de Löwenstein Jensen y en el sistema MB/Bac T, y finalmente el uso de la reacción en cadena de la polimerasa, empleándose la IS6110 específica del complejo M. tuberculosis. Los resultados obtenidos, fueron los siguientes: del total de muestras estudiadas, sólo 4.5 por ciento fueron positivas, de estas, 56 por ciento se determinaron por baciloscopías, 88 por ciento pro cultivo y la confirmación de especie fue en el 94 por ciento. El tiempo de detección más corto se detectó con el empleo de MB/Bac T. Sin embargo, la aplicación simultánea de los dos sistemas de cultivo, dio mayor ventaja, que el empleo individual de estos