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2.
Shanghai Kou Qiang Yi Xue ; 29(3): 293-297, 2020 Jun.
Artículo en Chino | MEDLINE | ID: mdl-33043347

RESUMEN

PURPOSE: To explore the efficacy and safety of ornidazole combined with periodontal tissue regeneration in the treatment of periodontitis. METHODS: From March 2018 to March 2019, 100 patients with periodontitis who received treatment in the Stomatological Hospital Affiliated to the School of Medicine of Nanjing University were selected and randomly divided into the regeneration group and combined treatment group with 50 patients in each group. Patients in the regeneration group received periodontal tissue regeneration treatment, while patients in the combined treatment group received ornidazole combined periodontal tissue regeneration treatment. Related periodontal indexes including periodontal probing depth(PPD), periodontal attachment level(PAL), tooth mobility degree(MD) were measured, serum malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (gsh-px) and interleukin 10 (IL-10) and interleukin 4 (IL-4), c-reactive protein(CRP) level and immune globulin level were detected before and after treatment, the therapeutic effects and complications were recorded and compared. SPSS 21.0 software package was used for statistical analysis of the data. RESULTS: After treatment, PPD, PAL and MD levels in the combined treatment groups were significantly lower than those in the regenerative group (P<0.05). Serum MDA level in the combined treatment group was significantly lower than that in the regenerative group, SOD and gsh-px levels were significantly higher than that in the regenerative group(P<0.05). The serum levels of IgA, IgM, IgG, IgE, IL-10, IL-4 and CRP in the combined treatment group were significantly lower than those in the regenerative treatment group (P<0.05). The total effective rate of the combined treatment group was significantly higher than that of the regenerative treatment group, and the incidence of complications was significantly lower than that of the regenerative group(P<0.05). CONCLUSIONS: Ornidazole combined with periodontal tissue regeneration can improve the level of periodontal index, alleviate oxidative stress injury, improve immune function, inhibit inflammation, and has a significant therapeutic effect with high safety.


Asunto(s)
Metronidazol , Periodontitis , Terapia Combinada , Humanos , Metronidazol/efectos adversos , Índice Periodontal , Periodontitis/tratamiento farmacológico , Periodoncio
3.
Med Gas Res ; 10(3): 134-138, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33004712

RESUMEN

Coronavirus disease 2019 (COVID-19) is the respiratory disease caused by the novel severe acute respiratory syndrome-coronavirus-2 and is characterized by clinical manifestations ranging from mild, flu-like symptoms to severe respiratory insufficiency and multi-organ failure. Patients with more severe symptoms may require intensive care treatments and face a high mortality risk. Also, thrombotic complications such as pulmonary embolisms and disseminated intravascular coagulation are frequent in these patients. Indeed, COVID-19 is characterized by an abnormal inflammatory response resembling a cytokine storm, which is associated to endothelial dysfunction and microvascular complications. To date, no specific treatments are available for COVID-19 and its life-threatening complication. Immunomodulatory drugs, such as hydroxychloroquine and interleukin-6 inhibitors, as well as antithrombotic drugs such as heparin and low molecular weight heparin, are currently being administered with some benefit. Ozone therapy consists in the administration of a mixture of ozone and oxygen, called medical ozone, which has been used for over a century as an unconventional medicine practice for several diseases. Medical ozone rationale in COVID-19 is the possibility of contrasting endothelial dysfunction, modulating the immune response and acting as a virustatic agent. Thus, medical ozone could help to decrease lung inflammation, slow down viral growth, regulate lung circulation and oxygenation and prevent microvascular thrombosis. Ozone-therapy could be considered a feasible, cost-effective and easy to administer adjuvant therapy while waiting for the synthesis of a therapy or the development of the vaccine.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/terapia , Ozono/uso terapéutico , Neumonía Viral/terapia , Terapia Combinada , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/virología , Humanos , Pandemias , Neumonía Viral/fisiopatología , Neumonía Viral/virología , Resultado del Tratamiento
4.
Urol Clin North Am ; 47(4): 419-431, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33008493

RESUMEN

The management of metastatic renal cell carcinoma (RCC) has evolved rapidly in recent years with several immunotherapy-based combinations of strategies approved as first-line therapies. Targeted strategies, including systemic antiangiogenesis agents and immune checkpoint blockade, form the basis of a therapeutic approach. With rising rates of recurrence after first-line treatment, it is increasingly important to not only adopt a personalized treatment plan with minimal adverse events but also develop predictive biomarkers for response. This review discusses currently available first-line and second-line therapies in RCC and their pivotal data, with specific focus on ongoing clinical trials in the adjuvant setting, including those involving novel agents.


Asunto(s)
Productos Biológicos/uso terapéutico , Carcinoma de Células Renales/tratamiento farmacológico , Inmunoterapia/métodos , Neoplasias Renales/tratamiento farmacológico , Carcinoma de Células Renales/mortalidad , Carcinoma de Células Renales/patología , Carcinoma de Células Renales/cirugía , Ensayos Clínicos Fase II como Asunto , Terapia Combinada , Quimioterapia Combinada , Femenino , Humanos , Neoplasias Renales/mortalidad , Neoplasias Renales/patología , Masculino , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Nefrectomía/métodos , Pronóstico , Análisis de Supervivencia , Resultado del Tratamiento , Estados Unidos
5.
Urol Clin North Am ; 47(4): 457-467, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33008496

RESUMEN

Biochemically recurrent prostate cancer represents a stage of prostate cancer where conventional (continued on next page) computed tomography and technetium Tc 99m bone scan imaging are unable to detect disease after curative intervention despite rising prostate-specific antigen. There is no clear standard of care and no systemic therapy has been shown to improve survival. Immunotherapy-based treatments potentially are attractive options relative to androgen deprivation therapy due to the generally more favorable side-effect profile. Biochemically recurrent prostate cancer patients have a low tumor burden and likely lymph node-based disease, which may make them more likely to respond to immunotherapy.


Asunto(s)
Antagonistas de Andrógenos/uso terapéutico , Inmunoterapia/métodos , Recurrencia Local de Neoplasia/terapia , Neoplasias de la Próstata/patología , Anciano , Terapia Combinada , Supervivencia sin Enfermedad , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Selección de Paciente , Pronóstico , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/terapia , Medición de Riesgo , Rol , Análisis de Supervivencia , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
6.
Urol Clin North Am ; 47(4): 523-536, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33008501

RESUMEN

Personalized medicine uses a patient's genotype, environment, and lifestyle choices to create a tailored diagnosis and therapy plan, with the goal of minimizing side effects, avoiding lost time with ineffective treatments, and guiding preventative strategies. Although most precision medicine strategies are still within the laboratory phase of development, this article reviews the promising technologies with the greatest potential to improve the diagnosis and treatment options for male infertility, including sperm cell transplantation, genomic editing, and new biomarker assays, based on the latest proteomic and epigenomic studies.


Asunto(s)
Genómica , Infertilidad Masculina/genética , Infertilidad Masculina/terapia , Medicina de Precisión/métodos , Biomarcadores/sangre , Terapia Combinada , Predicción , Humanos , Infertilidad Masculina/diagnóstico , Masculino , Proteómica , Medición de Riesgo , Resultado del Tratamiento
7.
Medicine (Baltimore) ; 99(40): e22598, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019480

RESUMEN

BACKGROUND: Early diagnosis and treatment of the osteonecrosis of the femoral head (ONFH), a refractory disease, is imperative to prevent femoral head collapse; however, the existing solutions remain controversial. This study assessed the safety and efficacy of extracorporeal shock wave therapy (ESWT) combined with multiple drilling and intramedullary drug injection, a novel cocktail therapy, as a randomized controlled trial (RCT) model to postulate an alternative therapy for patients with early-stage ONFH. METHODS: Femoral head necrosis patients aged 20 to 60 years with stage ARCO I-II were recruited. One hundred twenty eligible participants were randomized into four groups in a 1:1:1:1 ratio: extracorporeal shock wave therapy combined with multiple drilling and intramedullary drug injection (group EMI), extracorporeal shock wave therapy (group E), multiple drilling combined with intramedullary drug injection (group MI), and multiple drilling ("positive" control group; group M). The primary outcomes included effective rate, subchondral collapse rate of the femoral head, lesion size, and grade of bone marrow edema. Secondary outcomes included the Harris Hip Score and the visual analog scale. All outcomes were measured at the screening visit (baseline) and at the planned time intervals during treatment and follow-up, and the efficacy was statistically analyzed according to the intention-to-treat sub-populations and per-protocol sub-populations. OBJECTIVES: To examine the clinical efficacy of ESWT combined with multiple drilling and intramedullary drug injection to provide a safe and more effective method for treating early-stage ONFH. TRIAL REGISTRATION NUMBER: ChiCTR1900020888; Pre-results.


Asunto(s)
Tratamiento con Ondas de Choque Extracorpóreas/métodos , Necrosis de la Cabeza Femoral/terapia , Cabeza Femoral/patología , Infusiones Intraóseas/instrumentación , Adulto , Artroplastia Subcondral/efectos adversos , Artroplastia Subcondral/métodos , Enfermedades de la Médula Ósea/patología , Protocolos Clínicos , Terapia Combinada/métodos , Diagnóstico Precoz , Edema/inducido químicamente , Femenino , Cabeza Femoral/efectos de los fármacos , Necrosis de la Cabeza Femoral/clasificación , Estudios de Seguimiento , Humanos , Infusiones Intraóseas/métodos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Seguridad , Resultado del Tratamiento , Escala Visual Analógica
8.
Medicine (Baltimore) ; 99(40): e22637, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019486

RESUMEN

INTRODUCTION: Small cell lung cancer (SCLC) is an aggressive malignancy that progresses rapidly and easily relapses. To the best of our knowledge, advances have been minimal for decades and the first-line treatment is still platinum-etoposide and radiotherapy. However, elderly patients with severe renal failure who suffer from SCLC usually show more serious drug-related side effects. A large proportion of them cannot tolerate the standard treatment, and their prognosis is poorer compared with that of younger patients. Presently, oral etoposide capsules may be accepted as a replaceable option. We report the case of a male patient with SCLC on hemodialysis who was successfully treated with concurrent oral etoposide monotherapy and radiotherapy and achieved excellent outcomes. PATIENT'S CONCERNS: A 63-year-old man with severe renal failure was diagnosed with SCLC. PRIMARY DIAGNOSES: SCLC was diagnosed using transbronchial biopsy. INTERVENTIONS: He received concomitant single-agent oral etoposide (6 cycles) and local radiotherapy. Etoposide 100 mg once daily combined with thoracic radiation treatment (2 Gy/f, total DT: 50 Gy/25 f), was subsequently followed by prophylactic cranial irradiation plus anlotinib. OUTCOMES: The patient achieved complete response after 1 cycle and the subsequent treatment was effective without any kidney damage and other severe side effects. CONCLUSION: Though etoposide capsule is an old drug, its use should be considered in SCLC patients with renal insufficiency undergoing hemodialysis. However, treatment guidelines and research data for such patients are still lacking and further studies are needed. Although recent research focuses mainly on new drugs, some old drugs like etoposide which can bring unexpected positive effects should not be neglected.


Asunto(s)
Etopósido/uso terapéutico , Carcinoma Pulmonar de Células Pequeñas/tratamiento farmacológico , Carcinoma Pulmonar de Células Pequeñas/radioterapia , Inhibidores de Topoisomerasa II/uso terapéutico , Administración Oral , Terapia Combinada , Irradiación Craneana/métodos , Etopósido/administración & dosificación , Humanos , Indoles/uso terapéutico , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Quinolinas/uso terapéutico , Diálisis Renal/métodos , Insuficiencia Renal/terapia , Inhibidores de Topoisomerasa II/administración & dosificación , Resultado del Tratamiento
9.
Tumour Biol ; 42(10): 1010428320963811, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33028151

RESUMEN

This study aimed at investigating the expression of candidate microRNAs (miRs), at initial diagnosis, during neoadjuvant chemotherapy, and after the tumor resection in locally advanced breast cancer patients. Plasma samples were collected from locally advanced breast cancer patients (n = 30) and healthy subjects (n = 20) for the detection of candidate miRs' expression using the real-time quantitative polymerase chain reaction. At initial locally advanced breast cancer diagnosis, the expression of miR-21, miR-181a, and miR-10b was significantly increased, whereas that of miR-145 and let-7a was significantly decreased, compared to the healthy individuals. The diagnostic accuracy of miR-21 was superior to both carcinoembryonic antigen and carcinoma antigen 15-3 as diagnostic biomarkers for locally advanced breast cancer. By the end of the treatment, the expression of altered miRs rebound to control values. The expression levels of candidate plasma miRs are useful diagnostic biomarkers, as well as monitoring a proper response for locally advanced breast cancer patients to the treatment. Furthermore, miR-10b and miR-21 can be considered as predictive biomarkers for progression-free survival.


Asunto(s)
Biomarcadores de Tumor , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/genética , MicroARN Circulante , MicroARNs , Adulto , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/terapia , Terapia Combinada , Femenino , Regulación Neoplásica de la Expresión Génica , Humanos , Estimación de Kaplan-Meier , Persona de Mediana Edad , Clasificación del Tumor , Metástasis de la Neoplasia , Estadificación de Neoplasias , Pronóstico , Reacción en Cadena en Tiempo Real de la Polimerasa , Sensibilidad y Especificidad
10.
BMJ Case Rep ; 13(10)2020 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-33028570

RESUMEN

In March 2020, a 74-year-old man affected by end-stage renal disease and on peritoneal dialysis was referred to an emergency room in Modena, Northern Italy, due to fever and respiratory symptoms. After ruling out COVID-19 infection, a diagnosis of chronic obstructive pulmonary disease exacerbation was confirmed and he was thus transferred to the nephrology division. Physical examination and blood tests revealed a positive fluid balance and insufficient correction of the uraemic syndrome, although peritoneal dialysis prescription was maximised. After discussion with the patient and his family, the staff decided to start hybrid dialysis, consisting of once-weekly in-hospital haemodialysis and home peritoneal dialysis for the remaining days. He was discharged at the end of the antibiotic course, after an internal jugular vein central venous catheter placement and the first haemodialysis session. This strategy allowed improvement of depuration parameters and avoidance of frequent access to the hospital, which is crucial in limiting exposure to SARS-CoV-2 in an endemic setting.


Asunto(s)
Infecciones por Coronavirus , Fallo Renal Crónico , Pandemias , Diálisis Peritoneal/métodos , Neumonía Viral , Enfermedad Pulmonar Obstructiva Crónica , Diálisis Renal/métodos , Anciano , Antibacterianos/administración & dosificación , Betacoronavirus , Terapia Combinada/métodos , Terapia Combinada/tendencias , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Diagnóstico Diferencial , Unidades de Hemodiálisis en Hospital , Humanos , Control de Infecciones/métodos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/fisiopatología , Fallo Renal Crónico/terapia , Masculino , Innovación Organizacional , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Brote de los Síntomas
11.
Medicine (Baltimore) ; 99(41): e22515, 2020 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-33031290

RESUMEN

BACKGROUND: Alopecia areata (AA) is a common, inflammatory, nonscarring type of hair loss that is characterized by depression, anxiety and social isolation. In recent years, Plum-blossom needle plus Chinese herbal medicine has gradually shown its clinical advantages and been more and more widely used in China. Whereas, there has been no systematic review and meta-analysis. The purpose of this study is to estimate the safety and effectiveness of Plum-blossom needle plus Chinese herbal medicine in AA treatment. METHODS: Seven databases as following: PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), and Chinese Biomedical Literatures Database (CBM) will be searched from their inception to August 2020. Two reviewers (LBL and ZYZ) will respectively regulate research selection, data extraction, and risk of bias assessment. A third reviewer will be settled to consulting, if necessary. Review Manager Software 5.4 will be implemented for this study. RESULTS: The results will be published in a peer-reviewed medical journal. This meta-analysis will provide a synthetic review of the credible evidence for the treatment of Plum-blossom needle plus Chinese herbal medicine with AA. CONCLUSIONS: This systematic review and meta-analysis expects to provide high-quality evidence regarding the synergistic effect of Plum-blossom needle plus Chinese herbal medicine treatment for AA.


Asunto(s)
Alopecia Areata/terapia , Medicamentos Herbarios Chinos/uso terapéutico , Medicina China Tradicional/métodos , Agujas , Terapia Combinada , Humanos , Medicina China Tradicional/instrumentación , Metaanálisis como Asunto , Satisfacción del Paciente , Proyectos de Investigación , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
12.
Medicine (Baltimore) ; 99(41): e22584, 2020 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-33031309

RESUMEN

NATIONALE: Trichosporon species are widely distributed in nature and are emerging opportunistic human pathogens. Trichosporon infections are associated with superficial cutaneous involvement in immunocompetent individuals to severe systemic disease in immunocompromised patients. Until now, there is no report in infective endocarditis by Trichosporon mucoides confirmed by molecular diagnostics PATIENT CONCERNS:: A 66-year-old man presented with a fever that had occurred for a period of 6 months. He had undergone aortic valve replacement 10 years prior. Transthoracic echocardiography showed vegetations on the prosthetic aortic valve and native mitral valve. T mucoides was detected in the cultures of blood and vegetations. DIAGNOSIS: DNA sequencing using D/D2 region of rRNA and internal transcribed spacer were performed. INTERVENTIONS: Infections were successfully controlled with valve replacement and voriconazole plus liposomal amphotericin B therapy. OUTCOMES: There has been no sign of recurrence for 18-months after treatment completion. LESSONS: This is the first reported case of infective endocarditis due to T mucoides. Clinicians should consider Trichosporon species as causative agents of endocarditis in patients who have undergone cardiac surgery.


Asunto(s)
Endocarditis/microbiología , Implantación de Prótesis de Válvulas Cardíacas , Infecciones Relacionadas con Prótesis/microbiología , Trichosporon/aislamiento & purificación , Tricosporonosis/microbiología , Anciano , Antifúngicos/uso terapéutico , Terapia Combinada , Endocarditis/diagnóstico por imagen , Endocarditis/terapia , Humanos , Masculino , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/terapia , Reoperación , Tricosporonosis/diagnóstico por imagen , Tricosporonosis/terapia
14.
Acta Biomed ; 91(3): ahead of print, 2020 07 13.
Artículo en Inglés | MEDLINE | ID: mdl-32921739

RESUMEN

Covid-19 infection was a possible causal factor in the exhaustion and decrease number of NK clonal cells, resulting in a evident improvement of signs, symptoms and clinical features related to NK lymphoma refractory to previous immuno-chemiotherapy. It has been shown that SARS-CoV2 binds to ACE2. Covid-19 may infect NK cells to suppress their functions, as NK cells express angiotensin converting enzyme 2 (ACE2). The excessive production of proinflammatory cytokines in Covid-19 infection may have played a crucial role in lymphodepletion. Although not published in Covid-19, other RNA viruses that cause acute pulmonary infections promote NK cell apoptosis. In NK/T-cell lymphoma plasma EBV-DNA is a sensitive surrogate biomarker of lymphoma load. In this case, we also notice a dramatic transient reduction in plasmatic EBV-DNA viral copies during Covid-19 pneumonia other than NK clonal cells reduction, and after the infection resolution we described a lymphoma relapse as well as EBV-DNA increase and the rising in NK clonal cells count. Although the mechanism leading to spontaneous remission remain uncharacterized, we hypothezised that a favorable adaptive immunity against concurrent viral infection could render an enhanced anti-tumor effect. We suppose COVID-19 infection have induced a transient remission in this patient affected with NK neoplasm.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Células Asesinas Naturales/patología , Linfoma/complicaciones , Neumonía Viral/complicaciones , Terapia Combinada , Infecciones por Coronavirus/diagnóstico , Humanos , Linfoma/diagnóstico , Linfoma/terapia , Masculino , Pandemias , Neumonía Viral/diagnóstico , Tomografía Computarizada por Rayos X , Adulto Joven
16.
Zhonghua Zhong Liu Za Zhi ; 42(8): 682-686, 2020 Aug 23.
Artículo en Chino | MEDLINE | ID: mdl-32867462

RESUMEN

Objective: To analyze the safety and short-term efficacy of breast-conserving surgery combined with intraoperative radiotherapy for early-stage breast cancer. Methods: A total of 101 consecutive patients who received breast-conserving surgery plus intraoperative radiotherapy were recruited to summarize the recent follow-up results and clinicopathological data. Univariate analysis and Logistic regression model were used to evaluate the factors affecting the postoperative adverse reactions and cosmetic effects. Results: Among 101 patients, 4 patients had recurrence or metastasis. The 3-years disease free survival rate was 94.9%, and the 3-years cumulative recurrence rate was 5.1%. Univariate analysis showed that the menstrual status and postoperative whole breast radiotherapy were associated with the postoperative adverse reactions (P<0.05). The T stage and applicator diameter were associated with the cosmetic effect (P<0.05). Multivariate analysis indicated that the diameter of the applicator (OR=3.701, P=0.026) and postoperative whole breast radiotherapy (OR=5.962, P=0.005) were independent factors for the postoperative adverse reactions, and the diameter of the applicator (OR=2.522, P=0.037) was an independent factor for the cosmetic effect. Conclusion: Breast-conserving surgery combined with intraoperative radiotherapy shows safety and good short-term efficacy in low-risk early-stage breast cancer.


Asunto(s)
Neoplasias de la Mama/terapia , Mastectomía Segmentaria , Radioterapia Ayuvante/métodos , Neoplasias de la Mama/patología , Terapia Combinada , Humanos , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Resultado del Tratamiento
17.
Medicine (Baltimore) ; 99(33): e21705, 2020 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-32872045

RESUMEN

The optimal treatment strategy of newly diagnosed stage I/II, extranodal nasal-type natural killer/T cell lymphoma (NKTCL) remains unclear. This prospective phase II trial was conducted to explore the short-term and the long-term efficacy and safety of upfront concurrent chemoradiotherapy (CCRT) followed by pegaspargase, gemcitabine, dexamethasone, cisplatin (P-GDP) regimen in patients newly diagnosed with early stage NKTCL.Thirty patients newly diagnosed with stage I/II NKTCL were enrolled from January 2013 to December 2016, and treated as the following strategy: upfront CCRT with cisplatin weekly (25 mg/m) for 5 weeks, followed by 3 cycles of P-GDP regimen chemotherapy (pegaspargase 2500IU/m capped at 3750IU, intramuscular on day 4, gemcitabine 850 mg/m intravenous on days 1 and 8; dexamethasone 40 mg/day intravenous on days 1 to 4; and cisplatin 20 mg/m intravenous on days 1-3) 3 weeks after the completion of CCRT. The objective response rate (ORR) and the complete response (CR) rate were the primary endpoints, and the secondary endpoints were the overall survival (OS), progression-free survival (PFS), and the adverse event (AE).The median follow-up period was 51.5 months (range, 5-78months). The ORR was 93.3% (28/30) and all these 28 patients attained CR at the end of the treatment. Two patients suffered from lymphoma associated hemophagocytic syndrome (LAHS) during the period of consolidation chemotherapy and died within 2 months. The 5-year OS was 93.3%, and the 5-year PFS was 89.4%Mucositis was the most common grades 3/4 nonhematologic AEs (10%, 3/30) of CCRT. During the P-GDP chemotherapy, vomiting (6.7%, 2/30), neutropenia (43.3%, 13/30) and thrombocytopenia (23.3%, 7/30) were the major grades 3/4 toxicities during chemotherapy. No treatment-related deaths occurred.The upfront CCRT followed by P-GDP regimen chemotherapy is an effective and well-tolerated first-line treatment strategy for patients diagnosed with early stage NKTCL. Further investigation of larger sample size is warranted.


Asunto(s)
Antineoplásicos/uso terapéutico , Quimioradioterapia/métodos , Quimioterapia de Consolidación/métodos , Linfoma Extranodal de Células NK-T/terapia , Neoplasias Nasales/terapia , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Terapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radioterapia de Intensidad Modulada/métodos
18.
BMC Infect Dis ; 20(1): 645, 2020 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-32873242

RESUMEN

BACKGROUND: During the outbreak of cutaneous leishmaniasis in the Kurdistan Region of Iraq that started in 2015, the course of the disease and the treatment were not consistent with the available literature. Physicians, particularly dermatologists, faced challenges with treating the cutaneous leishmaniasis lesions with high rates of treatment failure and resistance to treatment. We used Q-methodology to understand the range and diversities of opinions and the practical experiences of dermatologists about the treatment difficulties of cutaneous leishmaniasis. METHODS: This Q-methodology study was carried out in Erbil, Kurdistan Region of Iraq, and involved 37 dermatologists. A set of 40 statements related to different aspects of difficulties and uncertainties of treating cutaneous leishmaniasis was prepared. The dermatologists were requested to distribute the 40 statements into a scaled grid of nine piles from least agree to most agree. We applied by-person factor analysis using PQMethod 2.35 for the data analysis. RESULTS: The analysis revealed two different viewpoints about the treatment of cutaneous leishmaniasis and a consensus viewpoint. The first viewpoint emphasized the use of sodium stibogluconate-based combination therapy, concerns with treatment failure, and lack of compliance with the treatment. The second viewpoint emphasized the lack of standard treatment and advances in the treatment of cutaneous leishmaniasis. There was a consensus between both groups of respondents about many aspects of the treatment of cutaneous leishmaniasis, including considering sodium stibogluconate the first drug of choice for cutaneous leishmaniasis treatment. CONCLUSIONS: This study revealed a diversity of viewpoints and uncertainties about the effectiveness of the available treatment modalities and treatment difficulties and failure. Interrupted supply and poor quality of the available drugs and lack of a standard and advanced treatment are the main problems facing the treatment of cutaneous leishmaniasis. More research is required to determine the best treatment modalities for the different types of cutaneous leishmaniasis. There is a need for the development of treatment guidelines specific to the Iraqi context with a particular focus on the treatment of the resistant and atypical cases of cutaneous leishmaniasis.


Asunto(s)
Gluconato de Sodio Antimonio/uso terapéutico , Actitud , Consenso , Dermatólogos/psicología , Leishmania , Leishmaniasis Cutánea/tratamiento farmacológico , Leishmaniasis Cutánea/epidemiología , Adulto , Terapia Combinada , Análisis Factorial , Femenino , Humanos , Incidencia , Irak/epidemiología , Leishmaniasis Cutánea/parasitología , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Insuficiencia del Tratamiento
19.
Acta Biomed ; 91(3): e2020022, 2020 09 07.
Artículo en Inglés | MEDLINE | ID: mdl-32921719

RESUMEN

COVID-19 has had a catastrophic effect on healthcare systems compromising the treatment of cancer patients. It has an increased disease burden in the cancer population. As a result, tele-oncology services have become essential to reduce the risk of cancer patients being exposed to the deadly pathogen. Many governmental establishments have endorsed the use of tele-oncology during COVID-19 era. However, telemedicine in oncology still has certain drawbacks that can be improved upon. Nevertheless, tele-oncology has shown great promise to support cancer care not only during this pandemic but also become a part of normal care in the future.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Prestación de Atención de Salud/métodos , Oncología Médica , Neoplasias/epidemiología , Pandemias , Neumonía Viral/epidemiología , Telemedicina/métodos , Terapia Combinada , Comorbilidad/tendencias , Humanos , Neoplasias/terapia
20.
Lancet ; 396(10253): 786-798, 2020 09 12.
Artículo en Inglés | MEDLINE | ID: mdl-32919518

RESUMEN

Complicated community-acquired pneumonia in a previously well child is a severe illness characterised by combinations of local complications (eg, parapneumonic effusion, empyema, necrotising pneumonia, and lung abscess) and systemic complications (eg, bacteraemia, metastatic infection, multiorgan failure, acute respiratory distress syndrome, disseminated intravascular coagulation, and, rarely, death). Complicated community-acquired pneumonia should be suspected in any child with pneumonia not responding to appropriate antibiotic treatment within 48-72 h. Common causative organisms are Streptococcus pneumoniae and Staphylococcus aureus. Patients have initial imaging with chest radiography and ultrasound, which can also be used to assess the lung parenchyma, to identify pleural fluid; CT scanning is not usually indicated. Complicated pneumonia is treated with a prolonged course of intravenous antibiotics, and then oral antibiotics. The initial choice of antibiotic is guided by local microbiological knowledge and by subsequent positive cultures and molecular testing, including on pleural fluid if a drainage procedure is done. Information from pleural space imaging and drainage should guide the decision on whether to administer intrapleural fibrinolytics. Most patients are treated by drainage and more extensive surgery is rarely needed; in any event, in low-income and middle-income countries, resources for extensive surgeries are scarce. The clinical course of complicated community-acquired pneumonia can be prolonged, especially when patients have necrotising pneumonia, but complete recovery is the usual outcome.


Asunto(s)
Neumonía Bacteriana/complicaciones , Neumonía Bacteriana/terapia , Corticoesteroides/uso terapéutico , Antibacterianos/uso terapéutico , Niño , Terapia Combinada , Infecciones Comunitarias Adquiridas/complicaciones , Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/terapia , Drenaje , Humanos , Neumonía Bacteriana/diagnóstico por imagen , Neumonía Bacteriana/epidemiología , Factores de Riesgo , Resultado del Tratamiento
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