Electrochemotherapy in treatment of canine oral malignant melanoma and factors influencing treatment outcome.

Background Oral malignant melanoma is the most common, but aggressive oral cancer in dogs with poor prognosis. Electrochemotherapy (ECT) has therapeutic potential in such tumors as effective local treatment. Therefore, the aim of this prospective clinical study was to evaluate treatment effectiveness of ECT in as first line treatment for canine oral malignant melanoma, and search for factors influencing treatment outcome. Methods Sixty-seven canines with primary oral malignant melanoma, non-candidates for first-line therapy, were enrolled. All dogs received ECT and follow-up exams for the span of two years. Results Based on RECIST criteria, the objective response rate was 100%, 89.5%, 57.7%, and 36.4%, in stage I, II, III and IV, respectively. Only patients in stage I, II and III with partial or complete response improved their quality of life. The median time to progression was 11, 7, 4 and 4 months, and median survival time after the treatment was 16.5, 9.0, 7.5 and 4.5 months, for patients in stage I, II, III and IV, respectively. Significantly better was local response in stage I and II disease (p = 0.0013), without the bone involvement (p = 0.043) Conclusions Electrochemotherapy is effective local treatment of oral canine malignant melanoma when no alternative treatment is available. Better response is expected in stage I and II patients with tumors without bone involvement.

Formación de la competencia promoción de salud en el técnico superior en enfermería en el contexto ecuatoriano / Training of the health promotion competence in nursing higher technician in the Ecuatorian context

Teniendo en cuenta la necesidad de que los procesos formativos respondan cada vez más a la complejidad y diversidad de los problemas profesionales, así como de vencer las dificultades educativas con optimización de tiempo y recursos, se diseñó una estrategia pedagógica para la formación de la competencia promoción de salud en el técnico superior en enfermería, en el contexto ecuatoriano, en correspondencia con las características de los sujetos y las condiciones que intervienen en dicho proceso, para contribuir a mejorar la calidad de la formación y el desempeño de estos(AU)

A pedagogic strategy was designed for training the health promotion competence in nursing higher technician, in the Ecuadorian context, according to the characteristics of the individuals and the conditions that intervene in this process, to contribute in improving the training quality and their performance; taking into account the necessity that the training processes respond even more to the complexity and diversity of the professional problems, as well as of overcoming the educational difficulties with optimization of time and resources(AU)

Formación de la competencia promoción de salud en el técnico superior en enfermería en el contexto ecuatoriano / Training of the health promotion competence in nursing higher technician in the Ecuatorian context

Teniendo en cuenta la necesidad de que los procesos formativos respondan cada vez más a la complejidad y diversidad de los problemas profesionales, así como de vencer las dificultades educativas con optimización de tiempo y recursos, se diseñó una estrategia pedagógica para la formación de la competencia promoción de salud en el técnico superior en enfermería, en el contexto ecuatoriano, en correspondencia con las características de los sujetos y las condiciones que intervienen en dicho proceso, para contribuir a mejorar la calidad de la formación y el desempeño de estos.

Teniendo en cuenta la necesidad de que los procesos formativos respondan cada vez más a la complejidad y diversidad de los problemas profesionales, así como de vencer las dificultades educativas con optimización de tiempo y recursos, se diseñó una estrategia pedagógica para la formación de la competencia promoción de salud en el técnico superior en enfermería, en el contexto ecuatoriano, en correspondencia con las características de los sujetos y las condiciones que intervienen en dicho proceso, para contribuir a mejorar la calidad de la formación y el desempeño de estos.

Efectividad del tratamiento con una composición tópica en el proceso de cicatrización de las úlceras por presión / Effectiveness of topical composition treatment in the healing of pressure ulcers

Resumen:

Introducción: el tratamiento de las heridas crónicas y en especial el de las úlceras por presión (UPP) constituye uno de los más complejos e importantes problemas asistenciales en el ámbito hospitalario. Objetivo: evaluar la efectividad del tratamiento con y sin una composición tópica en el proceso de cicatrización de las UPP.

Metodología: estudio de intervención, con muestreo probabilístico estratificado según el estadio de las UPP. Se incluyeron 12 pacientes, con seguimiento de 16 UPP; aleatoriamente se seleccionaron ocho para el grupo de estudio con la aplicación de la composición tópica y ocho para el grupo control. En ambos grupos se realizó el procedimiento de curación con base en una guía de práctica clínica. El seguimiento del proceso de cicatrización en ambos grupos fue semanal y la efectividad de la curación se estimó con la escala RESVECH V. 1.0. El análisis de datos se hizo con el estadístico SPSS, versión 20. Resultados: el 75 % de los pacientes fueron hombres, que en promedio tuvieron 64.1 ± 11.1 años de edad. El 37 % de las UPP se clasificó en estadio II, el 25 % en estadio III y el 38 % en estadio IV. La efectividad del procedimiento de curación se determinó en días de intervención. En el grupo experimental fue de 9.1 ± 3.3 y en el grupo control fue de 13 ± 2.3 días de intervención; la diferencia entre las medias fue significativa, t (14) = 2.155, p < 0.05, dos colas.

Conclusiones: la curación con la composición tópica es una alternativa de tratamiento para este tipo de lesiones.

Abstract:

Introduction: The treatment of chronic wounds and especially of pressure ulcers (PU) is one of the most complex and important health care problems in hospitals.

Objective: To evaluate the effectiveness of a treatment with and without a topical composition in the PU healing process.

Methodology: Intervention study, with a probability sampling stratified according to the stage of PU. Twelve patients were included, with a follow-up of 16 PU; eight were randomly selected for the study group with the application of the topical composition and eight for the control group. In both groups the healing process was done on the basis of a clinical practice guideline. The monitoring of the healing process in both groups was done weekly and the effectiveness of healing was calculated with the RESVECH V. 1.0 scale (Results expected from the assessment and healing progress of wounds). The statistical analysis was performed with SPSS, version 20. Results: 75 % of the patients were men, who on average were 64.1 ± 11.1 years old. Of all the PU, 37 % were classified as stage II, 25 % as stage III and 38 % as stage IV. The effectiveness of the healing process was established in the days of intervention, the experimental group was 9.1 ± 3.3 and in the control group was 13 ± 2.3 days of intervention, the difference between the means was significant, r (14) = 2.155 , p < 0.05, two-tailed.

Conclusions: healing with topical composition is an alternative treatment for PU.

Microbial transformation of the diterpene 7-epi-foliol by Fusarium fujikuroi.

The incubation of 3alpha,7alpha,18-trihydroxy-ent-kaur-16-ene (7-epi-foliol) with the fungus Fusarium fujikuroi gave 3alpha,7alpha,18-trihydroxy-ent-kaur-16-en-18-al as the sole product. The biotransformation of other 7alpha- or 7beta-hydroxy derivatives had led to the oxidation of C-19, which is a main step in the biosynthesis of gibberellins and kaurenolides. Now, the presence of the 3alpha-hydroxyl impedes that oxidation, which is directed to the adjacent C-18 hydroxymethyl forming the corresponding aldehyde.

Microbiological transformation of two 15α-hydroxy-ent-kaur-9(11),16-diene derivatives by the fungus Fusarium fujikuroi.

The incubation of 15α-hydroxy-ent-kaur-9(11),16-dien-19-oic acid (15α-hydroxy-grandiflorenic acid) with the fungus Fusarium fujikuroi gave as main metabolite its 3ß,6ß-dihydroxy derivative, which by an oxidative decarboxylation afforded a 19-nor compound with a 4,18-double bond. Other substances obtained were a 3α-hydroxy-19,6α-lactone, 3ß-hydroxy-6ß,7ß-epoxy-ent-kaur-9(11),16-dien-19-oic acid and 3ß-hydroxy-6-oxo-ent-kaur-9(11),16-dien-19-oic acid. Moreover, the biotransformation of 15α,18-dihydroxy-ent-kaur-9(11),16-diene led to the isolation of the corresponding 3ß-, 6ß-, 7α- and 12ß-hydroxy derivatives. Two metabolites formed by 16ß,17-epoxidation of the last compound and of the substrate were also obtained. These results indicated that the presence of the 9,11-double bond in the substrate impedes its 7ß-hydroxylation, which is necessary for the formation of gibberellins and seco-ring B ent-kaurenoids. However, this 9,11-unsaturation does not hinder a 6,7-dehydrogenation and further 6ß,7ß-epoxidation, characteristic steps of the kaurenolide biosynthetic pathway.

Biotransformation of ent-kaur-16-ene and ent-trachylobane 7ß-acetoxy derivatives by the fungus Gibberella fujikuroi (Fusarium fujikuroi).

Candol A (7ß-hydroxy-ent-kaur-16-ene) (6) is efficiently transformed by Gibberella fujikuroi into the gibberellin plant hormones. In this work, the biotransformation of its acetate by this fungus has led to the formation of 7ß-acetoxy-ent-kaur-16-en-19-oic acid (3), whose corresponding alcohol is a short-lived intermediate in the biosynthesis of gibberellins and seco-ring ent-kaurenoids in this fungus. Further biotransformation of this compound led to the hydroxylation of the 3ß-positions to give 7ß-acetoxy-3ß-hydroxy-ent-kaur-16-en-19-oic acid (14), followed by a 2ß- or 18-hydroxylation of this metabolite. The incubation of epicandicandiol 7ß-monoacetate (7ß-acetoxy-18-hydroxy-ent-kaur-16-ene) (10) produces also the 19-hydroxylation to form the 18,19 diol (20), which is oxidized to give the corresponding C-18 or C-19 acids. These results indicated that the presence of a 7ß-acetoxy group does not inhibit the fungal oxidation of C-19 in 7ß-acetoxy-ent-kaur-16-ene, but avoids the ring B contraction that leads to the gibberellins and the 6ß-hydroxylation necessary for the formation of seco-ring B ent-kaurenoids. The biotransformation of 7ß-acetoxy-ent-trachylobane (trachinol acetate) (27) only led to the formation of 7ß-acetoxy-18-hydroxy-ent-trachylobane (33).

The incubation of 13α,17-dihydroxystemodane with Cephalosporium aphidicola.

The biotransformation of 13α,17-dihydroxystemodane (3) with the fungus Cephalosporium aphidicola afforded 13α,17,18-trihydroxystemodane (4), 3ß,13α,17-tri-hydroxystemodane (5), 13α,17-dihydroxy-stemodan-18-oic acid (6), 3ß,11ß,13α,17-tetra-hydroxystemodane (7), 11ß,13α,17,18-tetrahydroxystemodane (8) and 3ß,13α,17,18-tetra-hydroxystemodane (9). The hydroxylation at C-18 of the substrate points to a biosynthetically-directed transformation, because aphidicolin (2) is hydroxylated at this carbon. However, the C-3(ß) and C-11(ß) hydroxylations seem to indicate a xenobiotic biotransformation.

On the biotransformation of ent-trachylobane to ent-kaur-11-ene diterpenes.

The microbiological transformation of trachinodiol (1) by the fungus Mucor plumbeus afforded the corresponding 1α, 2α, 3α, and 17-hydroxy derivatives (2-4 and 6), respectively. 7ß,16α,18-Trihydroxy-ent-kaur-11-ene (sicanatriol) (5) was also obtained in this feeding. The biotransformation of 1 to give 5 by this fungus may occur by enzymatic abstraction of a hydrogen atom, allylic to the cyclopropane ring, and subsequent cleavage of this ring. This route is similar to that postulated by us in plants of the genus Sideritis, where ent-trachylobane and ent-kaur-11-ene diterpenes coexist. This study confirms that hydroxylation of diterpenes by M. plumbeus occurs preferably at ring A carbons.

Biotransformation of 7alpha-hydroxy- and 7-oxo-ent-atis-16-ene derivatives by the fungus Gibberella fujikuroi.

The microbiological transformation of 7alpha,19-dihydroxy-ent-atis-16-ene by the fungus Gibberella fujikuroi gave 19-hydroxy-7-oxo-ent-atis-16-ene, 13(R),19-dihydroxy-7-oxo-ent-atis-16-ene, 7alpha,11beta,19-trihydroxy-ent-atis-16-ene and 7alpha,16beta,19-trihydroxy-ent-atis-16-ene, while the incubation of 19-hydroxy-7-oxo-ent-atis-16-ene afforded 13(R),19-dihydroxy-7-oxo-ent-atis-16-ene and 16beta,17-dihydroxy-7-oxo-ent-atisan-19-al. The biotransformation of 7-oxo-ent-atis-16-en-19-oic acid gave 6beta-hydroxy-7-oxo-ent-atis-16-en-19-oic acid, 6beta,16beta,17-trihydroxy-7-oxo-19-nor-ent-atis-4(18)-ene and 3beta,7alpha-dihydroxy-6-oxo-ent-atis-16-en-19-oic acid.

Terapias alternativas contra el cáncer basadas en la aplicación de campos eléctricos / Alternative therapies against cancer based on the application of electric fields

El cáncer es la segunda causa de muerte por enfermedad en el mundo y su incidencia sigue creciendo con el aumento de la contaminación y del envejecimiento del promedio poblacional. La Argentina no es la excepción, como lo muestran las estadísticas del Ministerio de Salud (Estadísticas Vitales de 2002 a 2006). Además de un problema médico, el cáncer es un problema económico: el impacto en la economía es enorme y la tendencia actual en los países centrales es invertir recursos en investigación, prevención y tratamiento precoz de la enfermedad, ya que el tratamiento de estadios avanzados resulta, a nivel poblacional, una carga económica excesiva y potencialmente inabordable aun por los países con mayores recursos.

Biotransformation of two ent-Pimara-9(11),15-diene derivatives by Gibberella fujikuroi.

The incubation of 19-hydroxy-13-epi-ent-pimara-9(11),15-diene (4) with Gibberella fujikuroi gave 8 alpha,19-dihydroxy-9 alpha,11alpha-epoxy-13-epi-ent-pimara-15-ene (6), 7-oxo-11 alpha,19-dihydroxy-13-epi-ent-pimara-8(9),15-diene (7), 7-oxo-11beta,19-dihydroxy-13-epi-ent-pimara-8(9),15-diene (9), and 8 alpha,19-dihydroxy-9 alpha,11 alpha:15,16-diepoxy-13-epi-ent-pimarane (11), while the feeding of 13-epi-ent-pimara-9(11),15-diene-19-oic acid (5) with this fungus afforded 1-oxo-2 alpha,9 alpha-dihydroxy-13-epi-ent-pimara-11,15-dien-19-oic acid (13), 1-oxo-2 beta,9 alpha-dihydroxy-13-epi-ent-pimara-11,15-dien-19-oic acid (14), 13-epi-ent-pimara-9(11),15-dien-1,19-dioic acid 1,2-lactone (15), and 1-oxo-12 beta-hydroxy-13-epi-ent-pimara-9(11),15-dien-19-oic acid (16). In both biotransformations, the main reaction was the epoxidation of the 9(11)-double bond, followed by rearrangement to afford allylic alcohols. The formation of lactone 15 represents the first time that a Baeyer-Villiger oxidation has been observed in a microbiological transformation with this fungus.

The microbiological transformation of 7alpha-hydroxy-ent-kaur-16-ene derivatives by Gibberella fujikuroi.

The biotransformation of 7alpha-hydroxy-ent-kaur-16-ene (epi-candol A) by the fungus Gibberella fujikuroi gave 7alpha,16alpha,17-trihydroxy-ent-kaur-16-ene and a seco-ring B derivative, fujenoic acid, whilst the incubation of candicandiol (7alpha,18-dihydroxy-ent-kaur-16-ene) and canditriol (7alpha,15alpha,18-trihydroxy-ent-kaur-16-ene) afforded 7alpha,18,19-trihydroxy-ent-kaur-16-ene and 7alpha,11beta,15alpha,18-tetrahydroxy-ent-kaur-16-ene, respectively. The presence of a 7alpha-hydroxyl group in epi-candol A avoids its biotransformation along the biosynthetic pathway of gibberellins, and directs it to the seco-ring B acids route. The 15alpha-hydroxyl group in canditriol inhibits oxidation at C-19 and direct hydroxylation at C-11(beta). The formation of fujenoic acid, from 7alpha-hydroxy-ent-kaur-16-ene, probably occurs via 7alpha-hydroxykaurenoic acid and 7-oxokaurenoic acid, with subsequent hydroxylation at the C-6(beta) position.

The microbiological transformation of two 15beta-hydroxy-ent-kaurene diterpenes by Gibberella fujikuroi.

The incubation of 15beta-hydroxy-3-oxo-ent-kaur-16-ene (1) with the fungus Gibberella fujikuroi afforded 11beta-hydroxy-3,15-dioxo-ent-kaurane (6), 11beta,15beta-dihydroxy-3-oxo-ent-kaur-16-ene (8), 7beta,11beta,15beta-trihydroxy-3-oxo-ent-kaur-16-ene (9), 7alpha,11beta-dihydroxy-3,15-dioxo-ent-kaurane (7), and 7alpha,11beta,15beta-trihydroxy-3-oxo-ent-kaur-16-ene (10). The incubation of 15beta-hydroxy-ent-kaur-2,16-diene (3) with the same fungus yielded 7alpha,11beta-dihydroxy-15-oxo-ent-kaur-2-ene (12), 7alpha,11beta,15beta-trihydroxy-ent-kaur-2,16-diene (13), 7beta,15beta-dihydroxy-ent-kaur-2,16-dien-19,6-olide (14), 1beta,7beta,15beta-trihydroxy-ent-kaur-2,16-dien-19-oic acid (15), 7alpha,11beta,16alpha-trihydroxy-15-oxo-ent-kaur-2-ene (17), and 7alpha,15beta,17-trihydroxy-11beta,16beta-epoxy-ent-kaur-2-ene (19). These results indicated that a 3-oxo group in ent-kaur-16-ene derivatives inhibits the oxidation at C-19, typical of the biosynthetic pathway of gibberellins and kaurenolides, while a 2,3-double bond or a 15beta-OH does not. In both substrates a 15beta-alcohol directs hydroxylations at C-11(beta) and C-7(alpha), while in those with a 2,3-double bond the functionalization of C-1(beta) is favored.

Incidencia de condicolomatosis y embarazo / Incidence of condyloma acuminatum and pregnancy

Se hace una investigación en el Hospital docente San Lorenzo de Los Mina, de los años 1994 al 1996, 26,400 casos. Encontramos 95 pacientes condilomatosis (0.35//), el 84// en pacientes embarazadas, 15// en pacientes ginecológicas, el 66.25// habían tenido mas de dos cónyuges, un 33.75// uno solo. Al 67.5// se le hizo cesárea, en 32.5 parto vaginal. El 58// estaba en edades de 14 a 19 años, el 57// tenían su primer embarazo, el 67// no fueron a consulta. El 75// procedían de la zona urbana y solo el 25// de la rural

Estimación del costo de las infecciones hospitalarias / An estimation of the cost of hospital infections

En Mar del Plata, Argentina, se valuó el costo de las infecciones hospitalarias que se produjeron durante un período de 14 meses en el servicio de pediatría de un hospital. De un total de 3.208 egresos se examinaron 2.632 historias clínicas de niños de uno a 14 años de edad entre los que se registraron 98 casos de infección hospitalaria de diversos tipos. El período de internación adicional por esa causa fue aproximadamente de 10 días, con un costo medio de tratamiento antibiótico de $US 10,10 diario y un gasto promedio de internación por paciente por día de $91,30; la suma de estas dos cantidades determinó un costo diario por paciente de $101,40. A pesar de las dificultades que existen para calcular el costo real de las infecciones hospitalarias, los resultados obtenidos justifican la elaboración de un programa que considere el mejoramiento de las técnicas de asepsia e higiene hospitalaria, el uso adecuado de los antibióticos y del laboratorio de microbiología, así como el adiestramiento del personal y la educación de los familiares

Un caso de S.I.D.A. (síndrome de inmunodeficiencia adquirida) / A case of AIDS (acquired immunodeficiency syndrome)

A propósito de un caso de SIDA en Mar del Plata se efectuá una revisión y actualización de esta patología, enfatizándose los elementos para su detección y seguimiento (AU)

Un caso de S.I.D.A. (síndrome de inmunodeficiencia adquirida) / A case of AIDS (acquired immunodeficiency syndrome)

A propósito de un caso de SIDA en Mar del Plata se efectuá una revisión y actualización de esta patología, enfatizándose los elementos para su detección y seguimiento