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1.
Invest. clín ; 58(1): 56-69, mar. 2017. ilus, graf
Artigo em Espanhol | LILACS-Express | ID: biblio-841137

RESUMO

The EVESCAM (EstudioVenezolano de Salud Cardio-Metabólica) is the first national, population survey in Venezuela, designed to examine the prevalence of diabetes and cardio-metabolic risk factors and its relationship with lifestyle. It is a cross-sectional, cluster sampling study, which recruited 4454 participants aged ≥ 20 years. The data were collected in community health-care centers by trained health professionals and medical students. The data collected from each subject included, after informed consent, structured questionnaires (clinical, demographic, physical activity, nutritional and psychological), anthropometric measurements (weight, height and waist circumference), body fat by bioelectrical impedance, hand grip, blood pressure, electrocardiogram, and biochemical measurements (standard 75 g oral glucose tolerance test, total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides). The data will be used to estimate the prevalence of overweight, obesity, prediabetes, diabetes, hypertension, dyslipidemias, sarcopenia and metabolic syndrome; and to examine their relationships with lifestyle factors. The risk of coronary heart disease and impaired glucose regulation will be estimated using the Framingham Coronary Heart Disease Risk Score and the Latin America adaptation of the Finnish Diabetes Risk Score (LA-FINDRISC), respectively. These results will guide national cardiovascular and diabetes prevention strategies, and will be available for government agencies to help in the implementation of public health policies.


El EVESCAM (Estudio Venezolano de Salud Cardio-Metabólica) es el primer estudio poblacional de muestreo nacional en Venezuela diseñado para examinar la prevalencia de diabetes y factores de riesgo cardio-metabólico, y su relación con el estilo de vida. Se trata de un estudio transversal de muestreo por conglomerados, reclutando 4454 participantes de 20 años o más. Los datos fueron recogidos en centros de salud de la comunidad por profesionales de salud y estudiantes de medicina entrenados. Después del consentimiento infor mado, los datos recolectados en cada sujeto incluyeron: cuestionarios estructurados (clínico, demográfico, actividad física, nutricional y psicológico), medidas antropométricas (peso, talla y circunferencia de cintura), grasa corporal por impedancia bioeléctrica, fuerza de aprehensión de la mano, presión arterial, electrocardiograma y medidas bioquímicas (prueba de tolerancia a la glucosa oral estándar con 75 g de glucosa, colesterol total, colesterol HDL, colesterol LDL y triglicéridos). Los datos se utilizarán para estimar la prevalencia de sobrepeso, obesidad, prediabetes, diabetes, hipertensión arterial, dislipidemias, sarcopenia y síndrome metabólico; y para examinar sus relaciones con factores de estilo de vida. El riesgo de cardiopatía coronaria y de alteración de la regulación de la glucosa se calculará utilizando la puntuación de riesgo de la enfermedad coronaria de Framingham y la adaptación para Latinoamérica de la puntuación finlandesa del riesgo de diabetes (LA-FINDRISC), respectivamente. Estos resultados guiarán las estrategias nacionales de prevención cardiovascular y diabetes, y estarán disponibles para que las agencias gubernamentales ayuden en la implementación de las políticas de salud pública.

2.
Eur J Cancer ; 75: 73-82, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28222309

RESUMO

BACKGROUND: Gemcitabine and erlotinib have shown a survival benefit in the first-line setting in metastatic pancreatic cancer (mPC). The aim of this study was to assess whether combining capecitabine (C) with gemcitabine + erlotinib (GE) was safe and effective versus GE in patients with mPC. PATIENTS AND METHODS: Previously untreated mPC patients were randomised to receive G (1000 mg/m2, days 1, 8, 15) + E (100 mg/day, days 1-28) + C (1660 mg/m2, days 1-21) or GE, q4 weeks, until progression or unacceptable toxicity. Primary end-point: progression-free survival (PFS); secondary end-points: overall survival (OS), response rate, relationship of rash with PFS/OS and safety. RESULTS: 120 patients were randomised, median age 63 years, ECOG status 0/1/2 33%/58%/8%; median follow-up 16.5 months. Median PFS in the gemcitabine-erlotinib-capecitabine (GEC) and GE arms was 4.3 and 3.8 months, respectively (hazard ratio [HR]: 0.88, 95% confidence interval [CI]: 0.58-1.31; p = 0.52). Median OS in the GEC and GE arms was 6.8 and 7.7 months, respectively (HR: 1.09, 95% CI: 0.72-1.63; p = 0.69). Grade 3/4 neutropenia (GEC 43% versus GE 15%; p = 0.0008) and mucositis (GEC 9% versus GE 0%; p = 0.03) were the only statistically significant differences in grade 3/4 adverse events. PFS and OS were significantly longer in patients with rash (grade ≥1) versus no rash (grade = 0): PFS 5.5 versus 2.0 months (HR = 0.39, 95% CI: 0.26-0.6; p < 0.0001) and OS: 9.5 versus 4.0 months (HR = 0.51, 95% CI: 0.33-0.77; p = 0.0014). CONCLUSION: PFS with GEC was not significantly different to that with GE in patients with mPC. Skin rash strongly predicted erlotinib efficacy. The study was registered with ClinicalTrials.gov: NCT01303029.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Pancreáticas/tratamento farmacológico , Administração Oral , Adulto , Idoso , Capecitabina/administração & dosagem , Capecitabina/efeitos adversos , Desoxicitidina/administração & dosagem , Desoxicitidina/efeitos adversos , Desoxicitidina/análogos & derivados , Esquema de Medicação , Erupção por Droga/etiologia , Cloridrato de Erlotinib/administração & dosagem , Cloridrato de Erlotinib/efeitos adversos , Exantema/induzido quimicamente , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Neoplasias Pancreáticas/mortalidade , Espanha/epidemiologia , Resultado do Tratamento
3.
Invest Clin ; 58(1): 56-69, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29939500

RESUMO

The EVESCAM (EstudioVenezolano de Salud Cardio-Metabólica) is the first national, population survey in Venezuela, designed to examine the prevalence of diabetes and cardio-metabolic risk factors and its relationship with lifestyle. It is a cross-sectional, cluster sampling study, which recruited 4454 participants aged ≥ 20 years. The data were collected in community health-care centers by trained health professionals and medical students. The data collected from each subject included, after informed consent, structured questionnaires (clinical, demographic, physical activity, nutritional and psychological), anthropometric measurements (weight, height and waist circumference), body fat by bioelectrical impedance, hand grip, blood pressure, electrocardiogram, and biochemical measurements (standard 75 g oral glucose tolerance test, total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides). The data will be used to estimate the prevalence of overweight, obesity, prediabetes, diabetes, hypertension, dyslipidemias, sarcopenia and metabolic syndrome; and to examine their relationships with lifestyle factors. The risk of coronary heart disease and impaired glucose regulation will be estimated using the Framingham Coronary Heart Disease Risk Score and the Latin America adaptation of the Finnish Diabetes Risk Score (LA-FINDRISC), respectively. These results will guide national cardiovascular and diabetes prevention strategies, and will be available for government agencies to help in the implementation of public health policies.


Assuntos
Síndrome Metabólica/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Venezuela/epidemiologia , Adulto Jovem
4.
Eur J Haematol ; 97(6): 576-582, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27157440

RESUMO

BACKGROUND: Non-Hodgkin lymphoma patients have a 25% increased risk of secondary primary neoplasms (SPNs). Regarding the controversy about the increased risk of SPN in patients exposed to radioimmunotherapy (RIT), we have analyzed this issue in a cohort of follicular lymphoma (FL) patients treated with/without RIT. PATIENTS AND METHODS: A retrospective study including all consecutive FL patients diagnosed since 2001 was performed. Demographic, clinical data including the incidence of any kind of neoplasm (excluding basocellular skin carcinoma) were recorded. RESULTS: A total of 242 patients were registered, male/female: 103/139, mean age: 59.9 yr (15-86), stage IV (57.8%), and Follicular Lymphoma Prognostic Index (FLIPI) low-risk (62.15%) predominance. Ninety-six patients (39.7%) were treated with 90Y-IT. The median follow-up for patients treated or not with 90Y-IT was 61 (8-273) and 38 (1-171) months. With respect to SPN incidence, 38 (15.6%) patients have at least two cancers, in 17 (44.7%), FL was the SPN; for the rest (226), the global incidence of SPNs was 9.3% (21), but there were no differences related to the exposition or not to 90Y-IT (P = 0.26). In seven patients, more than two (2-6) different therapies were registered; four were exposed to fludarabine-based therapy, three to radiotherapy and two to autologous stem-cell transplantation, and in the RIT cohort, two patients developed myelodysplastic syndrome. CONCLUSION: This is one of the largest single institution reports assessing the risk of SPN in FL patients treated (96) or not (146) with 90Y-IT. It seems that 90Y-IT does not increase significantly the risk of SPN but avoiding its use after fludarabine and other intense cytotoxic schemes is recommended.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Linfoma Folicular/epidemiologia , Linfoma Folicular/radioterapia , Segunda Neoplasia Primária/epidemiologia , Segunda Neoplasia Primária/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais/efeitos adversos , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Feminino , Seguimentos , Humanos , Incidência , Linfoma Folicular/diagnóstico , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Radioimunoterapia/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Adulto Jovem
5.
Clin Lymphoma Myeloma Leuk ; 15(8): 464-71, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25823889

RESUMO

BACKGROUND: The mean age of patients included in clinical trials does not reflect the current clinical practice for patients with B-cell non-Hodgkin lymphoma (B-NHL). We compared our outcomes for patients with B-NHL aged < 65 and > 65 years who were treated with 90-yttrium-ibritumomab tiuxetan therapy ((90)Y-IT). PATIENTS AND METHODS: A total of 108 patients who had received (90)Y-IT according to the hospital protocol (ISCRTN36210045) were eligible. A quality of life (QoL) assessment using the Medical Outcomes Study short form 36-item survey was performed for patients aged > 65 years. RESULTS: Of the 108 patients, 43 were aged > 65 years (mean age, 73.4 years; men 46.15%); 37 had follicular NHL (86.0%). Also, 27 patients had previously undergone < 2 therapy regimens (62.8%). The mean follow-up period was 45.2 months. The mean progression-free survival (PFS) period was 71.3 months, and the mean overall survival was 78.2 months. The median values were not reached. The overall response rate was 90.5%, and a complete response was observed in 36 of the 43 patients aged > 65 years (85.7%). Neutropenia (43.3%) and thrombocytopenia (45.2%) were the most frequent grade 3 and 4 toxicities. Five patients required a red blood cell transfusion and 11, a platelet transfusion. Five patients aged > 65 years (11.6%) developed a second tumor. These outcomes were similar to those for the younger patients. The QoL assessment showed scores similar to those of general population for general health and social functioning. CONCLUSION: This is the largest cohort of NHL treated with RIT in a single institution in Spain. We observed a high response rate and prolonged PFS in patients with B-NHL, independent of patient age. Thus, consolidation RIT offers better outcomes with manageable toxicity.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/radioterapia , Radioimunoterapia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/farmacologia , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
6.
Med. interna (Caracas) ; 31(2): 102-111, 2015. mapas, tab
Artigo em Espanhol | LILACS | ID: lil-777829

RESUMO

El Estudio Venezolano de Salud Cardio-Metabólica (EVESCAM) es el primer estudio multicéntrico sobre la Salud cardiometabólica del venezolano. Evaluar la prevalencia de diabetes y Factores de Riesgo Cardio-Metabólico (FRCM), y su relación con el estilo de vida en Venezuela. Es un estudio poblacional, transversal, con muestreo por conglomerados, cuyo objetivo es evaluar a 4200 participantes ≥ 20 años de las 8 regiones de Venezuela. Los datos serán recolectados en centros asistenciales por profesionales de la salud y estudiantes de medicina previamente capacitados y certificados. Después de obtener el consentimiento informado, en cada participante se realizarán: a. Cuestionarios estructurados para obtener datos clínicos, demográficos, de actividad física, nutricionales, psicológicos y estratos sociales; b. examen físico (peso, talla, grasa corporal por bioimpedancia, circunferencia de la cintura, fuerza de aprehensión de la mano, presión arterial y electrocardiograma) y c. Pruebas bioquímicas (Prueba de Tolerancia a la Glucosa -PTGO- estándar 75 g, colesterol total, HDL-colesterol, LDL-colesterol y triglicéridos). Además se calculará el riesgo de enfermedad cardíaca coronaria (por puntaje de Framingham) y la regulación de la glucosa alterada (por puntaje FINDRISC modificado). Se estimará la prevalencia de sobrepeso, obesidad, prediabetes, diabetes, hipertensión, dislipidemias, sarcopenia, síndrome metabólico y su relación con los factores de estilo de vida (nutrición, actividad física, estrés psicosocial, uso de tabaco y alcohol). En esta primera parte se explica la metodología y la aplicación del muestreo a la Ciudad de Barquisimeto.


This is the first cardiometabolic multicentric study of the Venezuelan people cardiometabolic health. To evaluate the relationship of the prevalence of diabetes and risk factors with Venezuelan lifestyle. This is a population, transverse, with conglomerates of 4200 of 20 or more years-old in 8 areas of Venezuela. Data were colected in different health centers by physicians and medical students, who had been enabled for this. After obtaining consented inform, to each participant the following was applied: 1) structured questionaires for clinical data, demography, physical activity, nutrition, psicological traits and social status. 2. complete physical examination, including EKG). 3. Glucose tolerance test, lipid profile, Framingham score and FINDRISK modified score. Prevalence of overweight, obesity, prediabetes, hypertension, dyslipidemia, sarcopenia, metabolic syndrome and their relationship with lifestyle factors. This is the first parte in the city of Barquisimeto.


Assuntos
Humanos , Masculino , Feminino , Cardiologia/educação , Inquéritos e Questionários , Metabolismo , Estudantes de Medicina
7.
Ann Hematol ; 93(12): 1985-92, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24985089

RESUMO

The aim of this study was to analyze the outcomes of 37 follicular lymphoma (FL) patients treated with (90)ytrium ibritumomab tiuxetan (90Y-IT), outside of clinical trial, according to protocol ISCRTN36210045, after ≥5 years follow-up to February 2014. Health-related quality of life (HRQoL) was evaluated with the SF-36, Spanish version, and compared with the general population of Spain. Patients had a mean age of 61.9 (range, 30-85) years and included 18 males. FLIPI, low: 25 (67.6 %), intermedium 9 (24.3 %), and low 3 (8.1 %). Previous therapy schedules >2: 48.6 % The median follow-up was 66 months, mean Time to Relapse (TTR) 71.3 months (58.8-83.8) median not reached. Thirty-four patients achieved complete response (91.8 %), and three no response. Mean overall survival: 82.3 months (71.6-92.9). Four patients presented with concomitant tumors (colon, breast, prostate, lung) after radioimmunotherapy, and three developed second primary neoplasms (esophagus, renal, and myelodysplastic syndrome in a relapsed patient who received fludarabine). Four of 10 deaths were related to lymphoma progression. Hematological toxicities were mild and easily managed. No patients required hospitalization. Negative scores were obtained in the physical and emotional roles items; however, the perception of general health and vitality were better than in the general population, with the best outcomes in non-relapsed patients. Radioimmunotherapy with 90Y-IT was safe and effective as long-term therapy in patients with FL. Early use of radioimmunotherapy could offer good, sustained responses with low toxicity over the long term and acceptable HRQoL.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Linfoma Folicular/radioterapia , Radioimunoterapia , Radioisótopos de Ítrio/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Murinos/administração & dosagem , Anticorpos Monoclonais Murinos/uso terapêutico , Citotoxicidade Celular Dependente de Anticorpos , Antígenos CD20/imunologia , Antígenos de Neoplasias/imunologia , Intervalo Livre de Doença , Avaliação de Medicamentos , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Linfoma Folicular/imunologia , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/epidemiologia , Segunda Neoplasia Primária/epidemiologia , Segunda Neoplasia Primária/etiologia , Neutropenia/induzido quimicamente , Qualidade de Vida , Indução de Remissão , Rituximab , Trombocitopenia/induzido quimicamente , Radioisótopos de Ítrio/administração & dosagem , Radioisótopos de Ítrio/efeitos adversos
8.
Rev. mex. cardiol ; 25(1): 36-42, ene.-mar. 2014. ilus
Artigo em Espanhol | LILACS-Express | ID: lil-717299

RESUMO

En los pacientes con síndrome coronario agudo, dos terceras partes de los casos fallece sin alcanzar a recibir atención hospitalaria (principalmente en las primeras dos horas) debido a la muerte súbita. Del tercio restante, el 50% lo hará en las 24 horas siguientes a su ingreso hospitalario, principalmente debido a las complicaciones mecánicas del infarto. Actualmente, la identificación y estratificación inmediata del paciente con síndrome coronario agudo, el papel de las unidades coronarias y la reperfusión temprana (farmacológica o mecánica) en los casos indicados, han demostrado disminuir la morbimortalidad por cardiopatía isquémica. Dentro de las complicaciones mecánicas del infarto, la ruptura de pared libre ventricular se presenta en el 5-10% de los pacientes hospitalizados que fallecen por infarto agudo del miocardio con elevación del segmento ST. Se presenta un caso clínico con estas características.


In patients with acute coronary ischemic syndrome, two-thirds of cases die without reaching hospital care (mainly in the first two hours) due to sudden death. Of the remaining third, 50% will do so within 24 hours of hospital admission, mainly due to mechanical complications of infarction. Currently, the identification and early stratification, the role of coronary care units and early reperfusion (pharmacologic or mechanical) where indicated, have been shown to decrease morbidity and mortality from ischemic heart disease. Within the mechanical complications of infarction, ventricular free wall rupture occurs in 5-10% of hospitalized patients dying of acute myocardial infarction with ST segment elevation. We report a case with these features.

10.
Clin Transl Oncol ; 10(2): 128-30, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18258513

RESUMO

A 48-year-old woman with a diagnosis of breast carcinoma was treated with adjuvant chemotherapy through a central venous catheter with subcutaneous reservoir (Port-A-Cath). While doxorubicin was administered, the patient presented thoracic pain and breathing distress due to superior vena cava perforation by the central catheter and subsequent extravasation of the drug into the mediastinum. The patient recovered without sequelae with conservative therapy. Cytostatic extravasation via central catheter is an uncommon complication in clinical practice. In this paper we present the first doxorubicin extravasation through a central catheter in adults and review the only ten cases found in the literature.


Assuntos
Antineoplásicos/administração & dosagem , Neoplasias da Mama/tratamento farmacológico , Cateterismo Venoso Central/efeitos adversos , Doxorrubicina/administração & dosagem , Extravasamento de Materiais Terapêuticos e Diagnósticos/complicações , Mediastino/patologia , Cateteres de Demora/efeitos adversos , Feminino , Humanos , Infusões Intravenosas , Pessoa de Meia-Idade , Derrame Pleural/etiologia
11.
J Clin Oncol ; 23(13): 3104-11, 2005 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-15860870

RESUMO

PURPOSE: To determine the tolerability of capecitabine in elderly patients with advanced colorectal cancer (CRC). PATIENTS AND METHODS: Fifty-one patients with advanced CRC who were >/= 70 years and considered ineligible for combination chemotherapy received oral capecitabine 1,250 mg/m(2) twice daily on days 1 to 14 every 3 weeks. Patients with a creatinine clearance of 30 to 50 mL/min received a dose of 950 mg/m(2) twice daily. RESULTS: A total of 248 cycles of capecitabine were administered (median, five cycles; range, one to eight cycles). The overall response rate was 24% (95% CI, 15% to 41%), including two complete responses (CR; 4%) and 10 partial responses (PR; 20%). Disease control (CR + PR + stable disease) was achieved in 67% of patients. The median times to disease progression and overall survival were 7 months (95% CI, 6.4 to 9.5 months) and 11 months (95% CI, 8.6 to 13.3 months), respectively. Of the 35 patients evaluated for clinical benefit response, 14 (40%; 95% CI, 24% to 58%) showed clinical benefit. Capecitabine was well tolerated. Treatment-related grade 3 and 4 adverse events were observed in only six patients (12%), and the most common events were diarrhea, hand-foot syndrome, and thrombocytopenia. One patient (2%) had an episode of angina, but no treatment-related deaths were reported. CONCLUSION: Our findings suggest that capecitabine is effective and well tolerated in elderly patients with advanced CRC who are considered ineligible for combination chemotherapy.


Assuntos
Antimetabólitos Antineoplásicos/uso terapêutico , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/patologia , Desoxicitidina/análogos & derivados , Desoxicitidina/uso terapêutico , Administração Oral , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antimetabólitos Antineoplásicos/administração & dosagem , Antimetabólitos Antineoplásicos/efeitos adversos , Capecitabina , Desoxicitidina/administração & dosagem , Desoxicitidina/efeitos adversos , Progressão da Doença , Feminino , Fluoruracila/análogos & derivados , Humanos , Masculino
14.
In. Hernández Morales, Dimas. Inmunoterapia en cáncer. Caracas, Litopar C.A de Artes Gráficas, 28 jun. 1997. p.101-7.
Monografia em Espanhol | LILACS | ID: lil-251924
19.
Rev. venez. neurol. neurocir ; 2(1): 49-51, ene.-jun. 1988. ilus
Artigo em Espanhol | LILACS | ID: lil-79105

RESUMO

Se presenta un caso de meningitis por Actinomices en una paciente femenina de 26 años de edad, diagnosticado por cultivo de LCR y tratado exitisamente en la Policlínica "Santiago de León". Se revisa la bibliografía, encontrandose que la Actinomicosis es una infección poco frecuente y su ubicación cerebral es aún más rara. Se presenta bajo la forma de meningitis, absceso o ambas, y su diagnóstico es dificil por lo inespecífico de los síntomas clínicos, realizándose mediante su sospecha epidemiológica (residencia en ambiente rural, localizaciones viscerales de la enfermedad conocidas, existencia de posibles puertas de entrada, alteraciones inmunitarias); y la posibilidad del cultivo del LCR o material purulento del absceso. El tratamiento es médico a base de antibióticos por tiempo prolongado, llegándose a la cirugía en aquellos casos donde existe un absceso cerebral


Assuntos
Adulto , Humanos , Feminino , Actinomyces/patogenicidade , Meningite/diagnóstico , Antibacterianos/uso terapêutico
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