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1.
Health Qual Life Outcomes ; 19(1): 207, 2021 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-34454527

RESUMO

BACKGROUND: The effect of COVID-19 on Health-Care Professionals' mental health has received increased attention in the last year's literature. However, previous studies essentially evaluated psychopathological symptoms and not the presence of positive mental health. Therefore, the first objective of the present research is to evaluate health-care professionals' mental illness (i.e., anxiety and traumatic intensity) and positive mental health (i.e., well-being) using the Complete State Model of Health. Our second objective is to study the effect of Personal Protection Equipment availability on professionals' mental health. METHODS: Two-hundred and thirty-two health-care professionals working in Spain in the first line of COVID-19 patient care participated in the study. To measure anxiety, traumatic intensity and well-being participants completed the State Trait Anxiety Inventory, the Davidson Trauma Scale, and the Mental Health Continuum-Short Form. Pearson correlations were used to examine the relationships between all scales. In order to test the two continua model of mental health, we used parallel analysis and exploratory factor analysis. To analyze anxiety, traumatic intensity, and well-being differences between health-care professionals with and without Personal Protection Equipment availability we conducted different ANOVAS. To test our hypothesis regarding the moderating role of Personal Protection Equipment availability in the effect of mental illness on positive mental health, data were subjected to a hierarchical regression analysis. RESULTS: As in previous studies, health-care professionals showed high levels of anxiety and traumatic intensity. They also presented low levels of well-being indicators. According to our hypothesis, results of parallel analysis and exploratory factorial analysis indicated that the measures of mental illness and positive mental health loaded on separate but correlated factors. Finally, Personal Protection Equipment availability moderated the effects of state anxiety and traumatic intensity on professionals' well-being. CONCLUSIONS: Health-care professionals' mental illness and positive mental health reflect distinct continua, rather than the extreme ends of a single spectrum. Therefore, it is essential to measure both psychopathology and the presence of positive health to comprehensively evaluate professionals' mental health. Finally, our results indicated that Personal Protection Equipment availability is essential not only for professionals' physical health, but also for their mental health.


Assuntos
Ansiedade/psicologia , COVID-19/psicologia , Pessoal de Saúde/psicologia , Equipamento de Proteção Individual/provisão & distribuição , Qualidade de Vida/psicologia , Adulto , Idoso , COVID-19/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equipamento de Proteção Individual/estatística & dados numéricos , SARS-CoV-2 , Espanha/epidemiologia
2.
Artigo em Inglês | MEDLINE | ID: mdl-34360187

RESUMO

Few studies have analyzed emotional educational experiences through physical education interventions. The objective of this study was to evaluate the effects on socio-emotional competencies of a physical education intervention (i.e., the MooN program) based on the instructional model known as the sports education model (SEM), compared to a physical education intervention based on the traditional model of direct instruction (TM-DI) in preadolescents. The sample consisted of 170 students between 10 and 13 years old (mean age: M = 10.76; standard deviation: SD = 0.73). Participants were randomly assigned to the experimental group (SEM; n = 87) and the active control group (TM-DI; n = 83). In the experimental group, the SEM-based intervention was applied, while in the active control group, an intervention based on the TM-DI was developed. A quasi-experimental design with repeated pre-test and post-test measures and an active control group was used. The self-efficacy inventory for multiple intelligences (IAMI-40) was used to assess the children's socio-emotional competencies. The child perfectionism inventory was applied to evaluate the self-demand perfectionist efforts. The results confirmed that the MooN program (SEM intervention) promoted significant improvements in socio-emotional competencies. These findings support the potential of this physical education instructional model as an emotional education pathway for the socio-emotional improvement of preadolescent students.


Assuntos
Lua , Educação Física e Treinamento , Adolescente , Criança , Emoções , Humanos , Autoeficácia , Estudantes
3.
Cancers (Basel) ; 13(4)2021 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-33672857

RESUMO

The aim of this study was to identify an easily reliable prognostic score that selects the subset of advanced soft tissue sarcoma (ASTS) patients with a higher benefit with trabectedin in terms of time to progression and overall survival. A retrospective series of 357 patients with ASTS treated with trabectedin as second- or further-line in 19 centers across Spain was analyzed. First, it was confirmed that patients with high growth modulation index (GMI > 1.33) were associated with the better clinical outcome. Univariate and multivariate analyses were performed to identify factors associated with a GMI > 1.33. Thus, GEISTRA score was based on metastasis free-interval (MFI ≤ 9.7 months), Karnofsky < 80%, Non L-sarcomas and better response in the previous systemic line. The median GMI was 0.82 (0-69), with 198 patients (55%) with a GMI < 1, 41 (11.5%) with a GMI 1-1.33 and 118 (33.1%) with a GMI > 1.33. The lowest GEISTRA score showed a median of time-to-progression (TTP) and overall survival (OS) of 5.7 and 19.5 months, respectively, whereas it was 1.8 and 3.1 months for TTP and OS, respectively, for the GEISTRA 4 score. This prognostic tool can contribute to better selecting candidates for trabectedin treatment in ASTS.

4.
Acta otorrinolaringol. cir. cabeza cuello ; 49(1): 57-61, 2021. ilus, tab, graf
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1152173

RESUMO

Las lesiones de la región nasofrontal en los niños son un reto diagnóstico debido a su rareza, y su potencial comunicación con el sistema nervioso central también aumenta su complicaciones. Dentro de las principales entidades de esta región se encuentran los quistes dermoides, los gliomas nasales y los encefaloceles. Un abordaje diagnóstico y terapéutico inapropiado podría generar desde simples recurrencias hasta fistulas e infecciones en el sistema nervioso central, que podrían contribuir a mayores complicaciones o incluso, poner en riesgo la vida de los pacientes.


Injuries to the naso-frontal region in children are a diagnostic challenge, associated with their rarity, their complexity also implies their potential communication with the central nervous system. Dermoid cysts, nasal gliomas, and encephaloceles are among the main entities in this region. An inappropriate diagnostic and therapeutic approach could generate from simple recurrences (as in our case), to fistulas and infections of the central nervous system that could contribute to greater complications or even put the lives of patients at risk.


Assuntos
Humanos , Masculino , Criança , Neoplasias Nasais/diagnóstico , Cisto Dermoide/diagnóstico , Nariz/anormalidades , Neoplasias Nasais/cirurgia , Cisto Dermoide/cirurgia
5.
Cancers (Basel) ; 12(9)2020 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-32911761

RESUMO

The Wnt signaling pathway is an important cellular mechanism for regulating differentiation processes as well as cell cycle events, and different inhibitors of this pathway, for example, PRI-724, are showing promising results in clinical trials for treatment of advanced pancreatic adenocarcinoma or ovarian cancer. Growing evidence suggests that Wnt signaling may also be crucial for tumorigenesis and progression of soft tissue sarcomas (STS), a malignant neoplasm with few therapeutic options at an advanced state. Our study with several STS cell lines and primary cultures shows that inhibition of Wnt/ß-catenin signaling with PRI-724 is able to suppress cell viability/proliferation and to increase cell death rates. TCF/ß-catenin-mediated transcriptional activity is decreased in treated cells, leading to downregulation of its target genes CCND1 and CDC25A. The latter was critical because its downregulation via siRNA was able to mimic the effect of PRI-724 on cell cycle arrest and cell death induction. An evaluation of NCBI/GenBank data confirmed that CDC25A mRNA is elevated in STS patients. Importantly, PRI-724 in combination with standard STS chemotherapeutics doxorubicin or trabectedin enhanced their antitumoral effect in a synergistic manner according to isobolographic analysis, suggesting that Wnt inhibition through PRI-724 could be a beneficial combination regime in patients with advanced STS.

6.
Front Psychol ; 11: 1305, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32595571

RESUMO

This study aims to evaluate the impact of an educational intervention on social competence and social acceptance among adolescents. The participants were 106 adolescents aged 12-15 years (M = 13.41 years; SD = 0.81 years). Participants were randomly assigned to the control group (n = 44) and an experimental group (n = 69). In the experimental group, an intervention based on the Sport Education Model (SEM) was applied. While in the control group, an intervention based on the Traditional Model of Direct Instruction (TM-DI) was carried out. An experimental design with repeated pretest and posttest measurements was developed. The Adolescent Multidimensional Social Competence Questionnaire (AMSC-Q) was used to assess social competence. The Guess Who (GW4) questionnaire was used to assess social acceptance (SA) among peers. The preliminary results showed that the intervention based on the SEM (experimental group) promoted more significant improvements in some indicators of social competence and social acceptance among peers than those obtained with the TM-DI (control group). The results confirm a similar impact of the intervention between boys and girls. These preliminary results suggest the potential of the Sport Education Model with adolescents.

8.
JAMA Oncol ; 6(4): 535-541, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32077895

RESUMO

Importance: Active therapeutic combinations, such as trabectedin and radiotherapy, offer potentially higher dimensional response in second-line treatment of advanced soft-tissue sarcomas. Dimensional response can be relevant both for symptom relief and for survival. Objective: To assess the combined use of trabectedin and radiotherapy in treating patients with progressing metastatic soft-tissue sarcomas. Design, Setting, and Participants: Phase 1 of this nonrandomized clinical trial followed the classic 3 + 3 design, with planned radiotherapy at a fixed dose of 30 Gy (3 Gy/d for 10 days) and infusion of trabectedin at 1.3 mg/m2 as the starting dose, 1.5 mg/m2 as dose level +1, and 1.1 mg/m2 as dose level -1. Phase 2 followed the Simon optimal 2-stage design. Allowing for type I and II errors of 10%, treatment success was defined as an overall response rate of 35%. This study was conducted in 9 sarcoma referral centers in Spain, France, and Italy from April 13, 2015, to November 20, 2018. Adult patients with progressing metastatic soft-tissue sarcoma and having undergone at least 1 previous line of systemic therapy were enrolled. In phase 2, patients fitting inclusion criteria and receiving at least 1 cycle of trabectedin and the radiotherapy regimen constituted the per-protocol population; those receiving at least 1 cycle of trabectedin, the safety population. Interventions: Trabectedin was administered every 3 weeks in a 24-hour infusion. Radiotherapy was required to start within 1 hour after completion of the first trabectedin infusion (cycle 1, day 2). Main Outcomes and Measures: The dose-limiting toxic effects of trabectedin (phase 1) and the overall response rate (phase 2) with use of trabectedin plus irradiation in metastatic soft-tissue sarcomas. Results: Eighteen patients (11 of whom were male) were enrolled in phase 1, and 27 other patients (14 of whom were female) were enrolled in phase 2. The median ages of those enrolled in phases 1 and 2 were 42 (range, 23-74) years and 51 (range, 27-73) years, respectively. In phase 1, dose-limiting toxic effects included grade 4 neutropenia lasting more than 5 days in 1 patient at the starting dose level and a grade 4 alanine aminotransferase level increase in 1 of 6 patients at the +1 dose level. In phase 2, among 25 patients with evaluable data, the overall response rate was 72% (95% CI, 53%-91%) for local assessment and 60% (95% CI, 39%-81%) for central assessment. Conclusions and Relevance: The findings of this study suggest that the recommended dose of trabectedin for use in combination with this irradiation regimen is 1.5 mg/m2. The trial met its primary end point, with a high overall response rate that indicates the potential of this combination therapy for achieving substantial tumor shrinkage beyond first-line systemic therapy in patients with metastatic, progressing soft-tissue sarcomas. Trial Registration: ClinicalTrials.gov Identifier: NCT02275286.


Assuntos
Sarcoma/tratamento farmacológico , Sarcoma/radioterapia , Trabectedina/administração & dosagem , Adulto , Idoso , Terapia Combinada , Intervalo Livre de Doença , Relação Dose-Resposta a Droga , Relação Dose-Resposta à Radiação , Feminino , França/epidemiologia , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Sarcoma/patologia , Espanha/epidemiologia , Trabectedina/efeitos adversos
9.
Lancet Oncol ; 21(3): 456-466, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32066540

RESUMO

BACKGROUND: Solitary fibrous tumour is an ultra-rare sarcoma, which encompasses different clinicopathological subgroups. The dedifferentiated subgroup shows an aggressive course with resistance to pazopanib, whereas in the malignant subgroup, pazopanib shows higher activity than in previous studies with chemotherapy. We designed a trial to test pazopanib activity in two different cohorts of solitary fibrous tumour: the malignant-dedifferentiated cohort, which was previously published, and the typical cohort, which is presented here. METHODS: In this single-arm, phase 2 trial, adult patients (aged ≥18 years) diagnosed with confirmed metastatic or unresectable typical solitary fibrous tumour of any location, who had progressed in the previous 6 months (by Choi criteria or Response Evaluation Criteria in Solid Tumors [RECIST]) and an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2 were enrolled at 11 tertiary hospitals in Italy, France, and Spain. Patients received pazopanib 800 mg once daily, taken orally, until progression, unacceptable toxicity, withdrawal of consent, non-compliance, or a delay in pazopanib administration of longer than 3 weeks. The primary endpoint was proportion of patients achieving an overall response measured by Choi criteria in patients who received at least 1 month of treatment with at least one radiological assessment. All patients who received at least one dose of the study drug were included in the safety analyses. This study is registered in ClinicalTrials.gov, NCT02066285, and with the European Clinical Trials Database, EudraCT 2013-005456-15. FINDINGS: From June 26, 2014, to Dec 13, 2018, of 40 patients who were assessed, 34 patients were enrolled and 31 patients were included in the response analysis. Median follow-up was 18 months (IQR 14-34), and 18 (58%) of 31 patients had a partial response, 12 (39%) had stable disease, and one (3%) showed progressive disease according to Choi criteria and central review. The proportion of overall response based on Choi criteria was 58% (95% CI 34-69). There were no deaths caused by toxicity, and the most frequent adverse events were diarrhoea (18 [53%] of 34 patients), fatigue (17 [50%]), and hypertension (17 [50%]). INTERPRETATION: To our knowledge, this is the first prospective trial of pazopanib for advanced typical solitary fibrous tumour. The manageable toxicity and activity shown by pazopanib in this cohort suggest that this drug could be considered as first-line treatment for advanced typical solitary fibrous tumour. FUNDING: Spanish Group for Research on Sarcomas (GEIS), Italian Sarcoma Group (ISG), French Sarcoma Group (FSG), GlaxoSmithKline, and Novartis.


Assuntos
Inibidores de Proteínas Quinases/uso terapêutico , Pirimidinas/uso terapêutico , Tumores Fibrosos Solitários/tratamento farmacológico , Sulfonamidas/uso terapêutico , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Prognóstico , Estudos Prospectivos , Critérios de Avaliação de Resposta em Tumores Sólidos , Tumores Fibrosos Solitários/patologia , Taxa de Sobrevida
10.
Acta otorrinolaringol. cir. cabeza cuello ; 48(2): 173-178, 2020. tab, graf, ilus
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1103906

RESUMO

Actualmente no es sólito tener pacientes con síntomas causados por la implicación de las amígdalas linguales y que pasemos por alto su sospecha. Los signos y síntomas que pueden presentar los pacientes son variados, desde el síndrome de apnea obstructiva del sueño (síntoma más común) y disfagia hasta tos crónica mal abordada y, por lo mismo, tratada inadecuadamente. Presentamos los casos clínicos de dos pacientes con hipertrofia de amígdalas linguales y una revisión narrativa del tema.


Currently, it is not unusual to have patients with symptoms due to the involvement of lingual tonsils and let us go unnoticed their suspicion. The signs and symptoms that patients may present are varied, from giving obstructive sleep apnea syndrome (the most common symptom) dysphagia to poorly treated and poorly treated chronic cough. We present the clinical cases of two patients with hypertrophy of the lingual tonsils and a narrative review of the subject.


Assuntos
Humanos , Síndromes da Apneia do Sono , Diagnóstico , Hipertrofia
11.
Front Psychol ; 10: 2541, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31798502

RESUMO

The objective of the present study was to experimentally assess the effects of a mindfulness-based intervention (MBI) for the improvement of subjective well-being, trait emotional intelligence (TEI), mental health, and resilience in a sample of women with fibromyalgia (FM). The sample consisted of 104 women, between 29 and 77 years old (M = 47.59; SD = 5.93). The measures used were as follows: Satisfaction with Life Scale (SWLS), Positive and Negative Affection Scale (PANAS), Trait Emotional Intelligence Questionnaire Short Form (TEIQue-SF), Mental Health Questionnaire (MH-5), and Resilience Scale (ER-14). A quasi-experimental design of repeated measures with a control group (CG) was used: before and after the application of the treatment and a follow-up assessment 6 months after the completion of the intervention. In order to assess the effect of the program, the participants were randomly assigned to the experimental and control conditions. In the pretest evaluation, a multivariate analysis of variance (MANOVA) and analysis of variance (ANOVA) were carried out. In the post-test evaluation, a multivariate analysis of covariance (MANCOVA) of the study variables as a whole was performed. Then, descriptive analyses and analysis of covariance (ANCOVA) of the post-test scores (covariate pretest score) were performed. In the follow-up evaluation, a MANCOVA of the study variables as a whole was performed. Then, descriptive and ANCOVA analyses of the follow-up scores (covariate pretest score) were performed. In addition, the effect size was calculated using partial eta-squared (µ2). The post-test results confirmed statistically significant differences in satisfaction with life (SWL), positive affect (PA), mental health, and resilience. The follow-up results showed statistically significant differences in SWL, PA, TEI, mental health, and resilience. The study provides an effective intervention tool that has been validated experimentally. The general results allow the emphasis of the importance of the implementation of MBIs framed in non-pharmacological treatments in FM.

12.
Artigo em Inglês | MEDLINE | ID: mdl-31126004

RESUMO

This study aimed to evaluate the impact of a physical-sport education pilot programme on adolescents' subjective well-being (health-related quality of life, positive affect and negative affect), trait emotional intelligence and social anxiety. The programme was based on the pedagogical sport education model within a quality physical education framework, and approached from the perspective of social and emotional learning. Participants were 113 compulsory secondary education students aged 12-15 years that were assigned to a control group (n = 44) and an experimental group (n = 69). A quasi-experimental design with repeated pre-test and post-test measures was used. Bonferroni correction was applied for multiple comparisons. The preliminary results obtained in this investigation revealed that the physical-sport education pilot programme promoted significant improvements in a specific indicator of subjective well-being and trait emotional intelligence in the experimental group. These encouraging findings support the pedagogical efficiency of the programme with regard to the programme aim. The findings also highlight the feasibility and appropriateness of the programme in terms of an innovative teaching proposal.


Assuntos
Comportamento do Adolescente/psicologia , Ansiedade/prevenção & controle , Inteligência Emocional , Qualidade de Vida/psicologia , Esportes/psicologia , Estudantes/psicologia , Adolescente , Criança , Feminino , Humanos , Masculino , Espanha
14.
Clin Chim Acta ; 487: 1-5, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30205081

RESUMO

BACKGROUND: High-dose methotrexate (HDMTX) therapy is a key component of many chemotherapy protocols. However, some patients develop HDMTX-induced nephrotoxicity. Carboxypeptidase-G2 (CPDG2) hydrolyses MTX into 2,4-diamino-N10-methylpteroic acid (DAMPA) and glutamic acid, and is used as a rescue agent in patients with nephrotoxicity and delayed elimination. Despite the frequency of HDMTX-induced renal injury, crystalluria is uncommon. Furthermore, crystals are rarely identified by conventional chemical methods. OBJECTIVE: To determine the composition of crystalluria in a patient with osteosarcoma who was treated with CPDG2. METHODS: Crystalluria was evaluated by optical microscopy, and chemical identification was performed by Fourier-transform infrared (FT-IR) spectroscopy, scanning electron microscopy (SEM) and Orbitrap™ high-resolution mass spectrometry (HRMS). RESULTS: The HRMS spectra of the patient's urine sediment showed a main peak at m/z 326.13, corresponding to the molecular mass of DAMPA [(C15H15O2N7) + H+]. The FT-IR spectral patterns of the sediment and DAMPA were not identical. SEM was unable to identify the crystal. CONCLUSION: DAMPA crystalluria was identified by Orbitrap™ HRMS in a patient treated with CPDG2 after HDMTX nephrotoxicity. This case reinforces the need to implement adequate measures to prevent nephrotoxicity. In cases of HDMTX-induced nephrotoxicity, urine sediment analysis should be requested.


Assuntos
Rim/efeitos dos fármacos , Metotrexato/análogos & derivados , Metotrexato/efeitos adversos , Osteossarcoma/metabolismo , gama-Glutamil Hidrolase/metabolismo , Adulto , Feminino , Humanos , Hidrólise , Rim/metabolismo , Rim/patologia , Metotrexato/química , Metotrexato/metabolismo , Metotrexato/uso terapêutico , Metotrexato/urina , Osteossarcoma/tratamento farmacológico , Osteossarcoma/patologia , Tamanho da Partícula , Propriedades de Superfície , gama-Glutamil Hidrolase/fisiologia
15.
Gastroenterol. hepatol. (Ed. impr.) ; 41(5): 293-301, mayo 2018. ilus, tab, graf
Artigo em Inglês | IBECS | ID: ibc-180597

RESUMO

BACKGROUND: Most pancreatic cysts (PCs) found incidentally by CT and MRI scans might not be clinically important according to the Fukuoka guidelines, the American Gastroenterological Association (AGA) guidelines and European guidelines. AIMS: To determine and compare the prevalence of incidental clinically important PCs (CIPCs). METHODS: Abdominal contrast-enhanced CT or MRI scans performed during a one-year period were retrospectively reviewed to identify incidental PCs. CIPCs were defined as those cysts that would be capable of triggering further evaluation with endoscopic ultrasound, immediate surveillance (within 3-6 months) and/or surgery. Prevalence was calculated as the number of patients with CIPCs per 100 subjects imaged (%). RESULTS: Sixty patients (mean age 70 ± 14 years) out of 565 were found to have incidental PCs, representing a prevalence of 8.7% (95% CI 6.3-11.5) in CT scans and 27.5% (95% CI 16-41) in MRI scans. Seven patients (11.6%, 95% CI 5-22) had CIPCs based on size ≥ 30 mm (n = 5), size ≥ 30 mm and pancreatic duct (PD) dilation (n = 1) and PD dilation and presence of solid component (n = 1). Based on the Fukuoka guidelines, the prevalence of CIPCs was 1.2% (95% CI 0.4-2.5) in CT scans (6/507) and 1.7% (95% CI 0.1-9) in MRI scans (1/58). Based on the AGA and European guidelines, the prevalence of CIPCs was 0.2% (95% CI 0.1-1) in CT scans (1/507) and 1.7% (95% CI 0.1-9) in MRI scans (1/58). Patients with PCs initially classified as "AGA- or European-positive" had a higher surgical probability and this decision was taken earlier in the follow-up. CONCLUSIONS: In our cohort, the prevalence of important incidental pancreatic cysts was not negligible at around 1% according to current guidelines


ANTECEDENTES: La mayoría de los quistes de páncreas (PC) hallados incidentalmente en las tomografías (TC) y las resonancias magnéticas (RMN) podrían no ser clínicamente importantes de acuerdo con las actuales guías Fukuoka, American Gastroenterological Association (AGA) y europea. OBJETIVOS: Determinar y comparar la prevalencia de PC incidentales clínicamente importantes (CIPCs). MÉTODOS: Se revisaron retrospectivamente las TC de abdomen con contraste y las RMN durante un período de un año para identificar PCs incidentales. Los CIPC se definieron como aquellos quistes que serían capaces de desencadenar una evaluación ulterior con ecoendoscopia, vigilancia en un corto intervalo (3-6 meses) y/o cirugía. La prevalencia se calculó como el número de pacientes con CIPC por cada 100 sujetos estudiados (%). RESULTADOS: Se encontró que 60 (edad media 70 ± 14 años) de 565 pacientes tenían PC incidentales, lo que representó una prevalencia de 8,7% (IC95% 6,3-11,5) en las TC y 27,5% (IC95% 16-41) en las RMN. Siete pacientes (11,6%, IC 95% 5-22) tenían CIPC basados en el tamaño ≥ 30 mm (n = 5), tamaño ≥ 30 mm y dilatación del conducto pancreático (PD) (n = 1), y dilatación de PD y presencia de componente sólido (n = 1). Basándonos en la guía Fukuoka, la prevalencia de CIPC fue de 1,2% (IC95% 0,4-2,5) en las TC (6/507) y 1,7% (IC95% 0,1-9) en las RMN (1/58). Basado en las guías AGA y europea, la prevalencia de CIPC fue de 0,2% (IC95% 0,1-1) en las TC (1/507) y 1,7% (IC 95% 0,1-9) en las RMN (1/58). Los pacientes con PC inicialmente clasificados como "AGA o europea positivo" tuvieron una mayor probabilidad quirúrgica y esta decisión se tomó antes en el seguimiento. CONCLUSIONES: En nuestra cohorte, la prevalencia de quistes pancreáticos incidentales y relevantes no fue despreciable, siendo cercana al 1% según las guías actuales


Assuntos
Humanos , Imageamento por Ressonância Magnética , Cisto Pancreático/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Cisto Pancreático/epidemiologia , Guias de Prática Clínica como Assunto , Prevalência , Estudos Retrospectivos , Achados Incidentais
16.
Gastroenterol Hepatol ; 41(5): 293-301, 2018 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29429557

RESUMO

BACKGROUND: Most pancreatic cysts (PCs) found incidentally by CT and MRI scans might not be clinically important according to the Fukuoka guidelines, the American Gastroenterological Association (AGA) guidelines and European guidelines. AIMS: To determine and compare the prevalence of incidental clinically important PCs (CIPCs). METHODS: Abdominal contrast-enhanced CT or MRI scans performed during a one-year period were retrospectively reviewed to identify incidental PCs. CIPCs were defined as those cysts that would be capable of triggering further evaluation with endoscopic ultrasound, immediate surveillance (within 3-6 months) and/or surgery. Prevalence was calculated as the number of patients with CIPCs per 100 subjects imaged (%). RESULTS: Sixty patients (mean age 70±14 years) out of 565 were found to have incidental PCs, representing a prevalence of 8.7% (95% CI 6.3-11.5) in CT scans and 27.5% (95% CI 16-41) in MRI scans. Seven patients (11.6%, 95% CI 5-22) had CIPCs based on size ≥ 30mm (n=5), size ≥ 30mm and pancreatic duct (PD) dilation (n=1) and PD dilation and presence of solid component (n=1). Based on the Fukuoka guidelines, the prevalence of CIPCs was 1.2% (95% CI 0.4-2.5) in CT scans (6/507) and 1.7% (95% CI 0.1-9) in MRI scans (1/58). Based on the AGA and European guidelines, the prevalence of CIPCs was 0.2% (95% CI 0.1-1) in CT scans (1/507) and 1.7% (95% CI 0.1-9) in MRI scans (1/58). Patients with PCs initially classified as "AGA- or European-positive" had a higher surgical probability and this decision was taken earlier in the follow-up. CONCLUSIONS: In our cohort, the prevalence of important incidental pancreatic cysts was not negligible at around 1% according to current guidelines.


Assuntos
Imageamento por Ressonância Magnética , Cisto Pancreático/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Achados Incidentais , Pessoa de Meia-Idade , Cisto Pancreático/epidemiologia , Guias de Prática Clínica como Assunto , Prevalência , Estudos Retrospectivos , Adulto Jovem
18.
Medicine (Baltimore) ; 96(52): e9523, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29384960

RESUMO

The main objective of the study was to evaluate the efficacy and safety of dabrafenib alone or combined with trametinib for compassionate use in patients with metastatic melanoma.This retrospective, observational study involved 135 patients with unresectable stage IIIC or stage IV melanoma from an expanded-access program at 30 Spanish centers.Forty-eight patients received dabrafenib monotherapy and 87 received combination dabrafenib and trametinib; 4.4% and 95.6% of the patients had stage IIIC and IV melanoma, respectively. All patients showed BRAF mutations in their primary or metastatic lesions; 3 were positive for V600K while the remainder had V600E or V600+. A positive response to treatment was reported in 89.3% of the patients. Overall survival rates at 12 and 24 months were 59.6% (95% confidence interval [CI], 52.5-68.9%) and 36.4% (95% CI, 27.8-45%), respectively. Progression-free survival rates at 12 and 24 months were 39.3% (95% CI, 31.1-47.5%) and 21.6% (95% CI, 14.5-28.7%), respectively. Fifty-seven patients (42.2%) reported cutaneous toxicity of any type, mainly hyperkeratosis (14.8%) and rash (11.9%). The most frequent adverse events were pyrexia (27.4%), asthenia (19.3%), arthralgia (16.9%), and diarrhoea (13.2%).Our results suggest that both dabrafenib alone or in combination with trametinib are effective for compassionate use in terms of response and/or survival rates. However, differences in patients' prognostic features ought to be considered. No new findings were revealed regarding the safety profiles of either regimen. This is the first study to evaluate the efficacy of these 2 selective BRAF and mitogen-activated extracellular signal-regulated kinase inhibitors in a real-world setting in Spain.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Imidazóis/uso terapêutico , Melanoma/tratamento farmacológico , Melanoma/patologia , Oximas/uso terapêutico , Piridonas/uso terapêutico , Pirimidinonas/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Ensaios de Uso Compassivo , Feminino , Humanos , Imidazóis/administração & dosagem , Imidazóis/efeitos adversos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Oximas/administração & dosagem , Oximas/efeitos adversos , Piridonas/administração & dosagem , Piridonas/efeitos adversos , Pirimidinonas/administração & dosagem , Pirimidinonas/efeitos adversos , Estudos Retrospectivos , Espanha , Análise de Sobrevida
19.
PLoS One ; 11(11): e0166962, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27893826

RESUMO

The seasonal and interannual variability of vertical transport (upwelling/downwelling) has been relatively well studied, mainly for the California Current System, including low-frequency changes and latitudinal heterogeneity. The aim of this work was to identify potentially predictable patterns in upwelling/downwelling activity along the North American west coast and discuss their plausible mechanisms. To this purpose we applied the min/max Autocorrelation Factor technique and time series analysis. We found that spatial co-variation of seawater vertical movements present three dominant low-frequency signals in the range of 33, 19 and 11 years, resembling periodicities of: atmospheric circulation, nodal moon tides and solar activity. Those periodicities might be related to the variability of vertical transport through their influence on dominant wind patterns, the position/intensity of pressure centers and the strength of atmospheric circulation cells (wind stress). The low-frequency signals identified in upwelling/downwelling are coherent with temporal patterns previously reported at the study region: sea surface temperature along the Pacific coast of North America, catch fluctuations of anchovy Engraulis mordax and sardine Sardinops sagax, the Pacific Decadal Oscillation, changes in abundance and distribution of salmon populations, and variations in the position and intensity of the Aleutian low. Since the vertical transport is an oceanographic process with strong biological relevance, the recognition of their spatio-temporal patterns might allow for some reasonable forecasting capacity, potentially useful for marine resources management of the region.


Assuntos
Ecossistema , Estações do Ano , Água do Mar/química , Movimentos da Água , América do Norte , Temperatura
20.
Am J Gastroenterol ; 111(6): 871-8, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27068719

RESUMO

OBJECTIVES: The risk of developing metachronous advanced neoplastic lesions (ANLs) during surveillance after resection of sessile serrated adenomas (SSAs) has not been quantified. METHODS: Patients with sporadic SSAs resected between 1 April 2007 and 31 December 2009 who underwent surveillance colonoscopy in our institution were prospectively evaluated. Patients with low-risk adenomas (LRAs), high-risk adenomas (HRAs), and negative index colonoscopy (NIC) during the same period were identified using the pathology database and electronic medical records, and were also included as a comparison cohort. The primary outcome was the comparison of the study groups with regard to incidence of metachronous ANLs during surveillance colonoscopy. RESULTS: A total of 185 patients had SSAs, of whom 75 with 101 resected polyps were finally included. The comparison cohort consisted of 564 patients: 140 LRAs (160 polyps), 87 HRAs (478 polyps), and 337 NICs. The overall mean colonoscopy follow-up was for 54.5 months (±s.d. 14). SSA patients with synchronous HRA on index colonoscopy presented a higher incidence rate of metachronous ANL (12.96 per 1,000 person-months) compared with patients with HRA (5.07 per 1,000 person-months), whereas those with synchronous LRA and without synchronous adenoma on index colonoscopy presented a low incidence rate of metachronous ANL (0 and 1.41 per 1,000 person-months, respectively) similar to LRA (1.47 per 1,000 person-months). Among patients with SSA the 3- and 5-year ANL free-cumulative probability was 64.3 and 32.1% in those with synchronous HRA, 100 and 100% in those with synchronous LRA, and 95.1 and 91.7% if no synchronous adenoma was found. CONCLUSIONS: Among patients with resected sporadic SSAs the risk of developing metachronous ANL is influenced by the presence of synchronous HRA on index colonoscopy. Patients with SSAs and synchronous HRA on index colonoscopy require closer surveillance, whereas those with synchronous LRA and those without synchronous adenomas may be followed up in the same way as those with LRAs.


Assuntos
Adenoma/patologia , Neoplasias do Colo/patologia , Pólipos do Colo/patologia , Segunda Neoplasia Primária/patologia , Adenoma/epidemiologia , Adenoma/cirurgia , Idoso , Argentina/epidemiologia , Neoplasias do Colo/epidemiologia , Pólipos do Colo/epidemiologia , Pólipos do Colo/cirurgia , Colonoscopia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária/epidemiologia , Vigilância da População , Risco
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