Métodos no farmacológicos como medida efectiva en el control del dolor en el parto eutócico / Non-pharmacological methods as an effective measure for pain management in normal delivery

Objetivo: estudiar el uso de las medidas no farmacológicas existentes para el control del dolor en el parto eutócico. Específicamente se pretende mostrar las ventajas y los inconvenientes de cada uno de estos métodos, así como reflejar el papel de la matrona en su aplicación.Método: se ha realizado una revisión narrativa en las bases de datos Pubmed, CINAHL, Cuiden, Scielo y Cochrane Plus. También se ha recurrido a Google Académico. Se han utilizado los filtros de idioma (español, inglés y portugués) y de fecha (de 2018 a 2023).Resultados: se han incluido 33 artículos. La hidroterapia, el acompañamiento, la libertad de movimientos, el balón suizo y las inyecciones de agua estéril han mostrado resultados favorables en relación con el alivio del dolor en el parto. La estimulación eléctrica nerviosa transcutánea, acupresión, aromaterapia, musicoterapia o técnicas de relajación cuentan con resultados de baja calidad. Su combinación tiene un efecto positivo. La matrona es la encargada principalmente de informar y ejecutar estos métodos.Conclusiones: los resultados muestran que estas medidas son una alternativa para controlar el dolor en el parto, ofreciendo numerosos beneficios y escasos efectos adversos, aunque es necesario realizar más investigación sobre alguna de estas técnicas. La formación de las matronas es esencial para seguir impulsando su utilización. (AU)

Objective: to study the use of existing non-pharmacological measures for pain management in normal delivery. It is specifically intended to show the advantages and drawbacks of each of these methods, as well as to show the role of the midwife in their application.Method: a narrative review was conducted in the Pubmed, CINAHL, Cuiden, Scielo and Cochrane Plus databases. Google Academic was also a resource. Language filters were used (Spanish, English and Portuguese), as well as date filters (from 2018 to 2023).Results: the study included 33 articles. Hydrotherapy, accompaniment, freedom of movements, the fitness ball, and sterile water injections, have shown favourable results in terms of pain relief during delivery. On the other hand, transcutaneous electrical nerve stimulation, acupressure, aromatherapy, music therapy or relaxation techniques presented low quality results. Their combination had a positive effect. The midwife is mostly in charge of informing about these methods and conducting them.Conclusions: the results showed that these measures are an alternative in order to manage pain during delivery, offering many benefits and few adverse effects, although it is necessary to conduct further research about some of these techniques. Midwife training is essential in order to continue promoting their use. (AU)

Papel de la radioterapia en el manejo de las metástasis vertebrales: últimas novedades / Role of radiotherapy in the management of spine metastases

Las metástasis vertebrales son una causa común de dolor en el paciente oncológico, lo cual puede generar limitación funcional, además de complicaciones derivadas de una posible compresión medular, radicular y fracturas. Se requiere de un abordaje complejo de estas metástasis por el riesgo de secuelas permanentes. Con el aumento de las supervivencia gracias a los nuevos tratamientos emergentes, las posibilidades de presentar metástasis vertebrales son cada vez mayores, por ende, el manejo de estas lesiones debe ir encaminado al alivio del dolor y el mantenimiento de la deambulación. La radioterapia juega un papel fundamental en el manejo de estas lesiones, y disponemos de avances tecnológicos en los últimos años que han permitido mejorar la calidad e intencionalidad de los tratamientos, pasando de ser meramente paliativos a proponer tratamientos que mejoren el control local. En este articulo hacemos una descripción de como la técnica de SBRT (stereotactic body radiotherapy), en pacientes seleccionados puede mejorar el control local de forma más duradera, y el valor que tiene en paciente oligometastásico y tras cirugía.(AU)

Spine metastases are a common cause of pain in the oncologic patient which can generate functional limitation, in addition to complications derived from spinal cord compression, radicular compression and fractures. A complex approach to these metastases is required due to the risk of permanent sequelae. With the increase in survival rates due to new emerging treatments, the possibilities of presenting vertebral metastases are increasing, therefore, the management of these lesions should be aimed at pain relief and maintenance of ambulation. Radiotherapy has a fundamental role in the management of these lesions, and technological advances in recent years have made it possible to improve the quality and intentionality of the treatments, going from having a palliative intent to proposing treatments that improve local control. In this article we describe how the stereotactic body radiotherapy (SBRT) technique, in selected patients, can improve local control and its value in oligometastatic patients and after surgery.(AU)

[Translated article] Role of radiotherapy in the management of spine metastases / Papel de la radioterapia en el manejo de las metástasis vertebrales: últimas novedades

Las metástasis vertebrales son una causa común de dolor en el paciente oncológico, lo cual puede generar limitación funcional, además de complicaciones derivadas de una posible compresión medular, radicular y fracturas. Se requiere de un abordaje complejo de estas metástasis por el riesgo de secuelas permanentes. Con el aumento de las supervivencia gracias a los nuevos tratamientos emergentes, las posibilidades de presentar metástasis vertebrales son cada vez mayores, por ende, el manejo de estas lesiones debe ir encaminado al alivio del dolor y el mantenimiento de la deambulación. La radioterapia juega un papel fundamental en el manejo de estas lesiones, y disponemos de avances tecnológicos en los últimos años que han permitido mejorar la calidad e intencionalidad de los tratamientos, pasando de ser meramente paliativos a proponer tratamientos que mejoren el control local. En este articulo hacemos una descripción de como la técnica de SBRT (stereotactic body radiotherapy), en pacientes seleccionados puede mejorar el control local de forma más duradera, y el valor que tiene en paciente oligometastásico y tras cirugía.(AU)

Spine metastases are a common cause of pain in the oncologic patient which can generate functional limitation, in addition to complications derived from spinal cord compression, radicular compression and fractures. A complex approach to these metastases is required due to the risk of permanent sequelae. With the increase in survival rates due to new emerging treatments, the possibilities of presenting vertebral metastases are increasing, therefore, the management of these lesions should be aimed at pain relief and maintenance of ambulation. Radiotherapy has a fundamental role in the management of these lesions, and technological advances in recent years have made it possible to improve the quality and intentionality of the treatments, going from having a palliative intent to proposing treatments that improve local control. In this article we describe how the stereotactic body radiotherapy (SBRT) technique, in selected patients, can improve local control and its value in oligometastatic patients and after surgery.(AU)

Translating Microbiome Research From and To the Clinic.

Extensive research has elucidated the influence of the gut microbiota on human health and disease susceptibility and resistance. We review recent clinical and laboratory-based experimental studies associating the gut microbiota with certain human diseases. We also highlight ongoing translational advances that manipulate the gut microbiota to treat human diseases and discuss opportunities and challenges in translating microbiome research from and to the bedside.

Recensión. El modelo PLISSIT: una propuesta de esquema conceptual para el tratamiento conductual de los problemas sexuales / Critical review. The PLISSIT model: a proposed conceptual scheme for the behavioral treatment of sexual problems

El artículo muestra una guía orientada a profesionales de la salud cuyo objetivo es ordenar los problemas sexuales y dar herramientas sobre cómo abordar los mismos a través de la teoría del aprendizaje. El modelo conceptual de Annon ha posibilitado un mejor manejo de la situación a la hora de implementar un abordaje en la esfera sexual por parte de los profesionales, y a través de esta recensión se discute su uso pertinente en la actualidad. (AU)

The article shows a guide aimed at health professionals whose objective is to order sexual problems and provide tools on how to address them through learning theory. Annon’s conceptual model has made possible a better management when implementing a sexual oriented approach by professionals, so through this critical review, its pertinent use nowadays is discussed. (AU)

Questioning Established Theories and Treatment Methods Related to Iron and Other Metal Metabolic Changes, Affecting All Major Diseases and Billions of Patients.

The medical and scientific literature is dominated by highly cited historical theories and findings [...].

Influencia de la actividad física en la prevención, tratamiento antineoplásico y supervivencia de pacientes con cáncer de mama / Influence of physical activity on the prevention, antineoplastic treatment and survival of patients with breast cancer

Introducción Durante las 2 últimas décadas, numerosos estudios han investigado el impacto de la actividad física en el tratamiento del cáncer. El objetivo de esta revisión versa en obtener recomendaciones basadas en la evidencia científica publicada más recientemente acerca de la influencia de la actividad física en el cáncer de mama, tanto en lo que se refiere a prevención, así como durante el tratamiento antineoplásico y supervivencia. Resultados La actividad física es capaz de interaccionar sobre diferentes mecanismos biológicos típicamente alterados en el cáncer de mama, como son: marcadores inflamatorios, hormonas sexuales, eje insulina/IGF-I, hormonas suprarrenales, vitamina D, sistema inmune, estrés oxidativo y reparación del ADN; dando así resultados positivos en cuanto a disminución del riesgo de carcinogénesis, aumento de calidad de vida y mejora de los efectos secundarios derivados del tratamiento, así como disminución de la recurrencia tumoral y aumento de la supervivencia global. Conclusión La actividad física aeróbica y de fuerza-resistencia aparecen ampliamente recomendadas y justificadas en la literatura científica para la prevención y mejora multidimensional de las pacientes con cáncer de mama y supervivientes, estableciendo una serie de precauciones/contraindicaciones ante situaciones de eventual riesgo. El conocimiento de la heterogeneidad del cáncer de mama y de los diferentes mecanismos biológicos implicados en su desarrollo y perpetuación permitirán personalizar la indicación y tratamiento farmacológico/físico para cada paciente. (AU)

Introduction In the last few decades, several studies have investigated the impact of physical activity on the treatment of cancer. The aim of this study was to establish recommendations based on the most recent scientific evidence on the effect of physical activity on breast cancer, in terms of prevention, antineoplastic treatment, and survival. Results Physical activity affects various biological mechanisms typically altered in breast cancer, such as inflammatory markers, sex hormones, insulin axis/IGF-1, adrenal hormones, vitamin D, the immune system, oxidative stress, and DNA repair. These findings indicate a positive impact in terms of reducing the risk of carcinogenesis, adverse treatment effects and tumoural recurrence, enhancing quality of life, and increasing overall survival. Conclusion Aerobic physical activity and strength-resistance training are widely recommended and justified in the scientific literature for prevention and multidimensional improvement in patients with breast cancer and breast cancer survivors, allowing a series of precautions/contraindications to be made in situations of eventual risk. Knowledge of the heterogeneity of breast cancer and of the various biological mechanisms involved in its development and perpetuation will allow personalised indications and drug/physical treatment for each patient. (AU)

Contemporary trends in management of stage 1 seminoma.

PURPOSE: Surveillance is now the preferred treatment strategy for patients with stage 1A/1B seminoma as reflected by the National Comprehensive Cancer Network guidelines. In this study, we aimed to describe trends in adjuvant management strategy for stage 1A/B seminoma from 2004 to 2016 using the National Cancer Database. MATERIALS AND METHODS: The database was queried for patients diagnosed with stage 1A/1B seminoma between 2004 and 2016. Staging was determined using the American Joint Committee on Cancer guidelines. Surveillance was defined as no treatment with chemotherapy or radiation within 60 days of diagnosis. Proportions of cancer patients utilizing surveillance, radiation, and single-agent chemotherapy were summarized annually. Kaplan-Meier survival analysis was used to compare overall survival between groups. RESULTS: 8,686 patients with stage 1A/1B seminoma met inclusion criteria over the course of the study period. Overall, 3,004 (34.6%) patients began adjuvant chemotherapy or radiation within 60 days. Utilization of surveillance increased from 39.8% in 2004 to 86.8% in 2016 while utilization of radiation decreased from 59.7% to 4.6%. High-volume centers adopted surveillance earlier than low-volume centers. CONCLUSION: This study describes trends in utilization of surveillance, chemotherapy, and radiotherapy for stage 1A/1B seminoma over 12 years. A major shift from utilization of adjuvant treatment to surveillance in patients with stage 1A/B seminoma is observed in this large national cancer database; a minority of patients now receive adjuvant treatment and risk-related toxicities. Survival analysis reveals similar survival at a median 5-year follow-up. The results provide insight into the time needed for clinical practice to adopt the preferred approach of surveillance over the time period studied.

DIRECTRIZ NACIONAL DE APOIO PSICOSSOCIAL NOS CUIDADOS E TRATAMENTO DO HIV / NATIONAL GUIDELINE FOR SUPPORT IN THE CARE AND AND TREATMENT OF HIV

A adesão do paciente ao TARV é considerada de uma dimensão crucial para os programas de HIV em todo o mundo. O Apoio Psicossocial (APSS) tem o papel fundamental de garantir acções de suporte e monitoria da adesão e deve fazer parte das directrizes técnicas voltadas para os serviços de saúde que assistem PVHIV em tratamento antirretroviral. A complexidade do tratamento antirretroviral, exige dos provedores de saúde um esforço acrescido para garantir qualidade na oferta dos seus serviços e responder as necessidades do elevado número de pacientes que procuram os cuidados de saúde para o HIV. Em 2015, o Ministério da Saúde, aprovou a Directriz Nacional de Apoio Psicossocial e Prevenção Positiva, de modo a padronizar as orientações de atendimento da equipe multidisciplinar da unidade sanitária, fornecendo um pacote de aconselhamento essencial para a preparação para o início do TARV, seguimento e reforço da adesão dos pacientes diagnosticados com o HIV. Na sua abordagem de introdução do APSS e PP, o MISAU menciona como prioridade, "Garantir que todas as PVHIV que procuram cuidados e tratamento tenham acesso a um pacote básico de serviços psicossociais e de suporte, incluindo a Prevenção Positiva para garantir autonomia, vida positiva e redução nas novas infecções, tendo como estratégia a implementação do pacote básico de APSS & PP em 80% das Unidades Sanitárias TARV do País".

Limites e potencialidades na pesquisa com foco em grupo terapêutico transdisciplinar / Limits and potentialities in research focusing on a transdisciplinary therapeutic group: an experimental report

Objetivo: Descrever os efeitos da realização de um grupo terapêutico transdisciplinar, en-volvendo a Psicologia e a Fonoaudiologia, destinada a uma criança com deficiência in-telectual e sua família, bem como apresentar os aspectos burocráticos para a execução desse projeto de pesquisa em uma faculdade de pequeno porte.Método: foi realizada uma pesquisa qualitativa e descritiva, com o relato de experiência do processo de tramitação do projeto até a execução dos grupos terapêuticos com uma criança com diagnóstico de deficiência intelectual e sua família, envolvendo profissionais e acadêmicas da Psicologia e da Fonoaudiologia. Resultados: Muitos desafios foram encontrados nesse percurso desde a elaboração do projeto até a captação dos participantes, entre eles o pouco engajamento da maioria das acadêmicas envolvidas e a interrupção do projeto devido à pandemia da COVID-19. Mesmo assim, alguns avanços foram percebidos na família, como busca por terapeuta ocupacional para auxiliar no caso e esforço para dar mais independência à crian-ça. Considerações finais: Conclui-se que a pesquisa ainda é pouco valorizada no Brasil em diferentes instâncias e que a realização de grupos terapêuticos transdisciplinares parece ser uma estratégia promissora na melhora da dinâmica familiar, na comunicação e na indepen-dência das pessoas com deficiência intelectual.

Aim:The aim was to describe the effects of a transdisciplinary therapeutic group, inclu-ding Psychology and Speech Pathology, with a child with an intellectual disability and her family. We also aimed to present the bureaucratic aspects faced to carry out this research in a small college. Method:Qualitative and descriptive research was conducted, with an experimental report on the whole project process and the implementation of therapeutic groups with a preteen diagnosed with intellectual disability and her family. The therapists were Psychology and Speech Therapy professionals and students. Results: Many challen-ges occurred in the process, such as: attracting participants, little engagement of students, and a project interruption due to the coronavirus pandemic. However, we were able to verify some progress; the family hired an occupational therapist to help them, for instance. They were also more engaged in promoting independence for the child.Conclusion: Re-search is underrated in Brazil, considering different places and situations. Implementing transdisciplinary groups can be a promising strategy for improving family relationships, communication, and independence of people with intellectual disabilities.

Water-Splitting Based and Related Therapeutic Effects: Evolving Concepts, Progress, and Perspectives.

Water-splitting has been extensively studied especially for energy applications. It is often not paid with enough attention for biomedical applications. In fact, several innovative breakthroughs have been achieved in the past few years by employing water-splitting for treating cancer and other diseases. Interestingly, among these important works, only two reports have mentioned the term "water-splitting." For this reason, the importance of water-splitting for biomedical applications is significantly underestimated. This progress work is written with the aims to explain and summarize how the principle of water-splitting is employed to achieve therapeutic results not offered by conventional approaches. It is expected that this progress report will not only explain the importance of water-splitting to scientists in the biomedical fields, it should also draw attention from scientists working on energy applications of water-splitting.

Sexual dysfunctions and sex therapy: The role of a general practitioner.

BACKGROUND: Medical management is undeniably an important therapeutic intervention for selected sexual dysfunctions, but it does not serve as a stand-alone approach to treat many common sexual dysfunctions such as lack of interest in sex, sexual performance anxiety, inability to reach orgasm or too quick an orgasm. OBJECTIVE: The aim of this article is to highlight the role of general practitioners (GPs) in recognising sexual problems, encourage initiation of conversation about sexual dysfunction with patients and raise awareness of sex therapy and presentations that may benefit from referral to sex therapists. DISCUSSION: GPs in Australia have a significant role in addressing sexual health concerns despite practice-related and doctor-patient-related barriers, thereby promoting the healthy sexuality of Australians. Sex therapy is a specialty comprised of various medical, cognitive, emotional and behavioural interventions. Sex therapists, who are healthcare professionals with tertiary training in human sexuality, can share care with GPs to help individuals and/or couples understand, improve and resolve their sexual dysfunctions.

Oncolytic viruses for cancer immunotherapy.

In this review, we discuss the use of oncolytic viruses in cancer immunotherapy treatments in general, with a particular focus on adenoviruses. These serve as a model to elucidate how versatile viruses are, and how they can be used to complement other cancer therapies to gain optimal patient benefits. Historical reports from over a hundred years suggest treatment efficacy and safety with adenovirus and other oncolytic viruses. This is confirmed in more contemporary patient series and multiple clinical trials. Yet, while the first viruses have already been granted approval from several regulatory authorities, room for improvement remains.As good safety and tolerability have been seen, the oncolytic virus field has now moved on to increase efficacy in a wide array of approaches. Adding different immunomodulatory transgenes to the viruses is one strategy gaining momentum. Immunostimulatory molecules can thus be produced at the tumor with reduced systemic side effects. On the other hand, preclinical work suggests additive or synergistic effects with conventional treatments such as radiotherapy and chemotherapy. In addition, the newly introduced checkpoint inhibitors and other immunomodulatory drugs could make perfect companions to oncolytic viruses. Especially tumors that seem not to be recognized by the immune system can be made immunogenic by oncolytic viruses. Logically, the combination with checkpoint inhibitors is being evaluated in ongoing trials. Another promising avenue is modulating the tumor microenvironment with oncolytic viruses to allow T cell therapies to work in solid tumors.Oncolytic viruses could be the next remarkable wave in cancer immunotherapy.

The pediatric patient and future fertility: optimizing long-term male reproductive health outcomes.

Globally, male factor infertility accounts for 20%-70% of couples struggling to conceive. Certain male pediatric developmental conditions, such as cryptorchidism, hypospadias, testicular and other childhood cancers, infections, and pediatric varicocele have been associated with future infertility. Early fertility preservation, especially in those with pending chemotherapy or genetic conditions such as Klinefelter syndrome, should be strongly considered in patients expected to experience testicular loss. Although optimal treatment timing may be unknown owing to a paucity of long-term prospective studies, early diagnosis and targeted treatment may optimize fertility potential in adulthood.

Enabling Technologies for Personalized and Precision Medicine.

Individualizing patient treatment is a core objective of the medical field. Reaching this objective has been elusive owing to the complex set of factors contributing to both disease and health; many factors, from genes to proteins, remain unknown in their role in human physiology. Accurately diagnosing, monitoring, and treating disorders requires advances in biomarker discovery, the subsequent development of accurate signatures that correspond with dynamic disease states, as well as therapeutic interventions that can be continuously optimized and modulated for dose and drug selection. This work highlights key breakthroughs in the development of enabling technologies that further the goal of personalized and precision medicine, and remaining challenges that, when addressed, may forge unprecedented capabilities in realizing truly individualized patient care.