RESUMO
INTRODUCTION: Training on impression disinfection is often limited to brief explanations in the clinic. This investigation assessed knowledge on this topic amongst clinical students in our university, produced a pill of knowledge to suit their needs, and evaluated its impact and acceptance. MATERIAL AND METHODS: A pre-post study was designed to identify knowledge gaps using an anonymous, voluntary self-applied questionnaire before and after watching an audio-visual clip (pill of knowledge). All 136 students in the school were invited to enter the study (estimated sample size: 116). RESULTS: Participants: 109 (26.6% in 3rd year; 37.6% in 4th year and 39.4% in 5th year). Participation dropped 10.29% (n = 95) in the post-intervention survey. Knowledge improvement was higher for those impression materials included in the pill. Most students (68.4%) reported to know more about impression disinfection after the pill and 70.5% felt more able to achieve correct disinfection. The pill was particularly well received (86.3%). All students would recommend it to their peers, and 93.5% are willing to receive pills on other topics. DISCUSSION: Our results disclosed an important gap in knowledge, which can be filled by a single, brief and concise pill adapted to the intended audience. Once made readily available through digital repositories, it may help solve this problem, given the ubiquitous presence of mobile devices. CONCLUSIONS: Our results found pills of knowledge as a useful approach to facilitating undergraduates' learning process. This method, using suitable information and communication technologies, has the potential to improve the performance on certain clinical tasks.
Assuntos
Educação em Odontologia , Estudantes , Humanos , Aprendizagem , Inquéritos e Questionários , UniversidadesRESUMO
The ideal gasoline must have a high pump octane number, in the 86 to 94 range, and a low environmental impact. Alkanes, as a family, have much lower photochemical reactivities than aromatics or olefins, but only the highly branched alkanes have adequate octane numbers. The purpose of this work is to examine the possibilities of extending the technological alternative of paraffin isomerization to heavier feedstocks (i.e., n-heptane) using non-conventional catalytic systems which have been previously proposed in the literature: a Pt/sulfated zirconia catalyst and a molybdenum sub-oxide catalyst. Under the experimental conditions at which these catalysts have been evaluated, the molybdenum sub-oxide catalyst maintains a good activity and selectivity to isomerization after 24 h, while the Pt/sulfated zirconia catalyst shows a higher dimethylpentanes/methylhexanes ratio, probably due to a lower operating temperature, but also a high formation of cracking products, and presents signs of deactivation after 8 h. Though much remains to be done, the performance of these catalysts indicates that there are good perspectives for their industrial application in the isomerization of n-heptane and heavier alkanes.
Assuntos
Heptanos/química , Catálise , Análise Espectral Raman , Difração de Raios X , Zircônio/químicaRESUMO
Carnitine palmitoyltransferase 1C (CPT1C) is a sensor of malonyl-CoA and is located in the ER of neurons. AMPA receptors (AMPARs) mediate fast excitatory neurotransmission in the brain and play a key role in synaptic plasticity. In the present study, we demonstrate across different metabolic stress conditions that modulate malonyl-CoA levels in cortical neurons that CPT1C regulates the trafficking of the major AMPAR subunit, GluA1, through the phosphatidyl-inositol-4-phosphate (PI(4)P) phosphatase SAC1. In normal conditions, CPT1C down-regulates SAC1 catalytic activity, allowing efficient GluA1 trafficking to the plasma membrane. However, under low malonyl-CoA levels, such as during glucose depletion, CPT1C-dependent inhibition of SAC1 is released, facilitating SAC1's translocation to ER-TGN contact sites to decrease TGN PI(4)P pools and trigger GluA1 retention at the TGN. Results reveal that GluA1 trafficking is regulated by CPT1C sensing of malonyl-CoA and provide the first report of a SAC1 inhibitor. Moreover, they shed light on how nutrients can affect synaptic function and cognition.
Assuntos
Carnitina O-Palmitoiltransferase/genética , Proteínas de Membrana/genética , Neurônios/metabolismo , Receptores de AMPA/genética , Animais , Encéfalo/metabolismo , Glucose/metabolismo , Humanos , Malonil Coenzima A/genética , Camundongos , Nutrientes/metabolismo , Fosfatos de Fosfatidilinositol/metabolismo , Transporte Proteico/genética , Transmissão Sináptica/genéticaRESUMO
The interaction between T-cell receptors (TCRs) of T-cells and potentially immunogenic peptides presented by MHCs of antigen presenting cells is one of the most important mechanisms of the adaptive human immune system. A large number of structural simulations of the TCR/peptide/MHC system have been carried out. However, to date no study has investigated the differences of the dynamics between free TCRs and pMHC bound TCRs on a large scale. Here we present a study totalling 37 100 ns investigating the LC13 TCR in its free form as well as in complex with HLA-B*08:01 and different peptides. Our results show that the dynamics of the bound and unbound LC13 TCR differ significantly. This is reflected in (a) expected results such as an increased flexibility and increased solvent accessible surface of the CDRs of unbound TCR simulations but also in (b) less expected results such as lower CDR distances and compactness as well as alteration in the hydrogen bond network around CDR3α of unbound TCR simulations. Our study further emphasises the structural flexibility of TCRs and confirms the importance of the CDR3 loops for the adoption to MHC.
Assuntos
Apresentação de Antígeno , Antígenos de Histocompatibilidade/imunologia , Peptídeos/imunologia , Receptores de Antígenos de Linfócitos T/metabolismo , Linfócitos T/imunologia , Linfócitos T/metabolismo , Algoritmos , Apresentação de Antígeno/imunologia , Sítios de Ligação , Antígenos HLA/química , Antígenos HLA/imunologia , Antígenos de Histocompatibilidade/química , Humanos , Ligação de Hidrogênio , Simulação de Acoplamento Molecular , Simulação de Dinâmica Molecular , Peptídeos/química , Ligação Proteica , Conformação Proteica , Receptores de Antígenos de Linfócitos T/química , Relação Estrutura-AtividadeRESUMO
Recovery of new samples of Montezumella amenosi Vía, 1959 and Moianella cervantesi Ossó Domínguez, 2013, with preserved cephalic appendages and ventral features, now allows for new and complete revision of Montezumellidae, an extinct eubrachyuran family that appeared in the Middle Eocene and lived until the Neogene. New data on antennular and antennal features, as well as additional data on the sternal and pleonal features of the females, have been analyzed. As a result, Montezumellidae is removed from Cancroidea, where it was previously placed. In view of the unique set of characters that this family presents, no other superfamily of Eubrachyura, fossil or recent, can accommodate it. Therefore, a new superfamily is proposed for it. Despite several basal characters that this group presents, its possible origins or phylogenetic relationships are not clear. Neither, based on the present fossil record, no relationships with potential ancestors or descendants can be suggested.
Assuntos
Braquiúros , Decápodes , Animais , Feminino , Fósseis , FilogeniaRESUMO
Anterograde transport of late endosomes or lysosomes (LE/Lys) is crucial for proper axon growth. However, the role of energetic nutrients has been poorly explored. Malonyl-CoA is a precursor of fatty acids, and its intracellular levels highly fluctuate depending on glucose availability or the energy sensor AMP-activated protein kinase (AMPK). We demonstrate in HeLa cells that carnitine palmitoyltransferase 1C (CPT1C) senses malonyl-CoA and enhances LE/Lys anterograde transport by interacting with the endoplasmic reticulum protein protrudin and facilitating the transfer of Kinesin-1 from protrudin to LE/Lys. In cultured mouse cortical neurons, glucose deprivation, pharmacological activation of AMPK or inhibition of malonyl-CoA synthesis decreases LE/Lys abundance at the axon terminal, and shortens axon length in a CPT1C-dependent manner. These results identify CPT1C as a new regulator of anterograde LE/Lys transport in response to malonyl-CoA changes, and give insight into how axon growth is controlled by nutrients.
Assuntos
Axônios/metabolismo , Carnitina O-Palmitoiltransferase/genética , Neurônios/metabolismo , Proteínas Quinases/genética , Quinases Proteína-Quinases Ativadas por AMP , Animais , Axônios/fisiologia , Transporte Biológico/genética , Encéfalo/metabolismo , Carnitina O-Palmitoiltransferase/metabolismo , Endossomos/genética , Endossomos/metabolismo , Glucose/metabolismo , Células HeLa , Humanos , Cinesinas/genética , Cinesinas/metabolismo , Lisossomos/genética , Lisossomos/metabolismo , Malonil Coenzima A/metabolismo , Camundongos , Nutrientes/metabolismoRESUMO
Entre los distintos problemas de seguridad pública en México, los delitos ambientales han ocupado un lugar periférico en las agendas de gobierno, la estadística nacional y en las investigaciones académicas. Estos factores han derivado en que no existan estudios sobre la prevalencia de delitos ambientales en el país, ni de su distribución territorial, por lo tanto, el presente artículo tiene como objetivo ex-plorar la distribución geográfica de delitos ambientales en el país, así como la identificación de paraísos verdes de la delincuencia ambiental en México. Para ello se analizaron las cifras de delitos ambienta-les reportadas por la Fiscalía General de la República en el periodo 2006-2018 y se cotejaron espacialmente con variables ambientales, económicas y sociales. Los hallazgos muestran que los paraísos verdes de criminalidad ambiental se concentran en estados de las regiones noroeste, occidente, centro y sur del país, por lo que las estrategias de actuación institucional y de políticas públicas pueden orientarse en estas regiones y estados.
Among the various public security problems in Mexico, environmental crime has occupied a peripheral place in government agendas, national statistics and academic research. These factors have meant that there are no studies on the prevalence of environmental crime in the country, nor on its territorial distribution. Therefore, this article aims to explore the geographical distribution of environmental crime in the country, as well as the identification of green havens of environmental crime in Mexico. To this end, the figures on environmental crime reported by the Attorney General's Office for the period 2006-2018 were analysed and spatially matched with environmental, economic and social variables. The findings show that the green havens of environmental crime are concentrated in states in the northwestern, western, central and southern regions of the country, so that strategies for institutional action and public policies can be oriented towards these regions and states.
Entre os vários problemas de segurança pública no México, o crime ambiental tem ocupado um lugar periférico nas agendas governamentais, nas estatísticas nacionais e nas pesquisas acadêmicas. Estes fatores fizeram com que não existam estudos sobre a prevalência de crimes ambientais no país, nem sobre sua distribuição territorial. Portanto, este artigo visa explorar a distribuição geográfica dos crimes ambientais no país, assim como a identificação de paraísos verdes de crimes ambientais no México. Para este fim, os números sobre crimes ambientais relatados pela Procuradoria Geral da República para o período 2006-2018 foram analisados e espacialmente combinados com variáveis ambientais, econômicas e sociais. Os resultados mostram que os paraísos verdes do crime ambiental estão concentrados nos estados das regiões noroeste, oeste, centro e sul do país, de modo que as estratégias de ação institucional e políticas públicas possam ser orientadas para essas regiões e estados.
Assuntos
Humanos , Meio Ambiente , Comportamento Antiambiental , Política Pública , Crime , Comportamento Criminoso , MéxicoRESUMO
OBJECTIVES: The treatment of non muscle invasive bladder cancer (NMIBC) continues to be a challenge. Hyperthermia (HT) combined with intravesical chemotherapy is used to enhance the effects of chemotherapy. METHODS: A review of the publications was carried out to synthesize the adverse effects (AE) reported by the use of chemohyperthermia (QHT) with Mitomycin-C (MMC). The most relevant data are exposed for each of the devices currently used in the QHT. RESULTS: SYNERGO®: The dropout rate varied between 3-40%, and the AE rate is up to 88%. The most common AEs were pain (2-40%), thermal reaction of the posterior wall (13-100%), bladder spasms (2-32%), dysuria (3-60%) and hematuria (2-62%). COMBAT BRS®: The dropout rate is 3-11%. The AEs reported were CTCAE Grade 1-2: Pain 13-27%, bladder spasms 6-27%and hematuria 3-20% are the most relevant. In general, CTCAE grade 3-4 toxicity is not reported. UNITHERMIA®: The dropout rate is 7-12%. The AEs described are: Pain 6-23%, bladder spasms 6-23%, hematuria 9-11, frequency 15-25% and allergy 6-11%. The majority of toxicities are CTCAE grade 1-2 (17-53%), with grade 3-4 in 9-15% and Grade 5 in 0-2%. QHT adds little to the AEs of the treatment with MMC. It neither adds severe effects, nor increases dropouts significantly, and does not increase the incidence of allergic reactions. The comparative study between BCG and QHT-MMC, is less likely to present urinary frequency, nocturia, incontinence, hematuria, fever, fatigue and arthralgia in patients in the QHT group. CONCLUSIONS: QHT has proven to be a safe alternative for the treatment of intermediate and high risk NMIBC, with AE mainly grade 1-2. The AEs reported have little variation with respect to the dose of MMC used, presenting different "profiles" related to the device used for its administration. The treatments with QHTMMC are well tolerated, without adding significantly more AE than the instillations of MMC alone and presenting a better toxicity profile than those reflected in the literature with respect to the treatment with BCG.
Assuntos
Antibióticos Antineoplásicos/uso terapêutico , Hipertermia Induzida , Neoplasias da Bexiga Urinária/terapia , Terapia Combinada , Humanos , Mitomicina/efeitos adversos , Mitomicina/uso terapêutico , Invasividade Neoplásica , Neoplasias da Bexiga Urinária/patologiaRESUMO
Introducción: La seguridad del paciente es la disminución del riesgo en la presentación de lesiones, incapacidad o muerte en el cuidado asistencial. La complejidad de los sistemas de salud, el entorno laboral, las situaciones propias del paciente, la infraestructura de los hospitales predispone la presentación de eventos adversos (EA). Objetivo: Determinar la relación entre cultura de seguridad del paciente, las horas por semana trabajadas y los incidentes en el último año del personal de enfermería de un hospital público de segundo nivel de atención de la ciudad de Saltillo, Coahuila. Métodos: Descriptivo correlacional, muestra de 113 enfermeras (os). Recolección a través de un enlace digital, para el personal de enfermería que cumpla con los criterios de inclusión. Se aplicó cédula de datos sociolaborales y el instrumento Hospital Survey on Patient Safety Culture. El análisis fue con estadística descriptiva e inferencial. Resultados: La cultura de seguridad del paciente en la mayoría de las dimensiones carece de fortaleza, con oportunidad de mejora: expectativas y acciones de la dirección (60.8%), aprendizaje organizacional (68.1%), feed-back y comunicación sobre errores (58.9%) y solo el trabajo en equipo refiere fortaleza (76.3%). Dimensiones con menor puntuación: franqueza en la comunicación (42.4%), apoyo a la gerencia 42.7%, dotación de personal 37.8 y la respuesta no punitiva a los errores 35.9%. Conclusiones: Es importante tomar en cuenta esta información para que se planten y se desarrollen estrategias que permitan ofrecer una atención hospitalaria segura. La acción gerencial es importante en la continuidad de acciones de seguridad del paciente. (AU)
Introduction: Patient safety is the reduction of risk in the presentation of injury, disability or death during health care. The complexity of health systems, the work environment, the patient's own situations and the hospital infrastructure predispose to the occurrence of adverse events (AE). Objective: To determine the relationship between patient safety culture, hours worked per week and the incidents in the last year of the nursing staff of a second level public hospital in the city of Saltillo, Coahuila. Methods: Descriptive correlational, sample of 113 nurses. Collection through a digital link, for the nursing staff that met the inclusion criteria. A social and labor data questionnaire and the Hospital Survey on Patient Safety Culture instrument were applied. The analysis was based on descriptive and inferential statistics. Results: The patient safety culture lacks strength in most of the dimensions, with opportunities for improvement: management expectations and actions (60.8%), organizational learning (68.1%), feedback and communication about errors (58.9%) and only teamwork refers strength (76.3%). Lower scoring dimensions: openness in communication (42.4%), management support 42.7%, staffing 37.8 and non-punitive response to errors 35.9%. Conclusions: It is important to take this information into account so that strategies can be planted and developed to provide safe hospital care. Management action is important in the continuity of patient safety actions. (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Segurança do Paciente , Recursos Humanos de Enfermagem Hospitalar , Epidemiologia Descritiva , Inquéritos e Questionários , Efeitos Colaterais e Reações Adversas Relacionados a MedicamentosRESUMO
The clinicopathological features currently used in breast cancer prognosis often fail to characterize the clinical heterogeneity of the disease accurately. Our study is aimed to investigate the predictive value of DNA flow cytometry in breast cancer. Previously untreated breast carcinoma samples (584) were snap frozen for flow-cytometry. Tumors were classified into three DNA index (DI) categories: i) tumors showing a DI =0.96-1.15 (diploid and near-diploid); ii) tumors with a DI >or=1.16 (hyperdiploid, tetraploid, multiploid and/or those with more than one diploid population); and iii) tumors with a DI Assuntos
Neoplasias da Mama/genética
, Ploidias
, Adulto
, Idoso
, Idoso de 80 Anos ou mais
, Neoplasias da Mama/patologia
, Neoplasias da Mama/cirurgia
, DNA de Neoplasias/análise
, DNA de Neoplasias/genética
, Feminino
, Citometria de Fluxo/métodos
, Humanos
, Pessoa de Meia-Idade
, Prognóstico
, Fase S/genética
, Análise de Sobrevida
RESUMO
BACKGROUND: Aim was to evaluate the efficacy and tolerability of a moxifloxacin-containing second-line triple regimen in patients whose previous Helicobacter pylori eradication treatment failed. METHODS: Prospective multicentre study including patients in whom a triple therapy or a non-bismuth-quadruple-therapy failed. Moxifloxacin (400mg qd), amoxicillin (1g bid), and esomeprazole (40 mg bid) were prescribed for 14 days. Eradication was confirmed by (13)C-urea-breath-test. Compliance was determined through questioning and recovery of empty medication envelopes. RESULTS: 250 patients were consecutively included (mean age 48 ± 15 years, 11% with ulcer). Previous (failed) therapy included: standard triple (n = 179), sequential (n = 27), and concomitant (n = 44); 97% of patients took all medications, 4 were lost to follow-up. Intention-to-treat and per-protocol eradication rates were 82.4% (95% CI, 77-87%) and 85.7% (95% CI, 81-90%). Cure rates were similar independently of diagnosis (ulcer, 77%; dyspepsia, 82%) and previous treatment (standard triple, 83%; sequential, 89%; concomitant, 77%). At multivariate analysis, only age was associated with eradication (OR = 0.957; 95% CI, 0.933-0.981). Adverse events were reported in 25.2% of patients: diarrhoea (9.6%), abdominal pain (9.6%), and nausea (9.2%). CONCLUSION: 14-day moxifloxacin-containing triple therapy is an effective and safe second-line strategy in patients whose previous standard triple therapy or non-bismuth quadruple (sequential or concomitant) therapy has failed, providing a simple alternative to bismuth quadruple regimen.
Assuntos
Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Esomeprazol/uso terapêutico , Fluoroquinolonas/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Inibidores da Bomba de Prótons/uso terapêutico , Adulto , Testes Respiratórios , Estudos de Coortes , Quimioterapia Combinada , Feminino , Helicobacter pylori , Humanos , Masculino , Pessoa de Meia-Idade , Moxifloxacina , Estudos Prospectivos , Retratamento , Falha de Tratamento , Resultado do Tratamento , Ureia/análiseRESUMO
RESUMEN Las redes sociales, como Facebook, son herramientas útiles para el comercio, por lo que la venta ilegal de animales y plantas, siendo el tercer mayor comercio ilegal del mundo, está aprovechando este nuevo mecanismo para la compraventa y distribución ilegal de especies amenazadas, en peligro de extinción o sin procedencia legal, en el estado de Tamaulipas, con una ventaja considerable, la de no poder iniciar un proceso legal in situ. El objetivo del presente estudio fue determinar el uso activo de Facebook como factor criminógeno en la compra y venta de flora y fauna enlistadas en categorías de riesgo o que no hayan sido adquiridas de manera legal y sostenible, de acuerdo a la NOM-059-SEMARNAT-2010, en Tamaulipas, México. Se realizó la búsqueda digital de las páginas de Facebook que se dedican a la venta de especies en la zona sur, centro y norte del estado, durante el periodo de enero a noviembre 2016. Mediante un método mixto de carácter retrospectivo, se analizó la venta ilegal de especies, como parte de la criminodinámica de una conducta antisocial que contraviene el patrimonio colectivo y el bien común. Se encontró que se movieron $ 176 260 del comercio ilegal en esta red en el periodo estudiado: la zona norte con un 96 % de la participación económica, seguida por la zona sur con un 3 %, y por último la zona centro, con el 1 %. La utilización de la perspectiva criminológica permitió establecer la criminodinámica existente en el comercio ilegal de especies, a través de las redes sociales. Este conocimiento puede servir a las autoridades correspondientes para fincar responsabilidades legales a los participantes, así como para impartir educación ambiental y orientación a la población, para no verse involucrado en delitos del fuero común y federal.
ABSTRACT Social media platforms such as Facebook are useful tools for trade. However, the illegal sale of animals and plants, which is the third biggest illegal trade in the world, is taking advantage of this new mechanism of illegal sale and distribution of threatened or illegal species in the state of Tamaulipas mainly due to the lack of legal proceedings to prosecute violators in situ. The objective of this study was to determine the active use of Facebook as a criminogenic factor in the buying and selling of flora and fauna species that have been either listed as endangered in the Mexican Official norm NOM-059-SEMARNAT-2010 or not acquired legally and sustainably in Tamaulipas, Mexico. The digital search of the Facebook pages dedicated to the sale of species in the southern, central and northern areas of the state was carried out during the period from January to November 2016. Through a mixed retrospective method, the illegal sale of species as part of the criminodynamics of antisocial behavior that violates the collective heritage and the common good was analyzed. It was found that more than $ 176 260 were earned through illegal trade in this platform during the period under study: the Northern Zone with 96 % of the economic participation, followed by the Sout-hern Zone with 3 %, and finally the Central Zone with the 1 %. The use of a criminogenic perspective has enabled us to characterize the existing criminodynamics in the illegal trade of species through social media platforms. This knowledge can help the corresponding authorities develop legal initiatives to be able to prosecute violators. Similarly, the knowledge generated here can also be used to develop environmental education programs that can prevent the population from getting involved in either local or federal crimes.
RESUMO
OBJETIVO: El tratamiento del cáncer de vejiga no músculo invasivo (CVNMI) continúa siendo un reto. La hipertermia (HT) combinada con la quimioterapia intravesical se usa para mejorar los efectos de la quimioterapia. MÉTODOS: Se realizó una revisión de las publicaciones para sintetizar los efectos adversos (EA) reportados por el uso de la quimiohipertermia (QHT) con Mitomicina- C (MMC). Se exponen los datos más relevantes para cada uno de los dispositivos empleados actualmente en la QHT. RESULTADOS: SYNERGO(R): La tasa de abandono varió entre 3-40%, y la tasa de EA es de hasta el 88%. Los EA con mayor frecuencia fueron dolor (2-40%), reacción térmica de la pared posterior (13-100%), espasmos vesicales (2-32%), disuria (3-60%) y hematuria (2-62%).COMBAT BRS®: La tasa de abandono de tratamiento es del 3-11%. Los EA reportados fueron CTCAE Grado 1-2: Dolor 13-27%, espasmos vesicales 6-27% y hematuria 3-20% son los más relevantes. En general, no se informan de toxicidad CTCAE grado 3-4. UNITHERMIA(R): La tasa de abandono de tratamiento es del 7-12%. Los EA descritos son: Dolor 6-23%, espasmos vesicales 6-23%, hematuria 9-11%, frecuencia 15-25% y alergia 6-11. La mayoría de las toxicidades son CTCAE grado 1-2 (17-53%), siendo grado 3-4 en 9-15% y Grado 5 en 0-2%. La QHT añade poco a los EA del tratamiento con MMC. No agrega efectos severos, no incrementa de forma significativa los abandonos al tratamiento, y no aumenta la incidencia de reacciones alérgicas. El estudio comparativo entre BCG y QHT-MMC encuentra menor probabilidad de presentar frecuencia miccional, nicturia, incontinencia, hematuria, fiebre, fatiga y artralgia, en los pacientes del grupo de QHT. CONCLUSIONES: La QHT ha demostrado ser una alternativa segura para el tratamiento de los CVNMI de riesgo intermedio y alto, con EA principalmente grado 1-2. Los EA reportados tienen poca variación con respecto a la dosis de MMC empleada, presentando diferentes "perfiles" relacionados con el dispositivo usado para su administración. Los tratamientos con QHT-MMC son bien tolerados, sin añadir significativamente más EA que las instilaciones de MMC sola y presentando mejor perfil de toxicidad que los reflejados en la literatura con respecto al tratamiento con BCG
OBJECTIVES: The treatment of non muscle invasive bladder cancer (NMIBC) continues to be a challenge. Hyperthermia(HT) combined with intravesical chemotherapy is used to enhance the effects of chemotherapy. METHODS: A review of the publications was carried out to synthesize the adverse effects (AE) reported by the use of chemohyperthermia (QHT) with Mitomycin-C (MMC). The most relevant data are exposed for each of the devices currently used in the QHT. RESULTS: SYNERGO(R): The dropout rate varied between 3-40%, and the AE rate is up to 88%. The most common AEs were pain (2-40%), thermal reaction of the posterior wall (13-100%), bladder spasms (2-32%), dysuria (3-60%) and hematuria (2-62%). COMBAT BRS(R): The dropout rate is 3-11%. The AEs reported were CTCAE Grade 1-2: Pain 13-27%, bladder spasms 6-27% and hematuria 3-20% are the most relevant. In general, CTCAE grade 3-4 toxicity is not reported. UNITHERMIA(R): The dropout rate is 7-12%. The AEs described are: Pain 6-23%, bladder spasms 6-23%, hematuria 9-11%, frequency 15-25% and allergy 6-11%. The majority of toxicities are CTCAE grade 1-2 (17-53%), with grade 3-4 in 9-15% and Grade 5 in 0-2%. QHT adds little to the AEs of the treatment with MMC. It neither adds severe effects, nor increases dropouts significantly, and does not increase the incidence of allergic reactions. The comparative study between BCG and QHT-MMC, is less likely to present urinary frequency, nocturia, incontinence, hematuria, fever, fatigue and arthralgia in patients in the QHT group. CONCLUSIONS: QHT has proven to be a safe alternative for the treatment of intermediate and high risk NMIBC, with AE mainly grade 1-2. The AEs reported have little variation with respect to the dose of MMC used, presenting different "profiles" related to the device used for its administration. The treatments with QHTMMC are well tolerated, without adding significantly more AE than the instillations of MMC alone and presenting a better toxicity profile than those reflected in the literature with respect to the treatment with BCG
Assuntos
Humanos , Antineoplásicos/uso terapêutico , Hipertermia Induzida , Neoplasias da Bexiga Urinária/terapia , Terapia Combinada , Mitomicina/efeitos adversos , Mitomicina/uso terapêutico , Invasividade Neoplásica , Neoplasias da Bexiga Urinária/patologiaRESUMO
This report describes a 28-year-old pregnant woman with mitral valve prolapse and sudden cardiac death due to a ventricular fibrillation who underwent an ICD implantation guided by tranesophageal echocardiography.
Assuntos
Desfibriladores Implantáveis , Ecocardiografia Transesofagiana , Complicações Cardiovasculares na Gravidez/terapia , Fibrilação Ventricular/terapia , Adulto , Morte Súbita Cardíaca/etiologia , Feminino , Humanos , Prolapso da Valva Mitral/terapia , GravidezRESUMO
La terapia trombolítica (TT) modifica la historia natural del infarto agudo del miocardio (IAM) al disminuir la morbi-mortalidad. Recientemente, al cambiar la velocidad de infusión, se logró disminuir la mortalidad en 10 puntos porcentuales. Objetivos: Demostrar que la administración de rt-PA en una hora es segura y práctica (administración "rapida"). Material y métodos: Estudio prospectivo cooperativo, llevado a cabo en 3 años, donde se incluyeron a pacientes con el diagnóstico de IAM con menos de 6 hrs de evolución éstos reciberon TT: rt-PA con bolo inicial de 10 mg y los 90 mg en los restantes 60 minutos. Al mismo tiempo del bolo de rt-PA, se administraron 500 UI de heparina y se continuó con infusión de 1000 UI/hr, para mantener TTPa 1.5 a 2 veces el valor basal. Todos los enfermos recibieron ácido acetil salicílico (ASA) y, de acuerdo a la evolución, terapia adyuvante (TA). Se determinó la presencia de sangrado y/o evento cerebral, como puntos finales mayores. Resultados: Se incluyeron en el estudio 225 pacientes, la edad promedio del grupo fue X 57.1 ñ 22.2 años (91 por ciento menores de 75 años): el 78.7 por ciento fueron del sexo masculino y 21.3 por ciento del sexo femenino. El tiempo de retraso en acudir al hospital fue X 2.93 ñ 1.7 hs. El 82.2 por ciento ingresaron en clase funcional I-II de la New York Heart Association (NYHA), el 59.5 por ciento de los infartos fueron de localización anterior y el 32.4 por ciento posteroinferior. El 80 por ciento tuvo criterios de reperfusión clínica. Sólo el 7.1 por ciento requirió de transfusiones y el 0.4 por ciento presentó sangrado a nivel de sistema nervioso central (SNC). La sobrevida fue de 95.2 por ciento a 21 días y la causa de muerte no se relacionó con el sangrado. Conclusiones: El esquema de administración resultó seguro y eficaz, ya que los requerimientos de transfusión no fueron mayores a lo consignado en la literatura y el sangrado del SNC fue del 0.4 por ciento