The anti-CD6 antibody itolizumab provides clinical benefit without lymphopenia in rheumatoid arthritis patients: results from a 6-month, open-label Phase I clinical trial.

Itolizumab is a humanized anti-CD6 monoclonal antibody (mAb) that has previously shown encouraging results, in terms of safety and positive clinical effects, in a 6-week monotherapy clinical trial conducted in rheumatoid arthritis (RA) patients. The current Phase I study evaluated the safety and clinical response for a longer treatment of 12 itolizumab intravenous doses in subjects with active RA despite previous disease-modifying anti-rheumatic drug (DMARD) therapy. Twenty-one subjects were enrolled into four dosage groups (0·1, 0·2, 0·4 and 0·8 mg/kg). Efficacy end-points including American College of Rheumatology (ACR)20, ACR50 and ACR70 response rates and disease activity score in 28 joints (DAS28) were monitored at baseline and at specific time-points during a 10-week follow-up period. Itolizumab was well tolerated up to the highest tested dose. No related serious adverse events were reported and most adverse events were mild. Remarkably, itolizumab treatment did not produce lymphopenia and, therefore, was not associated with infections. All patients achieved a clinical response (ACR20) at least once during the study. Eleven subjects (55%) achieved at least a 20% improvement in ACR just 1 week after the first itolizumab administration. The clinical response was observed from the beginning of the treatment and was sustained during 24 weeks. The efficacy profile of this 12-week treatment was similar to that of the previous study (6-week treatment). These results reinforce the safety profile of itolizumab and provide further evidence on the clinical benefit from the use of this anti-CD6 mAb in RA patients.

Prospective study on the application of a WALANT circuit for surgery of tunnel carpal syndrome and trigger finger. / Estudio prospectivo sobre la aplicación de un circuito WALANT para la cirugía del síndrome del túnel carpiano y dedo en resorte.

OBJECTIVES: To evaluate benefits for the patient and the economic impact for the implementation of a wide awake local anesthesia no tourniquet (WALANT) hand surgery compared to traditional major outpatient circuit. METHODS: A prospective cohort study was planned comparing 150 cases of ambulatory hand surgery (carpal tunnel and trigger finger) using WALANT technique intervention out from the operating room; with another 150 which underwent intervention, outpatient setting, with preoperative evaluation, sedation and tourniquet, in the operation room. Preoperative, intraoperative and postoperative pain was monitored, as well as the days that required postoperative analgesia.The resources used and costs were evaluated. Satisfaction was evaluated using a specific survey. RESULTS: The pain during the surgery was equivalent for both groups and was significantly lower postoperatively for the WALANT group, with less need for the use of analgesics. Satisfaction was greater for the local anesthesia group. The use of personnel resources and hospital material was less for the WALANT group, with total saving calculated by 1,019€ per patient. CONCLUSIONS: Procedures such as carpal tunnel surgery and trigger finger surgery can be safely performed using wide awake surgery. Patient satisfaction is higher to conventional procedure in the operation room. Pain control is excellent, especially during the postoperative period. WALANT technique for hand surgery represents a benefit for the patient in comfort, timeliness and no need for preoperative tests or evaluation. In addition, it represents a significant savings in hospital resources.

Safety of the transbronchial biopsy in outpatients.

The objective of our study was to determine the safety of transbronchial biopsy (TBB) in nonhospitalized patients. The design was a prospective study of the consecutive cases from July 1987 until September 1988 in the setting of a university hospital of the third level with 1,800 beds. The patients were a consecutive sample of 169 patients who had 184 procedures of fiberoptic bronchoscopy (FOB) with TBB performed. They suffered from different diseases: lung nodules or masses, diffuse interstitial disease, alveolar condensation, etc. An FOB with TBB was performed in immunocompetent outpatients, who were kept under observation for four hours and then had a chest roentgenogram taken afterwards. We contacted them again after 72 hours to rule out delayed complications. In three cases, more than 100 ml of blood were obtained during the FOB, without significant hemoptysis being recorded in those patients during the observation period; chest pain occurred in 15 patients during the TBB; pneumothorax occurred in two patients (1 percent), one of whom required admission to the hospital, without requiring chest tube drainage. Other complications are reported (bronchospasm, parenchymal hemorrhage, and pneumonia). In conclusion, we consider the TBB to be a technique with a low incidence of complications for outpatients, so therefore we do not believe that admission to the hospital is mandatory for this type of patient, although we do recommend a longer observation period.

Postabortal laparoscopic tubal sterilization. Results in comparison to interval procedures.

This report documents our experiences in 3 groups of women undergoing laparoscopic tubal sterilization: those undergoing sterilization as an interval procedure, those performed in association with suction curettage, and those performed within 18 hours of second trimester pregnancy termination via intraaminiotic injection of prostaglandin F 2 alpha. As a postabortal sterilization procedure, laparoscopy is effective, logistically appealing, and convenient. There is, however, an increased risk of complications to the procedure when performed on the postabortal women. These include specifically, a 10-fold increased risk of infection and a 2.5-fold increased risk of bleeding complications as seen in our series. The results of these findings are discussed, and some suggestions for reducing these risks are offered.

Experiencias de los alumnos en el Aprendizaje del Proceso de atención de enfermería / Students' experiences on learning the Nursing Process / Experiências dos alunos na Aprendizagem do Processo de Atenção de Enfermagem

Resumen Introducción La utilización del Proceso de Atención de Enfermería (PAE) como metodología propia de la disciplina, resuelve los problemas de las competencias de enfermería, permite intervenciones reflexivas para la solución de problemas individuales y atención integral a la persona, mejora la comunicación, delimita el campo profesional en cuanto identifica los fenómenos de interés y fundamenta la investigación; por ello tiene un espacio destacado en la formación del pregrado de enfermería. Objetivos a) Describir la experiencia de los alumnos de la Licenciatura en Enfermería en el aprendizaje y aplicación del PAE durante su formación académica, b) Identificar si el estudiante reconoce al proceso como la metodología propia de la disciplina para otorgar el cuidado. Metodología Estudio con enfoque cualitativo-fenomenológico-descriptivo, los participantes fueron alumnos del tercero al séptimo semestre de un programa de Licenciatura en Enfermería, se realizaron entrevistas a profundidad sobre el saber qué y cómo aprende y aplica el PAE, se realiza análisis de discurso, con codificación y decodificación hasta la construcción de las categorías. Resultados En el análisis emergieron tres categorías: a) Mundos diferentes, con tres subcategorías: darse cuenta, vinculación teoría-práctica e influencia del profesional de enfermería; b) Formación teórica con dos subcategorías: aprendizaje complejo y, salud y enfermedad; c) Ambivalencia en la enseñanza del PAE por el docente con dos subcategorías: heterogeneidad y desavenencia docente, y acompañamiento del profesor. Aquí se aborda la primera categoría. Discusión y conclusión Además de las diferencias entre la teoría y la práctica del PAE, la interacción del estudiante con personal de enfermería no favorece el desarrollo del aprendizaje y aplicación de este.

Abstract Introduction The utilization of the Nursing Process (NP), as a methodology of the discipline which addresses the issues on nursing competences, allows reflexive interventions aimed at solving individual problems and integrally assisting the person, improves the communications, locates the professional scope by identifying the phenomena of interest, and gives a foundation to nursing research. Because of this, the NP constitutes a fundamental part in nursing education. Objectives a) To describe the undergraduate students' experiences regarding learning and using the Nursing Process during their academic formation; and b) To identify if the student acknowledges the process as the discipline's methodology to provide healthcare. Methodology This is a qualitative phenomenological and descriptive study. Participants were students from the third to the seventh semesters of a baccalaureate nursing program. In-depth interviews focused on how to learn and apply the Nursing Process were carried out. A discourse analysis with codification and decodification was developed until categories emerged. Results From the analysis, three categories emerged: a) Different worlds, which included three sub-categories: realizing, linking the theory and practice, and the influence from the nursing professional; b) Theoretical formation, which included two sub-categories: complex learning, and health and illness; c) Ambivalence of the professional while teaching NP, which included two sub-categories: teacher's heterogeneity and incongruity, and teacher's support. Discussion and conclusion In addition to the remarks on the differences between the theory and the practice related to NP, some student-nursing staff interactions do not particularly favor learning and utilizing the Nursing Process.

Resumo Introdução A utilização do Processo de Atenção de Enfermagem (PAE) como metodologia própria da disciplina, resolve os problemas das competências de enfermagem, permite intervenções reflexivas para a solução de problemas individuais e atenção integral à pessoa, melhora a comunicação, delimita o campo profissional entanto identifica os fenómenos de interesse e fundamenta a pesquisa; por isso tem um espaço notável na formação do pre-grau de enfermagem. Objetivos a) Descrever a experiência dos alunos da licenciatura em enfermagem na aprendizagem e aplicação do PAE durante sua formação académica, b) Identificar se o estudante reconhece o processo como a metodologia própria da disciplina para conceder o cuidado. Metodologia Estudo com enfoque qualitativo-fenomenológico-descritivo, os participantes foram alunos do terceiro ao sétimo semestre de um programa de licenciatura em enfermagem, realizaram-se entrevistas a profundidade sobre o saber que e como aprende e aplica o PAE, realiza-se análise de discurso, com codificação e decodificação até a construção das categorias. Resultados Na análise emergiram três categorias: a) Mundos diferentes, com três subcategorias: dar-se conta, vinculação teoria-prática e influência do profissional de enfermagem; b) Formação teórica com duas subcategorias: aprendizagem complexa e, saúde e doença; c) Ambivalência no ensino do PAE pelo docente com duas subcategorias: heterogeneidade e desentendimento docente, e acompanhamento do professor. Aqui aborda-se a primeira categoria. Discussão e conclusão Além das diferenças entre a teoria e a prática do PAE, a interação do estudante com pessoal de enfermagem não favorece o desenvolvimento da aprendizagem e aplicação deste.

Modulation by nitric oxide of gastric acid secretion in toads.

Nitric oxide (NO) is a novel chemical messenger that mediates a variety of biological actions. This study was undertaken to investigate the effects of NO on parietal cell function. The rate of [3H]arginine conversion to [3H]citrulline, a parameter of NO synthase activity, and NO formation (as NO2-), were inhibited by the NO synthase inhibitor, NG-nitro-L-arginine methyl ester (L-NAME), in a concentration-dependent manner in the non-stimulated toad gastric mucosa. This range of concentrations of L-NAME provoked stimulation of H+ secretion in a similar fashion, which was blocked by L-arginine but not by D-arginine. Pre-treatment with carbachol plus ethylene glycol-bis(beta-aminoethyl ether)-N,N,N',N'-tetra-acetic acid (EGTA) prevented the effect of L-NAME on H+ secretion and drastically reduced NO synthase activity. L-arginine had an inhibitory effect on H+ secretion in non-stimulated and carbachol-stimulated gastric mucosa, which was reversed by L-NAME. Carbachol and pentagastrin, but not histamine, significantly increased NO formation in the toad gastric mucosa. The results suggest that changes in NO synthesis in the gastric mucosa may modulate parietal cell function and that a calcium-dependent mechanism may be involved.

Quimioterapia en el cáncer de pulmón / Chemotherapy in lung cancer

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