RESUMEN
Na cirurgia oral, dois princípios básicos são o acesso adequado e uma boa visualização. Em diversos casos, isto somente é alcançado afastando os tecidos moles adjacentes do local operado através de retalhos cirúrgicos. Os principais retalhos descritos na literatura para cirurgia oral são: envelope, em L ou triangular, trapezoidal e em Y. As técnicas para a realização de incisões e retalhos são essenciais para o acesso de determinados dentes ou patologias que surgem de maneira rotineira na clínica odontológica, além de também serem usadas para contornar complicações cirúrgicas, como fraturas radiculares. O objetivo deste trabalho é, através de um guia prático, expor os princípios para uma técnica adequada e a sequência para realização dos retalhos mais utilizados em cirurgia oral.
In oral surgery, two basic principles are access and good visualization. In many cases, this is only achieved by moving adjacent soft tissues away from the operated site using surgical flaps. The main flaps described in the literature for oral surgery are: envelope, L-shaped or triangular, trapezoidal and Y-shaped. Techniques for performing incisions and flaps are essential for accessing certain teeth or pathologies that arise routinely in the dental clinic, in addition to being used to circumvent surgical complications, such as root fractures. The objective of this work is, as a practical guide, to expose the principles for an adequate technique and a sequence for the realization of the most used flaps in oral surgery.
Asunto(s)
Cirugía BucalRESUMEN
The factorial reduction of Brief COPE has not been successfully replicated by independent studies, and few have been performed in Spanish-speaking populations; therefore, the objective of this study was to perform a factorial reduction of the instrument in a large sample of the Mexican population and perform a convergent and divergent validity of the factors obtained. We distributed a questionnaire via social networks with sociodemographic and psychological variables, including the Brief COPE and the scales of the CPSS, GAD-7, and CES-D to measure stress, anxiety, and depression. A total of 1283 persons were included, most of whom (64.8%) were women and had a bachelor's degree (55.2%). After performing the exploratory factorial analysis, we did not find a model with an adequate fit and a reduced number of factors; therefore, we decided to reduce the number of items according to the most representative ones of adaptive, maladaptive, and emotional coping strategies. The resulting model with three factors showed good fit parameters and good internal consistency of the factors. In addition, the nature and naming of the factors were confirmed by convergent and divergent validity, with significant negative correlations between factor 1 (active/adaptive) and stress, depression, and anxiety, significant positive correlations between factor 2 (avoidant/maladaptive) and these three variables, and no significant correlation between factor 3 (emotional/neutral) and stress or depression. This shortened version of the brief COPE (Mini-COPE) is a good option to evaluate adaptive and maladaptive coping strategies in Spanish-speaking populations.
RESUMEN
Malachra alceifolia Jacq. (family Malvaceae), known as "malva," is a medicinal plant used as a traditional therapy in many regions of America, Africa and Asia. Traditionally, this plant is used in the form of extracts, powder and paste by populations for treating fever, stomachache, inflammation, and parasites. However, the ethnopharmacological validation of M. alceifolia has been scarcely researched. This study showed that the chloroform fraction (MA-IC) and subfraction (MA-24F) of the leaves of M. alceifolia exhibited a potential antileishmanial activity against axenic amastigotes of Leishmania mexicana pifanoi (MHOM/VE/60/Ltrod) and had high and moderate cytotoxic effects on the viability and morphology of macrophages RAW 264.7. This study reports, for the first time, possible terpenoid metabolites and derivatives present in M. alceifolia with activity against some biosynthetic pathways in L. mexicana amastigotes. The compounds from the subfractions MA-24F were highly active and were analyzed by gas chromatography-mass spectrometry (GC-MS) and by a molecular docking study in L. mexicana target protein. This study demonstrates the potential modes of interaction and the theoretical affinity energy of the metabolites episwertenol, α-amyrin and methyl commate A, which are present in the active fraction MA-24F, at allosteric sites of the pyruvate kinase, glyceraldehyde-3-phosphate dehydrogenase, triose phosphate isomerase, aldolase, phosphoglucose isomerase, transketolase, arginase and cysteine peptidases A, target proteins in some vital biosynthetic pathways were responsible for the survival of L. mexicana. Some phytoconstituents of M. alceifolia can be used for the search for potential new drugs and molecular targets for treating leishmaniases and infectious diseases. Furthermore, contributions to research and the validation and conservation of traditional knowledge of medicinal plants are needed globally.
RESUMEN
We performed a cross-sectional study in order to determine the association between stress coping strategies and stress, depression, and anxiety, in which the Mexican population was invited to answer these variables by an electronic questionnaire. A total of 1283 people were included, of which 64.8% were women. Women presented higher levels of stress, depression, and anxiety than men; likewise, women showed a higher frequency of some maladaptive coping strategies (behavioral disengagement and denial) and lower levels of some adaptive ones (active coping and planning); additionally, maladaptive coping strategies were positively correlated with stress and depression in both sexes: self-blame, behavioral disengagement, denial, substance use, and self-distraction. Likewise, there were negative correlations between stress and depression and the adaptive strategies: planning, active coping, acceptance, and positive reframing. For women, religion presented negative correlations with stress, depression, and anxiety, and humor showed low positive correlations with stress, anxiety, and depression. In conclusion, most adaptive and maladaptive coping strategies are common in both sexes with the exception of religion, which seems to be adaptive in women and neutral in men, and humor, which seems to be adaptive in men and maladaptive in women. In addition, emotional and instrumental support seem to be neutral in both sexes.
RESUMEN
Somatization and number of diseases are interrelated variables, whose association with stress-coping strategies, according to sex, has not been investigated. Therefore, the aim of this study was to investigate such association in a sample of the Mexican general population. The general population was invited to answer an electronic questionnaire via the social networks-e-mail, WhatsApp and Facebook-by the research team. A sample of 1008 adults was obtained, of which 62.2% were women, in whom we detected higher levels of negative psychological variables, somatization and number of diseases and lower levels of sleep quality. Positive moderate correlations were found between depresion, anxiety and stress with somatization, on one hand, and with the number of diseases, on the other, and negative moderate correlations were found between sleep quality and the two dependent variables. As for the coping strategies, self-blame, behavioral disengagement, denial, self-distraction and substance use were positively correlated with somatization. Of these, self-blame, substance use, and self-distraction also showed a positive correlation with number of diseases in both sexes. Negative correlations were detected for active coping and the two dependent variables in men and for religion and planning with somatization in women. In conclusion, the coping strategies showed significant correlations with somatization and number of diseases in both sexes.
RESUMEN
Emotional intelligence has been associated with adaptive coping in the adolescent and young population; however, the association of specific dimensions of emotional intelligence with each coping strategy has not been associated in general nor by each sex separately. Therefore, the aim of the study was to determine such an association. The general population was invited to perform an electronic questionnaire via social networks. A sample of 984 individuals were included, from which 62.1% were women, in whom we detected higher levels of emotional attention, and lower levels of emotional clarity and emotional repair, as well as increased levels of stress, depression and anxiety than men. In the bivariate correlations we observed significant positive correlations between emotional attention with stress, depression and anxiety, and significant negative correlations between emotional clarity and emotional repair with the three negative psychological variables, in both sexes. Adaptive coping strategies (mainly active coping and planning) showed positive correlations with emotional attention, emotional clarity and repair, being higher for emotional clarity and repair in both sexes. In addition, these two subscales also showed low negative correlations between some maladaptive strategies in both sexes, which suggests that interventions addressed to increase these emotional abilities could be useful in increasing adaptive coping.
Asunto(s)
Adaptación Psicológica , Inteligencia Emocional , Estrés Psicológico , Femenino , Humanos , Masculino , México , Factores Sexuales , Estrés Psicológico/psicología , Encuestas y CuestionariosRESUMEN
BACKGROUND: The early integration of supportive care in oncology improves patient-centered outcomes. However, data are lacking regarding how to achieve this in resource-limited settings. We studied whether patient navigation increased access to multidisciplinary supportive care among Mexican patients with advanced cancer. MATERIALS AND METHODS: This randomized controlled trial was conducted between August 2017 and April 2018 at a public hospital in Mexico City. Patients aged ≥18 years with metastatic tumors ≤6 weeks from diagnosis were randomized (1:1) to a patient navigation intervention or usual care. Patients randomized to patient navigation received personalized supportive care from a navigator and a multidisciplinary team. Patients randomized to usual care obtained supportive care referrals from treating oncologists. The primary outcome was the implementation of supportive care interventions at 12 weeks. Secondary outcomes included advance directive completion, supportive care needs, and quality of life. RESULTS: One hundred thirty-four patients were randomized: 67 to patient navigation and 67 to usual care. Supportive care interventions were provided to 74% of patients in the patient navigation arm versus 24% in usual care (difference 0.50, 95% confidence interval [CI] 0.34-0.62; p < .0001). In the patient navigation arm, 48% of eligible patients completed advance directives, compared with 0% in usual care (p < .0001). At 12 weeks, patients randomized to patient navigation had less moderate/severe pain (10% vs. 33%; difference 0.23, 95% CI 0.07-0.38; p = .006), without differences in quality of life between arms. CONCLUSION: Patient navigation improves access to early supportive care, advance care planning, and pain for patients with advanced cancer in resource-limited settings. IMPLICATIONS FOR PRACTICE: The early implementation of supportive care in oncology is recommended by international guidelines, but this might be difficult to achieve in resource-limited settings. This randomized clinical trial including 134 Mexican patients with advanced cancer demonstrates that a multidisciplinary patient navigation intervention can improve the early access to supportive and palliative care interventions, increase advance care planning, and reduce symptoms compared with usual oncologist-guided care alone. These results demonstrate that patient navigation represents a potentially useful solution to achieve the adequate implementation of supportive and palliative care in resource-limited settings globally.
Asunto(s)
Neoplasias , Navegación de Pacientes , Adolescente , Adulto , Humanos , México , Neoplasias/terapia , Cuidados Paliativos , Calidad de VidaRESUMEN
Leishmaniasis is a chronic disease caused by protozoa of the distinct Leishmania genus transmitted by sandflies of the genus Phlebotomus (old world) and Lutzomyia (new world). Among the molecular factors that contribute to the virulence and pathogenesis of Leishmania are metalloproteases, e.g., glycoprotein 63 (gp63), also known as leishmanolysin or major surface protease (MSP). This protease is a zinc-dependent metalloprotease that is found on the surface of the parasite, abundant in Leishmania promastigote and amastigote. This study describes the prediction of three-dimensional (3D) structures of leishmanolysin (UniProt ID A0A088RJX7) of Leishmania panamensis employing a homology modeling approach. The 3D structure prediction was performed using the SWISS-MODEL web server. The tools PROCHECK, Molprobyty, and Verify3D were used to check the quality of the model, indicating that they are reliable. Best docking configurations were identified applying AutoDock Vina in PyRx 0.8 to obtain a potential antileishmanial activity. Biflavonoids such as lanaroflavone, podocarpusflavone A, amentoflavone, and podocarpusflavone B showed good scores among these molecules. Lanaroflavone appears to be the most suitable compound from binding affinity calculations.
RESUMEN
Praziquantel (PZQ), a broad spectrum anthelmintic drug, cannot be found in acceptable dosage forms for elderly patients, paediatric patients, and for veterinary use. In fact, very little has been done up to now in the formulation of liquid dosage forms, being they always formulated for parenteral administration. To beat this important challenge, it was accomplished a comprehensive analysis of the influence of two elementary physicochemical aspects, i.e. surface thermodynamic and electrokinetic properties, on the colloidal stability of PZQ nanosuspensions. The hydrophobic character of the drug, intensely determining the flocculation curves, was confirmed by the thermodynamic characterization. The electrophoretic characterization, in combination with the sedimentation and relative absorbance versus time curves, highlighted that the electrical double layer thickness and the surface charge can play an essential role in the stability of the pharmaceutical colloid. Finally, it was demonstrated that controlling the pH values and the incorporation of electrolytes can help in formulating PZQ aqueous nanosuspensions with appropriate stability and redispersibility behaviours for pharmaceutical use.
Asunto(s)
Antihelmínticos/síntesis química , Composición de Medicamentos/métodos , Nanosferas/química , Praziquantel/síntesis química , Antihelmínticos/farmacocinética , Química Farmacéutica/métodos , Electrólitos/síntesis química , Electrólitos/farmacocinética , Concentración de Iones de Hidrógeno , Interacciones Hidrofóbicas e Hidrofílicas , Nanosferas/metabolismo , Praziquantel/farmacocinética , Agua/química , Agua/metabolismoRESUMEN
BACKGROUND: Early specialized palliative care improves quality of life of patients with advanced cancer, and guidelines encourage its integration into standard oncology care. However, many patients fail to obtain timely palliative/supportive care evaluations, particularly in limited-resource settings. We aimed to determine the proportion of patients with advanced cancer who received an assessment of symptoms and were referred to supportive and palliative care services during the first year after diagnosis in a Mexican hospital. METHODS: Individuals with newly diagnosed advanced solid tumors and 1 year of follow-up at the oncology clinics in the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran in Mexico City from October 2015 to April 2016 were included in this retrospective study. RESULTS: Seventy-seven patients were included. Forty-two (54.5%) were referred to the various supportive care services during the first year after diagnosis, and 23 (29.8%) were referred to the palliative care clinic. The most commonly assessed symptoms by oncologists were pain (77.9%), anorexia (74.0%), fatigue (68.8%), and nausea (55.8%), while depression/anxiety were evaluated in 10 (12.9%) patients. The oncologist offered to clarify treatment goals in 39 (50.6%) cases and evaluated the understanding of diagnosis/illness and prognosis in 22 (28.5%). CONCLUSION: Palliative and supportive care services were widely underutilized, which may be related to a lack of standardized symptom assessments and poor end-of-life communication. Novel strategies are needed to improve the implementation of tools for systematic symptom assessment and to optimize the integration of supportive care interventions into oncology care in developing countries.
Asunto(s)
Neoplasias/enfermería , Cuidados Paliativos/normas , Selección de Paciente , Guías de Práctica Clínica como Asunto , Apoyo Social , Evaluación de Síntomas , Anciano , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Estudios Retrospectivos , Encuestas y CuestionariosRESUMEN
Biopolymeric films with silver sulfadiazine (AgSD) are proposed as an alternative to the occlusive AgSD-containing creams and gauzes, which are commonly used in the treatment of conventional burns. While the recognized cytotoxicity of AgSD has been reported to compromise its use as an antimicrobial drug in pharmaceuticals, this limitation can be overcome by developing sustained-release formulations. Microporous materials as zeolites can be used as drug delivery systems for sustained release of AgSD. The purpose of this work was the development and characterization of chitosan/zeolite composite films to be used as wound dressings. Zeolite was impregnated with AgSD before the production of the composite films. The physicochemical properties of zeolites and the films were evaluated, as well as the antimicrobial activity of the polymeric films and the cytotoxicity of the films in fibroblasts Balb 3T3/c. Impregnated zeolite exhibited changes in FTIR spectra and XRD diffraction patterns, in comparison to non-impregnated composites, which corroborate the results obtained with EDX-SEM. The pure chitosan film was compact and without noticeable defects and macropores, while the film with zeolite was opaquer, more rigid, and efficient against Candida albicans and some gram-negative bacteria. The safety evaluation showed that although the AgSD films present cytotoxicity, they could be used in a concentration-dependent fashion.
RESUMEN
BACKGROUND: The study of intimate partner violence has historically focused on violence perpetrated on females by males, but recent research suggests that, at least in teenage couples, the difference between genders is decreasing or even reversing. The objective of this study is to analyze the personality characteristics of adolescents who are violent with their partners. The sample consisted of 430 subjects (229 girls and 201 boys), between 14 and 19 years (M = 16.18, SD = 1.81), middle or high school students, which completed the Personality Assessment Inventory-Adolescents and the Conflict in Adolescent Dating Relationships Inventory. RESULTS: The results show that girls have higher personality scores on the scales that show problems of internal behavior (depression and anxiety), while boys show higher scores on the scales of external behavior problems (antisocial behavior and drug use). Through a regression analysis, the results show predictive weights in the aggression traits (ß = .331, p < .001), antisocial characteristics (ß = .202, p < .001), and mania (ß = .185, p < .05), as the scores on the scale of violence perpetrated increase in girls. For boys, personality variables do not seem to have such a decisive weight to explain the violence committed, since only heat and alcohol problems represent 5.4% of the variance found. These differences between boys and girls should be analyzed in future studies and, if the findings are maintained, taken into account when developing programs to prevent gender-based violence in adolescents. CONCLUSIONS: The results of this study show how the personality characteristics have a differential weight in the explanation of the teen dating aggression according to the gender of the aggressors, with a greater relevance in the prediction of the aggressive behaviors committed by the girls.
RESUMEN
Background: The study of intimate partner violence has historically focused on violence perpetrated on females by males, but recent research suggests that, at least in teenage couples, the difference between genders is decreasing or even reversing. The objective of this study is to analyze the personality characteristics of adolescents who are violent with their partners. The sample consisted of 430 subjects (229 girls and 201 boys), between 14 and 19 years (M =16.18, SD = 1.81), middle or high school students, which completed the Personality Assessment Inventory-Adolescents and the Conflict in Adolescent Dating Relationships Inventory. Results: The results show that girls have higher personality scores on the scales that show problems of internal behavior (depression and anxiety), while boys show higher scores on the scales of external behavior problems (antisocial behavior and drug use). Through a regression analysis, the results show predictive weights in the aggression traits (ß= .331, p < .001), antisocial characteristics (ß = .202, p < .001), and mania (ß = .185, p < .05), as the scores on the scale of violence perpetrated increase in girls. For boys, personality variables do not seem to have such a decisive weight to explain the violence committed, since only heat and alcohol problems represent 5.4% of the variance found. These differences between boys and girls should be analyzed in future studies and, if the findings are maintained, taken into account when developing programs to prevent gender-based violence in adolescents. Conclusions: The results of this study show how the personality characteristics have a differential weight in the explanation of the teen dating aggression according to the gender of the aggressors, with a greater relevance in the prediction of the aggressive behaviors committed by the girls.(AU)
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Personalidad , Violencia/psicología , Cortejo/psicología , Violencia de GéneroRESUMEN
Resumen El objetivo de esta investigación es analizar el autoconcepto en las víctimas de violencia de género entre adolescentes. Habiéndose constatado una menor autoestima en las víctimas de este tipo de violencia, se pretende comprobar si sucede lo mismo con el componente cognitivo de la visión que cada uno tenemos de nosotros mismos y que constituye el autoconcepto. Se ha utilizado una muestra compuesta por 266 adolescentes españoles con edades comprendidas entre los 14 y 19 años, que cursan estudios de Enseñanza Secundaria Obligatoria y Bachillerato. Se observa interacción significativa del género y la edad con el autoconcepto en adolescentes que sufren violencia en su relación, y las chicas con edades comprendidas entre los 16-17 años son el grupo de mayor vulnerabilidad. Son ellas las que presentan más bajo autoconcepto emocional y físico; así se constata que a medida que aumenta la edad, la prevalencia de este tipo de violencia se hace mayor. De cara a prevenir y paliar los efectos de la violencia de pareja en adolescentes, los programas de prevención deben incluir den tro de sus áreas de actuación acciones de educación emocional, que ayuden a mejorar el autoconcepto emocional de las víctimas.
Abstract This paper seeks to analyse self-concept in gender-based violence victims amongst adolescents. Having noticed a lower self-esteem in the victims of this type of violence, the authors wanted to verify whether the same effect takes place with the cognitive component of the vision that we each have of ourselves, which constitutes the self-concept. The popu lation sample consisted of 266 Spanish adolescents aged between 14 and 19 years attending middle school or high school. A significant interaction is observed between gender and age and self-concept in adolescents that suffer violence in their relationship. Similarly, girls aged 16-17 are the most vulnerable group. The latter have the lowest emotional and physical self-concept. Thus, it is corroborated that the prevalence of this type of violence becomes greater as age increases. In order to prevent and mitigate the effects of gender-based violence on adolescents, prevention programs must include emotional education aspects within their areas of action, so as to help improve the emotional self-concept of the victims.
RESUMEN
PURPOSE: Purulent or exudative genitourinary infections are a frequent cause of consultation in primary and specialized healthcare. The objectives of this study were: to determine the prevalence of Trichomonas vaginalis and co-infections with Candida spp. and Gardnerella vaginalis in vaginal secretion; and to use multilocus sequence typing (MLST) to analyse the genetic diversity of T. vaginalis strains. METHODOLOGY: The samples were submitted for analysis (n=5230) to a third-level hospital in Granada (Southern Spain) between 2011 and 2014; eight T. vaginalis strains isolated during 2015 were randomly selected for MLST analysis. Culture and nucleic acid hybridization techniques were used to detect microorganisms in the samples. RESULTS: The prevalence of T. vaginalis was 2.4â% between 2011 and 2014, being higher during the first few months of both 2011 and 2012. Among samples positive for T. vaginalis, co-infection with G. vaginalis was detected in 29 samples and co-infection with Candida spp. in 6, while co-infection with all three pathogens was observed in 3 samples. The only statistically significant between-year difference in co-infection rates was observed for T. vaginalis with G. vaginalis due to an elevated rate in 2011. MLST analysis results demonstrated a high genetic variability among strains circulating in our setting. CONCLUSION: These findings emphasize the need for the routine application of diagnostic procedures to avoid the spread of this sexually transmitted infection.
Asunto(s)
Candida/clasificación , Candidiasis/complicaciones , Gardnerella vaginalis/aislamiento & purificación , Variación Genética , Tricomoniasis/microbiología , Trichomonas vaginalis/genética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Candidiasis/epidemiología , Coinfección/epidemiología , Coinfección/microbiología , Coinfección/parasitología , Femenino , Infecciones por Bacterias Grampositivas/complicaciones , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Persona de Mediana Edad , España/epidemiología , Tricomoniasis/complicaciones , Tricomoniasis/epidemiología , Enfermedades Vaginales/epidemiología , Enfermedades Vaginales/microbiología , Enfermedades Vaginales/parasitología , Adulto JovenRESUMEN
The search for new alternatives for the prevention and treatment of cancer is extremely important to minimize human mortality. Natural products are an alternative to chemical drugs, since they are a source of many potential compounds with anticancer properties. In the present study, the (2S)-5,7-dihydroxy-6-prenylflavanone (semi-systematic name), also called (2S)-5,7-dihydroxy-6-(3-methyl-2-buten-1-yl)-2-phenyl-2,3-dihydro-4H-1-Benzopyran-4-one (CAS Name registered) (1) was isolated from Eysenhardtia platycarpa leaves. This flavanone 1 was considered as the lead compound to generate new cytotoxic derivatives 1a, 1b, 1c and 1d. These compounds 1, 1a, 1b, 1c, and 1d were then loaded in nanosized drug delivery systems such as polymeric nanoparticles (NPs). Small homogeneous spherical shaped NPs were obtained. Cytotoxic activity of free compounds 1, 1a, 1b, 1c, and 1d and encapsulated in polymeric NPs (NPs1, NPs1a, NPs1b, NPs1c and NPs1d) were evaluated against the pancreatic cancer cell line MiaPaCa-2. The obtained results demonstrated that NPs1a and NPs1b exhibited optimal cytotoxicity, and an even higher improvement of the cytotoxic efficacy was exhibited with the encapsulation of 1a. Based on these results, NPs1a were proposed as promising anticancer agent candidates.
Asunto(s)
Portadores de Fármacos/química , Fabaceae/química , Flavanonas/química , Nanopartículas/química , Extractos Vegetales/química , Copolímero de Ácido Poliláctico-Ácido Poliglicólico/química , Antineoplásicos/química , Antineoplásicos/aislamiento & purificación , Antineoplásicos/farmacología , Línea Celular Tumoral , Supervivencia Celular/efectos de los fármacos , Liberación de Fármacos , Ensayos de Selección de Medicamentos Antitumorales , Flavanonas/aislamiento & purificación , Flavanonas/farmacología , Humanos , Cinética , Neoplasias Pancreáticas , Tamaño de la Partícula , Extractos Vegetales/aislamiento & purificación , Hojas de la Planta/química , Propiedades de Superficie , TermodinámicaRESUMEN
BACKGROUND: Desmoid tumours are one of the rarest tumours worldwide, with an estimated yearly incidence of 2-4 new cases per million people. They are soft tissue monoclonal neoplasms that originate from mesenchymal stem cells. It seems that the hormonal and immunological changes occurring during pregnancy may play a role in the severity and course of the disease. CLINICAL CASE: The case is presented on 28-year-old female in her fifth week of gestation, in whom an abdominal wall tumour was found attached to left adnexa and uterus while performing a prenatal ultrasound. The patient was followed up under clinical and ultrasonographic surveillance. When she presented with abnormal uterine activity at 38.2 weeks of gestation, she was admitted and obstetrics decided to perform a caesarean section. Tumour biopsy was taken during the procedure. Histopathology reported a desmoid fibromatosis. A contrast enhanced abdominal computed tomography scan was performed, showing a tumour of 26×20.5×18cm, with well-defined borders in contact with the uterus, left adnexa, bladder and abdominal wall, with no evidence of infiltration to adjacent structures. A laparotomy, with tumour resection, hysterectomy and left salpingo-oophorectomy, components separation techniques, polypropylene mesh insertion, and drainage was performed. The final histopathology report was desmoid fibromatosis. There is no evidence of recurrence after 6 months follow-up. CONCLUSIONS: Desmoid tumours are locally aggressive and surgical resection with clear margins is the basis for the treatment of this disease, using radiotherapy, chemotherapy and hormone therapy as an adjunct in the treatment.
Asunto(s)
Pared Abdominal , Fibromatosis Abdominal/patología , Complicaciones Neoplásicas del Embarazo/patología , Adulto , Progresión de la Enfermedad , Femenino , Humanos , Embarazo , Factores de TiempoRESUMEN
Abstract: Background: Oral mucositis (OM) is an inflammatory reaction of the oropharyngeal mucosa to cumulative chemotherapy (CT) and radiation therapy (RT), affecting one or more parts of the digestive tract along with the quality of life (QoL) of the patient. The goal of this study was to identify valid and reliable tools to evaluate QoL related to OM. Methods: A systematic review of the literature was conducted up to May 2016. Articles were selected by peers using the PubMed database through a search following the inclusion and exclusion criteria and STAndards for the Reporting of Diagnostic accuracy studies (STARD) checklist with a cut-off point ≥ 70%. Results: We identified four relevant articles that described instruments to assess the QoL related to OM in patients undergoing cancer treatment. Conclusions: The evaluation of the QoL in patients with OM is a difficult scenario because of its multiple variables. The knowledge of this relationship is limited because general instruments of oral health or cancer therapy are commonly used for evaluation. However, valid instruments are already available for estimating the impact of OM on the QoL from the patient's perspective.
Resumen: Introducción: La mucositis oral (MO) es una reacción inflamatoria de la mucosa orofaríngea a la quimio y radioterapia acumulativa, que afecta una o varias partes del tracto digestivo, además de la calidad de vida (CV) del paciente. El objetivo de este estudio fue identificar instrumentos válidos y confiables para evaluar la CV relacionada con MO. Métodos: Se realizó una revisión sistemática de la literatura hasta mayo del 2016. Se realizó una selección por pares de los artículos a través de una búsqueda en PubMed, siguiendo los criterios de inclusión y exclusión y la lista de los estudios de precisión diagnóstica STARD (STAndards for the Reporting of Diagnostic) con un punto de corte ≥ 70%. Resultados: Se identificaron cuatro artículos relevantes que describen instrumentos para evaluar la CV relacionada con MO de pacientes que reciben tratamiento contra el cáncer. Conclusiones: El escenario para la evaluación de la CV de pacientes con MO resulta complicado debido a las múltiples variables. El conocimiento de la relación entre la CV y la MO es limitado porque los instrumentos generales son comúnmente utilizados tanto para la evaluación de la salud oral como para la terapia contra el cáncer. Sin embargo, ya se cuenta con instrumentos válidos para la evaluación del impacto de la MO sobre la CV desde la perspectiva del paciente.
RESUMEN
Prevalence of non-alcoholic fatty liver disease (NAFLD) may be 10%-15% worldwide, and these figures are even higher in obese and in type 2 diabetes mellitus patients. The most important risk factor is metabolic syndrome, especially central obesity. Even though the majority of patients with macrovesicular steatohepatitis will not progress to advanced liver disease, a subgroup of patients will evolve to non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma. Independent risk factors associated with NASH are older age, type 2 diabetes mellitus and obesity. Patients with significant hepatocellular lesion, such as hepatocyte ballooning, Mallory hyalline or fibrosis, have a higher risk of cirrhosis and are more likely to have a high liver-related mortality, although higher global mortality has not been demonstrated. Although NASH related cirrhosis may have better prognosis compared to hepatitis C cirrhosis, recent series suggest that it may be the third cause of liver transplantation. Steatosis, NASH and cirrhosis recurrence post-liver transplantation is common. The risk of hepatocellular carcinoma (HCC) is increased in patients with NAFLD, and all patients with cryptogenic cirrhosis should be screened for HCC
La enfermedad hepática grasa no alcohólica puede afectar al 15%-25% de la población, con cifras mayores en pacientes obesos y con diabetes mellitus tipo 2. El principal factor de riesgo es el síndrome metabólico, especialmente la obesidad central. Aunque la mayoría de los pacientes con esteatosis macrovacuolar simple no presentan progresión de su enfermedad, existe un subgrupo que progresa a esteatohepatitis no alcohólica, y aunque se desconocen los factores de riesgo para esta progresión, la mayoría de los estudios reconocen la edad, la presencia de diabetes mellitas tipo 2 y la obesidad como predictores de riesgo independientes de EHNA. La presencia de lesión hepatocelular significativa, como el abalonamiento hepatocitario o la hialina de Mallory y la fibrosis, incrementan significativamente el riesgo de cirrosis. Los pacientes que tienen esta lesión histopatológica presentan una mortalidad de causa hepática superior, si bien no se ha demostrado una mortalidad global aumentada. Aunque la cirrosis secundaria a esteatohepatitis no alcohólica parece tener un pronóstico ligeramente mejor que la secundaria a hepatitis C, en muchas series es la tercera causa de trasplante ortotópico de hígado. La recurrencia postrasplante de la esteatosis, de la esteatohepatitis no alcohólica y de la cirrosis es frecuente. Existe un aumento del riesgo de hepatocarcinoma en pacientes con enfermedad hepática grasa no alcohólica. En la actualidad se recomienda el seguimiento para la detección precoz de este tumor en todos los pacientes con cirrosis criptogénica