RESUMO
BACKGROUND: Retrospective data suggest an association between bevacizumab efficacy and the incidence of arterial hypertension (AHT). Additionally, epigenetic mechanisms have been related to AHT. METHODS: This prospective observational study conducted by GEICAM Spanish Breast Cancer Research Group included metastatic breast (MBC) or colorectal (mCRC) cancer patients treated with bevacizumab-containing chemotherapy as first-line treatment. Blood pressure (BP) levels were measured (conventional and 24-h Holter monitoring) at baseline and up to cycle 3. Primary endpoint assessed BP levels increase as predictive factor for progression-free survival (PFS). Germline DNA methylation profile was explored in pre-treatment blood samples; principal component analysis was used to define an epigenetic predictive score for increased BP levels. RESULTS: From Oct-2012 to Jul-2016, 143 (78 MBC and 65 mCRC) patients were included. The incidence of AHT according to guidelines was neither predictive of PFS nor of best overall tumor response (BOR). No statistically significant association was observed with systolic BP nor diastolic BP increment for PFS or BOR. Grade 3 and 4 adverse events were observed in 37 and 5% of patients, respectively. We identified 27 sites which baseline methylation status was significantly associated to BP levels increase secondary to bevacizumab-containing chemotherapy. CONCLUSIONS: Neither the frequency of AHT nor the increase of BP levels were predictive of efficacy in MBC and mCRC patients treated with bevacizumab-containing chemotherapy. CLINICAL TRIAL REGISTRY: ClinicalTrials.gov Identifier: NCT01733628.
Assuntos
Bevacizumab , Neoplasias da Mama , Neoplasias Colorretais , Hipertensão , Humanos , Bevacizumab/uso terapêutico , Bevacizumab/administração & dosagem , Feminino , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/patologia , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Pessoa de Meia-Idade , Hipertensão/induzido quimicamente , Estudos Prospectivos , Idoso , Masculino , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Idoso de 80 Anos ou mais , Intervalo Livre de Progressão , Metilação de DNARESUMO
PURPOSE: RAS (KRAS/NRAS) mutational status on a tumor biopsy is mandatory to guide the best treatment in metastatic colorectal cancer (mCRC). Determining the RAS mutational status by tumor-tissue biopsy is essential in guiding the optimal treatment decision for mCRC. RAS mutations are negative predictive factors for the use of EGFR monoclonal antibodies. Cell-free DNA (cfDNA) analysis enables minimally invasive monitoring of tumor evolution. METHODS/PATIENTS: PERSEIDA was an observational, prospective study assessing cfDNA RAS, BRAF and EGFR mutations (using Idylla™) in first-line mCRC, RAS wild-type (baseline tumor-tissue biopsy) patients (cohort 2). Plasma samples were collected before first-line treatment, after 20 ± 2 weeks, and at disease progression. RESULTS: 117 patients were included (103 received panitumumab + chemotherapy as first-line treatment). At baseline, 7 (6.8%) patients had RAS mutations, 4 (3.9%) BRAF mutations and no EGFR mutations were detected (cfDNA, panitumumab + chemotherapy subpopulation [panitumumab + Ch]). The baseline RAS mutational status concordance between tissue and liquid biopsies was 94.0% (93.2%, panitumumab + Ch). At 20 weeks, only one patient in the study (included in the panitumumab + Ch) had an emerging cfDNA RAS mutation. No emerging BRAF or EGFR mutations were reported. At disease progression, 6 patients had emergent mutations not present at baseline (RAS conversion rate: 13.3% [6/45]; 15.0% [6/40], panitumumab + Ch). CONCLUSIONS: The concordance rate between liquid and solid biopsies at baseline was very high, as previously reported, while our results suggest a considerable emergence of RAS mutations during disease progression. Thus, the dynamics of the genomic landscape in ctDNA may provide relevant information for the management of mCRC patients.
Assuntos
Ácidos Nucleicos Livres , Neoplasias Colorretais , Mutação , Panitumumabe , Proteínas Proto-Oncogênicas B-raf , Humanos , Neoplasias Colorretais/genética , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/patologia , Neoplasias Colorretais/sangue , Feminino , Masculino , Estudos Prospectivos , Idoso , Pessoa de Meia-Idade , Ácidos Nucleicos Livres/genética , Ácidos Nucleicos Livres/sangue , Proteínas Proto-Oncogênicas B-raf/genética , Panitumumabe/uso terapêutico , Proteínas Proto-Oncogênicas p21(ras)/genética , Receptores ErbB/genética , Adulto , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , GTP Fosfo-Hidrolases/genética , Progressão da Doença , Proteínas de Membrana/genéticaRESUMO
PURPOSE: The optimal drug regimen and sequence are still unknown for patients with metastatic colorectal cancer (mCRC) who are candidates for third-line (3L) or subsequent treatment. The aim of this study is to know the opinion of experts on the most appropriate treatment options for mCRC in 3L and to clarify certain clinical decisions in Spain. METHODS: Using a modified Delphi method, a group of experts discussed the treatment in 3L of patients with mCRC and developed a questionnaire with 21 items divided into 5 sections. RESULTS: After 2 rounds, the 67 panelists consulted agreed on 17 items (81%). They considered that the main objective of 3L is to equally increase survival and improve patients' quality of life (QoL), but preferably the QoL. It was agreed that patients with mCRC in 3L prefer to receive active versus symptomatic treatment. Panelists considered trifluridine/tipiracil (FTD/TPI) to be the best oral treatment available to them in 3L. In patients with MSI-H or dMMR and BRAF V600E, the panelists mostly prefer targeted treatments. Panelists agreed the use of a therapeutic sequence that not only increases outcomes but also allows patients to be treated later. Finally, it was agreed that FTD/TPI has a mechanism of action that allows it to be used in patients refractory to previous treatment with 5-fluorouracil. CONCLUSION: The experts agreed with most of the proposed items on 3L treatment of mCRC, prioritizing therapeutic options that increase survival and preserve QoL, while facilitating the possibility that patients can continue to be treated later.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias Colorretais , Técnica Delphi , Qualidade de Vida , Humanos , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Consenso , Pirrolidinas/uso terapêutico , Trifluridina/uso terapêutico , Timina/uso terapêutico , Inquéritos e Questionários , Metástase Neoplásica , Proteínas Proto-Oncogênicas B-raf/genética , EspanhaRESUMO
Colorectal cancer (CRC) is the second leading cause of cancer deaths in Spain. Metastatic disease is present in 15-30% of patients at diagnosis and up to 20-50% of those with initially localized disease eventually develop metastases. Recent scientific knowledge acknowledges that this is a clinically and biologically heterogeneous disease. As treatment options increase, prognosis for individuals with metastatic disease has steadily improved over recent decades. Disease management should be discussed among experienced, multidisciplinary teams to select the most appropriate systemic treatment (chemotherapy and targeted agents) and to integrate surgical or ablative procedures, when indicated. Clinical presentation, tumor sidedness, molecular profile, disease extension, comorbidities, and patient preferences are key factors when designing a customized treatment plan. These guidelines seek to provide succinct recommendations for managing metastatic CRC.
Assuntos
Neoplasias do Colo , Neoplasias Retais , Humanos , Gerenciamento Clínico , Preferência do Paciente , EspanhaRESUMO
Peritoneal metastases (PM) occur when cancer cells spread inside the abdominal cavity and entail an advanced stage of colorectal cancer (CRC). Prognosis, which is poor, correlates highly with tumour burden, as measured by the peritoneal cancer index (PCI). Cytoreductive surgery (CRS) in specialized centres should be offered especially to patients with a low to moderate PCI when complete resection is expected. The presence of resectable metastatic disease in other organs is not a contraindication in well-selected patients. Although several retrospective and small prospective studies have suggested a survival benefit of adding hyperthermic intraperitoneal chemotherapy (HIPEC) to CRS, the recently published phase III studies PRODIGE-7 in CRC patients with PM, and COLOPEC and PROPHYLOCHIP in resected CRC with high-risk of PM, failed to show any survival advantage of this strategy using oxaliplatin in a 30-min perfusion. Final results from ongoing randomized phase III trials testing CRS plus HIPEC based on mitomycin C (MMC) are awaited with interest. In this article, a group of experts selected by the Spanish Group for the Treatment of Digestive Tumours (TTD) and the Spanish Group of Peritoneal Oncologic Surgery (GECOP), which is part of the Spanish Society of Surgical Oncology (SEOQ), reviewed the role of HIPEC plus CRS in CRC patients with PM. As a result, a series of recommendations to optimize the management of these patients is proposed.
Assuntos
Neoplasias Colorretais , Hipertermia Induzida , Neoplasias Peritoneais , Humanos , Neoplasias Colorretais/patologia , Neoplasias Peritoneais/secundário , Estudos Retrospectivos , Estudos Prospectivos , Terapia Combinada , Hipertermia Induzida/métodos , Taxa de SobrevidaRESUMO
Pancreatic cancer and biliary tract cancer have a poor prognosis. In recent years, the development of new diagnostic techniques has enabled the identification of the main genetic alterations involved in the development of these tumours. Multiple studies have assessed the ability of certain biomarkers, such as BRCA in pancreatic cancer, IDH1 or FGFR2 in biliary tract cancer and microsatellite instability or NTRK fusions in an agnostic tumour fashion, to predict response to treatment.In this consensus, a group of experts selected by the Spanish Society of Medical Oncology (SEOM) and the Spanish Society of Pathology (SEAP) reviewed the role played by these mutations in the process of carcinogenesis and their clinical implications. As a result, this article proposes a series of recommendations to optimize the determination of these biomarkers to help standardize the diagnosis and treatment of these tumours.
Assuntos
Neoplasias do Sistema Biliar , Neoplasias Pancreáticas , Neoplasias do Sistema Biliar/diagnóstico , Neoplasias do Sistema Biliar/genética , Biomarcadores Tumorais/genética , Consenso , Humanos , Oncologia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/genética , Neoplasias PancreáticasRESUMO
OBJECTIVE: This study aims to investigate the relationship between the pre-operative indocyanine green (ICG) test, the chemotherapy-associated liver injury (CALI), and the development of severe post-operative complications (POC) in patients operated of colorectal liver metastases (CRLMs). MATERIALS AND METHODS: Sixty-nine patients previously treated with chemotherapy and submitted to liver resection for CRLM were retrospectively studied. Two pathologists independently reviewed the pathological specimens and assessed the presence of CALI. The correlation between ICG clearance and specific pathological features was analyzed. In addition, a logistic regression analysis was performed to seek for pre-operative factors associated with severe complications. RESULTS: After a mean of 10.6 (± 7.5) chemotherapy cycles, 44 patients (63.8%) developed CALI. ICG retention rate at 15 min (ICG-R15) was not statistically different between patients with and without CALI and it could only discriminate the presence of centrilobular fibrosis. Rate of severe complications was almost 6-fold in patients with CALI compared to patients without CALI (p = 0.024). ICG-R15 ≥ 10% was the only independent risk factor associated with severe POC at multivariable logistic regression (OR = 4.075 95% CI: 1.077-15.422, p = 0.039). CONCLUSIONS: Pre-operative ICG clearance test, although not useful to identify patients with hepatic drug toxicity, is a strong predictor for the development of severe post-hepatectomy complications.
OBJETIVO: Investigar la relación entre el test de aclaramiento del verde de indocianina (ICG) preoperatorio, las alteraciones patológicas derivadas de la quimioterapia (CALI) y el desarrollo de complicaciones posoperatorias en los pacientes sometidos a resección hepática por metástasis de cáncer colorrectal (MCCR). MATERIAL Y MÉTODOS: Sesenta y nueve pacientes previamente tratados con quimioterapia y operados de MCCR se estudiaron de manera retrospectiva. Dos patólogas revisaron independientemente el parénquima hepático no tumoral de los especímenes y determinaron la presencia de daño quimio-inducido. Se analizó la correlación entre el aclaramiento de ICG y las diferentes alteraciones anatomo-patológicas encontradas. Además, se realizó un análisis de regresión logística para identificar los factores preoperatorios asociados con las complicaciones posoperatorias. RESULTADOS: Tras una media de 10.6 (± 7.5) ciclos de quimioterapia, 44 pacientes (63.8%) desarrollaron CALI. La tasa de retención de ICG a los 15 minutos (ICG-R15) no fue estadísticamente diferente entre los pacientes con y sin CALI y solo pudo discriminar la presencia de fibrosis centrolobulillar. La tasa de complicaciones severas posoperatorias fue 6 veces superior en los pacientes con CALI, comparada con aquella de los pacientes sin CALI (p = 0.024). Un ICG-R15 ≥ 10% fue el único factor de riesgo independiente asociado a complicaciones severas (OR = 4.075 95% CI: 1.077-15.422, p = 0.039). CONCLUSIONES: La prueba preoperatoria de aclaramiento del ICG, a pesar de no identificar eficazmente los pacientes con daño por quimioterapia, es un fuerte predictor de desarrollo de complicaciones severas posoperatorias.
Assuntos
Neoplasias Colorretais , Hepatite , Neoplasias Hepáticas , Neoplasias Colorretais/complicações , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/cirurgia , Humanos , Verde de Indocianina/uso terapêutico , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos RetrospectivosRESUMO
This consensus statement, conceived as a joint initiative of the Spanish Society of Pathology and the Spanish Society of Medical Oncology, makes diagnostic and treatment recommendations for the management of patients with hereditary, localised and advanced CRC based on the current scientific evidence on biomarker use. This consensus statement thus provides an opportunity to improve healthcare efficiency and resource use, which will benefit these patients. Based on the currently available data on this subject, this expert group recommends testing for microsatellite instability (MSI) in patients with localised CRC, as this is a strong predictive factor for deciding on adjuvant treatment. However, although the ColoPrint(®) and Oncotype Dx(®) gene expression signatures have been shown to have prognostic value, no consensus yet exists concerning their use in clinical practice. For advanced CRC, it is essential to test for KRAS mutation status before administering an anti-EGFR treatment, such as cetuximab or panitumumab. However, testing for other biomarkers, such as BRAF, EGFR, PI3K and PTEN mutations, should not be done routinely, because this does not influence treatment planning at the present time. Other important issues addressed include organisational requirements and the quality controls needed for proper testing of these biomarkers as well as the legal implications to be borne in mind when testing some biomarkers.
Assuntos
Biomarcadores Tumorais/análise , Carcinoma/diagnóstico , Neoplasias Colorretais/diagnóstico , Consenso , Técnicas e Procedimentos Diagnósticos , Guias de Prática Clínica como Assunto , Algoritmos , Biomarcadores Tumorais/genética , Carcinoma/genética , Neoplasias Colorretais/genética , Humanos , Oncologia/legislação & jurisprudência , Oncologia/organização & administração , Instabilidade de Microssatélites , Patologia Clínica/legislação & jurisprudência , Patologia Clínica/organização & administração , Prognóstico , Sociedades Médicas/legislação & jurisprudência , Sociedades Médicas/organização & administração , EspanhaRESUMO
The identification of HER2 alterations in advanced gastric carcinomas is of critical importance in daily clinical practice as such neoplasms require specific treatment with trastuzumab. For these reasons, pathologists and oncologists with expertise in gastric carcinomas and HER2 testing from both organisations (SEAP and SEOM) have endeavoured to discuss and agree on national guidelines for HER2 testing in gastric carcinomas. These guidelines are based on the experience of those who participated in the discussions and also on experience published internationally. These agreed guidelines give the minimum requirements that a pathological anatomy laboratory must fulfil in order to guarantee adequate HER2 testing in daily practice. Any laboratories which do not meet the minimum standards set out in the guidelines must make every effort to achieve compliance.
Assuntos
Carcinoma/genética , Consenso , Genes erbB-2 , Testes Genéticos/métodos , Testes Genéticos/estatística & dados numéricos , Neoplasias Gástricas/genética , Algoritmos , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/genética , Carcinoma/diagnóstico , Carcinoma/patologia , Técnicas de Laboratório Clínico/métodos , Ensaios Clínicos como Assunto , Genes erbB-2/genética , Humanos , Oncologia/legislação & jurisprudência , Oncologia/métodos , Oncologia/organização & administração , Patologia Molecular/legislação & jurisprudência , Patologia Molecular/métodos , Patologia Molecular/organização & administração , Guias de Prática Clínica como Assunto , Sociedades Médicas/legislação & jurisprudência , Espanha , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologiaRESUMO
Metastatic colorectal cancer (CRC) represents an important health problem in which several biological predictive and prognostic factors have been identified, including clinical features and molecular markers that might influence the response to treatment. Actually, certain prognostic factors are considered key elements, along with disease extent, for deciding the therapeutic approach. However, a distinction between resectable/potentially resectable and unresectable patients must be made in order to establish an adequate therapeutic strategy. Different drugs and chemotherapy regimens are currently available, and their administration depends on patient characteristics, disease-related factors and the treatment objective. Moreover, special situations such as peritoneal carcinomatosis and local treatment of CRC in the setting of metastatic disease should be considered when deciding the most appropriate treatment strategy. This article reviews all the previously mentioned issues involved in the management of metastatic CRC and suggests some general recommendations for its treatment.
Assuntos
Neoplasias Colorretais/terapia , Metástase Neoplásica/terapia , Neoplasias Colorretais/patologia , Humanos , Metástase Neoplásica/patologia , Estadiamento de Neoplasias/métodos , Guias de Prática Clínica como AssuntoRESUMO
Colorectal cancer is the first cause of cancer diagnosis in Spain. Over half of the patients are diagnosed with or will eventually develop distant metastasis. The current manuscript aims to provide synthetic practical guidelines for the therapeutic approaches in advanced disease. Available systemic therapeutic options, and integration and sequencing of chemotherapy with surgical procedures are discussed. Extent of disease, treatment objective, tumor kras mutation status, as well as patient's functional and comorbid conditions shall be considered to properly design the most adequate therapeutic strategy.
Assuntos
Carcinoma/terapia , Neoplasias Colorretais/terapia , Oncologia/métodos , Guias de Prática Clínica como Assunto , Algoritmos , Carcinoma/patologia , Neoplasias Colorretais/patologia , Progressão da Doença , Humanos , Oncologia/tendências , Sociedades Médicas , EspanhaRESUMO
Colorectal cancer is the third most frequent malignant neoplasm in Western countries. After complete resection, 5-year overall survival varies according to the initial stage. Adjuvant chemotherapy (CT) is indicated in patients with colon cancer at high-risk stage II, stage III and after complete resection of metastases. 5-Fluorouracil (5FU), alone or modulated with levamisol or leucovorin (LV), oral fluoropyrimidines, raltitrexed, irinotecan and oxaliplatin have been studied as adjuvant therapy for colon cancer. Nowadays, oxaliplatin-based regimens, FOLFOX or FLOX, are considered as the standard adjuvant CT. If there are contraindications for oxaliplatin, the best alternatives are capecitabine or continuous infusion of 5FU/LV. The role of monoclonal antibodies, cetuximab and bevacizumab, combined with oxaliplatin/fluoropyrimidine-based CT is under investigation in clinical trials. This article reviews the state of the art and the future perspectives of adjuvant therapy in colon cancer. Prognostic and predictive factors are also commented on.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Neoplasias do Colo/tratamento farmacológico , Anticorpos Monoclonais Humanizados , Bevacizumab , Cetuximab , Neoplasias do Colo/patologia , Humanos , Estadiamento de NeoplasiasRESUMO
An 80-year-old man was admitted to hospital with low-grade fever, weight loss, asthenia and anorexia. Physical examination revealed generalised ichthyosis with palmoplantar hyperkeratosis. CT scan showed retroperitoneal and inguinal lymph node enlargement. An inguinal lymph node biopsy revealed Hodgkin's disease (nodular-sclerosing subtype). The patient received chemotherapy, showing a clear improvement of both skin lesions and lymph nodes.
Assuntos
Doença de Hodgkin/diagnóstico , Ictiose/diagnóstico , Síndromes Paraneoplásicas/diagnóstico , Idoso de 80 Anos ou mais , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/patologia , Humanos , Ictiose/patologia , Linfonodos/patologia , Masculino , Síndromes Paraneoplásicas/patologiaRESUMO
Primary ovarian Burkitt lymphoma (BL) is a rare neoplasm in adults. We report a 30-year-old woman diagnosed with primary bilateral ovarian BL. She presented features of a twisted ovarian cyst and underwent bilateral salpingo-oophorectomy. The histopathologic evaluation yielded the diagnosis of BL and subsequently she received chemoimmunotherapy with CODOX-M-IVAC plus rituximab (anti-CD20 monoclonal antibody).
Assuntos
Linfoma de Burkitt/diagnóstico , Neoplasias Ovarianas/diagnóstico , Adulto , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Murinos , Antineoplásicos/uso terapêutico , Linfoma de Burkitt/tratamento farmacológico , Feminino , Humanos , Neoplasias Ovarianas/tratamento farmacológico , RituximabRESUMO
There is no standard chemotherapy regimen in advanced gastric cancer with poor performance status and hepatic dysfunction. New chemotherapeutical agents and targeted therapy have demonstrated promising results in terms of efficacy and safety in phase II clinical trials. We report the case of a 68-year-old man with stage IV gastric cancer and severe hepatic dysfunction due to liver metastases treated with a combination of oxaliplatin, 5-fluorouracil and cetuximab.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Hepatopatias/tratamento farmacológico , Neoplasias Gástricas/tratamento farmacológico , Idoso , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais Humanizados , Cetuximab , Fluoruracila/administração & dosagem , Humanos , Masculino , Estadiamento de Neoplasias , Compostos Organoplatínicos/administração & dosagem , Oxaliplatina , Neoplasias Gástricas/patologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Current issues of adjuvant therapy for colon cancer concern the introduction of drugs other than fluorouracil-5/leucovorin (5-FU/LV), the benefits for stage II patients, the use of new primary endpoints and the influence of age on treatment benefits. These issues were addressed in a panel discussion and the conclusions were the following: FOLFOX4 is the first regimen that shows superiority over 5-FU/LV. The use of 3-year disease-free survival as primary endpoint could encourage the quicker adoption of improved therapeutic strategies into clinical practice. Available data suggest that there are some benefits for stage II patients, and the decision needs to be individualised for each patient. Further, therapeutic decisions based solely on the patient's age are inappropriate, and geriatric assessment tools will help in making this decision. This information would improve patient and physician understanding of the recent data regarding the potential benefits of adjuvant therapy.
Assuntos
Neoplasias do Colo/terapia , Fatores Etários , Idoso , Quimioterapia Adjuvante , Ensaios Clínicos como Assunto , Intervalo Livre de Doença , HumanosRESUMO
La diabetes en el senescente presenta una alta prevalencia, 15-20 por ciento de la población general; sobre el 95 por ciento corresponde a una diabetes tipo 2. El tratamiento no farmacológico logra el control metabólico en el 50 por ciento de los pacientes. En aquellos casos sin respuesta a la dieta y el ejercicio emplean drogas hipoglicemiantes orales (DHO) y eventualmente- después de largos años de evoluvión de la DM- insulinoterapia. De la amplia gama de DHO disponible, siguen siendo los fármacos de primera línea las sulfonilureas y la metformina. las nuevas drogas orales: meglitinidas(insulinosecretoras) y las thiazolidinedionas(insulinosensibilizadoras) se usan fundamentalmente en tratamientos asociados. Las meglitidinas, como monoterapia, se indican en los adultos mayores que con medidas no farmacológicas presentan hiperglicemias postprandiales. Los inhibidores de las alfaglucosidades tienen una limitada utilidad por su mala tolerancia digestiva. Cuando es necesaria la insulinoterapia, se debe iniciar con dosis bajas de insulina intermedia (0,25 U/kg peso) en una injección diaria, realizándose ajustes posteriores. En el tratamiento del diabético senescente la principal precaución es la prevención de las hipoglicemias
Assuntos
Humanos , Masculino , Feminino , Idoso , Diabetes Mellitus , HipoglicemiantesRESUMO
Background: Urinary tract infection (UTI) is frequent among diabetics, especially women. It may be preceded by asymptomatic bacteriuria. Aim: To study the frequency of asymptomatic bacteriuria in type 2 diabetic women. Patients and methods: Fifty women with type 2 diabetes and 50 non diabetic women were studied. In aseptic conditions, morning midstream urine specimens were obtained for microbiological analysis. The test was repeated in similar conditions during consecutive days. Urine samples were cultured in blood agar, Mac Conkey agar and CPS ID 2. Colony forming units were counted. Asymptomatic bacteriuria was defined as the presence of 100,000 or more colony forming units per ml. Leukocyturia was also quantified. Results: There was microbial growth in 40 percent of samples from diabetic women and 6 percent of samples from controls (p <0.01). Asymptomatic bacteriuria was present in 32 percent of diabetics and 4 percent of controls (p <0.01). E Coli was the most frequently isolated strain, in 55 percent of patients and 100 percent of controls. Klebsiella pneumonió was isolated in 10 percent of diabetics, coagulase negative Staphylococcus in 10 percent, Enterococcus spp in 10 percent and Pseudomonas aeruginosa in 5 percent. Leukocyturia of more than 10 cells per field, was present in 80 percent of diabetic women with positive culture. Women with positive cultures had a longer lasting diabetes than those with negative cultures. There was no association between urine microbiological results and glycosilated hemoglobin, fasting blood glucose, chronic complications of diabetes and treatment received. Conclusions: This study shows a high prevalence of asymptomatic bacteriuria among diabetic women
Assuntos
Humanos , Adulto , Feminino , Pessoa de Meia-Idade , Infecções Urinárias , Diabetes Mellitus Tipo 2 , Bacteriúria , Estudos de Casos e ControlesRESUMO
En los últimos años se han incorporado dos nuevos grupos de fármacos hipoglicemiantes orales para el tratamiento de la diabetes tipo 2: las meglitinides y las thiazolidinedionas (glitazonas). Las meglitinides son drogas insulinosecretoras, que tienen como principal característica ser reguladores prandiales de la glicemia. Se dispone en el país de repaglinide y nateglinide, de efectos hipoglicemiantes similares. Se emplean inmediatamente antes de cada comida. Poseen bajos efectos colaterales y se pueden usar en monoterapia, aunque su principal indicación es su asociación con metformina o glitazonas. Las thiazolidinedionas son insulinosensibilizadoras que disminuyen la insulino resistencia, con efectos hipoglicemiantes y antiaterogénicos. Se dispone de rosiglitazona y pioglitazona, ambas de similar potencia farmacológica. No deben emplearse en pacientes con transaminasas elevadas por su eventual daño hepático. Se pueden usar como fármaco único, pero más aún en tratamientos asociados a insulinosecretores (sulfonilureas y/o meglitinides) o a metformina