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Cervical cancer (CC) occupies the second place in incidence and mortality among women in México. Despite this, Cervical Cancer continues to have a late diagnosis which leads to a high rate of complications. Pain represents the most feared and disabling symptom, being present in up to 86% of patients with advanced disease. The approach to managing pain in this population has not been studied and described to a full extent. In addition, there is a pressing need to provide concise recommendations to promote adequate pain control. We performed a review of the literature in CC and had experts in the field of pain management evaluate the evidence found. We then issued relevant recommendations on pharmacology and interventional pain management. Thus, the approach to pain management must be comprehensive and individualized, considering the timely and appropriate use of pharmacologic treatment as well as interventional procedures.

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OBJECTIVE: Cervical cancer is the fourth most frequent neoplasm among women in terms of incidence and mortality. Health-related quality of life (HRQL) is an important outcome in oncology. The QLQ-CX24 instrument was developed to measure HRQL in patients with cervical cancer, and its Mexican-Spanish version had not been validated. METHODS: Between March 2018 and May 2019, Mexican women older than 18, with any-stage cervical cancer were invited to participate in the study. Patients answered the QLQ-C30 and QLQ-CX24 questionnaires. Current tests for psychometric and clinical validation were performed. RESULTS: Three hundred and thirty patients with cervical cancer were included in this study. All women invited to participate accepted and were included. The QLQ-CX24 internal consistency test demonstrated adequate convergent (Spearman correlation coefficient 0.001-0.847) and divergent validity (Spearman correlation coefficient <0.0001-0.45). Cronbach's alpha coefficients of the three multi-item scales were >0.7 (minimum 0.76, maximum 0.89). Four scales of the QLQ-CX24 distinguished patients in different clinical stages. The evaluation of responsiveness demonstrated that the peripheral neuropathy scale was sensitive to change over time during chemo-radiation therapy. Six scales of the QLQ-CX24 instrument were associated with survival. CONCLUSION: The Mexican-Spanish version of the QLQ-CX24 questionnaire is reliable and valid for the assessment of HRQL in patients with cervical cancer.

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The objective was to evaluate body composition and nutritional status in women with locally advanced cervical cancer (LACC) before receiving oncologic treatment. Women with cervical cancer diagnoses in clinical stage IB2 to IIIB were studied. Body composition was measured with bioimpedance, sarcopenia determined according to the European Consensus, and nutritional status according to the Patient-Generated Subjective Global Assessment. A total of 155 women with age 50.4 ± 13.7, 29 clinical stage I, 82 II, and 44 III, were studied. Patients in advanced clinical stage III, compared with patients in stage II and stage I, lower phase angle (III: 5.2 ± 0.98 vs. II: 5.7 ± 1.9 and I: 5.8 ± 0.69, p = 0.007). Impedance vector distribution was different in patients in clinical stage III vs. those in clinical stage II (p = 0.014) and I (p = 0.039). LACC patients in advanced stages had worse body composition and nutritional status before treatment.

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Cancer patients are particularly susceptible to undernourishment so associated weight loss is frequent. Approximately 15% of patients lose >10% of their usual body weight, 40-80% become undernourished, and about 20% die as a result. Well-nourished patients have a higher survival rate when compared with patients at risk of undernourishment (19.9 vs. 3.7 months); hence, nutritional intervention is pivotal. Undernourishment negatively influences the patient's prognosis, and its prevalence depends on the tumor type and location, disease stage, treatment, and the applied nutritional evaluation tool. During abdominopelvic radiotherapy, up to 90% of patients experience symptoms of varying severity; weight loss during radiotherapy is an early indicator of nutritional deterioration, and he the use of radiation is associated with a higher likelihood of undernourishment. In patients with gynecological malignancies, 12.5-54% are malnourished before receiving oncological treatment, worsening after treatment in 35.8-82% of cases. There is also deterioration of the nutritional status in patients with colorectal cancer once pelvic radiotherapy is initiated, whereby 50% of cases are malnourished at the beginning of treatment, and 66.7% are so when it ends. Although there are notable differences in the impact of radiotherapy on weight according to the radiated region, 88% patients receiving abdominal radiotherapy were found to lose weight compared to 38% of patients whose treatment was limited to the pelvis.

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BACKGROUND: Knowing nurses' workload in hemodialysis units allows a better organization of human resources. AIM: To determine nurses' workload according to dependence and risk profiles of patients undergoing chronic hemodialysis. MATERIAL AND METHODS: One hundred fifty one patients from five hemodialysis units were selected and categorized in terms of dependence and risk using the instrument "Care according to dependence and risk in hemodialysis (CUDYR-DIAL). Nurses' activities for direct and indirect care and the time taken to complete those activities were measured. RESULTS: Per patient, nurses used 36.5 ±10.7 min for direct and 23.6 min for indirect care. The time required for direct care of patients at high risk with partial dependence and at high risk and partial self-sufficiency was 41.2 and 40.3 minutes respectively. CONCLUSIONS: During a dialysis session, nurses occupy 60% of their time providing direct care, mainly directed to patients categorized as being of high risk-partial dependence and high risk-partial self-sufficiency.

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Background: Knowing nurses' workload in hemodialysis units allows a better organization of human resources. Aim: To determine nurses' workload according to dependence and risk profiles of patients undergoing chronic hemodialysis. Material and Methods: One hundred fifty one patients from five hemodialysis units were selected and categorized in terms of dependence and risk using the instrument "Care according to dependence and risk in hemodialysis (CUDYR-DIAL). Nurses' activities for direct and indirect care and the time taken to complete those activities were measured. Results: Per patient, nurses used 36.5 ±10.7 min for direct and 23.6 min for indirect care. The time required for direct care of patients at high risk with partial dependence and at high risk and partial self-sufficiency was 41.2 and 40.3 minutes respectively. Conclusions: During a dialysis session, nurses occupy 60% of their time providing direct care, mainly directed to patients categorized as being of high risk-partial dependence and high risk-partial self-sufficiency.

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BACKGROUND: Complex regional pain syndrome is characterized by spontaneous or induced pain disproportionate in relation to the initial event and is accompanied by a variety of regional and motor disturbances, leading to a variety of clinical presentations. It is often associated with surgery and minor trauma. PATHOPHYSIOLOGY: Three mechanisms are postulated: changes secondary to post traumatic inflammation, peripheral vasomotor dysfunction and structural and functional changes of the central nervous system as a result of maladaptation. DIAGNOSIS: made based on the criteria of Budapest. The patient must have one symptom and sign of each criterion at diagnosis: Continuing pain, disproportionate to any inciting event. A sensory, vasomotor, oedema and motor/trophic change sign and symptoms that are not explained by another diagnosis or cause. TREATMENT: Multimodal treatment is suggested. There is no gold standard. In early stage NSAIDs or steroids can be used. Drugs used for neuropathic pain treatment have been suggested, but there is not enough evidence for any of these. There is low evidence that bisphosphonates, calcitonin, ketamine and mirror therapy are effective compared to placebo. Interventional treatment should be stepped from epidural block, neurostimulation, intrathecal pump to experimental therapies in case of intractable pain. DISCUSSION: Although complex regional pain syndrome has been a recognized entity for over 100 years, no clear evidence exists for first-line treatments; however, new technologies that are applicable in complex regional pain syndrome treatment have been developed.

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OBJETIVO: Validar al español la "Escala de Auto percepción de Carga" de Cousineau (2003) en su versión larga. MÉTODOS: La muestra estuvo formada por 161 pacientes sometidos a HDC. La escala se tradujo al español, se realizó una aplicación piloto en 10 pacientes y a continuación se elaboró el instrumento final que fue sometido al proceso de validación. RESULTADOS: La confiabilidad de la escala se mantuvo estable al ir eliminando cada uno de los ítems, fluctuando el Alpha de Cronbach entre 0.903 y 0.915. Por lo anterior, se decide mantener los 25 ítems originales en la versión en español. CONCLUSIÓN: La confiabilidad total del instrumento fue de 0.91, muy cercana a la obtenida en la versión original (0.93).

OBJETIVO: Validar, en la lengua española, la versión amplia de la "Escala de Autopercepción de carga de los cuidados" de Cousineau et al. MÉTODOS: La muestra estuvo constituída por 161 pacientes sometidos a hemodiálisis crónica en cinco Centros de Diálisis de la ciudad de Santiago - Chile. Esa Escala fue traducida al español y fue realizado un test piloto con diez pacientes; después de este procedimiento, se elaboró el instrumento final sometido al proceso de validación. RESULTADOS: La confiabilidad de la escala se mantuvo estable, con fluctuación del coeficiente alpha de Cronbach entre 0,903 y 0, 915, decidiéndose así, por mantener los 25 items originales en la versión en español. CONCLUSIÓN: La confiabilidad total del instrumento fue de 0,91, muy próxima de la obtenida en la versión original (0,93).

OBJECTIVE: To validate the Spanish language version of the broad "self-perception of burden of care scale" by Cousineau et al. METHODS: The sample consisted of 161 patients undergoing chronic hemodialysis at five dialysis centers in the city of Santiago - Chile. This scale was translated into Spanish and a pilot test was conducted with ten patients; after this procedure, we developed the final instrument to be subjected to the validation process. RESULTS: The reliability of the scale was stable, with fluctuations of the Cronbach's alpha coefficient of 0.903 and 0.915; we decided therefore to maintain the 25 original items within the Spanish version. CONCLUSION: The overall reliability of the instrument was 0.91, very close to that obtained in the original version (0.93).

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OBJECTIVE: To determine the depressive symptoms, perceived social support, and self-perceived burden in chronic hemodialysis (CHD) patients; identify depressive symptoms and degree of fatigue in caregivers of CHD patients; evaluate-in patients-the association between self-perceived burden and perceived social support, and between self-perceived burden and depressive symptoms; and evaluate-in caregivers-the relationship between the number of years of care and the degree of fatigue reached. METHODS: A sample of 162 patient-caregiver pairs was selected in which an adapted version of the Multidimensional Scale of Perceived Social Support, along with the Self-perceived Burden Scale, the Center for Epidemiologic Studies Depression Scale, and the Fatigue Severity Scale were applied. The instruments were administered to patients by trained research assistants and, in the case of the caregivers, were self-administered. RESULTS: Forty percent of the patients were women, with an average age of 56 ± 14.9 years, whereas 75% of the primary caregivers were female spouses, with an average age of 50 ± 16.1 years. It was observed that the patients (40.74%) as well as the primary caregivers (43.82%) had depressive symptoms. A positive association (r = 0.43, P < 0.001) was found between self-perceived burden and the presence of depressive symptoms in patients. CONCLUSIONS: The majority of the primary caregivers were women and relatives of the patients. They perceived themselves as fatigued with care, as did the patients themselves. The presence of depressive symptoms was similar in patients and caregivers. There was a statistically significant association between self-perceived burden and the presence of depressive symptoms in patients.

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OBJETIVO: Determinar síntomas depresivos, apoyo social percibido y autopercepción de carga en pacientes en hemodiálisis crónica (HDC); identificar síntomas depresivos y grado de fatiga en cuidadores de pacientes en HDC, y evaluar -en el paciente- la asociación entre autopercepción de carga y apoyo social percibido, y entre autopercepción de carga y síntomas depresivos, y -en el cuidador- la relación entre el número de años de cuidado y el grado de fatiga alcanzado. MÉTODOS: Se tomó una muestra de 162 díadas paciente-cuidador, a quienes se les aplicaron los instrumentos "escala adaptada de percepción de apoyo social", "escala de autopercepción de carga", "escala de depresión del Centro de Estudios Epidemiológicos" y "escala de severidad de la fatiga". Los instrumentos fueron aplicados a los pacientes por ayudantes de investigación entrenados y, en el caso de los cuidadores, fueron autoaplicados. RESULTADOS: Del total de pacientes, 40 por ciento fueron mujeres, con un promedio de edad de 56 ± 14,9 años, mientras que entre los cuidadores principales, 75 por ciento fueron mujeres, cónyuges, con una edad promedio de 50 ± 16,1 años. Se observó que tanto los pacientes (40,74 por ciento) como los cuidadores principales (43,82 por ciento) presentaban síntomas de depresión. Se encontró una asociación positiva (r = 0,43, P < 0,001) entre la autopercepción de carga y la presencia de síntomas depresivos en los pacientes. CONCLUSIONES: Los cuidadores principales son en su mayoría mujeres y familiares de los pacientes. Se perciben fatigados con el cuidado, al igual que lo perciben los propios pacientes. La presencia de síntomas depresivos es similar en pacientes y cuidadores, y hay una asociación estadísticamente significativa entre autopercepción de carga y presencia de síntomas depresivos en los pacientes.

OBJECTIVE: To determine the depressive symptoms, perceived social support, and self-perceived burden in chronic hemodialysis (CHD) patients; identify depressive symptoms and degree of fatigue in caregivers of CHD patients; evaluate-in patients-the association between self-perceived burden and perceived social support, and between self-perceived burden and depressive symptoms; and evaluate-in caregivers-the relationship between the number of years of care and the degree of fatigue reached. METHODS: A sample of 162 patient-caregiver pairs was selected in which an adapted version of the Multidimensional Scale of Perceived Social Support, along with the Self-perceived Burden Scale, the Center for Epidemiologic Studies Depression Scale, and the Fatigue Severity Scale were applied. The instruments were administered to patients by trained research assistants and, in the case of the caregivers, were self-administered. RESULTS: Forty percent of the patients were women, with an average age of 56 ± 14.9 years, whereas 75 percent of the primary caregivers were female spouses, with an average age of 50 ± 16.1 years. It was observed that the patients (40.74 percent) as well as the primary caregivers (43.82 percent) had depressive symptoms. A positive association (r = 0.43, P < 0.001) was found between self-perceived burden and the presence of depressive symptoms in patients. CONCLUSIONS: The majority of the primary caregivers were women and relatives of the patients. They perceived themselves as fatigued with care, as did the patients themselves. The presence of depressive symptoms was similar in patients and caregivers. There was a statistically significant association between self-perceived burden and the presence of depressive symptoms in patients.

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Enhanced metabolism by oxidative enzymes is a major cause of pyrethroid resistance in insects. In this work, we evaluated the role of specific and non-specific esterases in head louse populations from Buenos Aires with different levels of resistance to permethrin. As esterase activity is substrate-dependent, four different esters were used as unspecific substrates in order to obtain a better characterization of the possible role of these enzymes in the resistance phenomenon. The unspecific substrates were phenylthioacetate, 1- and 2-naphtyl-acetate, and p-nitrophenyl acetate. A 7-coumaryl permethrate was synthesized and used as a specific substrate to measure pyrethroid esterases by a very sensitive microfluorometric method. The results on pyrethroid esterase activity obtained with this substrate showed that these enzymes contribute to the detoxifying activity in resistant populations, although no correlation was found between pyrethroid esterase activity and resistance ratios. In this study, we established that the activity of esterase against specific and non-specific substrates is increased in pyrethroid-resistant populations of head lice from Buenos Aires. Also, dichlorodiphenyltrichloroethane (DDT) resistance values demonstrated that there is a DDT cross-resistance phenomenon in pyrethroid-resistant head louse populations and suggested that an alteration in the receptor of the nervous system (kdr gen) is a key factor of the resistance phenomena in these head louse populations.

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New esterase substrates were synthesized using cis-, trans- and cis-trans-permethrinic acid chloride and then used to measure pyrethroid-cleaving enzymes in insects. The new substrates, namely cis-, trans- and cis-trans-7-coumaryl permethrates (7-CP), show a structure very similar to permethrin insecticide and yield fluorescent products on hydrolysis. These substrates were hydrolyzed by a commercial porcine preparation that provided esterase-specific activity, and were stable at different pH values (5.2-7.8). Studies made with house fly, Musca domestica (L.), homogenates showed that these compounds are appropriate for determining pyrethroid hydrolysis activity on individual insects. The measured activity of house fly esterase was 870 relative fluorescence units (RFU) min(-1) with cis-7-CP as substrate, 1117 RFU min(-1) with trans-7-CP as substrate and 1423 RFU min(-1) with cis-trans-7-CP as substrate. The fluorescent substrates for pyrethroid-cleaving esterases described in this paper have advantages over methods already given in the literature. They are substrates with structures very similar to pyrethroids, the cleavage of which can be followed by an increase in fluorescence emission at 440 nm; it takes only about 5 min to measure the reaction, and moreover the high sensitivity of the fluorescence technique allows the quantification of esterase activity on individual insects.

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Field populations of Triatoma infestans Klug were collected during 2002 from four villages in northern Argentina (El Chorro, La Toma, El Sauzal, and Salvador Mazza), after application of deltamethrin and other pyrethroids was ineffective. High levels of resistance to the pyrethroid insecticides deltamethrin, beta-cypermethrin, beta-cyfluthrin, and lambda-cyhalothrin were detected in all of the evaluated populations. The resistance ratio to pyrethroids determined by topical application ranged from 50.5 (deltamethrin, El Sauzal) to 667.6 (beta-cyfluthrin, Salvador Mazza). None of the pyrethroid-resistant insects was resistant to the organophosphorus insecticide fenitrothion. Topical application of piperonyl butoxide to the most deltamethrin-resistant population (Salvador Mazza) led to slight reduction in levels of resistance. Activity of P450 monooxygenase, measured in individual insects through ethoxycoumarine-O-deethylase, showed a slight but noticeable difference in the distribution of activities between susceptible and resistant populations. The total percentage of insects below 0.48 pmol of 7-OH coumarine/min/ insect was 36.4 for Salvador Mazza population and 64.3 pmol of 7-OH coumarine/min/insect for CIPEIN strain. Whereas a low level of resistance to deltamethrin was previously related to monooxygenase activity in T. infestans, the high levels of resistance shown by these populations seem to involve monooxygenase in combination with other resistance mechanisms, for example, insensitivity of nervous membrane. Research on T. infestans resistance is in progress to improve Chagas vector control programs in Latin America and to implement resistance management strategies.

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Deltamethrin and other pyrethroids have been extensively used in Argentina since 1980, for the chemical control of Triatoma infestans Klug (Hemiptera: Reduviidae). Recently, resistance to deltamethrin was detected in field populations by the survival of bugs exposed by topical application to the diagnostic dose estimated on the CIPEIN susceptible strain. Results of the current study showed low resistant ratios (RRs) to deltamethrin for the resistant populations (RR ranged from 2.0 for San Luis colony to 7.9 for Salta colony). Biochemical studies were made on the most resistant colony (Salta) and the susceptible strain (CIPEIN), in order to establish the importance of degradative mechanisms as a cause of the detected resistance. Esterase activity was measured on 3 days old first instars through phenylthioacetate and a-naphtyl acetate activities. The results showed a significant difference in no cholinesterase esterase activity from susceptible (7.6 +/- 0,7 micro M S./i.min.) and Salta resistant colony (9.5 +/- 0.8 microM S./i.min.). Cytochrome p450 mono-oxygenase (p450) activity was measured on individual insects through ethoxycoumarine deethylase (ECOD) activity using a fluorescence microplate reader. The dependence of ECOD activity on age and body region of the nymphs, and pH and time of incubation were studied in order to optimize the measurement. As a result, comparative studies were performed on abdomens of 2 days old first instars at pH 7.2 and 4 h incubation time. ECOD activity of first nymphs was significantly lower in the susceptible colony (61.3 +/- 9.08 pg ECOD/ insect) than in the resistant one (108.1+/- 5.7 pg ECOD/ insect). These results suggest that degradative esterases (no-cholinesterase) and mono-oxygenases cytochrome p450, play an important role in the resistance to deltamethrin in Salta colony from Argentina.

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Deltamethrin and other pyrethroids have been extensively used in Argentina since 1980, for the chemical control of Triatoma infestans Klug (Hemiptera: Reduviidae). Recently, resistance to deltamethrin was detected in field populations by the survival of bugs exposed by topical application to the diagnostic dose estimated on the CIPEIN susceptible strain. Results of the current study showed low resistant ratios (RRs) to deltamethrin for the resistant populations (RR ranged from 2.0 for San Luis colony to 7.9 for Salta colony). Biochemical studies were made on the most resistant colony (Salta) and the susceptible strain (CIPEIN), in order to establish the importance of degradative mechanisms as a cause of the detected resistance. Esterase activity was measured on 3 days old first instars through phenylthioacetate and a-naphtyl acetate activities. The results showed a significant difference in no cholinesterase esterase activity from susceptible (7.6 ± 0,7 æM S./i.min.) and Salta resistant colony (9.5 ± 0.8 æM S./i.min.). Cytochrome P450 mono-oxygenase (P450) activity was measured on individual insects through ethoxycoumarine deethylase (ECOD) activity using a fluorescence micro plate reader. The dependence of ECOD activity on age and body region of the nymphs, and pH and time of incubation were studied in order to optimize the measurement. As a result, comparative studies were performed on abdomens of 2 days old first instars at pH 7.2 and 4 h incubation time. ECOD activity of first nymphs was significantly lower in the susceptible colony (61.3 ± 9.08 pg ECOD/ insect) than in the resistant one (108.1± 5.7 pg ECOD/ insect). These results suggest that degradative esterases (no-cholinesterase) and mono-oxygenases cytochrome P450, play an important role in the resistance to deltamethrin in Salta colony from Argentina.

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Este artículo pretende presentar una visión general a nivel personal, colectivo y formativo del presente y futuro de enfermería en nuestro país

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