RESUMO
INTRODUCTION: The treatment of metastatic castration-resistant prostate cancer (mCRPC) has changed significantly in recent years. Inhibitors of androgen receptors have shown especially significant benefits in overall (OS) and progression-free survival (PFS), with a good toxicity profile. Treatment selection depends on the patient's individual clinical, radiological, and biological characteristics. OBJECTIVE: To describe treatment outcomes (efficacy, toxicity) in a cohort of patients with mCRPC in Spain. MATERIALS AND METHODS: Multicenter, retrospective study of patients with mCRPC included in a database of the Urological Tumour Working Group (URONCOR) of the Spanish Society of Radiation Oncology (SEOR). Metastatic CRPC was defined according to the prostate cancer working group 3 (PCWG3) criteria. The Kaplan-Meier technique was used to evaluate OS and the Common Terminology Criteria for Adverse Events (CTCAE, v.4.0) were used to assess toxicity. Univariate and multivariate Cox regression analyses were performed to identify the factors significantly associated with OS. RESULTS: A total of 314 patients from 17 hospitals in Spain diagnosed with mCRPC between June 2010 and September 2017 were included in this study. Mean age at diagnosis was 68 years (range 45-89). At a median follow-up of 35 months, OS at 1, 3, and 5 years were 92%, 38%, and 28%, respectively. Grades 1-2 and grade 3 toxicity rates were, respectively, 68% and 19%. No grade 4 toxicities were observed. On the multivariate analysis, the following factors were significantly associated with OS: age (hazard ratio [HR] 0.42, p = 0.010), PSA value at diagnosis of mCRPC (HR 0.55, p = 0.008), and Gleason score (HR 0.61, p = 0.009). CONCLUSIONS: Age, Gleason score, and PSA at diagnosis of mCRPC are independently associated with overall survival in patients with mCRPC. The efficacy and toxicity outcomes in this patient cohort treated in radiation oncology departments in Spain are consistent with previous reports.
Assuntos
Fatores Etários , Antineoplásicos/uso terapêutico , Antígeno Prostático Específico/sangue , Neoplasias de Próstata Resistentes à Castração , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/efeitos adversos , Neoplasias Ósseas/secundário , Progressão da Doença , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Prognóstico , Neoplasias de Próstata Resistentes à Castração/sangue , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Neoplasias de Próstata Resistentes à Castração/mortalidade , Neoplasias de Próstata Resistentes à Castração/patologia , Radioterapia (Especialidade) , Análise de Regressão , Estudos Retrospectivos , Sociedades Médicas , Espanha , Terminologia como AssuntoRESUMO
AIM: Radiation oncology services in Spain are undergoing a process of technical modernization, but-in a context of increasing demand by an ageing population-it is unclear whether there are enough radiation oncologists to staff the newly equipped units. This study aims to assess the number of specialists working in radiation oncology services in Spain relative to current and future needs. MATERIALS AND METHODS: In the second half of 2017, the Commission on Infrastructures of the Spanish Society for Radiation Oncology (SEOR) sent a questionnaire on radiation oncology staff to the heads of all 122 public (n = 76, 62%) and private (n = 46, 38%) radiation oncology services in Spain. Data collected were the number of professionals, their position, and their year of birth for specialists and residents in each service. In the descriptive analysis, for continuous variables we calculated means, standard deviations and ranges for each Spanish region and work post. For qualitative variables, we constructed frequency tables. All analyses were performed with R statistical software, version 3.5.1. RESULTS: The survey response rate was 100% among service heads across all 122 centers. The total number of radiation oncologists working in these centers is 721, or 15.4 per million population, with considerable variations between regions. Given the national recommendations to have 20 radiation oncologists per million population, there is currently a deficit of 204 specialists. If the 163 upcoming retirements are also taken into account, there will be 367 fewer radiation oncologists than required to meet the 25% increase in indications for radiotherapy projected for 2025. CONCLUSIONS: The classic model for calculating staff needs based on the number of treatments is outdated, and recommendations should be revised to reflect the current reality. A new model should integrate the most complex technological advances and emerging plans in radiotherapy, without neglecting the other activities carried out in radiation oncology services that are not directly linked to patient care.
Assuntos
Radio-Oncologistas/provisão & distribuição , Radioterapia (Especialidade)/estatística & dados numéricos , Adulto , Distribuição por Idade , Idoso , Feminino , Humanos , Internato e Residência/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Médicas/provisão & distribuição , Distribuição por Sexo , Espanha , Inquéritos e Questionários/estatística & dados numéricosRESUMO
Harnessing the patient's own immune system against an established cancer has proven to be a successful strategy. Within the last years, several antibodies blocking critical "checkpoints" that control the activation of T cells, the immune cells able to kill cancer cells, have been approved for the use in patients with different tumours. Unfortunately, these cases remain a minority. Over the last years, radiotherapy has been reported as a means to turn a patient's own tumour into an in situ vaccine and generate anti-tumour T cells in patients who lack sufficient anti-tumour immunity. Indeed, review data show that the strategy of blocking multiple selected immune inhibitory targets in combination with radiotherapy has the potential to unleash powerful anti-tumour responses and improve the outcome of metastatic solid tumours. Here, we review the principal tumours where research in this field has led to new knowledge and where radioimmunotherapy becomes a reality.
Assuntos
Neoplasias/terapia , Radioimunoterapia/métodos , Humanos , Neoplasias/imunologia , Neoplasias/patologia , PrognósticoRESUMO
BACKGROUND/PURPOSE: To evaluate the impact of intensity-modulated radiotherapy (IMRT) with intra-prostate fiducial markers image-guided radiotherapy (IGRT) on the incidence of late urinary toxicity compared to 3D conformal radiotherapy (3DCRT) for patients with prostate cancer (PC). METHODS AND MATERIALS: We selected 733 consecutive patients with localized PC treated with dose-escalation radiotherapy between 2001 and 2014. Eligibility criteria were radiation dose >72.0 Gy, no pelvic RT and minimum follow-up 24 months. 438 patients were treated with 3DCRT and 295 with IMRT. Acute and late urinary complications were assessed using the EORTC/RTOG and CTCAEs v3.0 definition. The Cox regression model was used to compare grade ≥2 urinary toxicity between both techniques. The median follow-up was 75 months (range 24-204). RESULTS: The median isocenter radiation dose was 78.7 Gy for 3DCRT and 80.7 Gy for IMRT/IGRT (p < 0.001). The 5-year incidence of late grade ≥2 urinary toxicity was 6.4% for IMRT and 10.8% for 3DCRT [hazard ratio (HR) 0.575, p = 0.056]. The corresponding 5-year estimates of late grade ≥2 hematuria were 2% for IMRT and 5.3% for 3DCRT (HR 0.296, p = 0.024). On multivariate analysis, the antecedent of prior transurethral resection of the prostate was also a strong predictor of a higher risk of urinary complications (HR 2.464, p = 0.002) and of hematuria (HR 5.196, p < 0.001). CONCLUSION: Compared with 3DCRT, high-dose IMRT/IGRT is associated with a lower rate of late urinary complications in spite of higher radiation dose.
Assuntos
Marcadores Fiduciais , Neoplasias da Próstata/radioterapia , Lesões por Radiação/prevenção & controle , Radioterapia Guiada por Imagem/métodos , Radioterapia de Intensidade Modulada/efeitos adversos , Bexiga Urinária/efeitos da radiação , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Radioterapia de Intensidade Modulada/métodos , Estudos RetrospectivosRESUMO
Introduction: Recommendations for Sudden Infant Death Syndrome (SIDS) are available, although it is uncertain the degree of adherence to these measures. The aim of the study is to assess the adherence to recommendations to reduce the risk of SIDS, seeking factors associated to the noncompliance with these recommendations. Patients and Method: 468 infants were enrolled in two maternity hospitals, one public and one private. Postpartum and 4-month assessments were performed. A questionnaire was used adapting a model validated by the International Child Care Practices Study. Results: Adherence to obstetric recommendations was higher (75.4%) than to pediatric recommendations (53.3%). Regarding pediatric recommendations, a compliance decrease was detected after 4 months. Follow-ups showed decrease in breastfeeding (p < 0.001 84.9% vs 48.6%) and supine position (61.2% vs 21.2%, p < 0.001). Conclusions: The decreased adherence to recommendations for SIDS prevention was mainly observed in younger and less educated women, who were not in a relationship and living in poor housing quality and crowded environments.
Introducción: Existen recomendaciones preventivas en el Sindrome de Muerte Súbita del lactante (SMSL), aunque es incierto el grado de adherencia a dichas medidas. El objetivo del estudio fue evaluar la adherencia a las recomendaciones para disminuir el riesgo de SMSL, buscando factores asociados al no cumplimiento de dichas recomendaciones. Pacientes y Método: Se incluyeron 468 recién nacidos de dos maternidades, pública y privada. Se efectuó una evaluación posparto y a los 4 meses de la adherencia a las recomendaciones. Se utilizó un cuestionario adaptando un modelo de encuesta validado por el International Child Care Practices Study Resultados: La adherencia a las recomendaciones obstétricas fue mayor (75,4%) que a las recomendaciones pediátricas (53,3%). A su vez en las recomendaciones pediátricas se evidenció una caída del cumplimiento de las recomendaciones a los 4 meses. Al seguimiento se observó reducción de lactancia (84,9% vs 48,6%; p < 0,001) y de posición supina (61,2% vs 21,2%; p < 0,001). Conclusiones: La disminución de la adherencia a las recomendaciones para la prevención del SMSL se observó principalmente en las mujeres de menor edad y menor nivel educativo, no estar en pareja, mala calidad habitacional y presencia de numerosos convivientes.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , Adulto Jovem , Aleitamento Materno/estatística & dados numéricos , Mães/estatística & dados numéricos , Cooperação do Paciente , Morte Súbita do Lactente/prevenção & controle , Fatores Etários , Seguimentos , Estudos Prospectivos , Decúbito Dorsal , Inquéritos e Questionários , Fatores de TempoRESUMO
INTRODUCTION: Recommendations for Sudden Infant Death Syndrome (SIDS) are available, although it is uncertain the degree of adherence to these measures. The aim of the study is to assess the adherence to recommendations to reduce the risk of SIDS, seeking factors associated to the noncompliance with these recommendations. PATIENTS AND METHOD: 468 infants were enrolled in two maternity hospitals, one public and one private. Postpartum and 4-month assessments were performed. A questionnaire was used adapting a model validated by the International Child Care Practices Study. RESULTS: Adherence to obstetric recommendations was higher (75.4%) than to pediatric recommendations (53.3%). Regarding pediatric recommendations, a compliance decrease was detected after 4 months. Follow-ups showed decrease in breastfeeding (p < 0.001 84.9% vs 48.6%) and supine position (61.2% vs 21.2%, p < 0.001). CONCLUSIONS: The decreased adherence to recommendations for SIDS prevention was mainly observed in younger and less educated women, who were not in a relationship and living in poor housing quality and crowded environments.
Assuntos
Aleitamento Materno/estatística & dados numéricos , Mães/estatística & dados numéricos , Cooperação do Paciente , Morte Súbita do Lactente/prevenção & controle , Adolescente , Adulto , Fatores Etários , Feminino , Seguimentos , Humanos , Recém-Nascido , Estudos Prospectivos , Decúbito Dorsal , Inquéritos e Questionários , Fatores de Tempo , Adulto JovemRESUMO
Las micosis superficiales representan un grupo heterogéneo de infecciones muy frecuentes a nivel mundial. Con objeto de conocer la frecuencia de hongos productores de micosis superficiales y conformar indicadores epidemiológicos que no aproximen a la realidad local es que, en el laboratorio de bacteriología del Hospital Obrero, se realizó un estudio retrospectivo de muestras de pacientes ambulatorios e internos de ambos sexos con diagnóstico presuntivo de dermatomicosis.
Assuntos
Humanos , Arthrodermataceae/patogenicidade , Dermatomicoses/diagnóstico , Micoses/epidemiologiaRESUMO
Conocida la experiencia exitosa de algunos investigadores en la utilización de glutamina en pacientes cuya patología produce alteración a nivel del intestino delgado, se realizó la presente investigación, cuyo objetivo fue evaluar la mejoría clínica a través de la ganancia de peso, y cambios histológicos de la mucosa duodenal en lactantes desnutridos moderados y graves que recibieron una dieta suplementada con glutamina. Se realizó un estudio experimental, con diagnóstico de desnutrición moderada y grave en el Hospital "Dr. Jorge Lizarraga". Cada grupo estuvo conformado por 9 niños, un grupo que recibió dieta y suplementada con glutamina (Glutapack-10) y otro recibió placebo. A todos los pacientes se les tomó biopsia de la porción mas distal del duodeno, al inicio y al final de estudio. Las biopsias fueron realizadas por microscopía óptica. El análisis se realizó a través de medidas de tendencia central y dispersión, Análisis de varianza y correlación de Pearson. En ambos grupos hubo incremento en el peso, Siendo éste estadísticamente significativo. Tanto el grupo de pacientes que recibió suplementación con Glutamina como el grupo control, experimentó aumento en el tamaño de la vellosidad duodenal, la cual no fué estadísticamente significativa. Un infiltrado de células mononucleares en dievrsos en diversoso grados fue descrito en al mucosa duodenal de ambos grupos (Duodenitis crónica no específica), estos hallazgos podrán influir en el normal funcionamiento de la mucosa intestinal de estos pequeños pacientes
Assuntos
Humanos , Masculino , Feminino , Lactente , Biópsia , Glutamina , Lactente , Intestino Delgado , Distúrbios Nutricionais , Pediatria , VenezuelaRESUMO
INTRODUCTION: Cerebrovascular disease causes different cognitive alterations. There is a need to develop tools that are capable of diagnosing them. One of them could be event related potentials. These provide an indicator of cognitive processing in real time. PATIENTS AND METHODS: A study was conducted of 10 patients with cerebral infarction in the frontal region and 10 paired healthy controls. Evaluation of the patients was performed a week after the stroke. A continuous performance test was applied to both groups together with the recording of the electrical activity in the brain in order to obtain the P300 component. The results were submitted to the non-parametric Student's t test, and the Bayesian model averaging method (BMAM) was employed to calculate the sources generating the electrical activity recorded on the electroencephalogram. RESULTS: Patients displayed significantly poorer performances compared to the healthy controls in the attention test. The BMAM showed that the P300 component was related to the right hand temporal structures in healthy controls, whereas the left temporoparietal regions were also involved in the patients. CONCLUSIONS: These findings indicate the existence of subclinical disorders affecting sustained attention and that they can only be detected by very sensitive tools; furthermore, they also have implications for the brain circuits regulating sustained attention and the P300 component.
Assuntos
Transtornos Cerebrovasculares/diagnóstico , Potenciais Evocados P300/fisiologia , Potenciais Evocados , Lobo Temporal/fisiopatologia , Atenção/fisiologia , Transtornos Cerebrovasculares/fisiopatologia , Transtornos Cerebrovasculares/psicologia , Dominância Cerebral , Eletroencefalografia , Feminino , Lobo Frontal/irrigação sanguínea , Lobo Frontal/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Desempenho Psicomotor , Sensibilidade e EspecificidadeRESUMO
INTRODUCTION: Event related potentials, and especially the component P300, can be used to achieve greater precision and sensitivity in the cognitive evaluation of patients. They also enable us to obtain more accurate information about deficiencies in sustained attention, which is a cognitive function associated with the generation of the above mentioned component. Furthermore, the study of disorders triggered off by cerebrovascular disease must be given priority because of the high incidence with which they occur. PATIENTS AND METHODS: We studied four groups of individuals divided according to the localization of the lesion and the etiopatogenic mechanism involved (10 patients with right parietal atherothrombotic infarction, 10 patients with left parietal atherothrombotic infarction, 10 patients with lacunar infarction, 10 paired healthy controls). They were administered a classic test for obtaining P300, which evaluates sustained attention. RESULTS: Patients with cerebral infarction in the right hemisphere presented alterations in the functions evaluated, since they showed more omissions, gave fewer correct answers, the values for latency were significantly increased in Fz derivation and amplitude values were reduced in Pz, as compared to healthy controls. Individuals with left cerebral infarction, however, showed no significant differences with regard to the controls. People with lacunar infarction made less mistakes and omissions, and scored more correct answers than those that had suffered right or left infarction. Their amplitude values were also higher than the values of the individuals with a right lesion in Pz derivation but showed no differences as regards the controls. CONCLUSIONS: These results provide new data on the cognitive mechanisms that are affected during a right parietal lesion and demonstrate the sensitivity of P300 in detecting alterations in sustained attention in individuals that differ as regards not only the localization of the lesion but also the type of etiopathogenic mechanism involved.
Assuntos
Atenção/fisiologia , Isquemia Encefálica/fisiopatologia , Infarto Cerebral/fisiopatologia , Transtornos Cognitivos/diagnóstico , Potenciais Evocados P300 , Adulto , Idoso , Infarto Cerebral/patologia , Circulação Cerebrovascular , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes NeuropsicológicosRESUMO
Para determinar el manejo de las fracturas diafisiarias de fémur en niños, en el Hospital "Pérez de León" de Petare, se analizaron retrospectivamente 57 historias con este diagnóstico entre enero de 1995 y enero del 2000. Fueron evaluados 44 varones y 13 hembras entre 1-12 años con un promedio de edad de 5,8 años. 43 (75 por ciento) se trataron de forma ortopédica, de las cuales 28 (48 por ciento) con tracción cutánea seguida de espica con un promedio de hospitalización de 25,8 días; 10 (18 por ciento) con tracción esquelética seguida de espica con un promedio de hospitalización de 27,9 días; 5 (9 por ciento) con yeso de espica inmediato con promedio de hospitalización de 7,6 días y 14 (24 por ciento) quirúrgicamente con enclavado endomedular todos tipo kuntscher con promedio de hospitalización de 19,9 días. Como mecanismo de lesión se encuentran las caídas de altura 38 por ciento, arrollamiento 24 por ciento; caída de sus pies 18 por ciento; trauma directo 11 por ciento; accidentes de tránsito 7 por ciento y heridas por arma de fuego 2 por ciento 50 por ciento de los pacientes presentaron daños asociados tales como traumatismo craneoencefálicos, excoriaciones múltiples, trauma abdominal cerrado y fracturas adicionales. Con estos resultados podemos concluir que las fracturas de diáfisis de fémur en niños son cada vez más frecuentes en las salas de emergencias, que tanto las caídas de altura, arrollamiento y caída de sus pies revisten gran importancia como factor causal; y que el tratamiento ortopédico es el más utlizado hasta la edad preescolar y el quirúrgico en la edad escolar
Assuntos
Humanos , Masculino , Feminino , Sulfato de Cálcio , Criança , Diáfises , Fraturas do Colo Femoral , Fraturas Ósseas , Ortopedia , Pediatria , Traumatologia , VenezuelaAssuntos
Broncoscopia , Equinococose Pulmonar/diagnóstico , Idoso , Animais , Diagnóstico Diferencial , Equinococose Pulmonar/diagnóstico por imagem , Equinococose Pulmonar/transmissão , Exposição Ambiental , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Ovinos/parasitologia , Tomografia Computadorizada por Raios X , Tuberculose/diagnóstico por imagemRESUMO
Interest in oral tolerance has been renewed in the last few years as a possibility of intervention in human autoimmune diseases. An obstacle in this direction is that, although easily induced in animals virgin of contact with the antigen, oral tolerance becomes hard to induce in previously immunized animals. The present results show that there is an early period after primary immunization in which prolonged oral exposure to the antigen may arrest ongoing immune responses. Beyond this period, oral exposures to the antigen become ineffective and may actually boost immune responses. The end of the susceptible period coincides with the emergence of free specific antibodies in serum. However, the previous administration of purified anti-ovalbumin antibodies (40 micrograms) was unable to block the induction of oral tolerance to ovalbumin in normal mice.
Assuntos
Formação de Anticorpos/imunologia , Antígenos/administração & dosagem , Doenças Autoimunes/imunologia , Dessensibilização Imunológica , Administração Oral , Animais , Antígenos/imunologia , Feminino , Tolerância Imunológica/imunologia , Masculino , Camundongos , Ovalbumina/administração & dosagem , Ovalbumina/imunologia , Fatores de TempoRESUMO
Interest in oral tolerance has been renewed in the last few years as a possibility of intervention in human autoimmume diseases. An obstacle in this direction in that, although easily induced in animals virgin of contact with the antigen, oral tolerance becomes hard to induce in previously immunized animals. The present results show that there is an early period after primary immunization in which prolonged oral exposure to the antigen may arrest ongoing immune responses. Beyond this period, oral exposures to the antigen become ineffective and may actually boost immune responses. The end of the susceptible period coincides with the emergence of free specific antibodies in serum. However, the previous administration of purified anti-ovalbumin antibodies (40 mug) was unable to block the induction of oral tolerance to ovalbumin in normal mice.
Assuntos
Animais , Feminino , Formação de Anticorpos/imunologia , Antígenos , Doenças Autoimunes/imunologia , Dessensibilização Imunológica , Administração Oral , Formação de Anticorpos/imunologia , Antígenos/imunologia , Tolerância Imunológica/imunologia , Camundongos , Ovalbumina , Ovalbumina/imunologia , Fatores de TempoRESUMO
La toma de impresiones al paciente totalmente desdentado tiene como objetivo registrar la anatomía de la cavidad bucal para reproducirla en escayola, y poder confeccionar las prótesis a su medida. Exponemos en este artículo los criterios recomendados para conseguir unas buenas impresiones. Aportamos pequeñas sugerencias que pueden facilitar al profesional la adquisición de la destreza necesaria para obtener unas impresiones correctas
Assuntos
Humanos , Pessoa de Meia-Idade , Materiais para Moldagem Odontológica , Técnica de Moldagem Odontológica , Prótese Total/normas , Alginatos/química , Sulfato de Cálcio/normas , Coloides/química , Modelos Dentários/normas , Arcada Edêntula/reabilitação , Arcada Osseodentária/anatomia & histologia , Silicones/química , Acetato de Zinco/químicaRESUMO
La toma de impresiones al paciente totalmente desdentado tiene como objetivo registrar la anatomía de la cavidad bucal para reproducirla en escayola, y poder confeccionar las prótesis a su medida. Exponemos en este artículo los criterios recomendados para conseguir unas buenas impresiones. Aportamos pequeñas sugerencias que pueden facilitar al profesional la adquisición de la destreza necesaria para obtener unas impresiones correctas (AU)
Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Prótese Total/normas , Técnica de Moldagem Odontológica , Materiais para Moldagem Odontológica , Arcada Edêntula/reabilitação , Sulfato de Cálcio/normas , Modelos Dentários/normas , Arcada Osseodentária/anatomia & histologia , Silicones/química , Coloides/química , Alginatos/química , Acetato de Zinco/químicaRESUMO
Mice immunized with ovalbumin develop a strong aversion to ingesting sweetened egg white dilutions or ovalbumin solutions. In immunized animals, gavage or voluntary ingestion of ovalbumin triggers an increase of vascular permeability in the intestine; pretreatment with a mixture of histamine and serotonin antagonists blocked this reaction, but not the aversion; dexamethasone inhibited both the aversion and the increase in permeability. The aversion was transferred to normal recipient mice with high-titre anti-Ova sera obtained with complete Freund's adjuvant, but not with lower-titre serum pools of mice immunized with the help of Al(OH)3 adjuvant. However, the aversion was also (adoptively) transferred with whole spleen cells from immune donors. This later condition is inefficient to transfer the formation of high titres of specific antibodies.
Assuntos
Transferência Adotiva/métodos , Aprendizagem da Esquiva/efeitos dos fármacos , Aprendizagem da Esquiva/fisiologia , Antagonistas dos Receptores Histamínicos/farmacologia , Ovalbumina/antagonistas & inibidores , Ovalbumina/imunologia , Ovalbumina/farmacologia , Antagonistas da Serotonina/farmacologia , Paladar/imunologia , Animais , Carboidratos/imunologia , Dexametasona/farmacologia , Clara de Ovo/análise , Feminino , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos EndogâmicosRESUMO
Since 1989, heroin production worldwide has risen; in New York City, as its purity rose and prices fell, street-level markets were restructured and offered heroin in addition to cocaine and crack (which had been popular during the 1980s). While officials estimate that there are between 500,000 and one million hard-core, chronic heroin users nationwide, evidence of supplemental users heralding another heroin era includes: more overdoses and overdose deaths, greater demand for treatment, larger seizures of heroin at all levels of distribution and related arrests, and broader media coverage. In this article, the authors describe the characteristics of populations in which there may have been a percentage increase of new users, such as young middle- or upper-class European-Americans, young Puerto Ricans and recent Haitian and Russian immigrants. The abstinence of young African-Americans is also noted. The article ends with a preliminary needs assessment of the new users in the areas of health (including AIDS), housing, employment, treatment, arrest and imprisonment.
Assuntos
Dependência de Heroína/epidemiologia , Administração por Inalação , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Região do Caribe/etnologia , Etnicidade , Feminino , Heroína/administração & dosagem , Heroína/química , Dependência de Heroína/economia , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Prognóstico , Porto Rico/etnologia , Abuso de Substâncias por Via Intravenosa/epidemiologiaRESUMO
1. Young adult BALB/c and B6D2F1 mice of both sexes (20 +/- 2 g) immunized ip with 2 doses of 10 micrograms ovalbumin (Ova), but not with 2 doses of 10 micrograms bovine gammaglobulins (BGG), show aversion to the ingestion of sweetened egg white or crystallized Ova solutions which are avidly ingested by normal mice. In 24 h, normal mice or mice immunized with BGG ingested, respectively, 340 +/- 80 and 265 +/- 56 mg of sweetened egg white per gram of body weight (mg/gbw); in the same period, Ova-immunized mice ingested less than one tenth these amounts (18 +/- 5 mg/gbw). ELISA-titers of anti-Ova and anti-BGG antibodies in immune mice were of similar magnitude. 2. Aversion arises coincidentally with the emergence of anti-ovalbumin antibodies in serum in the primary response, 14 days after primary immunization. 3. Previous induction of oral tolerance to ovalbumin by a single gavage with 20 mg Ova 7 days before primary ip immunization, which blocks the increase of specific antibodies in serum, also blocks the development of the aversive phenomenon. 4. Aversion was induced to 1 mg/ml but not 0.1 mg/ml sweetened crystallized ovalbumin solutions and was already noticeable 2 h after exposure of immunized mice to sweetened egg white solutions. 5. We conclude that, at least in experimental situations, immunological factors may be of decisive importance in diet selection.
Assuntos
Tolerância Imunológica/imunologia , Ovalbumina/imunologia , Paladar/imunologia , gama-Globulinas/imunologia , Administração Oral , Animais , Anticorpos/análise , Peso Corporal , Ensaio de Imunoadsorção Enzimática , Feminino , Imunização/métodos , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Ovalbumina/administração & dosagem , Fatores de Tempo , gama-Globulinas/administração & dosagemRESUMO
1. Young adult BALB/c and B6D2F1 mice of both sexes (20 +/- 2 g) immunized ip with 2 doses of 10 micrograms ovalbumin (Ova), but not with 2 doses of 10 micrograms bovine gammaglobulins (BGG), show aversion to the ingestion of sweetened egg white or crystallized Ova solutions which are avidly ingested by normal mice. In 24 h, normal mice or mice immunized with BGG ingested, respectively, 340 +/- 80 and 265 +/- 56 mg of sweetened egg white per gram of body weight (mg/gbw); in the same period, Ova-immunized mice ingested less than one tenth these amounts (18 +/- 5 mg/gbw). ELISA-titers of anti-Ova and anti-BGG antibodies in immune mice were of similar magnitude. 2. Aversion arises coincidentally with the emergence of anti-ovalbumin antibodies in serum in the primary response, 14 days after primary immunization. 3. Previous induction of oral tolerance to ovalbumin by a single gavage with 20 mg Ova 7 days before primary ip immunization, which blocks the increase of specific antibodies in serum, also blocks the development of the aversive phenomenon. 4. Aversion was induced to 1 mg/ml but not 0.1 mg/ml sweetened crystallized ovalbumin solutions and was already noticeable 2 h after exposure of immunized mice to sweetened egg white solutions. 5. We conclude that, at least in experimental situations, immunological factors may be of decisive importance in diet selection.