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INTRODUCTION: Low-cost, accurate high-risk HPV tests are needed for cervical cancer screening in limited-resource settings. OBJECTIVE: To compare the performance of the low-cost Hybribio-H13 test with the Hybrid Capture® 2 to detect cervical intraepithelial neoplasia grade 2 or 3 (CIN2 and CIN3). MATERIALS AND METHODS: Archived baseline samples tested by the Hybrid Capture® 2 from women of the ASCUS-COL trial, aged 20 to 69 years, with biopsy-colposcopy directed diagnosis of CIN2+ (n = 143), CIN3+ (n = 51), and < CIN2 (n = 632) were blindly tested by the Hybribio-H13 test. RESULTS: The relative sensitivity of the Hybribio-H13 test versus the Hybrid Capture® 2 for detecting CIN2+ was 0.89 (90% CI = 0,80-0,98; NIT = 0,66), and for CIN3+ was 0,92 (90% CI = 0,85-0,98; NIT = 0,35). Relative specificity was 1.19 (90% CI = 1.05-1.33; NIT <0.00001). In the analysis restricted to women older than 30 years, the relative sensitivity of the Hybribio-H13 for CIN3+ was marginally below unity (ratio = 0.97; 90% CI = 0.95-0.99), and the specificity remained higher than the Hybrid Capture® 2 test. CONCLUSION: The Hybribio-H13 test was as specific as the Hybrid Capture® 2 for detecting CIN2+ or CIN3+ but less sensitive. Considering these results and the young age of the population recruited for screening because of ASCUS cytology, we suggest our results warrant the evaluation of the Hybribio-H13 for screening cervical cancer, especially in the evaluated population.
Introducción. Se necesitan pruebas para detectar genotipos de VPH de alto riesgo, precisas y de bajo costo, para la tamización del cáncer de cuello uterino en entornos de recursos limitados. Objetivo. Comparar el desempeño de la prueba de bajo costo Hybrid-H13 con la de Hybrid Capture® 2 para detectar NIC2+ y NIC3+. Materiales y métodos. Se analizaron en ciego muestras de la línea base provenientes de mujeres del estudio ASCUS-COL, entre los 20 y los 69 años, con diagnóstico dirigido por biopsia-colposcopia de NIC2+ (n = 143), NIC3 + (n = 51) y < NIC2 (n = 632) con la prueba para detección de virus de papiloma humano Hybribio-H13. Estas muestras fueron previamente evaluadas con la prueba Hybrid Capture® 2. Resultados. La sensibilidad relativa de Hybribio-13 versus la de Hybrid Capture® 2 para detectar NIC2+ fue de 0,89 (IC90%: 0,80-0,98; NIT = 0,66) y para NIC3+ fue de 0,92 (IC90%: 0,85-0,98; NIT = 0,35). La especificidad relativa fue de 1,19 (IC90%: 1,05-1,33; NIT <0,00001). En el análisis restringido a mujeres mayores de 30 años, la sensibilidad relativa de Hybribio-H13 para NIC3+ estuvo marginalmente por debajo de la unidad (proporción = 0,97; IC90%: 0,95-0,99) y la especificidad permaneció más alta que la de la prueba Hybrid Capture® 2. Conclusión. La prueba de Hybribio-H13 fue tan específica como la de Hybrid Capture® 2, pero menos sensible para detectar NIC2+ o NIC3+. Teniendo en cuenta estos resultados y la temprana edad de la población reclutada en la tamización por la presencia de ASCUS en la citología, se sugiere continuar con la evaluación de la prueba Hybribio-H13 para la detección de cáncer de cuello uterino en poblaciones con las mismas características que las de la aquí evaluada.
Assuntos
Infecções por Papillomavirus , Sensibilidade e Especificidade , Displasia do Colo do Útero , Neoplasias do Colo do Útero , Humanos , Feminino , Displasia do Colo do Útero/diagnóstico , Displasia do Colo do Útero/virologia , Pessoa de Meia-Idade , Adulto , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/virologia , Idoso , Infecções por Papillomavirus/diagnóstico , Adulto Jovem , Detecção Precoce de Câncer/métodos , Papillomaviridae/genética , Papillomaviridae/isolamento & purificação , Papillomavirus HumanoRESUMO
Regulation of circulating free fatty acid (FFA) levels and delivery is crucial to maintain tissue homeostasis. Exosomes are nanomembranous vesicles that are released from diverse cell types and mediate intercellular communication by delivering bioactive molecules. Here, we sought to investigate the uptake of FFAs by circulating exosomes, the delivery of FFA-loaded exosomes to cardiac cells and the possible role of the FFA transporter CD36 in these processes. Circulating exosomes were purified from the serum of healthy donors after an overnight fast (F) or 20 minutes after a high caloric breakfast (postprandial, PP). Western blotting, Immunogold Electron Microscopy and FACS analysis of circulating exosomes showed that CD36 was expressed under both states, but was higher in postprandial-derived exosomes. Flow cytometry analysis showed that circulating exosomes were able to take-up FFA directly from serum. Importantly, preincubation of exosomes with a blocking CD36 antibody significantly impeded uptake of the FFA analogue BODIPY, pointing to the role of CD36 in FFA exosomal uptake. Finally, we found that circulating exosomes could delivery FFA analogue BODIPY into cardiac cells ex vivo and in vivo in a mice model. Overall, our results suggest a novel mechanism in which circulating exosomes can delivery FFAs from the bloodstream to cardiac tissue. Further studies will be necessary to understand this mechanism and, in particular, its potential involvement in metabolic pathologies such as obesity, diabetes and atherosclerosis.
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Antígenos CD36/sangue , Exossomos/metabolismo , Ácidos Graxos não Esterificados/sangue , Miócitos Cardíacos/metabolismo , Adulto , Animais , Aterosclerose/sangue , Linhagem Celular , Diabetes Mellitus/sangue , Modelos Animais de Doenças , Feminino , Humanos , Masculino , Camundongos , Camundongos Endogâmicos NOD , Camundongos SCID , Obesidade/sangue , Ratos WistarRESUMO
BACKGROUND: Flow cytometry (FC) is a valuable tool for the diagnosis of myelodysplastic syndromes (MDS). We present results of a survey carried out to evaluate FC current practice for MDS diagnosis in Latin America (LA), focusing on markers used and characteristics of the clinical diagnostic report. Compliance to IMDSflow recommendations was also evaluated. These practices were then compared with those used in other countries. METHODS: An online survey was sent through the Grupo Latino-Americano de Mielodisplasia to LA cytometrists and other international scientific societies. RESULTS: 91 responses from 15 LA countries were received. The median of the number of markers used was 20 ± 4.5, but only 8.1% of participants adopted the complete panel proposed by the International/European LeukemiaNet Working Group (IMDSflow). We received 140 eligible answers from regions other than LA (66 Europe, 59 USA-Canada, 8 Oceania, 6 Asia and 1 Africa). LA utilized more markers for MDS diagnosis than USA/Canada (p = 0.006), but similar to Europe. The use of MDS scoring systems differed among regions: 10.3% in LA, 0% USA/Canada and 25.7% Europe reported the "Ogata score". Finally, 52.0% of all participants included a general interpretation statement in the final report about the consistency of the FC results with MDS diagnosis, with no statistical differences between regions. CONCLUSIONS: This survey shows a low compliance with the IMDSflow recommendations and a scarce use of the scoring systems proposed in the literature. However, the number of surface markers used is high. We will work to develop a FC consensus for MDS diagnosis adapted to the clinical practice requirements in LA.
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Citometria de Fluxo , Síndromes Mielodisplásicas/diagnóstico , Padrões de Prática Médica/estatística & dados numéricos , África/epidemiologia , Ásia/epidemiologia , Biomarcadores/análise , Biomarcadores/sangue , Canadá/epidemiologia , Europa (Continente)/epidemiologia , Geografia , Humanos , Imunofenotipagem/métodos , América Latina/epidemiologia , Síndromes Mielodisplásicas/sangue , Síndromes Mielodisplásicas/epidemiologia , Oceania/epidemiologia , Inquéritos e Questionários , Estados Unidos/epidemiologiaRESUMO
The consequences of hybridization for biodiversity depend on the specific ecological and evolutionary context in which it occurs. Understanding patterns of gene flow among hybridizing species is crucial for determining the evolutionary trajectories of species assemblages. The recently discovered hybridization between two species of Darwin's tree finches (Camarhynchus parvulus and C. pauper) on Floreana Island, Galápagos, presents an exciting opportunity to investigate the mechanisms causing hybridization and its potential evolutionary consequences under conditions of recent habitat disturbance and the introduction of invasive pathogens. In this study, we combine morphological and genetic analysis with pairing observations to explore the extent, direction and drivers of hybridization and to test whether hybridization patterns are a result of asymmetrical pairing preference driven by females of the rarer species (C. pauper). We found asymmetrical introgression from the critically endangered, larger-bodied C. pauper to the common, smaller-bodied C. parvulus, which was associated with a lack of selection against heterospecific males by C. pauper females. Examination of pairing data showed that C. parvulus females paired assortatively, whereas C. pauper females showed no such pattern. This study shows how sex-specific drivers can determine the direction of gene flow in hybridizing species. Furthermore, our results suggest the existence of a hybrid swarm comprised of C. parvulus and hybrid birds. We discuss the influence of interspecific abundance differences and susceptibility to the invasive parasite Philornis downsi on the observed hybridization and recommend that the conservation of this iconic species group should be managed jointly rather than species-specific.
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Biodiversidade , Tentilhões/genética , Fluxo Gênico , Animais , Evolução Biológica , Conservação dos Recursos Naturais , Equador , Feminino , Tentilhões/parasitologia , Interações Hospedeiro-Parasita , Hibridização Genética , Masculino , Muscidae/fisiologiaRESUMO
AIM: This paper invites the reader into sharing a journey of change through a new curriculum grounded in a problem-based learning (PBL) approach to education in the first year of a diploma nursing programme in Guyana. BACKGROUND: In Guyana, students are trained using traditional teaching methods: lectures and a single, often outdated, text. The authors had been dissatisfied previously with their students' knowledge retention, critical thinking skills and application abilities. The authors became advocates for change through the introduction of a PBL approach in nursing education within their school. METHODS: PBL is quite different from 'problem solving', and the goal of learning is not to solve the problem, which has been presented. Rather, the problem is used to help students identify their own learning needs as they attempt to understand the problem, to pull together, synthesize and apply information to the problem, and to begin to work effectively to learn from group members as well as tutors. Students met in small groups to identify the problem; explore their pre-existing knowledge; generate hypotheses and possible mechanisms; and identify learning issues. CONCLUSION: Students in their first exposure to self-directed, small group learning can immediately thrive as active learners with minimal guidance and support. The programme was evaluated with the admission and scoring of homework/exams based on the school syllabus for the individual courses; and continual small group oral as well as a final written qualitative evaluation. Specific positive and negative learning factors are addressed.
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Países em Desenvolvimento , Educação em Enfermagem , Aprendizagem Baseada em Problemas , Adolescente , Adulto , Feminino , Guiana , Humanos , Ensino/métodos , Adulto JovemRESUMO
Host-parasite systems have been models for understanding the connection between shifts in resource use and diversification. Despite theoretical expectations, ambiguity remains regarding the frequency and importance of host switches as drivers of speciation in herbivorous insects and their parasitoids. We examine phylogenetic patterns with multiple genetic markers across three trophic levels using a diverse lineage of geometrid moths (Eois), specialist braconid parasitoids (Parapanteles) and plants in the genus Piper. Host-parasite associations are mapped onto phylogenies, and levels of cospeciation are assessed. We find nonrandom patterns of host use within both the moth and wasp phylogenies. The moth-plant associations in particular are characterized by small radiations of moths associated with unique host plants in the same geographic area (i.e. closely related moths using the same host plant species). We suggest a model of diversification that emphasizes an interplay of factors including host shifts, vicariance and adaptation to intraspecific variation within hosts.
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Cadeia Alimentar , Interações Hospedeiro-Patógeno/genética , Mariposas/genética , Mariposas/parasitologia , Piper/genética , Árvores , Vespas/genética , Animais , Sequência de Bases , Teorema de Bayes , Biologia Computacional , Costa Rica , DNA Mitocondrial/genética , Equador , Evolução Molecular , Especiação Genética , Interações Hospedeiro-Patógeno/fisiologia , Larva/parasitologia , Larva/fisiologia , Modelos Genéticos , Dados de Sequência Molecular , Mariposas/classificação , Mariposas/fisiologia , Filogenia , Análise de Sequência de DNA , Vespas/fisiologiaRESUMO
INTRODUCTION: Somatostatin receptors are expressed in a large number of human tumours. The somatostatin receptors types 1-5 expression in a series including 100 gastro-entero-pancreatic endocrine tumours were analysed. METHODS: From a prospectively built database of patients with gastro-entero-pancreatic endocrine tumours referred from three institutions, 100 cases with clinical and pathological data were selected. Somatostatin receptors expression by immunohistochemistry with somatostatin receptor types 1-5 antibodies in tissue paraffin sections were studied and correlated with the histological diagnosis according to the WHO classification, location and functional status. RESULTS: Of the 100 cases, 67 were gastrointestinal tumours, 25 pancreatic and 8 liver metastasis of unknown origin. Thirty-one of them were functioning tumours: 2 insulinomas, 5 gastrinomas, 1 glucagonoma and 23 carcinoids. Somatostatin receptors expression was observed in 94 tumours. The six negative cases were all non-functioning tumours. Somatostatin receptors 2a and 5 were highly expressed (86 and 62%, respectively), and surprisingly found even in poorly differentiated endocrine carcinomas. Somatostatin receptors expression was less frequent in pancreatic than in gastrointestinal tumours. Well-differentiated neoplasms had a higher density of somatostatin receptors. Only SSTR2a showed membrane staining. CONCLUSIONS: Immunohistochemistry revealed that somatostatin receptors were highly expressed in both primary and metastatic gastro-entero-pancreatic endocrine tumours with heterogeneous staining distribution. It proved to be a reliable technique even in small tumour samples.
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Neoplasias das Glândulas Endócrinas/metabolismo , Neoplasias Gastrointestinais/metabolismo , Receptores de Somatostatina/metabolismo , Adulto , Bases de Dados Factuais , Neoplasias das Glândulas Endócrinas/patologia , Neoplasias das Glândulas Endócrinas/secundário , Feminino , Neoplasias Gastrointestinais/patologia , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Receptores de Somatostatina/análiseRESUMO
A panel of experts from Latin America convened in Brazil, in May of 2007, for consensus recommendations regarding the management of neuroendocrine tumors (NETs) of the gastrointestinal tract and pancreas. The recently introduced World Health Organization classification of NETs represents a step forward, but the former classification of carcinoids into foregut, midgut and hindgut is still likely to be useful in the near future. Macroscopic description of the tumor should be followed by light microscopic examination and immunohistochemical staining, whereas other techniques might not be widely available in Latin America. Surgery remains the mainstay of treatment for patients with potentially curable tumors, and adequate selection is paramount in order to optimize treatment results. Regarding systemic therapy, patients with well-differentiated tumors or islet-cell carcinomas may be categorized as having indolent disease, while patients with poorly differentiated, anaplastic, and small-cell carcinomas, or with atypical carcinoids, may be approached initially as having aggressive disease. Somatostatin analogues play a cytostatic role in indolent tumors, and chemotherapy may play a role against other, more aggressive NETs. Obviously, there is an urgent need for novel therapies that are effective against NETs.
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Neoplasias Gastrointestinais/terapia , Tumores Neuroendócrinos/terapia , Neoplasias Pancreáticas/terapia , Algoritmos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Técnicas de Diagnóstico Endócrino , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Prova Pericial , Neoplasias Gastrointestinais/classificação , Neoplasias Gastrointestinais/diagnóstico , Diretrizes para o Planejamento em Saúde , Humanos , América Latina , Tumores Neuroendócrinos/classificação , Tumores Neuroendócrinos/diagnóstico , Neoplasias Pancreáticas/classificação , Neoplasias Pancreáticas/diagnósticoRESUMO
We have used a model of iron deficiency in the rat to analyze the effects of a disruption in iron availability on oligodendroglial cell (OLGc) maturation and myelinogenesis and to explore the possible beneficial influence of an intracranial injection (ICI) of apotransferrin (aTf) at 3 days of age on this process. Studies carried out on postnatal days 17 and 24 showed that iron deficiency produced a decrease in myelin proteins and lipids at 24 days of age. Immunohistochemistry showed that in untreated iron-deficient (ID) rats, the immunoreactivity of anti-adenomatous polyposis coli (APC) and anti-MBP antibodies decreased markedly with reference to normal controls, whereas in ID rats treated with an ICI of aTf, the immunoreactivity of these markers increased. A similar situation occurred with the immunoreactivity of H-ferritin. In primary OLGc cultures from ID rats, there was a high number of cells positive to the antibody against the polysialylated form of the cell surface glycoprotein NCAM (PSA-NCAM) compared with in OLGc cultures prepared from normal controls or from ID animals treated with aTf. The number of MBP+ cells in cultures from ID rats increased after treatment with aTf. The presence of lipid rafts evaluated with a specific anti-protein prion cellular (PrPc) antibody showed a smaller number of PrPc-positive structures in ID rat cultures. Treatment of the ID animals with a single ICI of aTf stimulated myelination, producing a significant correction in the different biochemical parameters affected by ID.
Assuntos
Anemia Ferropriva/tratamento farmacológico , Anemia Ferropriva/patologia , Apoproteínas/uso terapêutico , Doenças Desmielinizantes/tratamento farmacológico , Doenças Desmielinizantes/patologia , Fibras Nervosas Mielinizadas/patologia , Transferrina/uso terapêutico , Anemia Ferropriva/sangue , Animais , Animais Recém-Nascidos , Apoproteínas/farmacologia , Células Cultivadas , Doenças Desmielinizantes/sangue , Modelos Animais de Doenças , Feminino , Bainha de Mielina/efeitos dos fármacos , Bainha de Mielina/patologia , Fibras Nervosas Mielinizadas/efeitos dos fármacos , Gravidez , Ratos , Ratos Wistar , Transferrina/farmacologiaRESUMO
The wide geographical distribution of Triatoma dimidiata, one of the three major vectors of Chagas disease, ranges from Mexico to northern Peru. Since this species occupies a great diversity of artificial and natural ecotopes, its eradication is extremely difficult. In order to assist control efforts, we used chromosome analyses and DNA amount as taxonomic markers to study genetic variability in populations of T. dimidiata from Mexico, Guatemala, El Salvador and Colombia. We differentiated three groups or cytotypes defined by characteristic chromosome C-banding patterns and genome size measured by flow cytometry. The three cytotypes are restricted to different geographic locations. Cytotype 1 occurs in Mexico (excluding Yucatán), Guatemala (excluding Petén), El Salvador and Colombia. Cytotype 2 occurs in Yucatán and cytotype 3 occurs in Petén. Cytotype 1, commonly associated with domestic and peridomestic environments but also inhabiting sylvatic ecotopes, is the most widespread and with major epidemiological significance. In contrast, the Yucatán cytotype inhabits wild ecotopes but increasingly enters houses, while the Petén cytotype appears exclusively sylvatic. We suggest that these cytotypes represent cryptic species of T. dimidiata with different epidemiological relevance as Chagas disease vectors. Poor ability to colonize human dwellings, together with their restricted geographic distribution, indicate that the Yucatán and Petén putative species probably have much less epidemiological significance than cytotype 1. Thus, the genetic markers we describe are powerful tools to differentiate cryptic species in T. dimidiata with different epidemiological significance, contributing to planning the most effective control measures.
Assuntos
Doença de Chagas/transmissão , Cromossomos/genética , Insetos Vetores/genética , Triatoma/genética , Animais , Doença de Chagas/genética , Colômbia , El Salvador , Citometria de Fluxo/métodos , Marcadores Genéticos/genética , Variação Genética/genética , Genoma de Inseto/genética , Guatemala , Humanos , Cariotipagem/métodos , México , Especificidade da Espécie , Triatoma/classificaçãoRESUMO
Several observations suggest that iron is an essential factor in myelination and oligodendrocyte biology. However, the specific role of iron in these processes remains to be elucidated. This role could be as an essential cofactor in metabolic processes or as a transcriptional or translational regulator. In this study, we used animals models each with a unique defect in iron availability, storage, or transfer to test the hypothesis that disruptions in these mechanisms affect myelinogenesis and myelin composition. Disruption of iron availability either by limiting dietary iron or by altering iron storage capacity resulted in a decrease in myelin proteins and lipids but not the iron content of myelin. Among the integral myelin proteins, proteolipid protein was most consistently affected, suggesting that limiting iron to oligodendrocytes results not only in hypomyelination but also in a decrease in myelin compaction. Mice deficient in transferrin must receive transferrin injections beginning at birth to remain viable, and these mice had increases in all of the myelin components and in the iron content of the myelin. This finding indicates that the loss of endogenous iron mobility in oligodendrocytes could be overcome by application of exogenous transferrin. Overall, the results of this study demonstrate how myelin composition can be affected by loss of iron homeostasis and reveal specific chronic changes in myelin composition that may affect behavior and attempts to rescue myelin deficits.
Assuntos
Encéfalo/metabolismo , Ferro/metabolismo , Modelos Animais , Bainha de Mielina/metabolismo , Oligodendroglia/metabolismo , Animais , Transporte Biológico , Western Blotting/métodos , Química Encefálica , Dieta , Ácidos Graxos/metabolismo , Feminino , Ferritinas/genética , Ferritinas/metabolismo , Deficiências de Ferro , Masculino , Camundongos , Camundongos Mutantes Neurológicos , Camundongos Transgênicos , Proteínas da Mielina/metabolismo , Gravidez , Ratos , Ratos Sprague-Dawley , TransferrinaRESUMO
Oncologic emergencies have been extensively described and clearly defined. In oncology daily practice, cancer patients seek non-scheduled medical care in situations they perceive as a medical emergency, but which may not be a true emergency. The aim of the study was to identify the main symptoms leading to a non-scheduled consultation (NSC) and their relationship to the type of cancer, and to evaluate whether the diagnosis at discharge of patients admitted as result of a NSC correlates with a true oncologic emergency. This was a prospective observational study. Between July 2002 and April 2003, 365 NSCs were recorded. The most frequent baseline diseases were breast cancer (70), lung cancer (67), gastrointestinal cancer (52), lymphoma (42) and ovarian cancer (22). The most common symptoms for consultation were: fever (84), pain (81), cutaneous manifestations (26), dyspnea (23), bleeding (16) and abdominal distention (16). Overall, 114 of 365 NSCs (31%) resulted in admission. The most frequent symptoms resulting in admission were fever (42), pain (16), dyspnea (11), vomiting (9), neurologic manifestations (7), abdominal distention (6) and anuria (6). At discharge, only 30 patients (26%) admitted after a NSC were diagnosed with a defined oncologic emergency: febrile neutropenia (13), intestinal occlusion (12), obstructive uropathy (4) and abdominal perforation (1). True emergencies were not the most frequent causes of NSC at our institution.
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Serviço Hospitalar de Emergência/estatística & dados numéricos , Neoplasias/complicações , Serviço Hospitalar de Oncologia/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina , Neoplasias da Mama/complicações , Feminino , Neoplasias Gastrointestinais/complicações , Humanos , Obstrução Intestinal/etiologia , Perfuração Intestinal/etiologia , Neoplasias Pulmonares/complicações , Linfoma/complicações , Masculino , Pessoa de Meia-Idade , Neutropenia/etiologia , Neoplasias Ovarianas/complicações , Admissão do Paciente/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Estudos Prospectivos , Doenças Urológicas/etiologiaRESUMO
Objetivo: Evaluar retrospectivamente las características de nuestra población, sus patologías prevalentes y las drogas recibidas; evaluar la naturaleza de las reacciones agudas de hipersensibilidad (RAH) producidas por la infusión de agentes antineoplásicos; evaluar las maniobras médicas instauradas y la necesidad de que estos tratamientos sean realizados en el ámbito hospitalario. Material y métodos: Se consideraron los pacientes (ptes.) que concurrieron a hospital de día para recibir tratamiento ambulatorio; se categorizaron las reacciones agudas en severas (requieren maniobras médicas activas para reestablecer la estabilidad clínica y se debe suspender la infusión) y moderadas (requieren maniobras médicas activas pero se puede reiniciar la infusión) sin considerarse las reacciones leves (por ej.: acatisia, eritema facial) ni las extravasaciones, se categorizaron las maniobras médicas en complejas (inotrópicos, internación) y no complejas (corticoides, antihistamínicos, alta institucional)...
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Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Antineoplásicos/efeitos adversos , Hipersensibilidade a Drogas , Doença Aguda , Antineoplásicos/uso terapêutico , Carboplatina , Cisplatino , Hipersensibilidade a Drogas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Leucovorina , Neoplasias , Paclitaxel , Estudos RetrospectivosRESUMO
Introducción: los efectos adversos del tratamiento andrógeno ablativo en pacientes con cáncer de próstata avanzado han estimulado la búsqueda de nuevas combinaciones de tratamiento con actividad similar pero con menor toxicidad. La combinación de un antiandrogógeno periférico como flutamida o bicalutamida con el inhibidor de la 5-alfa reductasa, finasteride, constituye un desarrollo racional para el tratamiento del cáncer de próstata avanzado. Pacientes y métodos: flutamida 750 mg/día o bicalutamida 50 mg/día más finasteride 5 mg fue administrado a pacientes con cáncer de próstata avanzado que rechazaron bloqueo con análogos o, una vez iniciado el mismo, se negaron a continuar con dicho tratamiento. Entre 2/96 y 4/02 realizaron tratamiento 32 ptes., edad mediana de 67 (r 48-80) grupo A y 69,5 (r 49-88) grupo B; mediana de score de Gleason 6. Seis pacientes realizaron previamente tratamiento andrógeno ablativo por una mediana de 5 meses...
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Humanos , Masculino , Pessoa de Meia-Idade , Finasterida , Flutamida , Neoplasias da Próstata , Finasterida , Flutamida , Seguimentos , Estudos Retrospectivos , Comportamento SexualRESUMO
Introducción: CCB es una nueva fluoropirimidina que suma a las ventajas de la vía oral, su aceptable toxicidad y actividad, con bajo perfil costo-beneficio para el tratamiento paliativo del cáncer de mama. Objetivos: analizar nuestra experiencia en forma retrospectiva en relación a la utilización de CCB, en pacientes con cáncer de mama metastásico. Determinar su eficacia y perfil de toxicidad administrado por vía oral en régimen intermitente. Materiales y métodos: se evaluaron las historias clínicas de 67 pacientes (pts.), con diagnóstico de cáncer de mama metastásico que recibieron tratamiento con CCB, entre julio de 1999 y marzo de 2002, en el Instituto Alexander Fleming. Características de la población: edad mediana: 58 años (rango 32-79); receptores hormonales (RH) positivos 64,17 por ciento; el intervalo libre de enfermedad desde el diagnóstico a la primera manifestación metastásica, (ILE) fue de 115,5 meses (rango 0-231); presentaron patrón metastásico visceral (hepático y pulmonar) 41/67 pts., (61,19 por ciento). La mediana de líneas de tratamiento hormonal previo fue de 2 (rango 0-4) y de quimioterapia 4 (rango 0-7). El 17,91 por ciento de las pts. fueron resistentes a antraciclinas y el 79,10 por ciento, fueron expuestas a taxanos. En 6 pts. se efectuó tratamiento con altas dosis de quimioterapia. Las pacientes fueron tratadas con dosis de 1,5 a 2,5 gramos...
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Humanos , Adulto , Feminino , Pessoa de Meia-Idade , Antimetabólitos Antineoplásicos/uso terapêutico , Neoplasias da Mama , Fluoruracila , Cuidados Paliativos , Neoplasias da Mama , Ensaios Clínicos como Assunto , Fluoruracila , Resultado do TratamentoRESUMO
The location and function of iron in the central nervous system are reviewed with particular emphasis on human biology. Iron is distributed to different cell types in the brain in a heterogeneous fashion through the action of transferrin, transferrin receptors, and the metabolic needs of those cells. The function of this iron and its storage is documented in states of growth and development as well as during pathological states associated with aging. The information relating this biology to current observations of attention deficits in iron-deficient humans is also reviewed.
Assuntos
Encéfalo/metabolismo , Ferro/fisiologia , Adulto , Envelhecimento/metabolismo , Doença de Alzheimer/metabolismo , Animais , Criança , Pré-Escolar , Ferritinas/fisiologia , Humanos , Lactente , Ferro/metabolismo , Esclerose Múltipla/metabolismo , Doença de Parkinson/metabolismo , Ratos , Receptores da Transferrina/fisiologia , Transferrina/fisiologiaRESUMO
In order to assess further the clinical usefulness of vidarabine therapy of chicken pox, a double-blind, placebo-controlled trial was performed in immunocompromised patients. Thirty-four patients entered the trial; 19 received vidarabine and 15 the placebo. All patients had disease less than or equal to 72 hours in duration and 23 had lymphoproliferative malignancies. Both patient populations were balanced for underlying disease, preceding chemotherapy, and duration of chicken pox. No patient received zoster immune globulin. Drug therapy accelerated cessation of new vesicle formation (P = 0.015) and decreased median daily lesion counts (P = 0.06 on days 2 and 3). Fever (greater than or equal to 37.8 degrees C orally) resolved more rapidly in the drug-treated group. By day five, 70% of drug-treated subjects were afebrile in contrast to 35% of placebo recipients (P = 0.066). One drug recipient developed mild pneumonitis during the study which resolved with therapy, whereas eight placebo recipients developed varicella-related complications which led to death in two patients (P less than 0.01). These results were achieved with minimal evidence of laboratory or clinical toxicity related to drug administration. The findings indicate that vidarabine has a good therapeutic index (efficacy/toxicity) for treatment of chicken pox in immunocompromised patients when given early in the course of the infection.