RESUMO
BACKGROUND: MicroRNAs are 20-22 nucleotide molecular structures with post-transcriptional activity that are involved in the immune response, as well as in the inflammatory pathways of different cells and tissues. AIMS: We present herein a prospective study in which serum microRNA-21 expression was determined in patients diagnosed with acute appendicitis as a model of bowel inflammation. MATERIAL AND METHODS: A prospective cohort study of patients diagnosed with acute appendicitis was conducted. Serum microRNA-21 was analyzed through the PCR of blood samples taken from the patients prior to surgery. MicroRNA-21 values were compared with the analytic variables (leukocytes, hemoglobin, hematocrit, platelets, prothrombin activity, glucose, urea, and creatinine) and the anatomopathologic variables (normal appendix, phlegmonous, gangrenous, and perforated acute appendicitis). RESULTS: A total of 60 patients with acute appendicitis diagnosis were consecutively included in the study from June to October 2009. Sixty-six percent of the patients were men (40 men and 20 women), with a mean age of 26.2±14.8 years. The mean absolute level of microRNA-21 was 24.8±0.93, whereas the mean microRNA-21 gene expression was 1.04±0.28. No correlation between the analytic and anatomopathologic parameters evaluated was observed (P=.47). CONCLUSIONS: It is necessary to continue to search for the most appropriate microRNAs, so that their determination in serum can lead to greater precision in establishing the diagnosis and outcome of inflammatory disorders of the bowel.
Assuntos
Apendicite/sangue , Colite/sangue , MicroRNAs/sangue , Doença Aguda , Adulto , Feminino , Humanos , Masculino , Estudos ProspectivosRESUMO
Por iniciativa de tres instituciones: Liga Chilena contra la Epilepsia (LICHE), Sociedad de Epileptología de Chile (SOCEPCHI) y Sociedad de Psiquiatría y Neurología de la Infancia y Adolescencia (SOPNIA) de Chile, se constituye un comité de trabajo que convoca a un consenso de uso de fármacos antiepilépticos (FAEs) en un grupo de 16 Síndromes electro-clínicos y otras Epilepsias en niños y adolescentes. Cuarenta y dos médicos neuropediatras especialistas en Epilepsias de todas las regiones de Chile, participaron en la discusión y realizaron una propuesta de tratamiento farmacológico para cada cuadro. El comité de trabajo realizó un análisis exhaustivo y discusión de los documentos, para finalmente concluir en una recomendación de tratamiento para cada cuadro. Este consenso es una guía práctica de orientación para ayudar a las decisiones de tratamiento en situaciones clínicas concretas. Su objetivo final es ofrecer una mejor calidad de atención a los niños y adolescentes con epilepsias, a través de decisiones fundadas que contribuyan a disminuir la variabilidad de las decisiones terapéuticas.
Committed by three institutions: Liga Chilena contra la Epilepsia (LICHE), Sociedad de Epileptología de Chile (SOCEPCHI) y Sociedad de Psiquiatría y Neurología de la Infancia y Adolescencia (SOPNIA) de Chile, a 6-member working committee called for a meeting of 42 Chilean pediatric epileptologists from all over the country, with the aim of reaching a consensus on the use of antiepileptic drugs in 16 selected children and adolescents electro-clinical syndromes and epilepsies. These treatment proposals were analyzed and fully discussed by the working committee, ending in an antiepileptic drug treatment recommendation guideline for each condition. This consensus is a practical guideline to be used in specific clinical situations, which aims to support treatment decision making. Its main purpose is to offer the best evidence based treatments to our children and adolescents patients with epilepsy, thus contributing to diminish variability in therapeutic decisions.
Assuntos
Humanos , Adolescente , Criança , Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Chile , ConsensoRESUMO
As part of phase I/II melanoma BNCT clinical trial conducted in Argentina in a cooperative effort of the Argentine Atomic Energy Commission (CNEA) and the Oncology Institute Angel H. Roffo (IOAHR), 7 patients (6 female-1 male) received eight treatment sessions covering ten anatomical areas located in extremities. Mean age of the patients was 64 years (51-74). The treatments were performed between October 2003 and June 2007. All patients presented multiple subcutaneous skin metastases of melanoma and received an infusion containing approximately 14 gr/m(2) of (10)borophenyl-alanine (BPA) followed by the exposition of the area to a mixed thermal-epithermal neutron beam at the RA-6 reactor. The maximum prescribed dose to normal skin ranged from 16.5 to 24 Gy-Eq and normal tissue administered dose varied from 15.8 to 27.5 Gy-Eq. Considering evaluable nodules, 69.3% of overall response and 30.7% of no changes were seen. The toxicity was acceptable, with 3 out of 10 evaluable areas showing ulceration (30% toxicity grade 3).
Assuntos
Terapia por Captura de Nêutron de Boro/métodos , Melanoma/radioterapia , Neoplasias Cutâneas/radioterapia , Idoso , Argentina , Compostos de Boro/uso terapêutico , Feminino , Humanos , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Fenilalanina/análogos & derivados , Fenilalanina/uso terapêutico , Radiossensibilizantes/uso terapêutico , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por ComputadorRESUMO
We recently initiated a program aimed to investigate the suitability of dynamic infrared imaging for following-up nodular melanoma patients treated with BNCT. The reason that makes infrared imaging attractive is the fact that it constitutes a functional and non-invasive imaging method, providing information on the normal and abnormal physiologic response of the nervous and vascular systems, as well as the local metabolic rate and inflammatory processes that ultimately appear as differences in the skin temperature. An infrared camera, with a focal plane array of 320 x 240 uncooled ferroelectric detectors is employed, which provides a video stream of the infrared emission in the 7-14 microm wavelength band. A double blackbody is used as reference for absolute temperature calibration. After following a protocol for patient preparation and acclimatization, a basal study is performed. Subsequently, the anatomic region of interest is subjected to a provocation test (a cold stimulus), which induces an autonomic vasoconstriction reflex in normal structures, thus enhancing the thermal contrast due to the differences in the vasculature of the different skin regions. Radiation erythema reactions and melanoma nodules possess typically a faster temperature recovery than healthy, non-irradiated skin. However, some other non-pathological structures are also detectable by infrared imaging, (e.g. scars, vessels, arteriovenous anastomoses and injuries), thus requiring a multi-study comparison in order to discriminate the tumor signal. Besides the superficial nodules, which are readily noticeable by infrared imaging, we have detected thermal signals that are coincident with the location of non-palpable nodules, which are observable by CT and ultrasound. Diffuse regions of fast temperature recovery after a cold stimulus were observed between the third and sixth weeks post-BNCT, concurrent with the clinical manifestation of radiation erythema. The location of the erythematous visible and infrared regions is consistent with the 3D dosimetry calculations.
Assuntos
Terapia por Captura de Nêutron de Boro , Raios Infravermelhos , Melanoma/radioterapia , Neoplasias Cutâneas/radioterapia , Termografia/métodos , Idoso , Terapia por Captura de Nêutron de Boro/efeitos adversos , Temperatura Baixa , Eritema/etiologia , Eritema/patologia , Eritema/fisiopatologia , Feminino , Humanos , Perna (Membro) , Masculino , Melanoma/patologia , Melanoma/fisiopatologia , Planejamento da Radioterapia Assistida por Computador , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/fisiopatologia , Fenômenos Fisiológicos da Pele , Temperatura Cutânea , Fatores de TempoRESUMO
A previous work concerning tumor control and skin damage in cutaneous melanoma treatments with BNCT has been extended to include doses, volumes and responses of 104 subcutaneous lesions from all patients treated in Argentina. Acute skin reactions were also scored for these patients, and cumulative dose-area histograms and dose-based figures of merit for skin were calculated. Broadening the tumor response analysis with the latest data showed that the (minimum or mean) tumor dose is not a good predictor of the observed clinical outcome by itself. However, when the tumor volume was included in the model as second explicative variable, the dose increases its significance and becomes a critical variable jointly with the volume (p-values<0.05). A preliminary analysis to estimate control doses for two groups of tumor sizes revealed that for small tumor volumes (< 0.1cm(3)) doses greater than 20 Gy-Eq produce a high tumor control (> 80%). However, when tumor volumes are larger than 0.1cm(3), control is moderate (< 40%) even for minimum doses up to 40 Gy-Eq. Some quantities based on skin doses, areas and complication probabilities were proposed as candidates for predicting the severity of the early skin reactions. With the current data, all the evaluated figures of merit derived similar results: ulceration is present among the cases for which these quantities take the highest values.
Assuntos
Terapia por Captura de Nêutron de Boro/efeitos adversos , Terapia por Captura de Nêutron de Boro/estatística & dados numéricos , Melanoma/radioterapia , Lesões por Radiação/etiologia , Neoplasias Cutâneas/radioterapia , Relação Dose-Resposta à Radiação , Eritema/etiologia , Humanos , Melanoma/patologia , Valor Preditivo dos Testes , Planejamento da Radioterapia Assistida por Computador/estatística & dados numéricos , Neoplasias Cutâneas/patologia , Úlcera Cutânea/etiologiaRESUMO
A study of the (10)B-enriched p-boronophenylalanine-fructose complex ((10)BPA-F) infusion procedure in potential BNCT patients, including four melanoma of extremities and two high-grade gliomas (glioblastoma and ganglioglioma) was performed. T/B and S/B ratios for (10)B concentrations in tumor (T), blood (B) and skin (S) were determined. The T/B ratio for the glioblastoma was in the 1.8-3.4 range. The ganglioglioma did not show any significant boron uptake. For the nodular metastasic melanoma T/B values were between 1.5 and 2.6 (average 2.1+/-0.4), corresponding to the lower limit of the mean values reported for different melanoma categories. This result might suggest a lower boron uptake for nodular metastasic melanomas. S/B was 1.5+/-0.4. An open two-compartment pharmacokinetic model was applied to predict the boron concentration during the course and at the end of a BNCT irradiation.
Assuntos
Compostos de Boro/farmacocinética , Compostos de Boro/uso terapêutico , Terapia por Captura de Nêutron de Boro , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/radioterapia , Frutose/análogos & derivados , Frutose/farmacocinética , Frutose/uso terapêutico , Melanoma/metabolismo , Melanoma/radioterapia , Adulto , Idoso , Argentina , Boro/sangue , Boro/farmacocinética , Feminino , Ganglioglioma/metabolismo , Ganglioglioma/radioterapia , Glioblastoma/metabolismo , Glioblastoma/radioterapia , Humanos , Masculino , Melanoma/secundário , Pessoa de Meia-IdadeRESUMO
A Phase I/II protocol for treating cutaneuos melanomas with BNCT was designed in Argentina by the Comisión Nacional de Energía Atómica and the medical center Instituto Roffo. The first of a cohort of thirty planned patients was treated on October 9, 2003. This article depicts the protocol-based procedure and describes the first clinical case, treatment regime and planning, patient irradiation, retrospective dosimetric analysis and clinical outcome. Considering the low acute skin toxicity and the complete response in 21 of the 25 subcutaneous melanoma nodules treated, a second irradiation was performed in a different location of the extremity of the same patient. The corresponding clinical outcome is still under evaluation.
Assuntos
Terapia por Captura de Nêutron de Boro , Frutose/análogos & derivados , Melanoma/radioterapia , Neoplasias Cutâneas/radioterapia , Argentina , Boro/sangue , Boro/farmacocinética , Compostos de Boro/farmacocinética , Compostos de Boro/uso terapêutico , Terapia por Captura de Nêutron de Boro/métodos , Protocolos Clínicos , Feminino , Frutose/farmacocinética , Frutose/uso terapêutico , Humanos , Melanoma/metabolismo , Melanoma/secundário , Pessoa de Meia-Idade , Planejamento da Radioterapia Assistida por Computador , Neoplasias Cutâneas/metabolismo , Neoplasias Cutâneas/secundário , Resultado do TratamentoRESUMO
El tratamiento estándar para el CCLA consiste en radioterapia más qiomioterapia en forma concurrente. El agregado de gemcitabina al cisplatino es factible sin agregarle toxicidad (Abs.2150 ASCO 2001). Basándonos en esos resultados, diseñamos un estudio evaluando la eficacia y toxicidad de la radioterapia con dosis bajas bisemanales de gemcitabina más cisplatino en el CCLA. Se incluyeron 60 pacientes; la edad media fue de 49 años (r:25-76). Los estadíos en el momento del diagnóstico se distribuyeron de la siguiente manera: 17 (28 por ciento): estadíos IIIB; 40 (66,6 por ciento): IIAB; y 3: IB Bulky (la paciente tenía contraindicada la cirugía). Se administró radioterapia externa a la pelvis total en 23 fracciones, alcanzando 46 Gys. en 5 semanas, con 2 inserciones de braquiterapia al final de la tercera y quinta semana. El total de la dosis administrada al punto A fue de 85 to 90 Gys. La quimioterapia consistió en gemcitabina 20 mg/m²/d 2 veces por semana (comenzando 3 días previo a la radioterapia) y cisplatino 30 mg/m² semanalmente. Toxicidad: 60 pacientes son evaluables para toxicidad y respuesta. Tres pacientes tuvieron que demorar 1 semana la primera braquiterapia debido a toxicidad gastrointestinal. Seis pacientes debieron omitir una aplicación de QT por toxicidad hematológica y gastrointestinal. Hubo 1 muerte durante el tratamiento, no relacionada con el tratamiento. No hubo alopecia ni mucositis. Cinco pacientes tuvieron trombocitopenia G2; 1 paciente: G3. Ocho pacientes experimentaron neutropenia G2, mientras que una sola paciente tuvo G3, y una G4...(AU)
Assuntos
Humanos , Adulto , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias do Colo do Útero/tratamento farmacológico , Antimetabólitos Antineoplásicos/administração & dosagem , Cisplatino/administração & dosagem , Neoplasias do Colo do Útero/radioterapia , Antimetabólitos Antineoplásicos/uso terapêutico , Antimetabólitos Antineoplásicos/efeitos adversos , Citarabina/análogos & derivados , Cisplatino/uso terapêutico , Radiossensibilizantes , Resultado do TratamentoRESUMO
El tratamiento estándar para el CCLA consiste en radioterapia más qiomioterapia en forma concurrente. El agregado de gemcitabina al cisplatino es factible sin agregarle toxicidad (Abs.2150 ASCO 2001). Basándonos en esos resultados, diseñamos un estudio evaluando la eficacia y toxicidad de la radioterapia con dosis bajas bisemanales de gemcitabina más cisplatino en el CCLA. Se incluyeron 60 pacientes; la edad media fue de 49 años (r:25-76). Los estadíos en el momento del diagnóstico se distribuyeron de la siguiente manera: 17 (28 por ciento): estadíos IIIB; 40 (66,6 por ciento): IIAB; y 3: IB Bulky (la paciente tenía contraindicada la cirugía). Se administró radioterapia externa a la pelvis total en 23 fracciones, alcanzando 46 Gys. en 5 semanas, con 2 inserciones de braquiterapia al final de la tercera y quinta semana. El total de la dosis administrada al punto A fue de 85 to 90 Gys. La quimioterapia consistió en gemcitabina 20 mg/m²/d 2 veces por semana (comenzando 3 días previo a la radioterapia) y cisplatino 30 mg/m² semanalmente. Toxicidad: 60 pacientes son evaluables para toxicidad y respuesta. Tres pacientes tuvieron que demorar 1 semana la primera braquiterapia debido a toxicidad gastrointestinal. Seis pacientes debieron omitir una aplicación de QT por toxicidad hematológica y gastrointestinal. Hubo 1 muerte durante el tratamiento, no relacionada con el tratamiento. No hubo alopecia ni mucositis. Cinco pacientes tuvieron trombocitopenia G2; 1 paciente: G3. Ocho pacientes experimentaron neutropenia G2, mientras que una sola paciente tuvo G3, y una G4...
Assuntos
Humanos , Adulto , Feminino , Pessoa de Meia-Idade , Antimetabólitos Antineoplásicos/administração & dosagem , Cisplatino , Neoplasias do Colo do Útero , Radiossensibilizantes , Antimetabólitos Antineoplásicos/efeitos adversos , Antimetabólitos Antineoplásicos/uso terapêutico , Cisplatino , Citarabina , Resultado do Tratamento , Neoplasias do Colo do ÚteroRESUMO
The various forms of renal osteodystrophy are predominant hyperparathyroid bone disease, mixed uremic osteodystrophy, low turnover osteomalacia, and adynamic bone disease. The present study analyses a total number of 1,209 bone biopsies from 5 different countries (Brazil, Uruguay, Argentina, Portugal, and Spain). Low turnover osteomalacia and mixed uremic osteodystrophy were more common in Brazil, Uruguay, and Argentina than in Portugal and Spain whereas predominant hyperparathyroid bone disease was seen more often in Portugal and Spain. In all centers, independent of the aluminum staining technique used, the extent of aluminum deposited in bone was greater in patients presenting with low bone turnover, whether from low turnover osteomalacia or adynamic bone disease, than in the predominant hyperparathyroid bone disease. In summary, even though recent reports have indicated that, over the last decade, the incidence of aluminum-induced toxicity was reduced, aluminum still seems to be implicated in a great percentage of symptomatic low bone remodelling lesions in Iberoamerica.
Assuntos
Alumínio/análise , Osso e Ossos/química , Distúrbio Mineral e Ósseo na Doença Renal Crônica/epidemiologia , Distúrbio Mineral e Ósseo na Doença Renal Crônica/patologia , Hormônio Paratireóideo/sangue , Argentina/epidemiologia , Biópsia/estatística & dados numéricos , Doenças Ósseas/sangue , Doenças Ósseas/epidemiologia , Doenças Ósseas/patologia , Osso e Ossos/metabolismo , Osso e Ossos/patologia , Brasil/epidemiologia , Distúrbio Mineral e Ósseo na Doença Renal Crônica/sangue , Distúrbio Mineral e Ósseo na Doença Renal Crônica/classificação , Comorbidade , Humanos , Hiperparatireoidismo/sangue , Hiperparatireoidismo/epidemiologia , Hiperparatireoidismo/patologia , Falência Renal Crônica/sangue , Falência Renal Crônica/patologia , Osteomalacia/sangue , Osteomalacia/epidemiologia , Osteomalacia/patologia , Portugal/epidemiologia , Prevalência , Espanha/epidemiologia , Uruguai/epidemiologiaRESUMO
BACKGROUND: Tourette's syndrome is a childhood-onset hereditary neurobehavioural disorder believed to occur without geographical restrictions. Although there have been reports of this disorder worldwide just a few are from Latin America. AIM: To report a preliminary experience with a series of 70 patients and to review recent advances in this disorder. PATIENTS AND METHOD: We reviewed patients seen in pediatric and adult neurological clinics in Santiago, Chile, all of whom fulfilled clinical diagnostic criteria for Tourette Syndrome. RESULTS: Seventy patients were studied, 54 males (77.1%) and 16 females (22.8%), their mean age at first evaluation was 13.6 years (range 2-46). The mean age of onset of symptoms was 6.4 (range 2-20), the mean time of follow-up was 3 years. Fifty-eight patients showed simple motor tics (blinking, facial grimacing, shoulder shrugging), whereas dystonic tics like head jerking were seen in 38 patients, torticollis in 6 and oculogyric movements in 2. Complex motor tics like jumping, antics, trunk bending and head shaking were present in 16 subjects. Vocal tics were predominantly of the simple type: sniffing, throat clearing, blowing, and whistling. Complex vocal tics were seen in 12 patients, five cases showed palilalia, 3 echolalia and only six displayed coprolalia (8.5%). Tics were of mild to moderate severity in most patients. Obsessive-compulsive disorder was observed in 22.8% and attention deficit and hyperactivity disorder were present in 35.7%. Forty-five patients (64.2%) had a first degree relative with tics, nine patients (12.8%) had a family history of obsessive-compulsive disorder. The current evidence involving desinhibition of cortico-striatum-thalamic-cortical neuronal circuits in the pathogenesis of this disorder is analyzed. CONCLUSION: Our report supports the recognized clinical homogeneity and genetical basis of Tourette's syndrome regardless of geographical region and ethnic origin.
Assuntos
Síndrome de Tourette/epidemiologia , Adulto , Idade de Início , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Criança , Pré-Escolar , Chile/epidemiologia , Transtorno da Personalidade Compulsiva/complicações , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Síndrome de Tourette/complicações , Síndrome de Tourette/genéticaRESUMO
Acute childhood diarrhea is highly common in our country and its treatment include rehydration, the early dietary management and in few cases the use of antibiotics. At the same time, watery diarrhea is much more common than bloody diarrhea. The ideal in the management of infectious diarrhea is to identify the microorganisms that are producing the disease, however, it is very important to mention that in the majority of etiological studies done in our country, two were the more common identified microorganisms: Rotavirus and E. coli (in its different types). Usually and due to the high price of Lab. tests, we don't search those microorganisms and the majority of Laboratories used to report as a result, Salmonella, Shigella or negative. Normally, we receive the results of these cultures after few days and as we can understand these results are not necessarily useful in the early management of the disease and as we mentioned, these results will not include the more common pathogens. In this article we propose to perform three simple fecal tests in patients affected with acute diarrhea: 1) Count and differentiation of leucocytes; 2) Occult blood; 3) Reducing substances. If we play with these three results, it is not too difficult to suspect in the probable pathogen that is affecting our patient. In that concern, we propose this very simple, cheap and highly practical method for the etiological management of our patients that, of course, is not infallible, but our experience for many years have shown us that it is of great help for pediatricians in their daily work.
Assuntos
Diarreia/diagnóstico , Diarreia/terapia , Doença Aguda , Fatores Etários , Criança , Diarreia/etiologia , Dieta , Hidratação , Humanos , Sangue OcultoAssuntos
Epilepsia , Adolescente , Criança , Pré-Escolar , Seguimentos , Humanos , Lactente , Recém-Nascido , Prognóstico , RecidivaRESUMO
El 12,8% de 47 ninos que tuvieron su primera crisis epileptica no tratada, volvio a tener un segundo episodio. Se concluye que la edad de inicio del cuadro no es un factor predictivo de nuevas crisis, que 1 de cada 2 enfermos que recaen lo hacen con un episodio similar al primero, observandose um empeoramiento del EEG en aquellos ninos que repiten el cuadro