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PURPOSE: Cancer patients require implantation of venous access devices to meet their personalized therapeutic needs, which are often complex due to the nature of the medication and the disease status. Therefore, it is essential to have standardized protocols that guarantee the best results in health and patient safety. METHODS: To learn about the availability of protocols and aspects related to safety in clinical practice and to detect possible opportunities for improvement, a survey has been conducted in various Spanish hospitals, in addition to a review of the evidence regarding the various devices available and complications associated with the administration of chemotherapy. RESULTS: As a result of both analyses, the Foundation for Excellence and Quality in Oncology (ECO), the Spanish Society of Medical Oncology (SEOM), and the Spanish Society of Oncology Nursing (SEEO) have developed a catheter selection algorithm based on patient characteristics and treatment to facilitate the clinical decision-making process, as well as some recommendations aimed at ensuring patient safety and rational use of available resources. CONCLUSIONS: In conclusion, both the venous access catheter selection algorithm and the proposed recommendations aim to respond to the needs revealed in clinical practice and to become an integrable tool in electronic prescription systems to offer homogeneous criteria for action in cancer patients that require venous access, optimizing the use of available health resources with the highest safety and quality of life for the patient.
Assuntos
Oncologia/normas , Neoplasias/tratamento farmacológico , Segurança do Paciente , Adulto , Cateteres de Demora/efeitos adversos , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Enfermagem Oncológica , Sociedades MédicasRESUMO
The extent to which pre-Columbian societies altered Amazonian landscapes is hotly debated. We performed a basin-wide analysis of pre-Columbian impacts on Amazonian forests by overlaying known archaeological sites in Amazonia with the distributions and abundances of 85 woody species domesticated by pre-Columbian peoples. Domesticated species are five times more likely than nondomesticated species to be hyperdominant. Across the basin, the relative abundance and richness of domesticated species increase in forests on and around archaeological sites. In southwestern and eastern Amazonia, distance to archaeological sites strongly influences the relative abundance and richness of domesticated species. Our analyses indicate that modern tree communities in Amazonia are structured to an important extent by a long history of plant domestication by Amazonian peoples.
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Domesticação , Florestas , Árvores , Brasil , História Antiga , HumanosRESUMO
AIM: The type of estrogen and progestin as well as their doses, route and regimens of administration may each affect the benefit-risk profile of postmenopausal hormone therapy. The aim of this study was to evaluate the endometrial effect of progesterone released continuously from a vaginal ring, combined with transdermal estradiol in postmenopausal women. METHOD: Forty-four postmenopausal women participated in a randomized, double-blind, dose-finding study evaluating two hormonal treatments, combining 50 microg/day of estradiol delivered by transdermal patches and either 0.5-g or 1-g progesterone vaginal rings (PVR) given for 12 weeks. The effect on the endometrium was assessed by histology and the detection of the proliferative marker Ki-67. We also measured the serum concentration of estradiol and progesterone, the tissue concentration of progesterone and the immunolocalization of estradiol and progesterone receptors in the endometrium. RESULTS: Endometrial thickness was increased after both treatments, although endometrial histology appeared atrophic in most biopsies. A circulating dose-response of serum progesterone levels was observed from the first to the 12th week of PVR use. In the high-progesterone-dose group, the scarce presence of Ki-67 and hormone receptors reflected the predominant action of progesterone in endometrial glands and stroma, in parallel with a lower tissue concentration of progesterone in this group. CONCLUSION: The PVR appears to be a promising method of administering natural progesterone to postmenopausal women treated with estrogen. Estradiol levels corrected the menopausal symptoms, as expected, and the presence of atrophic endometrium in the majority of women indicated that both doses of progesterone oppose the stimulatory estradiol effects, although the percentage of proliferative tissue was not negligible in both groups.
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Sistemas de Liberação de Medicamentos , Endométrio/efeitos dos fármacos , Estradiol/administração & dosagem , Terapia de Reposição de Estrogênios/métodos , Pós-Menopausa , Progesterona/administração & dosagem , Progestinas/administração & dosagem , Administração Cutânea , Dispositivos Anticoncepcionais Femininos , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Vagina/efeitos dos fármacos , Saúde da MulherRESUMO
Obesity is associated to chronic metabolic entities affecting the quality of life and life expectancy. An early treatment, if efficient, can overcome most of the problems. The normalisation of body composition, of energy reserves and their distribution, as well as the minimisation of weight dependent metabolic upsets and the establishment of therapeutic priorities, according to the repercussions of obesity, are important factors for the treatment of this disease. Prevention is important and its basis is teaching and the setting in healthy life style with modification of the food habits and the incorporation of physical work into everyday activities. Diet therapy, physical activity, pharmacotherapy, surgery education and psychology are the forms proposed for the treatment and prevention of obesity.
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A new category of oncogenes regulating apoptosis, p53 and bcl-2, and the Epstein Barr virus (EBV) latent membrane protein-1 (LMP-1) have been related to Hodgkin's disease (HD) pathogenesis. We attempt to determine p53, mdm2, p21waf-1, bcl-2 and LMP-1 immunohistochemical expression in tissue sections from formalin-fixed, paraffin-embedded lymph node biopsies of pediatric HD. P53 was detected in the nucleus of Reed Sternberg cells and their variants (H-RS) in 68% of the HD cases. However, there was no statistically significant association with either clinical stages or with histological subtypes. P21waf-1, an indirect marker of p53 functional status, showed nuclear labelling of H-RS in all the studied cases. MDM2 co-expressed with p53 in 62% of the cases, suggesting that both proteins regulate one another, in HD by a self regulatory loop. Bcl-2 cytoplasmatic expression in H-RS was demonstrated in 65% of the cases. There was co-expression of bcl-2 and p53 in 51%, but it failed to correlate with a poor prognosis. LMP-1 labelling was shown in 51% of the cases, disclosing a statistically significant association with the under 6-year group (p = 0.005, Fisher's exact test). Since LMP-1 induces the expression of bcl-2 in vitro, the relation of both proteins was analysed and found to co-express in 15/37 cases, with a statistically significant association only in the under 6-year group (p = 0.001, Fisher's exact test). Abnormal accumulation of these oncoproteins in tumour cells could play a role in the pathogenesis of a subset of pediatric HD.
Assuntos
Herpesvirus Humano 4/fisiologia , Doença de Hodgkin/virologia , Proteínas Nucleares , Proteínas Oncogênicas Virais/metabolismo , Proteínas Proto-Oncogênicas/metabolismo , Adolescente , Antígenos Virais/metabolismo , Argentina , Criança , Pré-Escolar , Inibidor de Quinase Dependente de Ciclina p21 , Ciclinas/metabolismo , Feminino , Doença de Hodgkin/metabolismo , Doença de Hodgkin/patologia , Humanos , Técnicas Imunoenzimáticas , Hibridização in Situ Fluorescente , Lactente , Linfonodos/metabolismo , Linfonodos/patologia , Linfonodos/virologia , Masculino , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Proteínas Proto-Oncogênicas c-mdm2 , Proteína Supressora de Tumor p53/metabolismo , Proteínas da Matriz Viral/metabolismoRESUMO
An infrequent clinical case with spontaneous uterine rupture in a 14 weeks primigesta with symptoms and signs of hemoperitoneum with hypovolemic shock. The emergency laparotomy revealed 2,000 ml of hemoperitoneum and a rupture of depth of 5 cm the diameter with fetus alive in the inner. Ovular emptying and histerorraphya were carried out. Biopsy in the edge of the uterine rupture revealed placenta increta.
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Placenta Acreta/complicações , Ruptura Uterina/complicações , Adulto , Feminino , Humanos , GravidezRESUMO
Se hizo ensayo terapeutico con un antagonista del calcio, nifedipina (BAY 1040), en estudio doble ciego randomizado en 40 pacientes ambulatorios, por medio de ergometria (cicloergometro) previa y luego de la administracion de placebo o medicamento a los 7 y 14 dias respectivamente. La dosis utilizada del medicamento fue de 10 mg cada 8 horas. No se observaron modificaciones significativas en la frecuencia cardiaca, ni en la presion arterial en reposo y al esfuerzo, pero di discreta disminucion del ITTM al esfuerzo. En la mayoria de pacientes (61,3%) disminuyeron las crisis anginosas, y en el 16,1% desaparecieron totalmente. El 50% disminuyo el consumo de nitritos diarios. El descenso del S-T al esfuerzo para una misma frecuencia cardiaca, disminuyo o desaparecio en alto porcentaje. Los resultados globales fueron considerados como buenos y muy buenos en el 77,5% y negativos en el 22,5% de casos
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Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Nifedipino , Angina Pectoris , Método Duplo-Cego , Frequência Cardíaca , Pressão ArterialRESUMO
Se analizan los resultados obtenidos en 226 pacientes que han realizado ejercicios programados en rehabilitacion, durante el lapso de 5 anos y de los cuales 145 han completado el plan minimo de 6 meses. Se evaluan los registros de varios parametros tendientes a objetivar las modificaciones en la capacidad funcional miocardica, en relacion con la clase funcional al comienzo del tratamiento. Comprobamos en los resultados que los pacientes considerados globalmente, aumentaron su capacidad fun cional miocardica en un 87%, disminuyeron su frecuencia cardiaca para una misma carga en un 15.2%, aumentaron la carga maxima tolerada en un 86% y disminuyeron el I.T.M para una misma carga en un 21,2%