42,451 research outputs found

    Control and management of gastrointestinal side effects due to therapy in the oncological patient

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    RESUMEN: El c√°ncer es una de las enfermedades cr√≥nicas con m√°s incidencia actualmente. Muchos de los tratamientos antineopl√°sicos a los que se someten estos pacientes implican unos efectos t√≥xicos que hacen m√°s abrupto el proceso de enfermedad, reduciendo la calidad de vida de las personas que los sufren, implicando en ocasiones el abandono del tratamiento curativo. Durante la enfermedad existen varias manifestaciones y cambios que afectan directamente sobre la alimentaci√≥n y el estado nutricional. Entre las manifestaciones gastrointestinales m√°s frecuentes se encuentran las n√°useas y v√≥mitos, la hipo-anorexia, la mucositis oral, la disgeusia, la diarrea o el estre√Īimiento. Conocer las diferentes estrategias para la prevenci√≥n y el manejo de estos efectos secundarios no deseados ayuda a mejorar el bienestar y el confort de las personas que los sufren, adem√°s de encaminar actuaciones propias del cuidado enfermero. Una buena profilaxis antiem√©tica, terapias de relajaci√≥n para la disminuci√≥n de los niveles de ansiedad, medidas higi√©nico-diet√©ticas durante las ingestas, la nutrici√≥n enteral cuando no se puede garantizar el aporte cal√≥rico, la crioterapia oral o el uso de la miel en la mucositis oral destacan como medidas a adoptarABSTRACT: Cancer is one of the most today‚Äôs prevalent chronic diseases. Many of the antineoplastic treatments which these patients are subjected involve toxic effects that make the disease process more abrupt, reducing the quality of life of the people who suffer them, sometimes involving the abandonment of curative treatment. During the disease there are several manifestations and changes that directly affect the diet and nutritional status. Among the most frequent gastrointestinal manifestations are nausea and vomiting, hypo-anorexia, oral mucositis, dysgeusia, diarrhea or constipation. Knowing the different strategies for the prevention and management of these unwanted side effects helps to improve the well-being and comfort of the people who suffer them, in addition directs actions proper to nursing care. Appropiate anti-emetic prophylaxis, relaxation therapies for the reduction of anxiety levels, hygienic-dietary measures during intakes, enteral nutrition when caloric intake cannot be guaranteed, oral cryotherapy or the use of honey in oral mucositis stand out as measures to be adoptedGrado en Enfermer√≠

    Factors associated with 6-month mortality in patients in home palliative care in Bogot√°

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    Introducci√≥n: El claro envejecimiento de la poblaci√≥n mundial y la incidencia de enfermedades no transmisibles, implican una transformaci√≥n en la demanda de servicios de salud principalmente en Cuidados Paliativos (CP). Existen departamentos de Colombia que a√ļn no tienen servicios de CP, concentr√°ndose la mayor√≠a en la zona central del pa√≠s. En un Programa de Cuidados Paliativos Domiciliarios de baja complejidad (PCPDBC) en Bogot√°, se ha encontrado falta de precisi√≥n en la estimaci√≥n de la supervivencia, lo que no permite una adecuada clasificaci√≥n de los pacientes susceptibles de recibir CP domiciliarios, dificultando la administraci√≥n de un recurso indispensable y escaso. Objetivo: Identificar los factores sociodemogr√°ficos y cl√≠nicos asociados a mortalidad a 6 meses de los pacientes que ingresaron al (PCPDBC) en Bogot√°, desde el 1 de enero del 2018 hasta el 30 de junio del a√Īo 2019. Metodolog√≠a: Estudio observacional de cohorte retrospectiva anal√≠tica, se midi√≥ la funci√≥n de supervivencia calculando el estimador de Kaplan Meier con su respectiva curva e intervalo de confianza del 95%. Adem√°s, por medio del Modelo de Riesgos Proporcionales de COX se evalu√≥ la relaci√≥n entre el conjunto de variables explicativas (sociodemogr√°ficas y cl√≠nicas) y la tasa del evento de estudio (fallecimiento dentro de los 6 meses de ingreso), obteniendo la Raz√≥n de Peligro (RP) como medida de asociaci√≥n. Resultados: El modelo final, con una concordancia de 0.678 y p global de la prueba de proporcionalidad de 0.08, incluye: ingresar al programa a causa de una enfermedad oncol√≥gica (RP= 2.23, IC 95%: 1.47-3.37), con hiporexia/anorexia (RP= 1.60, IC 95%: 1.07-2.39), cat√©ter subcut√°neo (CS) implantado (RP= 2.21, IC 95%: 1.21-4.03), disfagia (RP= 1.92, IC 95%: 1.27-2.91) y √ļlceras por presi√≥n (RP= 1.56, IC 95%: 1.002-2.45). No ingresaron a este modelo variables sociodemogr√°ficas. Conclusiones: La evaluaci√≥n de factores sociodemogr√°ficos y cl√≠nicos asociados a mortalidad en CP, sigue siendo una herramienta invaluable que mejora la calidad de la atenci√≥n en salud, la administraci√≥n de los recursos en CP y la calidad de vida de los pacientes al final de la vida. Un diagn√≥stico principal de tipo oncol√≥gico, la disminuci√≥n del apetito o la p√©rdida de la v√≠a oral, la presencia de disfagia, cat√©ter subcut√°neo o su implantaci√≥n en la primera valoraci√≥n y la existencia de √ļlceras por presi√≥n sobre todo en estadios 3 y 4, son factores cl√≠nicos que pueden estar asociados a mortalidad a 6 meses en CP domiciliarios, su identificaci√≥n desde la primera valoraci√≥n m√©dica permitir√° a los equipos interdisciplinarios (EI) la anticipaci√≥n de las necesidades paliativas de los pacientes y sus familias.Introduction: The clear aging of the global population and the incidence of non-communicable illness implies a transformation in the demand for health services, specifically in palliative care. There are departments in Colombia that don‚Äôt have palliative care services, as the majority are concentrated in the country‚Äôs central zone. In a low complexity Palliative Home Care Program (PHCP) in Bogot√°, a lack of precision has been found in the estimation of survival, wasting part of the resources. Objective: To identify the sociodemographic and clinical factors associated with 6-month mortality in patients admitted to the low-complexity PHCP in Bogot√° from January 1, 2018 to June 30, 2019. Method: Analytical retrospective observational cohort study, the survival function was measured by calculating the Kaplan Meier estimator and curve with 95% confidence interval. COX Proportional Hazards Model was used for the correlation between explanatory variables (sociodemographic and clinical) and the rate of the study event (death within 6 months of admission) through obtaining the Hazard Ratio (HR) as the measure of association. Results: The final model, with a concordance of 0.678 and a global p proportionality test of 0.08, includes: previous diagnosis of oncological disease (HR = 2.23, 95% CI: 1.47-3.37), hyporexia / anorexia (HR = 1.60, 95% CI: 1.07-2.39), implanted subcutaneous catheter (SC) (HR = 2.21, 95% CI: 1.21-4.03), dysphagia (HR = 1.92, 95% CI: 1.27-2.91) and pressure ulcers (HR = 1.56, 95% CI: 1.002-2.45). Sociodemographic variables were not entered into this model. Conclusions: The evaluation of the sociodemographic and clinical features associated with mortality in palliative care continues to be an invaluable tool that improves the quality of health care, quality end of life care and administration of resources. An oncological diagnosis, loss of appetite or loss of the oral intake, dysphagia, subcutaneous catheter and pressure ulcers, especially in stages 3 and 4, are clinical factors that may be associated with 6-month mortality in Palliative Home Care Programs. Their identification will allow interdisciplinary teams to anticipate difficulties and needs faced by patients in palliative care and their families

    Relación de edad y sobrevida tras cirugía con intención curativa por cáncer gástrico en adultos. Instituto del Cáncer SOLCA. Cuenca. 2012-2017

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    Antecedentes: el c√°ncer g√°strico constituye como una de las enfermedades de mayor morbimortalidad a nivel mundial; no obstante, la mortalidad se puede reducir si se diagnostica de manera temprana y se aplica la terap√©utica adecuada. Objetivo: determinar la relaci√≥n entre la edad y la sobrevida tras cirug√≠a con intenci√≥n curativa por c√°ncer g√°strico en pacientes atendidos en el Instituto del c√°ncer SOLCA, Cuenca, en el periodo 2012-2017. Metodolog√≠a: estudio anal√≠tico, retrospectivo, realizado con la base de datos digital y anonimizada del Instituto del C√°ncer SOLCA-Cuenca. Los datos fueron presentados en tablas de frecuencia y porcentajes. Se aplic√≥ Chi-cuadrado (X 2 ), an√°lisis de Kaplan Meier y regresi√≥n de Cox, para relacionar las variables edad y a√Īos de sobrevida, consider√°ndose estad√≠sticamente significativo cuando p<0,05. Resultados: De los 603 pacientes con c√°ncer g√°strico registrado durante el periodo de evaluaci√≥n, el 35,3% fueron intervenidos quir√ļrgicamente, logr√°ndose el seguimiento del 45,1%. Un total de 96 pacientes fueron incluidos, el 70,8% fueron intervenidos quir√ļrgicamente con intenci√≥n curativa. En la muestra predominaba los hombres (52,9%) y el grupo etario de 70 a 79 a√Īos (30,2%). La tasa de sobrevida a los 5 a√Īos fue de 69,1% con un tiempo promedio de supervivencia de 7,24¬Ī0,49 a√Īos. La edad no se relacion√≥ significativamente con la sobrevida de los pacientes (X 2=3,15; p=0,667). Conclusiones: existe una elevada tasa de sobrevida a los 5 a√Īos en los pacientes con c√°ncer g√°strico intervenidos quir√ļrgicamente con intenci√≥n curativa, la cual no asoci√≥ con la edad.Background: gastric cancer is one of the diseases with the highest morbidity and mortality worldwide; however, mortality can be reduced if it is diagnosed early and appropriate therapy is applied. Objective: to determine the relationship between age and survival after surgery with curative intent for gastric cancer in patients treated at the SOLCA Cancer Institute, Cuenca, in the period 2012-2017. Methodology: An analytical, retrospective study was carried out with the digital and anonymized database of the SOLCA-Cuenca Cancer Institute. Data were presented in frequency and percentage tables. Chi-square (X2), Kaplan Meier analysis and Cox regression were applied to relate the variables age and years of survival, being considered statistically significant when p<0.05. Results: Of the 603 patients with gastric cancer registered during the evaluation period, 35.3% underwent surgery, achieving follow-up of only 45.1%. A total of 96 patients were included, 70.8% underwent surgery with curative intentions. The sample was dominated by men (52.9%) and age groups from 70 to 79 years (30.2%). The 5-year survival rate was 69.1% with a median survival time of 7.24¬Ī0.49 years. Age was not significantly related to patient survival (X 2=3.15; p=0.667). Conclusions: there is a high 5-year survival rate in patients with gastric cancer who underwent surgery with curative intent, which was not associated with ageM√©dicoCuenc

    BCG Aortitis, a Rare Complication of BCG Therapy

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    Introduction: Intravesical Bacillus Calmette-Guerin (BCG) is an effective treatment for in situ bladder carcinomas; however, extravesical BCG infection may occur in remote organs in patients with underlying primary immunodeficiency and is a potentially serious complication in 3‚Äď5% of cases. It includes granulomatous pneumonia, hepatitis as well as specific dermatological, ophthalmic, and haematopoietic manifestations. Diagnosis is difficult and often based on high clinical suspicion as in many cases Mycobacterium bovis is not isolated. This report presents a rare case of BCGaortitis treated in a tertiary care centre. Report: A 74 year old man, with a history of bladder cancer treated with BCG therapy over a year ago, presented with malaise, abdominal pain, anorexia, and significant weight loss for several months associated with acute on chronic renal failure and a tender aneurysm. He was diagnosed with hepatic BCGitis and pararenal BCGaortitis. He was considered too high risk for open surgery after a multidisciplinary team meeting and was treated with a four vessel physician modified endograft (PMEG) and antituberculous therapy. At seven month follow up, he was clinically well and control computed tomography showed a patent endograft with complete exclusion of the aortic aneurysm. Discussion: Infectious BCG complications after intravesical BCG administration for in situ bladder carcinomas can lead to severe early and late complications. In the present case, the patient presented with both liver and aortic BCG infection. The lack of positive microbiological data should not discourage clinicians from considering BCG infection even if several months have passed since the last BCG instillation

    Osteosarcoma fusocelular atípica en diáfisis y epífisis proximal de la tibia: reporte de caso clínico

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    El osteosarcoma es el tumor maligno primario m√°s frecuente a nivel del sistema hueso, que se caracteriza por la formaci√≥n de osteoide proveniente de c√©lulas tumorales. Su principal localizaci√≥n es la met√°fisis de los huesos largos; sin embargo, la parte proximal de la tibia es tambi√©n una de las m√°s afectadas con un 50% o 60% de los casos. El objetivo de este trabajo es exponer un estudio de caso de un paciente masculino diagnosticado con osteosarcoma fusocelular localizado en di√°fisis y ep√≠fisis proximal de la tibia que present√≥ signos y s√≠ntomas tres meses previos a la valoraci√≥n, secundario a un traumatismo localizado en su miembro inferior. Desde el punto de vista imagenol√≥gico se observ√≥ imagen sugestiva de lesi√≥n tumoral metafisiaria que se extendi√≥ a la ep√≠fisis y al canal medular. Con el estudio histopatol√≥gico e imagenol√≥gico se concluy√≥ que el paciente present√≥ un osteosarcoma fusocelular grado II en la tibia proximal derecha, que amerit√≥ manejo quir√ļrgico y quimioterapia con buena respuesta cl√≠nica. Se evidencia la importancia de los avances cient√≠ficos y biom√©dico, que han permitido un mejor manejo de estas enfermedades y un tratamiento que genera mejores condiciones de rehabilitaci√≥n posquir√ļrgica y de expectativa de vida

    Suicidal Behavior in Eating Disorders

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    Many studies have shown that people with eating disorders have higher rates of suicidal ideation, suicide attempts, and completed suicide than the general population. One of the diseases with the highest suicide rate among psychiatric disorders is anorexia nervosa. Some hypotheses have been proposed to explain possible causes of increased suicidal behavior in eating disorders. Some conditions common to eating disorders and suicidal behavior, such as dissatisfaction with the body and interoceptive deficits, have been cited. It has been conclusively shown that psychiatric comorbidity, especially the co-diagnosis of depression, increases the risk of suicide in patients with eating disorders. However, increased suicidal behavior in eating disorders cannot be explained by comorbidity alone. The interpersonal psychological theory of suicide (IPTS), developed by Joiner, aims to understand why people commit suicide and to explain the differences in individual suicidal behavior. Some researchers have thought that the increased suicidal behavior of people with eating disorders, especially anorexia nervosa patients, is expected from the perspective of IPTS. The compensatory behaviors of patients with eating disorders, such as vomiting or chronic restrictive food intake, are painful and challenging actions for the body. It can be considered that repeated encounters with painful and challenging experiences form a habit in the individual and reduce pain avoidance. When viewed from the IPTS perspective, decreased pain avoidance may explain the increased suicide attempts and completed suicides of individuals. Clinicians working with eating disorder patients must conduct regular and comprehensive assessments of suicide. Comorbidities such as major depression, anxiety disorder, and substance-use disorder should not be overlooked in patients with eating disorders and should be taken seriously

    Nutritional risk and a high NRS2002 score are closely related to disease progression and poor prognosis in patients with COVID-19

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    BackgroundOrganism can lead to excessive nutrient consumption in the infected state and increase nutritional risk, which is detrimental to the control of the infection and can further aggravate the disease.ObjectivesTo investigate the impact of nutritional risk and the NRS2002 score on disease progression and prognosis in patients with COVID-19.MethodsThis was a retrospective cohort study including 1,228 COVID-19 patients, who were divided into a with-nutritional risk group (patients with NRS2002 score ‚Č•‚ÄČ3) and a without-nutritional risk group (patients with NRS2002 score &lt;‚ÄČ3) according to the NRS2002 score at admission. The differences in clinical and outcome data between the two groups were compared, and the relationship between the NRS2002 score and the disease progression and prognosis of COVID-19 patients was assessed.ResultsOf 1,228 COVID-19 patients, including 44 critical illness patients and 1,184 non-critical illness patients, the rate of harboring nutritional risk was 7.90%. Compared with those in the without-nutritional risk group, patients in the with-nutritional risk group had a significantly longer coronavirus negative conversion time, significantly lower serum albumin (ALB), total serum protein (TP) and hemoglobin (HGB) at admission, discharge or 2 weeks, a significantly greater proportion with 3 or more comorbidities, and a significantly higher rate of critical illness and mortality (all p &lt; 0.001). Multiple regression analysis showed that nutritional risk, NRS2002 score and ALB at admission were risk factors for disease severity. In addition, nutritional risk, NRS2002 score and TP at admission were risk factors for prognosis. The NRS2002 score showed the best utility for predicting critical illness and death in COVID-19 patients.ConclusionNutritional risk and a high NRS2002 score are closely related to disease progression and poor prognosis in COVID-19 patients. For patients with NRS2002 score &gt; 0.5, early intervention of malnutrition is needed to reduce the occurrence of critical disease. Additionally, for patients with NRS2002 score &gt; 5.5, continuous nutritional support therapy is needs to reduce mortality and improve prognosis.Clinical Trial registration: [https://www.chictr.org.cn/historyversionpub.aspx?regno=ChiCTR2000034563], identifier [Chinese Clinical Trial Register ChiCTR2000034563]

    Impact of acute consumption of beverages containing plant-based or alternative sweetener blends on postprandial appetite, food intake, metabolism, and gastro-intestinal symptoms: Results of the SWEET beverages trial

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    Project SWEET examined the barriers and facilitators to the use of non-nutritive sweeteners and sweetness enhancers (hereafter ‚ÄúS&SE‚ÄĚ) alongside potential risks/benefits for health and sustainability. The Beverages trial was a double-blind multi-centre, randomised crossover trial within SWEET evaluating the acute impact of three S&SE blends (plant-based and alternatives) vs. a sucrose control on glycaemic response, food intake, appetite sensations and safety after a carbohydrate-rich breakfast meal. The blends were: mogroside V and stevia RebM; stevia RebA and thaumatin; and sucralose and acesulfame-potassium (ace-K). At each 4 h visit, 60 healthy volunteers (53% male; all with overweight/obesity) consumed a 330 mL beverage with either an S&SE blend (0 kJ) or 8% sucrose (26 g, 442 kJ), shortly followed by a standardised breakfast (‚ąľ2600 or 1800 kJ with 77 or 51 g carbohydrates, depending on sex). All blends reduced the 2-h incremental area-under-the-curve (iAUC) for blood insulin (p 0.05 for all). Compared with sucrose, there was a 3% increase in LDL-cholesterol after stevia RebA-thaumatin (p < 0.001 in adjusted models); and a 2% decrease in HDL-cholesterol after sucralose-ace-K (p < 0.01). There was an impact of blend on fullness and desire to eat ratings (both p < 0.05) and sucralose-acesulfame K induced higher prospective intake vs sucrose (p < 0.001 in adjusted models), but changes were of a small magnitude and did not translate into energy intake differences over the next 24 h. Gastro-intestinal symptoms for all beverages were mostly mild. In general, responses to a carbohydrate-rich meal following consumption of S&SE blends with stevia or sucralose were similar to sucrose

    Management of valvular heart disease in patients with cancer: Multidisciplinary team, cancer-therapy related cardiotoxicity, diagnosis, transcatheter intervention, and cardiac surgery. Expert opinion of the Association on Valvular Heart Disease, Association of Cardiovascular Interventions, and Working Group on Cardiac Surgery of the Polish Cardiac Society

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    The Association on Valvular Heart Disease, Association of Cardiovascular Interventions, and the Working Group on CardiacSurgery of the Polish Cardiac Society have released a position statement on risk factors, diagnosis, and management of patients with cancer and valvular heart disease (VHD). VHD can occur in patients with cancer in several ways, for example, it can exist or be diagnosed before cancer treatment, after cancer treatment, be an incidental finding during imaging tests, endocarditis related to immunosuppression, prolonged intravenous catheter use, or combination treatment, and nonbacterial thrombotic endocarditis. It is recommended to employ close cardiac surveillance for patients at high risk of complications during and after cancer treatment and for cancer treatments that may be cardiotoxic to be discussed by a multidisciplinary team. Patients with cancer and pre-existing severe VHD should be managed according to the 2021 European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS) guidelines for VHD management, taking into consideration cancer prognosis and patient preferences
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