The role of primary pharmacological therapy in acromegaly

BACKGROUND AND OBJECTIVES: Primary pharmacological therapy may be the only viable treatment option for many patients with acromegaly, especially those presenting with advanced disease with large inoperable tumors. Long-acting somatostatin analogs are currently the first-line treatment of choice in this setting, where they provide biochemical control and reduce tumor size in a significant proportion of patients. We herein present a brief overview of the role of primary pharmacological therapy in the treatment of acromegaly within the context of Latin America and support this with a representative case study. CASE DESCRIPTION: A 20 year old male presented with clinical and biochemical evidence of acromegaly. The glucose-suppressed growth hormone (GH) was 5.3 μg/L, his insulin-like growth factor-1(IGF-1) was 3.5 times the ULN and serum prolactin greater than 4,000 μg/L. Pituitary MRI revealed a large and invasive mass, extending superiorly into the optic chiasm and laterally into the left cavernous sinus. He was treated with a combination of octreotide and cabergoline with remarkable clinical improvement, normalization of GH and IGF-1 values and striking shrinkage of the adenoma. CONCLUSION: This case illustrates how effective the pharmacological therapy of acromegaly can be and yet at the same time, raises several important issues such as the need for life-long treatment with costly medications such as the somatostatin analogs. Access to these agents may be limited in regions where resources are restricted and clinicians face challenges in order to make the most efficient use of available options

First description of feline inflammatory mammary carcinoma: clinicopathological and immunohistochemical characteristics of three cases

INTRODUCTION: Inflammatory breast cancer is a special type of locally advanced mammary cancer that is associated with particularly aggressive behaviour and poor prognosis. The dog was considered the only natural model in which to study the disease because, until now, it was the only species known to present with inflammatory mammary carcinoma (IMC) spontaneously. In the present study we describe clinicopathological and immunohistochemical findings of three cats with IMC, in order to evaluate its possible value as an animal model. METHODS: We prospectively studied three female cats with clinical symptoms of IMC, identified over a period of 3 years. Clinicopathological and immunohistochemical evaluations of Ki-67, and oestrogen, progesterone and androgen receptors were performed. RESULTS: All three animals presented with secondary IMC (postsurgical) characterized by a rapid onset of erythema, severe oedema, extreme local pain and firmness, absence of subjacent mammary nodules, and involvement of extremities. Rejection of the surgical suture was observed in two of the cats. Histologically, highly malignant papillary mammary carcinomas, dermal tumour embolization of superficial lymphatic vessels, and severe secondary inflammation were observed. The animals were put to sleep at 10, 15 and 45 days after diagnosis. Metastases were detected in regional lymph nodes and lungs in the two animals that were necropsied. All tumours had a high Ki-67 proliferation index and were positive for oestrogen, progesterone and androgen receptors. CONCLUSION: Our findings in feline IMC (very low prevalence, only secondary IMC, frequent association of inflammatory reaction with surgical suture rejection, steroid receptor positivity) indicate that feline IMC could be useful as an animal model of human inflammatory breast cancer, although the data should be considered with caution

Management of acromegaly in Latin America: expert panel recommendations

Although there are international guidelines orienting physicians on how to manage patients with acromegaly, such guidelines should be adapted for use in distinct regions of the world. A panel of neuroendocrinologists convened in Mexico City in August of 2007 to discuss specific considerations in Latin America. Of major discussion was the laboratory evaluation of acromegaly, which requires the use of appropriate tests and the adoption of local institutional standards. As a general rule to ensure diagnosis, the patient’s GH level during an oral glucose tolerance test and IGF-1 level should be evaluated. Furthermore, to guide treatment decisions, both GH and IGF-1 assessments are required. The treatment of patients with acromegaly in Latin America is influenced by local issues of cost, availability and expertise of pituitary neurosurgeons, which should dictate therapeutic choices. Such treatment has undergone profound changes because of the introduction of effective medical interventions that may be used after surgical debulking or as first-line medical therapy in selected cases. Surgical resection remains the mainstay of therapy for small pituitary adenomas (microadenomas), potentially resectable macroadenomas and invasive adenomas causing visual defects. Radiotherapy may be indicated in selected cases when no disease control is achieved despite optimal surgical debulking and medical therapy, when there is no access to somatostatin analogues, or when local issues of cost preclude other therapies. Since not all the diagnostic tools and treatment options are available in all Latin American countries, physicians need to adapt their clinical management decisions to the available local resources and therapeutic options

Territorio, Recursos Naturales y Ambiente: hacia una historia comparada : Estudio a través de Argentina, México, Costa Rica, Haití, Paraguay, Uruguay y Venezuela

Libro -- Universidad de Costa Rica. Centro de Investigaciones Geofísicas, 2014Nuestro objetivo principal ha sido establecer parámetros para una estudio comparativo de los recursos naturales y el ambiente, en función del territorio, en América Latina, a partir del estudio de casos particulares. Más concetamente, nos propusimos determinar: 1. las formas de conocimiento sobre el territorio, sus recursos naturales y su ambiente; y caracterizar los estilos científicos prevalecientes en cada etapa y región; 2. el papel de las instituciones y programas científicos en la formación de una tradición ambientalista local y las modalidades de desarrollo de estas temáticas a lo largo de la historia latinaomericana; 3. los parámetros de comprensión de las temáticas territoriales y ambientales desde las normativas y las políticas públicas de los estados; 4. los objetivos, áreas de investigación,campos de interés y resultados, según surgen de las publicaciones, productos y documentación científicos.Universidad de Costa Rica. Instituto Panamericano de Geografía e Historia (IPGH) Proyecto GEO 01.2013 – HIST. 02.2013.UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Básicas::Centro de Investigaciones Geofísicas (CIGEFI

Validation of the spanish version of the multiple sclerosis international quality of life (musiqol) questionnaire

<p>Abstract</p> <p>Background</p> <p>The Multiple Sclerosis International Quality Of Life (MusiQoL) questionnaire, a 31-item, multidimensional, self-administrated questionnaire that is available in 14 languages including Spanish, has been validated using a large international sample. We investigated the validity and reliability of the Spanish version of MusiQoL in Spain.</p> <p>Methods</p> <p>Consecutive patients with different types and severities of multiple sclerosis (MS) were recruited from 22 centres across Spain. All patients completed the MusiQoL questionnaire, the 36-Item Short Form (SF-36) health survey, and a symptoms checklist at baseline and 21 days later. External validity, internal consistency, reliability and reproducibility were tested.</p> <p>Results</p> <p>A total of 224 Spanish patients were evaluated. Dimensions of MusiQoL generally demonstrated a high internal consistency (Cronbach's alpha: 0.70-0.92 for all but two MusiQoL domain scores). External validity testing revealed that the MusiQoL index score correlated significantly with all SF-36 dimension scores (Pearson's correlation: 0.46-0.76), reproducibility was satisfactory (intraclass correlation coefficient: 0.60-0.91), acceptability was high, and the time taken to complete the 31-item questionnaire was reasonable (mean [standard deviation]: 9.8 [11.8] minutes).</p> <p>Conclusions</p> <p>The Spanish version of the MusiQoL questionnaire appears to be a valid and reliable instrument for measuring quality of life in patients with MS in Spain and constitutes a useful instrument to measure health-related quality of life in the clinical setting.</p

Assessment of range of motion and muscular shortening in female flamenco dancers. Valoración de las amplitudes articulares y acortamientos musculares en bailaoras de flamenco.

The purpose of the study was to assess flexibility and range of motion in flamenco dancers of Cádiz, Sevilla and Jaén (Spain) through a tests battery. The study population comprised 37 healthy flamenco dancers (25 ± 7,2 years, 1,6 ± 0,5 m y 56 ± 7,6 Kg). They performed a range of flexibility and motion tests (i.e. Kendall test, Nachlas test). Results has shown that there is muscle shortening in most of the tests that flamenco dancers has passed. We conclude that there are not many articles on physiological and fitness aspects of dance and we think that it is necessary a specific physical dancer training, to prevent injuries and to extend dancers life.El objetivo de este estudio es la valoración de la flexibilidad muscular y la amplitud articular en bailaoras de flamenco de la provincia de Cádiz, Sevilla y Jaén, a través de una batería de tests. En el estudio participaron 37 bailaoras de danza flamenca de 25 ± 7,2 años, con una altura con valores de 1,6 ± 0,5 m y 56 ± 7,6 Kg de peso. La batería está compuesta de las siguientes pruebas que se realizarán a través del protocolo de actuación especificado: Prueba de rotadores internos y aductores del hombro, Prueba de Kendall, Prueba de Diagonal Posterior, Prueba de Nachlas, Prueba de Ridge, Prueba de Flexión de cadera con rodilla en extensión, Prueba de Thomas y Prueba de Elongación de los flexores plantares. Los resultados demuestran que existen acortamientos en diferente musculatura implicada como los rotadores internos y aductores del hombro, dorsal ancho, pectoral mayor, redondo mayor, cintura escapular, psoas-ilíaco, recto anterior del muslo y sóleo. Concluir con la escasa existencia de artículos relacionados con la valoración de la condición física de bailarines de cualquier modalidad de danza y con la necesaria aplicación de un entrenamiento planificado complementario con una propuesta de ejercicios de mejora de la musculatura implicada y, así, poder prevenir futuras lesiones haciendo que la vida del profesional de la danza sea más duradera y plena

Valoración de las amplitudes articulares y acortamientos musculares en bailaoras de flamenco.

El objetivo de este estudio es la valoración de la flexibilidad muscular y la amplitud articular en bailaoras de flamenco de la provincia de Cádiz, Sevilla y Jaén, a través de una batería de tests. En el estudio participaron 37 bailaoras de danza flamenca de 25 ± 7,2 años, con una altura con valores de 1,6 ± 0,5 m y 56 ± 7,6 Kg de peso. La batería está compuesta de las siguientes pruebas que se realizarán a través del protocolo de actuación especificado: Prueba de rotadores internos y aductores del hombro, Prueba de Kendall, Prueba de Diagonal Posterior, Prueba de Nachlas, Prueba de Ridge, Prueba de Flexión de cadera con rodilla en extensión, Prueba de Thomas y Prueba de Elongación de los flexores plantares. Los resultados demuestran que existen acortamientos en diferente musculatura implicada como los rotadores internos y aductores del hombro, dorsal ancho, pectoral mayor, redondo mayor, cintura escapular, psoas-ilíaco, recto anterior del muslo y sóleo. Concluir con la escasa existencia de artículos relacionados con la valoración de la condición física de bailarines de cualquier modalidad de danza y con la necesaria aplicación de un entrenamiento planificado complementario con una propuesta de ejercicios de mejora de la musculatura implicada y, así, poder prevenir futuras lesiones haciendo que la vida del profesional de la danza sea más duradera y plena

Estudio cinemático de una bailaora de flamenco.

El objetivo de este estudio fue determinar el perfil biomecánico del bailaor/a de flamenco para el análisis de la técnica de danza. De esta manera se consigue una mayor optimización del rendimiento y preservar la integridad física del bailaor/a, al igual que sucede con los deportistas. Se realizó un estudio de un caso, siendo el sujeto experimental, una bailaora de flamenco de la ciudad de Cádiz, participando en el análisis cinemático mediante video. Se procedió a la filmación de una secuencia de baile flamenco la cual comprende gestos técnicos tales como braceo, marcaje de pies con y sin desplazamiento, vuelta de tacón en dehors, zapateado, vuelta normal y cierre. Se llevaron a cabo la creación de un modelo de “mono” alámbrico, la sincronización de las imágenes, la digitalización y renderización de las mismas. Destaca entre los resultados obtenidos la posibilidad de deducir el número de zapateados realizados con cada pie (41 derecho y 42 izquierdo), y que, debido a la altura del tacón derecho e izquierdo durante la fase de zapateado, se observa que un ángulo de flexión de rodillas excesiva puede producir sobrecarga en la articulación y desencadenar lesiones y desequilibrios musculares entre otros. Además, se puede verificar si los pies se mantienen paralelos durante el baile, que velocidad del zapateado era superior en el pie derecho con respecto al izquierdo, etc. Con dicho análisis se pueden obtener datos de gran relevancia para reflexionar acerca de la técnica empleada por el bailaor/a, de manera que se tomen medidas de corrección y mejora

Deletion of the Bcnrps1 Gene Increases the Pathogenicity of Botrytis cinerea and Reduces Its Tolerance to the Exogenous Toxic Substances Spermidine and Pyrimethanil

During the infection of grapevine (Vitis vinifera) by the fungus Botrytis cinerea, the concentration of polyamines, which are toxic substances for the phytopathogen, increases in the grape. Nine NRPS genes have been identified in the genome of B. cinerea, yet the function of five of them remains unknown. For this reason, we have studied the expression of the 9 NRPS genes by RT-qPCR in a medium supplemented with sublethal concentrations of three polyamines (1,3-diaminopropane (1,3-DAP), spermidine (SPD), and spermine (SPM)). Our results show that the presence of polyamines in the culture medium triggered the overexpression of the Bcnrps1 gene in the pathogen. Deleting Bcnrps1 did not affect mycelial growth or adaptation to osmotic stress, and we show that its expression is not essential for the cycle of infection of the B. cinerea. However, mutating the Bcnrps1 gene resulted in overexpression of the Bcnrps6 gene, which encodes for the excretion of siderophores of the coprogen family. Moreover, gene deletion has reduced the tolerance of B. cinerea B05.10 to toxic substances such as the polyamine SPD and the fungicide pyrimethanil, and its virulence has increased. Our findings provide new insights into the function of the Bcnrps1 gene and its involvement in the tolerance of B. cinerea against exogenous toxic compounds.This work was supported by the Spanish Government and European Union, MINECOFEDER, RTI2018-097356-B-C22 and MINECO, AGL2015-65684-C2-2-R