Preservation of swallowing in resected oral cavity squamous cell carcinoma: examining radiation volume effects (PRESERVE): study protocol for a randomized phase II trial

Background: Patients with resected oral cavity squamous cell carcinoma (OCSCC) are often treated with adjuvant radiation (RT) ± concomitant chemotherapy based on pathological findings. Standard RT volumes include all surgically dissected areas, including the tumour bed and dissected neck. RT has significant acute and long-term toxicities including odynophagia, dysphagia, dermatitis and fibrosis. The goal of this study is to assess the rate of regional failure with omission of radiation to the surgically dissected pathologically node negative (pN0) hemi-neck(s) compared to historical control, and to compare oncologic outcomes, toxicity, and quality of life (QoL) profiles between standard RT volumes and omission of RT to the pN0 neck. Methods: This is a multicentre phase II study randomizing 90 patients with T1-4 N0-2 OCSCC with at least one pN0 hemi-neck in a 1:2 ratio between standard RT volumes and omission of RT to the pN0 hemi-neck(s). Patients will be stratified based on overall nodal status (nodal involvement vs. no nodal involvement) and use of concurrent chemotherapy. The primary endpoint is regional failure in the pN0 hemi-neck(s); we hypothesize that a 2-year regional recurrence of 20% or less will be achieved. Secondary endpoints include overall and progression-free survival, local recurrence, rate of salvage therapy, toxicity and QoL. Discussion: This study will provide an assessment of omission of RT to the dissected pN0 hemi-neck(s) on oncologic outcomes, QoL and toxicity. Results will inform the design of future definitive phase III trials. Trial registration: Clinicaltrials.gov identifier: NCT03997643 . Date of registration: June 25, 2019, Current version: 2.0 on July 11 2020. Keywords: De-escalation; Head and neck cancer; Oral cavity; Quality of life; Radiotherapy; Randomized controlled trial; Recurrence; Survival

REFLEXIONES DEL CUIDADO ENFERMERO EN TIEMPOS DE COVID-19

La Pandemia del Covid 19 originada en Wuhan, provincia de Hubei, China en diciembre de 2019, ha impuesto al mundo cambios trascendentales en las dimensiones humanas, generando una realidad de enfermedad y muerte en la población mundial. “El Covid 19 forma parte de un grupo de coronavirus (CoV), que produce desde una congestión nasal hasta enfermedades muy graves, de acuerdo a la OMS, por lo que fue declarada una emergencia de salud pública con caracterización de pandemia. En Colombia las cifras de enfermos y muertos han ido aumentando, desde “marzo 6 cuando se confirma el primer caso en una mujer de 19 años”. Los profesionales de enfermería llamados a atender en primera línea a las personas que presentan COVID 19, es personal preparado de manera científica, con una visión integral que los hace líderes para afrontar todas las situaciones con la ética, desde diferentes puntos de vista: administrativo, investigativo, docente, asistencial en el ámbito clínico y comunitario. Con el conocimiento pertinente asumen su responsabilidad de cuidado en la situación real que vive la población.  En consecuencia, se evidencia por medio de la reflexión participativa (25 enfermeras/os) que la mayor emoción presentada por los profesionales de enfermería es el miedo al contagio personal y familiar, la tristeza por el rechazo social y el cambio en los estilos de la vida personal, familiar y laboral desde el momento que se anuncia la cuarentena.   Abstract The Covid 19 Pandemic originated in Wuhan, Hubei province, China in December 2019, has imposed on the world transcendental changes in human dimensions, generating a reality of disease and death in the world population. "Covid 19 is part of a group of coronaviruses (CoV), which produces from a nasal congestion to very serious diseases, according to the WHO, which is why it was declared a public health emergency with a pandemic characterization. In Colombia the numbers of sick and dead have been increasing, since "March 6 when the first case is confirmed in a 19-year-old woman." The nursing professionals called to attend the front line against the COVID-19 are highly qualified personnel, with a comprehensive scientific vision which allows them to face all situations ethically, from different points of view: administrative, investigative, educational, healthcare in both clinical and community settings. With the pertinent knowledge, they assume their responsibility in the real situation of the population´s lives. Consequently, when asked to reflect on the whole experience (sample of 25 nurses), being contaminated has been cited as the main fear of those on the front line, as well as the feeling of sadness due to social rejection and compulsory changes in personal, family, and work-life balance since the quarantine has been announced

Cáncer de colon: epidemiología, clínica, diagnóstico y tratamiento 1990–1997

Tipo de estudio: se realizó un estudio estadístico retrospectivo en el Hospital de la Sociedad Oncológica de Lucha Contra el Cáncer (SOLCA) de la ciudad de Guayaquil, durante el período comprendido de Enero de 1990 a Diciembre de 1997, sobre cáncer de colon.Objetivo: nuestro objetivo fue observar datos epidemiológicos, síntomas, métodos diagnósticos, localización del tumor, tratamiento y remisión de la enfermedad.Resultados: se analizaron las historias clínicas de 161 pacientes y se observó que la edad media de presentación fue 54 años. Según el sexo, hubo una relación hombre/mujer de 1.2/1. Los síntomas que predominaron fueron dolor abdominal y pérdida de peso. El método diagnóstico más usados fue la colonoscopía (45.96%). De los 161 pacientes, 128 (79.5%) fueron quirúrgicos, de los cuales 77 (60%) recibieron terapia adyuvante.Conclusiones: los casos de cáncer de colon han ido aumentando en los últimos años, siendo el rango donde hubo más pacientes entre 50 y 59 años, lo que concuerda con la literatura mundial que se presenta en mayores de 50 años. Es importante tener presente que este tipo de cáncer es previsible y curable cuando se detecta oportunamente

Estandarización de una técnica para la certificación de jardines clonales de plantas de cacao(Theobroma cacao) usando marcadores moleculares rapd

Se estandarizó una técnica para certificación de jardines clonales de plantas de cacao utilizando marcadores moleculares RAPD, se analizaron las variedades CCN-51, TSH-565, ICS-60, ICS-95, IMC- 67 y se compararon los clones existentes en el jardín clonal con sus lotes de injertación; para ello se utilizaron 8 primers capaces de generar mayor número de polimorfismos distinguidos mediante la electroforesis de productos de PCR. Los resultados obtenidos muestran que las variedades IMC-67, CCN-51, ICS-95 presentan mayores índices de similitud que las variedades ICS-60, TSH-565. Se encontraron que los índices de similitud están dentro del rango de confiabilidad reportado de los marcadores moleculares RAPD, permitiendo la certificación de estos lotes de injertación pertenecientes al jardín clonal del SENA sede Aguas Calientes municipio el Playón Santander, Colombia. Cabe destacar que la técnica RAPDs permite discriminar clones de aquellos individuos que no lo son

CT-guided versus MR-guided radiotherapy: Impact on gastrointestinal sparing in adrenal stereotactic body radiotherapy

Background and purpose: To quantify the indication for adaptive, gated breath-hold (BH) MR-guided radiotherapy (MRgRTBH) versus BH or free-breathing (FB) CT-based image-guided radiotherapy (CTIGRT) for the ablative treatment of adrenal malignancies. Materials and methods: Twenty adrenal patients underwent adaptive IMRT MRgRTBH to a median dose of 50 Gy/5 fractions. Each patient was replanned for VMAT CT-IGRTBH and CT-IGRTFB on a c-arm linac. Only CT-IGRTFB used an ITV, summed from GTVs of all phases of the 4DCT respiratory evaluation. All used the same 5 mm GTV/ITV to PTV expansion. Metrics evaluated included: target volume and coverage, conformality, mean ipsilateral kidney and 0.5 cc gastrointestinal organ-at-risk (OAR) doses (D0.5cc). Adaptive dose for MRgRTBH and predicted dose (i.e., initial plan re-calculated on anatomy of the day) was performed for CT-IGRTBH and MRgRTBH to assess frequency of OAR violations and coverage reductions for each fraction. Results: The more common VMAT CT-IGRTFB, with its significantly larger target volumes, proved inferior to MRgRTBH in mean PTV and ITV/GTV coverage, as well as small bowel D0.5cc. Conversely, VMAT CTIGRTBH delivered a dosimetrically superior initial plan in terms of statistically significant (p 0.02) improvements in target coverage, conformality and D0.5cc to the large bowel, duodenum and mean ipsilateral kidney compared to IMRT MRgRTBH. However, non-adaptive CT-IGRTBH had a 71.8% frequency of predicted indications for adaptation and was 2.8 times more likely to experience a coverage reduction in PTV D95% than predicted for MRgRTBH. Conclusion: Breath-hold VMAT radiotherapy provides superior target coverage and conformality over MRgRTBH, but the ability of MRgRTBH to safely provide ablative doses to adrenal lesions near mobile luminal OAR through adaptation and direct, real-time motion tracking is unmatched

Bacilos Gram negativos entéricos y no fermentadores de la glucosa en pacientes con enfermedad periimplante

Introduction. Implants can be colonized by microorganisms from oral biofilms and may affect peri-implant tissues health. Among these bacteria, pathogens typically associated with periodontitis can be found, such as Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, as well as Gram negative enteric bacilli not typically associated with periodontal diseases.Objective. Superinfecting bacteria were characterized from peri-implant lesions in patients with history of periodontitis.Materials and methods. Sixty-eight implants were studied in 55 patients; the average patient age was 56 years. Forty-nine implants had peri-implant lesions and 19 were considered stable. Subgingival samples were obtained in affected and stable implants. The samples were streaked on Mac-Conkey agar and incubated at 37°C for 24 hours. The colonies were identified with the kit-BD BBL Crystal E/NF®.Results. Superinfecting organisms were detected in 20 patients--they were seen more frequently at diseased implants (n=15) than at healthy implants (n=5). The prevalence of superinfecting bacteria on the selected implants was 33.8% (n=23/68). These bacteria were more prevalent among affected implants (n=17 or 25%) than those with stable implants n=6 (8.8%). Klebsiella pneumoniae was the most frequent Gram negative rod detected (n=12).Conclusions. One-third of the implants had superinfecting organisms. Implants with a peri-implant lesion had a higher frequency of superinfecting bacteria. Klebsiella pneumoniae was the most common superinfecting organism isolated. A multiple infection caused by superinfecting bacteria was present only at diseased implants. These microbial agents potentially affect implant stability.Introducción. Los implantes pueden ser colonizados por microorganismos de la biopelícula oral y así afectarse su salud. Entre los patógenos encontrados están los típicamente relacionados con periodontitis, como Aggregatibacter actinomycetemcomitans y Porphyromonas gingivalis, así como bacilos Gram negativos entéricos, los cuales no son clásicos de la enfermedad periodontal.Objetivo. Determinar el perfil de las bacterias sobreinfecciosas en lesiones periimplante (mucositis o periimplantitis), en pacientes con historia de periodontitis.Materiales y métodos. Se estudiaron 68 implantes en 55 pacientes; 49 implantes tuvieron lesión periimplante19 se consideraron estables. Se obtuvieron muestras subgingivales de implantes afectados y estables; éstas fueron sembradas en Agar MacConkey e incubadas a 37 °C por 24 horas. Las colonias aisladas fueron identificadas con el estuche BD BBL-Cristal E/NF®.Resultados. En 20 de los pacientes estudiados se detectaron bacterias sobreinfecciosas, pero, con mayor frecuencia en pacientes con implantes afectados (n=15) que en portadores de implantes sanos (n=5). La prevalencia de bacterias sobreinfecciosas en todos los implantes fue de 33,8 % (n=23/68), y también fue más frecuente su aislamiento en implantes afectados (n=17) (25%), que en estables (n=6) (8,8%). Klebsiella pneumoniae fue el microorganismo que se aisló con mayor frecuencia en todos los implantes (n=12).Conclusiones. Un tercio de los implantes estudiados presentaron organismos sobreinfecciosos. Los implantes con lesiones periimplante presentan una mayor frecuencia de bacterias sobreinfecciosas. K. pneumoniae es la especie sobreinfecciosa más frecuente en los implantes estudiados. Se presentó infección múltiple con dichas bacterias en los implantes afectados. Estos microorganismos pueden afectar la estabilidad de los implantes

Quality of life after high-dose-rate brachytherapy monotherapy for prostate cancer

Purpose There is little information in the literature on health-related quality of life (HRQOL) changes due to high-dose-rate (HDR) brachytherapy monotherapy for prostate cancer. Materials and Methods We conducted a prospective study of HRQOL changes due to HDR brachytherapy monotherapy for low risk or favorable intermediate risk prostate cancer. Sixty-four of 84 (76%) patients who were treated between February 2011 and April 2013 completed 50 questions comprising the Expanded Prostate Cancer Index Composite (EPIC) before treatment and 6 and/or 12 months after treatment. Results Six months after treatment, there was a significant decrease (p<0.05) in EPIC urinary, bowel, and sexual scores, including urinary overall, urinary function, urinary bother, urinary irritative, bowel overall, bowel bother, sexual overall, and sexual bother scores. By one year after treatment, EPIC urinary, bowel, and sexual scores had increased and only the bowel overall and bowel bother scores remained significantly below baseline values. Conclusions HDR brachytherapy monotherapy is well-tolerated in patients with low and favorable intermediate risk prostate cancer. EPIC urinary and sexual domain scores returned to close to baseline 12 months after HDR brachytherapy