Criterio poblacional y de expertos sobre el cáncer de esófago y cardias avanzado

Introducción: El paciente con un cáncer avanzado del esófago debe fallecer antes del año, estableciéndose el problema de la alimentación, cómo hacerla, fácil mediante estomas abdominales, u otras fórmulas establece un conflicto biosicosocial. La búsqueda de una respuesta de representaciones es nuestra principal motivación.Objetivo: Determinar los criterios de expertos, pacientes enfermos y personas sanas que no estén familiarizada con el cáncer de esófago, sobre la discusión ética de la alimentación de pacientes con cáncer de esófago y cardias avanzado.Material y Métodos: Se evalúan grupos representativos que incluyen consultas a pacientes, familiares y grupo de expertos por medio de encuestas. Se respetaron los parámetros éticos en el procesamiento de la información recopilada.Resultados: Existe un criterio más flexible del personal médico por mayor conocimiento de la enfermedad, con insistencia a una solución ética a pesar de conocer que los esfuerzos son para un período corto de la vida del enfermo. Los pacientes con esta afección prefieren mantener la capacidad de comer a pesar de los riesgos que puede implicar. Conclusiones: Comer no es solo una necesidad para la alimentación biológica sino una necesidad sicológica y social, siendo la búsqueda de métodos para restablecer esta función en el cáncer de esófago es una prioridad, pudiendo las prótesis esofágicas solventar este dilema ético

Composición botánica y valor nutritivo de la dieta consumida por bovinos en un área invadida por pasto rosado [Melinis repens (willd.) Zizka]

The objective was to evaluate the botanical composition and nutritional value in the diet of bovine cattle in areas invaded by natal grass [Melinis repens (Willd.) Zizka]. The research was conducted at the Salinas Ranch, in the municipality of Satevó, Chihuahua, in a brush grassland. Botanical composition of the area was determined by the line-point intercept method. Sampling was conducted from August 2013 to February 2014. The botanical composition of the diet (microhistological technique) and the nutritional value were determined using two esophageal-fistulated Hereford/Angus heifers (350 ± 5 kg). The data were subjected to a variance analysis, and the chemical composition of the diet was fitted using the PROC MIXED procedure of SAS to a mixed model. The average available forage during the four phenological stages was 1,279 kg DM ha-1, with a presence of 87.5 % natal grass (1,119.13 kg DM ha-1). The highest preference indexes were for Aristida divaricata (8.43) and Croton pottsii (12.95) during the growing stage; whereas the least preferred species was Melinis repens (0.33 to 0.41). The highest crude protein content was observed during the growing (13.23 %) and flowering stages (10.71 %). During this study the best quality of the diet was determined during the growing and flowering stages and was mainly composed of Melinis repens during four stages.Se evaluó la composición botánica y el valor nutricional de la dieta de ganado bovino en áreas invadidas por pasto rosado [Melinis repens (Willd.) Zizka]. La investigación se realizó en el Rancho Salinas, municipio de Satevó, Chihuahua, en un pastizal amacollado arbosufrutescente. La composición botánica del área se determinó por el método de línea de puntos. Los muestreos se realizaron de agosto de 2013 a febrero de 2014 y se utilizaron dos vaquillas fistuladas del esófago de la cruza Hereford-Angus de 350 ± 5 kg. La composición botánica de la dieta se obtuvo mediante la técnica microhistológica y su valor nutricional por análisis bromatológico. Los datos se sometieron a un análisis de varianza; los datos de calidad de la dieta se ajustaron a un modelo mixto mediante el procedimiento PROC MIXED del SAS. El promedio de forraje disponible durante las cuatro etapas fenológicas fue de 1,279 kg MS ha-1, con presencia del pasto rosado del 87.5 % (1,119.13 kg MS ha-1). La dieta seleccionada por el ganado bovino estuvo compuesta por 74 % de gramíneas, 19 % de arbustivas y 7 % de herbáceas. Las especies preferidas fueron Aristida divaricata (8.43) y Croton pottsii (12.95) durante la etapa de crecimiento; el menor índice de preferencia fue para Melinis repens (0.33 a 0.41). El mayor contenido de proteína cruda se obtuvo durante las etapas de crecimiento (13.23 %) y floración (10.71 %). La mejor calidad de la dieta se presentó durante las etapas de crecimiento y floración, y estuvo compuesta principalmente por Melinis repens en las cuatro etapas.

Association between chronic lymphocityc thyroiditis and papillary thyroid carcinoma: Systematic review and meta-analysis of studies on surgical specimens

Introduction. Inconsistent results exist in the literature regarding the hypothesis statement suggesting an increased likelihood of documenting papillary thyroid carcinoma (PTC) in surgical specimens with changes compatible with chronic lymphocytic thyroiditis. Existing meta-analyses have included studies that are not methodologically comparable and do not propose clear sources of bias, thus, this is justification for the present meta-analysis. Methods. A literature search in PubMed and Embase was performed from January 1, 1950 to December 31, 2020. Retrospective studies comparing the prevalence of papillary thyroid carcinoma in specimens with and without chronic lymphocytic thyroiditis changes were obtained. The collected evidence was statistically analyzed. Results. A total of 22 articles were included. The study population consisted of 63,548 surgical specimens. The pooled OR, based on the studies, was 1.81 (95% CI: 1.51-2.21). There was heterogeneity between the distribution of prevalence ratios and opportunity ratios across studies (I²= 91%; p>0.00001). The funnel plot shape of the studies included in the analysis appears to be symmetrical, indicating the absence of bias attributable to small studies. Conclusions. The current literature suggests that there is an increased risk of documenting papillary thyroid carcinoma in surgical specimens in which chronic lymphocytic thyroiditis-compatible changes are observed; however, there are sources of bias that will not be possible to control for in retrospective studies, so we recommend studying the hypothesis suggesting an increased likelihood of diagnosing PTC in specimens with chronic lymphocytic thyroiditis-compatible changes using prospective methodologies

Neuroaxial anesthesia caused paraplegia: a case report

Patients who undergo; anesthesia, neuraxial analgesia, or some type of neuraxial blockage are exposed to multiple complications. 33-year-old male patient, suffers a femur fracture with a long oblique trace causing pain and functional limitation for movements. Surgical resolution is determined using neuraxial block at L2-L3 level, and intravenous sedation. During his postoperative follow-up, a decrease in strength was confirmed in the lower limbs with 0/5 on the Daniels scale, 100% sensitivity without sphincter control, steroids were prescribed along with magnetic resonance imaging and a neurosurgical evaluation was requested. The MRI shows bulging of the fibrous annulus that obliterates the epidural fat and makes contact with the thecal sac in the L5-S1 intervertebral disc level. The neurosurgery service prescribes rehabilitation sessions at home, electrostimulation and neuropathic medications. Patient was discharged with rehabilitation sessions at home and medical treatment. In his last consultation, an evaluation from the psychiatry department was requested for ideas of disability, hopelessness, fantasies of death without a suicide plan related to limitations and loss of functionality. Patient does not return to external follow-up, cannot be located

The neurobiology of splitbrain crayfish

Background: They crayfish brain is segmented into two symmetrical hemiganglia. Normally both hemiganglia are in direct communication through a series of well-defined neural bridges that cross de midline to form reciprocal cross connections.Methods: An original study was carried out in the Department of Physiology of the Faculty of Medicine, UNAM during the period from August 2019 to August 2020. 13 Crayfish Procambarus clarkii weighing between 1g to 30g were used. Each eyestalk of the animals was tied to a displacement transducer coupled with a polygraph so that optomotor or electrical activity was bilaterally recorded. The separation of the right from the left hemiganglia from the cerebral or supraesophageal ganglion was performed with a sagittal section, splitbrain (SB).Results: The normal photo motor reflex in crayfish eye is measured as a gradual decrease in the ERG amplitude. During tactile stimulation, the visual activation of both eyestalks in normal crayfish leads to a highly regular bilateral activity. The regular activity can only be altered by disturbing the mechanoreceptors located in the shell surrounding the eyestalks.Conclusions: The procedure presented in this article provides unique characteristics for the study of the nervous system such as a detailed response of the bilateral optomotor reflex

Osimertinib in advanced EGFR-T790M mutation-positive non-small cell lung cancer patients treated within the Special Use Medication Program in Spain : OSIREX-Spanish Lung Cancer Group

AURA study reported 61% objective response rate and progression-free survival of 9.6 months with osimertinib in patients with EGFR/T790M+ non-small cell lung cancer. Due to lack of real-world data, we proposed this study to describe the experience with osimertinib in Spain. Post-authorization, non-interventional Special Use Medication Program, multicenter, retrospective study in advanced EGFR/T790M+ non-small cell lung cancer. One hundred-fifty five patients were enrolled (August 2016-December 2018) from 30 sites. Primary objective: progression-free survival. Secondary objectives: toxicity profile, objective response rate, and use of health service resources. 70% women, median age 66. 63.9% were non-smokers and 99% had adenocarcinoma. Most patients had received at least one prior treatment (97%), 91.7% had received previous EGFR-tyrosine kinase inhibitors and 2.8% osimertinib as first-line treatment. At data cutoff, median follow-up was 11.8 months. One hundred-fifty five patients were evaluable for response, 1.3% complete response, 40.6% partial response, 31% stable disease and 11.6% disease progression. Objective response rate was 42%. Median progression-free survival was 9.4 months. Of the 155 patients who received treatment, 76 (49%) did not reported any adverse event, 51% presented some adverse event, most of which were grade 1 or 2. The resource cost study indicates early use is warranted. This study to assess the real-world clinical impact of osimertinib showed high drug activity in pretreated advanced EGFR/T790M+ non-small cell lung cancer, with manageable adverse events. Clinical trial registration number : NCT03790397

Chronic venous insufficiency: a review

Chronic venous insufficiency (CVI) comprises a complete spectrum of morphological and functional abnormalities of the venous system1 including any long-term functional and morphological alteration. CVI accounts for several abnormalities of the venous system. It is a highly prevalent disease that causes serious economic consequences, a decrease in the quality of life and can lead to serious complications. An exhaustive review was performed with the available literature, using the PubMed, ScienceDirect, Scopus and Cochrane databases from 2004 to 2021. The search criteria were formulated to identify reports related to chronic venous insufficiency. The pathophysiology of chronic venous insufficiency begins with chronic venous hypertension and the dilation of the vessel, this leads to a series of pathological changes in the venous wall and surrounding tissues, in advanced stages of CVI, skin lesions are associated with an increased proliferation of skin capillaries and microcirculatory abnormalities that may be the result of an altered level of factors responsible for the angiogenic response, such as vascular endothelial growth factor (VEGF), fibroblast growth factor 2 (FGF2) and angiostatin. In this review, updates on pathophysiology, clinic, diagnosis, classification and treatment of this disease are analyzed, with special emphasis on therapeutic options. Chronic venous insufficiency is a disease that affects the patient at several levels, mainly diminishing his/her quality of life. Currently there are various treatments ranging from habit modifications, pharmacological, to endovenous and surgical treatment.

Coriocarcinoma de placenta metastásico: artículo de revisión

Choriocarcinoma is a highly vascularized tumor of malignant origin that is defined within gestational trophoblastic neoplasms. It occurs in women of reproductive age after any type of pregnancy, with complete molar pregnancy being the most frequently associated. The clinical manifestations are usually non-specific and related to metastatic involvement with the main organ, the lung; however, vaginal bleeding is the main finding. The diagnosis is based on the measurement of beta-hCG levels accompanied by a complete clinical history, a thorough physical examination and the use of imaging aids such as transabdominal or transvaginal ultrasound. Medical management should be early and based on the administration of chemotherapy, ideally with multiple drugs, always depending on the degree of the disease as well as institutional care protocols. The prognosis is generally favorable, however, in those cases in which the diagnosis is late, the survival rates and associated complications increase drastically, which is why health personnel must maintain a high index of diagnostic suspicion that facilitates the establishment of comprehensive medical management.El coriocarcinoma es un tumor de origen maligno altamente vascularizado que se encuentra definido dentro de las neoplasias trofoblásticas gestacionales. Se presenta en mujeres en edad reproductiva posterior a cualquier tipo de gestación siendo el embarazo molar completo el más frecuentemente asociado. Las manifestaciones clínicas suelen ser inespecíficas y estar relacionadas con afectación metastásica con órgano principal pulmón, sin embargo, el sangrado vaginal es el hallazgo principal. El diagnóstico se encuentra basado en la medición de niveles de beta-hCG acompañado de una historia clínica completa, un examen físico exhaustivo y el uso de ayudas imagenológicas como la ecografía transabdominal o transvaginal. El manejo médico debe ser precoz y basado en la administración de quimioterapia idealmente con múltiples fármacos dependiendo siempre del grado de la enfermedad, así como de los protocolos de atención institucional. El pronóstico generalmente es favorable sin embargo en aquellos casos en los que el diagnóstico sea tardío las tasas de supervivencia y complicaciones asociadas aumentan de manera drástica es por esto por lo que, el personal de la salud debe mantener un alto índice de sospecha diagnóstica que facilite la instauración oportuna del manejo médico integral.&nbsp

Determination of essential biomarkers in lung cancer: a real-world data study in Spain.

Background: The survival of patients with lung cancer has substantially increased in the last decade by about 15%. This increase is, basically, due to targeted therapies available for advanced stages and the emergence of immunotherapy itself. This work aims to study the situation of biomarker testing in Spain. Patients and Methods: The Thoracic Tumours Registry (TTR) is an observational, prospective, registry-based study that included patients diagnosed with lung cancer and other thoracic tumours, from September 2016 to 2020. This TTR study was sponsored by the Spanish Lung Cancer Group (GECP) Foundation, an independent, scientific, multidisciplinary oncology society that coordinates more than 550 experts and 182 hospitals across the Spanish territory. Results: 9,239 patients diagnosed with stage IV non-small cell lung cancer (NSCLC) between 2106 and 2020 were analysed. 7,467 (80.8%) were non-squamous and 1,772 (19.2%) were squamous. Tumour marker testing was performed in 85.0% of patients with non-squamous tumours vs 56.3% in those with squamous tumours (p-value <0.001). The global testing of EGFR, ALK, and ROS1 was 78.9%, 64.7%, 35.6% respectively, in non-squamous histology. PDL1 was determined globally in the same period (46.9%), although if we focus on the last 3 years it exceeds 85%. There has been a significant increase in the last few years of all determinations and there are even close to 10% of molecular determinations that do not yet have targeted drug approval but will have it in the near future. 4,115 cases had a positive result (44.5%) for either EGFR, ALK, KRAS, BRAF, ROS1, or high PDL1. Conclusions: Despite the lack of a national project and standard protocol in Spain that regulates the determination of biomarkers, the situation is similar to other European countries. Given the growing number of different determinations and their high positivity, national strategies are urgently needed to implement next-generation sequencing (NGS) in an integrated and cost-effective way in lung cancer