Thuya occidentalis 12 ch como variante de tratamiento de la carúncula uretral en Pinar del Río. Enero 2000 - diciembre 2005. Thuja occidentalis 12ch as an option of treatment in urethral caruncule in Pinar del Rio- January 2000-December 2005

La Carúncula uretral es una enfermedad femenina. Hasta el momento actual, la indicación eficaz de tratamiento es el proceder quirúrgico o largos períodos de tratamientos estrogénicos. Se realizó estudio prospectivo, descriptivo analítico longitudinal, desde enero del  año 2000 hasta diciembre del 2005, a un grupo de 46 pacientes, en el HCQ "León Cuervo Rubio" de Pinar del Río, con el objetivo de validar la aplicación de un medicamento homeopático, Thuya Occidentalis  12 CH, que entre otras indicaciones según patogenesia, tiene la de actuar sobre formaciones polipoideas o estructuras semejantes a la Carúncula uretral. Fue utilizada la estadística descriptiva y como método estadístico la media porcentual para el análisis de los resultados. Se encontró en el grupo coincidencia con la literatura en cuanto a edad y síntomas de presentación. Se magnifica el resultado de desaparición de la lesión antes de las tres semanas en el 92,8% de las pacientes  El 85,7% de las pacientes sobrepasa el año de evolución sin aparición de recidivas del tumor y sus síntomas acompañantes. Se convierte en un tratamiento eficiente, no invasivo, aporta un método de diagnóstico diferencial con otras entidades. Palabras clave: Thuya occidentalis / Carúncula uretral / eficiencia. ABSTRACT Urethral Caruncle is a female disease. Even in current times the most effective treatments are surgical approach or long-term periods of estrogen. A prospective, descriptive, analytic-longitudinal study from January 2000 to December 2005 was carried out in a group of 46 patients at "León Cuervo Rubio" Hospital in Pinar del Río, aimed at validating the use of the homeopathic drug Thuya occidentalis 12 CH, that among other indications and according to the pathogeny, acts on polypoid formations or structures similar to urethral caruncle. Descriptive statistics was used, and percentage mean was taken as a statistic method to analyze the results; coinciding age and symptoms of presentation with medical literature. The result of the disappearence of the lesion was significant before three weeks in 92,8% of the cases, 85,9% of them surpass one year without relapses of the tumor or its symptoms. Becoming an efficient, non-invasive treatment and provinding a method of differential diagnosis with other entities. Key words: THUYA OCCIDENTALIS, URETHRAL CARUNCLE, EFFICIENCY

Finding electrophysiological sources of aging-related processes using penalized least squares with Modified Newton-Raphson algorithm

In this work, we evaluate the flexibility of a modified Newton-Raphson (MNR) algorithm for finding electrophysiological sources in both simulated and real data, and then apply it to different penalized models in order to compare the sources of the EEG theta rhythm in two groups of elderly subjects with different levels of declined physical performance. As a first goal, we propose the MNR algorithm for estimating general multiple penalized least squares (MPLS) models and show that it is capable to find solutions that are simultaneously sparse and smooth. This algorithm allowed to address known and novel models such as the Smooth Non-negative Garrote and the Non-negative Smooth LASSO. We test its ability to solve the EEG inverse problem with multiple penalties -using simulated data- in terms of localization error, blurring and visibility, as compared with traditional algorithms. As a second goal, we explore the electrophysiological sources of the theta activity extracted from resting-state EEG recorded in two groups of older adults, which belong to a longitudinal study to assess the relationship between measures of physical performance (gait speed) decline and normal cognition. The groups contained subjects with good and bad physical performance in the two evaluations (6 years apart). In accordance to clinical studies, we found differences in EEG theta sources for the two groups, specifically, subjects with declined physical performance presented decreased temporal sources while increased prefrontal sources that seem to reflect compensating mechanisms to ensure a stable walking

Safety and effectiveness of CIMAvax-EGF administered in community polyclinics

In spite of the advances in immunotherapy and targeted therapies, lung cancer continues to be the leading cause of cancer-related death. The epidermal growth factor receptor is an established target for non-small cell lung cancer (NSCLC), and its overactivation by the ligands can induce accelerated proliferation, angiogenesis, and metastasis as well as proinflammatory or immunosuppressive signals. CIMAvax-EGF is an epidermal growth factor (EGF)-depleting immunotherapy that is approved for the treatment of NSCLC patients in Cuba. The study was designed as a phase IV trial to characterize the safety and effectiveness of CIMAvax-EGF in advanced NSCLC patients treated in 119 community polyclinics and 24 hospitals. CIMAvax-EGF treatment consisted of four bi-weekly doses followed by monthly boosters. Overall, 741 NSCLC patients ineligible for further cancer-specific treatment were enrolled. CIMAvax-EGF was safe, and the most common adverse events consisted of mild-to-moderate injection site reactions, fever, chills, tremors, and headache. For patients completing the loading doses, the median survival was 9.9 months. For individuals achieving at least stable disease to the frontline and completing vaccination induction, the median survival was 12 months. Most of the functional activities and symptoms evaluated through the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire improved over time. In conclusion, this real-world trial demonstrated that CIMAvax-EGF was safe and effective in patients who were vaccinated in the maintenance scenario. A larger effect was seen in subjects with poor prognosis like those with squamous tumors and high EGF levels. Remarkably, this community-based intervention was very important because it demonstrated the feasibility of treating advanced lung cancer patients with active immunotherapy in primary care institutions. In addition to CIMAvax-EGF, patients received supportive care at the community clinic. Vaccine administration by the family doctors at the polyclinics reduced the patients’ burden on the medical oncology services that continued providing chemotherapy and other complex therapies. We conclude that community polyclinics constitute the optimal scenario for administering those cancer vaccines that are safe and require prolonged maintenance in patients with advanced cancer, despite the continuous deterioration of their general condition.Clinical trial registrationhttps://rpcec.sld.cu/trials/RPCEC00000205-En, identifier RPCEC00000205

Comparison of two recombinant erythropoietin formulations in patients with anemia due to end-stage renal disease on hemodialysis: A parallel, randomized, double blind study

BACKGROUND: Recombinant human erythropoietin (EPO) is used for the treatment of last stage renal anemia. A new EPO preparation was obtained in Cuba in order to make this treatment fully nationally available. The aim of this study was to compare the pharmacokinetic, pharmacodynamic and safety properties of two recombinant EPO formulations in patients with anemia due to end-stage renal disease on hemodialysis. METHODS: A parallel, randomized, double blind study was performed. A single 100 IU/Kg EPO dose was administered subcutaneously. Heberitro (Heber Biotec, Havana, formulation A), a newly developed product and Eprex (CILAG AG, Switzerland, formulation B), as reference treatment were compared. Thirty-four patients with anemia due to end-stage renal disease on hemodialysis were included. Patients had not received EPO previously. Serum EPO level was measured by enzyme immunoassay (EIA) during 120 hours after administration. Clinical and laboratory variables were determined as pharmacodynamic and safety criteria until 216 hours. RESULTS: Both groups of patients were similar regarding all demographic and baseline characteristics. EPO kinetics profiles were similar for both formulations; the pharmacokinetic parameters were very close (i.e., AUC: 4667 vs. 4918 mIU.h/mL; Cmax: 119.1 vs. 119.7 mIU/mL; Tmax: 13.9 vs. 18.1 h; half-life, 20.0 vs. 22.5 h for formulations A and B, respectively). The 90% confidence intervals for the ratio between both products regarding these metrics were close to the 0.8 – 1.25 range, considered necessary for bioequivalence. Differences did not reach 20% in any case and were not determined by a formulation effect, but probably by a patients' variability effect. Concerning pharmacodynamic features, a high similitude in reticulocyte counts increments until 216 hours and the percentage decrease in serum iron until 120 hours was observed. There were no differences between formulations regarding the adverse events and their intensity. The more frequent events were pain at injection site (35.3%) and hypertension (29%). Additionally, further treatment of the patients with the study product yielded satisfactory increases in hemoglobin and hematocrit values. CONCLUSION: The formulations are comparable. The newly developed product should be acceptable for long-term application

Automated Discrimination of Brain Pathological State Attending to Complex Structural Brain Network Properties: The Shiverer Mutant Mouse Case

Neuroimaging classification procedures between normal and pathological subjects are sparse and highly dependent of an expert's clinical criterion. Here, we aimed to investigate whether possible brain structural network differences in the shiverer mouse mutant, a relevant animal model of myelin related diseases, can reflect intrinsic individual brain properties that allow the automatic discrimination between the shiverer and normal subjects. Common structural networks properties between shiverer (C3Fe.SWV Mbpshi/Mbpshi, n = 6) and background control (C3HeB.FeJ, n = 6) mice are estimated and compared by means of three diffusion weighted MRI (DW-MRI) fiber tractography algorithms and a graph framework. Firstly, we found that brain networks of control group are significantly more clustered, modularized, efficient and optimized than those of the shiverer group, which presented significantly increased characteristic path length. These results are in line with previous structural/functional complex brain networks analysis that have revealed topologic differences and brain network randomization associated to specific states of human brain pathology. In addition, by means of network measures spatial representations and discrimination analysis, we show that it is possible to classify with high accuracy to which group each subject belongs, providing also a probability value of being a normal or shiverer subject as an individual anatomical classifier. The obtained correct predictions (e.g., around 91.6–100%) and clear spatial subdivisions between control and shiverer mice, suggest that there might exist specific network subspaces corresponding to specific brain disorders, supporting also the point of view that complex brain network analyses constitutes promising tools in the future creation of interpretable imaging biomarkers

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe