Cardiac Toxicities Associated with Immune Checkpoints Inhibitors:Mechanisms, Manifestations and Management

Immune checkpoint inhibitor (ICI) associated cardiovascular adverse events (CVAE) have become more frequent with the growing use of cancer immunotherapy. CVAEs include a wide spectrum of diseases such as myocarditis, pericarditis, heart failure, arrhythmias, coronary artery disease, and hypertension. The induction of cardiovascular side effects by ICI use is hypothesized to occur due to inflammation and immune dysregulation of normal tissue in response to immunotherapy. Management of ICI-associated CVAEs mitigates an overactive immune response by utilizing steroids, immunomodulatory drugs and hemodynamic stabilization. However, few controlled studies on the cardiovascular safety of ICIs exist and treatment of their side effects are mostly from limited case series. Our review seeks to provide the most recent understanding of ICI-associated CVAEs and their management.

Cardiac Toxicities Associated with Immune Checkpoints Inhibitors:Mechanisms, Manifestations and Management

Immune checkpoint inhibitor (ICI) associated cardiovascular adverse events (CVAE) have become more frequent with the growing use of cancer immunotherapy. CVAEs include a wide spectrum of diseases such as myocarditis, pericarditis, heart failure, arrhythmias, coronary artery disease, and hypertension. The induction of cardiovascular side effects by ICI use is hypothesized to occur due to inflammation and immune dysregulation of normal tissue in response to immunotherapy. Management of ICI-associated CVAEs mitigates an overactive immune response by utilizing steroids, immunomodulatory drugs and hemodynamic stabilization. However, few controlled studies on the cardiovascular safety of ICIs exist and treatment of their side effects are mostly from limited case series. Our review seeks to provide the most recent understanding of ICI-associated CVAEs and their management.

Recomendaciones para el uso de la hormona de crecimiento humana recombinante en pacientes pediátricos de talla baja en Colombia / Recommendations for treatment with recombinant human growth hormone in pediatric patients in Colombia

resumen está disponible en el texto completo

Abstract In Colombia there are no guidelines for diagnosis and management of patients with short stature and for the use of recombinant human growth hormone, mainly caused by the diversity of training centers in pediatric endocrinology. In response to this situation, the Asociación Colegio Colombiana de Endocrinología Pediátrica leds the first colombian short stature expert committee in order to standardize the use of human recombinant growth hormone. This work had the participation and endorsement of a consortium of clinical experts representing the Sociedad Colombiana de Pediatría, Secretaría Distrital de Salud de Bogotá- Subred Integrada de Servicios de Salud Suroccidente, Fundación Universitaria Sanitas, Universidad de los Andes and some public and private health institutions in the country, in addition to the participation of methodological experts from the Instituto Global de Excelencia Clínica Keralty. By reviewing the literature and with the best available evidence, we proposed to unify definitions, a diagnostic algorithm, biochemical and dynamic tests with their reference parameters, a description of the considerations about growth hormone use among the indications approved by regulatory agency for medications and food in Colombia and finally a proposal for an informed consent and a medication fact sheet available for parents and patients.

Soil organic matter fractions and carbon management index under integrated crop-livestock system / Frações da matéria orgânica do solo e índice de manejo de carbono em sistema de integração lavoura-pecuária

The objective of this work was to evaluate the carbon content of the physical, chemical and oxidizable fractions of soil organic matter (SOM) and to calculate the carbon management index (CMI) in an area managed under an integrated crop-livestock system (ICLS) in the western region of Paraná - Brazil. The experiment was carried out at the experimental farm, belonging to the Universidade Estadual do Oeste do Paraná. Seventeen areas, which are managed in different ways, fifteen in ICLS and two areas of controls (Forest and Haymaking), using the design divided with two nested controls, with three replications were evaluated. Deformed and undisturbed soil samples were collected from all the areas to determine the total organic carbon (TOC), carbon stock, the physical, chemical and oxidizable fractions of SOM and the CMI in the layers of 0-0.05, 0.05-0.1 and 0.1-0.2 m. Little significant changes in the fractions were found for the management of the ICLS area in relation to the Forest and the area of Haymaking, although the Forest presented the best values for most of the studied fractions. It is recommended to adopt sustainable practices, such as ICLS, even though the average fractions tend to take time to match reference areas.

O objetivo desse trabalho foi avaliar os teores de carbono das frações física, química e oxidável da matéria orgânica do solo (MOS) e calcular o índice de manejo de carbono (IMC) em uma área manejada em sistema de integração lavoura pecuária (ILP) na região Oeste do Paraná - Brasil. O experimento foi realizado na fazenda experimental, pertencente à Universidade Estadual do Oeste do Paraná. Foram avaliadas dezessete áreas, que foram manejadas de diferentes formas, quinze em ILP e duas testemunhas (Mata e Fenação), sendo empregado o delineamento subsubsubdividido com duas testemunhas aninhadas, com três repetições. Em todas as áreas foram coletadas amostras deformadas e indeformadas de solo para serem determinados o carbono orgânico total, estoque de carbono e as frações físicas granulométricas, oxidáveis e químicas da MOS e o IMC nas camadas de 0-0,05, 0,05-0,1 e 0,1-0,2 m. Alterações pouco significativas das frações foram encontradas para os manejos da área em ILP em relação a mata e a área de fenação, entretanto a mata apresentou os melhores valores para a maioria das frações estudadas. Recomenda-se a adoção de práticas sustentáveis, como a ILP, mesmo que os teores médios das frações tendem a demorar tempo para igualar-se a áreas de referência.

Remaining straw and release of nutrients from oat managed in integrated crop-livestock / Palhada remanescente e liberação de nutrientes da aveia preta manejada em sistema de integração lavoura-pecuária

This study aimed to evaluate the decomposition and nutrient release from residues of the culture of oats and fallow in crop-livestock integration system. The experimental design was a randomized complete block design with two replications, as parcels being formed by four managements (fallow, oats without grazing, oats grazed once and twice), and the subplots for evaluation periods along the soybean crop in succession (0, 10, 20, 30, 50, 100 and 120 days after sowing). The residual amounts of dry matter and the contents of Carbon (C), Nitrogen (N), Phosphorus (P) and Potassium (K) were determined. Oats without grazing and fallow with natural reappearance of turnip + ryegrass were the treatments that presented the highest amount of dry matter remaining, reaching 5,219 and 6,781 kg ha-1, respectively. The amount of nutrients, N, P and K released from the residues, were similar independent from the management adopted, with exponential reduction proportional to the reduction of the remaining dry matter. K was the nutrient released faster from the residues and should be considered at the time of fertilization calculation of the culture to be implanted. The integrated crop-livestock system in which takes place one and two grazing oats, even reducing soil cover, enables high nutrient cycling.

O objetivo do trabalho foi avaliar a decomposição e liberação de nutrientes dos resíduos da cultura da aveia preta e do pousio conduzidos em sistema de integração lavoura-pecuária. O delineamento experimental utilizado foi o de blocos casualizados, em esquema de parcelas subdivididas, com duas repetições, sendo as parcelas constituídas por quatro manejos (pousio, aveia sem pastejo, aveia pastejada uma e duas vezes) e as subparcelas, pelas épocas de avaliação ao longo do cultivo da soja em sucessão (0, 10, 20, 30, 50, 100 e 120 dias após a semeadura). Foram determinadas as quantidades residuais de matéria seca e os teores de Carbono (C), Nitrogênio (N), Fósforo (P) e Potássio (K). A aveia sem pastejo e o pousio com ressemeadura natural de aveia + azevém, foram os manejos que apresentaram as maiores quantidades de matéria seca remanescentes, chegando a 5.219 e 6.781 kg ha-1, respectivamente. A quantidade dos nutrientes, N, P e K liberados dos resíduos, foram semelhantes independente do manejo adotado, com redução exponencial e proporcional à redução da matéria seca remanescente. O K foi o nutriente liberado mais rapidamente dos resíduos e deve ser considerado no momento do cálculo de adubação da cultura a ser implantada. O sistema de integração lavoura-pecuária no qual se realiza um e dois pastejos da aveia, mesmo reduzindo a cobertura do solo, possibilita elevada ciclagem de nutrientes.

Clinical and functional results in patients with cervical spondylotic myelopathy treated surgically by anterior approach in a tertiary health care center / Resultados clínicos e funcionais em pacientes com mielopatia espondilótica tratados cirurgicamente através de uma abordagem anterior em um centro de referência para cuidados / Resultados clínicos y funcionales en pacientes con mielopatía espondilótica cervical tratados quirúrgicamente mediante abordaje anterior en un centro de tercer nivel de atención

ABSTRACT Objective: To evaluate the clinical and functional results in patients with cervical spondylotic myelopathy treated surgically by anterior approach in a reference center. Methods: An observational, longitudinal, analytical study was carried out. The patients were evaluated using the JOA, Nurick and SF12v2 scales at hospital admission, at 3 and 6 months after surgery, analyzing the data with the Student's T test in the IBM SPSS Statistics version 24. Results: The male sex predominated, the mean age was 61 years; the mean JOA score before surgery, at 3 and 6 months was 8, 10.9, and 11.6, respectively. The Nurick scale obtained a presurgical score, at 3 and 6 months of 2.8, 2.2, and 1.9, respectively. Regarding the quality of life (PCS), 93.3% of the patients were found to be below the mean, 2.2% in the mean, and 4.5% above the mean, while at 6 months, 91.1% of the patients were below the mean, 6.7% in the mean, and 2.2% above the mean. In the preoperative evaluation the SF 12v2 scale, 68.9% of the patients were below the mean, 2.2% in the mean, and 28.9% above the mean, being that at 6 months, 31.1% of the patients were below the mean, 15.6% in the mean, and 53.3% above the mean. A statistically significant improvement was observed with the JOA and Nurick scales from preoperative to 3 and 6 months (p<0.05) with a statistically significant difference in the mental component of quality in the same periods. Conclusions: Anterior approach decompression gives a significant clinical improvement at 3 and 6 months. However, this improvement does not correlate with the patient's perception of his or her health condition. Level of Evidence III; Case control study.

RESUMO Objetivo: Avaliar os resultados funcionais clínicos em pacientes com compressão da medula espinhal (CME) tratados cirurgicamente pela abordagem anterior, em um centro de referência. Métodos: Foi realizado um estudo observacional, longitudinal e analítico. Os pacientes foram avaliados na admissão hospitalar através das escalas JOA, Nurick e SF12v2, aos três e seis meses após a cirurgia, analisando os dados com o teste t de Student, no programa IBM SPSS Statistics versão 24. Resultados: O estudo mostrou uma predominância no sexo masculino, com idade média de 61 anos. Avaliação do JOA pré-cirúrgica teve uma pontuação média, no terceiro e no sexto mês, de 8, 10,9 e 11,6. Por sua vez, a escala de Nurick, obtida em um pré-operatório, foi nos mesmos meses, com pontuação de 2.8, 2.2 e 1.9. Tal como para a qualidade de vida (PCS), que foi encontrado na avaliação pré-operatória, 93,3% dos pacientes estavam abaixo da média, 2,2%,na média e 4,5% superior à média. Enquanto aos 6 meses, 91,1% dos pacientes estavam abaixo da média, 6,7%, na média e 2,2% superior à média. Na avaliação pré-operatória de escala 12v2 SF, 68,9% dos pacientes estavam abaixo da média, 2,2% na média e 28,9% superior à média, sendo que aos 6 meses, 31,1% dos pacientes estavam abaixo da média, 15,6%, na média e 53,3% superior à média. Uma melhoria estatisticamente significativa com as escalas JOA e Nurick de pré-operatória em 3 e 6 meses (p <0,05) foi observada e, também, uma melhoria estatisticamente significativa na qualidade do componente mental nos mesmos períodos. Conclusões: Pode-se concluir que a abordagem da descompressão anterior proporciona uma melhoria clínica significativa, mas esta melhoria não está correlacionada com a percepção do paciente sobre sua saúde. Nível de Evidencia II;Estudo de caso.

RESUMEN Objetivo: Valorar los resultados clínicos y funcionales en pacientes con mielopatía espondilótica cervical tratados quirúrgicamente mediante abordaje anterior en un centro de referencia. Métodos: Se realizó un estudio observacional, longitudinal y analítico. Los pacientes fueron evaluados mediante las escalas JOA, Nurick y SF12v2 a su ingreso hospitalario, a los 3, y 6 meses de la cirugía, analizando los datos con prueba T de Student en el programa IBM SPSS Statistics versión 24. Resultados: Predominó el sexo masculino, el promedio de edad fue 61 años; la valoración de JOA media antes de la cirugía, a los 3 y 6 meses fue de 8, 10,9 y 11,6, respectivamente. La escala de Nurick obtuvo una puntuación prequirúrgica, a los 3 y 6 meses de 2,8, 2,2 y 1,9 respectivamente. En cuanto a la calidad de vida (PCS), se encontró en la evaluación prequirúrgica que el 93,3% de los pacientes estaba por debajo de la media, 2,2% en la media y el 4,5% por arriba de la media, mientras que a los 6 meses, el 91,1% de los pacientes estaba por debajo de la media, el 6,7% en la media y el 2,2% por arriba de la media. En la evaluación prequirúrgica la puntuación de la escala SF 12v2, el 68,9% de los pacientes estaba por debajo de la media, 2,2% en la media y el 28,9% por arriba de la media, siendo que a los 6 meses, el 31,1% de los pacientes estaba por debajo de la media, el 15,6% en la media y el 53,3% por arriba de la media. Se observó una mejoría estadísticamente significativa con las escalas de JOA y Nurick desde el prequirúrgico hasta los 3 y 6 meses (p < 0,05) con una diferencia estadísticamente significativa en el componente mental de la calidad en los mismos periodos. Conclusiones: La descompresión por vía anterior otorga una mejoría clínica significativa a los 3 y 6 meses; sin embargo esta mejoría no se correlaciona con la percepción que tiene el paciente sobre su estado de salud. Nivel de evidencia III; Estudio de caso control.

Characterization and evaluation of liver fibrosis grade in patients with chronic hepatitis B virus infection and normal transaminases

BACKGROUND/AIMS: The objective of our study was to determine the epidemiological, laboratory, and serological characteristics of patients with chronic hepatitis B virus (HBV) infection and normal transaminases. The study also aimed to evaluate liver damage by measuring the liver fibrosis (LF) grade and to identify possible factors associated with the presence of fibrosis. METHODS: A retrospective observational study was conducted in patients with chronic HBV infection and classified as inactive carriers or immune-tolerant. Epidemiological variables of age, sex, immigrant, alcohol consumption, and body mass index (BMI), as well as virological variables (HBV DNA) and transaminase level were collected throughout the follow-up. The LF grade was evaluated by transient elastography. The cutoff value for significant fibrosis (SF) was liver stiffness ≥7.9 kPa. RESULTS: A total of 214 patients were included in the analysis, and 62% of them had a BMI ≥25 kg/m². During follow-up, 4% of patients showed transaminase elevation ( < 1.5 times normal). Most patients had a viral DNA level < 2,000 IU/mL (83%). Data on LF were available in 160 patients; of these, 14% had SF, 9% F3, and 6% F4. The variables associated with the presence of SF were transaminase alteration during follow-up, as 23% of patients with SF had elevated transaminases versus 3% of patients without SF (P < 0.005), and BMI, as the vast majority of patients with SF (88%) had a BMI ≥25 kg/m² versus 56% of patients without SF (P < 0.05). CONCLUSIONS: In patients with chronic HBV infection and normal transaminases, liver damage does not seem to be related to DNA levels, alcohol consumption, or immigrant status. SF seems to be associated with transaminase alteration during follow-up and elevated BMI. It is therefore recommended to measure LF grade with validated non-invasive methods in such patients.

Effect of isoespintanol isolated from Oxandra cf. xylopioides against DNA damage of human lymphocytes

Synthetic antioxidants are used in the food and pharmaceutical industry, however, there is concern about their safety; this has prompted the search for new antioxidants that are effective, safe and act at low concentrations. The objective of this study is to evaluate the oxygen radical scavenging capacity and clastogenic effect of the Isoespintanol /2-isopropyl-3,6-dimethyl-5-methylphenol] in DNA of human lymphocyte compared with the BHA [Butylated hydroxyanisole]. The oxygen radical scavenging ability was evaluated by methods ORAC[FL] and ORACP[GR], genotoxicity was determined by comet assay and data analysis was performed using ANOVA and Duncan test. The results show that the oxygen radical scavenging capacity of the BHA is higher than Isoespintanol, however according to the reactivity concept proposed by Lopez-Alarcon and Lissi, the Isoespintanol it is more reactive than BHA. Furthermore, according to some studies, BHA presented adverse effects on the health of consumers. Comet assay results revealed that at concentrations between 3 and 1620 MuM the Isoespintanol don't show clastogenic effects on DNA. In conclusion, the antioxidant capacity for the BHA is higher than Isoespintanol, but considering reactivity concepts proposed by Lopez- Alarcon and Lissi, the Isoespintanol is faster to neutralize radicals that the BHA, furthermore, according to the National Institute of Health "BHA" is a human carcinogen

Mature bone in the eye: A case of choroidal osteoma

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To describe a case of choroidal osteoma.</p> <p style="text-align: justify;"><strong>METHODS:</strong> This is a case report.</p> <p style="text-align: justify;"><strong>RESULTS:</strong> A 49-year old female had unilateral, gradual, progressive, painless, blurring of vision. She was previously started on anti-TB treatment because of positive PPD skin test. T-spot test was negative and vision of hand movement persisted in the left eye. Both eyes had yellow, slightly elevated, peripapillary subretinal patches with scalloped margins. Fluorescein angiography revealed bilateral subretinal patchy hyperfluorescence and perifoveal petalloid hyperfluorescence in the left. Macular OCT showed hyporeflective ill-defined sub-retinal pigment epithelial (RPE) lesion in the right eye and a hyporelective well-defined sub-RPE thickening with large cystoid macular edema in the left. B-scan ultrasonography revealed bilateral densely hyperechoic subretinal concave band with posterior shadowing that persisted on decreased gain. These were consistent with bilateral choroidal osteoma with secondary cystoid macular edema in the left eye.</p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> Choroidal osteoma is a rare benign choroidal tumor of healthy young women wherein the choroid is replaced with mature bone. It is a clinical diagnosis with characteristic ultrasonographic findings.</p> <p style="text-align: justify;"> </p>

Arboles Comunes del Paraguay : Nande ybyra mata Kuera

Estelibro trata sobre los árboles comunes del Paraguay decribe e ilustra 156 especies no solamente de la región oriental también de la occidental, incluyendo elgran choco, la introducción contiene notas sobre un resumen de especies, relaciones de los árboles y otras referencias

Discursos e intervenciones del C. Subsecretario de Regulación y Fomento Sanitario, Dra. Mercedes Juan López, durante el año de 1990 (primera parte) / Discourses and interventions of the Subsecretary of Regulation and Sanitary Promotion, Dr. Mercedes Juan Lopez, during the year 1990 (first part)

En este documento se reúnen diversos documentos relativos a: discursos, intervenciones y presentaciones, de la Subsecretaría de Regulación y Fomento Sanitario, de la Secretaría de Salud (SSA), Dra. Mercedes Juan López, con motivo de la realización de diferentes eventos, todos relativos a los servicios de salud, durante el período enero-mayo del año de 1990. Estos documentos o discursos reflejan la política que en materia de salud desarrolla el Estado Mexicano a través de la SSA

Discursos e intervenciones del C. Subsecretario de Regulación y Fomento Sanitario, Dra. Mercedes Juan López, durante el año de 1990 (segunda parte) / Discourses and interventions of the Subsecretary of Regulation and SAnitary Promotion, Dr. Mercedes Juan Lopez, during the year 1990 (second part)

En este documento se reúnen diversos documentos relativos a: discursos, intervenciones y presentaciones, de la Subsecretaría de Regulación y Fomento Sanitario, de la Secretaría de Salud (SSA), Dra. Mercedes Juan López, con motivo de la realización de diferentes eventos, todos relativos a los servicios de salud, durante el período junio-agosto del año de 1990. Estos documentos o discursos reflejan la política que en materia de salud desarrolla el Estado Mexicano a través de la SSA

Discursos e intervenciones del C. Subsecretario de Regulación y Fomento Sanitario, Dra. Mercedes Juan López, durante el año de 1990 (tercera parte) / Discourses and interventions of the Subsecretary of Regulation and Sanitary Promotion, Dr. Mercedes Juan Lopez, during the year 1990 (third part)

En este documento se reúnen diversos documentos relativos a: discursos, intervenciones y presentaciones, de la Subsecretaría de Regulación y Fomento Sanitario, de la Secretaría de Salud (SSA), Dra. Mercedes Juan López, con motivo de la realización de diferentes eventos, todos relativos a los servicios de salud, durante el período septiembre-octubre del año de 1990. Estos documentos o discursos reflejan la política que en materia de salud desarrolla el Estado Mexicano a través de la SSA

Discursos e intervenciones del C. Subsecretario de Regulación y Fomento Sanitario, Dra. Mercedes Juan López, durante el año de 1990 (cuarta parte) / Discourses and interventions of the Subsecretary of Regulation and Sanitary Promotion, Dr. Mercedes Juan Lopez, during the year 1990 (fourth part)

En este documento se reúnen diversos documentos relativos a: discursos, intervenciones y presentaciones, de la Subsecretaría de Regulación y Fomento Sanitario, de la Secretaría de Salud (SSA), Dra. Mercedes Juan López, con motivo de la realización de diferentes eventos, todos relativos a los servicios de salud, durante el período noviembre-diciembre del año de 1990. Estos documentos o discursos reflejan la política que en materia de salud desarrolla el Estado Mexicano a través de la SSA

Discursos e intervenciones del C. Subsecretario de Regulación Sanitaria y Desarrollo, Dra. Mercedes Juan López, durante el año de 1989 / Discourses and interventions of the Subsecretary of Sanitary Regulation and DEvelopment, Dra. Mercedes Juan Lopez, during the year 1989

En este documento se reúnen diversos documentos relativos a: discursos, intervenciones y presentaciones, de la Subsecretaría de Regulación Sanitaria y Desarrollo, de la Secretaría de Salud (SSA), Dra. Mercedes Juan López, con motivo de la realización de diferentes eventos, todos relativos a los servicios de salud, durante el año de 1989. Estos documentos o discursos reflejan la política que en materia de salud desarrolla el Estado Mexicano a través de la SSA

La mujer en las acciónes de atención a la salud en México / The women in activities of health care in Mexico

Se hace un recorrido histórico anecdótico de las acciones de la mujer en la atención a la salud desde la prehistoria hasta el siglo XIX en general y, en particular, en México de la época precortesiana hasta nuestros días, destacando los hechos más relevantes

Estudio multicentrico del tratamiento de osteoartrosis con indoprofen inyectable. / Multicentric study of the treatment of osteoarthrosis with parenteral indoprofen

En este estudio se observan detalladamente los resultados obtenidos en noventa y ocho pacientes con osteoartrosis sometidos a tratamiento con indoprofen inyectable.Pudo observarse que a partir de los primeros cuatro dias de iniciado el tratamiento, la mayoria de los parametros valorables mejoraron significativamente, a las dosis diarias de 400 mg I.M. cada 12 hrs., principalmente en lo referente a la resolucion del dolor y a la mejoria de la motilidad articular. Los efectos secundarios observados se circunscribieron al sitio de su aplicacion. En general, en este estudio pudo comprobarse la eficacia de indoprofen en el tratamiento de la osteoartrosis