ABSTRACT
BACKGROUND: The Center of Molecular Immunology of Cuba has developed a programme for the conducting of multicentre oncology clinical trials in primary healthcare centres since 2009. AIM: To evaluate the ability to conduct oncology clinical trials in primary health care. DESIGN & SETTING: A longitudinal, prospective, analytical study was developed between July 2010 and August 2020 in the Villa Clara province. METHOD: Structure, process, and outcome indicators were evaluated by the methods of a structured interview, direct observation, documentary observation, and databases analysis. The investigators' curricula vitae, the investigator site file, minutes of workshops, the monitoring reports, the clinical trial training records, and databases were employed as sources of information. The following criteria were considered adequate: when the indicator met the standard; and not adequate: when the indicator did not meet the standard. RESULTS: The six structure indicators reached adequate results and showed that the programme has allowed building of capacities to conduct clinical trials in primary care. The eight processes indicators and two outcome indicators were considered adequate too. Trials conducted in primary care showed better indicators of patient recruitment than secondary care. Both scenarios showed similar behaviour for the process indicators: retention, protocol compliance, and safety. Survival and satisfaction with health services were also comparable in both scenarios. CONCLUSION: The evaluation of the programme showed adequate indicators for conducting oncology clinical trials in primary care in Villa Clara and these were comparable to those determined in the secondary care.
ABSTRACT
Rickettsia sibirica mongolitimonae is considered a rare pathogen that can cause different clinical presentations. Approximately, one-third of the patients with this infection experience lymphangitis from the inoculation eschar to the draining lymph nodes, and, in that case, the infection is named "lymphangitis-associated rickettsiosis" (LAR). There are several reports of infections by this Rickettsia but none of LAR in children. We report a case of LAR in a Spanish child, which confirms the distribution of this agent in our country, and his implication in pediatric population.
Subject(s)
Lymphangitis , Rickettsia Infections , Rickettsia , Child , Humans , Lymphangitis/diagnosis , Rickettsia Infections/diagnosis , Rickettsia Infections/drug therapyABSTRACT
Lung cancer (LC) is the leading cause of cancer death and is responsible for more than one-quarter (27%) of all cancer deaths. Non-small-cell LC (NSCLC) is the main histological subtype of LC and is the leading cause of mortalities associated with cancer. This case report focused on a patient showing a history of chronic obstructive pulmonary disease (COPD) with a NSCLC squamous cell carcinoma (single mass with a diameter of 8×7 cm, without metastasis). Due to the COPD, neither a surgical treatment (pneumonectomy) nor chemotherapy was possible. After 15 days following the diagnosis, the patient was treated for 45 days with radiotherapy and the neurokinin-1 receptor, aprepitant (compassionate use, 1,140 mg/day). Radiotherapy was administered to the right lung and mediastinum, reaching 50.4 Gy and then overprinted to 65 Gy. In each successive control, the tumor volume decreased and, after 6 months of treatment, the chest computed tomography scan showed that the tumor mass had disappeared. No side-effects were observed during the combination therapy; in contrast, the patient was in very good general health with a weight gain and showing no biochemical analytical alteration. This case report suggests a witness episode to the antitumor effect of aprepitant/radiotherapy against NSCLC. Urgent development is required for clinical trials to test the combination treatment (radiotherapy and aprepitant) as an antitumor therapy for patients with LC.
ABSTRACT
The primary target for nicotine in the brain is the neuronal nicotinic acetylcholine receptor (nAChR). It has been well documented that nAChRs respond to chronic nicotine exposure by up-regulation of receptor numbers, which may underlie some aspects of nicotine addiction. In order to investigate the mechanism of nicotine-induced nAChR up-regulation, we have developed a cell culture system to assess membrane trafficking and nicotine-induced up-regulation of surface-expressed alpha(4)beta(2) nAChRs. Previous reports have implicated stabilization of the nAChRs at the plasma membrane as the potential mechanism of up-regulation. We have found that whereas nicotine exposure results in up-regulation of surface receptors in our system, it does not alter surface receptor internalization from the plasma membrane, postendocytic trafficking, or lysosomal degradation. Instead, we find that transport of nAChRs through the secretory pathway to the plasma membrane is required for nicotine-induced up-regulation of surface receptors. Therefore, nicotine appears to regulate surface receptor levels at a step prior to initial insertion in the plasma membrane rather than by altering their endocytic trafficking or degradation rates as had been previously suggested.
