Lepra: puesta al día. Definición, patogénesis, clasificación, diagnóstico y tratamiento / Leprosy. An Update: Definition, Pathogenesis, Classification, Diagnosis, and Treatmen

La lepra es una enfermedad granulomatosa crónica causada por una micobacteria (M. leprae) que presenta predisposición por la piel y los nervios periféricos. La lepra continúa siendo endémica en distintas regiones del mundo. La presentación clínica de la enfermedad depende del estado inmunológico del paciente al adquirirla y de la evolución de la misma. Es una infección que se asocia a discapacidad y marginación. El diagnóstico de lepra es clínico y se hace al tener uno o más de los signos cardinales establecidos por la OMS: máculas hipopigmentadas o eritematosas con disminución de la sensibilidad, engrosamiento de los nervios periféricos y la demostración de bacilos ácido alcohol resistentes en una baciloscopia o biopsia de piel, con pérdida de anexos en los sitios afectados. El tratamiento consta de tres fármacos: rifampicina, clofazimina y dapsona. Existen principalmente dos modalidades de tratamiento dependiendo de la presentación clínica del paciente: paucibacilar o multibacilar (AU)

Leprosy is a chronic granulomatous disease caused by the bacillus Mycobacterium leprae. It primarily affects the skin and peripheral nerves and is still endemic in various regions of the world. Clinical presentation depends on the patient's immune status at the time of infection and during the course of the disease. Leprosy is associated with disability and marginalization. Diagnosis is clinical and is made when the patient has at least 1 of the following cardinal signs specified by the World Health Organization: hypopigmented or erythematous macules with sensory loss; thickened peripheral nerves; or positive acid-fast skin smear or skin biopsy with loss of adnexa at affected sites. Leprosy is treated with a multidrug combination of rifampicin, clofazimine, and dapsone. Two main regimens are used depending on whether the patient has paucibacillary or multibacillary disease (AU)

Leprosy. An update: definition, pathogenesis, classification, diagnosis, and treatment.

Leprosy is a chronic granulomatous disease caused by the bacillus Mycobacterium leprae. It primarily affects the skin and peripheral nerves and is still endemic in various regions of the world. Clinical presentation depends on the patient's immune status at the time of infection and during the course of the disease. Leprosy is associated with disability and marginalization. Diagnosis is clinical and is made when the patient has at least 1 of the following cardinal signs specified by the World Health Organization: hypopigmented or erythematous macules with sensory loss; thickened peripheral nerves; or positive acid-fast skin smear or skin biopsy with loss of adnexa at affected sites. Leprosy is treated with a multidrug combination of rifampicin, clofazimine, and dapsone. Two main regimens are used depending on whether the patient has paucibacillary or multibacillary disease.

Combination chemotherapy with docetaxel and cisplatin for locally advanced and metastatic gastric cancer.

BACKGROUND: Poor treatment results obtained with palliative chemotherapy for advanced gastric cancer indicate the need for new effective and well-tolerated regimens. PATIENTS AND METHODS: Forty-three patients with locally advanced or metastatic gastric cancer were enrolled in a phase II study to evaluate the efficacy and safety of combination chemotherapy with doxetacel 75 mg/m2 and cisplatin 75 mg/m2 given every three weeks. RESULTS: Thirty-nine patients were evaluable for response. Four achieved a complete response and twelve a partial response, for an overall response rate of 37.2% (16 of 43 patients; 95% confidence interval (CI): 22.98-53.72). Median time to progression was 6.1 months and median overall survival 10.4 months. Forty-two percent of all patients were still alive at one year and twelve percent at two years. The major toxicity was leukopenia which reached grade 3-4 in 18.6% (n = 8) of the patients. However, no febrile neutropenia occurred. Non-haematological toxicities were usually mild to moderate. Grade 3 toxicities included diarrhea (9% of the patients), nausea and vomiting (7%), and alopecia (7%). Severe ototoxicity with or without peripheral neuropathy developed after completion of chemotherapy in two patients. CONCLUSIONS: These results suggest that the combination of docetaxel and cisplatin has moderate toxicity and is an effective regimen for the treatment of advanced gastric cancer, both with regard to response rate and survival.