Quimioterapia antineoplásica frente al cáncer de mama en mujeres embarazadas: Prevención de Extravasaciones / Antineoplastic chemotherapy against breast cancer in pregnant women: Extravasation Prevention

El cáncer gestacional se puede definir como el cáncer que ocurre durante el embarazo o durante el primer año posterior al parto. Entre ellos, el cáncer de mama ocupa el primer lugar en frecuencia con una incidencia en aumento y que se sitúa cerca de 1 por cada 3.000 mujeres embarazadas. En la mujer embarazada el diagnóstico de cáncer representa un desafío en términos de manejo clínico, debido a la necesidad de garantizar la seguridad materna y asegurar el estado de gestación. Este tiende a retrasarse y detectarse en estadios más tardíos debido a que los síntomas asociados pueden relacionarse fácilmente con una situación normal de gestación. Las embarazadas diagnosticadas de cáncer deben ser evaluadas por un comité multidisciplinario de tumores, especializado en cáncer durante el embarazo. Uno de los tratamientos utilizados para el abordaje del cáncer de mama es la quimioterapia antineoplásica, que debe ser administrada en un hospital, atendiendo a diferentes factores como son el estado general del paciente, las posibles enfermedades previas, el tipo, estadio y localización del tumor, así como la semana de gestación en la que se encuentra la mujer. A partir de la semana 13-14 de gestación puede iniciarse el tratamiento, siendo los regímenes más utilizados a día de hoy: ciclos de 3 semanas de FAC (5-fluorouracilo, doxorrubicina y ciclofosfamida), FEC (5-fluorouracilo, epirubicina y ciclofosfamida), AC (doxorrubicina y ciclofosfamida) y EC (epirubicina y ciclofosfamida) o epirubicina semanal como monoterapia. Asimismo, destaca el uso de los taxanos (paclitaxel como agente único). La enfermera constituye un pilar fundamental dentro del equipo multidisciplinario de tumores, especializado en cáncer de mama durante el embarazo, que atenderá y acompañará a la embarazada durante todo el proceso de la enfermedad. El cáncer de mama, y más en la embarazada, conlleva una serie de cambios en su vida que requieren diferentes procesos de adaptación física, psicológica y social (AU)

Gestational cancer can be defined as cancer that occurs during pregnancy or within the first year after delivery. Among them, breast cancer occupies the first place in frequency with an increasing incidence that is situated at about 1 per 3.000 pregnant women. In pregnant women, the diagnosis of cancer represents a challenge in terms of clinical management, due to the need to guarantee maternal safety and ensure the state of pregnancy. This tends to be delayed and detected at later stages because the associated symptoms can be easily related to a normal pregnancy situation. Pregnant women diagnosed with cancer should be evaluated by a multidisciplinary tumor team, specialized in cancer during pregnancy. One of the treatments used to address breast cancer is antineoplastic chemotherapy, which must be administered in a hospital, taking into account different factors such as the general condition of the patient, possible previous diseases, the type, stage and location of the tumor, as well as the week of gestation in which the woman is. Treatment can be started from week 13-14 of gestation, the most widely used regimens to date are: 3-week cycles of FAC (5-fluorouracil, doxorubicin and cyclophosphamide), FEC (5-fluorouracil, epirubicin and cyclophosphamide), AC (doxorubicin and cyclophosphamide) and EC (epirubicin and cyclophosphamide) or weekly epirubicin as monotherapy. Likewise, the use of taxanes (paclitaxel as a single agent) stands out. The nurse is a fundamental pillar within the multidisciplinary team of tumors, specialized in breast cancer during pregnancy, who will care for and accompany the pregnant woman throughout the disease process. Breast cancer, and more in pregnant women, entails a series of changes in their lives that require different processes of physical, psychological and social adaptation. (AU)

Ictus vertebrobasilar: registro de tiempos de asistencia y factores relacionados con la atención precoz / Vertebrobasilar stroke: recording of care times and factors related to early care

OBJETIVO: Conocer el estado de la cadena asistencial del ictus vertebrobasilar en el área de referencia de nuestro centro hospitalario, evaluando los factores relacionados con la activación del código ictus y tiempos de actuación. PACIENTES Y MÉTODOS: Estudio observacional, analítico y retrospectivo, realizado durante el período 2017-2018, que incluye a pacientes ingresados con diagnóstico de ictus confirmado por neuroimagen. Se recogieron los datos de manera consecutiva durante su valoración en urgencias e ingreso en la unidad de ictus. Se evaluaron factores clínicos, síntomas y signos neurológicos en el momento del ingreso, detección de oclusión de gran vaso y variables relacionadas con la cadena asistencial: primera asistencia, activación de código ictus, tiempo inicio-puerta y tiempo puerta-imagen. RESULTADOS: Se incluyó a 954 pacientes, 233 con ictus vertebrobasilar. Los tiempos inicio-puerta y puerta-imagen registrados fueron significativamente mayores para el ictus de circulación posterior. Los factores relacionados con menor retraso en el tiempo inicio-puerta fueron: National Institute of Health Stroke Scale > 4, disartria y pérdida de fuerza. Se observó un menor retraso en el tiempo puerta-imagen para las variables: primera asistencia por servicio de emergencias médicas, disartria, pérdida de fuerza y presencia de más de un síntoma/signo. Fueron variables predictoras de activación del código ictus el antecedente de fumador, la clínica de disartria o pérdida de fuerza, y la presencia de más de una manifestación clínica. CONCLUSIONES: Existen dificultades en la fase prehospitalaria para identificar el ictus vertebrobasilar, lo cual origina retrasos en los tiempos de asistencia. La formación en conocimientos sobre la clínica de ictus vertebrobasilar podría permitir la optimización de esos tiempos

AIM: To determine the state of the vertebrobasilar stroke care chain in our hospital reference area by evaluating the factors related to stroke code activation and management times. PATIENTS AND METHODS: Observational, analytical and retrospective study, carried out during the period 2017-2018, which includes patients admitted with a diagnosis of stroke confirmed by neuroimaging. Data were collected consecutively during assessment in the emergency department and admission to the stroke unit. Clinical factors, neurological signs and symptoms at the time of admission, detection of large-vessel occlusion and variables related to the care chain were evaluated, namely, basic medical attention, stroke code activation, onset-to-door time and door-to-imaging time. RESULTS: Altogether 954 patients were included in the study, 233 with vertebrobasilar stroke. The onset-to-door and door-to-imaging times registered were significantly higher for posterior circulation stroke. The factors related to a lower delay in onset-to-door time were: National Institutes of Health Stroke Scale > 4, dysarthria and loss of strength. A shorter delay in door-to-imaging time was observed for the variables basic attention by medical emergency service, dysarthria, loss of strength and presence of more than one symptom/sign. Predictive variables for stroke code activation were a history of smoking, clinical signs of dysarthria or loss of strength, and the presence of more than one clinical manifestation. CONCLUSIONS: In the pre-hospital phase is is difficult to identify vertebrobasilar stroke, which causes delays in care times. Training in knowledge of the clinical features of vertebrobasilar stroke could allow these times to be optimized

Crisis de la prestación farmacéutica en los centros penitenciarios: el tratamiento de la hepatitis C / Crisis in pharmaceutical provisions within prisons: sanitary treatment of hepatitis C

El inicio de la andadura de nuevos medicamentos antivirales, como el boceprevir y telaprevir, específicos para el tratamiento de la hepatitis C, trajo nuevas esperanzas de curación para los afectados; esperanzas que se concentraron especialmente en un grupo ciudadano con una alta prevalencia de la enfermedad como la población reclusa y que chocaron de frente con las limitaciones que conllevaban: el aumento de los efectos adversos y el considerable aumento del coste del tratamiento. La ineficaz gestión de los tratamientos por parte de las instituciones, centradas más en las reclamaciones entre comunidades autónomas y el Gobierno por la asunción de los costes, revelaron en el seno del conflicto jurídico un problema de fondo con respecto a la prestación farmacéutica en los centros penitenciarios, donde se pusieron de relieve el incumplimiento del trasvase de competencias en materia de sanidad penitenciaria y la anacronía de la normativa penitenciaria en materia de fármacos con respecto a la legislación vigente, así como la desorganización de la prestación farmacéutica en los recintos penitenciarios. Problemas todos ellos que imponen la necesidad de la reflexión sobre la gestión de un sistema sanitario que afecta a una parte de la población privada de libertad y que tiende a ser olvidada

The beginning of the new antiviral drugs, such as boceprevir and telaprevir, specific for the treatment of Hepatitis C, brought new hopes of healing for those affected; hopes that especially affected to a group of people with a high prevalence of the disease, as the inmate population, and that clashed head-on with the limitations that entailed: the increase in side effects and the considerable increase in the cost of treatment. The inefficient management of the treatments by the institutions, focused more on the claims between the Autonomous Communities and the Government for the assumption of the costs, revealed in the heart of the legal conflict a substantive problem regarding the pharmaceutical provision in the prisons, where the breach of the transfer of powers in the field of prison health, and the anachronism of prison regulations regarding drugs with respect to current legislation, as well as the disorganization of pharmaceutical provision in prisons were highlighted. Problems all of them that impose the need for reflection on the management of a health system that affects a part of the population deprived of liberty and that tends to be forgotten

Nutritional profile of multiple sclerosis / Perfil nutricional de la esclerosis múltiple

Background: multiple sclerosis (MS) is an inflammatory, neurodegenerative disease of the central nervous system. Weight loss and malnutrition are prevalent in advanced stages of MS. Objective: the aim of this study was to define the nutritional profile in moderate-advanced MS (especially by documenting malnutrition) and its evolution. Methods: a case-control study was designed; cross-sectional observational study was complemented by a 12-month prospective longitudinal observational study of MS patients. Nutritional status was evaluated by collecting clinical, anthropometric, dietary and analytical data. Results: one hundred and twenty-four patients with MS and 62 controls were recruited; 8% of the patients were malnourished or at risk of malnutrition. Only MS patients with advanced disability needed nutritional support. During the follow-up, five patients died and four of them received nutritional support. Conclusions: malnutrition was unusual in our sample of patients with moderate-advanced MS. The need for nutritional support is related to dysphagia in patients with advanced neurological disability. The nutritional status of patients with moderate-advanced MS is defined by a tendency to overweight and by the decrease in basal energy expenditure and handgrip strength test in relation to the loss of muscle mass. The deficient intake of polyunsaturated fatty acids, fiber and vitamin D is exacerbated in the evolution of the disease

Introducción: la esclerosis múltiple (EM) es una enfermedad inflamatoria y neurodegenerativa del sistema nervioso central. La pérdida de peso y la malnutrición son frecuentes en fases avanzadas de la EM. Objetivo: el objetivo de este estudio fue definir el perfil nutricional de la EM en estadio moderado-avanzado (especialmente, documentando la malnutrición) y su evolución a 12 meses. Métodos: se realizó un estudio de casos-controles; el estudio observacional transversal se complementó con un estudio observacional longitudinal prospectivo a 12 meses de los pacientes con EM. El estado nutricional se evaluó mediante la recogida de datos clínicos, antropométricos, dietéticos y analíticos. Resultados: se incluyeron en el estudio 124 pacientes con EM y 62 controles. El 8% de los pacientes estaban desnutridos o en riesgo de desnutrición. Solo los pacientes con EM con discapacidad avanzada necesitaban soporte nutricional. Durante el seguimiento, cinco pacientes fallecieron y cuatro de ellos estaban recibiendo soporte nutricional. Conclusiones: la desnutrición es infrecuente en nuestra muestra de pacientes con EM moderada-avanzada. La necesidad de apoyo nutricional está relacionada con la disfagia en pacientes con discapacidad neurológica avanzada. El estado nutricional de los pacientes con EM moderada-avanzada se define por una tendencia al sobrepeso y por valores bajos en el gasto energético basal y en la dinamometría manual en relación con la pérdida de masa muscular. La ingesta deficiente de ácidos grasos poliinsaturados, fibra y vitamina D se acentúa en la evolución de la enfermedad

Nutritional profile of multiple sclerosis.

INTRODUCTION: Background: multiple sclerosis (MS) is an inflammatory, neurodegenerative disease of the central nervous system. Weight loss and malnutrition are prevalent in advanced stages of MS. Objective: the aim of this study was to define the nutritional profile in moderate-advanced MS (especially by documenting malnutrition) and its evolution. Methods: a case-control study was designed; cross-sectional observational study was complemented by a 12-month prospective longitudinal observational study of MS patients. Nutritional status was evaluated by collecting clinical, anthropometric, dietary and analytical data. Results: one hundred and twenty-four patients with MS and 62 controls were recruited; 8% of the patients were malnourished or at risk of malnutrition. Only MS patients with advanced disability needed nutritional support. During the follow-up, five patients died and four of them received nutritional support. Conclusions: malnutrition was unusual in our sample of patients with moderate-advanced MS. The need for nutritional support is related to dysphagia in patients with advanced neurological disability. The nutritional status of patients with moderate-advanced MS is defined by a tendency to overweight and by the decrease in basal energy expenditure and handgrip strength test in relation to the loss of muscle mass. The deficient intake of polyunsaturated fatty acids, fiber and vitamin D is exacerbated in the evolution of the disease.

INTRODUCCIÓN: Introducción: la esclerosis múltiple (EM) es una enfermedad inflamatoria y neurodegenerativa del sistema nervioso central. La pérdida de peso y la malnutrición son frecuentes en fases avanzadas de la EM. Objetivo: el objetivo de este estudio fue definir el perfil nutricional de la EM en estadio moderado-avanzado (especialmente, documentando la malnutrición) y su evolución a 12 meses. Métodos: se realizó un estudio de casos-controles; el estudio observacional transversal se complementó con un estudio observacional longitudinal prospectivo a 12 meses de los pacientes con EM. El estado nutricional se evaluó mediante la recogida de datos clínicos, antropométricos, dietéticos y analíticos. Resultados: se incluyeron en el estudio 124 pacientes con EM y 62 controles. El 8% de los pacientes estaban desnutridos o en riesgo de desnutrición. Solo los pacientes con EM con discapacidad avanzada necesitaban soporte nutricional. Durante el seguimiento, cinco pacientes fallecieron y cuatro de ellos estaban recibiendo soporte nutricional. Conclusiones: la desnutrición es infrecuente en nuestra muestra de pacientes con EM moderada-avanzada. La necesidad de apoyo nutricional está relacionada con la disfagia en pacientes con discapacidad neurológica avanzada. El estado nutricional de los pacientes con EM moderada-avanzada se define por una tendencia al sobrepeso y por valores bajos en el gasto energético basal y en la dinamometría manual en relación con la pérdida de masa muscular. La ingesta deficiente de ácidos grasos poliinsaturados, fibra y vitamina D se acentúa en la evolución de la enfermedad.

Evaluation of the Association Metformin: Plantago ovata Husk in Diabetic Rabbits.

In this experimental study we have investigated whether the inclusion of the dietary fiber Plantago ovata husk could be recommended as coadjuvant in treatments with oral hypoglycemic drugs. We evaluated the use of Plantago ovata husk-metformin association in diabetic rabbits by determining its effects on glucose and insulin concentrations. Six groups of 6 rabbits were used. Groups 1 to 3 were fed with standard chow and groups 4 to 6 with chow supplemented with Plantago ovata husk (3.5 mg/kg/day). Two groups (numbers 1 and 4) were used as controls (receiving standard or supplemented chow), two groups (numbers 2 and 5) received metformin orally, and the other two (numbers 3 and 6) were treated orally with metformin and psyllium. Plasma glucose concentrations were lower in groups fed with fiber-supplemented chow whereas insulin levels showed important interindividual variations. Glucose pharmacokinetics parameters showed significant differences in Cmax and t(max) in relation to fiber intake. Insulin pharmacokinetics parameters after treatment with oral metformin showed an important increase in Cmax, AUC, and t(max) in animals fed with fiber. We conclude that Plantago ovata husk intake can contribute to the oral antihyperglycemic treatment of type 2 diabetes.

A randomised clinical trial to evaluate the effects of Plantago ovata husk in Parkinson patients: changes in levodopa pharmacokinetics and biochemical parameters.

BACKGROUND: Plantago ovata husk therapy could be used in patients with Parkinson disease to reduce the symptoms of gastrointestinal disorders, but it is important to know whether this compound modifies levodopa pharmacokinetics. The maintenance of constant plasma concentrations of levodopa abolishes the clinical fluctuations in parkinsonian patients. The aim of this randomised clinical trial was to establish the influence of the fiber Plantago ovata husk in the pharmacokinetics of levodopa when administered to Parkinson patients well controlled by their oral medication. METHODS: To evaluate the effects of this fiber on several biochemical parameters. 18 volunteers participated in the study and received alternatively two treatments (Plantago ovata husk or placebo) with their usual levodopa/carbidopa oral dose. On days 0 (initial situation), 14 and 35 of the study, blood samples were taken to assess levodopa pharmacokinetics and to determine biochemical parameters. RESULTS: Levodopa Cmax was very similar in the initial situation (603.2 ng/ml) and after placebo administration (612.0 ng/ml), being slightly lower (547.8 ng/ml) when Plantago ovata husk was given. AUC was very similar in the three groups: initial situation.- 62.87 µg.min/ml, fiber treatment.- 64.47 µg.min/ml and placebo treatment.- 65.10 µg.min/ml. Fiber reduced significantly the number of peaks observed in the levodopa concentrations, maintaining concentrations more stable. No significant differences were found in total cholesterol, LDL-cholesterol and triglycerides with the administration of Plantago ovata husk. CONCLUSIONS: Plantago ovata husk administration caused a smoothing and homogenization of levodopa absorption, providing more stable concentrations and final higher levels, resulting in a great benefit for patients. TRIAL REGISTRATION: EudraCT2006-000491-33.

Enrofloxacin: pharmacokinetics and metabolism in domestic animal species.

Enrofloxacin is a fluorquinolone exclusively developed for use in veterinary medicine (1980). The kinetics of enrofloxacin are characterized, in general terms, by high bioavailability in most species and rapid absorption after IM, SC or oral administration. However, several studies reported that enrofloxacin showed low bioavailability after oral administration in ruminants. This drug has a broad distribution in the organism, excellent tissue penetration and long serum half-life. Also, enrofloxacin is characterized by a low host toxicity, a broad antibacterial spectrum and high bactericidal activity against major pathogenic bacteria (both Gram-positive and Gram-negative), and intracellular organisms found in diseased animals. The kinetics vary according to the route of administration, formulation, animal species, age, body condition, and physiological status, all of which contribute to differences in drug efficacy. The pharmacokinetic properties of drugs are closely related to their pharmacological efficiency, so it is important to know their behavior in each species that is used. This article reviews the pharmacokinetics of enrofloxacin in several domestic animal species.

Tissue distribution of enrofloxacin after intramammary or simulated systemic administration in isolated perfused sheep udders.

OBJECTIVE: To determine the tissue distribution of enrofloxacin after intramammary or simulated systemic administration in isolated perfused sheep udders by measuring its concentration at various sample collection sites. SAMPLE: 26 udders (obtained following euthanasia) from 26 healthy lactating sheep. PROCEDURES: For each isolated udder, 1 mammary gland was perfused with warmed, gassed Tyrode solution. Enrofloxacin (1 g of enrofloxacin/5 g of ointment) was administered into the perfused gland via the intramammary route or systemically via the perfusion fluid (equivalent to a dose of 5 mg/kg). Samples of the perfusate were obtained every 30 minutes for 180 minutes; glandular tissue samples were obtained at 2, 4, 6, and 8 cm from the teat base after 180 minutes. The enrofloxacin content of the perfusate and tissue samples was analyzed via high-performance liquid chromatography with UV detection. RESULTS: After intramammary administration, maximun perfusate enrofloxacin concentration was detected at 180 minutes and, at this time, mean tissue enrofloxacin concentration was detected and mean tissue enrofloxacin concentration was 123.80, 54.48, 36.72, and 26.42 µg/g of tissue at 2, 4, 6, and 8 cm from the teat base, respectively. Following systemic administration, perfusate enrofloxacin concentration decreased with time and, at 180 minutes, tissue enrofloxacin concentrations ranged from 40.38 to 35.58 µg/g of tissue. CONCLUSIONS AND CLINICAL RELEVANCE: By 180 minutes after administration via the intramammary or systemic route in isolated perfused sheep mammary glands, mean tissue concentration of enrofloxacin was greater than the minimum inhibitory concentration required to inhibit growth of 90% of many common mastitis pathogens in sheep. Use of either route of administration (or in combination) appears suitable for the treatment of acute mastitis in sheep.

Pharmacokinetic behavior of doxycycline after intramuscular injection in sheep.

OBJECTIVE: To determine the pharmacokinetics of a commercial formulation of doxycycline hyclate after IM administration of a single dose to sheep. ANIMALS: 11 healthy domestic sheep. PROCEDURES: For each sheep, doxycycline was administered as a single dose of 20 mg/kg, IM. Blood samples were obtained prior to and for 84 hours after doxycycline administration. Plasma concentrations of doxycycline were determined via high-performance liquid chromatography with UV detection. Pharmacokinetic data were analyzed with noncompartmental methods. RESULTS: Mean ± SD values for pharmacokinetic parameters included maximum plasma concentration (2.792 ± 0.791 µg/mL), time to reach maximum plasma concentration (0.856 ± 0.472 hours), mean residence time (91.1 ± 40.78 hours), elimination half-life (77.88 ± 28.45 hours), and area under the curve (65.67 ± 9.877 µg•h/mL). CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that doxycycline had prolonged absorption and elimination in sheep after IM administration. A daily dose of 20 mg/kg would be sufficient to reach effective plasma concentrations against Chlamydia spp (minimum inhibitory concentration, 0.008 to 0.031 µg/mL) and Staphylococcus aureus (minimum inhibitory concentration, 0.12 µg/mL). Doxycycline administered IM could be an option for therapeutic use in sheep, although further studies are needed.

Seguridad de la ivermectina: toxicidad y reacciones adversas en diversas especies de mamíferos / Safety of ivermectin: toxicity and adverse reactions in several mammal species

La ivermectina es un fármaco antiparasitario muy utilizado en Medicina Veterinaria, dado su espectro de actividad que abarca tanto endo como ectoparásitos, elevada eficacia y amplio margen de seguridad. No obstante, su administración puede dar lugar a efectos tóxicos. La mayoría de ellos derivan de la sobredosificación del compuesto, aunque también se han descrito, a dosis terapéuticas, casos de susceptibilidad extrema a los efectos neurotóxicos del fármaco en determinadas razas o subpoblaciones de animales, así como reacciones anafilácticas por la destrucción masiva de parásitos.

A review of the pharmacological interactions of ivermectin in several animal species.

The antiparasitic activity of ivermectin depends on the presence of an active drug concentration at the site of parasites location for an adapted length of time. Ivermectin interactions with another concurrently administered drug can occur. Concomitant administration of some drugs can increase the bioavailability of simultaneously administered ivermectin. This can, in some cases, become a useful pharmacological strategy to improve its antiparasitic efficacy and to delay the development of resistance in livestock or, in other cases, lead to adverse drug reactions and toxicities. On the other hand, other interactions can result in lower levels of this drug, determining that moderate resistant residual populations of the parasites may persist to contaminate pastures. The characterisation of ivermectin interactions can be used to predict and optimise the value of the parasiticide effects. This article reviews the pharmacological interactions of ivermectin in several domestic animal species.

The pharmacokinetics and interactions of ivermectin in humans--a mini-review.

Ivermectin is an antiparasitic drug with a broad spectrum of activity, high efficacy as well as a wide margin of safety. Since 1987, this compound has a widespread use in veterinary medicine and it use has been extended in humans. Here we present a brief review of the information available regarding the pharmacokinetics and interactions of ivermectin in humans. Awareness of these characteristics could improve the clinical efficacy of Ivermectin. All Authors declare that they do not have any Conflict of interest and that the work is original. All Authors agree that the contents of the manuscript are confidential and will not be copyrighted, submitted, or published elsewhere (including the Internet), in any language, while acceptance by the Journal is under consideration.