Doxorubicin, doxorubicinol, cardiotoxicity, breast cancer, volumetric absorptive microsampling, LC-MS/MS.

<b>Background and Objective:</b> Doxorubicin is an anticancer therapy belonging to the anthracycline class, which has clinical activity in breast cancer. Doxorubicin can cause cardiotoxic effects due to the formation of doxorubicinol as its main metabolite. The purpose of this study was to obtain the optimum sample preparation conditions for the analysis of doxorubicin in VAMS and as a form of therapeutic drug monitoring (TDM) in patients with cancer breasts. <b>Materials and Methods:</b> Analyze doxorubicin and doxorubicinol levels with Volumetric Absorptive Microsampling (VAMS) in patients' cancer breasts receiving doxorubicin in their therapeutic regimen. The sample was analyzed using Ultra Performance Liquid Chromatography tandem Mass Spectrometry (LC-MS/MS). The method uses deep linear range concentrations of 8-200 ng/mL for doxorubicin and 3-100 ng/mL for doxorubicinol. <b>Results:</b> Multiple reaction monitoring (MRM) value set at m/z 544.22>396.9 for doxorubicin; m/z 546.22>398.9 for doxorubicinol and m/z 528.5>362.95 for daunorubicin. The LLOQ value obtained was 8 ng/mL for doxorubicin and 3 ng/mL for doxorubicinol with linearity of 0.9904 for doxorubicin and 0.9902 for doxorubicinol. Analysis results show doxorubicin levels were in the range of 9.47 ng/mL to 87.84 ng/mL and doxorubicinol range between 4.24 and 54.02 ng/mL. <b>Conclusion:</b> Dosage cumulative doxorubicin ranges between 47.93 and 346.09 mg/m²; with this, the risk of cardiomyopathy in the patients surveyed is under 4%, according to the literature.

Características clínicas y demográficas de los pacientes con apnea obstructiva de sueño manejados quirúrgicamente en el servicio de otorrinolaringología del Hospital Militar Central entre los años 2016-2020 / Clinical and demographic characteristics of patients with obstructive sleep apnea surgically managed in the otorhinolaryngology service of the Central Military Hospital of Bogota between 2016-2020

Introducción: la apnea obstructiva del sueño (AOS) conlleva un alto riesgo cardiovascular, metabólico y neurológico. Los dispositivos de presión positiva continua (CPAP) o dispositivos de avance mandibular (DAM) pueden ferulizar la vía aérea superior (VAS) y mejorar la obstrucción; sin embargo, la adherencia es muy baja. Se ha demostrado que los procedimientos quirúrgicos de la VAS pueden llevar a una reducción significativa en la frecuencia de apneas e hipopneas. El objetivo del estudio fue describir las características clínicas y demográficas y los cambios en la somnolencia diurna excesiva, en el índice de apnea e hipopnea (IAH) y en la saturación de oxígeno (SpO2 ) de los pacientes con AOS manejados quirúrgicamente en el Servicio de Otorrinolaringología entre los años 2016 a 2020. Materiales y métodos: Se realizó un estudio observacional descriptivo tipo serie de casos. Resultados: se incluyeron nueve pacientes que cumplían los criterios de inclusión, el 77,8 % presentaban sobrepeso u obesidad. Se disminuyó la puntuación de la Epworth Sleepiness Scale (ESS) en el 100 % de los pacientes pre y posquirúrgicos. Adicionalmente, la polisomnografía (PSG) pre y posoperatoria mostró un aumento en la eficiencia de sueño con la mejoría de parámetros de oxigenación. Se encontró una disminución en el IAH en el 88,8 % de los pacientes. Conclusión: los hallazgos en este estudio sugieren que la cirugía de VAS es segura para realizar en pacientes con AOS. No todos los pacientes son candidatos a manejo quirúrgico y es importante una selección adecuada para disminuir las complicaciones.

Introduction: Obstructive sleep apnea (OSA) is a pathology that leads to a high risk of developing cardiovascular, metabolic, and neurological diseases. Positive airway pressure (CPAP) or mandibular advancement devices (MAD) can open superior airway (SAW) improve the obstruction, however, adherence is too low. It has already been shown that surgical SAW procedures, compared with medical management, can lead to a significant reduction in the frequency of apneas and hypopneas. The aim of this study was to describe the clinical and demographic characteristics, changes in excessive daytime sleepiness using Epworth Sleepiness Scale (ESS), apnea-hipopnea index (AHI) and SpO2 in patients with OSA managed surgically. Methods: A descriptive observational case series type study was carried out. Results: Nine patients were included, 77.8% were overweight or obese. A decrease in the ESS was found in 100% of the patients when pre- and post-operative scores were compared. Additionally, pre and postoperative polysomnography (PSG) showed an increase in sleep efficiency with improvement in oxygenation parameters such as mean saturation and minimum saturation. Regarding respiratory events, we found a decrease in AHI in 88.8% of patients. Conclusion: The findings in this study suggest that SAW surgery is safe to perform in patients with OSA. However, it is necessary to keep in mind that not all patients are candidates for surgical management and that adequate patient selection is important to reduce procedural complications.

Manejo del tinnitus con estimulador de sonido con especificidad frecuencial / Treatment of tinnitus with sound stimulator with frequency specificity

Introducción: el tinnitus tiene efectos deletéreos sobre la calidad de vida de un paciente. Cuando la lesión está a nivel coclear, se puede usar acondicionamiento acústico para su tratamiento. Objetivo: determinar el cambio en la percepción del tinnitus antes y después de la intervención terapéutica. Metodología: se planteó un estudio de serie de casos. Pacientes con tinnitus no pulsátil de moderado a catastrófico tratados con estimulador REVE 134™. Se incluyeron pacientes que no mejoraron luego de 3 meses con tratamiento médico. Se les practicó microaudiometría (67 frecuencias) para definir la región coclear afectada. Se excluyeron pacientes con umbrales audiométricos > 60 dB, aquellos con lesiones retrococleares y quienes no desearon participar. Las variables de desenlace fueron Tinnitus Handicap Inventory (THI), escala visual análoga (EVA) y Tinnitus Reaction Questionnaire (TQR), que se midieron pretratamiento y a los 3 y 6 meses postratamiento. Resultados: se incluyeron 11 pacientes (hombres = 5, mujeres = 6). En 5 casos el tinnitus fue bilateral y en 6, unilateral. Los valores pretratamiento fueron THI = 61,4 ± 27,4, EVA = 6,9 ± 2,7 y TQR = 43,2 ± 31,9 (Kolmogorov-Smirnov, p > 0,05). Hubo mejoría estadísticamente significativa con el tratamiento, THI (3 meses = 30,6 ± 21,1; 6 meses = 19 ± 19,2), EVA (3 meses = 5,6 ± 2,3; 6 meses = 3,5 ± 2,0), TQR (3 meses = 25,6 ± 20,0; 6 meses = 14,3 ± 19,9); ANOVA de medidas repetidas (p = 0,007, p = 0,027, p = 0,037; respectivamente). Conclusión: el tratamiento con REVE 134™ fue efectivo en pacientes con tinnitus no pulsátil de moderado a catastrófico.

Introduction: tinnitus can affect the quality of life of a patient. Acoustic stimulation can be used as treatment when the cause of tinnitus is located in the cochlea. Objective: To determine changes in tinnitus perception before and after therapeutic intervention. Methodology: We performed a case series study. Patients with nonpulsatile tinnitus, with no improvement with medical therapy, and moderate to catastrophic grade were treated with the REVE 134™ system. A microaudiometry (67 frequencies) was performed to determine the cochlear regions affected. Patients with auditory thresholds >60 dB, retrocochlear pathologies and who did not want to participate in the study were excluded. The variables studied were Tinnitus Handicap Inventory (THI), Visual Analog Scale (VAS) and Tinnitus Reaction Questionnaire (TQR), that were measured before, three and six months after treatment. Results: 11 patients (male: 5, women: 6) were included. In 5 of them, tinnitus was bilateral and in 6, unilateral. Pretreatment values were: THI = 61.4 ± 27.4, VAS = 6.9 ± 2.7 and TQR = 43.2 ± 31.9 (Kolmogorov-Smirnov, p > 0.05). We found improvement in tinnitus perception with the therapy, and this values had statistical significance (THI: 3rd month = 30.6 ± 21.1; 6th month = 19 ± 19.2), VAS (3rd month = 5.6 ± 2.3; 6th month = 3.5 ± 2.0), TQR (3rd month = 25.6 ± 20.0; 6th month =14.3 ± 19.9); repetitive measures of ANOVA (p = 0.007, p = 0.027, p = 0.037; respectively). Conclusion: Treatment with REVE 134™ was effective in patients with moderate to catastrophic tinnitus.

As, Cr, Hg, Pb, and Cd Concentrations and Bioaccumulation in the Dugong Dugong dugon and Manatee Trichechus manatus: A Review of Body Burdens and Distribution.

The death of dozens of manatees Trichechus manatus recently in Tabasco, Mexico, has captured international attention. Speculation about possible causes include water and food contamination by metals. Although federal authorities have ruled out water chemical pollution, the cause of these deaths is still awaiting conclusive laboratory results. Present work seeks to summarize information currently available on non-essential metals and those of great toxicological relevance in Sirenia (dugongs and manatees), highlighting its body distribution, presence in blood, and its relationship with their geographical distribution, gender and age, whenever possible. This paper focuses on the five elements: As, Cr, Hg, Pb and Cd, which are commonly considered as threats for marine mammals and reported in Sirenia. Some of these metals (Cr and Cd) were thought to be related to the recent deaths in Tabasco. All five elements are accumulated by Sirenia at different levels. Metal presence is associated to their diet but does not necessarily imply adverse effects for dugongs and manatees. Toxicological aspects and the human consumption risk in case of any illegal or traditional consumption in some cultures are discussed. Important toxicological research areas that need to be addressed are highlighted.