ABSTRACT
Alzheimer's disease is the leading cause of dementia worldwide and a critical public health problem. While deaths from cardiovascular diseases have decreased, those attributed to Alzheimer's disease have increased in recent years with no curative treatment to date. In this context, effective treatment development has become a global priority. Aducanumab is a human anti-amyloid ß monoclonal antibody approved by the FDA in June 2021 for the treatment of Alzheimer's disease but failed to show the expected clinical efficacy in phase III trials. This review analyzes the history of its controversial acceptance, implications, and prospects for future treatment.
La enfermedad de Alzheimer es la principal causa de demencia en todo el mundo y representa un importante problema de salud pública. Si bien las muertes por enfermedades cardiovasculares han disminuido, las atribuidas a la enfermedad de Alzheimer han aumentado en los últimos años y hasta la fecha no existe tratamiento curativo. Por este motivo, el desarrollo de un tratamiento eficaz se ha convertido en una prioridad mundial. Aducanumab es un anticuerpo monoclonal anti-amiloide ß humano aprobado para el tratamiento de la enfermedad de Alzheimer en junio de 2021 por la FDA, sin la eficacia clínica esperada en los ensayos de fase III. Esta revisión analiza la historia de su controvertida aceptación, implicaciones y perspectivas para el tratamiento futuro.
Subject(s)
Alzheimer Disease , Antibodies, Monoclonal, Humanized , Drug Approval , Humans , Antibodies, Monoclonal, Humanized/therapeutic use , Alzheimer Disease/drug therapy , United StatesABSTRACT
Abstract: Background: This systematic review aims to report the current knowledge of retinoblastoma (Rb) and its implications in Mexico. We analyzed clinical and demographic data of patients with Rb at select hospitals with Rb programs or that treat and refer patients with Rb, and identified the gaps in practice. We propose solutions to improve diagnosis, provide adequate treatment, and improve patient uptake. Methods: A general review was conducted on PubMed of peer-reviewed literature on Rb in Mexico. Ophthalmology Department Heads or Directors of Rb programs at seven hospitals in Mexico were contacted for data available on their patients with Rb. Results: Five hospitals provided clinical data on 777 patients with Rb in a period spanning 2000-2015. Of the 122 patients with treatment, 83.4% underwent enucleation. From 33 to 45.3% of Rb tumors in Mexico reach an advanced intraocular stage of development. Knowledge of the disease is limited, despite the fact that the Mexican Retinoblastoma Group has elaborated Rb treatment guidelines and is developing a national Rb registry. Especially in the Southern states, prevalence and outcomes are comparable to African and Asian countries, and only few patients are referred to national treatment centers. Only three institutions have comprehensive Rb programs. Conclusions: There is an immediate need in Mexico to expand primary care providers' knowledge of Rb and to expand and upgrade current Rb programs to meet the needs of the population adequately. Diagnosis and care of Rb patients in Mexico can also be improved by the establishment of a national Rb registry and a national early detection program, and by increased use of the national treatment protocol.
Resumen: Introducción: Esta es una revisión sistemática de los conocimientos actuales del retinoblastoma (Rb) y sus implicaciones en los centros de referencia más importantes del país. Se presenta un análisis situacional de los programas de Rb en México, se identificaron las brechas en la práctica, y se proponen soluciones para mejorar el diagnóstico, tratamiento y referencia oportuna de pacientes. Métodos: Se realizó una revisión general de la literatura publicada sobre Rb en México a través de PubMed. Los datos sociodemográficos de pacientes con Rb fueron obtenidos a través de los directores de programas de retinoblastoma en siete hospitales. Resultados: Casi una tercera parte de los casos Rb se diagnostican en estadios avanzados. A pesar de la existencia del Grupo Mexicano de Retinoblastoma, el conocimiento de esta patología entre los médicos es limitado. Las diferencias en el tratamiento son notorias en el sur del país, donde la prevalencia y los resultados son comparables con África y Asia. Solamente tres instituciones a nivel nacional tienen un programa establecido de Rb. Conclusiones: Existe la necesidad inmediata de consolidar los programas de Rb para cubrir las necesidades reales de la población. Se requiere mejorar la educación del médico de primer contacto, establecer el registro nacional de casos y el programa de detección temprana, establecer los programas de salvamento ocular nacional, y reforzar las instituciones que brindan tratamiento.
Subject(s)
Humans , Retinoblastoma/diagnosis , Practice Guidelines as Topic , Retinal Neoplasms/diagnosis , Referral and Consultation/statistics & numerical data , Retinoblastoma/therapy , Retinoblastoma/epidemiology , Registries , Health Knowledge, Attitudes, Practice , Prevalence , Retinal Neoplasms/therapy , Retinal Neoplasms/epidemiology , Early Detection of Cancer/methods , Mexico/epidemiologyABSTRACT
BACKGROUND: This systematic review aims to report the current knowledge of retinoblastoma (Rb) and its implications in Mexico. We analyzed clinical and demographic data of patients with Rb at select hospitals with Rb programs or that treat and refer patients with Rb, and identified the gaps in practice. We propose solutions to improve diagnosis, provide adequate treatment, and improve patient uptake. METHODS: A general review was conducted on PubMed of peer-reviewed literature on Rb in Mexico. Ophthalmology Department Heads or Directors of Rb programs at seven hospitals in Mexico were contacted for data available on their patients with Rb. RESULTS: Five hospitals provided clinical data on 777 patients with Rb in a period spanning 2000-2015. Of the 122 patients with treatment, 83.4% underwent enucleation. From 33 to 45.3% of Rb tumors in Mexico reach an advanced intraocular stage of development. Knowledge of the disease is limited, despite the fact that the Mexican Retinoblastoma Group has elaborated Rb treatment guidelines and is developing a national Rb registry. Especially in the Southern states, prevalence and outcomes are comparable to African and Asian countries, and only few patients are referred to national treatment centers. Only three institutions have comprehensive Rb programs. CONCLUSIONS: There is an immediate need in Mexico to expand primary care providers' knowledge of Rb and to expand and upgrade current Rb programs to meet the needs of the population adequately. Diagnosis and care of Rb patients in Mexico can also be improved by the establishment of a national Rb registry and a national early detection program, and by increased use of the national treatment protocol.
Subject(s)
Practice Guidelines as Topic , Retinal Neoplasms/diagnosis , Retinoblastoma/diagnosis , Early Detection of Cancer/methods , Health Knowledge, Attitudes, Practice , Humans , Mexico/epidemiology , Prevalence , Referral and Consultation/statistics & numerical data , Registries , Retinal Neoplasms/epidemiology , Retinal Neoplasms/therapy , Retinoblastoma/epidemiology , Retinoblastoma/therapyABSTRACT
OBJECTIVE: to describe the ocular findings in children with mucopolysaccharidosis at the Ophtalmology department. METHODS: clinical, descriptive, retrospective, transversal, and observational study was done. The cohort included patients under 16 years old, treated at the Hospital General, Centro Médico Nacional La Raza, with diagnosis of mucopolysaccharidosis. The variables were age, gender, damaged eye, visual acuity, ocular findings, type of mucopolysaccharidosis. RESULTS: there were 11 patients with mucopolysaccharidosis, 10 of them (90.9 %) full filled the inclusion criteria; nine were men. Mean age was 5.5 ± 2.8 years. There were ocular findings in both eyes in 60 % of the patients, 10 % of them in just one eye. The most frequent finding was corneal opacity (70 %), bilateral in 85.7 %, and in a single eye in 14.3 %. The ocular findings (40 %) were common in mucopolysaccharidosis type I. CONCLUSIONS: there is visual sequels secondary to mucopolysaccharidosis. It is important to study the ocular disorders in order to treat it timely and give to patients the immediate rehabilitation to improve the quality of life.
Subject(s)
Eye Diseases/etiology , Mucopolysaccharidoses/complications , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Male , Retrospective StudiesABSTRACT
BACKGROUND: retinoblastoma is an intraocular malignancy of the childhood. Tumor invasion and metastases are the cause of mortality. The objective was to determine the clinical characteristics, the appearance and site of metastases in patients with retinoblastoma. METHODS: descriptive, observational, retrospective and cross-sectional study was carried out. We reviewed 86 patients with retinoblastoma. RESULTS: the average age was 24.5 months. There were 51.2 % women. 75.6 % had unilateral presentation and 24.4 % bilateral; two of these were trilateral The clinical manifestation were leukokoria, strabismus and glaucoma. We found metastatic disease in 18 patients (20 %), being the central nervous system (CNS) and bones frequently affected. The metastases odds ratio was 3.50 associated to choroidal invasion; 6.25 for patients with invasion to optical nerve with edge with tumor; 3.75 for which they had choroidal invasion and optic nerve with free edge and 5.62 for patients with choroidal invasion and optic nerve with surgical edge with tumor. CONCLUSIONS: choroidal invasion and surgical edge with tumor showed a greater relative risk for development of metastatic disease. The sites commonly affected were the CNS and bones.