Principales aplicaciones de la ecografía clínica en cuidados paliativos / Main applications of clinical ultrasound in palliative care

Las personas con enfermedades oncológicas avanzadas padecen procesos clínicos intercurrentes y otras manifestaciones relacionadas con la propia progresión tumoral que generan un gran impacto en su calidad de vida. Los profesionales que trabajan en este campo necesitan incorporar nuevos conocimientos y herramientas de diagnóstico y tratamiento que faciliten el manejo de estas personas, de complejidad tan elevada, de la forma menos invasiva posible1. La ecografía clínica (EC) es una de esas herramientas cuyo desarrollo ha sido excepcional en las últimas décadas. Los avances tecnológicos han permitido disponer de equipos de bolsillo cada vez más sofisticados, asequibles económicamente y que pueden ser utilizados allí donde se encuentre la persona enferma como una extensión de la exploración física2. De esta manera el profesional puede dar respuesta a diferentes situaciones o entidades sindrómicas en las que la rentabilidad de la EC puede ser elevada. La pretensión es evitar, en la medida de lo posible, el traslado del paciente al hospital o a una ubicación intrahospitalaria, lo que redunda en su confort y calidad de vida, además de empoderar al profesional en la toma de decisiones clínicas. (AU)

People with advanced cancer suffer from intercurrent clinical conditions and other tumor progression-related manifestations that can have a great impact on their quality of life. Professionals working in this field need to incorporate new knowledge, as well as diagnostic and treatment tools to facilitate the management of these highly complex patients in the least invasive way possible1. Clinical ultrasound (CU) is one of those tools whose development has been exceptional in recent decades. Technological advances have made it possible to have increasingly sophisticated and affordable pocket equipments available, which can be used wherever the patient is as an extension of physical examination2. In this way, a professional can respond to different situations or syndromic conditions in which CU yield may be high. The aim is to avoid, whenever possible, the transfer of patients to in-hospital facilities, which can result in loss of both comfort and quality of life. In addition, an appropriate use of CU can empower the team charged with making clinical decisions. (AU)

Biological properties of aqueous extract and pyranocoumarins obtained from the bark of Brosimum alicastrum tree.

ETHNOPHARMACOLOGICAL RELEVANCE: Brosimum alicastrum is a tree used in Mexican traditional medicine for the treatment of several diseases, including uterine cancer. AIM OF THE STUDY: In this study, the cytotoxic activity of aqueous extract of B. alicastrum bark and isolated compounds xanthyletin (1), luvangetin (2), and 8-hydroxyxanthyletin (3) on three human cancer cell lines was determined. Moreover, the biological effects of 8-hydroxyxanthyletin (3) were investigated. MATERIALS AND METHODS: The aqueous extract was prepared according to the ethnomedical information reported from the bark. The compounds were purified using chromatographic methods and their structures were elucidated by spectroscopic techniques. The antiproliferative effect of aqueous extract and isolates was determined in three human tumor cell lines: HeLa, A2780, and MSTO-211H, and evaluated by trypan blue exclusion assay. The cell cycle and the mitochondrial transmembrane potential (ΔΨ) were measured by flow cytometry, while Reactive Oxygen Species (ROS) levels were determined using 2',7'-dichlorofluorescein diacetate (DCFH-DA) probe. The effect on the relaxation activity, mediated by topoisomerase I and II, was evaluated by electrophoresis, and docking studies were performed using Autodock 4.2 to analyze the interactions. RESULTS: Aqueous extract of B. alicastrum bark showed significant antiproliferative effect on the evaluated cancer cell lines (IC50 = 1.6, 8.5, and 21.4 µg/ml). Four coumarins were identified in the extract and three of them were also evaluated. A2780 cell line exhibited higher sensitivity against pyranocoumarins with IC50 values ranging from 32 to 47 µmol/l. 8-hydroxyxanthyletin (3) exerts an interesting effect on human topoisomerases I and II, by inhibiting the enzymes at concentrations comparable to those obtained in antiproliferative assay. Moreover, 8-hydroxyxanthyletin (3) arrests the cell cycle at G0/G1 phase and induces in A2780 cells a concentration-dependent increase in ROS levels. The results of molecular docking suggest the participation of the hydroxyl group in the interaction between 8-hydroxyxanthyletin (3) and topoisomerase I and II. CONCLUSION: This is the first report that demonstrates the cytotoxic activity of the aqueous extract of B. alicastrum bark, and determines the main metabolites.

Biological Properties of New Chiral 2-Methyl-5,6,7,8-tetrahydroquinolin-8-amine-based Compounds.

The synthesis of a small library of 8-substituted 2-methyl-5,6,7,8-tetrahydroquinoline derivatives is presented. All the compounds were tested for their antiproliferative activity in non-cancer human dermal microvascular endothelial cells (HMEC-1) and cancer cells: human T-lymphocyte cells (CEM), human cervix carcinoma cells (HeLa), human dermal microvascular endothelial cells (HMEC-1), colorectal adenocarcinoma (HT-29), ovarian carcinoma (A2780), and biphasic mesothelioma (MSTO-211H). Compounds 3a, 5a, and 2b, showing significant IC50 values against the whole panel of the selected cells, were further synthesized and tested as pure enantiomers in order to shed light on how their stereochemistry might impact on the related biological effect. The most active compound (R)-5a was able to affect cell cycle phases and to induce mitochondrial membrane depolarization and cellular ROS production in A2780 cells.

Validation of an HPLC-DAD method for the determination of plant phenolics

Abstract A selective, sensitive and precise reversed phase HPLC-DAD method was developed and validated for the simultaneous determination of six phenolic acids in the aqueous extract and their hydrolyzed forms prepared from Solanum elaeagnifolium Cav., Solanaceae, Ampelocissus acapulcensis (Kunth) Planch., Vitaceae, or Brosimum alicastrum Sw., Moraceae. The new method showed good linearity (r > 0.999) in a relatively wide concentration range (0.5-100 mg/l). The limits of detection and quantification for the compounds were in the range of 0.097-0.467 mg/l and 0.097-0.496 mg/l, respectively. The recoveries of compounds were calculated in three different concentrations in the range of 88.07-109.17% and matrix effect was less than 5% for all phenolic acids. Finally, our developed HPLC method is simple, reliable and successfully applied to identify and quantify the phenolic acids in complex aqueous extracts from medicinal species, that can be useful for the analysis of infusions that people consume in folk medicine.

Improving availability of and access to opioids in Colombia: description and preliminary results of an action plan for the country.

Latin America consumes less than 2.7% of the morphine in the world, as reported by the governments to the International Narcotics Control Board. Methods to improve access to opioids for the treatment of pain have been developed by the Pain & Policy Studies Group (PPSG), a World Health Organization Collaborating Center at the University of Wisconsin. This article describes the preparation and implementation of an action plan in Colombia as a part of an international fellowship program on opioid policy developed by the PPSG and funded by the Open Society Institute. The action plan for Colombia included three steps: 1) a survey of regulators and health care providers to identify the current situation and their perceptions of opioid availability in the regions of the country; 2) a workshop with representatives of the Ministry of Health, the national and state competent authorities, pain and palliative care physicians, and international leaders; and 3) implementation workshops at the local level throughout the country. For the survey, response rates of 47% and 96% were registered among physicians and competent authorities, respectively. The survey identified significant regional differences in perceived opioid availability between physicians and regulators. Focus group discussions during the workshop identified several reasons leading to limited availability of opioids in the country, including deficiencies in the procurement process, insufficient human resources, excessive bureaucratic tasks, insufficient number of pharmacies authorized to dispense controlled medications in the country, lack of training in the health care professions, and overly restrictive laws and regulations governing opioid availability. The third step of the action plan has not been implemented. Additional and continuous monitoring needs to be implemented to measure the progress of this project.