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OBJECTIVE: In 2017, the government of Puerto Rico legalized medical cannabis for several conditions including Crohn's disease (CD). There is little information about cannabis use in this population. This study aimed to develop a demographic characterization and evaluate patient perception on cannabis use for Inflammatory Bowel Disease (IBD) at the University of Puerto Rico Center for Inflammatory Bowel Diseases. METHODS: One hundred patients of ages 21 or older with a confirmed diagnosis of IBD were recruited to complete a voluntary anonymous questionnaire. RESULTS: 27% of the surveyed participants reported use of cannabis. Of these, 39% reported moderate knowledge and 53% reported little to no knowledge of medical cannabis. The majority did not discuss cannabis use with their physician (78%), and most saw improvement of their symptoms (68%). CONCLUSION: Cannabis is frequently considered by patients as a treatment option for IBD but most have limited knowledge about its use. The low number of patients that discuss cannabis use with their physician suggests the need for physician awareness of unreported use. It should also lead to the development of strategies for patient orientation regarding the uses, properties, and expectations of cannabis as a therapy.
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Cannabis/química , Doença de Crohn/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde , Doenças Inflamatórias Intestinais/tratamento farmacológico , Maconha Medicinal/uso terapêutico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Porto Rico , Adulto JovemRESUMO
Introducción: hay poca información sobre las relaciones entre la falla de la terapia antimalárica y algunos factores del hospedero (estado nutricional, fenotipo y genotipo del citocromo CYP450 que metaboliza el medicamento antipalúdico). Objetivo: explorar si la falla terapéutica de la mefloquina dada a pacientes con malaria falciparum no complicada se puede explicar por la influencia del estado nutricional del enfermo y del fenotipo y genotipo de su citocromo CYP3A4. Materiales y métodos: estudio de casos y controles no pareado. Pacientes: hombres y mujeres adultos, de Turbo y El Bagre (Antioquia, Colombia). Resultados: se evaluó la respuesta terapéutica en 46 enfermos; hubo solo tres fallas (6,5%); por la muy baja ocurrencia de falla terapéutica (n = 3/46), los resultados se presentan en forma descriptiva para los 46 pacientes. La relación dextrometorfano/3-metoximorfinano fue 0,39 (mediana); 20% fueron metabolizadores lentos. Las concentraciones sanguíneas medianas de mefloquina a las 24 horas (C24h) y al día 14 (Cd14) fueron 1.363 + 397 ng/mL y 978 + 106 ng/mL, respectivamente. Los 46 pacientes presentaron el alelo CYP3A4*2 (silvestre). Conclusión: no se pudo evaluar con profundidad la relación entre la respuesta a la terapia antimalárica, por una parte y, por otra, la actividad del CYP450 y el estado nutricional, pero hubo hallazgos que justifican la evaluación y control de las características del hospedero en estudios posteriores de farmacocinética antimalárica.
Introduction: Information on the relationship between treatment failure in malaria and factors of the host (nutritional status, phenotype and genotype of cytochrome CYP450) involved in the metabolism of antimalarials is scarce. Objective: To explore whether treatment failure of mefloquine administered to patients with noncomplicated falciparum malaria can be explained in terms of the patients nutritional status and the CYP3A4 phenotype and genotype. Materials and methods: Non-matched case-control study. Patients were adult males and females, inhabitants of Turbo and El Bagre (Antioquia, Colombia). Results: The therapeutic response was assessed in 46 patients, and there were only three failures (6.5%); due to the rare occurrence of therapeutic failure (n = 3/46), results are presented in a descriptive way for the 46 patients. The dextrometorphan/3-methoxymorphinan ratio was 0.39 (median); 20% of the patients were slow metabolizers. The blood concentrations of mefloquine at 24 hours (C24h) and at day 14 (Cd14) were (median) 1.363 ± 397 ng/mL and 978 ± 106 ng/mL, respectively. All 46 patients had the wild CYP3A4*2 allele. Conclusion: We were unable to assess in depth the relationship between the response to mefloquine, on the one hand and, on the other, CYP450 activity and nutritional status. However, there were findings that justify the assessment and control of the characteristics of the host in subsequent studies of antimalarial pharmacokinetics.
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Alelos , Desnutrição , Ferritinas , Malária , Mefloquina , Selênio , Vitamina ARESUMO
Introducción: La malaria, la anemia y la parasitosis intestinal coexisten y constituyen problemas de salud pública en Colombia. Datos disponibles en la literatura biomédica llevan a pensar que estos problemas no son aislados sino que estßn interrelacionados. Por otra parte, los suplementos de retinol han sido efectivos para reducir la mortalidad infantil, con disminución de complicaciones en niños palúdicos, posiblemente por efectos del retinol sobre la función inmune, desviando la respuesta de citocinas hacia un patrón TH2, que también protege de desarrollar anemia grave. Esta revisión tiene como objetivo describir parte de las relaciones vistas en la literatura biomédica mundial, entre retinol y malaria, retinol y anemia, retinol, malaria y parasitosis intestinal, anemia y malaria y mostrar la mediación de estas interrelaciones por el patrón de citocinas TH1/TH2 en sujetos con malaria. Metodología: Se consultaron las siguientes bases de literatura biomédica: Medline, Lilacs, Spingerlik, Md Consultant, Web of Science, Ovid, Scient Direct, Ebsco y Cochrane. También se buscó información para documentar la prevalencia de desnutrición, deficiencia subclínica de retinol, anemia y malaria en niños colombianos, lo mismo que sobre el papel antinfeccioso del retinol.Resultados: Existe asociación entre parasitosis intestinal y malaria; algunos estudios indican que los helmintos predisponen a contraer malaria en niños. De otro lado, los parßsitos mencionados, también se han relacionado con anemia y bajas concentraciones plasmßticas de retinol, que a la vez se asocian con malaria. Sin embargo, no se encontró información que relacione simultaneamente todos estos tópicos y que muestre la respuesta de citocinas TH1/TH2 como la articulación de todos ellos.
Introduction: Malaria infection, anaemia and intestinal parasitism, are important public health problems in Colombia. Available data suggests that these are not separate conditions, but interrelated. On the other hand, retinol supplementation successfully decreases mortality in children. In malaria endemic areas, this supplement reduces severe malaria in children, due to immune modulation by retinol. For example, retinoic acid induced a bias towards a TH2 immune response, an event that is associated with protection against severe anaemia. This review aimed at describing some relationships, reported in global biomedical literature, between retinol and malaria; retinol and anaemia; retinol, malaria and intestinal parasites; anaemia and malaria; and to how the TH1/TH2 cytokine pattern in individuals with malaria changes according to retinol supplementation. Methods: The following biomedical literature databases were consulted: Medline, Lilacs, Spingerlik, Md. Consultant, Web of Science, Ovid, Scient Direct, Ebsco and Cochrane. Information documenting prevalence of malnutrition, subclinical retinol deficiency, anaemia and malaria in Colombian children, as well as papers on the anti-infectious role of retinol were also. Results: A relationship between malaria and intestinal parasitic infections was reported. Some studies indicate that helminth infection predispose children to suffer malaria. On the other hand, these intestinal parasites have also been associated with anaemia and low retinol plasma concentrations, which in turn are associated with malaria. No co-relation regarding a simultaneous link between all these conditions, and the TH1/TH2 balance was observed. Conclusions: The study of associations between malaria, anaemia, intestinal parasite infections and low retinol level, with the TH1/TH2 cytokine response as centerpiece is essential to prevent or provide early treatment.
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Anemia , Helmintos , Ferro , Malária , Vitamina A , Imunidade CelularRESUMO
BACKGROUND: Surgery is a curative treatment for gastric cancer (GC). As relapse is frequent, adjuvant therapies such as postoperative chemo radiotherapy have been tried. In Chile, some hospitals adopted Macdonald's study as a protocol for the treatment of GC. AIM: To determine methodological quality and internal and external validity of the Macdonald study. MATERIAL AND METHOD: Three instruments were applied that assess methodological quality. A critical appraisal was done and the internal and external validity of the methodological quality was analyzed with two scales: MINCIR (Methodology and Research in Surgery), valid for therapy studies and CONSORT (Consolidated Standards of Reporting Trials), valid for randomized controlled trials (RCT). Guides and scales were applied by 5 researchers with training in clinical epidemiology. RESULTS: The reader's guide verified that the Macdonald study was not directed to answer a clearly defined question. There was random assignment, but the method used is not described and the patients were not considered until the end of the study (36% of the group with surgery plus chemo radiotherapy did not complete treatment). MINCIR scale confirmed a multicentric RCT, not blinded, with an unclear randomized sequence, erroneous sample size estimation, vague objectives and no exclusion criteria. CONSORT system proved the lack of working hypothesis and specific objectives as well as an absence of exclusion criteria and identification of the primary variable, an imprecise estimation of sample size, ambiguities in the randomization process, no blinding, an absence of statistical adjustment and the omission of a subgroup analysis. CONCLUSION: The instruments applied demonstrated methodological shortcomings that compromise the internal and external validity of the.
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Pesquisa Biomédica/normas , Medicina Baseada em Evidências/normas , Guias de Prática Clínica como Assunto , Projetos de Pesquisa/normas , Neoplasias Gástricas/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/normas , Chile , Terapia Combinada/normas , Interpretação Estatística de Dados , Humanos , Controle de Qualidade , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Neoplasias Gástricas/cirurgiaRESUMO
Background: Surgery is a curative treatment for gastric cancer (GC). As relapse is frequent, adjuvant therapies such as postoperative chemo radiotherapy have been tried. In Chile, some hospitals adopted Macdonald's study as a protocol for the treatment of GC. Aim: To determine methodological quality and internal and external validity of the Macdonald study. Material and method: Three instruments were applied that assess methodological quality. A critical appraisal was done and the internal and external validity of the methodological quality was analyzed with two scales: MINCIR (Methodology and Research in Surgery), valid for therapy studies and CONSORT (Consolidated Standards of Reporting Trials), valid for randomized controlled trials (RCT). Guides and scales were applied by 5 researchers with training in clinical epidemiology. Results: The reader's guide verified that the Macdonald study was not directed to answer a clearly defined question. There was random assignment, but the method used is not described and the patients were not considered until the end of the study (36% of the group with surgery plus chemo radiotherapy did not complete treatment). MINCIR scale confirmed a multicentric RCT, not blinded, with an unclear randomized sequence, erroneous sample size estimation, vague objectives and no exclusion criteria. CONSORT system proved the lack of working hypothesis and specific objectives as well as an absence of exclusion criteria and identification of the primary variable, an imprecise estimation of sample size, ambiguities in the randomization process, no blinding, an absence of statistical adjustment and the omission of a subgroup analysis. Conclusion: The instruments applied demonstrated methodological shortcomings that compromise the internal and external validity of the study.
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Humanos , Pesquisa Biomédica/normas , Medicina Baseada em Evidências/normas , Guias de Prática Clínica como Assunto , Projetos de Pesquisa/normas , Neoplasias Gástricas/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/normas , Chile , Terapia Combinada/normas , Interpretação Estatística de Dados , Controle de Qualidade , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Neoplasias Gástricas/cirurgiaRESUMO
The goal was to study our experience in the management of a series of patients with a potentially curative subserosal gallbladder cancer who were prospectively treated by the authors. Between April 1988 and July 2004, 139 patients were enrolled in our prospective database. Of the above, 120 were operated on with an open procedure and the rest with laparoscopic surgery. In only eight patients was the diagnosis suspected before the cholecystectomy. The majority of tumors were adenocarcinoma. Six patients had an epidermoid tumor, and one had a carcinosarcoma. Of the patients, 74 underwent reoperation, while in 55 (70.2%) it was possible to perform an extended cholecystectomy with a curative aim. Operative mortality was 0%, and operative morbidity was 16%. Lymph node metastases were found in 10 (18.8%), while in 7 (13.2%) the liver was involved. The overall survival rate was 67.7%, while in those who underwent resection, the survival rate was 77%. Through the use of a multivariate analysis, the presence of lymph node metastasis was found to be an independent factor with respect to prognosis. The feasibility of performing an extended cholecystectomy in patients with gallbladder cancer and invasion of the subserosal layer allows for a good survival rate. The presence of lymph node metastases represents the main poor prognosis factor, and some type of adjuvant therapy should be studied in this particular group.
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Neoplasias da Vesícula Biliar/cirurgia , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colecistectomia , Colecistectomia Laparoscópica , Estudos de Coortes , Cisto Epidérmico/patologia , Cisto Epidérmico/cirurgia , Feminino , Seguimentos , Doenças da Vesícula Biliar/patologia , Doenças da Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/patologia , Humanos , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Prognóstico , Estudos Prospectivos , Reoperação , Membrana Serosa/patologia , Taxa de SobrevidaRESUMO
Numerous reports suggest more recurrences and a worse prognosis after laparoscopic cholecystectomy (LC) than after open cholecystectomy (OC). The objective of this study was to compare the survival rate of patients undergoing a laparoscopic procedure versus those undergoing an open operation. A series of 24 patients with gallbladder cancer detected after LC were compared with 40 consecutive patients with gallbladder cancer detected after OC. Patients were matched by wall invasion, age, and whether they underwent a reoperation or only cholecystectomy. The series included 2 patients with in situ tumors, 2 with mucosal tumors, 1 with muscular invasion, 13 with subserosal invasion, and 6 with serosal invasion. Recurrences were observed in 4 of the 10 patients with subserosal compromise who underwent reoperation. In contrast, in the OC group of 26 patients with subserosal invasion, 20 of whom were reoperated, only 2 had a recurrence. Of the six patients with serosal infiltration, three in the LC underwent reoperation, all of whom had recurrences that precluded resection. Of the 12 patients in the OC group who presented with serosal invasion, 6 were reoperated and 4 had a recurrence. Overall survival curves did not show differences when patients were compared according to the type of procedure performed. Similarly, the analysis of patients according to the level of wall invasion indicated that there was no significant difference in survival. Although multiple reports have shown a worse prognosis for patients with gallbladder cancer undergoing LC, this study did not show a significant survival difference between the two methods. Although there is a higher but insignificant recurrence rate among the patients who underwent LC, this is not translated into survival.
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Colecistectomia Laparoscópica , Neoplasias da Vesícula Biliar/mortalidade , Neoplasias da Vesícula Biliar/cirurgia , Idoso , Feminino , Neoplasias da Vesícula Biliar/patologia , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Prognóstico , Modelos de Riscos Proporcionais , Membrana Serosa/patologiaRESUMO
BACKGROUND: Gallbladder cancer is the leading cause of death of cancer among women in Chile. Detection of early forms of the disease during the pathological study of the cholecystectomy specimen is common. The management of these cases, specially those with invasion of the muscular layer is under discussion. AIM: To analyze the clinical features of patients with gallbladder cancer and muscular layer invasion and their prognosis after a simple cholecystectomy. PATIENTS AND METHODS: We studied a series of 46 patients with gallbladder cancer and invasion of the muscular layer. In the majority of cases diagnosis was performed at the moment of specimen study. Eleven patients underwent reoperation. Of these, ten underwent lymphadenectomy and liver resection while one patient underwent resection of the cystic duct stump. RESULTS: During follow up, five patients died as a consequence of gallbladder cancer. Overall survival was 78%, with no differences between patients subjected or not a new operation. CONCLUSIONS: Gallbladder cancer with muscular infiltration has a good prognosis, independent of the type of therapy.
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Colecistectomia , Neoplasias da Vesícula Biliar/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colecistectomia/mortalidade , Feminino , Seguimentos , Neoplasias da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Análise de SobrevidaRESUMO
BACKGROUND: Gallbladder cancer is generally associated with a poor prognosis, being local recurrence the main pattern of failure. AIM: To evaluate neoadjuvant chemoradiation as a means to improve the prognosis in gallbladder cancer. PATIENTS AND METHODS: Twenty three gallbladder cancer patients were prospectively treated between June 1993 and September 1999 in the Temuco Regional Hospital. Eighteen (82%) patients had subserosal infiltration, while three (13%) had serosal and two (9%) adipose tissue infiltration. Chemotherapy was done with 5-fluorouracil in continuous infusion during 5 days at day 1 and 28 of treatment. Radiotherapy consisted in a total dose of 4500 cGy, divided in 25 sessions. Patients' survival was compared with a series of 19 patients not subjected to chemoradiation, formerly treated at the institution. RESULTS: Twenty patients had hematological problems secondary to the therapy. Leucopenia and thrombocytopenia were the most common toxic effects and eight had leucopenia under 2.0 x 10(3) during the treatment course. Chemoradiation delayed surgical treatment in eight patients. After the chemoradiation protocol, seven patients were excluded from surgical treatment and 14 patients underwent resection. Three of the latter (11%) had liver involvement and four (14%) had lymph node involvement. Among the patients who underwent resection, five are still alive with a follow up of 43.8 months. Treated patients had a worst actuarial survival than subjects not treated with chemoradiation. CONCLUSIONS: In this series of patients chemoradiation had no positive effect and a potentially detrimental effect in patients with gallbladder cancer.
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Neoplasias da Vesícula Biliar/tratamento farmacológico , Neoplasias da Vesícula Biliar/radioterapia , Adulto , Idoso , Antimetabólitos Antineoplásicos/uso terapêutico , Quimioterapia Adjuvante , Terapia Combinada , Feminino , Fluoruracila/uso terapêutico , Neoplasias da Vesícula Biliar/mortalidade , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Radioterapia Adjuvante , Análise de Sobrevida , Resultado do TratamentoRESUMO
All pancreatic neuroendocrine tumors derive from Langerhans islet cells and have a low incidence. Half of them are functioning tumors that produce diverse hormones and occasionally cause serious clinical endocrine syndromes. They may be malignant, but they have a better survival, if compared to pancreatic ductal adenocarcinoma. Insulinoma, gastrinoma, glucagonoma, VIPoma (VIP=vasoactive intestinal peptide), somatostatinoma and ACTHoma are functioning tumors and they may also be part of Multiple Endocrine Neoplasia type I (MEN 1) syndrome and of von Hippel-Lindau disease. Diagnosis of non-functioning tumors is usually late, when they reach a big size and have even developed nodal and hepatic metastases. Nowadays, there are effective medical treatments for the medical problems secondary to excessive hormone production. For example, the hypergastrinemia typical of the Zollinger-Ellison syndrome in gastrinoma, can be adequately managed. Surgical resection is the most advisable therapy for pancreatic endocrine tumors, especially when they are small, when long time survival is better. Pre and intra operative imagenology is a great aid to locate these tumors. There are several surgical alternatives, according to the tumor size and location within the pancreas. Furthermore, palliative therapy can be used in disseminated disease. Treatment success is the result of a multidisciplinary medical team work of endocrinologists, surgeons, gastroenterologists, pathologists and geneticists.