Acta Medica Port
-
Chronic plaque psoriasis is an immune-mediated, inflammatory skin disease with a heavy burden on quality of life of patients. Conventional systemic therapies, including cyclosporine, methotrexate, acitretin and photo(chemo)therapy, have proved to be effective, but the risk of toxicity prevents their prolonged and continuous use. ⋯ This review will focus on the mechanisms of action, guidelines for usage, efficacy data and safety concerns of the main biologics used in Europe for the treatment of moderate to severe plaque psoriasis: etanercept, infliximab, adalimumab. Although efalizumab's marketing authorization, approved since 2003, has been suspended recently (February 2009) across the European Union, it will also be briefly discussed.
-
In the intensive care unit (ICU), enteral feeding is the method of choice for providing adequate nutrition in intubated patients. The oesophageal impactation (EI) by enteric nutrition (EN) results from solidification of the solution in esophagus lumen with formation of bezoar and although rare, is gradually becoming more common in clinical practice. In recent years some have been diagnosed cases of enteric nutrition impact, in an ICU. The authors seek to better understand their risk factors in order to prevent its occurrence. ⋯ The EI frequency is low. The ICU average delay (32 days) in this series is twice the total of patients admitted during this period (14,27 days), reflecting the greater severity of the patients studied. Several cases could be implicated in the etiology of that clinical entity. Whenever risk factors are present it should be considered both the endoscopic introduction of nasojejunal tube and specific positioning strategies, to prevent reflux and gastric estasis. Medical and endoscopic treatment solved the majority of related cases that are available in the literature; however, in some specific cases it was necessary to use surgical treatment.
-
The genetic and epigenetic alterations are being studied as one of the causes of gastric cancer (GC) progression and development. DNA methylation is an epigenetic alteration which leads to suppressor gene silencing and proto-oncogene activation, playing an important role in carcinogenesis. The histological types of gastric carcinoma have different genetic paths and the knowledge of the molecular bases of tumoral progression leads to diagnostic accuracy and attempted therapy. ⋯ In CG, CpG island methylation was found in 100% for CDH1 and COX-2 genes, 90% for p16(INK4A) and 20% for EGFR. These results reveal significant differences in EGFR gene methylation distinguishing GC from CG (p < 0, 01), suggesting that gene demethylation leads to malignant transformation and favours the use of tyrosine-kinase inhibitors in its treatment. Genes COX2 e p16INK4A lower methylation in intestinal and diffuse types of GC, favours their different role in respective histogenesis.
-
The ambulatory surgery includes those surgical procedures that require a small period of post-operative recovery so that the patients will be discharged from the hospital in the same day of the surgical intervention. In Urology, the vast amount of pathology that allows the cure with medium and low complexity surgical procedures makes this specialty a privileged one in which ambulatory surgery is concerned. In this paper the authors propose to describe how their Urology group works in the ambulatory field. 472 patients where reviewed in an evaluation period from January 2006 to April 2008. ⋯ Surgical complications represented 1.6% of total procedures, all of them late ones. With this specific ambulatory program our service managed to reduce drastically the waiting time for this kind of procedures (now-a-days is about 3-4 weeks), with a satisfaction rate of about 95%. According to the great outcomes, low complications rate and great acceptance of the patients, the development of this unit is without doubt a winning project in patients care.
-
Pharyngitis is a very prevalent illness in the ambulatory care setting. Its diagnosis is a challenge, especially in the differentiation between the viric and streptococcal causes. ⋯ The distinction between streptococcal pharyngitis and non-streptococcal pharyngitis is not always correct when based on clinical characteristics. The use of diagnostic tests is important in order to avoid unnecessary antibiotherapy as well as to allow the correct use in the positive cases.