Revista médica de Chile
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Revista médica de Chile · Oct 2023
Review[Siponimod (BAF312): General Characteristics and Clinical Implications of Pharmacogenomic Dosage in the Treatment of Active Secondary Progressive Multiple Sclerosis].
Siponimod is a selective immunosuppressive medication, developed as the first oral therapy for active secondary progressive multiple sclerosis. This medication acts by modulating the sphingosine 1 phosphate (S1P) receptor, as an antagonist of S1P1 and S1P5, thus preventing the egress of lymphocytes from lymph nodes and preventing inflammatory processes in the Central Nervous System that trigger demyelination. There is extensive scientific knowledge regarding the administration of the medication to patients, which will depend on their pharmacogenetic characteristics. ⋯ Additionally, before prescribing it, an electrocardiogram, assessments of antibody status, ophthalmic evaluation, varicella vaccination status, and peripheral lymphocyte count should be conducted, as the medication's effect is dose-dependent. Therefore, a titration process is carried out starting from 0.25mg up to 2 mg. The pharmacotherapeutic protocol of siponimod is a reliable reflection of the utility of pharmacogenetics in personalized medicine.
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Revista médica de Chile · Oct 2023
Review[Barrett's Esophagus: Update on the Diagnosis and Treatment. Review].
Barrett's esophagus (BE) is the condition in which a metaplastic columnar mucosa predisposed to neoplasia replaces the squamous mucosa of the distal esophagus. The current guidelines recommends that diagnosis requires the finding of intestinal metaplasia (IM) with goblet cells of at least 1 cm in length. BE affects approximately 1% of the general population and up to 14% of patients with gastroesophageal reflux disease (GERD). ⋯ It is recommended that from the presence of LGD patients are referred to an expert center for confirmation of the diagnosis, stage and thus define their management. In patients with BE and dysplasia or early-stage cancer, endoscopic therapy with resection and ablation is successful in about 90% of the patients. The main adverse event is esophageal stricture, which is managed endoscopically.
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Revista médica de Chile · Oct 2023
Review[Local advances and challenges in the molecular diagnosis of solid tumors: a health perspective towards precision oncology in Chile].
Cancer will remain one of the most significant challenges for public health, locally and globally. Currently, cancer is the leading cause of death in our country. Thanks to the enormous knowledge accumulated in recent decades on the cellular and molecular bases of cancer, precision oncology has been developed, an approach that allows for increasingly precise pharmacological treatment based on diagnostic tests. ⋯ It is essential to implement these technologies in current and future health systems to optimize the arsenal of strategies for cancer control. This review discusses some of the achievements of precision oncology, particularly applied to solid tumors. It addresses the state-of-the-art minimum biomarkers required for the diagnosis of this important group of neoplasms, the local situation regarding technological capabilities installed in the national territory, either for research or diagnosis, and the potential health impact of applying all this practical knowledge to serve people with cancer, both in the public and private sectors.
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Revista médica de Chile · Oct 2023
Review[Implantable automatic defibrillators and their deactivation, a necessary conversation. Literature review].
The use of implantable cardioverter-defibrillators (ICDs) has been on the rise. Patients using ICDs inevitably transit towards the end of life at some point, including some who develop terminal illnesses. In this context, it is relevant to discuss and evaluate the deactivation of these devices with the aim of addressing patients' comfort and avoiding shocks during the end-of-life phase. ⋯ Secondly, there is a significant lack of knowledge among patients, family members, and even doctors about the benefits of ICDs, as well as the deactivation process and ethics considerations, which leads them to believe that immediate death will occur, considering it as euthanasia or assisted suicide. Finally, the management of hospice patients or end-of-life ICDs users is poorly standardized, with low rates of deactivation, resulting in shocks in the last minutes of life, which can cause marked distress to patients and families. It is necessary to address these barriers and discuss these issues with patients to inform and educate them about the functioning of their devices, with the ultimate goal of enabling informed and shared decision-making for patient well-being.
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The Nobel Prize originated in 1895 when Alfred Nobel signed his will, leaving a large part of his wealth to the creation of the Nobel Foundation and the establishment of this prize, with the vision that people could help improve humanity through knowledge, science, and humanism. The Nobel Prize has been awarded in areas such as physics, physiology or medicine, chemistry, literature, peace, and economics. 943 people and 25 organizations have been awarded since 1901 to this day. The history and knowledge commemorated in the Nobel Prize have allowed an integral development in the understanding, diagnosis, therapy, and scientific progress in different types of cancer, laying the foundations and being the inspiration for thousands of scientists worldwide who work hard in the area of oncology. GLOBOCAN estimates indicated that there were approximately 19 million new cancer cases globally and almost 10 million cancer deaths in 2020 alone; hence, this study reviews and brings together the main scientific discoveries awarded with the Nobel Prize in the area of physiology or medicine and chemistry, which contributed to the knowledge, diagnosis and/or treatment of cancer from 1901 to 2021.