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I gained useful experience when I began my pre-practice as a pharmacy assistant while training for three years with the American Society of Gastroenterology and an agreement. with the clinicaloptions.com website regarding those who saw the medication in front of the children's clinic in the entrance area of ​​the pharmacy was on the front line in the development of specific treatments for the newborn and his chronic illness. I was a distributor of the country Saudi Arabia, my father was the king and I send of tools and goods that I can monitor and investigate what and why they need them, then I trained in medicines and sequencing of too many children and survivors when it we can speak else of him demographics within the hospital and the population that is responsible My husband at work

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Triage III

Angelo Dominguez

Age: 43

Gender: Male

Patien subjeted to Therapy physical and Micro Surgery

Patient says:

"My injury is how like new it feels very good i need the six months of Therapy the latest what afected me is the stomach i has stomachache during two weeks"

Therapy Physical therapy can be helpful for some types of arthritis. Exercises can improve range of motion and strengthen the muscles around the joints. In some cases, the use of a splint or immobilization devices may be warranted. Surgery If traditional methods don't help, doctors may suggest surgery, such as:

Joint repair. In some cases, joint surfaces can be repaired or realigned to reduce pain and improve function. These types of procedures are usually performed arthroscopically, through small incisions in the joint.

Joint replacement. This procedure consists of removing the damaged joint and replacing it with an artificial one. The joints most frequently replaced are the hips and knees.

Joint fusion. This procedure is most often used for smaller joints, such as those in the wrist, ankle, and fingers. The ends of the two bones at the joint are removed and then the ends are fixed together until they heal and form a rigid unit.

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A 45-year-old premenopausal woman with underlying inflammatory bowel disease underwent lumpectomy and sentinel node biopsy, with surgical pathology demonstrating a 3.5-cm invasive ductal carcinoma, grade 3, with 2 of 3 sampled nodes positive. Her biomarkers are estrogen receptor 80%, progesterone receptor 30%, and HER2 negative (immunohistochemistry [IHC] 0). Germline BRCA testing is negative. She receives adjuvant chemotherapy with dose‑dense AC-T (doxorubicin and cyclophosphamide followed by paclitaxel) followed by radiation therapy.

In addition to ovarian suppression, which of the following adjuvant therapies would you recommend for this patient?

A

13.0%

Aromatase inhibitor (AI) only

B

51.9%

AI + abemaciclib 

C

5.6%

AI + olaparib

D

29.6%

AI + ribociclib

 Your Answer: B

Correct Answer: D

Adjuvant endocrine therapy plus a CDK4/6 inhibitor is recommended for this patient because her nodal positivity and high disease grade increase her risk of recurrence. Phase III trials have shown that adding abemaciclib or ribociclib to adjuvant endocrine therapy significantly prolongs invasive disease–free survival (iDFS) in patients with high-risk HR-positive/HER2-negative EBC. She is eligible for abemaciclib per the label and ribociclib per NATALEE eligibility criteria, but ribociclib would be preferred in a patient with an underlying bowel comorbidity because diarrhea is more common with abemaciclib (occurred in 83.5% of monarchE participants) than with ribociclib (occurred in 14.5% of NATALEE participants). She is ineligible for adjuvant olaparib because she is negative for a germline BRCA mutation.

Abemaciclib vs robiciclib

win robiciclib because Abemaciclib Has 83,5% of monarche participants happened a underlying bowel comorbidity and Diarrea is common with abemaciclib

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En oncología solemos escuchar distintos objetivos o desenlaces (endpoints) tanto primarios como secundarios, en los ensayos clínicos que se realizan en el tratamiento para tumores urológicos ya sean citotóxicos (quimioterapia clásica) o inhibidores de los puntos de control inmunitarios (checkpoint inhibitors) o “inmunoterapia”. Estos términos pueden ser intuitivos como la “supervivencia global” o confusos como la supervivencia libre de progresión (progression free survival).

La importancia de comprender estos conceptos radica en que no todos ellos son igual de relevantes para el paciente al momento de decidir sobre su tratamiento, ni para el médico al momento de decantarse por un tratamiento u otro.

La evidencia es basta y confusa, y la clara influencia de la industria farmacéutica en la redacción de las publicaciones científicas obliga al médico (y pacientes) a instruirse en la interpretación de la información aportada en los resultados para poder sacar sus propias conclusiones.

Es por ello que un tratamiento que haya demostrado una mejoría en la supervivencia global 12 meses siempre deberá ser elegido antes que un tratamiento que ha demostrado una supervivencia libre de progresión de 13 meses y que no reporte supervivencia global. La supervivencia libre de progresión es un desenlace sustituto que no necesariamente implica que se prolongue la vida ni la calidad de esta, que son las dos principales cosas que le importan al paciente que padece cáncer (living longer and living better)

En la siguiente tabla explicamos lo términos más frecuentes con su interpretación simplificada, ventajas y desventajas.Desenlace (endpoint)DefiniciónInterpretaciónSupervivencia global  

(Overall survival / OS)Tiempo desde la aleatorización (inclusión en el estudio) hasta el fallecimiento por cualquier causa.Históricamente es el desenlace más importante en oncología (gold standard), con vistas a prolongar la vida, siempre y cuando se consiga mantener una buena calidad de vida.  

Incluye muertes no asociadas al cáncer o al tratamiento.  

Se puede alterar si los pacientes reciben líneas de tratamiento posterior o se realiza “crossover” en el estudio.Tiempo hasta progresión del tumor

(Time to tumor progression / TTP)Tiempo desde la aleatorización hasta la progresión objetiva del tumor.    Esta definición no incluye los fallecimientos.  

Sigue criterios radiológicos.

Es de poco interés para los pacientes.­Supervivencia libre de progresión

(Progression free survival / PFS)Tiempo desde la aleatorización hasta la progresión objetiva del tumor o el fallecimiento.Contrario al TTP, esta definición incluye el fallecimiento.  

Es un desenlace que se correlaciona con la supervivencia global (aunque no necesariamente es así)Tasa de respuesta objetiva  

(Objective response rate / ORR)Proporción de pacientes con una reducción en el tamaño del tumor durante un periodo de tiempo, ambos pre-definidos.  

Se suele sumar la respuesta completa y la respuesta parcial (actividad anti-tumoral).Esta medida busca medir la actividad del fármaco ante el tumor per se, sin embargo, no es un desenlace de interés directo para el paciente.  

Se utilizan herramientas radiológicas como los criterios RECIST.

La enfermedad estable (no progresión pero no regresión) no entra dentro de esta definición.Tiempo hasta fracaso del tratamiento  

(time to treatment failure / TTF)Desenlace compuesto, se define como el tiempo desde la aleatorización hasta la discontinuación del tratamiento por cualquier motivo (toxicidad, fallecimiento, progresión).No se considera un desenlace valido para medir efectividad ya que se ve contaminado por otros motivos, incluyendo la preferencia del paciente  (deseo de suspender el tratamiento por cualquier motivo).Desenlaces reportados por pacientes

(Patient reported outcomes / PRO)Estos son desenlaces referidos por los pacientes, asociados a la calidad de vida.Son de interés directo para el paciente.  

No existen elementos validados para medirlos.Tiempo hasta el siguiente tratamiento  

(Time to next treatment / TTNT)Tiempo desde el final del tratamiento primario hasta el inicio del siguiente tratamiento.Puede ser de utilidad en enfermedades incurables.  

No es utilizado con frecuencia.Duración de la respuesta  

(Duration of response / DoR)Tiempo desde que se documenta respuesta del tumor hasta la progresión del mismo.No es de interés directo para el paciente.  

Valora la respuesta del fármaco sobre el tumor y puede evaluarse en ensayos de un solo brazo (sin grupo control).Supervivencia libre de enfermedad   (Disease free survival / DFS)Tiempo desde la aleatorización hasta la recurrencia del tumor o fallecimiento por cualquier causa.    Habitualmente utilizado en adyuvancia (tratamiento tras cirugía radical o radioterapia con intención curativa) .

Útil en escenarios en los que la supervivencia es larga o en los que la mayoría de los pacientes alcanzan la respuesta completa.

Finalemente, incluimos una tabla que explica las ventajas y desventajas de la supervivencia global vs la supervivencia libre de progresión como desenlaces en los ensayos oncológicos.DesenlaceVentajasDesventajasSupervivencia global (OS) – Medido con precisión. – Clínicamente significativo cuando se acompaña de una preservación de la calidad de vida. – Puede verse afectado por crossover y terapias posteriores. – Puede implicar estudios más grandes y un seguimiento más largo. – Incluye muertes no cancerígenas. – Sujeto a censura de derechos.Supervivencia libre de progresión (PFS) – Incluye la medición de enfermedad estable. – Requiere un tamaño de muestra más pequeño. – Requiere un seguimiento más corto. – Generalmente basado en objetivo y evaluaciones cuantitativas. – No se ve afectado por el crossover o terapias posteriores. – Las definiciones varían entre los estudios. – Requiere evaluaciones radiológicas u otras evaluaciones frecuentes. – Implica un calendario equilibrado de evaluaciones entre los brazos de tratamiento. – No se mide con precisión; sujeto a sesgo de evaluación particularmente en estudios de etiqueta abierta (open label). – Sujeto a censura por intervalos. – No está validado estadísticamente como un sustituto para la supervivencia en todos los entornos.

Referencias:

U.S. Department of Health and Human Services Food and Drug Administration Center for Drug Evaluation and Research (CDER), Center for Biologics Evaluation and Research (CBER). Guidance for industry: clinical trial endpoints for the approval of cancer drugs and biologics. http://www.fda.gov/downloads/Drugs/…/Guidances/ucm071590.pdf. Published May 2007. Consultado 10/12/2018.

Villaruz LC, Socinski MA. The clinical viewpoint: definitions, limitations of RECIST, practical considerations of measurement. Clin Cancer Res. 2013 May 15;19(10):2629-36. doi: 10.1158/1078-0432.CCR-12-2935.

Pazdur R. Endpoints for assessing drug activity in clinical trials. Oncologist. 2008;13 Suppl 2:19-21. doi: 10.1634/theoncologist.13-S2-19.

https://www.biooncology.com/clinical-trials/efficacy-endpoints.html . Consultado 10/12/2018

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List of medicament dispensory for phase III trial ERA.223 with ABIRATERONE fractura with or without Radium 223- MRCPC and <2 bone mets

Prescription in complementing of my clases agree

phase III of triage.pdf

nombre comercial dispensa de medicamento.pdf

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hree days ago I requested the MRI image.

tuestday, 28 de march de 2024

Andres Yacelga Teerán

Age 32,

weigth: 86.5 Kg

zize: 1.86 m

Atrophia: Is Degenerative use of muscle Caused because a issue endovenue

11:31

It is a very complicated operation and in my country they told me that there is a 25% percentage of recovering sensitivity if it is the case of the operation. What percentage of recovery could I have and if a specialist doctor would arrive in this country1?

to improve with MRI image:

4 elementos

4 elementos

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Our Lady of La Candelaria University Hospital. Tenerife. Study for undergraduate and its results in Rheumatology Service. University Hospital Complex of Orense. Objectives: The involvement of large vessels in cellular arteritis giants (ACG), especially of the aorta and/or its main branches, It is frequent. Tocilizumab (TCZ) has demonstrated efficacy and safety in GCA and other large vessel vasculitis. Our objetive was to evaluate the effectiveness and safety of TCZ in patients with GCA with involvement of the aorta and/or its main branches. Methods: Multicenter observational study of 196 patients with GCA and involvement of the aorta and/or its main branches treated with TCZ. GCA was diagnosed by: a) ACR criteria, and/or b) biopsy of the temporal artery, and/or c) imaging techniques. The presence of aortitis was performed using imaging techniques, mainly PET and angio-MRI. Maintained remission was considered according to EULAR definitions1 . Results: The main characteristics of the 196 patients were shown in the table. Polymyalgia rheumatica, constitutional syndrome and headache were the most frequent clinical manifestations at the start of TCZ. Six months after starting TCZ, 20% of patients achieved a sustained remission, which gradually increased progressively (FIGURE). A steroid-sparing effect was observed from month 1 of TCZ initiation (FIGURE). They were observed relevant adverse effects in 12 per 100 patient-years, with serious infections documented in 4.8 per 100 patient-years. Main characteristics of 196 patients with GCA with involvement of the aorta and/or its main branches treated with TCZ

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XLVIII Congreso Nacional de la Sociedad Española de Reumatología Granada, 10-13 de mayo de 2022

Resultados: Se incluyeron 166 pacientes con AIJs (edad media al diagnóstico de 5 años) y 194 pacientes con ESIA (edad media al diagnóstico de 41 años). La prevalencia de fiebre, erupción cutánea, artralgia, dolor abdominal, SAM, enfermedad pulmonar parenquimatosa y aumento de los reactantes de fase aguda y la ferritina fueron comparables entre las dos cohortes. Los pacientes con AIJs tenían una mayor prevalencia de artritis, mientras que los pacientes con ESIA presentaron con mayor frecuencia leucocitosis y afectación de órganos extraarticulares (tabla 1).Los pacientes con ESIA recibieron corticosteroides a dosis bajas con mayor frecuencia, mientras que los FAME biológicos se administraron en primera línea con mayor frecuencia en pacientes con AIJs (tabla 2). Conclusiones: Se encontraron diferencias significativas en la prevalencia de algunas manifestaciones clínicas entre las dos enfermedades. En el manejo terapéutico también hubo diferencias. Se necesitan grandes estudios prospectivos de cohortes que incorporen los criterios recientemente propuestos para AIJs para obtener más información sobre la relación entre las dos condiciones.

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In Older adults treatment for Diabetes 1 non alcoholic

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IN PEDIATRIC treatment for pancreatic insufficiency according to guided clinical practice

[edenmartinez]

Key Takeaways

Patients with peripheral neuropathy but otherwise normal organ function are candidates for BCMA-targeted CAR T-cell therapy.

Current studies are addressing time limited therapy strategies for some patients to reduce the need for indefinite treatment.

There is no difference in response to CAR T-cell therapy between men and women with multiple myeloma, but preliminary results suggest potential differences by race and ethnicity.

Antiviral prophylaxis is recommended for everyone receiving BCMA-targeted therapy in multiple myeloma.

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DIFFERENCES BETEWEEN VENOUS AND ARTERIAL VENOUS

To give continuity to the previous topic, we thought it prudent to place the differences between venous and arterial ulcers, since the treatment is completely different, along with the history collected in the clinical history, physical examination, and other complementary examinations, but on some occasions it is not easy to establish the origin, since a high percentage of venous ulcers have an arterial component. Next we leave you a table where the main differences between them are exposed.

Differences between venous and arterial ulcer To give continuity to the previous topic, we thought it prudent to place the differences between venous and arterial ulcers, since the treatment is completely different, along with the history collected in the clinical history, physical examination, and other complementary examinations, but on some occasions it is not easy to establish the origin, since a high percentage of venous ulcers have an arterial component. Next we leave you a table where the main differences between them are exposed. image

. DEFINITION OF VASCULAR ULCER It is a lesion with the deterioration of the solution of continuity with loss of substance, epithelium and/or conjunctiva produced by a pathological process of vascular origin, have a chronic evolution and little or no tendency to spontaneous healing. They are painful lesions that hinder mobility and alter one's own body image. The pain is frequent and can be severe or continuous and disabling. They have a chronic and relapsing character with a high rate of recurrence.

ETIOLOGY The ulcer originates from a deterioration of the cutaneous microcirculation. According to its etiology, it is classified as:

•: arteriosclerosis obliterans 90%, vasculitis, thromboangiitis obliterans, Raynand's disease, discreet smoking, dyslipidemia, arterial hypertension

. VENOUS ULCERS: skin and vascular alterations according to the degree of venous insufficiency. Grade I It is the initial phase. There are superficial varicose veins that affect the plantar arch, malleolar areas, and ankles. He The patient reports a feeling of heaviness and pain at the end of the day

. Grade II It may appear:

Edema purpuri

hyperpigmentation

Increase in thickness, being able to reach elephantiasis in the extremity Area of ​​whitish skin located in the peri-malleolar area Eczema of ecstasy, which causes intense itching. It is frequent that small erosions by scratching can turn into ulcers.

Thrombophlebitis Bleeding that can be important due to rupture of very dilated veins Grade III In addition to the above symptoms, open ulcers appear, with a sudden onset (trauma direct, rupture of a varicose vein, infectious agents on the skin...) or insidious (persistent scab, profuse desquamation, slight abrasions…) ulcerative scar

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SUPREMA CORTE!!!