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Hospital de Órbigo, Spain

de Pedro M.,Nuevo Belen University Hospital | Baeza S.,Hospital Nuestra Senora de Sonsoles | Escudero M.-T.,Santander University | Dierssen-Sotos T.,University of Cantabria | And 3 more authors.
Breast Cancer Research and Treatment

Evidence on non-steroidal anti-inflammatory drugs (NSAID) use and breast cancer risk shows a slightly protective effect of these drugs, but previous studies lack randomized clinical trial results and present high heterogeneity in exposure measurement. This systematic review and meta-analysis widens the knowledge about NSAID use and breast cancer risk, updating the information from the last meta-analysis, focusing on evidence on specific effects of COX-2 inhibitors and differential expression patterns of hormonal receptors. A PubMed-database search was conducted to include all entries published with the keywords “BREAST CANCER NSAID ANTI-INFLAMMATORY” until 10/24/2013 providing original results from cohort studies, case–control studies, or randomized clinical trials with at least one reported relative risk (RR) or odds ratio (OR) on the association between any NSAID use and incidence of invasive breast cancer. This resulted in 49 publications, from which the information was retrieved about type of study, exposure characteristics, breast cancer characteristics, and breast cancer-NSAID association. Meta-analyses were performed separately for case–control and cohort studies and for different hormone-receptor status. NSAID use reduced invasive breast cancer risk by about 20 %. A similar effect was found for aspirin, acetaminophen, COX-2 inhibitors and, to a lesser extent, ibuprofen. The effect of aspirin was similar in preventing hormone-receptor-positive breast cancer. This meta-analysis suggests a slightly protective effect of NSAIDs-especially aspirin and COX-2 inhibitors- against breast cancer, which seems to be restricted to ER/PR+tumors. © 2015, Springer Science+Business Media New York. Source

Mir-Bonafe J.M.,University of Salamanca | Roman-Curto C.,University of Salamanca | Santos-Briz A.,University of Salamanca | Canueto J.,Hospital Nuestra Senora de Sonsoles | And 2 more authors.
Journal of Cutaneous Pathology

Gemcitabine is a deoxycytidine analog antimetabolite that is now accepted as first-line treatment for advanced and metastatic pancreatic carcinoma. Gemcitabine-related thrombotic microangiopathy associated with systemic hemolytic-uremic syndrome or thrombotic thrombocytopenia purpura has rarely been described. Herein, we report a patient who developed a livedoid thrombotic microangiopathy with no signs of associated hemolytic-uremic syndrome. Cutaneous thrombotic microangiopathy occurred after the administration of his 17th cycle and a cumulative dose of 53.65 g/m 2 of gemcitabine. Some authors have suggested that this toxicity may be dose-related, and a 10th cycle or a cumulative dose of 9-56 g/m 2 have been proposed as the prothrombotic threshold. Interestingly, dermatopathologic findings were limited to the subcutis and they consisted of small-vessel occlusion by intravascular fibrin and leukocytes, vessel wall thickening and endothelial cell swelling. Surprisingly, we observed some structures arranged radially with needle-shaped clefts resembling those of sclerema neonatorum. Awareness of this potential cutaneous toxicity by dermatologists and dermatopathologists is extremely important. Mir-Bonafé JM, Román-Curto C, Santos-Briz A, Cañueto J, Fernández-Lõpez E, Unamuno P. Gemcitabine- associated livedoid thrombotic microangiopathy with associated sclerema neonatorum-like microscopic changes. Copyright © 2012 John Wiley & Sons A/S. Source

Paiva B.,Hospital Universitario Of Salamanca | Montes M.C.,Hospital Universitario Of Salamanca | Garcia-Sanz R.,Hospital Universitario Of Salamanca | Ocio E.M.,Hospital Universitario Of Salamanca | And 19 more authors.

Although multiparameter flow cytometry (MFC) has demonstrated clinical relevance in monoclonal gammopathy of undetermined significance (MGUS)/myeloma, immunophenotypic studies on the full spectrum of Waldenström's Macroglobulinemia (WM) remain scanty. Herein, a comprehensive MFC analysis on bone marrow samples from 244 newly diagnosed patients with an immunoglobulin M (IgM) monoclonal protein was performed, including 67 IgM-MGUS, 77 smoldering and 100 symptomatic WM. Our results show a progressive increase on the number and light-chain-isotype-positive B-cells from IgM-MGUS to smoldering and symptomatic WM (P<.001), with only 1% of IgM-MGUS patients showing >10% B cells or 100% light-chain-isotype-positive B-cells (P<.001). Complete light-chain restriction of the B-cell compartment was an independent prognostic factor for time-to progression in smoldering WM (median 26 months; HR: 19.8, P=0.001) and overall survival in symptomatic WM (median 44 months; HR: 2.6, P=0.004). The progressive accumulation of light-chain-isotype-positive B-cells accompanied the emergence of a characteristic Waldenstrom's phenotype (CD22+dim/ CD25+/CD27+/IgM+) that differed from other B-NHL by negative expression of CD5, CD10, CD11c or CD103. In contrast to myeloma, light-chain-isotype-positive plasma cells in IgM monoclonal gammopathies show otherwise normal antigenic expression. Our results highlight the potential value of MFC immunophenotyping for the characterization of the Waldenström's clone, as well as for the differential diagnosis, risk of progression and survival in WM. © 2014 Macmillan Publishers Limited. Source

The Acute confusional state or delirium is a serious problem in hospitalized patients over 65 years. It alters the relationship and communication with their caregivers. To know the experiences of family caregivers and immigrants to the delirium of the patient, the differences between them and their demands to the nurse. Methodology: Qualitative investigation phenomenological path, as proposed by Taylor-Bogdan. Depth interviews were conducted in eight caregivers, Spanish and immigrants. Results: We interpreted the stress of caregivers increases with the aggressiveness of the sick in delirium and decreased physical endurance. Require information on delirium. Cares more immigrants apply physical restraint altered the patient. Discussion: To get the involvement of informal caregivers caring for patients with delirium and minimize its effects, it is important to reduce your stress and report on the process. © 2013 Fundación Index. Source

Pellegrini Belinchon J.,Centro Salud Pizarrales | de Arriba Mendez S.,Hospital Nuestra Senora de Sonsoles
Pediatria Integral

Asthma is the most common chronic disease among children. Treatment of childhood asthma is based on three pillars: education of the patient and his/her family; control measures of the factors that worsen the disease; and drug therapy. This chapter reviews the current pharmacological treatment of the crisis and maintenance treatment of the disease. The national and international consensus, the clinical practice guidelines and manuals agree that the ultimate goal of treatment is to achieve and maintain total control of asthma. This means no limitations on the child's normal activity, absence of symptoms, exacerbations and normal lung function. It is not always possible to fully achieve it but all efforts must be aimed at this purpose. Source

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