Articles: ninos.
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The evaluation of renal function in older adults is usually carried out with a creatinine clearance or an estimation of glomerular filtration rate using formulas such as Cockcroft-Gault, MDRD or CKD-EPI. The results obtained with these formulas are often regarded as equivalent. However, in adults older than 70 years, the Cockcroft-Gault formula frequently underestimates the glomerular filtration rate with respect to reference methods and the MDRD formula overestimates it. ⋯ Also, when kidney function is overestimated, CKD patients are prevented from receiving the treatments appropriate for their condition. In recent years, new formulas have been proposed (FAS, BIS) with a greater accuracy to estimate glomerular filtration rate in older adults. This review describes the behavior of these formulas in a significant number of older adults, from various countries, and proposes using those equations with the best performance in older adults.
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Peripheral nerves in the upper extremities are at risk of injury and entrapment because of their superficial nature and length. Injury can result from trauma, anatomic abnormalities, systemic disease, and entrapment. The extent of the injury can range from mild neurapraxia, in which the nerve experiences mild ischemia caused by compression, to severe neurotmesis, in which the nerve has full-thickness damage and full recovery may not occur. ⋯ Patients with nerve injury typically present with pain, weakness, and paresthesia. A detailed history and physical examination alone are often enough to identify the injury or entrapment; advanced diagnostic testing with magnetic resonance imaging, ultrasonography, or electrodiagnostic studies can help confirm the clinical diagnosis and is indicated if conservative management is ineffective. Initial treatment is conservative, with surgical options available for refractory injuries or entrapment caused by anatomic abnormality.
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Treatment of multiple myeloma (MM) patients has radically changed over the last years following the introduction of next generation proteasome inhibitors (PI) and immunomodulatory derivative (IMiDs). In the last years, one further therapeutic option for MM patients is represented by monoclonal antibodies (MoAbs), that seem to change the paradigm of MM treatment, particularly for heavily pretreated or double refractory to a PI and IMiDs patients. Antibodies have an immune-based mechanism, induce durable responses with limited toxicity and combine well with existing therapies. ⋯ Immunotherapeutic strategies offer a new and exciting approach to target key molecular pathways that continue to be implicated in the survival of malignant plasma cells. These targets include cell surface proteins (CD38, CD138 [SDC1], B cell maturation antigen [BCMA, TNFRSF17]), cytokines that play a role in plasma cell survival and proliferation (interleukin 6 [IL6] and B cell activating factor), signal regulators of bone metabolism (RANKL [TNFSF11], DKK1) and regulators of the immune system (PD-1[PDCD1], PD-L1[CD274]). This article focuses on new MoAbs and related innovative immunotherapeutic modalities currently under investigation in the treatment landscape of MM.
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High prevalence of human immunodeficiency virus (HIV) infection and occurrence of drug-resistant strains have been recorded in northern Brazil. Abandonment of treatment and insufficient and inadequate adherence to antiretroviral therapy (ART) among people living with HIV/AIDS (PLWHA) have been recorded in the metropolitan area of Belém, the capital of the state of Pará. ⋯ The participants' low level of education and poor socioeconomic conditions may have been interfering with their adherence to ART. Such influences can be minimized through multiprofessional interventions that take the individuality of women served by the healthcare service into consideration.
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Multiple myeloma (MM) represents the second-most common hematologic malignancy. In the 1980s, induction therapy with alkylating agents, such as anthracyclines and steroids, as well as high-dose chemotherapy followed by autologous stem cell transplantation were the main therapeutic approaches for MM. Since the introduction of more effective drugs, such as proteasome inhibitors, immunomodulatory drugs, monoclonal antibodies and histone deacetylase inhibitor, the new therapeutic algorithm allows of achieving a significantly improvement of prognosis. ⋯ Also, this is particular true in specific situations, such as extramedullary manifestations, in which tumor mass reduction becomes an urgent clinical need, or in case of chemotherapy-induced stem-cell mobilization. Moreover, melphalan represents the gold standard conditioning regimen since 2002, either alone or, possibly in the next future, in combination with busulfan. Finally, new chemotherapeutic agents with new mechanisms of action, such as melflufen, are in early experimental phase.