Rheumatoid arthritis in the latin american context.punta cana 2011

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Carlo V Caballero Uribe MD

Differences and similitu

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RA in Latin America. Special concerns, similarities and differences with developed regions. Carlo Vinicio Caballero Uribe MD Unidad de Reumatología. Universidad del Norte. Barranquilla. Colombia Ex Presidente. Asociación Colombiana de Reumatología. Miembro Gladar Editor Salud Uninorte Journal (Scopus journal) Twitter: @carvicab Punta Cana Abril 2011

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NOTAS DEL PRESIDENTE Los invito a compartir en este espacio los avances de mi gestión como presidente de PANLAR, que incluye reflexiones, ideas y posiciones con respecto a nuestra profesión y con el deseo de intercambiar con cada uno, sin la camisa de fuerza del correo formal o del editorial en una revista científica. Será un espacio informativo en el cual conocerán de primera mano lo que ocurre en PANLAR. Iniciaré con la visión de cómo veo a PANLAR actualmente y qué es lo que debemos hacer en los siguientes dos años, con cada uno de los retos que tenemos bajo nuestra responsabilidad. En las siguientes notas iré profundizando sobre estos aspectos y respondiendo a sus comentarios e inquietudes, que espero sean frecuentes. Les prometo que con este espacio, estaré más cerca de todos Uds. Ahora PANLAR somos todos. En you tube pueden ver algunos vídeos con el concepto de estas notas. Ver videos Carlo Vinicio Caballlero Uribe.

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John Tesser, MD, FACP, FACR, prepared useful Practice Aids pertaining to rheumatoid arthritis for this CME activity titled "Overcoming Challenges in the Management of Refractory Rheumatoid Arthritis: Expert Insight on the Clinical Potential of Novel Therapeutic Options." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2GoDoEt. CME credit will be available until April 28, 2020.

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APRIL 2018, VOL. 22 NO. 2 CLINICAL JOURNAL OF ONCOLOGY NURSING 175CJON.ONS.ORG C Nephrotoxicity Evidence in patients receiving cisplatin therapy Elizabeth A. Duffy, DNP, RN, CPNP, Wendy Fitzgerald, RN, MSN, PPCNP-BC, CPON®, Kelley Boyle, MSN, RN, PCNS-BC, and Radha Rohatgi, PharmD, BCOP CISPLATIN IS A PLATINUM COMPOUND THAT HAS BEEN USED as a chemotherapeutic agent for many different cancers, including ovarian, testicular, lung, cervical, and bladder cancers (Ruggiero, Rizzo, Trombatore, Maurizi, & Riccardi, 2016; Santoso, Lucci, Coleman, Shafer, & Hannigan, 2003). The primary dose- limiting toxicity of cisplatin is nephrotoxicity, a well-known side effect (Jones, Spunt, Green, & Springate, 2008; Miller, Tadagavadi, Ramesh, & Reeves, 2010). Nephrotoxicity involves glomerular or tubular dysfunction of the kidneys after exposure to medications, other treatments, or toxins (Skinner, 2011). Nephrotoxicity associated with cisplatin is related to accumulation of metabolites in the renal proximal tubule cells of the kidneys, where about 90% of cisplatin undergoes urinary excretion (Ruggiero et al., 2016). Accumulation of these metabolites causes direct inflammation; the production of reactive oxygen species, which leads to oxidative cell damage; and cell death (Miller et al., 2010; Ruggiero et al., 2016). Many methods are available to measure kidney function and define nephrotoxicity or acute kidney injury (see Table 1). Most patients receiving cisplatin experience acute impairment of glomerular and tubular function in varying degrees. Toxicity is dependent on individual cisplatin pharmacokinetics and is usually more severe with high total cisplatin doses and when other potential nephrotoxic medications are given concurrently (Skinner, 2011; Womer, Pritchard, & Barratt, 1985). In one study, children aged 10 years or older at treatment had a lower glomerular filtration rate 10 years after therapy compared to children aged younger than 10 years at treatment (Skinner et al., 2009). Nephrotoxicity can be reversible, but for some individuals, it can result in permanent kidney injury, chronic progressive renal failure, or renal tubule function impairment (Skinner et al., 2009). Chronic and severe reductions of renal function have several sequelae. The immediate impact may be dose reduction or cessation of potentially lifesaving nephrotoxic chemotherapy, thereby increasing the risk of relapse or progression of the cancer. In the event of a disease relapse or progression, changes to renal function may limit enrollment in phase 1 or 2 clinical trials because of inclusion parameters related to baseline renal function. Hydration and diuretics have been used in conjunction with cisplatin administration for decades to improve the excretion of cisplatin and reduce the incidence of nephrotoxicity. One method of promoting this excretion is through osmotic diuresis with mannitol (Morgan et al., 2014). However, the amount ...

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