Hypercalcaemia is a common paraneoplastic syndrome caused by the production by tumours of several factors which affect bone resorption and/or tubular calcium reabsorption. Antihypercalcaemic therapy in cancer patients involves rehydration manoeuvres, as well as the use of a variety of available drugs which inhibit bone resorption, namely plicamycin, calcitonin, bisphosphonates and gallium nitrate. While plicamycin is currently out of use because of its considerable toxicity, bisphosphonates have become the standard therapy in hypercalcaemia of malignancy (HM). These compounds are potent inhibitors of bone resorption but they do not affect tubular calcium reabsorption, which limits their efficacy in humoral HM (HHM) cases. In these patients, gallium nitrate should be the therapy of choice. Among the available bisphosphonates, pamidronate administered in a single infusion of 90 mg, normalises serum calcium levels in > 90% of HM patients. A recently introduced bisphosphonate, zoledronate, is likely to replace pamidronate as a first-line therapy in these patients. The effectiveness of calcitonin in HM treatment is limited, although it seems to be useful at the outset in cases with severe symptomatic hypercalcaemia. Future treatment options of HM are likely to include new bone resorption inhibitors, for example, naturally-occurring osteoprotegerin, or alternate approaches aimed at reducing the tumour production of parathyroid hormone-related protein with noncalcaemic analogues of calcitriol or ras-isoprenylation inhibitors. The development of putative therapeutic agents targeted to inhibit distal calcium reabsorption should be valuable in the management of HHM cases.
La investigación aborda el tema de la Ciudadanía Ecológica en México, centrándose en el rol del Estado y su contribución a través de los ordenamientos legales, a la resolución de la problemática medioambiental. Se planteó como objetivo general: determinar si en la normatividad legal vigente en México, se incluyen soluciones para atenuar el accionar humano sobre el medio ambiente, considerando la perspectiva de la ciudadanía ecológica. Para ello, se empleó una aproximación metodológica teórica, vinculando a la ciudadanía ecológica con su trascendencia en el Derecho. Luego, se analizaron las leyes federales, ubicando su objeto, sanciones y las disposiciones tendientes a motivar la corresponsabilidad de los ciudadanos con la práctica de valores en favor de la conservación medioambiental. Los resultados apuntan a que es necesario incorporar en los ordenamientos legales, incentivos que alienten acciones para la conservación de la naturaleza y desmotiven su depredación.
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