Kaposi sarcoma (KS) is the most common malignant tumor in HIV-infected individuals. Although its most common form consists of skin and mucosal lesions, it can also present itself in a disseminated way affecting the gastrointestinal tract, lungs and eye structures. We present the case of a 27-year-old male patient with HIV infection and disseminated Kaposi sarcoma. Disseminated KS is an uncommon form of the disease. Therefore, it is important to take this into account, particularly in HIV-infected individuals with characteristic cutaneous lesions.
The communication between tumor cells and the microenvironment plays a fundamental role in the development, growth and further immune escape of the tumor. This communication is partially regulated by extracellular vesicles which can direct the behavior of surrounding cells. In recent years, it has been proposed that this feature could be applied as a potential treatment against cancer, since several studies have shown that tumors treated with radiotherapy can elicit a strong enough immune response to eliminate distant metastasis; this phenomenon is called the abscopal effect. The mechanism behind this effect may include the release of extracellular vesicles loaded with damage-associated molecular patterns and tumor-derived antigens which activates an antigen-specific immune response. This review will focus on the recent discoveries in cancer cell communications via extracellular vesicles and their implication in tumor development, as well as their potential use as an immunotherapeutic treatment against cancer.
Delirium or acute confusional syndrome is a common problem in geriatric patients, although its diagnosis is often overlooked, especially in its hypoactive form. Risk factors for delirium are previous cognitive alterations and certain comorbidities, different environmental factors and acute organic alterations typical of critically ill patients. Delirium is associated with increased short- and long-term mortality, to the prolongation of mechanical ventilation, to prolonged stays in the Intensive Care Unit (ICU) and in the hospital and to cognitive deterioration after hospital discharge. In recent years, specific tools have been developed for the detection of delirium in ICU. The implementation of specific interventions on certain risk factors can reduce the incidence of delirium in hospitalized patients. The treatment of delirium it is based on identifying and correcting the underlying causes, establishing support measures and, sometimes, pharmacological treatment to control symptoms. Haloperidol is the first-line drug for the control of delirium, since experience with atypical neuroleptics, such as olanzapine and risperidone, as well as with other drugs, it is insufficient to be able to make recommendations on their use. Neuroleptics can have serious side effects that must be taken into account. In cases with agitation, the simultaneous use of benzodiazepines or propofol may be necessary and, sometimes, in a temporary and protocolized manner, the use of physical restraints.
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