Estudio de manipuladores de drogas antineoplĂĄsicas en centros de quimioterapia Pinda y Panda de Chile: micronĂșcleo una prueba de tamizaje
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Fecha
2008
Autores
Profesor/a GuĂa
Facultad/escuela
Idioma
es
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Universidad Andrés Bello
Nombre de Curso
Licencia CC
Licencia CC
Resumen
RESUMEN: Las drogas antineoplĂĄsicas son ampliamente utilizadas en la terapia contra
el cĂĄncer y otras patologĂas. Los mecanismos de acciĂłn de dichas drogas, han sido Ăștiles
para detener el avance de neoplasias pese a las reacciones adversas que pudieran
presentarse.
El personal de salud que manipula preparados oncolĂłgicos en los recintos hospitalarios o
centros de quimioterapia, estarĂan potencialmente expuestos al efecto genotĂłxico si no
adoptan las medidas de prevenciĂłn (5, 12). Este efecto es descrito en la literatura
utilizando métodos citogenéticos tales como estudio de aberraciones cromosómicas,
cromĂĄtidas hermanas y anĂĄlisis de MicronĂșcleo (MN). Asimismo, se han descrito anĂĄlisis
quĂmicos de presencia de citostĂĄticos o de sus metabolitos en orina.
El anĂĄlisis de MN es un anĂĄlisis de laboratorio sencillo, rĂĄpido y de baja complejidad. Es
uno de los exĂĄmenes utilizados en la bĂșsqueda y cuantificaciĂłn de esta alteraciĂłn nuclear
de las células, debido a errores en la división por causas de agentes genotóxicos (1, 4,
26).
OBJETIVOS: Desarrollar, aplicar y validar una prueba de tamizaje, conjuntamente con
una encuesta para determinar el efecto genotĂłxico en el personal de la salud expuesto a
drogas antineoplésicas en centros de quimioterapia PNDA (Programa Nacional de Drogas
AntineoplĂĄsicas) de Chile.
METODOLOGĂA Y MATERIALES: Se considerarĂĄ un grupo expuesto v/s un grupo
control del mismo centro asistencial. El personal para el estudio responderĂĄ una encuesta
personal con previo consentimiento informado. Se realizarĂĄ 3 a 4 frotis de mucosa oral por
persona con un cepillo citológico y fijado con spray citológico. Luego cada frotis se teñirå
con naranja de acridina y se contarĂĄn 1200 cĂ©lulas bajo microscopĂa de fluorescencia en
bĂșsqueda de MN.
RESULTADOS: El rango de células con MN observados en 1200 células contadas fue de
0 a 70 y el måximo de MN por célula fue de 10 MN. Se obtuvo una diferencia significativa
en la frecuencia de células con MN (p=0,002), cariorrexis (p=0,027) y binucleación
(p=0,001) entre los grupos expuesto v/s control. Se logrĂł precisar un punto de corte
siendo este de 16 células con MN. Se pudo determinar que las actividades de mayor
riesgo corresponden a las de PreparaciĂłn y AdministraciĂłn de drogas antineoplĂĄsicas y
los funcionarios/as: tĂ©cnicos paramĂ©dicos, enfermeras universitarias y quĂmicos
farmacĂ©uticos representarĂan los grupos de mayor exposiciĂłn. Gracias a la naranja de
acridina y su cambio metacromĂĄtico que sufre segĂșn la integridad del ADN (fluorescencia
verde si estĂĄ integro o roja si no lo estĂĄ), se observĂł que en el grupo control se
contabilizaron 54 MN verdes ( 18%) y 243 MN rojos (81%) dando un total de 297 MN
contados. Mientras que para el grupo expuestos fue de 149 MN verdes (13,7%) y 939 MN
rojos (86,3), dando como total 1088 MN contados. EstadĂsticamente no se pudo afirmar la
vinculaciĂłn entre el grupo expuesto y MN rojos (p=0.05265). Sobre los implementos de
seguridad, se puede decir que en la parte de preparaciĂłn se cumplĂa con casi todos los
elementos de seguridad, en cambio la parte de administraciĂłn se observĂł una debilidad
en esta ĂĄrea. Se observĂł el uso casi exclusivo de guantes con talco en ambas partes
(90,48% preparaciĂłn y 92,3% administraciĂłn), siendo que en la literatura especializada
desaconseja el uso de este tipo de guantes ya que actuarĂan como vector.
CONCLUSIĂN: Se puede concluir que personas expuestas laboralmente a drogas
antineoplĂĄsicas tienen un aumento de la presencia de MN, cariorrexis y binucleaciĂłn en
su mucosa oral comparado con individuos ajenos a esa actividad, lo que evidenciarĂa una
exposición riesgosa con daño al ADN de las células epiteliales. El no uso adecuado de los
elementos de seguridad para la manipulaciĂłn de estas drogas, podrĂa favorecer este
aumento de MN, lo que indicarĂa la importancia del uso de estos implementos para la
salud de personal expuesto.
SUMMARY: The antineoplastic drugs are widely used in therapy against the cancer and other pathologies. The action mechanisms above mentioned have been useful to stop the advance of malignancies in spite of the adverse reactions that they could present. The health workers that manipulates oncologic treatments in hospitals or chemotherapy centers, they would be potentially exposed to the genotoxic effect but they adopt safety strategies for prevention (5, 12). This effect is described in the literature and will be measured using cytogenetic methods such as the study of chromosomal aberrations, sister chromatid exchange, and Micronuclei (MN) analysis. Likewise, cytostatic metabolite chemical analyses in urine have shown the presence of these substances. The Micronuclei analysis is a simple, low complexity and rapid laboratory analysis. lt is one of the tests used in the search and quantification of this nuclear alteration in cells. (1, 4, 26). OBJECTIVE: To develop and validate a test for MN count screening and determine the the genotoxic effect in health workers exposed to antineoplastic drugs, in chemotherapy centers PNDA (National Program of Drugs Antineoplastics), Chile. MATERIAL ANO METHODS: lt was considered exposed health workers group compared with a control group (non-exposed subjects) of the same center, searching for a relevant MN count in the first group. The personnel for the study answers a simple and brief questionnaire with previous informed consent. A 3- 4 smears of oral mucose by the person were taken in a cytological brush and fixed with cytological spray. Then every smear was dye with acridine orange and 1200 cells were be counted under fluorescence microscopy, in MN's search. RESUL TS: The standardization of the MN screening test in oral mucose smear observed by means of fluorescence microscopy with acridine orange was obtained. The rank of cells with MN observed in 1200 cells (every sample analyzed) counted from O to 70 and the maximum of MN by cell was 10. Significant differences in the MN frequency (p=0,002), cariorrexis (p=0,027) and binucleation (p=0,001) between the groups (exposed v/s control) was obtained .. lt was managed to need a cut- off, being this of 16 MN. lt was possible to determine that the activities of greater risk correspond to those of preparation and administration of the antineoplastic drugs. According to work type, the paramedic technicians, nurses and pharmacists would represent the groups of greater expose. Thanks to acridine orange and the metachromatic change that suffers according to the integrity of the DNA (integral green fluorescence if this or red one if it is not it), was observed that in the group control 54 green MN (18%) were entered and 243 red MN (81 %) giving a counted total of 297 MN. Whereas for the group exposed it was of 149 green MN (13,7) and 939 red MN (86,3), giving like counted total1088 MN. Statistically (p=0.05265) could not be affirmed to the entailment between the red exposed group and MN, but the nonexistence of a tendency cannot be rejected. About the personal protection elements (PPE), the preparation procedures it was fulfilled almost all the PPE, however, the administration procedures was observed weakness in this topic. lt is important to emphasize the almost exclusive use of gloves with dust in both areas (90.48% preparation and 92.3% administration), being that in specialized literature the use of this type of gloves advises against since they would act like a vector. CONCLUSION: Can be concluded that exposed people labor to antineoplastic drugs (manipulation and administration) have an increased number of MN in their oral mucose compared with individuals other people's to that activity, would demonstrate a risky expose damage to the DNA of the epithelial cells. The suitable nonuse of the PPE for the manipulation of these drugs could favor the MN increase, which would indicate the importance of the use of these elements for the exposed health workers.
SUMMARY: The antineoplastic drugs are widely used in therapy against the cancer and other pathologies. The action mechanisms above mentioned have been useful to stop the advance of malignancies in spite of the adverse reactions that they could present. The health workers that manipulates oncologic treatments in hospitals or chemotherapy centers, they would be potentially exposed to the genotoxic effect but they adopt safety strategies for prevention (5, 12). This effect is described in the literature and will be measured using cytogenetic methods such as the study of chromosomal aberrations, sister chromatid exchange, and Micronuclei (MN) analysis. Likewise, cytostatic metabolite chemical analyses in urine have shown the presence of these substances. The Micronuclei analysis is a simple, low complexity and rapid laboratory analysis. lt is one of the tests used in the search and quantification of this nuclear alteration in cells. (1, 4, 26). OBJECTIVE: To develop and validate a test for MN count screening and determine the the genotoxic effect in health workers exposed to antineoplastic drugs, in chemotherapy centers PNDA (National Program of Drugs Antineoplastics), Chile. MATERIAL ANO METHODS: lt was considered exposed health workers group compared with a control group (non-exposed subjects) of the same center, searching for a relevant MN count in the first group. The personnel for the study answers a simple and brief questionnaire with previous informed consent. A 3- 4 smears of oral mucose by the person were taken in a cytological brush and fixed with cytological spray. Then every smear was dye with acridine orange and 1200 cells were be counted under fluorescence microscopy, in MN's search. RESUL TS: The standardization of the MN screening test in oral mucose smear observed by means of fluorescence microscopy with acridine orange was obtained. The rank of cells with MN observed in 1200 cells (every sample analyzed) counted from O to 70 and the maximum of MN by cell was 10. Significant differences in the MN frequency (p=0,002), cariorrexis (p=0,027) and binucleation (p=0,001) between the groups (exposed v/s control) was obtained .. lt was managed to need a cut- off, being this of 16 MN. lt was possible to determine that the activities of greater risk correspond to those of preparation and administration of the antineoplastic drugs. According to work type, the paramedic technicians, nurses and pharmacists would represent the groups of greater expose. Thanks to acridine orange and the metachromatic change that suffers according to the integrity of the DNA (integral green fluorescence if this or red one if it is not it), was observed that in the group control 54 green MN (18%) were entered and 243 red MN (81 %) giving a counted total of 297 MN. Whereas for the group exposed it was of 149 green MN (13,7) and 939 red MN (86,3), giving like counted total1088 MN. Statistically (p=0.05265) could not be affirmed to the entailment between the red exposed group and MN, but the nonexistence of a tendency cannot be rejected. About the personal protection elements (PPE), the preparation procedures it was fulfilled almost all the PPE, however, the administration procedures was observed weakness in this topic. lt is important to emphasize the almost exclusive use of gloves with dust in both areas (90.48% preparation and 92.3% administration), being that in specialized literature the use of this type of gloves advises against since they would act like a vector. CONCLUSION: Can be concluded that exposed people labor to antineoplastic drugs (manipulation and administration) have an increased number of MN in their oral mucose compared with individuals other people's to that activity, would demonstrate a risky expose damage to the DNA of the epithelial cells. The suitable nonuse of the PPE for the manipulation of these drugs could favor the MN increase, which would indicate the importance of the use of these elements for the exposed health workers.
Notas
Tesis (TecnĂłlogo MĂ©dico)
Palabras clave
Agentes AntineoplĂĄsicos, Personal de Salud, Enfermedades, Chile