RESUMEN
BACKGROUND: The onset of the SARS-Cov-2 pandemic brought with it important changes in the hospital care for all diseases. According to the international literature, since the beginning of the pandemic there has been an impact in the incidence, etiology, and severity of head trauma, all these changes as a direct consequence of lockdown. OBJECTIVE: In this article we analyzed the characteristics of craniofacial trauma in patients admitted to a private hospital in Mexico City during the SARS-CoV-2 pandemic. METHOD: Medical records from patients admitted in Medica Sur between March 2020 and June 2021. In this study, incidence, etiology, severity of the injuries and the SARS-CoV-2 PCR result performed upon admission were analyzed. RESULTS: Although there is no study in Mexico like ours, the results were similar to those reported by other hospital centers worldwide, presenting a greater number of cases classified as mild craniofacial trauma, in addition to finding that the main age group affected were older adults. CONCLUSIONS: The reported information in our study provides a general view of craniofacial trauma characteristics during SARS-CoV-2 pandemic.
INTRODUCCIÓN: El inicio de la pandemia provocada por SARS-CoV-2 trajo consigo importantes cambios en los cuidados hospitalarios para todas las enfermedades. De acuerdo con la literatura internacional, desde el comienzo, y a consecuencia del aislamiento, ha existido un impacto en la incidencia, la etiología y la gravedad del trauma craneomaxilofacial. OBJETIVO: Estudiar las características del trauma craneofacial en los pacientes ingresados a un hospital privado en la Ciudad de México durante la pandemia por SARS-CoV-2. MÉTODO: Se revisaron los expedientes clínicos de los pacientes ingresados a Médica Sur, entre marzo de 2020 y junio de 2021. Se analizaron la incidencia, la etiología, la gravedad de las lesiones y el resultado de la prueba de reacción en cadena de la polimerasa para SARS-CoV-2 que se realizó durante la atención hospitalaria. RESULTADOS: En México no existe un estudio semejante al nuestro, pero los resultados fueron similares a los reportados por otros centros hospitalarios en el mundo, presentando un mayor número de casos clasificados como traumatismo craneofacial leve, además de encontrar que el principal grupo de edad afectado fueron los adultos mayores. CONCLUSIONES: La información reportada en nuestro estudio brinda un panorama general sobre las características del trauma craneofacial durante la pandemia por SARS-CoV-2.
Asunto(s)
COVID-19 , Traumatismos Craneocerebrales , Traumatismos Faciales , Hospitales Privados , Pandemias , Anciano , COVID-19/diagnóstico , COVID-19/epidemiología , COVID-19/prevención & control , Ciudades/epidemiología , Control de Enfermedades Transmisibles , Traumatismos Craneocerebrales/epidemiología , Traumatismos Craneocerebrales/etiología , Traumatismos Craneocerebrales/terapia , Traumatismos Faciales/epidemiología , Traumatismos Faciales/etiología , Traumatismos Faciales/terapia , Humanos , Puntaje de Gravedad del Traumatismo , México/epidemiología , SARS-CoV-2/aislamiento & purificaciónRESUMEN
Miliary metastasis to the central nervous system (CNS) is a rare presentation of metastasis mainly found in primary adenocarcinoma of the lung. Its association with breast cancer is even less frequent. We present the case of a 50-year-old female patient diagnosed in 2010 with stage IIA infiltrating ductal breast cancer RE (-), RP (+), HER 2 (-), HER2 NEU (+). She was treated with modified radical left breast mastectomy, radiation therapy, and chemotherapy. Her condition began presenting oppressive frontal headache without irradiation, predominantly in the evening, intensity 8/10, which decreased when sleeping and was exacerbated with stressful situations, in addition to progressive cognitive deterioration. Simple and contrasted computed tomography (CT) of the skull and thoracoabdominal were requested, showing multiple micronodular lesions with calcium density in the brain parenchyma, left pleural effusion, hypo and hyperdense lesions in the liver parenchyma, as well as osteoblastic lesions in the lumbar spine. Simple and contrasted magnetic resonance imaging (MRI) of the skull showed multiple supra and infratentorial intra-axial lesions. The most frequent associated symptom with miliary metastasis is cognitive impairment. Miliary metastasis, confirmed by imaging studies and histopathology, requires the ruling out of other causes of this calcification pattern, such as neurocysticercosis, due to specific treatment for each pathology.
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The advance of technology has made possible the use of new techniques within medicine for the treatment of diseases; monoclonal antibodies are a clear example of this. Keloid scars are one of the most difficult pathologies to treat due to the high percentage of recidivism, formed by the growth of a scar with benign fibrous tissue in genetically predisposed individuals, resulting from a process of inflammation and abnormal scarring. Monoclonal antibodies, being a line of treatment that has increased over the years, can show a new frontier in the treatment of them by focusing on the signaling that causes it. We review the literature on the signaling mechanisms of keloid scars and the possible monoclonal approach.
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Hemangiopericytoma (HPC) is a rare vascular tumor that was first described in 1942 and whose classification and treatment continue to develop. The proper classification for HPC is still under discussion, being considered a solitary fibrous tumor (SFT), classified as an aggressive biological form. The World Health Organization (WHO) has considered it to be part of extrapleural solitary fibrous tumors, however, neuropathologists still consider it to be an HPC when it is found in the central nervous system. We present a case of a patient with HPC of complex localization in the infratemporal fossa and middle floor of the skull base, which confirmed the diagnosis of HPC after resection by the craniofacial approach. Hemangiopericytomas are tumors that can present along with distant metastasis in 23% of cases even after resection. Surgery is the therapeutic basis; however, the still-controversial pathological classification of these vascular tumors and their uncertain biological behavior are the main reasons the ideal treatment continues to be investigated.