RESUMEN

Background: Pulmonary rehabilitation is recognized widely as one of the most effective measures to promote postoperative recovery of lung transplant recipients (LTRs), and it has positive effects on both short- and long-term quality of life (QoL) and survival outcomes. However, no standardized pulmonary rehabilitation training programs exist specifically for LTRs. The pulmonary rehabilitation programs widely used in clinical practice focus mainly on exercise or respiratory training, to some extent neglecting other therapeutic methods that could promote patient health, such as nutrition support, pain control, spiritual comfort, and so on. This study aimed to develop a postoperative pulmonary rehabilitation training program for LTRs and evaluate its effectiveness. Methods: Using convenience sampling, all patients who underwent lung transplantation (LTx) at Shanghai Pulmonary Hospital from January 2021 to December 2022 were screened for inclusion and exclusion criteria, and a total of 68 patients were finally included in this study. A non-synchronous quasi-experimental design was used, with patients who underwent LTx in 2021 as the control group and patients who underwent LTx in 2022 as the experimental group. The control group received routine treatment, health education, and rehabilitation guidance when patients determined the date of surgery. In addition to this, the experimental group received pulmonary rehabilitation training. The incidence of postoperative pulmonary complications (pulmonary infections), duration of chest tube drainage, intensive care unit (ICU) length of stay, postoperative pain scores, postoperative QoL, pulmonary function, oxygenation index, and the distance in the 6-minute walking test (6MWD) were compared between the two groups. Results: The length of ICU stay and duration of chest tube drainage in the experimental group were lower than those in the control group, and the results of oxygenation index, 6MWD, and St. George's Respiratory Questionnaire (reflecting the QoL) were better than those of the control group (P<0.05). There was no significant difference in the pain of the two groups 1 week after surgery and 3 months after surgery, and the pain score of the experimental group was lower than that of the control group at 1 month after surgery (P<0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). Conclusions: The postoperative pulmonary rehabilitation training program for LTRs is safe and effective. It can shorten both the duration of chest tube drainage and ICU stay, it can also improve patients' exercise capacity and pulmonary function while also promote safety outcomes of LTRs, and improve QoL scores.

RESUMEN

Fertility preservation (FP) in pediatric and adolescent oncology patients presents a complex interplay between cancer treatment imperatives and reproductive aspirations, demanding a multi-disciplinary approach. Essential guidelines emphasize the importance of early referrals to FP specialists, ensuring timely counseling on oocyte and ovarian tissue cryopreservation options. Proper patient selection and risk assessment, considering intrinsic and extrinsic factors, is crucial for judicious resource utilization and optimal outcomes. Gonadotoxic effects of cancer treatments pose significant threats to reproductive capabilities. Oocyte cryopreservation (OC) is preferred in post-pubertal adolescents without partners. Cultural and religious concerns, especially regarding hymenal integrity, influence FP decisions, necessitating culturally sensitive consent processes. Ovarian tissue cryopreservation (OTC) offers an alternative for those unfit for OC. Despite its experimental label in some societies, emerging data support the efficacy of OTC, with ovarian tissue transplantation (OTT) showing promise in restoring ovarian function. However, the reintroduction of potentially malignant cells during transplantation remains a concern. Overall, while FP offers hope for future parenthood, the intricacies of decision-making and the potential medical, ethical, and cultural challenges underscore the importance of a personalized, multi-disciplinary approach. In this review, guidelines from various societies have been comprehensively reviewed and analyzed to provide insight into the clinical practice of oncofertility.

Asunto(s)

RESUMEN

Dog-bite-related laryngotracheal injuries are rare but can be life-threatening. We present a case of penetrating laryngotracheal trauma in a six-year-old male and the management, considerations, and outcomes. The patient suffered extensive laryngotracheal trauma, including near complete tracheal transection, complete thyroid cartilage fracture, crush injury to the cricoid, and multiple tracheal perforations after a dog attack. We review initial management, subsequent airway interventions, multi-disciplinary approach, and airway outcomes. We present one of the few reports describing extensive dog-related penetrating laryngotracheal trauma in a pediatric patient, with successful airway management.

RESUMEN

Multiple primary malignancies (MPMs) are defined as two or more histopathologically distinct malignancies in the same individual. MPMs are classified as synchronous when tumors are diagnosed within six months of each other. The most common malignancies in MPMs are melanoma, breast, lung, and prostate cancer. Synchronous lymphoma and solid tumors are relatively rare. In these cases, a multi-disciplinary approach to treatment is essential. The early detection of additional primary malignancies such as myeloid and lymphatic tumors will enable prompt management with curative intent. The authors present a case of diffuse B-cell non-Hodgkin lymphoma and invasive lobular breast carcinoma presented as a chylous pleural effusion.

Asunto(s)

RESUMEN

INTRODUCTION AND IMPORTANCE: Poly-trauma is among the top ten leading causes of mortality and morbidity in developing countries. Road traffic injuries are the major cause of mortality in the overall burden of deaths related to injuries. The aim of this publication is to show how important are the principles of management in saving life even in austere limited resource settings. CASE PRESENTATION: We herein present a case of a 17-year-old male who presented to our emergency department about an hour after being involved in motor traffic accident in a semiconscious state, in hypovolemic shock and sustained multiple injuries. He had multiple limb and ribs fractures and blunt abdominal injury. He was rushed to the hospital where he was resuscitated at the emergency department and admitted in the Intensive Care Unit (ICU). He was scheduled for surgery the following day. His post-operative recovery was uneventful and was discharged after one month. CLINICAL DISCUSSION: The scarce resources and efforts spent on these patients prove to be futile in many situations because of delayed admission, lack of proper pre-hospital care and associated complications which cause irreversible damage. Management of a Poly-trauma patient should start from the scene of accident, during transportation and finally in the hospital by following all the principles of poly-trauma management using a multi-disciplinary approach. CONCLUSION: Timely diagnosis and proper management of a Poly-trauma patient can save life even in limited resource Centers.

RESUMEN

Benign tracheal stenosis can cause dyspnea, wheezing, and cough mimicking other obstructive lung diseases which often leads to a delay in the diagnosis. Risk factors and etiologies for tracheal strictures include autoimmune diseases, infection, gastro-esophageal reflux disease (GERD), radiation injury and iatrogenic factors such as post-intubation and post-tracheostomy. Once suspected, tracheal strictures are diagnosed by performing a thorough evaluation involving clinical exam, laboratory workup, pulmonary function test, chest imaging and bronchoscopy. Bronchoscopy plays a pivotal role in the diagnosis of stenosis and along with the imaging and physiologic assessments leads to a proper description of the stenosis based on all parameters that matters for management. Surgical resection provides a definitive management in most patients with idiopathic or post intubation/tracheostomy stenosis, however, factors such as severe co-morbidities, length and location of the stricture can preclude patients from undergoing curative surgery. Several bronchoscopic interventions including mechanical or laser assisted dilation, electrosurgery (ES), airway stenting and pharmacological treatment with mitomycin C (MMC) and intralesional steroid have been reported in the literature for management of patients who are not surgical candidates. Herein, we review the role of bronchoscopy and illustrate the importance of a multi-disciplinary team (MDT) approach comprising of interventional pulmonologists, thoracic surgeons and otorhinolaryngologists in the diagnosis and management of patients with benign tracheal stenosis.

RESUMEN

Vitamin D is truly unique-not a 'vital' amine in the true sense of the word, but rather a prohormone, which is produced in the skin during exposure to sunlight (UVB radiation at 290-315 nm) and which can also be obtained from food and from supplements. A high prevalence of low vitamin D status has been reported across the world in a wide range of population groups, and this includes communities living in low latitude areas despite the abundance of sunlight. It is accepted that vitamin D status is reflected by the level of the circulating metabolite 25-hydroxyvitamin D (25[OH]D), which is produced by hepatic hydroxylation of vitamin D, derived either from the skin from UV exposure or the gut from oral intake. Vitamin D has been associated with a wide range of health outcomes, but controversies remain as to their exact nature and extent and whether associations are in the causal pathway. In order to enable wider discussions on this nutrient, a 'Hot Topic' Vitamin D Workshop achieved funding from the UK Nutrition Research Partnership Medical Research Council call. The objectives of the workshop were (1) to elucidate the role of vitamin D in human health and (2) develop strategies to improve vitamin D status in the UK population. This paper provides a detailed resume of the discussions of the workshop; of the presentations and concomitant Q&As; and of identified areas for future research.

Asunto(s)

RESUMEN

IntroductionHematopoietic stem cell transplantation (HSCT) is a curative option for patients with Fanconi anemia (FA) and hematological manifestations but it does not prevent solid tumors, especially squamous cell carcinomas (SCC).MethodsRetrospective study in 22 FA patients who had received HSCT and had been followed up beyond 2 years after HSCT.ResultsThe median follow-up was 15 years. Six patients developed head-and-neck SCC after transplantation. The cumulative incidence of SCC at 15 and 30 years from the HSCT was 14.2% and 71.2%, respectively. One patient was diagnosed in stage IV and the rest, who were being followed up in cancer screening programs, in stage I. Treatment of SCC consisted of surgery in all patients; radiotherapy and chemotherapy were used in two patients and were poorly tolerated.ConclusionFA patients have high risk of head-and-neck SCC. Multi-disciplinary programs for early cancer detection are of special relevance in these patients.

Asunto(s)

RESUMEN

INTRODUCTION: Hematopoietic stem cell transplantation (HSCT) is a curative option for patients with Fanconi anemia (FA) and hematological manifestations but it does not prevent solid tumors, especially squamous cell carcinomas (SCC). METHODS: Retrospective study in 22 FA patients who had received HSCT and had been followed up beyond 2 years after HSCT. RESULTS: The median follow-up was 15 years. Six patients developed head-and-neck SCC after transplantation. The cumulative incidence of SCC at 15 and 30 years from the HSCT was 14.2% and 71.2%, respectively. One patient was diagnosed in stage IV and the rest, who were being followed up in cancer screening programs, in stage I. Treatment of SCC consisted of surgery in all patients; radiotherapy and chemotherapy were used in two patients and were poorly tolerated. CONCLUSION: FA patients have high risk of head-and-neck SCC. Multi-disciplinary programs for early cancer detection are of special relevance in these patients.

Asunto(s)

RESUMEN

INTRODUCTION: Diabetic Foot (DF) as a common complication of Diabetes should be intensive intervention for prevention, management and rehabilitation. In this regard, Diabetes Research Center of Endocrinology and Metabolism Research Institute (EMRI) of Tehran University of Medical Sciences (TUMS) considered DF as a priority research area to investigate multidimensional aspects of DF care. We are intended to summarize DF research studies affiliated to the EMRI for over the last two decades. METHODS: Three Electronic databases including Web of Science, PubMed, and Scopus were searched until January 2020 to find articles about DF published affiliated to EMRI. The main concepts of search strategies were "diabetes", "Foot". 115 documents retrieved from these databases which screened for inclusion and exclusion criteria. The visualization of the network of co-authorship of authors and co-occurrence of keywords was illustrated and documents were analyzed for content according to the Main areas of DF Research studies. RESULT: 64 related documents including original articles, reviews, letters, notes, and book chapter have included to this study. According to the objectives of the retrieved studies, DF documents and research studies categorized in the two main groups including DF prevention, classification and risk stratification in addition management of DF. CONCLUSION: Despite conducted research and educational activities in DF prevention and management, the following topics would be considered as well: effective offloading treatment, correcting the nutritional status for improving wound healing and novel educational strategies for diabetic foot multi-disciplinary team.

RESUMEN

Disturbances of gait occur in all stages of Huntington's disease (HD) including the premanifest and prodromal stages. Individuals with HD demonstrate the slower speed of gait, shorter stride length, and increased variability of gait parameters as compared to controls; cognitive disturbances in HD often compound these differences. Abnormalities of gait and recurrent falls lead to decreased quality of life for individuals with HD throughout the disease. This scoping review aims to outline the cross-disciplinary approach to gait evaluation in HD and will highlight the utility of objective measures in defining gait abnormalities in this patient population.

RESUMEN

The increase in frequency of multidrug-resistant bacteria worldwide is largely the result of the massive use of antibiotics in the second half of the 20th century. These relatively recent changes in human societies revealed the great evolutionary capacities of bacteria towards drug resistance. In this article, we hypothesize that the success of future antibacterial strategies lies in taking into account both these evolutionary processes and the way human activities influence them. Faced with the increasing prevalence of multidrug-resistant bacteria and the scarcity of new antibacterial chemical molecules, the use of bacteriophages is considered as a complementary and/or alternative therapy. After presenting the evolutionary capacities of bacteriophages and bacteria, we show how the development model currently envisaged (based on the classification of bacteriophages as medicinal products similar to antibacterial chemical molecules) ignores the evolutionary processes inherent in bacteriophage therapy. This categorization imposes to bacteriophage therapy a specific conception of what a treatment and a therapeutic scheme should be as well as its mode of production and prescription. We argue that a new development model is needed that would allow the use of therapeutic bacteriophages fully adapted (after in vitro 'bacteriophage training') to the aetiologic bacteria and/or aimed at rendering bacteria either avirulent or antibiotic-susceptible ('bacteriophage steering'). To not repeat the mistakes made with antibiotics, we must now think about and learn from the ways in which the materialities of microbes (e.g. evolutionary capacities of both bacteriophages and bacteria) are intertwined with those of societies.

Asunto(s)

RESUMEN

The authors propose "Barocrinology", a novel terminology in medical literature, to comprehensively describe the rapidly expanding field of obesity medicine. This new term highlights the need to appreciate the role of endocrine physiology in the evolution of obesity, insights into its complications and changes in the hormonal milieu following weight loss therapies, including bariatric surgery. This term would not only reduce the stigma associated with obesity in affected individuals but also give them a better appreciation of its biological origin rather than self-criticism. This paper also undermines the importance of a multi-disciplinary approach needed in this field for achieving practical and sustainable goals, individualized to each person.

Asunto(s)

RESUMEN

The Leyes' Delta lies at the Middle Paraná River, the second-largest fluvial system in South America, and it is being quickly formed into the Setúbal fluvial lake, Argentina. In the context of the Fluvial Biogeomorphic Succession theory, our aim was to better understand interactions between physical and biotic processes contributing to the formation of the Leyes' Delta. We studied the genesis, morphologic development, and vegetation in three groups of its deltaic islands with contrasting formation ages. Different methodologies were applied. Genesis and morphologic development were interpreted from time-series of satellite images and aerial photography obtained from 1974 to 2014. Then landforms and vegetation communities were mapped on the most current images, and they were corroborated and characterized during fieldwork. Our results evidence that the three island groups (Channel crevasse splay islands, Delta bar-plain islands, and Delta front islands) were formed via two different geomorphic processes, determining differences in the initial vegetation colonization. Eight fluvial-lacustrine landforms and eight vegetation communities, both differently represented among the island groups, currently characterize these islands. The species richness accumulation curves and beta diversity showed that the morphodynamic activity can be as important in the floristic composition of the deltaic islands as formation ages. The floristic composition differed statistically among island groups. After identifying three of the four phases of the FBS, we concluded that even though the morphodynamic activity under which islands were formed determined differences in the initial vegetation colonization, under similar subsequent levels of morphodynamics the resulting vegetation heterogeneity tends to be similar even under contrasting genesis. Among the vegetation types, Lotic prairies would play a key role in the morphologic evolution of the deltaic islands, therefore, their distribution and interactions with flow and sediments should be considered during the studies of social ecological systems as the Leyes' Delta, in Santa Fe, Argentina.

Asunto(s)

RESUMEN

Modern education of healthcare managers is one of key preconditions in making reforms towards increasing quality of care and making the provision of health services more cost-effective and efficient. This paper presents unique multidisciplinary approach for education of healthcare managers developed and accredited in Montenegro with elaboration results of the first year of its implementation. The results confirm the interest of experts of different profiles in multidisciplinary studies, as well as the optimality in using resources at national level in Montenegro.

Asunto(s)

RESUMEN

INTRODUCTION: The term Spondylodiscitis (SD) involves infection of the vertebra (Spondylitis), infection of the intervertebral disc (Discitis), or both (Spondylodiscitis). SD represents a diagnostic and therapeutic challenge to any spine surgeon. Any delay in its diagnosis or management may cause serious long-term morbidity or even lead to mortality. In this study, we report the experience of our Institution in the management of severe and complicated cases of SD. METHODS: Over a period of 1 year, 39 patients with the diagnosis of SD were surgically treated in Assiut University Hospital, Assiut, Egypt. The management processes were tailored according to the clinical condition, radiological and lab studies of each case; and patients were then prospectively followed-up until they were cured (for a minimum of 6 months). The outcomes were analyzed, to be able to give recommendations while aiming to improve the overall outcome of such dangerous health issue. RESULTS: In this series, patients were managed surgically by drainage and debridement of the infection site with/without instrumented fusion. Results included: satisfactory fusion was achieved in 97.3% of patients (confidence interval [CI] = 0.6856-1.3421). Neurological Improvement Rate (NIR) was 71.5% (Statistically significant improvement P-value = 0.014) and reoperation rate was 5% (CI = 0.00621-0.18525). Mortality rate was 7.7% (CI = 0.016-0.209). Several aspects were analyzed in each case. CONCLUSION: Surgical management of severe and complicated cases of SD allows for effective debridement and rapid cure of inflammation, earlier patient mobilization and significantly shorter duration of antibiotic usage.

RESUMEN

Chemotherapy resistance is a rising concern in Gastric Cancer (GC) and has led to the investigation of various cellular compounds. Α functional equilibrium of histone acetylation and deacetylation was discovered in all cells, regulated by Histone Acetyltransferases and Deacetylases (HDACs), controlling chromatin coiling status and changing gene expression appropriately. In accordance with recent research, this equilibrium can be dysregulated in cancer cells aiding in the process of carcinogenesis and tumor progression by altering histone and non-histone proteins affecting gene expression, cell cycle control, differentiation, and apoptosis in various malignancies. In addition, increased HDAC expression in GC cells has been associated with increased stage, tumor invasion, nodal metastases, increased distant metastatic potential, and decreased overall survival. HDAC inhibitors could be used as treatment regimens for GC patients and could develop important synergistic interactions with chemotherapy drugs. The aim of this article is to review the molecular identity and mechanism of action of HDAC inhibitors, as well as highlight their potential utility as anti-cancer agents in GC.

Asunto(s)

RESUMEN

BACKGROUND: To understand user needs, system requirements and organizational conditions towards successful design and adoption of Clinical Decision Support Systems for Type 2 Diabetes (T2D) care built on top of computerized risk models. METHODS: The holistic and evidence-based CEHRES Roadmap, used to create eHealth solutions through participatory development approach, persuasive design techniques and business modelling, was adopted in the MOSAIC project to define the sequence of multidisciplinary methods organized in three phases, user needs, implementation and evaluation. The research was qualitative, the total number of participants was ninety, about five-seventeen involved in each round of experiment. RESULTS: Prediction models for the onset of T2D are built on clinical studies, while for T2D care are derived from healthcare registries. Accordingly, two set of DSSs were defined: the first, T2D Screening, introduces a novel routine; in the second case, T2D Care, DSSs can support managers at population level, and daily practitioners at individual level. In the user needs phase, T2D Screening and solution T2D Care at population level share similar priorities, as both deal with risk-stratification. End-users of T2D Screening and solution T2D Care at individual level prioritize easiness of use and satisfaction, while managers prefer the tools to be available every time and everywhere. In the implementation phase, three Use Cases were defined for T2D Screening, adapting the tool to different settings and granularity of information. Two Use Cases were defined around solutions T2D Care at population and T2D Care at individual, to be used in primary or secondary care. Suitable filtering options were equipped with "attractive" visual analytics to focus the attention of end-users on specific parameters and events. In the evaluation phase, good levels of user experience versus bad level of usability suggest that end-users of T2D Screening perceived the potential, but they are worried about complexity. Usability and user experience were above acceptable thresholds for T2D Care at population and T2D Care at individual. CONCLUSIONS: By using a holistic approach, we have been able to understand user needs, behaviours and interactions and give new insights in the definition of effective Decision Support Systems to deal with the complexity of T2D care.

Asunto(s)