RESUMEN
Shaggy aorta (SA) is characterized by a critical and extensive atheromatous disease of the thoracic and abdominal aorta. This degenerative and dangerous pathology is the result of the confluence of multiple modifiable and non-modifiable risk factors. The clinical importance of this pathology relies on the various syndromes that can develop from its etiopathogenesis, which generates great morbidity and mortality in the affected patients. In this document, we present an updated and detailed review of this entity, developing aspects of its pathophysiology, diagnosis, including the importance of multimodal imaging, and its therapeutic approach. Finally, we present the clinical settings of patients with SA in different aortic scenarios (aortic dissection, ulcerated plaques, and thrombosed aneurysms) that denote the nature of this disease and its high mortality.
La aorta shaggy (AS) se caracteriza por ser una enfermedad ateromatosa crítica y extensa de la aorta torácica y abdominal. Esta patología degenerativa y peligrosa es el resultado de la confluencia de múltiples factores de riesgo modificables y no modificables. La importancia clínica de esta afección radica en los diversos síndromes que pueden desarrollarse a partir de su etiopatogenia, los cuales generan una gran morbimortalidad en los pacientes afectados. En este documento presentamos una revisión actualizada y detallada de esta entidad; se revisan aspectos sobre su fisiopatología, su diagnóstico, se incluye la importancia de la imagen multimodal y su abordaje terapéutico. Finalmente, presentamos escenarios clínicos de pacientes con AS con diferentes síndromes aórticos (disección aórtica, placas ulceradas y aneurismas trombosados) que denotan la naturaleza de esta enfermedad y su elevada mortalidad.
RESUMEN
Abstract Postoperative pain management in hip surgery is classified as severe and its inadequate control leads to complications that increase patient morbidity and mortality. The PENG block is advocated as a safe, opioid-sparing analgesic technique, which provides an adequate level of analgesia. The purpose of this study is to analyze about the efficacy, safety and therapeutic appropriateness of the PENG block in hip surgery. To this end, a narrative review is conducted using various databases such as PubMed and the Cochrane library. In all of the studies analyzed, an adequate postoperative pain control was achieved using the PENG block, with reduction in pain assessment scales and opioid consumption in the first postoperative hours. Improved results were also seen as compared with other regional blocks. There were few adverse effects and none of them was classified as severe. The PENG block contributes with numerous advantages and few adverse effects for hip surgery. Further studies are needed on this block, whether alone or in combination with other regional techniques, so as to include it in analgesia protocols, developing a standardized approach and study the outcomes in more controlled settings.
Resumen El manejo del dolor posoperatorio en cirugía de cadera se cataloga como severo y su inadecuado control conduce a complicaciones que aumentan la morbimortalidad de los pacientes. El bloqueo PENG se postula como una técnica analgésica segura, ahorradora de opioides, que otorga un nivel analgésico adecuado. El objetivo de este estudio es analizar acerca de la eficacia, seguridad y el lugar terapéutico del bloqueo PENG en cirugía de cadera. Para ello, se hace una revisión narrativa utilizando distintas bases de datos como PubMed y la biblioteca Cochrane. En todos los estudios analizados se observó un adecuado control del dolor posoperatorio con el uso del bloqueo PENG, con reducción en las escalas de evaluación del dolor y en el consumo de opioides en las primeras horas del posoperatorio. También se evidenciaron mejores resultados en comparación con otros bloqueos regionales. Los efectos adversos fueron escasos, y ninguno se catalogó como grave. El bloqueo PENG aporta numerosas ventajas con escasos efectos adversos para cirugía de cadera. Es necesario continuar estudiando este bloqueo, solo o en combinación con otras técnicas regionales, e incluirlo en protocolos de analgesia, estandarizarlo y estudiar sus resultados en escenarios más controlados.
RESUMEN
INTRODUCTION: knee arthroscopy is a common orthopedic procedure associated with postoperative pain, so optimizing pain management is essential for patient recovery and satisfaction. Lidocaine, a local anesthetic with well-established safety profiles, offers a potential alternative to traditional analgesic methods. Research regarding lidocaine patches has been conducted in several types of surgeries (laparoscopy, gynecological surgery, prostatectomy, etc.) showing promising results for some. This study investigates the effectiveness of transdermal lidocaine 5% patches as a novel approach to postoperative analgesia after knee arthroscopy. MATERIAL AND METHODS: a randomized, single-blind, placebo-controlled trial was conducted with participants undergoing knee arthroscopy. Patients were divided into two groups: one receiving transdermal lidocaine 5% patches and the other a placebo, both along traditional postoperative pain management, and using opioid only in cases with moderate-severe pain. Pain scores, opioid consumption, and patient-reported outcomes were assessed at various postoperative intervals. RESULTS: there was a significant reduction in pain scores and opioid consumption in the lidocaine patch group compared to the placebo group. CONCLUSIONS: transdermal lidocaine 5% patches emerge as a promising adjunct to postoperative pain management in knee arthroscopy patients. Their ease of application, minimal side effects, and opioid-sparing effects contribute to a multifaceted analgesic approach. This study underscores the potential of transdermal lidocaine patches in enhancing the overall postoperative experience for knee arthroscopy patients, advocating for their consideration in clinical practice.
INTRODUCCIÓN: la artroscopía de rodilla es un procedimiento ortopédico común asociado con dolor postoperatorio, por lo que optimizar el manejo del dolor es esencial para la recuperación y la satisfacción del paciente. La lidocaína, un anestésico local con perfiles de seguridad bien establecidos, ofrece una alternativa potencial a los métodos analgésicos tradicionales. Se ha llevado a cabo investigación sobre los parches de lidocaína en diversos tipos de cirugías (laparoscopía, cirugía ginecológica, prostatectomía, etcétera), mostrando resultados prometedores en algunos casos. MATERIAL Y MÉTODOS: se realizó un ensayo clínico aleatorizado, ciego simple y controlado con placebo que incluyó participantes sometidos a artroscopía de rodilla. Los pacientes fueron divididos en dos grupos: uno recibió parches transdérmicos de lidocaína al 5% y otro un placebo, ambos junto con el manejo tradicional del dolor postoperatorio y utilizando opioides sólo en casos de dolor moderado a severo. Se evaluaron las puntuaciones de dolor, el consumo de opioides y los resultados informados por los pacientes en varios intervalos postoperatorios. RESULTADOS: se registró una reducción significativa en las puntuaciones de dolor y el consumo de opioides en el grupo de parches de lidocaína en comparación con el grupo de placebo. CONCLUSIONES: los parches transdérmicos de lidocaína al 5% emergen como un complemento prometedor para el manejo del dolor postoperatorio en pacientes sometidos a artroscopía de rodilla. Su facilidad de aplicación, mínimos efectos secundarios y efectos ahorradores de opioides contribuyen a un enfoque analgésico multifacético. Este estudio destaca el potencial de los parches de lidocaína transdérmica para mejorar la experiencia postoperatoria general de los pacientes con artroscopía de rodilla, abogando por su consideración en la práctica clínica.
Asunto(s)
Anestésicos Locales , Artroscopía , Lidocaína , Dolor Postoperatorio , Parche Transdérmico , Humanos , Lidocaína/administración & dosificación , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Artroscopía/métodos , Anestésicos Locales/administración & dosificación , Método Simple Ciego , Femenino , Masculino , Adulto , Persona de Mediana Edad , Articulación de la Rodilla/cirugía , Administración Cutánea , Analgésicos Opioides/administración & dosificación , Resultado del Tratamiento , Adulto JovenRESUMEN
Resumen Las malformaciones arteriovenosas AVM del cuero cabelludo, comúnmente conocidas como aneurismas cirsoides, son colecciones complejas de arterias y venas que se comunican directamente. Dependiendo de su tamaño y complejidad, se puede utilizar una variedad de estrategias para tratarlos. Se presenta el caso de un paciente del sexo masculino de 53 años de edad, que acudió a valoración por presentar una aumento de volumen de una lesión pulsátil que se extendía desde la región parietotemporal derecha acompañado de cefalea holocraneana y tinnitus, se realizó una angiotomografía cerebral en la que se observó una lesión compuesta de imágenes serpentiformes ectásicas, con una localización extracraneal derecha, posteriormente se realizó una angiografía cerebral diagnóstica que demostró un cortocircuito arteriovenoso plexiforme y fistuloso frontoparietal derecho alimentado por aferencias provenientes de la arteria temporal superficial, auricular posterior, occipital y meníngea media derechas, con drenaje a través de una vena varicosa y ectásica hacia la vena yugular externa. Se realizó por vía femoral una embolización por vía endovascular del cortocircuito arteriovenoso en dos tiempos, logrando una construcción de "olla a presión" para realizar la inyección de líquido embolizante y tener una embolización subtotal del 93%, con esto se pudo realizar una resección microquirúrgica con un abordaje frontoparietotemporal derecho, resecando la parte más profunda, y dejando la piel cabelluda con vasos embolizados sin resecar. Para el cierre de la herida quirúrgica se realizó rotación de colgajo simple para cubrir el defecto de piel derivado de su resección. Se sometió al paciente a panangiografía cerebral postresección, y se identificó la ausencia de cortocircuito arteriovenoso. Dependiendo de la extensión y la complejidad anatómica de la malformación, las manifestaciones clínicas pueden variar. Más del 80% de las MAV estarán presentes al nacer y el resto se pueden desarrollar después de un trauma craneal o intervenciones quirúrgicas. Se necesita una intervención terapéutica adecuada a través de una angiografía selectiva, durante la cual se puede realizar la embolización endovascular de los principales vasos de alimentación antes de la intervención quirúrgica abierta. Las reconstrucciones por tomografía computarizada tridimensionales por volumen se pueden utilizar para una mayor planificación quirúrgica, la reducción del aporte arterial postembolización disminuirá la hemorragia intraoperatoria, facilitando la resección quirúrgica total. La eliminación puede dar lugar a defectos cutáneos grandes y de espesor completo que pueden ser difíciles de reconstruir sin comprometer los resultados funcionales y cosméticos.
Abstract Scalp arteriovenous malformations AVMs, commonly known as cirsoid aneurysms, are complex collections of arteries and veins that communicate directly. It has been postulated that AVMs occur both through the activation of inactive fistulous lesions and through the formation of new fistulous vascular channels through the canalization of injured vessels. Depending on their size and complexity, a variety of strategies can be used to treat them. The case of a 53-year-old male is presented who came for evaluation due to an increase in the volume of a pulsating lesion that extended from the right parietotemporal region accompanied by holocraneal headache and tinnitus. A cerebral angiotomography was performed in which a lesion composed of ectatic serpentine images, with a right extracranial location, subsequently diagnostic cerebral angiography was performed demonstrating a right frontoparietal fistulous and plexiform arteriovenous shunt fed by afferents from the right superficial temporal, posterior auricular, occipital and middle meningeal arteries, with drainage through a varicose and ectatic vein towards the external jugular vein. An endovascular embolization of the arteriovenous shunt was performed via the femoral route in two stages, achieving a "pressure cooker" construction to perform the injection of embolizing fluid and have a subtotal embolization of 93%, with this it was possible to perform a microsurgical resection with a right fronto-parietal-temporal approach resecting the deepest part, leaving the scalp with embolized vessels without resecting. To close the surgical wound, a simple flap rotation was performed to cover the skin defect derived from its resection. The patient underwent post-resection cerebral panangiography, identifying the absence of arteriovenous shunt. Depending on the extent and anatomical complexity of the malformation, clinical manifestations may vary. More than 80% of AVMs will be present at birth and the rest may develop after head trauma or surgical interventions. Appropriate therapeutic intervention is needed through selective angiography, during which endovascular embolization of the major feeding vessels can be performed before open surgical intervention. Volume-based three-dimensional computed tomography reconstructions can be used for further planning. Surgical reduction of post-embolization arterial supply will reduce intraoperative hemorrhage, facilitating total surgical resection. Removal can result in large, full-thickness skin defects that may be difficult to reconstruct without compromising functional and cosmetic results.
RESUMEN
Cloning by somatic cell nuclear transfer (SCNT) remained challenging for Rhesus monkeys, mostly due to its low efficiency and neonatal death. Genome-scale analyses revealed that monkey SCNT embryos displayed widespread DNA methylation and transcriptional alterations, thus including loss of genomic imprinting that correlated with placental dysfunction. The transfer of inner cell masses (ICM) from cloned blastocysts into ICM-depleted fertilized embryos rescued placental insufficiency and gave rise to a cloned Rhesus monkey that reached adulthood without noticeable abnormalities.
Asunto(s)
Clonación de Organismos , Metilación de ADN , Macaca mulatta , Técnicas de Transferencia Nuclear , Animales , Técnicas de Transferencia Nuclear/veterinaria , Macaca mulatta/genética , Femenino , Embarazo , Impresión Genómica , Blastocisto/citología , Blastocisto/metabolismo , GenomaRESUMEN
Pheochromocytoma is a tumor derived from neural crest cells able to produce sympathomimetic substances and, hence, a particular clinical picture. It is responsible for less than 1% of high blood pressure cases, with an estimated incidence between 0.4 and 0.6 cases per 100,000 people each year, and an average survival of seven years. Pheochromocytoma is a solid tumor with a high genetic component, as heritability can reach 40%. Once diagnosed, its treatment and prognosis are partly conditioned by the associated pathogenic variants that can be documented, especially those related to RET, SDHx, VHL, and NF1 genes. We present the case of a young woman with abdominal pain and high blood pressure, who was found to have a pheochromocytoma. Genetic testing detected a rare and recently discovered pathogenic variant: the SDHA:c.1A>C (p.Met1Leu). The patient responded adequately to the surgical treatment and continued the follow-up without documented recurrences. The diagnostic approach for pheochromocytoma patients must start with a clinical suspicion, followed by metabolite measurement in blood and urine, and finally, imaging. Currently, technology development allows precision medicine applicability. In this case of pheochromocytoma, recent developments in precision medicine resulted in the detection of associated genetic components involving the patient and her family. Adequate screening of the index patient is required for documenting pathogenic variants and better characterizing the disease.
El feocromocitoma es un tumor derivado de las células de la cresta neural con la capacidad de producir sustancias simpaticomiméticas y, por ende, un cuadro clínico particular. Causa menos del 1 % de los casos de hipertensión arterial sistémica y su incidencia se estima entre 0,4 y 0,6 casos por 100.000 personas cada año, con una supervivencia media de siete años. De todos los tumores sólidos, el feocromocitoma tiene un mayor componente genético, que puede heredarse hasta en el 40 % de los casos. Una vez diagnosticada la enfermedad, se debe definir el tratamiento y el pronóstico, en parte condicionados por las variantes genéticas asociadas, en especial RET, SDHx, VHL y NF1. Se presenta el caso de una mujer joven con dolor abdominal e hipertensión arterial sistémica, a quien se le diagnosticó feocromocitoma. Al secuenciar el exoma, se identificó una variante patogénica extremadamente rara y de reciente descubrimiento: SDHA: c.1A>C (p.Met1Leu). La paciente respondió adecuadamente al tratamiento quirúrgico y continuó en seguimiento sin recurrencias. El abordaje diagnóstico de los pacientes con feocromocitoma comienza con la sospecha clínica, seguida de la medición de determinados metabolitos en sangre y orina, y, finalmente, los estudios de imagenología. Los desarrollos tecnológicos actuales permiten la aplicación de la medicina de precisión en este campo. En este caso de feocromocitoma, se identificó un componente genético importante que no solo afecta al paciente, sino también, a sus familiares. La tamización adecuada del caso índice permite identificar mutaciones y caracterizar mejor la enfermedad.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales , Hipertensión , Feocromocitoma , Humanos , Feocromocitoma/complicaciones , Feocromocitoma/genética , Feocromocitoma/diagnóstico , Femenino , Neoplasias de las Glándulas Suprarrenales/complicaciones , Neoplasias de las Glándulas Suprarrenales/genética , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Hipertensión/etiología , Hipertensión/complicaciones , Colombia , Paraganglioma/genética , Paraganglioma/complicaciones , Paraganglioma/diagnóstico , AdultoRESUMEN
Textual data often describe events in time but frequently contain little information about their specific timing, whereas complementary structured data streams may have precise timestamps but may omit important contextual information. We investigate the problem in healthcare, where we produce clinician annotations of discharge summaries, with access to either unimodal (text) or multimodal (text and tabular) data, (i) to determine event interval timings and (ii) to train multimodal language models to locate those events in time. We find our annotation procedures, dashboard tools, and annotations result in high-quality timestamps. Specifically, the multimodal approach produces more precise timestamping, with uncertainties of the lower bound, upper bounds, and duration reduced by 42% (95% CI 34-51%), 36% (95% CI 28-44%), and 13% (95% CI 10-17%), respectively. In the classification version of our task, we find that, trained on our annotations, our multimodal BERT model outperforms unimodal BERT model and Llama-2 encoder-decoder models with improvements in F1 scores for upper (10% and 61%, respectively) and lower bounds (8% and 56%, respectively). The code for the annotation tool and the BERT model is available (link).
RESUMEN
Robotic surgery has emerged as a cornerstone in urological interventions, offering effectiveness and safety for patients. For anesthesiologists, this technological advancement presents a myriad of new challenges, spanning from patient selection and assessment to intraoperative dynamics and post-surgical pain management. This article aims to elucidate these challenges and provide guidance for anesthesiologists in navigating the complexities of anesthesia administration in robotic urological procedures. Through a detailed exploration of patient optimization, team coordination, intraoperative adjustments, and post-surgical care, this article serves as a valuable resource for ensuring the success of such interventions.
Asunto(s)
Anestesia , Procedimientos Quirúrgicos Robotizados , Procedimientos Quirúrgicos Urológicos , Humanos , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Urológicos/métodos , Anestesia/métodos , Dolor Postoperatorio/prevención & control , Selección de Paciente , Grupo de Atención al PacienteRESUMEN
Resumen: Introducción: La buprenorfina en la anestesia multimodal intratecal ofrece buena eficacia anestésica en histerectomías, pero por el mal entendimiento de su farmacocinética su efecto no está bien descrito. Objetivo: Evaluar la eficacia anestésica de la buprenorfina en la anestesia multimodal intratecal en histerectomías abdominales. Material y métodos: Ensayo clínico, controlado, aleatorizado, doble ciego, en mujeres programadas para histerectomía abdominal, distribuidas en tres grupos: grupo BBMD: buprenorfina 150 μg + bupivacaína hiperbárica 0.15% 4.5 mg + morfina 150 μg + dexmedetomidina 7.5 μg; grupo FBMD: fentanilo 50 μg + bupivacaína hiperbárica 0.15% 4.5 mg + morfina 150 μg + dexmedetomidina 7.5 μg; y grupo BM: bupivacaína hiperbárica 0.42% 12.5 mg + morfina 150 μg. Se evaluó la eficacia anestésica previo a la incisión, durante la disección de la pared abdominal, al ingreso a cavidad abdominal, en la entrada de compresas a cavidad abdominal, en la salida de compresas de cavidad abdominal y en el postquirúrgico inmediato. Resultados: Se analizaron 108 mujeres. Los tres grupos tuvieron muy buena eficacia anestésica; sin embargo, al salir compresas, antes de la dosis peridural y en el postquirúrgico inmediato, el grupo BM fue el que tuvo más molestias (p = 0.004, 0.01 y 0.01, respectivamente). Conclusión: La anestesia multimodal con BBMD demostró muy buena eficacia anestésica.
Abstract: Introduction: Buprenorphine in intrathecal multimodal anesthesia offers good anesthetic efficacy in hysterectomies, but due to the misunderstanding of its pharmacokinetics its effect is not well described. Objective: To evaluate the anesthetic efficacy of buprenorphine in intrathecal multiomodal anesthesia in abdominal hysterectomies. Material and methods: Controlled, randomized, double-blind clinical trial in women scheduled for abdominal hysterectomy, divided into three groups: BBMD group: buprenorphine 150 μg + hyperbaric bupivacaine 0.15% 4.5 mg + morphine 150 μg + dexmedetomidine 7.5 μg; FBMD group: fentanyl 50 μg + hyperbaric bupivacaine 0.15% 4.5 mg + morphine 150 μg + dexmedetomidine 7.5 μg; and BM group: hyperbaric bupivacaine 0.42% 12.5 mg + morphine 150 μg. Anesthetic efficacy was avaluated prior to the incision, during dissection of the abdominal wall, upon entry into the abdominal cavity, upon entry of compresses into the abdominal cavity, upon exit of compresses from the abdominal cavity, and in the immediate postoperative period. Results: 108 women were analyzed, the 3 groups had very good anesthetic efficacy, however, when the compresses come out of the cavity, the BM group had the most discomfort (p = 0.004). Conclusion: Multimodal anesthesia with BBMD demostrated very good anesthetic efficacy.
RESUMEN
El feocromocitoma es un tumor derivado de las células de la cresta neural con la capacidad de producir sustancias simpaticomiméticas y, por ende, un cuadro clínico particular. Causa menos del 1 % de los casos de hipertensión arterial sistémica y su incidencia se estima entre 0,4 y 0,6 casos por 100.000 personas cada año, con una supervivencia media de siete años. De todos los tumores sólidos, el feocromocitoma tiene un mayor componente genético, que puede heredarse hasta en el 40 % de los casos. Una vez diagnosticada la enfermedad, se debe definir el tratamiento y el pronóstico, en parte condicionados por las variantes genéticas asociadas, en especial RET, SDHx, VHL y NF1.Se presenta el caso de una mujer joven con dolor abdominal e hipertensión arterial sistémica, a quien se le diagnosticó feocromocitoma. Al secuenciar el exoma, se identificó una variante patogénica extremadamente rara y de reciente descubrimiento: SDHA: c.1A>C (p.Met1Leu). La paciente respondió adecuadamente al tratamiento quirúrgico y continuó en seguimiento sin recurrencias.El abordaje diagnóstico de los pacientes con feocromocitoma comienza con la sospecha clínica, seguida de la medición de determinados metabolitos en sangre y orina, y, finalmente, los estudios de imagenología. Los desarrollos tecnológicos actuales permiten la aplicación de la medicina de precisión en este campo. En este caso de feocromocitoma, se identificó un componente genético importante que no solo afecta al paciente, sino también, a sus familiares. La tamización adecuada del caso índice permite identificar mutaciones y caracterizar mejor la enfermedad.
Pheochromocytoma is a tumor derived from neural crest cells able to produce sympathomimetic substances and, hence, a particular clinical picture. It is responsible for less than 1% of high blood pressure cases, with an estimated incidence between 0.4 and 0.6 cases per 100,000 people each year, and an average survival of seven years. Pheochromocytoma is a solid tumor with a high genetic component, as heritability can reach 40%. Once diagnosed, its treatment and prognosis are partly conditioned by the associated pathogenic variants that can be documented, especially those related to RET, SDHx, VHL, and NF1 genes.We present the case of a young woman with abdominal pain and high blood pressure, who was found to have a pheochromocytoma. Genetic testing detected a rare and recently discovered pathogenic variant: the SDHA:c.1A>C (p.Met1Leu). The patient responded adequately to the surgical treatment and continued the follow-up without documented recurrences.The diagnostic approach for pheochromocytoma patients must start with a clinical suspicion, followed by metabolite measurement in blood and urine, and finally, imaging. Currently, technology development allows precision medicine applicability. In this case of pheochromocytoma, recent developments in precision medicine resulted in the detection of associated genetic components involving the patient and her family. Adequate screening of the index patient is required for documenting pathogenic variants and better characterizing the disease.
Asunto(s)
Humanos , Paraganglioma , Feocromocitoma , Tumores Neuroendocrinos , Hipertensión , Succinato Deshidrogenasa , Medicina de Precisión , Imagen MultimodalRESUMEN
Isolated apical ventricular hypoplasia is an extremely rare congenital heart disease. We describe 2 cases, each affecting a different side, presenting with unique clinical and imaging characteristics not hitherto delineated in the literature.
RESUMEN
BACKGROUND: Intracranial pressure (ICP) monitoring plays a key role in patients with traumatic brain injury (TBI), however, cerebral hypoxia can occur without intracranial hypertension. Aiming to improve neuroprotection in these patients, a possible alternative is the association of Brain Tissue Oxygen Pressure (PbtO2) monitoring, used to detect PbtO2 tension. METHOD: We systematically searched PubMed, Embase and Cochrane Central for RCTs comparing combined PbtO2 + ICP monitoring with ICP monitoring alone in patients with severe or moderate TBI. The outcomes analyzed were mortality at 6 months, favorable outcome (GOS ≥ 4 or GOSE ≥ 5) at 6 months, pulmonary events, cardiovascular events and sepsis rate. RESULTS: We included 4 RCTs in the analysis, totaling 505 patients. Combined PbtO2 + ICP monitoring was used in 241 (47.72%) patients. There was no significant difference between the groups in relation to favorable outcome at 6 months (RR 1.17; 95% CI 0.95-1.43; p = 0.134; I2 = 0%), mortality at 6 months (RR 0.82; 95% CI 0.57-1.18; p = 0.281; I2 = 34%), cardiovascular events (RR 1.75; 95% CI 0.86-3.52; p = 0.120; I2 = 0%) or sepsis (RR 0.75; 95% CI 0.25-2.22; p = 0.604; I2 = 0%). The risk of pulmonary events was significantly higher in the group with combined PbtO2 + ICP monitoring (RR 1.44; 95% CI 1.11-1.87; p = 0.006; I2 = 0%). CONCLUSIONS: Our findings suggest that combined PbtO2 + ICP monitoring does not change outcomes such as mortality, functional recovery, cardiovascular events or sepsis. Furthermore, we found a higher risk of pulmonary events in patients undergoing combined monitoring.
Asunto(s)
Lesiones Traumáticas del Encéfalo , Presión Intracraneal , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Encéfalo/fisiopatología , Lesiones Traumáticas del Encéfalo/mortalidad , Lesiones Traumáticas del Encéfalo/terapia , Lesiones Traumáticas del Encéfalo/fisiopatología , Hipertensión Intracraneal/etiología , Hipertensión Intracraneal/diagnóstico , Presión Intracraneal/fisiología , Monitoreo Fisiológico/métodos , Monitorización Neurofisiológica/métodos , Oxígeno/análisis , Oxígeno/metabolismoRESUMEN
The importance of radiology in modern medicine is acknowledged for its non-invasive diagnostic capabilities, yet the manual formulation of unstructured medical reports poses time constraints and error risks. This study addresses the common limitation of Artificial Intelligence applications in medical image captioning, which typically focus on classification problems, lacking detailed information about the patient's condition. Despite advancements in AI-generated medical reports that incorporate descriptive details from X-ray images, which are essential for comprehensive reports, the challenge persists. The proposed solution involves a multimodal model utilizing Computer Vision for image representation and Natural Language Processing for textual report generation. A notable contribution is the innovative use of the Swin Transformer as the image encoder, enabling hierarchical mapping and enhanced model perception without a surge in parameters or computational costs. The model incorporates GPT-2 as the textual decoder, integrating cross-attention layers and bilingual training with datasets in Portuguese PT-BR and English. Promising results are noted in the proposed database with ROUGE-L 0.748, METEOR 0.741, and NIH CHEST X-ray with ROUGE-L 0.404 and METEOR 0.393.
RESUMEN
We present the case of a 56-year-old patient with fever of unknown origin associated with chest and lumbar pain. Multimodality imaging revealed diffuse peri-aortitis in the thoracic aorta without involvement of the aortic valve, contributing substantially to the diagnosis of Ig G4-associated aortitis. Immunosuppressive therapy was started. Follow-up at five months with cardiac magnetic resonance imaging showed a reduction in the inflammatory process in the thoracic aorta.
Presentamos el caso de un paciente de 56 años, con cuadro febril de origen desconocido asociado a dolor torácico y lumbar. La imagen multimodal demostró periaortitis difusa en la aorta torácica sin afectación de la válvula aórtica, lo que contribuyó sustancialmente al diagnóstico de aortitis asociada a Ig4. Se inició tratamiento inmunosupresor. El seguimiento a los 5 meses, la resonancia magnética cardíaca mostró una reducción del proceso inflamatorio en la aorta torácica.
RESUMEN
INTRODUCTION: Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy about 50% of PDAC are metastatic at presentation. In this study, we evaluated PDAC demographics, annual trend analysis, racial disparities, survival rate, and the role of different treatment modalities in localized and metastatic disease. METHODS: A total of 144,824 cases of PDAC were obtained from the SEER database from 2000 to 2018. RESULTS: The median age was 69 years, with a slightly higher incidence in males (52%) and 80% of all cases were white. Among cases with available data, 43% were grade III tumors and 57% were metastatic. The most common site of metastasis was the liver (15.7%). The annual incidence has increased steadily from 2000 to 2018. The overall observed (OS) 5-year survival rate was 4.4% (95% CI 4.3-4.6%), and 5 years cause-specific survival (CSS) was 5% (95% CI 5.1-5.4%). The 5-year survival with multimodal therapy (chemotherapy, surgery, and radiation) was 22% (95% CI 20.5-22.8%). 5-year CSS for the blacks was lower at 4.7% (95% CI 4.2-5.1%) compared to the whites at 5.3% (95% CI 5.1-5.4%). Multivariate analysis found male gender and black race associated with worse prognosis. Kaplan-Meier survival analysis found multimodal therapy to have the best outcomes in all three stages. CONCLUSION: PDAC is an aggressive malignancy with male gender and black race are associated with a poor prognosis. Surgery with chemoradiation was associated with the best overall survival. With steadily increasing rates of PDAC, improved treatment modalities are paramount to improving survival in these patients.
Asunto(s)
Carcinoma Ductal Pancreático , Neoplasias Pancreáticas , Programa de VERF , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Negro o Afroamericano/estadística & datos numéricos , Carcinoma Ductal Pancreático/etnología , Carcinoma Ductal Pancreático/mortalidad , Terapia Combinada , Disparidades en Atención de Salud , Incidencia , Neoplasias Hepáticas/etnología , Neoplasias Hepáticas/mortalidad , Neoplasias Pancreáticas/etnología , Neoplasias Pancreáticas/mortalidad , Tasa de Supervivencia , Estados Unidos/epidemiología , BlancoRESUMEN
OBJECTIVE: To determine the effectiveness and adverse effects of urethrectomy alone or as part of multimodal therapy (MMT). METHODS: A comprehensive search was conducted across MEDLINE (OVID), EMBASE, LILACS and the Cochrane Central Register of Controlled Trials (CENTRAL) databases, from their inception to the present date. The study cohort comprised individuals aged 16 years and older diagnosed with urethral tumours at any stage who underwent either isolated urethrectomy or urethrectomy as an integral component of MMT. RESULTS: Ninety-two studies comprising 25 480 patients met the inclusion criteria. Surgical outcomes for urethral cancer vary considerably, with 5-year overall survival (OS) ranging from 10% to 68% based on disease extent, approach, and gender. Radiotherapy (RT) alone provides 5-year OS of approximately 40%. Combined regimens provide better outcomes compared to single modalities, including reduced recurrence and enhanced survival. However, trimodal therapy showed survival benefits only for urothelial subtypes, indicating the need to tailor management according to cancer type. MMT with neoadjuvant chemotherapy prior to surgery demonstrated the most consistent survival gains. CONCLUSIONS: The management of urethral cancer demands a nuanced, personalised approach, accounting for factors such as tumour location, sex, and tumour stage. MMT combining surgery, chemotherapy and RT has shown the ability to enhance outcomes in advanced disease. More extensive collaborative studies through specialised centres are imperative to advance evidence-based protocols and refine treatment in order to improve survival.
Asunto(s)
Neoplasias Uretrales , Humanos , Neoplasias Uretrales/terapia , Masculino , Terapia Combinada , FemeninoRESUMEN
INTRODUCCIÓN: La higiene de manos (HM) es la principal medida para disminuir las IAAS, las que en las Unidades de Cuidados Intensivos (UCI) presentan una alta prevalencia. En Chile no existe información sobre el impacto de la estrategia multimodal de la OMS para la HM en adultos. El objetivo fue evaluar el impacto de la implementación de la estrategia en una UPC. METODOLOGÍA: Estudio longitudinal con evaluación pre y post-intervención, entre los años 2018 y 2021, en la UCI del Hospital del Trabajador (HT), Santiago, Chile. La implementación se evaluó con pautas de cumplimiento de HM, consumo de jabón y productos en base alcohólica (PBA). El impacto se midió con las tasas de neumonía asociada a ventilación mecánica (NAVM), infecciones del torrente sanguíneo asociadas a CVC (ITS- CVC) y del tracto urinario por CUP (ITU-CUP), y la incidencia anual de dermatitis. RESULTADOS: El cumplimiento de pautas aumentó de 91 a 96% (p < 0,05). El consumo total de productos para la HM aumentó de 0,17 a 0,31 L/día/cama y de PBA en 10%. Las tasas de IAAS pre y post-intervención fueron para NAVM de 10,3 y 8,4; ITS-CVC de 0,8 y 1,5 e ITU-CUP de 4,2 y 5,3 por 1.000 días de exposición. La incidencia anual de dermatitis disminuyó en 30% (p < 0,05). CONCLUSIONES: La implementación de la estrategia multimodal se asoció a una disminución de las tasas de NAVM y de dermatitis en la UCI del HT.
INTRODUCTION: Hand hygiene is the main measure to decrease infections related to healthcare and the Intensive Care Unit has a high prevalence. In Chile there aren't reports about the impact of the World Health Organization multimodal hand hygiene improvement strategy. AIM: To assess the implementation impact of this strategy at the ICU. METHODOLOGY: Longitudinal study with pre- and postintervention evaluation during the years 2018-2021 at ICU. The implementation was assessed against hand hygiene compliance guidelines, soap consumption and alcohol-based products. The impact was evaluated with the rates of ventilator-associated pneumonia (VAP), catheter related bloodstream infection (CRBSI) and catheter associated urinary tract infection (CAUTI) and the annual dermatitis incidence. RESULTS: The guidelines compliance increased from 91% to 96% (p < 0.05). The total product consumption increased from 0.17 to 0.31 Liters/day/bed. The use of alcohol-based products increased by 10%. HAI rates pre- and post-intervention were for VAP 10.3 and 8.4, CRBSI 0.8 and 1.5 and CAUTI 4.2 and 5.3. The annual dermatitis incidence decreased by 30.8% (p < 0.05). CONCLUSIONS: The strategy implementation benefited the decrease of VAP and the dermatitis prevention in ICU.
Asunto(s)
Humanos , Desinfección de las Manos/métodos , Infección Hospitalaria/prevención & control , Unidades de Cuidados Intensivos/normas , Infecciones Urinarias/prevención & control , Infecciones Urinarias/epidemiología , Organización Mundial de la Salud , Infección Hospitalaria/epidemiología , Estudios Longitudinales , Dermatitis/prevención & control , Dermatitis/epidemiología , Neumonía Asociada al Ventilador/prevención & control , Neumonía Asociada al Ventilador/epidemiología , Infecciones Relacionadas con Catéteres/prevención & control , Infecciones Relacionadas con Catéteres/epidemiologíaRESUMEN
Resumen: El liposarcoma pleomórfico es una neoformación de tejidos blandos, que afecta principalmente las extremidades. Los pacientes que los presentan son candidatos a resección amplia o incluso amputación del miembro afectado. Como parte de una técnica anestésica integral y multimodal, destaca la utilización de bloqueos ecoguiados que disminuirán los requerimientos de opioides, teniendo un impacto importante en la preservación de la inmunidad del paciente oncológico, lo que le permitirá aumentar la tasa de supervivencia y su período libre de enfermedad; adicionando además un alfa 2 agonista, el cual nos brinda una adecuada analgesia postoperatoria, y realizando los bloqueos previos a la amputación, tenemos mayor tasa de éxito en la prevención del dolor y síndrome de miembro fantasma.
Abstract: Pleomorphic liposarcoma is a neoformation, which mainly affects the extremities. Being the patient candidate to perform a wide resection or even amputation of the affected limb. As part of a multimodal anesthetic technique, the use of ultrasound-guided blocks are useful, reducing opioid requirements, having an important impact on the preservation of the cancer patient's immunity, also adding an alpha 2 agonist, which provides adequate postoperative analgesia, and performing the blocks prior to amputation, we have a higher success rate in the prevention of pain and phantom limb syndrome.
RESUMEN
In the field of plant breeding, various machine learning models have been developed and studied to evaluate the genomic prediction (GP) accuracy of unseen phenotypes. Deep learning has shown promise. However, most studies on deep learning in plant breeding have been limited to small datasets, and only a few have explored its application in moderate-sized datasets. In this study, we aimed to address this limitation by utilizing a moderately large dataset. We examined the performance of a deep learning (DL) model and compared it with the widely used and powerful best linear unbiased prediction (GBLUP) model. The goal was to assess the GP accuracy in the context of a five-fold cross-validation strategy and when predicting complete environments using the DL model. The results revealed the DL model outperformed the GBLUP model in terms of GP accuracy for two out of the five included traits in the five-fold cross-validation strategy, with similar results in the other traits. This indicates the superiority of the DL model in predicting these specific traits. Furthermore, when predicting complete environments using the leave-one-environment-out (LOEO) approach, the DL model demonstrated competitive performance. It is worth noting that the DL model employed in this study extends a previously proposed multi-modal DL model, which had been primarily applied to image data but with small datasets. By utilizing a moderately large dataset, we were able to evaluate the performance and potential of the DL model in a context with more information and challenging scenario in plant breeding.