RESUMO
BACKGROUND: Bone radiation-induced sarcomas (B-RIS) are secondary neoplasms with reportedly worse overall survival than de novo bone sarcoma. Treatment strategy for these neoplasms remains uncertain. Our systematic review sought to assess overall survival based on histology and surgical intervention. METHODS: A systemic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and registered in PROSPERO (438415). Studies describing oncologic outcomes of patients with B-RIS in the appendicular and axial skeleton were included. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used for quality assessment. Survival analysis by histologic subtype and surgery type was performed in a subset of 234 patients from 11 articles with individualized data. A total of 20 articles with a total of 566 patients were included. The most frequent location was the pelvis (27.7%), and the main histological types were osteosarcoma (69.4%), undifferentiated pleomorphic sarcoma (14.1%), and fibrosarcoma (9.2%). Limb-salvage and amputation were performed in 68.5% and 31.5% of cases, respectively. RESULTS: Local recurrence was 13%, without difference between limb-salvage surgery and amputation (p = 0.51). The metastasis rate was 42.3%. Five-year OS was 43.7% (95% confidence interval [CI], 33.3%-53.5%) for osteosarcoma, 31.5% (95% CI, 11.3%-54.2%) for UPS, and 28.1% (95% CI, 10.6%-48.8%) for fibrosarcoma. Five-year OS was 49.2% (95% CI, 35.3%-61.6%) for limb-salvage and 46.9% (95% CI, 29.1%-62.9%) for amputation. There was no difference in 5-year OS between histologic subtypes (p = 0.18) or treatment type (p = 0.86). CONCLUSION: B-RIS demonstrated poor OS at 5 years after initial management regardless of histology. Limb-salvage surgery was not associated with lower 5-year OS compared with amputation. Future studies should compare both groups while controlling for confounders. LEVEL OF EVIDENCE: Level III. See Instructions for Authors for a complete description of levels of evidence.
Assuntos
Neoplasias Ósseas , Neoplasias Induzidas por Radiação , Sarcoma , Humanos , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/cirurgia , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/patologia , Sarcoma/radioterapia , Sarcoma/patologia , Sarcoma/cirurgia , Sarcoma/mortalidade , Neoplasias Induzidas por Radiação/patologia , Neoplasias Induzidas por Radiação/cirurgia , Neoplasias Induzidas por Radiação/etiologia , Salvamento de Membro , Masculino , Feminino , Osteossarcoma/patologia , Osteossarcoma/mortalidade , Osteossarcoma/cirurgia , Osteossarcoma/radioterapia , Adulto , Resultado do Tratamento , Pessoa de Meia-Idade , AdolescenteRESUMO
Anthocyanins are colored water-soluble plant pigments. Upon consumption, anthocyanins are quickly absorbed and can penetrate the blood-brain barrier (BBB). Research based on population studies suggests that including anthocyanin-rich sources in the diet lowers the risk of neurodegenerative diseases. The copigmentation caused by copigments is considered an effective way to stabilize anthocyanins against adverse environmental conditions. This is attributed to the covalent and noncovalent interactions between colored forms of anthocyanins (flavylium ions and quinoidal bases) and colorless or pale-yellow organic molecules (copigments). The present work carried out a theoretical study of the copigmentation process between cyanidin and resveratrol (CINRES). We used three levels of density functional theory: M06-2x/6-31g+(d,p) (d3bj); ωB97X-D/6-31+(d,p); APFD/6-31+(d,p), implemented in the Gaussian16W package. In a vacuum, the CINRES was found at a copigmentation distance of 3.54 Å between cyanidin and resveratrol. In water, a binding free energy ∆G was calculated, rendering -3.31, -1.68, and -6.91 kcal/mol, at M06-2x/6-31g+(d,p) (d3bj), ωB97X-D/6-31+(d,p), and APFD/6-31+(d,p) levels of theory, respectively. A time-dependent density functional theory (TD-DFT) was used to calculate the UV spectra of the complexes and then compared to its parent molecules, resulting in a lower energy gap at forming complexes. Excited states' properties were analyzed with the ωB97X-D functional. Finally, Shannon aromaticity indices were calculated and isosurfaces of non-covalent interactions were evaluated.
Assuntos
Antocianinas , Teoria da Densidade Funcional , Resveratrol , Antocianinas/química , Resveratrol/química , Termodinâmica , Modelos Moleculares , Água/químicaRESUMO
BACKGROUND: Soft tissue sarcomas are a group of rare neoplasms which can be mistaken for benign masses and be excised in a non-oncologic fashion (unplanned excision). Whether unplanned excision (UE) is associated with worse outcomes is highly debated due to conflicting evidence. METHODS: We performed a systematic review and meta-analysis following PRISMA guidelines. Main outcomes analyzed were five-year overall survival (OS), five-year local recurrence-free survival (LRFS), amputation rate and plastic reconstruction surgery rate. Risk ratios were used to compare outcomes between patients treated with planned and unplanned excision. RESULTS: We included 16,946 patients with STS, 6017 (35.5%) with UE. UE was associated with worse five-year LRFS (RR 1.35, p = 0.019). Residual tumor on the tumor bed was associated with lower five-year LRFS (RR = 2.59, p < 0.001). Local recurrence was associated with worse five-year OS (RR = 1.82, p < 0.001). UE was not associated with a worse five-year OS (RR = 0.90, p = 0.16), higher amputation rate (RR = 0.77, p = 0.134), or a worse plastic reconstruction surgery rate (RR = 1.25, p = 0.244). CONCLUSIONS: Unplanned excision of Soft Tissue Sarcomas and the presence of disease in tumor bed after one were associated with worse five-year LRFS. Tumor bed excision should remain the standard approach, with special consideration to the presence of residual disease.
RESUMO
INTRODUCTION: Radiation-induced soft tissue sarcomas (RISs) are rare secondary malignancies with a dire prognosis. The literature on the management of these tumors remains scarce due to their low incidence. Our systematic review sought to assess the treatment alternatives and outcomes of patients with RIS. METHODS: A systematic review was conducted following the PRISMA guidelines. Our study was registered in PROSPERO (ID: CRD42023438415). Quality assessment was performed using the STROBE checklist. Weighted means for both continuous and categorical values were calculated. RESULTS: Twenty-one studies comprising 1371 patients with RIS were included. The mean latency period from radiation to RIS diagnosis was 14 years, and the mean radiation dose delivered to the primary malignancy was 29.2 Gy. The most common histological type was undifferentiated pleomorphic sarcoma (42.2%), and 64% of all tumors were high-grade. The trunk was the most common location (59%), followed by extremities (21%) and pelvis (11%). Surgery was performed in 68% of patients and, among those with an appendicular tumor, the majority (74%) underwent limb-salvage surgery. Negative margins were attained in 58% of patients. Chemotherapy and radiotherapy were administered in 29% and 15% of patients, respectively. The mean 5-year overall survival was 45%, and the local recurrence and metastasis rates were 39% and 27%, respectively. CONCLUSIONS: In our study, the most common treatment was surgical resection, with RT and chemotherapy being administered in less than one third of patients. Patients with RIS exhibited poor oncologic outcomes. Future studies should compare RIS with de novo STS while controlling for confounders.
RESUMO
Cellular homeostasis is lost or becomes dysfunctional during septic shock due to the activation of the inflammatory response and the deregulation of oxidative stress. Antioxidant therapy administered alongside standard treatment could restore this lost homeostasis. We included 131 patients with septic shock who were treated with standard treatment and vitamin C (Vit C), vitamin E (Vit E), N-acetylcysteine (NAC), or melatonin (MT), in a randomized trial. Organ damage quantified by Sequential Organ Failure Assessment (SOFA) score, and we determined levels of Interleukins (IL) IL1ß, Tumor necrosis factor alpha (TNFα), IL-6, monocyte chemoattractant protein-1 (MCP-1), Transforming growth factor B (TGFß), IL-4, IL-10, IL-12, and Interferon-γ (IFNγ). The SOFA score decreased in patients treated with Vit C, NAC, and MT. Patients treated with MT had statistically significantly reduced of IL-6, IL-8, MCP-1, and IL-10 levels. Lipid peroxidation, Nitrates and nitrites (NO3- and NO2-), glutathione reductase, and superoxide dismutase decreased after treatment with Vit C, Vit E, NAC, and MT. The levels of thiols recovered with the use of Vit E, and all patients treated with antioxidants maintained their selenium levels, in contrast with controls (p = 0.04). The findings regarding oxidative stress markers and cytokines after treatment with antioxidants allow us to consider to future the combined use of antioxidants in a randomized clinical trial with a larger sample to demonstrate the reproducibility of these beneficial effects.
Assuntos
Melatonina , Choque Séptico , Humanos , Antioxidantes/uso terapêutico , Interleucina-6 , Síndrome da Liberação de Citocina/tratamento farmacológico , Interleucina-10 , Choque Séptico/tratamento farmacológico , Reprodutibilidade dos Testes , Estresse Oxidativo , Ácido Ascórbico/uso terapêutico , Vitamina E/uso terapêutico , Acetilcisteína/uso terapêutico , Melatonina/uso terapêutico , Adjuvantes Imunológicos/uso terapêuticoRESUMO
Introducción: La Organización Mundial de la Salud declaró el COVID-19 como una pandemia el 11 de marzo de 2020. El antecedente de cáncer es considerado un factor de riesgo de mortalidad para múltiples padecimientos; la evolución de los pacientes con enfermedades neoplásicas puede verse influida por afecciones sobreañadidas como fue el caso del COVID-19. Objetivo: Caracterizar, desde el punto de vista clínico, a los pacientes oncológicos que ingresaron con COVID-19. Métodos: Se realizó una investigación descriptiva y transversal en pacientes con diagnóstico de enfermedad oncológica ingresados por COVID-19, en el Hospital Universitario Dr. Celestino Hernández Robau, Villa Clara, en el período de enero-diciembre 2021. Se incluyeron en el estudio 78 pacientes con diagnóstico de neoplasia de 5 años o menos de evolución. Resultados: Predominó el sexo masculino y los mayores de 60 años de edad. El 39,7 % de los pacientes presentó cáncer de pulmón o de laringe seguido por cáncer de mama, hemolinfopoyético y colorrectal. El 46,2 % se encontraba en estadio estable y el 29,5 % en paliativo. El 34,6 % de los pacientes recibía tratamiento con quimioterapia en el momento del ingreso. Los fármacos más utilizados fueron: esteroides (85,9 %), interferón alfa (73,1 %) y heparina sódica (55,1 %). Conclusiones: En los pacientes oncológicos hospitalizados con COVID-19, los tumores de pulmón y laringe fueron los más frecuentes, aunque el de mama, próstata y colorrectal, en ese orden, se relacionaron con mayor mortalidad. Los pacientes que se encontraban en progresión de la enfermedad y los que recibían tratamiento con quimioterapia presentaron mayor probabilidad de morir.
Introduction: the World Health Organization declared COVID-19 as a pandemic on March 11, 2020. A history of cancer is considered a mortality risk factor for multiple diseases; the evolution in patients with neoplastic diseases can be influenced due to superadded conditions such as the case of COVID-19. Objective: to characterize, from a clinical point of view, cancer patients admitted with COVID-19. Methods: a descriptive and cross-sectional research was carried out in cancer patients admitted with COVID-19 at "Dr. Celestino Hernández Robau" University Hospital in Villa Clara from January to December 2021. A number of 78 cancer patients with 5 years or less of evolution was included in the study. Results: male gender and those over 60 years of age predominated. The 39.7% of the patients had lung or laryngeal cancer followed by breast, hemolymphopoietic and colorectal cancers. The 46.2% were in a stable state and 29.5% in palliative care. The 34.6% of them were receiving chemotherapy treatment at the time of admission. Steroids (85.9%), alpha interferon (73.1%) and sodium heparin (55.1%) were the most used drugs. Conclusions: lung and laryngeal tumours were the most common malignancy in cancer patients hospitalized with COVID-19, although breast, prostate, and colorectal tumours, in that order, were associated with higher mortality. Patients with disease progression and those receiving chemotherapy were more likely to die.
Assuntos
Assistência Centrada no Paciente , Neoplasias Pulmonares , Neoplasias , COVID-19RESUMO
BACKGROUND: Subtrochanteric pathological fractures (PFs) occur in approximately one-third of femur bone metastases. We seek to analyze surgical treatment strategies for subtrochanteric metastatic PFs and their revision rates. METHODS: A systematic review was performed using the PubMed and Ovid databases. Reoperations as a result of complications were analyzed according to initial treatment modality, primary tumor site, and type of revision procedure. RESULTS: We identified a total of 544 patients, 405 with PFs and 139 with impending fractures. The study population's mean age was 65.85 years with a male/female ratio of 0.9. Patients with subtrochanteric PFs who underwent an intramedullary nail (IMN) procedure (75%) presented a noninfectious revision rate of 7.2%. Patients treated with prosthesis reconstruction (21%) presented a noninfectious revision rate of 8.9% for standard endoprostheses and 2.5% for tumoral endoprostheses (p < 0.001). Revision rates because of infection were 2.2% for standard and 7.5% for tumoral endoprostheses. There were no infections within the IMN and plate/screws group (p = 0.407). Breast was the most common primary tumor site (41%) and had the highest revision rate (14.81%). Prosthetic reconstructions were the most common type of revision procedure. CONCLUSION: No consensus exists regarding the optimal surgical approach in patients with subtrochanteric PFs. IMN is a simpler, less invasive procedure, ideal for patients with a shorter survival. Tumoral prostheses may be better suited for patients with longer life expectancies. Treatment should be tailored considering revision rates, patient's life expectancy, and surgeon's expertise. LEVEL OF EVIDENCE: Level III. See Instructions for Authors for a complete description of levels of evidence.
Assuntos
Neoplasias Ósseas , Fixação Intramedular de Fraturas , Fraturas do Quadril , Humanos , Masculino , Feminino , Idoso , Fixação Intramedular de Fraturas/métodos , Fraturas do Quadril/cirurgia , Fraturas do Quadril/etiologia , Neoplasias Ósseas/cirurgia , Implantação de Prótese , Fêmur/cirurgiaRESUMO
PURPOSE: Fascial dehiscence is still an important cause of morbidity and mortality in the postoperative period of abdominal surgery. Different authors have sought to identify risk factors for this entity. Two risk scores have been developed, but they include postoperative variables, which hinder preventive decision-making during the early surgical period. Our aim is to identify preoperative and intraoperative risk factors for fascial dehiscence and to develop and validate a risk prediction score that allows taking preventive behaviors. METHODS: All adult patients, with no prior history of abdominal surgery, who underwent midline laparotomy by a general surgery division between January 2009 and December 2019 were included. Recognized preoperative risk factors for fascial dehiscence were evaluated in a univariate analysis and subsequently entered in a multivariate stepwise logistic regression model. A prognostic risk model was developed and posteriorly validated by bootstrapping. This study was conducted following the STROBE statement. RESULTS: A total of 594 patients were included. Fascial dehiscence was detected in 41 patients (6.9%). On multivariate analysis, eight factors were identified: chronic obstructive pulmonary disease (COPD), immunosuppression, smoking, prostatic hyperplasia, anticoagulation use, sepsis, and overweight. The resulting score ranges from 1 to 8. Scores above 3 are predictive of 18% risk of dehiscence with a sensitivity of 70% and specificity of 80% (ROC 0.88). CONCLUSIONS: We present a new preoperative prognostic score to identify patients with a high risk of fascial dehiscence. It can be a guide for decision-making that allows taking intraoperative preventive measures. External validation is still required.
Assuntos
Laparotomia , Deiscência da Ferida Operatória , Adulto , Humanos , Estudos Retrospectivos , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/cirurgia , Fatores de Risco , Laparotomia/efeitos adversos , Laparotomia/métodos , Modelos LogísticosRESUMO
PURPOSE: Recently, treatment of Hinchey III diverticulitis by laparoscopic peritoneal lavage has been questioned. Moreover, long-term outcomes have been scarcely reported. Primary outcome was to determine the recurrence rate of diverticulitis after a successful laparoscopic peritoneal lavage in Hinchey III diverticulitis. Secondary outcomes were identification of associated risk factors for recurrence and elective sigmoidectomy rate. METHODS: A retrospective cohort study in a tertiary referral center was performed. Patients with Hinchey III diverticulitis who underwent a successful laparoscopic peritoneal lavage between June 2006 and December 2019 were eligible. Diverticulitis recurrence was analyzed according to the Kaplan-Meier and log-rank test, censoring for death, loss of follow-up, or elective sigmoid resection in the absence of recurrence. Risk factors for recurrence were identified using Cox regression analysis. RESULTS: Sixty-nine patients had a successful laparoscopic peritoneal lavage (mean age: 63 years; 53.6% women). Four patients had an elective sigmoid resection without recurrences. Recurrence rate was 42% (n = 29) after a median follow-up of 63 months. The cumulative global recurrence at 1, 3, and 5 years was 30% (95% CI, 20-43%), 37.5% (95% CI, 27-51%), and 48.9% (95% CI, 36-64%), respectively. Smoking (HR, 2.87; 95% CI, 1.22-6.5; p = 0.016) and episodes of diverticulitis prior to laparoscopic peritoneal lavage (HR, 5.2; 95% CI, 2.11-12.81; p < 0.001) were independently associated with an increased risk of recurrence. CONCLUSIONS: Diverticulitis recurrence after a successful laparoscopic peritoneal lavage is high, decreasing after the first year of follow-up. Smoking and previous episodes of acute diverticulitis independently increase the risk of new episodes of diverticulitis.
Assuntos
Doença Diverticular do Colo , Diverticulite , Perfuração Intestinal , Laparoscopia , Peritonite , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Doença Diverticular do Colo/complicações , Lavagem Peritoneal/efeitos adversos , Estudos Retrospectivos , Diverticulite/terapia , Fatores de Risco , Laparoscopia/efeitos adversos , Peritonite/etiologia , Peritonite/cirurgia , Perfuração Intestinal/cirurgia , Resultado do TratamentoRESUMO
Resumen: Introducción: se ha demostrado que los niveles iniciales de marcadores inflamatorios involucrados en COVID-19 (ej. ferritina, proteína C reactiva, procalcitonina, dímero D e interleucina-6) se relacionan con la mortalidad, sin encontrar resultados similares en pacientes con COVID-19 severo o quienes se encuentran bajo ventilación mecánica invasiva. Objetivo: determinar el nivel sérico con mayor sensibilidad y especificidad en los marcadores inflamatorios con relación a la mortalidad y gravedad de la disfunción orgánica en pacientes con COVID-19 severo usuarios de ventilación mecánica invasiva en las primeras 48 horas tras el ingreso hospitalario. Material y métodos: se realizó un estudio descriptivo de tipo cohorte retrospectiva y longitudinal en pacientes con diagnóstico de COVID-19 severo que fueran intubados antes de 48 horas tras el ingreso hospitalario por falla respiratoria aguda de enero de 2021 a agosto de 2021. Se determinó la relación entre los niveles de estos marcadores con las escalas pronósticas (SOFA, APACHE-II y SAPS-II), días de estancia hospitalaria, días en la Unidad de Terapia Intensiva Respiratoria, días de ventilación mecánica invasiva y las características de la mecánica ventilatoria inicial. Se agruparon los marcadores en niveles elevados y bajos para determinar su papel individual y en conjunto con los desenlaces. Resultados: se estudió una N = 218, con predominio de género masculino (77.5%) con media de edad de 60.3 ± 12.8 años. La hipertensión arterial sistémica y la diabetes mellitus tipo 2 fueron las comorbilidades más prevalentes (50.5% y 26.1%, respectivamente). La mediana de la relación PaO2/FiO2 fue de 128 mmHg (83.3-204.2), con una mortalidad total de 24.8%. Los niveles de biomarcadores con mayor sensibilidad para mortalidad y disfunción orgánica fueron: proteína C reactiva: ≥ 16 mg/dL, procalcitonina: ≥ 0.83 ng/mL, dímero D: ≥ 1,290 ng/mL, ferritina: ≥ 1,450 ng/mL e interleucina-6: ≥ 195 pg/mL. La procalcitonina y la interleucina-6 de manera aislada demostraron mayor riesgo de mortalidad y peor disfunción orgánica. Los marcadores inflamatorios se relacionaron a peor desenlace con respecto a las características del sistema respiratorio y el grado de alteración en gases arteriales. De forma conjunta (≥ 3 altos), los marcadores inflamatorios se relacionaron a mayor número de días de estancia hospitalaria, días en la Unidad de Terapia Intensiva Respiratoria y de días de ventilación mecánica invasiva. La proteína C reactiva, procalcitonina e interleucina-6 se asociaron a mayor riesgo de peor grado de disfunción orgánica por SOFA y peor pronóstico por APACHE-II y SAPS-II. Conclusión: la medición individual y conjunta de marcadores inflamatorios al ingreso hospitalario puede identificar a pacientes con mayor riesgo de estancia hospitalaria prolongada, así como ventilación mecánica invasiva, con mayor riesgo de mortalidad en el caso de procalcitonina e interleucina-6.
Abstract: Introduction: it has being demonstrated that the initial levels of inflammatory markers involved in COVID-19 (eg. C-reactive protein, procalcitonin, D-dimer, ferritin and interleukine-6) have an association with mortality, in different degree on severe COVID-19 patients or in those on invasive mechanical ventilation secondary to COVID-19 related acute respiratory distress syndrome. Objective: to determine the serum levels of these markers with the greatest sensibility and specificity for mortality and worst organ dysfunction in patients under invasive mechanical ventilation within the first 48 hours of hospitalization. Material and methods: in a retrospective and longitudinal cohort of severe COVID-19 patients on invasive mechanical ventilation within first 48 hours of hospitalization due to respiratory failure through January 2021 to August 2021, we determined the relation of inflammatory markers with prognostic scores (SOFA, APACHE-II and SAPS-II), hospital length-of-stay (LOS), intensive care LOS, invasive ventilation's days and initial ventilatory mechanics. We divided markers in high and low levels to identify the relation between each one and by groups with the outcomes. Results: we studied a N = 218, with male predominance (77.5%) and mean age of 60.3 ± 12.8 years. Arterial hypertension and diabetes mellitus type 2 were the most prevalent co-comorbidities (50.5% y 26.1%, respectively). The median initial PaO2/FiO2 was 128 mmHg (83.3-204.2), with a total mortality rate of 24.8%. Inflammatory markers levels with the highest sensibility for mortality were: C-reactive protein: ≥ 16 mg/dL, procalcitonin: ≥ 0.83 ng/mL, D-dimer: ≥ 1,290 ng/mL, ferritin: ≥ 1,450 ng/mL and interleukin-6: ≥ 195 pg/mL. Procalcitonin and interleukin-6 were associated to higher risk of mortality and worst organ dysfunction. The inflammatory markers were related with worst outcome in relation to respiratory mechanics and the amount of arterial-blood gases' alteration. Having ≥ 3 inflammatory markers within high levels was associated with prolonged LOS, more intensive care LOS and more days under invasive mechanical ventilation. The c-reactive protein, procalcitonin and interleukin-6 had higher organic dysfunction defined by SOFA and worst outcome defined by APACHE-II and SAPS-II. Conclusion: individual and joint measurement of inflammatory markers at hospitalization can identify patients with greater risk of longer hospital LOS, intensive care LOS and longer mechanical ventilation's days, with greater risk of mortality with higher procalcitonin and interleukine-6 serum levels.
Resumo: Introdução: demonstrou-se que os níveis iniciais de marcadores inflamatórios envolvidos no COVID-19 (por exemplo, ferritina, proteína C reativa, procalcitonina, D-dímero e interleucina-6) estão relacionados à mortalidade, sem encontrar resultados semelhantes em pacientes com COVID-19 grave ou que estejam sob ventilação mecânica invasiva. Objetivos: nosso objetivo foi determinar o nível sérico com maior sensibilidade e especificidade em marcadores inflamatórios em relação à mortalidade e gravidade da disfunção orgânica em pacientes com COVID-19 grave que usaram ventilação mecânica invasiva nas primeiras 48 horas após a admissão hospitalar. Material e métodos: realizou-se um estudo descritivo do tipo coorte retrospectivo e longitudinal em pacientes diagnosticados com COVID-19 grave que foram intubados nas primeiras 48 horas após a internação hospitalar por insuficiência respiratória aguda no período de janeiro de 2021 a agosto de 2021. A relação entre os níveis desses marcadores com as escalas de prognóstico (SOFA, APACHE-II e SAPS-II), dias de internação, dias na unidade de terapia intensiva respiratória, dias de ventilação mecânica invasiva e as características da ventilação mecânica inicial. Agrupou-se marcadores em níveis altos e baixos para determinar seu papel individualmente e em conjunto com os resultados. Resultados: estudou-se uma N = 218, com predominância do sexo masculino (77.5%) com idade média de 60.3 ± 12.8 anos. A hipertensão arterial sistêmica e a diabetes mellitus tipo 2 foram as comorbidades mais prevalentes (50.5% e 26.1%, respectivamente). A mediana da relação PaO2/FiO2 foi de 128 mmHg (83.3-204.2), com mortalidade total de 24.8%. Os níveis de biomarcadores com maior sensibilidade para mortalidade e disfunção orgânica foram: proteína C reativa: ≥ 16 mg/dL, procalcitonina: ≥ 0.83 ng/mL, dímero: ≥ 1.290 ng/mL, ferritina: ≥ 1.450 ng/mL, e interleucina-6: ≥ 195 pg/mL. A procalcitonina e a interleucina-6 sozinhas demonstraram maior risco de mortalidade e pior disfunção orgânica. Os marcadores inflamatórios foram relacionados a pior evolução quanto às características do sistema respiratório e ao grau de alteração dos gases arteriais. Juntos (≥ 3 altos), os marcadores inflamatórios foram relacionados a um maior número de dias de internação, dias na unidade de terapia intensiva respiratória e dias de ventilação mecânica invasiva. A proteína C-reativa, procalcitonina e interleucina-6 foram associadas a maior risco de pior grau de disfunção orgânica pelo SOFA e pior prognóstico pelo APACHE-II e SAPS-II. Conclusão: a medida individual e conjunta de marcadores inflamatórios na admissão hospitalar pode identificar pacientes com maior risco de internação prolongada e ventilação mecânica invasiva, com maior risco de mortalidade no caso da procalcitonina e interleucina-6.
RESUMO
Bones are the third most common site of metastatic disease. Treatment is rarely curative; rather, it seeks to control disease progression and palliate symptoms. Imaging evaluation of a patient with symptoms of metastatic bone disease should begin with plain X-rays. Further imaging consists of a combination of (PET)-CT scan and bone scintigraphy. We recommend performing a biopsy after imaging workup has been conducted. Metastatic bone disease is managed with a combination of systemic treatment, radiotherapy (RT), and surgery. External beam RT (EBRT) is used for pain control and postoperatively after fracture stabilization. Single-fraction and multiple-fractions schemes are equally effective achieving pain control. Adequate assessment of fracture risk should guide the decision to stabilize an impending fracture. Despite low specificity, plain X-rays are the first tool to determine risk of impending fractures. CT scan offers a higher positive predictive value and can add diagnostic value. Surgical management depends on the patient's characteristics, tumor type, and location of fracture/bone stock. Fixation options include plate and screw fixation, intramedullary (IM) nailing, and endoprostheses. Despite widespread use, the need for prophylactic stabilization of the entire femur should be individually analyzed in each patient due to higher complication rates of long stems.
RESUMO
INTRODUCTION: Merkel cell carcinoma (MCC) is an aggressive cutaneous cancer that frequently compromises the lymph nodes (LN) and distal organs. We sought to describe clinical and demographic characteristics of affected patients, analyze risk factors for LN compromise, metastasis, and death, and evaluate their impact on survival. MATERIALS AND METHODS: Patients with MCC were retrieved from the SEER database. Demographic, clinical and treatment data were analyzed. Logistic and Cox proportional hazard regression were used to analyze risk factors. Survival analysis was done with the Kaplan-Meier method. RESULTS: A total of 2010 patients were included, among which 288 (14.33%) had distant metastases at diagnosis. LN involvement occurred in 45.8% and 20.1% of patients with and without distant metastasis, respectively. Males were more likely to present LN compromise (OR = 1.33, p<0.001). Tumors >10 mm showed a significantly higher risk for LN involvement and distant metastasis, with those >20 mm showing the highest risk (OR = 2.76 p<0.001 and OR = 8.88 p<0.001 respectively). Location of the tumor in the trunk was a protective factor for overall death (OR = 0.27), while LN compromise was a risk factor (OR = 3.12). Only history of previous malignancy significantly affected disease-specific death (OR = 0.32, p = 0.01). One-year survival was 79.7% and 38.2% for patients with regional LN disease and distant metastasis, respectively. CONCLUSION: MCC is an aggressive cancer with high rates of LN involvement and distant metastases. Male gender and tumor size were risk factors for regional LN and metastatic disease. Tumor location in the trunk decrease the risk of overall death, while LN involvement increased it.
Assuntos
Carcinoma de Célula de Merkel , Neoplasias Cutâneas , Humanos , Masculino , Carcinoma de Célula de Merkel/terapia , Carcinoma de Célula de Merkel/patologia , Modelos de Riscos Proporcionais , Linfonodos/patologia , Excisão de Linfonodo , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapiaRESUMO
Introduction: Dedifferentiated chondrosarcoma (DDC) is an aggressive osseous neoplasm with a dismal prognosis. Treatment commonly involves limb-salvage surgery or amputation. In patients with appendicular DDC, we sought to describe demographic, clinical and treatment characteristics (1), analyze risk factors for metastasis (2) and overall death (3), and assess survival rates by treatment (4). Materials and methods: Two-hundred-and-five patients from the SEER Database were included in our analysis. Demographic, clinical and treatment variables were analyzed. Multivariate regression was performed to identify risk factors. Survival analysis was performed using the Kaplan-Meier method. Results: Fifty-one (24.9 %) of the patients included presented metastasis at diagnosis. The most common locations were the lungs, other sites, and bone. Surgery to the primary site was more common in patients without metastasis (94.2 %) than those with (78.2 %); limb-salvage procedures were more common than amputations. Tumors >8 cm (T2) and those discontinuous (T3) were more likely to present metastasis at diagnosis (OR = 2.54, p = 0.043 and OR = 7.4, p = 0.008, respectively). Female gender was found to be a protective factor for overall death on crude analysis (OR = 0.33, p = 0.019). Metastases to sites other than the lungs (M1b) had the highest risk of overall death (OR = 49, p = 0.01). Combination of surgery and chemotherapy showed a trend towards higher overall survival in non-metastatic patients (p = 0.1069 and p = 0.1703). Conclusions: Appendicular DDC displays a high metastatic rate and low survival rates. The most common procedure is a limb-salvage surgery. Tumor size increases the risk of presenting metastases at diagnosis and female gender is a protective factor against death.
RESUMO
Rapid changes in technology force Higher Education Institutions (HEIs) to generate policies and permanent digital adaptations in their exercise of forming professionals through university professors. HEIs -in their permanent desire to qualify teaching faculty and graduate high-level professionals-develop continuous training events to strengthen and update techno-pedagogical skills that allow giving concrete responses to the needs of a globalized society during a human-educational crisis that arises from the COVID-19 pandemic. This study aims at analyzing whether nano-MOOCs improve digital teaching competences in university professors since in the scientific literature, this topic does not show with certainty the effectiveness of these types of courses in teacher training. By conducting a quantitative descriptive-inferential, comparative quasi-experimental research (pre-test and post-test) and with a sample made up of 297 faculty members from Universidad Técnica del Norte (UTN, Ibarra-Ecuador) belonging to the five academic units that compose it, it was identified that the teaching staff has limitations in two of the areas of competence that are articulated by INTEF Common Framework: creation of digital content and security; nevertheless, they did show optimal skills in the areas of information and information literacy, communication and collaboration, and problem solving. The findings also determined that online training based on a nano-MOOC format becomes a successful alternative for university faculty training, 83.84% of the participants under study improved their level of digital competence. These results show that an efficient customizable training can be achieved in less time and adjusted to the needs and characteristics of the professors. The criteria of various authors in this field are ratified with this research, it is, therefore, relevant to evaluate the level of digital competence of teachers and, based on that, be able to plan a personalized training program.
RESUMO
Introduction: Hand-assisted laparoscopic colorectal surgery (HALS) is an alternative to straight laparoscopic approach (SL) that requires the use of a specific device to maintain the pneumoperitoneum. Our group has described an original double glove technique to replace it. Our purpose was to compare perioperative outcomes of patients undergoing HALS using this original technique vs SL. Methods: Retrospective review of a prospective database including patients who underwent elective laparoscopic colorectal resections between 2004 to 2020 at the Hospital Italiano, Argentina. Logistic regression analysis, propensity score matching, and inverse probability weighting were used to estimate adjusted treatment effects for perioperative outcomes. Results: HALS (n=458) and SL (n=1692) cases were demographically similar. HALS was associated with a shorter operative time (170.3 vs 206.9 minutes, p<0.001). Such difference was even more pronounced in obese (44.1 min), large patients (37.5 min), complex procedures (33.8 min) and surgeries carried out by non-trained surgeons (57,6 vs 31,6 minutes, p<0.001). Hand-assisted was associated with a lower conversion rate (5% vs 9.9%, p<0.001) with an adjusted odds ratio of 0.45 (95%CI 0.28-0.73). No difference in hospital stay, morbidity, and readmission rates was found. Conclusions: HALS with double-glove technique is comparable to SL in terms of postoperative outcomes keeping reduced operative time and conversion rates, especially in obese patients undergoing complex procedures.
Introducción: La cirugía colorrectal laparoscópica mano asistida (CLMA) es un abordaje alternativo a la laparoscopia directa (LD) que requiere de un dispositivo específico para mantener el neumoperitoneo. Nuestro grupo describió una técnica original de doble guante como alternativa a este dispositivo. El objetivo del presente trabajo fue analizar los resultados de esta técnica comparándola con la técnica de LD. Métodos: Se analizó una serie consecutiva de pacientes sometidos a cirugías colorrectales laparoscópicas entre 2004 y 2020 en el Hospital Italiano de Bs, As, Argentina. Se realizó un modelo de regresión múltiple de selección progresiva y apareamiento por puntaje de propensión para analizar los resultados perioperatorios. Resultados: Los casos de CLMA (n=458) y LD (n=1692) fueron demográficamente similares. CLMA se asoció a un menor tiempo operatorio (170,3 vs 206,9 minutos, p<0.001). Dicha reducción fue más marcada en obesos (44.1 min), pacientes grandes (37.5 min), cirugías complejas (33.8 min) y en procedimientos realizados por cirujanos no entrenados (57,6 vs 31,6 minutos, p<0.001). CLMA resultó tener menor índice de conversión (5% vs 9.9%, p<0.001) con una razón de probabilidades ajustada de 0,45. No se hallaron diferencias en cuanto a estadía hospitalaria, morbimortalidad y readmisión. Conclusión: CLMA con doble guante es comparable a la LD manteniendo un tiempo operatorio reducido y bajo índice de conversión, particularmente en pacientes obesos sometidos a procedimientos complejos.
Assuntos
Cirurgia Colorretal , Laparoscopia Assistida com a Mão , Argentina , Humanos , Estudos RetrospectivosRESUMO
â¢: In soft-tissue sarcomas (STSs), the use of positron emission tomography-computed tomography (PET-CT) through a standardized uptake value reduction rate correlates well with histopathological response to neoadjuvant treatment and survival. â¢: PET-CT has shown a better sensitivity to diagnose systemic involvement compared with magnetic resonance imaging and CT; therefore, it has an important role in detecting recurrent systemic disease. However, delaying the use of PET-CT scan, to differentiate tumor recurrence from benign fluorodeoxyglucose uptake changes after surgical treatment and radiotherapy, is essential. â¢: PET-CT limitations such as difficult differentiation between benign inflammatory and malignant processes, inefficient discrimination between benign soft-tissue tumors and STSs, and low sensitivity when evaluating small pulmonary metastases must be of special consideration.
Assuntos
Sarcoma , Neoplasias de Tecidos Moles , Humanos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Terapia Neoadjuvante , Tomografia por Emissão de Pósitrons/métodos , Recidiva Local de Neoplasia , Sarcoma/diagnóstico por imagem , Sarcoma/terapia , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/terapiaRESUMO
Patients with critical illness develop physiological dysfunction which provokes multi-organ system failure and triggers fatal outcomes and irreversible injuries or even death. Inside Internal Medicine services of Mexican hospitals, especially in public hospitals, there is a considerable number of critically ill patients with multiple pathologies who require surveillance to reach clinical goals of their treatment. We present a summary of guidelines and goals of the most prevalent critical diseases inside Internal Medicine services, which are necessary to guide treatments.
Los pacientes en estado crítico presentan disfunción fisiológica que provoca inestabilidad en órganos y sistemas del cuerpo, con desenlaces fatales y lesiones irreversibles o incluso la muerte. En los servicios de Medicina Interna de los hospitales de México, en especial en los públicos, hay pacientes críticos con múltiples patologías que requieren vigilancia en el cumplimiento de diversas metas de su tratamiento. Se presenta un compendio de las guías y metas de patologías críticas con mayor prevalencia en los servicios de Medicina Interna, las cuales son necesarias para guiar el tratamiento.
Assuntos
Estado Terminal , Objetivos , Estado Terminal/terapia , HumanosRESUMO
Los pacientes en estado crítico presentan disfunción fisiológica que provoca inestabilidad en órganos y sistemas del cuerpo, con desenlaces fatales y lesiones irreversibles o incluso la muerte. En los servicios de Medicina Interna de los hospitales de México, en especial en los públicos, hay pacientes críticos con múltiples patologías que requieren vigilancia en el cumplimiento de diversas metas de su tratamiento. Se presenta un compendio de las guías y metas de patologías críticas con mayor prevalencia en los servicios de Medicina Interna, las cuales son necesarias para guiar el tratamiento.
Patients with critical illness develop physiological dysfunction which provokes multi-organ system failure and triggers fatal outcomes and irreversible injuries or even death. Inside Internal Medicine services of Mexican hospitals, especially in public hospitals, there is a considerable number of critically ill patients with multiple pathologies who require surveillance to reach clinical goals of their treatment. We present a summary of guidelines and goals of the most prevalent critical diseases inside Internal Medicine services, which are necessary to guide treatments.
Assuntos
Humanos , Estado Terminal , Guias de Prática Clínica como Assunto , COVID-19 , Medicina Interna , Patologia , Sepse , Insuficiência Hepática , Parada Cardíaca , Hospitais Públicos , MéxicoRESUMO
INTRODUCCIÓN: la obesidad infantil es un importante problema de salud pública, por su prevalencia y consecuencias sobre las expectativas y la calidad de vida. En población infantil y adolescente, no hay consenso para diagnosticar el síndrome metabólico, esto explica las diferentes prevalencias reportadas. OBJETIVO: Determinar la prevalencia del síndrome metabólico en estudiantes de tres instituciones de educación diversificada del Municipio Iribarren Barquisimeto Estado Lara mediante los criterios establecidos por Adult Treatment Panel III. MATERIAL Y MÉTODO: se realizó una investigación transversal, descriptiva, donde se evaluó las medidas antropométricas, los parámetros clínicos y paraclínicos que se incluyen en los criterios establecidos para el diagnóstico de síndrome metabólico. La muestra estuvo conformada por 108 adolescentes pertenecientes a la U.E. Colegio "Inmaculada Concepción", U.E. "Rafael Villavicencio" y "Escuela Técnica Industrial Lara". Los resultados obtenidos fueron analizados mediante frecuencias absolutas y porcentajes. RESULTADOS: Se encontró que 4,6% de adolescentes presentó 3 o más criterios establecidos para el diagnóstico de síndrome metabólico. La dislipidemia (27,78%) y la hipertensión (19,4%) fueron los factores más frecuentes, seguidos por la obesidad abdominal. CONCLUSIÓN: la prevalencia de síndrome metabólico en adolescentes fue de 4,6% lo que refleja la importancia de identificar los factores de riesgo en edades tempranas para promover cambios de estilos de vida más saludable con el fin de prevenir enfermedades cardiometabólicas en la edad adulta.
INTRODUCTION: childhood obesity is an important public health problem, due to its prevalence and consequences on expectations and quality of life. In children and adolescents, there is no consensus to diagnose metabolic syndrome, this explains the different reported prevalences. OBJECTIVE: To determine the prevalence of metabolic syndrome in students from three diversified educational institutions in the Municipality of Iribarren Barquisimeto, Lara State, using the criteria established by Adult Treatment Panel III. METHODS: a cross-sectional, descriptive investigation was carried out, where the anthropometric measures, the clinical and paraclinical parameters that are included in the criteria established for the diagnosis of metabolic syndrome were evaluated. The sample consisted of 108 adolescents belonging to the U.E. Colegio "Inmaculada Concepción", U.E. "Rafael Villavicencio" and "Lara Industrial Technical School". The results obtained were analyzed using absolute frequencies and percentages. RESULTS: It was found that 4.6% of adolescents presented 3 or more established criteria for the diagnosis of metabolic syndrome. Dyslipidemia (27.78%) and hypertension (19.4%) were the most frequent factors, followed by abdominal obesity. CONCLUSION: the prevalence of metabolic syndrome in adolescents was 4.6%, which reflects the importance of identifying risk factors at an early age to promote healthier lifestyle changes in order to prevent cardiometabolic diseases in adulthood.