RESUMO
OBJECTIVE: Since the beginning of the 2019 global pandemic of Coronavirus Disease, using invasive mechanical ventilation as support therapy has been a critical treatment of acute respiratory failure. In the context of a collapsed health system, having an early extubation predictor becomes a useful way of supporting clinical management, by enabling to anticipate the availability of mechanical ventilators. Hence, we assessed the relationship between the progression of lactate dehydrogenase and early extubation in patients with COVID-19. DESIGN: A retrospective study. SETTING: A single private hospital in Chile. PATIENTS: Adults aged 18 or older diagnosed with COVID-19 pneumonia and requiring mechanical ventilation, having been admitted to an ICU during the study period. INTERVENTIONS: None. NEASUREMENTS AND MAIN RESULTS: Fifty two individuals, 73% males, were included with a median age of 47.1 years old and a median body mass index of 29. Individuals extubated within the first 5 days of mechanical ventilation, early extubation group, amounted to 34.6%. The average decrease in serum lactate dehydrogenase levels was 27.5 UI/L per day (p < 0.01) in the early extubation group compared to 14.7 UI/L per day (p < 0.01) in the late extubation group (individuals extubated after day 5). During the first 48 hours, the average daily decrease was 56.7 UI/L in the early extubation group compared to 13.2 UI/L per day in late extubation group (p < 0.01). CONCLUSIONS: Serum lactate dehydrogenase daily level decrease during the first days of mechanical ventilation is associated with earlier patient extubation
OBJETIVO: Desde inicios de la pandemia de 2019 de enfermedad por Coronavirus, la terapia de soporte con ventilación mecánica invasiva ha sido fundamental en el tratamiento de la falla respiratoria aguda. En contexto de un sistema de salud saturado, es útil contar con un predictor de extubación precoz para apoyar el manejo clínico, al anticipar disponibilidad de ventiladores mecánicos. Por lo tanto, evaluamos la relación entre progresión de lactato deshidrogenasa y extubación precoz en paciente cursando con COVID-19. DISEÑO: Estudio retrospectivo. ÁMBITO: Centro único, hospital privado en Chile. PACIENTES: Adultos mayores o igual a 18 años, con diagnóstico de Neumonía por COVID-19 y requerimientos de ventilación mecánica, ingresado a UCI durante el período estudiado. INTERVENCIÓN: No. RESULTADOS: Fueron incluidos cincuentas y dos individuos, 73% de sexo masculino, con una mediana de 47,1 años de edad e índice de masa corporal de 29. El grupo de extubación precoz, individuos extubados dentro de los 5 primeros días de ventilación mecánica, correspondió al 34,6%. El descenso promedio de lactato deshidrogenasa en el grupo de extubación precoz fue de 27,5 UI/L diario (p < 0,01), comparado con 14,7 UI/L diario en el grupo de extubación tardía (individuos extubados posterior al día 5 - p < 0,01). En las primeras 48 horas el descenso promedio en el grupo de extubación precoz fue 56,7 UI/L diario, comparado con 13,2 UI/L diario en el grupo de extubación tardía (p < 0,01). CONCLUSIONES: El descenso diario del nivel sérico de lactato deshidrogenasa en los primeros días de ventilación mecánica se asocia con una extubación precoz.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Lactato Desidrogenases/análise , Extubação/métodos , COVID-19/terapia , Fatores de Tempo , Estudos RetrospectivosRESUMO
OBJECTIVE: To prospectively determine the prevalence of testicular microlithiasis in symptomatic patients who were referred for scrotal ultrasound examination and to evaluate the possible association of testicular microlithiasis with testicular cancer and other conditions such as cryptorchidism or history of ascending testis. MATERIALS AND METHODS: 391 men who were referred to our institutions between July 2002 and May 2005 for any type of symptoms from the testicles, underwent physical and scrotal ultrasound examination. The presence of testicular microlithiasis, the number of lesions and the involvement of both testicles in relation to the symptoms as well as the coexistence of other lesions were studied. RESULTS: Eighteen (4.6%) of 391 men enrolled into the study had testicular microlithiasis. Two out of the eighteen patients (11%) had concomitant testicular cancer, which was confirmed by pathological evaluation of the orchidectomy specimen. One of the patients with testicular microlithiasis presented a rising in biochemical tumor markers (LDH, and HCG) and underwent orchidectomy one year later. Five of the remaining 373 (1.3%) patients without microlithiasis were diagnosed with testicular cancer. Thirty six men reported having a history of ascending testis, but none of them was found with testicular cancer. Two cases of testicular torsion in a cryptorchid position had testicular microlithiasis, but the orchidectomy specimen (after surgery) was negative for testicular cancer. The correlation between testicular cancer and testicular microlithiasis found in our study was statistically significant (p < 0.05). CONCLUSION: There seems to be an association between testicular microlithiasis and testicular cancer.
Assuntos
Criptorquidismo/complicações , Litíase/complicações , Escroto , Neoplasias Testiculares/complicações , Adulto , Idoso , Biomarcadores Tumorais/análise , Gonadotropina Coriônica/análise , Criptorquidismo/diagnóstico por imagem , Criptorquidismo/epidemiologia , Humanos , Lactato Desidrogenases/análise , Litíase/diagnóstico por imagem , Litíase/epidemiologia , Masculino , Pessoa de Meia-Idade , Orquiectomia , Prevalência , Estudos Prospectivos , Escroto/diagnóstico por imagem , Doenças Testiculares/complicações , Doenças Testiculares/diagnóstico por imagem , Doenças Testiculares/epidemiologia , Neoplasias Testiculares/diagnóstico por imagem , UltrassonografiaRESUMO
OBJECTIVE: To prospectively determine the prevalence of testicular microlithiasis in symptomatic patients who were referred for scrotal ultrasound examination and to evaluate the possible association of testicular microlithiasis with testicular cancer and other conditions such as cryptorchidism or history of ascending testis. MATERIALS AND METHODS: 391 men who were referred to our institutions between July 2002 and May 2005 for any type of symptoms from the testicles, underwent physical and scrotal ultrasound examination. The presence of testicular microlithiasis, the number of lesions and the involvement of both testicles in relation to the symptoms as well as the coexistence of other lesions were studied. RESULTS: Eighteen (4.6 percent) of 391 men enrolled into the study had testicular microlithiasis. Two out of the eighteen patients (11 percent) had concomitant testicular cancer, which was confirmed by pathological evaluation of the orchidectomy specimen. One of the patients with testicular microlithiasis presented a rising in biochemical tumor markers (LDH, and HCG) and underwent orchidectomy one year later. Five of the remaining 373 (1.3 percent) patients without microlithiasis were diagnosed with testicular cancer. Thirty six men reported having a history of ascending testis, but none of them was found with testicular cancer. Two cases of testicular torsion in a cryptorchid position had testicular microlithiasis, but the orchidectomy specimen (after surgery) was negative for testicular cancer. The correlation between testicular cancer and testicular microlithiasis found in our study was statistically significant (p < 0.05). CONCLUSION: There seems to be an association between testicular microlithiasis and testicular cancer.