Impact of COVID-19 Pandemic on Cutaneous Squamous Cell Carcinoma: A Single-Centre Study of Epidemiologic, Clinic and Histopathological Factors.

BACKGROUND: The COVID-19 pandemic may have adversely affected the early diagnosis of skin cancer. OBJECTIVE: To compare epidemiological, clinical and histopathological characteristics in patients undergoing cutaneous squamous cell carcinoma (SCC) surgery before and after the beginning of the pandemic. MATERIAL & METHODS: We conducted a cross-sectional study including two case series: (1) patients operated on for SCC in the year after the first state of alarm in Spain (15 March 2020), and (2) patients with SCC operated on in the previous year. Epidemiological, clinical and histopathological variables, tumour stage and risk grade were collected. RESULTS: 248 patients were included (127 undergoing surgery before the pandemic and 121 after the pandemic). After the beginning of the pandemic, the percentage of high-risk SCC significantly increased from 35.3% to 46.2% (p=0.011). However, no significant differences were found in thickness, perineural invasion or metastases. CONCLUSIONS: Although there has not been a significant reduction in the number of SCC operated on after the pandemic, there has been a significant increase in high-risk SCC. All this could lead to an increase in skin cancer mortality in the future.

Impact of COVID-19 Pandemic on Cutaneous Squamous Cell Carcinoma: A Single-Centre Study of Epidemiologic, Clinic and Histopathological Factors. / [Artículo traducido] Impacto de la pandemia COVID-19 en el carcinoma de células escamosas cutáneo: un estudio unicéntrico de los factores epidemiológicos, clínicos e histopatológicos.

BACKGROUND: The COVID-19 pandemic may have adversely affected the early diagnosis of skin cancer. OBJECTIVE: To compare epidemiological, clinical and histopathological characteristics in patients undergoing cutaneous squamous cell carcinoma (SCC) surgery before and after the beginning of the pandemic. MATERIAL & METHODS: We conducted a cross-sectional study including two case series: (1) patients operated on for SCC in the year after the first state of alarm in Spain (15 March 2020), and (2) patients with SCC operated on in the previous year. Epidemiological, clinical and histopathological variables, tumour stage and risk grade were collected. RESULTS: 248 patients were included (127 undergoing surgery before the pandemic and 121 after the pandemic). After the beginning of the pandemic, the percentage of high-risk SCC significantly increased from 35.3% to 46.2% (p=0.011). However, no significant differences were found in thickness, perineural invasion or metastases. CONCLUSIONS: Although there has not been a significant reduction in the number of SCC operated on after the pandemic, there has been a significant increase in high-risk SCC. All this could lead to an increase in skin cancer mortality in the future.

Quality of Professional Life Among Dermatologists: Impact of the COVID-19 Pandemic and Suggestions for Improvement. / Calidad de vida profesional en dermatología: impacto de la pandemia y propuestas de mejora.

BACKGROUND AND OBJECTIVE: Quality of professional life (QPL) is defined as a sense of well-being derived from a balance between the challenges of work and the resources available to deal with them. Impaired QPL can contribute to burnout. The aim of this study was to evaluate QPL in Spanish dermatologists using a validated questionnaire. MATERIAL AND METHODS: We designed a cross-sectional study in which Spanish dermatologists were invited to complete an online questionnaire sent out by messaging applications. The dermatologists were asked to provide sociodemographic information, answer 3 open questions, and complete the 35-item Spanish QPL questionnaire (Spanish abbreviation, CVP-35). RESULTS: We analyzed the information submitted by 106 dermatologists (62 women, 58%) with a mean age of 41 years (95% CI, 43.3-38.8 years). Women and department heads scored significantly higher in the workload domain of the questionnaire (P=.02 and P=.005, respectively). A heavy caseload was mentioned as the main factor contributing to impaired QPL and the main change in the wake of the COVID-19 pandemic. CONCLUSIONS: Female dermatologists reported heavier workloads. Heavy caseloads and more remote work were the main changes identified after the COVID-19 pandemic. Heavy caseloads have a significant impact on the QPL of dermatologists in Spain. Reducing caseloads would improve general job satisfaction and quality of care provision.

Fontan procedure: imaging of normal post-surgical anatomy and the spectrum of cardiac and extracardiac complications.

Univentricular congenital heart diseases include a range of entities that result in a functionally single ventricular chamber. Although the only curative therapy is cardiac transplantation, there are several palliative surgical techniques that prevent ventricular volume overload, diverting part or all the systemic venous circulation into the pulmonary arteries. The modern Fontan procedure, which consists of anastomosing both the superior (SVC) and inferior vena cava (IVC) to the right pulmonary artery (RPA), is nowadays the last step before transplantation. The importance of imaging in these entities lies not only in the understanding of the new circuit established after surgical correction, but also in the early detection of the wide spectrum of cardiac and extracardiac complications that can occur due to the new physiological condition. Due to the increased survival of these patients, long-term complications are becoming more common. The main cardiac complications are atrial enlargement, ventricular dysfunction, and stenosis or thrombosis of the conduit. Pulmonary artery stenosis, pulmonary arteriovenous fistulae (PAVF), systemic-pulmonary veno venous shunts (VVS), hepatic congestion, cardiac cirrhosis, and protein-losing enteropathy are potential extracardiac complications.

Incidence and risk factors of post-engraftment invasive fungal disease in adult allogeneic hematopoietic stem cell transplant recipients receiving oral azoles prophylaxis.

Studies that analyze the epidemiology and risk factors for invasive fungal disease (IFD) after engraftment in alloSCT are few in number. This single-center retrospective study included 404 alloSCT adult recipients surviving >40 days who engrafted and were discharged without prior IFD. All patients who received ⩾20 mg/day of prednisone were assigned to primary oral prophylaxis (itraconazole or low-dose voriconazole). The primary end point was the cumulative incidence (CI) of probable/proven IFD using the European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC/MSG) criteria. The independent prognostic factors after multivariate analyses were used to construct a post-engraftment IFD risk score. The 1-year CI of IFD was 11%. The non-relapse mortality was 40% in those developing IFD and 16% in those who did not. The intent-to-treat analysis showed that 17% of patients abandoned the assigned prophylaxis. Age >40 years, ⩾1 previous SCT, pre-engraftment neutropenia >15 days, extensive chronic GVHD and CMV reactivation were independent risk factors. The post-engraftment IFD score stratified patients into low risk (0-1 factor, CI 0.7%), intermediate risk (2 factors, CI 9.9%) and high risk (3-5 factors, CI 24.7%) (P<0.0001). The antifungal prophylaxis strategy failed to prevent post-engraftment IFD in 11% of alloSCT. Our risk score could be useful to implement risk-adapted strategies using antifungal prophylaxis after engraftment.

[Magnetic resonance imaging of the left ventricle in healthy subjects: normal values for morphology, function, perfusion, and viability]. / Resonancia magnética del ventrículo izquierdo en sujetos sanos: valores normales de morfología, función, perfusión y viabilidad.

OBJECTIVE: To define normal values of MRI parameters related to cardiac morphology, function, perfusion, and delayed enhancement of the left ventricle and to analyze differences based on age and sex. MATERIAL AND METHODS: We used 1.5T and 3T MRI scanners to analyze 18 healthy subjects ranging in age from 15 to 77 years old. Dedicated image processing software (Cardio-MR, View Forum, Philips Medical Systems) was used to evaluate morphological and functional parameters (end-diastolic and end-systolic volume, stroke volume, ejection fraction, cardiac output, wall mass, wall thickness, wall thickening, wall motion), perfusion parameters (relative maximum upslope, relative maximum enhancement), and delayed enhancement (percentage of late hyperenhancement). Student's t-test was used for statistical analyses. RESULTS: Sex differences were observed: end-diastolic and end-systolic volumes, stroke volume, and wall mass were significantly higher in men and the ejection fraction was significantly larger in women. Healthy subjects over 45 years of age had significantly greater wall thickness. CONCLUSION: We report cardiac MRI reference values for morphological, functional, perfusion, and delayed enhancement parameters. Sex and age should be taken into account as important variables related to some of these parameters.

[MRI quantification of myocardial function, perfusion, and enhancement in patients with left-ventricular noncompaction]. / Cuantificación de la función, perfusión y realce tardío del ventrículo izquierdo no compactado mediante resonancia magnética.

OBJECTIVE: Left ventricular noncompaction is a congenital malformation characterized by a myocardium organized into two layers, one compacted and one noncompacted. We aimed to quantify myocardial function, perfusion, and delayed enhancement using MRI in patients with left-ventricular noncompaction and to compare these results with those of normal patients. MATERIAL AND METHODS: We included 12 patients with a myocardial noncompaction / compaction ratio>2.3 at end-diastole in at least one segment apart from the apex and 12 healthy subjects matched for age and sex. We calculated the end-diastolic and end-systolic volumes, stroke volume, ejection fraction, cardiac output, myocardial volume and mass, end-diastolic thickness, and left-ventricular wall thickening and motion. From the delayed enhancement images, we obtained the volume and percentage of hyperenhanced myocardium. Student's t test was used to compare groups. RESULTS: We observed a statistically significant increase in end-diastolic and end-systolic volumes in patients with left-ventricular noncompaction, as well as decreased ejection fraction, wall motion, and relative maximum upslope in segments 4, 9, and 10. No significant differences were found in delayed hyperenhancement. CONCLUSION: MRI quantification revealed decreased systolic cardiac function and decreased perfusion (lower relative maximum upslope) in the lower segments in patients with noncompaction.

[Smoking-related interstitial lung diseases: findings at high-resolution CT]. / Enfermedades intersticiales relacionadas con el tabaco: hallazgos en TC de alta resolución.

OBJECTIVE: To describe the anatomic and radiologic characteristics common to smoking-related interstitial lung diseases use and to evaluate the association between smoking and these diseases. MATERIAL AND METHODS: We reviewed the clinical histories of patients with suspected smoking-related interstitial lung diseases from 2001 to 2005 who underwent high-resolution computed tomography and had radiologic findings of desquamative interstitial pneumonia, respiratory bronchiolitis, histiocytosis X, or pulmonary fibrosis. We analyzed the presence of emphysema, ground glass, centrilobar nodules, cysts, honey combing, and overlap among these findings. RESULTS: Fourteen patients were included. In desquamative interstitial pneumonia, the most common finding was ground glass (100%); in respiratory bronchiolitis, it was centrilobar nodules (100%); cysts were the most common finding in histiocytosis (85.7%) and honey combing was the most common finding in fibrosis (100%). Furthermore, over 75% of the patients had emphysema, which supported the relation with tobacco use. The patients with bronchiolitis also had signs common to the other three diseases (ground glass, honey combing, and cysts). CONCLUSIONS: There is a relation between smoking and these interstitial diseases, as well as overlapping in their clinical and radiological manifestations.

[Ultrasound and CT study of duodenal pathology]. / Ecografía y tomografía computarizada de la patología duodenal.

The radiological evaluation of the duodenum has traditionally been based on barium transit studies; however, ultrasound (US) and computed tomography (CT) are becoming more important in the assessment of this portion of the intestine and the structures that surround it. This report describes and illustrates the CT and US findings for different entities that affect the duodenum, including diseases of the duodenum itself and those of neighboring organs that affect this portion of the small intestine. We classify the pathologies by etiology into congenital, traumatic, iatrogenic and foreign bodies, bezoars, hematologic, inflammatory and neoplastic. Moreover, we present the incidental duodenal and periduodenal findings in US and CT that radiologists should be familiar with given the widespread use of these techniques.