RESUMO
BACKGROUND: Malignant melanoma (MM) is the most fatal cutaneous neoplasm. Its incidence is increasing progressively, which cannot be explained only by early diagnosis. Chilean population, due to the geography of the country, has a very varied solar exposure. AIM: To know the incidence of MM in a Chilean population, according to the level of sun exposure and to describe its clinical and histopathological characteristics. MATERIAL AND METHODS: Two hundred seventy-four surgeries for malignant melanoma with histological confirmation, carried out between 2016 and 2018 in an oncological institute were included. RESULTS: The annualized incidence of MM was 13.83 cases per 100,000 people over 15 years of age in the 2016-2018 period. The geographical distribution of the incidence did not have a clear relationship with sun exposure. The most frequent locations of the primary lesions were trunk, head/neck and lower limb. Sixty-one per cent of cases were invasive MM; lesion thickness and presence of ulceration were associated with a higher risk of sentinel node involvement. CONCLUSIONS: No association between the level of sun exposure and the incidence of MM was observed in this study.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/epidemiologia , Melanoma/patologia , Melanoma/epidemiologia , Chile/epidemiologia , Incidência , Distribuição por Idade e Sexo , Linfonodo SentinelaRESUMO
BACKGROUND: Malignant melanoma (MM) is the most fatal cutaneous neoplasm. Its incidence is increasing progressively, which cannot be explained only by early diagnosis. Chilean population, due to the geography of the country, has a very varied solar exposure. AIM: To know the incidence of MM in a Chilean population, according to the level of sun exposure and to describe its clinical and histopathological characteristics. MATERIAL AND METHODS: Two hundred seventy-four surgeries for malignant melanoma with histological confirmation, carried out between 2016 and 2018 in an oncological institute were included. RESULTS: The annualized incidence of MM was 13.83 cases per 100,000 people over 15 years of age in the 2016-2018 period. The geographical distribution of the incidence did not have a clear relationship with sun exposure. The most frequent locations of the primary lesions were trunk, head/neck and lower limb. Sixty-one per cent of cases were invasive MM; lesion thickness and presence of ulceration were associated with a higher risk of sentinel node involvement. CONCLUSIONS: No association between the level of sun exposure and the incidence of MM was observed in this study.
Assuntos
Melanoma , Linfonodo Sentinela , Neoplasias Cutâneas , Humanos , Neoplasias Cutâneas/patologia , Melanoma/epidemiologia , Melanoma/cirurgia , Linfonodo Sentinela/patologia , Chile/epidemiologia , Melanoma Maligno CutâneoRESUMO
Background: In Chile, Thyroid cancer (TC) is included in a list of diseases that have a guaranteed access to treatment, endorsed by the Ministry of Health. The care burden of the disease will depend on its incidence. Aim: To estimate the incidence of TC in Chilean patients with access to thyroid surgery and describe its histopathological characteristics. Material and methods: Analysis of the registry of all thyroidectomies performed at a private oncological clinic in Metropolitan Santiago, between 2016 and 2018. Incidence was estimated the number of persons affiliated to an insurance system managed by the same clinic, separated by age and gender. Results: TC adjusted incidence varied from 60.8 cases per 100,000 persons/year in 2016 to 48.7 cases per 100,000 persons/year in 2018. The proportion of microtumors was 34% when the diameter of all foci was considered. Papillary and follicular carcinomas were the pathological diagnoses in 96 and 2% of cases respectively. Twenty-one percent of tumors had extra-thyroidal invasion. Conclusions: The TC incidence herein reported is higher than the figure of 7.9 cases per 100,000 persons/year reported by us in 2014. This difference could be due to a true increase in the incidence of TC, following worldwide trends or to differences in the methods used in both studies.
Assuntos
Humanos , Institutos de Câncer , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/epidemiologia , Tireoidectomia , Chile/epidemiologia , Sistema de Registros , IncidênciaRESUMO
BACKGROUND: In Chile, Thyroid cancer (TC) is included in a list of diseases that have a guaranteed access to treatment, endorsed by the Ministry of Health. The care burden of the disease will depend on its incidence. AIM: To estimate the incidence of TC in Chilean patients with access to thyroid surgery and describe its histopathological characteristics. MATERIAL AND METHODS: Analysis of the registry of all thyroidectomies performed at a private oncological clinic in Metropolitan Santiago, between 2016 and 2018. Incidence was estimated the number of persons affiliated to an insurance system managed by the same clinic, separated by age and gender. RESULTS: TC adjusted incidence varied from 60.8 cases per 100,000 persons/year in 2016 to 48.7 cases per 100,000 persons/year in 2018. The proportion of microtumors was 34% when the diameter of all foci was considered. Papillary and follicular carcinomas were the pathological diagnoses in 96 and 2% of cases respectively. Twenty-one percent of tumors had extra-thyroidal invasion. CONCLUSIONS: The TC incidence herein reported is higher than the figure of 7.9 cases per 100,000 persons/year reported by us in 2014. This difference could be due to a true increase in the incidence of TC, following worldwide trends or to differences in the methods used in both studies.
Assuntos
Institutos de Câncer , Neoplasias da Glândula Tireoide , Chile/epidemiologia , Humanos , Incidência , Sistema de Registros , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/cirurgia , TireoidectomiaRESUMO
Osteoporosis is a silent and frequent disease, which increases fracture risk. Approximately half of women and one of five men over 50 years old will suffer an osteoporotic fracture throughout their lives. Dual-energy x-ray absorptiometry (DXA) allows a real bone mineral density (BMD) measurement in different parts of the skeleton and is considered the "gold standard" for quantifying osteoporosis with high accuracy and precision. The Board of the Chilean Society of Endocrinology and Diabetes (SOCHED) required from the Bone Disease Study Group to develop a consensus about the "Correct use of bone densitometry in clinical practice in Chilean population". Therefore, we elaborated 25 questions which addressed key aspects about the indications for a DXA scan, and the details of how to perform and report this test. Since some of the evidence obtained was of low quality or inconclusive, we decided to create a multidisciplinary group of national experts in osteoporosis to develop a consensus in this subject. The group consisted of 22 physicians including endocrinologists, gynecologists, geriatricians, radiologists, rheumatologists and nuclear medicine specialists. Using the Delphi methodology to analyze previously agreed questions, we elaborated statements that were evaluated by the experts who expressed their degree of agreement. The final report of this consensus was approved by the SOCHED board.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Osteoporose/diagnóstico por imagem , Absorciometria de Fóton/normas , Densidade Óssea , Sociedades Médicas , Chile , Consenso , Endocrinologistas/normasRESUMO
Osteoporosis is a silent and frequent disease, which increases fracture risk. Approximately half of women and one of five men over 50 years old will suffer an osteoporotic fracture throughout their lives. Dual-energy x-ray absorptiometry (DXA) allows a real bone mineral density (BMD) measurement in different parts of the skeleton and is considered the "gold standard" for quantifying osteoporosis with high accuracy and precision. The Board of the Chilean Society of Endocrinology and Diabetes (SOCHED) required from the Bone Disease Study Group to develop a consensus about the "Correct use of bone densitometry in clinical practice in Chilean population". Therefore, we elaborated 25 questions which addressed key aspects about the indications for a DXA scan, and the details of how to perform and report this test. Since some of the evidence obtained was of low quality or inconclusive, we decided to create a multidisciplinary group of national experts in osteoporosis to develop a consensus in this subject. The group consisted of 22 physicians including endocrinologists, gynecologists, geriatricians, radiologists, rheumatologists and nuclear medicine specialists. Using the Delphi methodology to analyze previously agreed questions, we elaborated statements that were evaluated by the experts who expressed their degree of agreement. The final report of this consensus was approved by the SOCHED board.
Assuntos
Absorciometria de Fóton/normas , Densidade Óssea , Osteoporose/diagnóstico por imagem , Adulto , Idoso , Chile , Consenso , Endocrinologistas/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sociedades MédicasRESUMO
BACKGROUND: Thyroid cancer (TC) detection is increasing steadily. AIM: To determine the incidence of TC based on pathological reports of thyroidectomies. MATERIAL AND METHODS: Fifty pathology laboratories performing thyroid gland pathological studies were identified. Those that accepted to participate were required to send trimestral reports of all thyroid pathological studies, from March 2011 to February 2012. RESULTS: In the study period, 1309 case of TC were confirmed in 2614 thyroidectomy surgical samples. Considering the susceptible population according to 2012 census, the estimated incidence of TC during 2011 should be higher than 7.86 cases per 100,000 persons/year. Papillary cancer was the most common pathological type in 92% of samples (95% confidence intervals 90-93%). The proportion of microtumors was significantly higher in women than in men and among papillary than in follicular or medullary tumors. Only one fourth of tumors came from thyroidectomies performed in the Ministry of Health network. CONCLUSIONS: The incidence and features of TC in Chile are similar to the figures reported abroad.
Assuntos
Neoplasias da Glândula Tireoide/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Chile/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia , Adulto JovemRESUMO
Background: Thyroid cancer (TC) detection is increasing steadily. Aim: To determine the incidence of TC based on pathological reports of thyroidectomies. Material and Methods: Fifty pathology laboratories performing thyroid gland pathological studies were identified. Those that accepted to participate were required to send trimestral reports of all thyroid pathological studies, from March 2011 to February 2012. Results: In the study period, 1309 case of TC were confirmed in 2614 thyroidectomy surgical samples. Considering the susceptible population according to 2012 census, the estimated incidence of TC during 2011 should be higher than 7.86 cases per 100,000 persons/year. Papillary cancer was the most common pathological type in 92% of samples (95% confidence intervals 90-93%). The proportion of microtumors was significantly higher in women than in men and among papillary than in follicular or medullary tumors. Only one fourth of tumors came from thyroidectomies performed in the Ministry of Health network. Conclusions: The incidence and features of TC in Chile are similar to the figures reported abroad.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Neoplasias da Glândula Tireoide/epidemiologia , Chile/epidemiologia , Incidência , Estadiamento de Neoplasias , Neoplasias da Glândula Tireoide/patologia , TireoidectomiaRESUMO
Objective: To determine whether overweight is a risk factor for the development of early childhood caries (ECC) in preschoolers. Patients and Method: An observational retrospective cohort study was performed in 196 children under 2 years of age at Calbuco Hospital, Los Lagos Region, Chile, who were admitted between 2007 and 2009. Patients were grouped based on their nutritional status at admission in the two following categories: eutrophic and overweighed children as a result of excessive intake. Information regarding caries incidence and nutritional status were annually retrieved from records until the age of 5 years, according to medical and dental records. Results: At the beginning of the study, 33.67% were overweight and 16.33% were obese, reaching 40% overweight and 20.56% obese at four years of age. The incidence of early childhood caries in overweighed children was 57.14% compared to 40.82% in normal weight children (p = 0.022), with 1.4 RR (95% CI, 1044-1.88). Conclusions: The increased risk of early childhood decay in overweighed patients makes necessary to create instances of timely mutual referral between the professional that diagnoses overweighed children and the pediatric dentist in order to develop preventive treatments for both diseases.
Objetivo: Determinar si la malnutrición por exceso es un factor de riesgo para el desarrollo de caries temprana de la infancia (CTI) en preescolares. Pacientes y Método: Se realizó un estudio observacional de cohorte retrospectivo en 196 niños de 2 años del Hospital de Calbuco, Región de Los Lagos, Chile, ingresados durante los años 2007 a 2009. Los pacientes fueron agrupados de acuerdo a su estado nutricional al ingreso en niños eutróficos y niños con malnutrición por exceso. La información respecto a incidencia de caries y el estado nutricional fueron recuperados de la ficha anualmente hasta la edad de 5 años, según registro de las fichas médicas y odontológicas. Resultados: El 33,67% estaba en sobrepeso al inicio de la cohorte y el 16,33% obeso, alcanzando 40% sobrepeso y 20,56% obesidad a los cuatro años de edad. La incidencia de caries temprana de la infancia en niños con malnutrición por exceso fue de 57,14% en relación al 40,82% de los niños eutróficos (p = 0,022) con RR de 1,4 (95% IC, 1.044-1,88). Conclusiones: El mayor riesgo asociado a CTI en pacientes con malnutrición por exceso invita a generar las instancias de derivación oportuna desde el profesional que pesquisa a niños con malnutrición por exceso hacia el odontólogo infantil, con el fin de desarrollar intervenciones preventivas para ambas patologías.
Assuntos
Pré-Escolar , Feminino , Humanos , Masculino , Cárie Dentária/etiologia , Obesidade/complicações , Sobrepeso/complicações , Estudos de Coortes , Chile/epidemiologia , Cárie Dentária/epidemiologia , Seguimentos , Peso Corporal Ideal , Incidência , Estado Nutricional , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
OBJECTIVE: To determine whether overweight is a risk factor for the development of early childhood caries (ECC) in preschoolers. PATIENTS AND METHOD: An observational retrospective cohort study was performed in 196 children under 2 years of age at Calbuco Hospital, Los Lagos Region, Chile, who were admitted between 2007 and 2009. Patients were grouped based on their nutritional status at admission in the two following categories: eutrophic and overweighed children as a result of excessive intake. Information regarding caries incidence and nutritional status were annually retrieved from records until the age of 5 years, according to medical and dental records. RESULTS: At the beginning of the study, 33.67% were overweight and 16.33% were obese, reaching 40% overweight and 20.56% obese at four years of age. The incidence of early childhood caries in overweighed children was 57.14% compared to 40.82% in normal weight children (p = 0.022), with 1.4 RR (95% CI, 1044-1.88). CONCLUSIONS: The increased risk of early childhood decay in overweighed patients makes necessary to create instances of timely mutual referral between the professional that diagnoses overweighed children and the pediatric dentist in order to develop preventive treatments for both diseases.
Assuntos
Cárie Dentária/etiologia , Obesidade/complicações , Sobrepeso/complicações , Pré-Escolar , Chile/epidemiologia , Estudos de Coortes , Cárie Dentária/epidemiologia , Feminino , Seguimentos , Humanos , Peso Corporal Ideal , Incidência , Masculino , Estado Nutricional , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
The beneficial effect angiotensin converting enzyme inhibitors (ACEI) and angiotensin II receptor antagonists (ARA) for diabetic nephropathy can be hampered by the phenomenon of aldosterone escape. Aldosterone antagonists such as espironolactone or epleronone could potentiate the effects of ACEI and ARA and avoid the later problem. We performed a systematic search of the literature on the effects of aldosterone antagonists on diabetic nephropathy. We searched for clinical trials and follow up studies measuring the effects of aldosterone antagonists on urinary albumin excretion among patients with diabetic nephropathy. We retrieved 1345 papers on the subject and 10 were selected for analysis. Among these, spironolactone was more effective than comparing drugs to achieve a reduction in urinary albumin excretion of approximately 30 to 40 percent. On the other hand epleronone was not superior to comparing drugs. All studies reported a modest reduction in glomerular filtration rate and an increase in serum potassium levels. In conclusion, spironolactone in doses of 25 to 100 mg/day reduces urinary albumin excretion but reduces also glomerular filtration rate and increases serum potassium levels.
Assuntos
Humanos , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Espironolactona/uso terapêutico , Nefropatias Diabéticas/tratamento farmacológico , Albuminúria/tratamento farmacológico , Antagonistas de Receptores de Mineralocorticoides/efeitos adversos , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Creatinina , Diabetes Mellitus , Espironolactona/análogos & derivados , Espironolactona/efeitos adversos , Taxa de Filtração Glomerular , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , PotássioRESUMO
Atypical antipsychotic drugs have less extra pyramidal side effects and are more effective to control the clinical manifestations of schizophrenia. However, their use may be associated to a higher incidence of weight gain, dyslipidemia, metabolic syndrome, glucose intolerance and type 2 diabetes mellitus. We performed a systematic literature search to evaluate the risk of type 2 diabetes mellitus incidence associated to the use of atypical antipsychotic drugs, compared to conventional treatment. If users of all types of atypical antipsychotic drugs are compared with users of conventional treatment, no significant differences in the incidence of type 2 diabetes mellitus were observed. If individual drugs are evaluated, clozapine and risperidone are associated with a higher risk of diabetes than haloperidol. Quetiapine is associated with a lower risk of diabetes than conventional treatment. The quality of the evidence found was low; therefore, new studies should been performed.
Assuntos
Humanos , Antipsicóticos/efeitos adversos , /induzido quimicamente , Transtornos Mentais/tratamento farmacológico , Antipsicóticos/classificação , Doença Crônica , Clozapina/efeitos adversos , Fatores de Risco , Risperidona/efeitos adversosAssuntos
Humanos , Medicina Baseada em Evidências , Endocrinologia/métodos , Doenças do Sistema Endócrino/diagnóstico , Doenças do Sistema Endócrino/terapia , Metanálise como Assunto , Publicações Periódicas como Assunto , Guias de Prática Clínica como Assunto , Testes Diagnósticos de Rotina/métodos , Literatura de Revisão como AssuntoRESUMO
Atypical antipsychotic drugs have less extra pyramidal side effects and are more effective to control the clinical manifestations of schizophrenia. However, their use may be associated to a higher incidence of weight gain, dyslipidemia, metabolic syndrome, glucose intolerance and type 2 diabetes mellitus. We performed a systematic literature search to evaluate the risk of type 2 diabetes mellitus incidence associated to the use of atypical antipsychotic drugs, compared to conventional treatment. If users of all types of atypical antipsychotic drugs are compared with users of conventional treatment, no significant differences in the incidence of type 2 diabetes mellitus were observed. If individual drugs are evaluated, clozapine and risperidone are associated with a higher risk of diabetes than haloperidol. Quetiapine is associated with a lower risk of diabetes than conventional treatment. The quality of the evidence found was low; therefore, new studies should been performed.
Assuntos
Antipsicóticos/efeitos adversos , Diabetes Mellitus Tipo 2/induzido quimicamente , Transtornos Mentais/tratamento farmacológico , Antipsicóticos/classificação , Doença Crônica , Clozapina/efeitos adversos , Humanos , Fatores de Risco , Risperidona/efeitos adversosRESUMO
We report a 47 year-old diabetic male, admitted due to metabolic decompensation, malaise, purulent pharyngeal discharge and a mass in the posterior cervical region. Blood glucose was 270 mg/dl, a nasopharyngoscopy showed a pharyngeal phlegmon and CT scan confirmed the presence of a phlegmon in the retropharyngeal region. He was treated with sodium penicillin, cloxacillin and ceftriazone and the phlegmon was drained surgically. The culture of the purulent discharge gave growth to a Group B Streptococcus. The evolution was favorable and the patient completed seven days with intravenous antimicrobials and additional seven days with oral ampicillin/sulbactam.
Assuntos
Celulite (Flegmão)/microbiologia , Complicações do Diabetes/microbiologia , Abscesso Retrofaríngeo/microbiologia , Infecções Estreptocócicas/complicações , Streptococcus agalactiae/isolamento & purificação , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Celulite (Flegmão)/tratamento farmacológico , Cloxacilina/uso terapêutico , Complicações do Diabetes/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço , Abscesso Retrofaríngeo/tratamento farmacológico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus agalactiae/efeitos dos fármacosRESUMO
We report a 47 year-old diabetic male, admitted due to metabolic decompensation, malaise, purulent pharyngeal discharge and a mass in the posterior cervical region. Blood glucose was 270 mg/dl, a nasopharyngoscopy showed a pharyngeal phlegmon and CT scan confirmed the presence of a phlegmon in the retropharyngeal region. He was treated with sodium penicillin, cloxacillin and ceftriazone and the phlegmon was drained surgically. The culture of the purulent discharge gave growth to a Group B Streptococcus. The evolution was favorable and the patient completed seven days with intravenous antimicrobials and additional seven days with oral ampicillin/sulbactam.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Celulite (Flegmão)/microbiologia , Complicações do Diabetes/microbiologia , Abscesso Retrofaríngeo/microbiologia , Infecções Estreptocócicas/complicações , Streptococcus agalactiae/isolamento & purificação , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Celulite (Flegmão)/tratamento farmacológico , Cloxacilina/uso terapêutico , Complicações do Diabetes/tratamento farmacológico , Pescoço , Abscesso Retrofaríngeo/tratamento farmacológico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus agalactiae/efeitos dos fármacosRESUMO
Parathyroid carcinoma is an uncommon cause of primary hyperparathyroidism; however, when this condition is severe, cancer must be suspected. We report on a 28-year-old male with severe hypercalcemia, cachexia, acute pancreatitis, urolithiasis, anemia and a severe skeletal involvement with multiple fractures. The patient had a 4-cm parathyroid tumor, that was surgically excised, along with the ipsilateral thyroid lobe. During the postoperative period, he had a severe and prolonged hungry bone syndrome, with a slow recovery of fractures, with functional and anatomical sequelae in the extremities. PTH levels were adequate for the serum calcium during the 16 months of follow-up.
Assuntos
Fraturas do Fêmur/etiologia , Fraturas do Úmero/etiologia , Hiperparatireoidismo/etiologia , Neoplasias das Paratireoides/complicações , Adulto , Fraturas do Fêmur/terapia , Seguimentos , Humanos , Fraturas do Úmero/terapia , Hipercalcemia/etiologia , Hiperparatireoidismo/cirurgia , Masculino , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgiaRESUMO
Parathyroid carcinoma is an uncommon cause of primary hyperparathyroidism; however, when this condition is severe, cancer must be suspected. We report on a 28-year-old male with severe hypercalcemia, cachexia, acute pancreatitis, urolithiasis, anemia and a severe skelletal involvement with multiple fractures. The patient had a 4-cm parathyroid tumor, that was surgically excised, along with the ipsilateral thyroid lobe. During the postoperative period, he had a severe and prolonged hungry bone syndrome, with a slow recovery of fractures, with functional and anatomical sequelae in the extremities. PTH levels were adequate for the serum calcium during the 16 months of follow-up.
Assuntos
Adulto , Masculino , Humanos , Neoplasias das Paratireoides , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/terapia , Fraturas do Úmero/cirurgia , Fraturas do Úmero/etiologia , Hiperparatireoidismo/cirurgia , Hiperparatireoidismo/etiologia , Seguimentos , Hipercalcemia/etiologiaRESUMO
With the availability of new diagnostic techniques, numerous alterations are found, whose real importance for health is uncertain. The term <