ABSTRACT
La neuralgia del trigémino es un trastorno neuropático craneofacial que sigue una o más de las ramas del nervio craneal V y ocasiona ataques paroxísticos de alta intensidad, produce discapacidad y es más prevalente en el sexo femenino. El tratamiento de primera línea es el farmacológico, con el objetivo de aliviar los síntomas, evitar recidivas y complicaciones. Sin embargo, presenta un alto índice de refractariedad, por lo que se han desarrollado otros procedimientos no invasivos como la radiocirugía estereotáctica. Este tratamiento ofrece un alivio de los síntomas durante un periodo más prolongado que permite al paciente puntuar entre el rango I-III en la escala del Instituto Neurológico Barrow; sin embargo, también puede reaparecer. Con el objetivo de determinar la recurrencia de neuralgia del trigémino refractaria en pacientes tratados con radiocirugía estereotáctica, se realizó una revisión narrativa de artículos originales de revistas científicas en inglés y español, publicados de 2019 a 2024. La recurrencia posterior a la radiocirugía puede estar determinada por características propias de la enfermedad, así como por el plan de tratamiento. A pesar de ello, debido a la seguridad y eficacia que ofrece, es posible realizar múltiples intervenciones sin presentar complicaciones graves y obteniendo baja incidencia de casos de hipoestesia y una escasa prevalencia de aneurismas.
Trigeminal neuralgia is a neuropathic disease with a craniofacial trajectory following one or all the branches of the V cranial nerve. It is characterized by paroxysmal pain of high intensity that may cause disability, with higher prevalence in females. The first line of treatment is pharmacological seeking to alleviate the symptoms, diminishing the odds of recurrence and complications. Nonetheless, this therapy has a high rate of refractoriness. As a result, other non-invasive procedures have been developed such as stereotactic surgery. This treatment offers symptom relief for a longer period allowing the patient to score between I-III range in the Barrow Neurological Institute scale; however, it can also present refractoriness. This paper was written with the objective of determining the recurrence of trigeminal neuralgia in patients that have been treated with stereotactic surgery. The current review was done using original articles from journals in English and Spanish from 2019 to 2024. Post-radiosurgery recurrence may be determined by characteristics of the disease as well as the treatment plan. Despite this, due to the safety and effectiveness, multiple interventions can be performed, with low cases of hypoesthesia and aneurysms
Subject(s)
Patients , Recurrence , Trigeminal Neuralgia , Radiosurgery , El SalvadorABSTRACT
Introducción. La herniorrafia inguinal es una cirugía ampliamente realizada a nivel mundial, con casi 20 millones de procedimientos anuales. En la literatura no se describen diferencias significativas en las tasas de recurrencia entre las técnicas laparoscópicas, pero estos resultados difieren en cuanto a la fijación de la malla. Métodos. Estudio retrospectivo observacional en el que se incluyeron los pacientes sometidos a herniorrafia inguinal por laparoscopia en una institución de cuarto nivel en Medellín, Colombia, entre enero de 2019 y junio de 2023. Se registraron los datos demográficos, como edad, género y comorbilidades, y los datos del procedimiento, como técnica utilizada, tipo de hernia, tipo de malla y fijación o no de la malla. Los desenlaces posoperatorios evaluados fueron dolor agudo y crónico, recurrencia y otras complicaciones. Resultados. De un grupo de 1106 pacientes sometidos a herniorrafia inguinal por vía laparoscópica, 69,0 % fueron sometidos a la técnica transabdominal preperitoneal, 23,1 % a la técnica totalmente extraperitoneal y 7,9 % a totalmente extraperitoneal extendida. La malla macroporosa de baja densidad fue la más utilizada (56,3 %). A 784 (70,9 %) se les fijó la malla y a 322 (29,1 %) no. La tasa de complicaciones fue menor al 8 %. Al final, 77 (7,0 %) pacientes experimentaron dolor agudo y 26 crónico (2,3 %). Hubo recurrencia de la hernia en 20 pacientes (1,8 %). Conclusión. El uso de prótesis sin fijación en la herniorrafia inguinal por laparoscopia pareciera ser un procedimiento seguro, con una tasa de recidivas equiparables a los procedimientos con fijación y con una leve tendencia a un menor dolor posquirúrgico agudo y crónico.
Introduction. Inguinal herniorrhaphy is a widely performed surgery worldwide, with almost 20 million procedures annually. The literature does not describe significant differences in recurrence rates between laparoscopic techniques, but these outcomes differ in terms of mesh fixation. Methods. Retrospective observational study that included patients undergoing laparoscopic inguinal herniorrhaphy at a fourth-level institution in Medellin, Colombia, between January 2019 and June 2023. Demographic data, including age, gender, and comorbidities were recorded, along with data related to the procedure details, such as technique used, type of hernia, type of mesh, and mesh fixation or not. Postoperative outcomes evaluated were acute and chronic pain, recurrences, and other complications. Results. Of a group of 1106 patients undergoing laparoscopic inguinal herniorrhaphy, 69.0% underwent the preperitoneal transabdominal technique, 23.1% underwent the totally extraperitoneal tecnhique, and 7.9% underwent the extended totally extraperitoneal tecnique. Low-density macroporous mesh was the most used (56.3%); 784 (70.9%) had the mesh fixed and 322 (29.1%) did not. The complication rate was less than 8%. In the end, 77 (7.0%) patients experienced acute pain and 26 (2.3%) developed chronic pain. There was hernia recurrence in 20 patients (1.8%). Conclusion. The use of prostheses without fixation in laparoscopic inguinal herniorrhaphy seems to be a safe procedure, with a recurrence rate comparable to procedures with fixation and with slight tendency towards less acute and chronic postsurgical pain.
Subject(s)
Humans , Prostheses and Implants , Herniorrhaphy , Postoperative Complications , Recurrence , Laparoscopy , Hernia, InguinalABSTRACT
Antineutrophil cytoplasmic antibody-associated vasculitis is a group of disorders characterized by inflammation and destruction of small blood vessels. Cardiac involvement as the initial manifestation is rare. We present the case of a patient with acute myopericarditis as the initial manifestation of ANCA-associated vasculitis.
La vasculitis asociada a anticuerpos anticitoplasma de neutrófilos (ANCA) es un grupo de trastornos caracterizados por la inflamación y destrucción de vasos sanguíneos de tamaño pequeño. El compromiso cardíaco como manifestación inicial es poco frecuente. Se presenta el caso de un paciente con miopericarditis aguda como manifestación inicial de vasculitis asociada a ANCA.
Subject(s)
Humans , Male , Adult , Pericarditis/etiology , Granulomatosis with Polyangiitis/complications , Granulomatosis with Polyangiitis/diagnosis , Recurrence , Clinical Laboratory TechniquesABSTRACT
Introducción. Los pacientes octogenarios y nonagenarios conforman un grupo etario en progresivo crecimiento. La hernia inguinal es una patología que aumenta progresivamente con la edad. Este trabajo tuvo como objetivo conocer los resultados quirúrgicos de los pacientes mayores de 80 años a quienes se les realizó herniorrafía inguinal. Métodos. De acuerdo con las guías PRISMA, se realizó una revisión sistemática de PubMed, Embase y Google Scholar. Se incluyeron estudios que reportaron la incidencia de complicaciones y mortalidad después de una herniorrafía inguinal en los pacientes octogenarios y nonagenarios. Se calculó la proporción de pacientes con complicaciones después de una herniorrafía inguinal según los datos presentados, con su respectivo intervalo de confianza del 95 %. Resultados. Catorce estudios reportaron un total de 19.290 pacientes, entre quienes se encontró una incidencia acumulada de infección del sitio operatorio de 0,5 % (IC95% 0,460 - 0,678), seroma de 8,7 % (IC95% 6,212 - 11,842), hematoma de 2,6 % (IC95% 2,397 - 2,893), dolor crónico de 2,1 % (IC95% 0,778 - 4,090) y recidiva de 1,2 % (IC95%0,425 - 2,284), para una morbilidad de 14,7 % (IC95% 9,525 - 20,833). Conclusión. Las complicaciones de la herida quirúrgica, el dolor crónico y la recidiva en los pacientes mayores de 80 años a quienes se les realiza herniorrafia inguinal son comparables con las de la población general.
Introduction. Octogenarian and nonagenarian patients constitute a progressively growing age group. Inguinal hernia is a pathology that increases with age. This study aims to understand the surgical outcomes of inguinal herniorrhaphy in patients over 80 years of age. Methods. A systematic review of PubMed, Embase, and Google Scholar was conducted following PRISMA guidelines. Studies reporting the incidence of complications and mortality after inguinal herniorrhaphy in octogenarian and nonagenarian patients were included. The proportion of patients with complications after inguinal herniorrhaphy was calculated based on the data presented, with its respective 95% confidence interval. Results. Fourteen studies reported a total of 19,290 patients, among whom a cumulative incidence of surgical site infection of 0.5 (95% CI 0.460 0.678), seroma of 8.7% (95% CI 6.212 11.842), hematoma of 2.6% (95% CI 2.397 2.893), chronic pain 2.1% (95% CI 0.778 4.090), recurrence 1.2% (95% CI 0.425 2.284), and morbidity 14.7% (95% CI 9.525 20.833) were found. Conclusion. Surgical wound complications, chronic pain, and recurrence in patients over 80 years of age undergoing inguinal herniorrhaphy are comparable to those in the general population.
Subject(s)
Humans , Herniorrhaphy , Hernia, Inguinal , Postoperative Complications , Recurrence , Aged, 80 and over , Meta-AnalysisABSTRACT
Basal cell carcinoma (BCC) is the most common skin cancer, but oral involvement is extremely rare. Here, we showed a case of a 71-year-old Caucasian male patient presenting an asymptomatic submucosal nodule in the left buccal mucosa on the same side of a previous BCC skin lesion. Intraoral examination revealed a circumscribed sessile and fibrous mass covered by normal mucosa. An incisional biopsy was performed. Microscopically, the lesion showed uniform, ovoid, dark-staining basaloid cells with medium-sized nuclei and little cytoplasm arranged in islands and strands, invading the underlying connective tissue. These islands demonstrated palisading of the peripheral cells and occasionally central areas with epidermoid differentiation. The final diagnosis was nodular basal cell carcinoma. Although uncommon, recurrent BCC may occur in the oral cavity. (AU)
Subject(s)
Humans , Male , Aged , Recurrence , Carcinoma, Basal Cell , Pathology, Oral , Surgery, OralABSTRACT
INTRODUCCIÓN: En la diarrea asociada a Clostridioides dfficile (DACD) leve-moderada se recomienda tratar con vancomicina por sobre metronidazol, a pesar de su difícil acceso y poca evidencia en el medio ambulatorio. OBJETIVO: Comparar la tasa de cura clínica y recurrencia entre vancomicina y metronidazol en adultos chilenos con primer episodio leve-moderado de DACD de manejo ambulatorio. MÉTODOS: Cohorte retrospectiva entre enero 2015 y diciembre 2020 en centros de una red de salud universitaria de pacientes de ≥ 18 años con DACD tratados ambulatoriamente. RESULTADOS: Se obtuvieron 161 pacientes, 59% mujeres, edad promedio de 53 años (entre 18 y 94 años). De ellos, 109 (67,7%) usaron metronidazol y 52 (32,3%) vancomicina. En el análisis multivariado ajustado por edad y comorbilidades se obtuvo un OR 3,00 (IC 95% 1,12-9,59) para cura clínica y 0,27 (IC 95% 0,06-0,88) para recurrencia a ocho semanas, ambos a favor de vancomicina, sin diferencias en recurrencia a 12 meses, necesidad de hospitalización o mortalidad. CONCLUSIÓN: La terapia con vancomicina comparada contra metronidazol en el tratamiento ambulatorio de la infección leve-moderada por C. dfficile se asocia a mayor cura clínica y menor tasa de recurrencia a corto plazo, sin diferencias en desenlaces a largo plazo.
BACKGROUND: Recommended treatment against mild cases of Clostridioides difficile associated diarrhea is vancomycin despite the difficulties of access compared to metronidazole. AIM: To compare the effectiveness of vancomycin and metronidazole in Chilean adults with first mild-moderate episode of Clostridiodes difficile infection (CDI). METHODS: Retrospective cohort of patients with CDI between January 2015 and December 2020 treated in centers of a university health network. The patients were adults treated for C. difficile infection on an outpatient basis. Recurrent and severe cases were excluded. Outcomes included clinical cure and recurrence rate. RESULTS: Data from 161 patients was recovered. Fifty-nine percent were women and average age was 53 (18-94). One hundred and nine patients were treated with metronidazole (67.7%) and 52 (32.3%) used vancomycin. Multivariate analysis adjusted by age and comorbidities showed an Odds Ratio of 3.00 (IC 95% 1.12-9.59) for clinical cure and 0.27 (IC 95% 0.06-0.88) for 8-week recurrence rate, both in favor of vancomycin, without differences in 12-month recurrence rate, hospitalization rate nor mortality. CONCLUSIONS: Vancomycin is associated with better short-term outcomes in the treatment of outpatient mild-moderate first episode C. difficile infection, without differences in long term recurrence or mortality when compared with metronidazole.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Vancomycin/therapeutic use , Clostridium Infections/drug therapy , Diarrhea/drug therapy , Metronidazole/therapeutic use , Outpatients , Recurrence , Multivariate Analysis , Regression Analysis , Retrospective Studies , Ambulatory Care , Anti-Bacterial Agents/therapeutic useABSTRACT
Introducción: El prolapso de órganos pélvicos (POP) o distopia genital, es el descenso o desplazamiento de los órganos del suelo pélvico a través del canal vaginal o fuera de este. Objetivo: Evaluar los resultados de la histeropexia vaginal en la corrección quirúrgica del prolapso genital apical grado III o IV, usando prótesis de polipropileno; además describir la tasa de éxito, recurrencias y complicaciones. Método: Estudio de cohorte, en 42 mujeres sometidas a histeropexia vaginal (histero-cistopexia ortotópica) mediante prótesis de polipropileno (Splentis®), entre 2016 y 2021. Se realizaron tres evaluaciones postoperatorias (tres, seis y 12 meses). Se hizo muestreo no probabilístico. Se utilizó estadística descriptiva. Resultados: La edad media fue de 56,19 ± 9,27 años. El tiempo quirúrgico de 58,95 ± 13,74 minutos, el sangrado quirúrgico de 119,85 ± 68,73 ml. La tasa de éxito a los 12 meses fue del 90,47%. La recurrencia del prolapso apical fue del 4,76% a los seis meses y del 9,52% a los 12 meses; el de compartimento anterior a los seis meses arrojó un 7,14%, frente al 11,9% a los 12 meses. El 14,28% de las pacientes presentaron complicaciones menores. La incidencia de incontinencia urinaria de esfuerzo a los 12 meses fue del 16,66%. Conclusiones: la histeropexia vaginal es un procedimiento efectivo y seguro, con bajas tasas de recurrencias o complicaciones. Es importante que se sigan haciendo estudios con mejores diseños estadísticos.
Introduction: Pelvic organ prolapse (POP), or genital dystopia, is the descent or displacement of pelvic floor organs through the vaginal canal or outside of it. Objective: To evaluate the results of vaginal hysteropexy in the surgical correction of grade III or IV apical genital prolapse, using polypropylene prosthesis; also describe the success rate, recurrences and complications. Method: Cohort study in 42 women undergoing vaginal hysteropexy (orthotopic hystero-cystopexy) using a polypropylene prosthesis (Splentis®); between 2016 and 2021. Three postoperative evaluations were carried out (three, six and twelve months). Non-probabilistic sampling was done. Descriptive statistics were used. Results: The mean age was 56.19 ± 9.27 years. Surgical time of 58.95 ± 13.74 minutes, surgical bleeding of 119.85 ± 68.73 ml. The success rate after twelve months was 90.47%. Apical prolapse recurrence was 4.76% at six months and 9.52% at twelve months; that of the previous compartment, after six months it showed 7.14%, compared to 11.9% after twelve months; 14.28% of the patients presented minor complications. The incidence of stress urinary incontinence, at twelve months, was 16.66%. Conclusions: Vaginal hysteropexy is an effective and safe procedure, with low rates of recurrence or complications. It is important that studies continue to be carried out with better statistical designs.
Subject(s)
Humans , Female , Middle Aged , Polypropylenes , Prostheses and Implants , Gynecologic Surgical Procedures/methods , Pelvic Organ Prolapse/surgery , Recurrence , Vagina/surgery , Uterine Prolapse/surgery , Treatment Outcome , Analgesics/administration & dosage , Intraoperative ComplicationsABSTRACT
Objective: To synthesize evidence involving pathophysiological and clinical-epidemiological linking mechanisms in women with breast cancer and metabolic syndrome. Method: This is a structured scoping review according to the Joanna Briggs Institute and was conducted in the PubMed, BDENF, LILACS, IBECS, CUMED, WPRIM, BINACIS, and Embase databases. This review is registered in the Open Science Framework. Result: Regarding the level of evidence of the included studies, moderate and strong evidence levels were predominant. There were no weak evidence findings in this research. The chronic inflammatory state of breast adipose tissue in patients with obesity can worsen the negative impact on cancer cells, directly affecting survival and recurrence. Unexplained weight gain or loss is associated with shorter survival in women with breast cancer, highlighting the need for specific guidance during treatment. Conclusion: Metabolic syndrome is associated with the risk of breast cancer; however, massive weight loss during active disease can be associated with a worse prognosis and should therefore be prevented. Patients should be advised to maintain a stable weight during chemotherapy and to receive guidance on adequate nutrition and physical activity to increase muscle mass
Objetivo: Sintetizar as principais evidências envolvendo os mecanismos de ligação fisiopatológico e clínico-epidemiológico em mulheres com câncer de mama e a síndrome metabólica. Método: Trata-se de uma revisão de escopo estruturada conforme o Instituto Joanna Briggs, realizado nas bases de dados PubMed, BDENF, LILACS, IBECS, CUMED, WPRIM, BINACIS e Embase. Esta revisão encontra-se protocolada no Open Science Framework. Resultado: Com relação ao nível de evidência dos estudos inclusos, houve predominância para níveis fortes de evidência. Não houve achados de evidência fraca nesta pesquisa. O estado inflamatório crônico do tecido adiposo mamário em casos de obesidade pode agravar o impacto negativo nas células cancerígenas, afetando diretamente a sobrevida e recorrência. Ganho ou perda de peso inexplicável estão associados a uma menor sobrevida em mulheres com câncer de mama, sublinhando a necessidade de orientações específicas durante o tratamento. Conclusão: A síndrome metabólica esta associada ao risco de câncer de mama, entretanto, a perda maciça de peso durante a doença ativa pode ser um fator de pior prognóstico, devendo assim, ser realizada de forma preventiva. Os pacientes devem ser orientados a manter um peso estável durante a quimioterapia e receber orientações sobre alimentação adequada e atividade física em busca de aumento de massa muscular
Subject(s)
Humans , Female , Therapeutics , Breast , Breast Neoplasms , Exercise , Cells , Metabolic Syndrome , Patients , Prognosis , Recurrence , Research , Science , Women , Weight Gain , Weight Loss , Adipose Tissue , Disease , Risk , PubMed , Diet , Drug Therapy , Nutritional Sciences , LILACS , Methods , Muscles , Neoplasms , ObesityABSTRACT
Objective@#This study described the clinical profile and outcomes of patients with ocular dermoid cysts at a subspecialty Ophthalmology clinic of the Philippine General Hospital (PGH). @*Methods@#Medical records of 38 patients seen at the External Disease & Cornea Clinic from January 2012 to June 2023 were reviewed. Demographics, best-corrected visual acuity (BCVA), refraction, other associated malformations, and dermoid characteristics were collected. For those that underwent surgery, the procedures performed and histopathology reports were reviewed. Most recent refraction, BCVA, presence of amblyopia, recurrence, and complications were recorded. @*Results@#Mean age at presentation was 8.33 years old with equal male:female distribution (52% vs 48%). Thirtyfour (34) participants (89.5%) had unilateral dermoids and 4 participants (10.5%) had bilateral dermoids, for a total of 42 eyes. Thirty-five (35) or 83.3% of the dermoids were located at the inferotemporal quadrant of the cornea. There were 42.1% participants who had associated congenital anomalies, with dermolipoma and preauricular tags being the most common ocular and craniofacial findings, respectively. Twenty-seven (27) eyes (64.2%) underwent surgery and the most common procedure was excision with limbal conjunctival autograft (55.6%). In the 8 eyes that underwent simple excision, recurrence of the dermoid was seen in 1 patient and development of pseudopterygium in 5 patients. Dermoid was the histopathological diagnosis in 96.3% of the excised tissues. Twenty-four (24) patients (63.2%) presented with ambylopia with BCVA <20/30, and regardless of type of intervention done, only 7 participants (23.3%) had a visual acuity better than 20/30 during their latest consult.@*Conclusion@#Ocular dermoid is a common congential anomaly usually presenting as an isolated, unilateral mass at the inferotemporal limbal area. Aside from the obvious effect on the cosmetic appearance of the eye, a more pressing concern is the high incidence of amblyopia. Timely excision with limbal conjunctival autograft is highly recommended coupled with aggressive amblyopia therapy.
Subject(s)
Recurrence , AmblyopiaABSTRACT
BACKGROUND@#Immunoglobulin G4-related disease (IgG4-RD) is a recently recognized immune-mediated disorder that can affect almost any organ in the human body. IgG4-RD can be categorized into proliferative and fibrotic subtypes based on patients' clinicopathological characteristics. This study aimed to compare the clinical manifestations, laboratory findings, and treatment outcomes of IgG4-RD among different subtypes.@*METHODS@#We prospectively enrolled 622 patients with newly diagnosed IgG4-RD at Peking Union Medical College Hospital from March 2011 to August 2021. The patients were divided into three groups according to their clinicopathological characteristics: proliferative, fibrotic, and mixed subtypes. We compared demographic features, clinical manifestations, organ involvement, laboratory tests, and treatment agents across three subtypes. We then assessed the differences in treatment outcomes among 448 patients receiving glucocorticoids alone or in combination with immunosuppressants. Moreover, risk factors of relapse were revealed by applying the univariate and multivariate Cox regression analysis.@*RESULTS@#We classified the 622 patients into three groups consisting of 470 proliferative patients, 55 fibrotic patients, and 97 mixed patients, respectively. We found that gender distribution, age, disease duration, and frequency of allergy history were significantly different among subgroups. In terms of organ involvement, submandibular and lacrimal glands were frequently involved in the proliferative subtype, while retroperitoneum was the most commonly involved site in both fibrotic subtype and mixed subtype. The comparison of laboratory tests revealed that eosinophils ( P = 0.010), total IgE ( P = 0.006), high-sensitivity C-reactive protein ( P <0.001), erythrocyte sedimentation rate ( P <0.001), complement C4 ( P <0.001), IgG ( P = 0.001), IgG1 (P <0.001), IgG4 (P <0.001), and IgA ( P <0.001), at baseline were significantly different among three subtypes. Compared with proliferative and mixed subtypes, the fibrotic subtype showed the lowest rate of relapse (log-rank P = 0.014).@*CONCLUSIONS@#Our study revealed the differences in demographic characteristics, clinical manifestations, organ involvement, laboratory tests, treatment agents, and outcomes across proliferative, fibrotic, and mixed subtypes in the retrospective cohort study. Given significant differences in relapse-free survival among the three subtypes, treatment regimens, and follow-up frequency should be considered separately according to different subtypes.
Subject(s)
Humans , Immunoglobulin G4-Related Disease/pathology , Retrospective Studies , Prospective Studies , Treatment Outcome , Immunoglobulin G , RecurrenceABSTRACT
Chimeric antigen receptor (CAR)-modified T-cell therapy has achieved remarkable success in the treatment of acute lymphoblastic leukemia (ALL). Measurable/minimal residual disease (MRD) monitoring plays a significant role in the prognostication and management of patients undergoing CAR-T-cell therapy. Common MRD detection methods include flow cytometry (FCM), polymerase chain reaction (PCR), and next-generation sequencing (NGS), and each method has advantages and limitations. It has been well documented that MRD positivity predicts a poor prognosis and even disease relapse. Thus, how to perform prognostic evaluations, stratify risk based on MRD status, and apply MRD monitoring to guide individual therapeutic decisions have important implications in clinical practice. This review assesses the common and novel MRD assessment methods. In addition, we emphasize the critical role of MRD as a prognostic biomarker and summarize the latest studies regarding MRD-directed combination therapy with CAR-T-cell therapy and allogeneic hematopoietic stem cell transplantation (allo-HSCT), as well as other therapeutic strategies to improve treatment effect. Furthermore, this review discusses current challenges and strategies for MRD detection in the setting of disease relapse after targeted therapy.
Subject(s)
Humans , Receptors, Chimeric Antigen/therapeutic use , Neoplasm, Residual , Transplantation, Homologous/methods , Transplantation Conditioning/methods , Hematopoietic Stem Cell Transplantation/methods , Recurrence , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapyABSTRACT
Objective: To analyze the clinical characteristics and prognosis of patients with infant acute lymphoblastic leukemia (IALL). Methods: A retrospective cohort study.Clinical data, treatment and prognosis of 28 cases of IALL who have been treated at Beijing Children's Hospital, Capital Medical University and Baoding Children's Hospital from October 2013 to May 2023 were analyzed retrospectively. Based on the results of fluorescence in situ hybridization (FISH), all patients were divided into KMT2A gene rearrangement (KMT2A-R) positive group and KMT2A-R negative group. The prognosis of two groups were compared. Kaplan-Meier method and Log-Rank test were used to analyze the survival of the patients. Results: Among 28 cases of IALL, there were 10 males and 18 females, with the onset age of 10.9 (9.4,11.8) months. In terms of immune classification, 25 cases were B-ALL (89%), while the remaining 3 cases were T-ALL (11%). Most infant B-ALL showed pro-B lymphocyte phenotype (16/25,64%). A total of 22 cases (79%) obtained chromosome karyotype results, of which 7 were normal karyotypes, no complex karyotypes and 15 were abnormal karyotypes were found. Among abnormal karyotypes, there were 4 cases of t (9; 11), 2 cases of t (4; 11), 2 cases of t (11; 19), 1 case of t (1; 11) and 6 cases of other abnormal karyotypes. A total of 19 cases (68%) were positive for KMT2A-R detected by FISH. The KMT2A fusion gene was detected by real-time PCR in 16 cases (57%). A total of 24 patients completed standardized induction chemotherapy and were able to undergo efficacy evaluation, 23 cases (96%) achieved complete remission through induction chemotherapy, 4 cases (17%) died of relapse. The 5-year event free survival rate (EFS) was (46±13)%, and the 5-year overall survival rate (OS) was (73±10)%.The survival time was 31.3 (3.3, 62.5) months. There was no significant statistical difference in 5-year EFS ((46±14)% vs. (61±18)%) and 5-year OS ((64±13)% vs. (86±13)%) between the KMT2A-R positive group (15 cases) and the KMT2A-R negative group (9 cases) (χ2=1.88, 1.47, P=0.170, 0.224). Conclusions: Most IALL patients were accompanied by KMT2A-R. They had poor tolerance to traditional chemotherapy, the relapse rate during treatment was high and the prognosis was poor.
Subject(s)
Male , Child , Infant , Female , Humans , Retrospective Studies , In Situ Hybridization, Fluorescence , Prognosis , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Abnormal Karyotype , RecurrenceABSTRACT
Objective: To evaluate the relapse rate after discontinuation of biological therapy in patients with Crohn's disease treated at the University Hospital. Methods: This is a series of 9 cases of CD patients who used long-term immunobiologicals. Non-randomized sample, followed for 1 year, prospectively. Results: Nine patients were studied, 8 females, with an average age of 43.8 years, and non-smokers. The average time of use of the immunobiological for suspension was 6.77 years, with 66.66% of them having been in use for more than 5 years. The mean initial CDAI was 25. After 6 months of follow-up, CRP was less than 10 mg/L in 88.8% of them. Only 3 patients measured the Calprotectin, low. (10, 15 and 30 mcg/g). The ESR averaged 15.77 mm/h. In 66.6% of those studied, the 6-month colonoscopy was normal - mayo 0. In the 1-year follow-up, 3 patients underwent CT, normal. At 1-year colonoscopy of 3 patients, there was endoscopic recurrence in 2. The mean CDAI after the first year was 38.11. The mean ESR was 17.11 mm/h. The worst outcomes occurred in 2 (20%) patients, both Montreal A3L3B2, with clinical and endoscopic recurrence. The same previous immunobiological was reintroduced, with excellent clinical response. Conclusion: Individualized analysis of the course of the disease proves to be the best way for adequate clinical monitoring during its use, optimization of the therapeutic regimen, and the possibility of interruption. (AU)
Subject(s)
Humans , Male , Female , Adult , Crohn Disease/therapy , Recurrence , Biological TherapyABSTRACT
Introduction: Almost 25% of colorectal cancer (CRC) patients have synchronous colorectal liver metastasis (SCLM) coinciding with the disease diagnosis. Liver-first approach for the treatment of SCLM involves neoadjuvant chemotherapy, subsequent liver resection, and then primary tumor resection. This strategy is adopted as the prognosis of the disease depends mainly on the metastases, not the primary tumor. This study aims to evaluate the feasibility of the liver-first approach and clinical prognosis in managing SCLM. Materials and Methods: This retrospective study included 25 patients with SCLM from July 2015 to July 2020. All patients were subjected to a liver-first approach with an "intention-to-treat" approach. Follow-up was planned for at least 3 years. Data were collected from the hospital records and included survival rates and univariate analyses of the prognostic factors, such as gender, age, and number of chemotherapy cycles to evaluate their effect on the survival probability. Results: Nineteen patients completed the treatment paradigm. Long-term outcomes reported a median overall survival (OS) of 32 months. One-year and 3-year survival probabilities were 89.5% and 42.1%, respectively. The median disease-free survival was 13 months. The number of metastatic lesions, unilobar versus bilobar disease, and the frequency of administered chemotherapy cycles significantly affected survival (p < 0.05). Seven patients (36.84%) remained disease free (no recurrence) while 2 patients (10.53%) survived with recurrence. The overall mortality included 10 deaths (52.63%) due to recurrence. Conclusion: Synchronous colorectal liver metastasis treated with the liver-first approach achieved a notable overall advantage. However, the recurrence rate remained relatively high. (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Colorectal Neoplasms/therapy , Liver Neoplasms/secondary , Postoperative Complications , Recurrence , Retrospective Studies , Treatment OutcomeABSTRACT
O ameloblastoma é uma neoplasia odontogênica benigna originada de remanescentes do epitélio odontogênico com padrão de crescimento lento, porém infiltrativo nos tecidos adjacentes. Apresenta três variantes clínicas: convencional, unicística e periférica, as quais diferem em seu comportamento biológico e consequentemente na resposta às modalidades terapêuticas disponíveis. Essas modalidades são classificadas como conservadoras (enucleação e excisão cirúrgicas) e radicais (ressecção marginal e segmentar). As técnicas conservadoras são empregadas para o tratamento do ameloblastoma unicístico, devido ao seu aspecto encapsulado, e para o periférico, por se tratar de uma lesão restrita aos tecidos moles. Já as técnicas radicais são mais indicadas para o manejo do ameloblastoma convencional, o qual apresenta um comportamento mais infiltrativo. Os protocolos terapêuticos para o manejo da lesão disponíveis variam de acordo com os autores dos trabalhos e seu emprego sofre influência de fatores clínicos e imaginológicos (localização e extensão da lesão, envolvimento de dentes adjacentes, idade e escolha do paciente, histórico de recidivas, preferência do cirurgião) e histológicos (subtipo histológico). Por esse motivo o presente estudo visou analisar, de forma retrospectiva, casos de ameloblastoma tratados por um mesmo cirurgião entre os anos de 2002 e 2023. A amostra foi constituída por 12 casos de ameloblastoma unicístico e 24 de ameloblastoma convencional. Os dois grupos foram avaliados separadamente. Houve predileção pelo sexo feminino em ambos, e a média de idade foi de 27,25 e 40,2 anos, respectivamente. As lesões foram predominantemente encontradas em mandíbula posterior nos dois grupos. Radiograficamente, houve predominância do aspecto unilocular, nos casos de ameloblastoma unicístico (91,7%), e do padrão multilocular, para o ameloblastoma convencional (83%). A extensão média das lesões foi de 46,14mm e 41,06mm, respectivamente. Reabsorção radicular, deslocamento dentário e perfuração de corticais foram observados em ambos os grupos. O subtipo histológico mural correspondeu a 75% dos casos de ameloblastoma unicístico, enquanto o subtipo folicular respondeu por 79% dos casos do tipo convencional. A análise microscópica de margens quanto à infiltração tumoral foi realizada nas amostras de ameloblastoma convencional e revelou margens infiltradas em 4 casos (16%) e livres de doença em 20 casos (83%). Quanto à terapia cirúrgica adotada, todos os casos unicísticos (n=12, 100%) foram tratados conservadoramente (enucleação + ostectomia periférica + cauterização com solução de Carnoy), enquanto todos os casos de ameloblastoma convencional (n=24; 100%) foram submetidos à ressecção (marginal ou segmentar). Nenhuma abordagem adicional foi empregada nos casos de ameloblastoma convencional que apresentaram as margens infiltradas. As taxas de recidiva observadas foram de 8,33% em ambos os grupos, correspondentes a uma lesão unicística mural e a dois casos de ameloblastoma convencional do subtipo folicular cujas margens encontravam-se livres de doença, o que não exclui a possibilidade de recidivas. O período médio de follow-up foi de 62 e 79 meses, respectivamente. Nossos achados sugerem que uma abordagem conservadora deve ser a primeira opção para o tratamento do ameloblastoma unicístico, mesmo para aqueles com proliferação mural e que o ameloblastoma convencional deve ser tratado preferencialmente através de ressecçã marginal/segmentar por se considerar seu caráter mais infiltrativo nos tecidos adjacentes.
Ameloblastoma is a benign odontogenic neoplasm originating from remnants of odontogenic epithelium which grows slowly but infiltrating the surrounding tissues. It has three clinical variants: conventional, unicystic and peripheral, according to which differ in their biological behavior and consequently in their response to the available therapeutic modalities. These modalities are classified as conservative (enucleation and surgical excision) and radical (marginal and segmental resection) ones. Conservative techniques are used for the treatment of unicystic ameloblastoma, due to its encapsulated aspect, and for the peripheral subtype. Radical techniques are advised for the management of conventional ameloblastoma. The available treatment protocols vary between surgeons and their use is influenced by clinicoradiographic aspects (location and size of the lesion, involvement of adjacent teeth, age, history of recurrences, surgeon preference), histological subtype and literary (lack of standardization of data relating to the issue). For this reason, the present study will retrospectively analyze cases of ameloblastoma treated uniformly by the same surgeon from 2002 to 2023. The sample was formed by 12 cases of unicystic and 24 cases of conventional ameloblastomas. These groups were analyzed separately. There was a female predilection, and the mean age of patients were 27,25 and 40,2 years respectively. Almost all lesions affected the posterior mandible in both groups. Radiographically, we observed a predominant unilocular pattern for unicystic ameloblastoma (91,7%) and a multilocular pattern for conventional ones (83%). Lesions measured, on average, 46,14mm and 41,06mm respectively. Root resorption, tooth displacement and cortical perforation were also observed. The mural histological subtype corresponded to 75% of the unicystic cases, while follicular pattern (79%) was predominant in conventional samples. Microscopic analysis of margins for tumour infiltration was performed in conventional ameloblastoma samples and revealed 4 positive margins (16%) and 20 margins free of disease (83%). Regarding the surgical therapy adopted, all unicystic cases (n=12, 100%) were treated conservatively (enucleation + peripheral ostectomy + cauterization with Carnoy's solution) and all cases of conventional ameloblastoma (n=24; 100%) underwent marginal/segmental resection. No additional approach was used in cases of conventional ameloblastoma that presented infiltrated margins. Recurrence occurred in 8,33% of both groups, corresponded to one mural and two follicular ameloblastomas whose margins were free of disease, which does not exclude the possibility of recurrence. The mean follow up period was 62 and 79 months, respectively. Our findings suggest that a conservative approach should be the first option for the treatment of unicystic ameloblastoma, even for those with mural proliferation. Conventional ameloblastomas, on the other hand, should be managed through a radical approach due to its infiltrative behavior.
Subject(s)
Recurrence , Ameloblastoma , Dental Care , Oral Surgical Procedures , Conservative TreatmentABSTRACT
Background: Odontogenic keratocyst is a challenging odontogenic lesion, originating from the epithelial remnants of the dental lamina, ranging from small cysts to extensive lesions with a high recurrence rate and morbidity for patients. The sometimes aggressive nature of these pathological entities explains the controversy among researchers regarding the best classification for these lesions, justifying the fact that these odontogenic cysts were once defined as benign odontogenic tumors for some years. However, there is consensus among scholars that it is a disease that requires careful follow-up of affected patients due to the high recurrence rates, especially in the first two decades after treatment completion. Objectives: The present study aims to elucidate the case of a patient with a mandibular odontogenic keratocyst who prematurely discontinued follow-ups and had a significant recurrence of the lesion after 7 years. Description: the second treatment was performed using Carnoy's solution. Conclusion: Carnoy's solution is an absolutely essential therapeutic resource in the treatment of odontogenic keratocysts, as its use significantly reduces the potential recurrence of the disease (AU)
Contexto: Ceratocisto odontogênico é uma lesão odontogênica desafiadora, originada a partir dos restos epiteliais da lâmina dentária, que permeia desde pequenos cistos até extensas lesões com alta taxa de recorrência e morbidade para os pacientes. O caráter por vezes agressivo destas entidades patológicas, explica as controvérsias entre os pesquisadores com relação à qual seria a melhor classificação destas lesões, justificando o fato de que estes cistos odontogênicos já foram por alguns anos definidos como tumores odontogênicos benignos. Entretanto, é consensual entre os estudiosos que se trata de uma enfermidade que carece de criteriosa proservação dos pacientes acometidos dado as elevadas taxas de recidiva, especialmente nas duas primeiras décadas após o tratamento finalizado. Objetivos: O presente estudo objetiva elucidar o caso de um paciente portador de ceratocisto odontogênico mandibular que abandonou os acompanhamentos precocemente e teve importante recidiva da lesão após 7 anos. Descrição: Descrição: o segundo tratamento foi realizado empregando-se a solução de Carnoy. Conclusão: A solução de Carnoy mostrou ser um recurso essencial no tratamento do queratocisto odontogênico por ter reduzido significativamente o potencial de recorrência da doença(AU)
Subject(s)
Humans , Recurrence , Odontogenic Cysts , Odontogenic Tumors , Decompression , MandibleABSTRACT
O objetivo deste estudo foi investigar os efeitos terapêuticos da Psicoterapia Breve Operacionalizada (PBO) na adaptação de mulheres diagnosticadas com câncer de mama e em tratamento oncológico. O câncer de mama mostra-se mobilizador de sofrimento psíquico para as mulheres tanto no diagnóstico quanto no tratamento, o que justifica identificar intervenções psicológicas adequadas para essa população. As participantes foram 17 mulheres com idade entre 30 e 65 anos. A Escala Diagnóstica Adaptativa Operacionalizada (EDAO) foi o instrumento utilizado para avaliação da adaptação em quatro setores: afetivo-relacional, produtividade, orgânico e sociocultural. Referida avaliação foi feita em três momentos: antes e após a intervenção breve, e no follow-up . A PBO foi a intervenção breve utilizada. Os resultados mostraram que o setor orgânico foi o mais comprometido, seguido do afetivo-relacional, com soluções pouquíssimo adequadas. Como foco da psicoterapia breve, a situação-problema mais recorrente se relacionava ao câncer de mama, que, na compreensão psicodinâmica, mostrou-se associada ao intenso desamparo egóico diante do adoecimento e tratamento oncológico. Na avaliação adaptativa final e follow-up , 82,4% das participantes apresentaram evolução de grupo adaptativo. Concluímos que, neste estudo, a intervenção com a PBO possibilitou efeitos terapêuticos na adaptação, reverberando na solução das situações-problema e na crise adaptativa por perda.(AU)
This study aimed to investigate the therapeutic effects of Operationalized Brief Psychotherapy (PBO) so women diagnosed with breast cancer could adapt to treatment. Breast cancer has mobilized psychological suffering for women during diagnosis and treatment, justifying the identification of the appropriate psychological interventions for this population. Participants included 17 women aged 30 to 65 years. Adaptative Operational Diagnostic Scale (EDAO) was used to evaluated adaptation in four sectors: affective-relational, productivity, organic, and sociocultural before and after a brief psychological intervention and follow-up. The PBO was used as the brief intervention. Results showed that the organic sector was the most compromised, followed by the affective-relational one, which showed very little adequate solutions. As a focus of brief psychotherapy, the most recurring problem-situation was related to breast cancer, which, in yjr psychodynamic understanding, was associated with the intense helplessness of the ego in the face of illness and treatment. In the final adaptative evaluation and follow-up, 82.4% of participants showed evolution in the adaptive group. This study concluded that the intervention with PBO enabled therapeutic effects in these participants' adaptation, reverberating in the solution of problem-situation and in the adaptive crisis by loss.(AU)
El propósito de este estudio fue investigar los efectos terapéuticos de la psicoterapia breve operacionalizada (PBO) en la adaptación de mujeres diagnosticadas con cáncer de mama y en tratamiento oncológico. El cáncer de mama moviliza sufrimiento psicológico para las mujeres tanto en el diagnóstico como en el tratamiento, lo que justifica identificar intervenciones psicológicas adecuadas para esta población. Participaron 17 mujeres de entre 30 y 65 años. El instrumento utilizado fue la Escala de Diagnóstico Adaptativo Operacionalizada (EDAO) para la evaluación adaptativa en cuatro sectores: afectivo-relacional, productividad, orgánico y sociocultural. La evaluación se realizó en tres momentos: antes, después de la intervención breve y en el seguimiento. La PBO fue la intervención breve utilizada. Los resultados mostraron que el sector orgánico fue el más comprometido, seguido por el afectivo-relacional con soluciones poquísimas adecuadas. Como foco de la psicoterapia breve, la situación-problema más recurrente estuvo relacionada con el cáncer de mama, que en la comprensión psicodinámica resultó estar asociada a un intenso desamparo ante la enfermedad y el tratamiento oncológico. En la evaluación adaptativa final y el seguimiento, el 82,4% de las participantes tuvieron evolución grupal adaptativa. Se concluye que la intervención con PBO permitió efectos terapéuticos en la adaptación de estos participantes, repercutiendo en la solución de situaciones-problema y en la crisis adaptativa por pérdida.(AU)
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Psychotherapy, Brief , Breast Neoplasms , Health , Diagnosis , Anxiety , Pain , Psychology , Recurrence , Rehabilitation , Shame , Solutions , Surgical Procedures, Operative , Therapeutics , Women , Bereavement , Adaptation, Psychological , Mastectomy, Radical , Homeopathic Cure , Disease , Follow-Up Studies , Aftercare , Life , Crisis Intervention , Death , Comprehension , Therapeutic Uses , Depression , Drug Therapy , Drug-Related Side Effects and Adverse Reactions , Efficiency , Fear , Return to Work , Physical Appearance, Body , Sadness , Psychological Distress , Psychological Well-Being , Lymph Node Excision , Medical OncologyABSTRACT
Objetivo principal: Conocer la epidemiologia de las fracturas del cuarto distal del radio en el esqueleto en crecimiento y el tratamiento realizado en el CHPR en los años 2017 y 2018. Objetivos específicos: Valorar re-desplazamiento, necesidad de re manipulación, complicaciones, re-fractura. Metodología: Estudio observacional descriptivo retrospectivo. Criterios de inclusión: pacientes de 0 a 14 años con fractura de radio distal (fisaria, metafisaria y suprametafisaria) valorados en el CHPR entre 1 enero del 2017 y 31 diciembre del 2018. Criterios de exclusión: pacientes con radiografía normal, fracturas en miembros con malformaciones, infecciones óseas, patología tumoral maligna o benigna. Obtención de datos: Valoración de radiografías de puño y antebrazo realizadas en el CHPR en 2017 y 18, iniciales y evolutivas. Se analizaron: edad, sexo, fecha fractura, topografía de la fractura, desplazamiento inicial, tratamiento, evolución radiográfica y complicaciones. Resultados: se incluyeron 662 pacientes. Siendo en su mayoría de género masculino (65%), con una media de 9 años, miembro derecho (61%), en los meses de verano (36%). En cuanto a la topografía se evidenció una frecuencia mayor en fracturas tipo rodete y metafisarias (31.72% y 31.57%), seguido por suprametafisaria (18.43%) y fisaria (18.28%). El tratamiento realizado fue ortopédico en el 86.56% de los casos, mientras que quirúrgico fue el 12.84%, en su gran mayoría con alambres de Kirschner (11,2%). El tiempo de inmovilización promedio fue de 6 semanas, con un porcentaje de complicaciones del 14.05% del total de las fracturas. Conclusiones: Se valoraron las características de los pacientes y fracturas de radio distal en el CHPR en los años 2017 y 18, siendo un total de 662 fracturas, en las que su mayoría se realizó tratamiento ortopédico con un índice de complicaciones que ronda el 14%, siendo mayor cuanto mayor es el desplazamiento inicial de la fractura.
Objetivo principal: Conhecer a epidemiologia das fraturas do quarto distal do rádio no esqueleto em crescimento e o tratamento realizado no CHPR nos anos de 2017 e 2018. Objetivos específicos: Avaliar re-deslocamento, necessidade de remanipulação, complicações, refratura. Metodologia: Estudo observacional descritivo retrospectivo. Critérios de inclusão: pacientes de 0 a 14 anos com fratura do rádio distal (fisário, metafisário e suprametafisário) avaliados no CHPR entre 1º de janeiro de 2017 e 31 de dezembro de 2018. Critérios de exclusão: pacientes com radiografias normais, fraturas em membros com malformações, osso infecções, patologia tumoral maligna ou benigna. Coleta de dados: Avaliação das radiografias de punho e antebraço realizadas no CHPR em 2017 e 18, inicial e evolutiva. Foram analisados: idade, sexo, data da fratura, topografia da fratura, deslocamento inicial, tratamento, evolução radiográfica e complicações. Resultados: 662 pacientes foram incluídos. Sendo maioritariamente do sexo masculino (65%), com média de 9 anos, membro direito (61%), nos meses de verão (36%). Em relação à topografia, foi evidenciada maior frequência nas fraturas da borda e metafisárias (31,72% e 31,57%), seguidas das suprametafisárias (18.43%) e fisárias (18.28%). O tratamento realizado foi ortopédico em 86.56% dos casos, enquanto cirúrgico em 12.84%, sendo a maioria com fios de Kirschner (11,2%). O tempo médio de imobilização foi de 6 semanas, com percentual de complicações de 14.05%. Conclusões: Foram avaliadas as características dos pacientes e fraturas do rádio distal no CHPR nos anos de 2017 e 18, com um total de 662 fraturas (0,9 por dia), em que a maioria foi submetida a tratamento ortopédico com índice de complicações que fica em torno de 14%, sendo maior quanto maior for o deslocamento inicial da fratura.
Title: Fractures of the distal end of the radius in the immature skeleton. Epidemiological study at the Pereira Rossell Hospital Center. Main objective: To know the epidemiology of fractures of the distal fourth of the radius in the growing skeleton and the treatment carried out in the CHPR in the years 2017 and 2018. Specific objectives: To assess re-displacement, need for re-manipulation, complications, re- fracture. Methodology: Retrospective descriptive observational study. Inclusion criteria: patients aged 0 to 14 years with distal radius fracture (physeal, metaphyseal and suprametaphyseal) evaluated at the CHPR between January 1, 2017 and December 31, 2018. Exclusion criteria: patients with normal radiographs, fractures in limbs with malformations, bone infections, malignant or benign tumor pathology. Data collection: Assessment of fist and forearm X-rays performed at the CHPR in 2017 and 18, initial and evolutionary. The following were analyzed: age, sex, fracture date, fracture topography, initial displacement, treatment, radiographic evolution and complications. Results: 662 patients were included. Being mostly male (65%), with an average of 9 years, right limb (61%), in the summer months (36%). Regarding the topography, a higher frequency was evidenced in rim and metaphyseal fractures (31.72% and 31.57%), followed by suprametaphyseal (18.43%) and physeal (18.28%). The treatment performed was orthopedic in 86.56% of the cases, while surgical was 12.84%, mostly with Kirschner wires (11.2%). The average immobilization time was 6 weeks, with a percentage of complications of 14.05%. Conclusions: The characteristics of the patients and fractures of the distal radius in the CHPR in the years 2017 and 18 were evaluated, with a total of 662 fractures (0.9 per day), in which the majority underwent orthopedic treatment with an index of complications that is around 14%, being greater the greater the initial displacement of the fracture.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Wrist Fractures/epidemiology , Recurrence , Skeleton/growth & development , Uruguay/epidemiology , Retrospective Studies , Treatment Outcome , Age and Sex Distribution , Temporal Distribution , Wrist Fractures/classification , Wrist Fractures/complications , Wrist Fractures/therapyABSTRACT
Introducción: en niños y adolescentes con glomerulopatías (GP) las infecciones pueden desencadenar empujes; la infección por SARS-CoV-2 podría causar consecuencias por la comorbilidad de la enfermedad renal y si eventualmente reciben inmunosupresión (IS). Objetivos: describir la severidad de la infección por SARS-CoV-2 en niños menores de 15 años con GP y evaluar la evolución de la enfermedad renal. Metodología: realizamos un estudio retrospectivo multicéntrico en Uruguay (1/4/2020 - 30/6/2022) de niños < 15 años con infección confirmada por SARS-CoV-2, portadores de GP crónica, con o sin tratamiento inmunosupresor. Recogimos datos demográficos, clínicos, tratamiento y evolución de los pacientes. Resultados: incluimos 30 niños, 18 varones, mediana de edad 9 años, 16 (53%) tenían un síndrome nefrótico idiopático (SNI), 28 (93,3%) habían recibido alguna IS, 23 (76,6%) la estaban recibiendo al momento de la infección. Los síntomas respiratorios fueron leves en todos los pacientes; 6/30 (20%) estuvieron asintomáticos. El pico de incidencia (86,6%) ocurrió entre enero y mayo de 2022; 7/30 (23,3%) tuvieron repercusión renal: dos (6,6%) fueron hospitalizados con injuria renal aguda: uno (3,3%) con GP IgA, presentó una emergencia hipertensiva y requirió hemodiálisis, y otro (3,3%) con GP IgM, tuvo recaída nefrótica. Tres (10%) niños con SNI recayeron (dos (6,6%) eran asintomáticos) y dos (6,6%) tuvieron proteinuria no nefrótica. Todos volvieron a su situación previa, 6/7 (85,7%) con corticoides. Se redujo temporalmente el micofenolato mofetil en 3/11 (27,2%) niños, se suspendió en uno (9%). Ninguno con lupus recayó (n=4). Ninguno requirió oxígeno ni presentó síndrome inflamatorio multisistémico. No se registraron fallecimientos. Conclusiones: a pesar de la baja frecuencia de complicaciones y la buena evolución, los pacientes pediátricos con COVID-19 y GP deben ser monitorizados. La recaída puede ocurrir en infecciones asintomáticas.
Introduction: infections can trigger a relapse in children with glomerulopathies (GP); the SARS-CoV-2 infection can have consequences for the cases of kidney disease comorbidity and for cases when patients receive immunosuppression (IS). Objectives: describe the SARS-CoV-2 infection severity in children with GP and assess the clinical course of the kidney disease. Methodology: we conducted a multicenter retrospective study in Uruguay (04/01/2020 - 06/30/2022) of children <15 years of age with a chronic GP, either on IS treatment or not, who presented a confirmed SARS-CoV-2 infection. We collected demographic, clinical, treatment, and patient evolution data. Results: we included 30 children, 18 boys, median age 9 years, 16 (53%) had an idiopathic nephrotic syndrome (INS), 28 (93%) had received some IS treatment, 23 (77%) were taking it at the time of the infection. Respiratory symptoms were mild in all patients; 6/30 (20%) were asymptomatic. The peak incidence (86.6%) occurred between January-May/2022; 7/30 (23.3%) had renal repercussions. Two patients (6,6%) were hospitalized with acute kidney failure: one (3,3%), with IgA nephropathy, presented with emergency hypertension and required hemodialysis, and the other one (3,3%), with IgM nephropathy, presented with nephrotic syndrome. Three children (10%) with INS relapsed (2 (6,6%) were asymptomatic) and 2 (6,6%) had no nephrotic proteinuria. All patients recovered their previous situation, 6/7 (85,7%) with steroids. Mophetil mycophenolate was temporarily reduced in 3/11 (27,2%) children and stopped in one (9%). None with lupus relapsed (n=4). None required oxygen, nor did they present multisystem inflammatory syndrome. No deaths were recorded. Conclusions: despite the low frequency of complications and good outcome, pediatric patients with COVID-19 should be monitored. Relapse can occur in asymptomatic infections.
Introdução: em crianças e adolescentes com glomerulopatias (GP), as infecções podem desencadear evacuações; a infecção por SARS-CoV-2 pode causar consequências devido à comorbidade causada por doença renal e caso eventualmente recebam imunossupressão (IS). Objetivos: descrever a gravidade da infecção por SARS-CoV-2 em crianças menores de 15 anos com GP e avaliar a evolução da doença renal. Metodologia: realizamos um estudo retrospectivo multicêntrico no Uruguai (01/04/2020 - 30/06/2022) de crianças < 15 anos com infecção confirmada por SARS-CoV-2, portadoras de PG crônica, com ou sem tratamento de EI. Coletamos dados demográficos, clínicos, de tratamento e evolução dos pacientes. Resultados: incluímos 30 crianças, 18 meninos, média de idade 9 anos, 16 (53%) apresentavam síndrome nefrótica idiopática (SNI), 28 (93,3%) haviam recebido algum IS, 23 (76,6%) estavam recebendo no momento da infecção. Os sintomas respiratórios foram leves em todos os pacientes; 6/30 (20%) eram assintomáticos. O pico de incidência (86,6%) ocorreu entre janeiro-maio/2022; 7/30 (23,3%) tiveram repercussão renal: 2 (6,6%) foram internados com lesão renal aguda: (3,3%) com GP IgA, apresentaram emergência hipertensiva e necessitaram de hemodiálise, e (3,3%) com GP IgM, tiveram recidiva nefrótica. Três (10%) crianças com SNI recidivaram (2 (6,6%) eram assintomáticas) e 2 (6,6%) tiveram proteinúria não nefrótica. Todos retornaram à situação anterior, 6/7 (85,7%) com corticoide. O micofenolato de mofetil foi reduzido temporariamente em 3/11 (27,2%) das crianças e descontinuado em (9%). Ninguém com lúpus teve recaída (n=4). Nenhum necessitou de oxigênio e nem apresentou síndrome inflamatória multissistêmica. Nenhuma morte foi registrada. Conclusões: apesar da baixa frequência de complicações e da boa evolução, os pacientes pediátricos com COVID-19 e GP devem ser monitorados. A recidiva pode ocorrer em infecções assintomáticas.