RESUMO
BACKGROUND: We compared the new outpatient clinic referrals during the first 10 months of the COVID-19 pandemic with the year before. METHODS: We compared baseline characteristics of the 2208 new referrals in 2020 (n=922) and 2019 (n=1286) with Χ2 and Mann-Whitney U tests and calculated ORs with binary logistic regression. To evaluate the expected changes in the cancer survival secondary to stage migration, we used the 5-year survival data of Survival, Epidemiology and End Results (SEER) Program 2010-2016. RESULTS: The percentage of patients with inoperable or metastatic disease was significantly increased during the pandemic (49.8% vs 39%, OR: 1.553, 95% CI: 1.309 to 1.843, p<0.001). We observed a significant decrease in the percentage of patients diagnosed via the screening methods (18.8% vs 28.7%, OR: 1.698, 95% CI: 1.240 to 2.325, p=0.001). The 90-day mortality after the cancer diagnosis was significantly higher during the pandemic (10.5% vs 6.6%, OR: 1.661, 95% CI: 1.225 to 2.252, p=0.001). Due to the increased advanced-stage disease rate at first referral, significant decreases in 5-year survival rates were expected for breast cancer (-8.9%), colorectal cancer (-11.1%), cervix cancer (-10.3%) and melanoma (-7%). CONCLUSION: We think that collaborative efforts are paramount to prevent the pandemic of late cancer diagnoses and ensure patient safety during the pandemic.
RESUMO
BACKGROUND: It has been shown by various diagnostic methodologies that angiotensin receptor blockage reduces left ventricular mass, improves diastolic function and increases contractility in hypertensive left ventricular hypertrophy (LVH). We planned to detect the effect of angiotensin receptor blockage on midwall mechanics and myocardial dynamics in hypertensive patients with LVH. METHODS: Angiotensin 2 type 1 receptor blocker (valsartan 80-160âmg) was administered to 38 previously untreated hypertensive patients with LVH for 6 months. Left ventricular midwall mechanics and tissue Doppler velocities were measured at baseline and at the end of the study. RESULTS: Mean blood pressure was reduced from 152â±â14/92â±â8 to 131â±â14/83â±â9âmmHg (Pâ<â0.05). Left ventricular mass index was decreased from 135â±â15 to 114â±â14âg/m(2) (Pâ<â0.001). Midwall fractional shortening was increased from 19.0â±â4 to 22.4â±â3% (Pâ<â0.05). Circumferential end-systolic wall stress was decreased from 131â±â44 to 119â±â37â×â10(3) dyn/cm(2) (Pâ<â0.05). Left ventricular interventricular septal myocardial tissue peak systolic velocity was increased from 6.7â±â1 to 8.1â±â0.9âcm/s (Pâ<â0.001) and lateral wall myocardial tissue peak systolic velocity was increased from 7.5â±â1 to 9.0â±â1âcm/s (Pâ<â0.001), and E/E(m) ratio was significantly decreased (11.0â±â0.3 to 8.90â±â0.1, Pâ<â0.05) with 6-month valsartan therapy. CONCLUSION: This study suggests that valsartan exhibits not only blood pressure-lowering qualities but also cardioprotective actions in patients with hypertension because it enhances regression of LVH and improves left ventricular myocardial contractility and relaxation.