Análisis del cáncer de pulmón en un hospital de referencia de la ciudad de Santa Fe en 21 años de seguimiento / Analysis of Lung Cancer in a Reference Hospital in the City of Santa Fe with a Follow-Up of 21 Years

El cáncer de pulmón es una neoplasia de mal pronóstico. Es la tercera causa de muerte por cáncer y el de mayor mortalidad a nivel mundial. El objetivo del estudio es describir las características clínicas de los pacientes con diagnóstico de cáncer de pulmón, evaluados a lo largo de 21 años por el Comité multi­disciplinario de un hospital de la ciudad de Santa Fe, Argentina y el análisis comparativo entre el primer período del 2001 al 2011 (P1) y el segundo (P2) entre 2012 y 2022. Es un estudio descriptivo, observacional y retrospectivo. Se analizó un total de 416 pacientes adultos, de ambos sexos con diagnóstico de cáncer de pulmón compren­didos entre junio 2001 a julio 2022, en la primera década 211 pacientes y 205, en la segunda. Se excluyeron del análisis 65 pacientes con diagnóstico clínico radiológico de cáncer de pulmón. Del total de pacientes 294 (70,7%) eran varones, con edad media de 60 años. Se observó que 249 pacientes (80,72%) padecía una o más comorbilidades y las pato­logías más frecuentes fueron 146 casos de enfermedad pulmonar obstructiva crónica (58,9%, p = 0,05), 19 casos de diabetes (7,7%), 11 pacientes con hepatopatía crónica (5%), 23 casos con patología cardíaca (9.32%) y 10 pacientes con enfermedad renal crónica (4,3%). El tabaquismo se registró en 320 pacientes (81,3%) incluye a los exfumadores (66,7% de las mujeres y 87,1% de los hombres) con una media de 50 paquetes/año (3 a 169 p/a). El tabaquismo en general disminuyó a expensas de los hombres, pero se evidenció un incremento del hábito tabáquico en las mujeres. La histología más frecuente fue el adenocarcinoma, con 149 casos (35,6%, p = 0,04), seguidos del carcinoma escamoso o epidermoide, con 128 casos (30,8%, p = 0,04), 44 casos de carcinoma neuroendocrino de pequeñas células u oat cell (10,6%, p = 0,06), 65 indiferenciados (15,6%, p = 0,05), 10 carcinomas de células grandes (2,4% p = 0,12), 7 tumores carcinoides (1,7%, p = 0,15) y otras histologías registradas fueron 6 casos de mesotelioma (1,44%) y 7 (1,7%) tumores extrapulmonares. Se observó que en el segundo período el adenocarcinoma aumentó significativamente del 32,7% al 39,02%, mientras que, para epidermoide, los casos descendieron de 40,7% a 32,8%. También se estableció para los casos indiferenciados un incremento del 9,45% al 21,46% y en los tipos histológicos oat cell no se percibieron cambios (10,9% al 10,2%). Los métodos diagnósticos más utilizados fueron la broncofibroscopia y la punción bajo tomografía computarizada. Se realizaron 172 endoscopias (41,7%) que fueron de mayor rendimiento en el cáncer epidermoide y se realizaron 110 punciones guiadas por tomo­grafía computarizada (26,7%), de mayor rendimiento diagnóstico en el adenocarcinoma. Para la estadificación se utilizó la edición TNM al momento del diagnóstico, ambos sexos se encontraban en estadios avanzados en las principales estirpes de neoplasias no células pequeñas. Recibieron tratamiento quirúrgico con intención curativa 92 pacientes (22%), tratamiento oncológico a base de quimioterapia o radioterapia 292 pacientes (70%), y 33 pacientes (8%) recibieron tratamiento paliativo único(AU)

Lung cancer (LC) is a neoplasm with a poor prognosis, it is the third leading cause of cancer death and the highest mortality worldwide. The objective of the study is to describe the clinical characteristics of patients diagnosed with lung cancer, evaluated over 21 years by the multidisciplinary Committee of a hos­pital in the city of Santa Fe, Argentina (MCLC) and the comparative analysis between the first period from 2001 to 2011 (p1) and the second (p2) between 2012 and 2022. It is a descriptive, observational and retrospective study. A total of 416 adult patients of both sexes with a diagnosis of lung cancer between June 2001 and July 2022 were studied, 211 patients in the first decade and 205 in the second. 65 patients with clinical radiological diagnosis of lung cancer were excluded from the analysis. The results showed that 294 (70.7%) were male, with a mean age of 60 years. It was observed that 249 patients (80.72%) suffered from one or more comorbidities and the most frequent pathologies were 146 cases of COPD (58.9%, p: 0.05), 19 cases of dia­betes (7.7%), 11 patients with chronic liver disease (5%), 23 cases with cardiac disease (9.32%) and 10 patients with chronic kidney disease (4.3%). Smoking was recorded in 320 patients (81.3%) includes ex-smokers (66.7% of women and 87.1% of men) with a mean of 50 pack-years (3 to 169 p/y). Smoking in general decreased at the expense of men, but there was an increase in smoking in women. The most frequent histology was adenocarcinoma with 149 cases (35.6%, p: 0.04), followed by squamous or squamous cell carcinoma with 128 cases (30.8%, p: 0.04), 44 cases of small cell neuroendocrine carcinoma or oat cell (10.6%, p: 0.06), 65 undif­ferentiated (15.6%, p 0.05), 10 large cell carcinoma (2.4% p. 0.12), 7 carcinoid tumors (1.7%, p: 0.15) and other recorded histologies there were 6 cases of mesothelioma (1.44%) and 7 (1.7%) extra tumors pulmonary. It is observed that in the second period adenocarcinoma increased significantly from 32.7% to 39.02%, while for epidermoid the cases decreased from 40.7% to 32.8%. An increase from 9.45% to 21.46% was also established for undifferentiated cases and in oat cell histological types no changes were seen (10.9 to 10.2%). The most used diagnostic methods were bronchoscopy and puncture under CT. A total of 172 endoscopies (41.7%) were performed, which had the highest performance in the 91 ca epidermoid and 110 °CT-guided punctures (26.7%) were performed, with the highest diagnostic yield in adenocarcinoma. For staging, the TNM edition was used at the time of diagnosis, both sexes were in advanced stages in the main strains of non- small cell neoplasms. Ninety-two patients (22%) received surgical treatment with curative intent, 292 patients (70%) received cancer treatment based on chemotherapy and/or radiotherapy, and 33 patients (8%) received only palliative treatment(AU)

[Cardiac compromise in patients recovered from COVID-19 without troponin elevation assessed by cardiac magnetic resonance imaging]. / Hallazgos en resonancia cardiaca post COVID-19 en pacientes sin elevación de troponinas.

Background: The disease caused by coronavirus (COVID-19) affects the cardiovascular system, whether by direct viral aggression or indirectly through systemic inflammation and multiple organ compromise. A widely used method to determine cardiac injury is troponin measurement. The aim of this study is to evaluate the prevalence of cardiac involvement (CINV) in a population recovered from COVID-19, referred to cardiac MRI (CMR), who did not present troponin elevation. Methods: There were 156 patients that recovered from COVID-19 and who did not present troponin elevation referred to CMR. CINV was considered to be the presence of: late gadolinium enhancement (LGE), edema, myocarditis, pericarditis, left ventricular systolic dysfunction (LVSD) and/or depressed right ventricular systolic dysfunction (RVSD). Results: Prevalence of CINV was 28.8%, being more frequent in men (p=0.002), in patients who required hospitalization (p=0.04) and in those who experienced non-mild cases of infection (p=0.007). RVSD (17.9%) and LVSD (13.4%) were the most frequent findings. The rate of myocarditis was 0.6%. LGE manifested in 7.1% of patients and its presence was related to less left ventricular ejection fraction (LVEF) (p=0.0001) and right ventricular ejection fraction (RVEF) (p=0.04). Conclusion: In patients who recovered from COVID-19, 28.8% of CINV was found. It was more frequent in men, in patients who required admission and in patients with cases of non-mild infection. The patients that presented LGE had less LVEF and RVSF.

Antecedentes: La enfermedad por coronavirus 2019 (COVID-19) afecta al sistema cardiovascular, ya sea mediante la agresión directa viral o indirectamente por medio de la inflamación sistémica y afectación multiorgánica. Las troponinas son ampliamente utilizadas para determinar lesión cardiaca. La finalidad de este estudio es evaluar la prevalencia de afectación cardiaca (ACARD) en una población recuperada de COVID-19, derivada a resonancia magnética cardiaca (RMC), sin elevación de troponinas al momento del estudio. Métodos: Ciento cincuenta y seis pacientes que se recuperaron de COVID-19 y que no presentaron elevación de troponinas fueron derivados a RMC. Se consideró ACARD a la presencia de: realce tardío de gadolinio (RTG), edema, miocarditis, pericarditis, deterioro de la función sistólica del ventrículo izquierdo (DFSVI) y/o depresión de la función sistólica del ventrículo derecho (DFSVD). Resultados: La prevalencia de ACARD fue del 28.8%, siendo más frecuente en hombres (p = 0.002), en pacientes que requirieron hospitalización (p = 0.04) y en aquellos que cursaron cuadro no leve de infección (p = 0.007). La DFSVD (17.9%) y la DFSVI (13.4%) fueron las hallazgos más frecuentes. La frecuencia de miocarditis fue del 0.6%. El RTG se manifestó en el 7.1% de los pacientes y se relacionó con menor fracción de eyección del ventrículo izquierdo (FEVI) (p = 0.0001) y derecho (FEVD) (p = 0.04). Conclusión: La prevalencia de ACARD fue del 28.8%. Esta es más frecuente en hombres, en pacientes que requirieron internación y que cursaron cuadros de infección no leve. La miocarditis presentó una prevalencia muy baja. Los pacientes que presentaron RTG tuvieron menor FEVI y FSVD.

Sarcopenia in hemodialysis patients from Buenos Aires, Argentina.

OBJECTIVES: Sarcopenia is the loss of skeletal muscle mass and function that occurs with aging that can lead to greater morbidity and mortality. Chronic kidney disease and hemodialysis (HD) favors the development of sarcopenia. We studied the prevalence of sarcopenia and its components using European Working Group on Sarcopenia in Elderly People 2 proposed criteria and risk factors for its development in HD patients. METHODS: In 100 adult HD patients, we evaluated: hand grip strength (HGS), muscle mass by dual energy X-ray absorptiometry and physical performance (gait-speed and sit-stand test). RESULTS: Sixty patients were male and 40 were female; mean age 55.6 years. Prevalence of sarcopenia was 16% (11.1% in males and 25% in females; P = 0.05); 7% had severe sarcopenia. Prevalence of low HGS was 33% in males and 28% in females; low muscle mass was 30% in males but 70% in females and low physical performance 23% in males and 45% in females. Falls were reported by 23 patients. Patients with lower HGS had a higher prevalence of falls in the last year (40% two or more falls; P = 0.03). Only females with sarcopenia had lower bone mineral content. Neither age, body mass index, time on dialysis, or prevalence of diabetes predicted sarcopenia. CONCLUSIONS: A significant proportion of dialysis patients had sarcopenia, more frequent in females. Low HGS was associated with a higher prevalence of falls. Only females with sarcopenia had lower bone mineral content.