Overall Survival and Related Factors of Patients Undergoing Breast-Conserving Surgery with Boost Through Interstitial Brachytherapy in a Cancer Center in Medellin, Colombia.

Liza María González-HernándezPatients with breast cancer undergoing conservative surgery require management with radiotherapy to decrease the risk of recurrence. Moreover, the use of tumor bed boost in high-risk patients has shown an absolute reduction in the 10-year local recurrence risk from 23.9 to 13.5%. Therefore, this study aimed to estimate the overall survival of a group of patients undergoing conservative surgery with a boost through interstitial brachytherapy at a cancer center in Medellin, Colombia. A retrospective cohort study was performed, and records from 2014 to 2020 of patients with in situ or infiltrating breast cancer treated with a boost through interstitial brachytherapy were included. Univariate analysis was conducted to characterize the study population; median survival was calculated using the Kaplan-Meier method. Moreover, associations concerning survival were calculated with each of the factors independently. A total of 186 patients were included. Their overall survival was 93.5%, with a median survival of 79 months. The presence of negative hormone receptors, having two or more irradiated fields and having a locally advanced stage were factors associated independently with higher mortality. The overall survival of patients with in situ or infiltrating breast cancer was favorable and correlated with studies regarding intervention with a boost through interstitial brachytherapy and the factors associated with higher mortality, such as having a locally advanced stage.

Pancreatitis aguda por áscaris en un adulto del área urbana de Bogotá, a propósito de una presentación inusual. Reporte de caso / Acute pancreatitis due to ascaris in an adult from the urban area of Bogotá, regarding an unusual manifestation. Case report

Resumen Introducción: la pancreatitis aguda es una de las entidades que afectan más normalmente el tracto gastrointestinal. Sus causas más frecuentes son la biliar y la alcohólica; sin embargo, no se deben descartar las causas infecciosas, entre ellas las parasitarias. Caso: se presenta un caso de un hombre de 35 años de edad procedente del área urbana de Bogotá que ingresó por un dolor torácico al servicio de urgencias del Hospital San Ignacio, posteriormente con migración hacia el abdomen y síntomas gastrointestinales asociados. Se diagnosticó pancreatitis aguda, se descartaron las causas biliar y alcohólica, y se evidenció en la escanografía un cuerpo extraño endoluminal gástrico hacia las asas intestinales, cuyo diagnóstico se confirmó de manera endoscópica (áscaris lumbricoides). Se extrajo el helminto en su totalidad y se continuó el manejo intrahospitalario. Como complicación presentó un compromiso necrotizante con colecciones asociadas en imágenes de control, sin compromiso multiorgánico. Finalmente, se dio egreso por una adecuada evolución clínica. Conclusión: la ascariasis es una causa infrecuente de pancreatitis aguda en adultos de zonas urbanas, incluso en países en vías de desarrollo como Colombia. Su diagnóstico y manejo terapéutico se realizan vía endoscópica con la extracción del helminto. Como en todos los casos de pancreatitis, debe realizarse un seguimiento clínico en busca de complicaciones asociadas y compromiso multiorgánico.

Abstract Introduction: Acute pancreatitis is one of the most common entities affecting the gastrointestinal tract. Its most frequent causes are biliary and alcoholic; however, infectious causes, including parasitic ones, should not be ruled out. Case: We present the case of a 35-year-old man from the urban area of Bogotá who was admitted to the emergency department of the San Ignacio Hospital due to chest pain, with subsequent migration to the abdomen and associated gastrointestinal symptoms. Acute pancreatitis was diagnosed, biliary and alcoholic causes were ruled out, and the scan revealed a gastric endoluminal foreign body towards the intestinal loops; the diagnosis was confirmed endoscopically (Ascaris lumbricoides). The helminth was entirely extracted, and the intrahospital management was continued. As a complication, he had necrosis with associated collections in control images without multi-organ involvement. Finally, he was discharged due to adequate clinical evolution. Conclusion: Ascariasis is a rare cause of acute pancreatitis in adults in urban areas, even in developing countries such as Colombia. Its diagnosis and therapeutic management are carried out endoscopically with the extraction of the helminth. As in all cases of pancreatitis, a clinical follow-up should be conducted in search of associated complications and multi-organ involvement.

Risk scores for Kawasaki disease, a management tool developed by the KAWA-RACE cohort.

INTRODUCTION/OBJECTIVES: Asian scores developed to predict unresponsiveness to intravenous immunoglobulin (IVIG) or development of coronary artery aneurysms (CAA) in patients with Kawasaki disease (KD) are not appropriate in Western populations. The purpose of this study is to develop 2 scores, to predict unresponsiveness to IVIG and development of CAA, appropriate for Spanish population. METHOD: Data of 625 Spanish children with KD collected retrospectively (2011-2016) were used to identify variables to develop the 2 scores of interest: unresponsiveness to IVIG and development of CAA. A statistical model selected best variables to create the scores, and scores were validated with data from 98 patients collected prospectively. RESULTS: From 625 patients of the retrospective cohort, final analysis was performed in 439 subjects: 37 developed CAA, and 212 were unresponsive to IVIG. For the score to predict CAA, a cutoff ≥ 8 was considered for high risk, considering a score system with a different weight for each of the eight variables. External validation showed a sensitivity of 22% and a specificity of 75%. The score to predict unresponsiveness to IVIG established a cutoff ≥ 8 for high risk, considering a score system with a different weight for each of the nine variables. External validation showed a sensitivity of 78% and a specificity of 50%. CONCLUSIONS: Two risk scores for KD were developed from Spanish population, to predict development of CAA and unresponsiveness to IVIG; validation in other cohorts could help to implement these tools in the management of KD in other Western populations.

Megaesófago como complicación de acalasia: reporte de caso y revisión narrativa de la literatura / Megaesophagus as a complication of achalasia: Case report and narrative literature review

Resumen El megaesófago se presenta entre el 5 % y el 20 % de pacientes con acalasia, un trastorno motor esofágico primario reconocido hace más de 300 años, a considerarse en todo paciente con disfagia no explicada por un proceso obstructivo o inflamatorio luego de un estudio endoscópico detallado. Se presenta el caso de un paciente con disfagia progresiva, en quien se documentó megaesófago como complicación de una acalasia de largo tiempo de evolución, no tratada. Se descartó la enfermedad de Chagas mediante enzimoinmunoensayo (ELISA) e inmunofluorescencia indirecta (IFI), tal como recomiendan las guías actuales. Ante la baja frecuencia de esta entidad en nuestro medio y las implicaciones terapéuticas que tiene para los pacientes con acalasia, se realizó una revisión narrativa en la literatura sobre su diagnóstico y alternativas de manejo.

Abstract Megaesophagus occurs in between 5% and 20% of patients with achalasia. It is a primary esophageal motor disorder that has been known for more than 300 years. It should be considered in all patients with dysphagia that is not explained by an obstructive or inflammatory process after a detailed endoscopic study. The following is the case of a patient with progressive dysphagia, in whom megaesophagus was documented as a complication of untreated, long-standing achalasia. Chagas disease was ruled out by enzyme immunoassay (ELISA) and indirect immunofluorescence (IF), as recommended by current guidelines. Given the low frequency of this entity in our environment and the therapeutic implications for patients with achalasia, a narrative literature review was carried out to describe its diagnosis and treatment alternatives.

Prevalence and Clinical Characteristics of SARS-CoV-2 Confirmed and Negative Kawasaki Disease Patients During the Pandemic in Spain.

Introduction: COVID-19 has a less severe course in children. In April 2020, some children presented with signs of multisystem inflammation with clinical signs overlapping with Kawasaki disease (KD), most of them requiring admission to the pediatric intensive care unit (PICU). This study aimed to describe the prevalence and clinical characteristics of KD SARS-CoV-2 confirmed and negative patients during the pandemic in Spain. Material and Methods: Medical data of KD patients from January 1, 2018 until May 30, 2020 was collected from the KAWA-RACE study group. We compared the KD cases diagnosed during the COVID-19 period (March 1-May 30, 2020) that were either SARS-CoV-2 confirmed (CoV+) or negative (CoV-) to those from the same period during 2018 and 2019 (PreCoV). Results: One hundred and twenty-four cases were collected. There was a significant increase in cases and PICU admissions in 2020 (P-trend = 0.001 and 0.0004, respectively). CoV+ patients were significantly older (7.5 vs. 2.5 yr) and mainly non-Caucasian (64 vs. 29%), had incomplete KD presentation (73 vs. 32%), lower leucocyte (9.5 vs. 15.5 × 109) and platelet count (174 vs. 423 × 109/L), higher inflammatory markers (C-Reactive Protein 18.5vs. 10.9 mg/dl) and terminal segment of the natriuretic atrial peptide (4,766 vs. 505 pg/ml), less aneurysm development (3.8 vs. 11.1%), and more myocardial dysfunction (30.8 vs. 1.6%) than PreCoV patients. Respiratory symptoms were not increased during the COVID-19 period. Conclusion: The KD CoV+ patients mostly meet pediatric inflammatory multisystem syndrome temporally associated with COVID-19/multisystem inflammatory syndrome in children criteria. Whether this is a novel entity or the same disease on different ends of the spectrum is yet to be clarified.

Correlación entre estudios electrocardiográficos y cinecoronariográficos en enfermedades coronarias / Connection between electrocardiographic and cinecoronariographic studies in coronary diseases

Las enfermedades cardiovasculares son la principal causa de muerte en Chile. Los Síndromes Coronarios Agudos (SCA), obligan a los sistemas de salud a destinar recursos de elevado costo para su diagnóstico. Procedimientos como el electrocardiograma (ECG) y la cinecoronariografía (CCG) orientan en el diagnóstico de dichas patologías, siendo el ECG un examen no invasivo de fácil ejecución y de bajo costo. El objetivo de este estudio fue relacionar el examen ECG con la CCG para mejorar la precisión diagnóstica de obstrucción coronaria. El estudio fue de tipo descriptivo de corte transversal, constituido por 44 pacientes adultos de ambos sexos que presentaron infarto de miocardio con elevación de segmento ST (STEMI), derivados al Servicio de Hemodinamia de la Clínica Iquique, Chile, para intervención coronaria. Los 44 pacientes tenían un ECG previo y se les realizó una CCG. Los resultados establecieron una fuerte correlación entre los diagnósticos por ECG y por CCG del total de las arterias obstruidas (según prueba de Correlación de Pearson = 0,80; p < 0,001). Se demostró relación entre ambos exámenes en un 92,3 % (p = 0,001) para la obstrucción de la arteria coronaria derecha (ACD) con hallazgo electrocardiográfico que correspondía a infarto de pared inferior. Relación de 100 % para la obstrucción de la rama circunfleja de la arteria coronaria izquierda (ACI) (p = 0,036) y 100 % para la obstrucción de la rama interventricular anterior de la ACI o arteria coronaria descendente anterior (p = 0,001) correspondiente a infarto de pared lateral. Se concluyó que existe relación significativa entre el infarto de pared anterior según los hallazgos electrocardiográficos y la obstrucción de la ACD y la rama circunfleja de la ACI según CCG; además, la relación es significativa entre los infartos de pared lateral y pared anterior con hallazgos por ECG y la obstrucción de la rama interventricular anterior de la arteria coronaria izquierda diagnosticada por CCG. Es fundamental la interpretación correcta del ECG para mejorar la atención del infarto agudo al miocardio.

Cardiovascular diseases are the leading cause of death in Chile. Acute Coronary Syndrome (ACS) forces health systems to allocate high-cost resources for diagnosis. Procedures like Electrocardiogram (ECG) and cinecoronariography (CCG) guide the diagnosis of these pathologies, with ECG being a noninvasive exam easy to perform and of low cost. The aim of this study was to connect ECG exams with CCG to improve the diagnostic accuracy of coronary obstruction. This was a descriptive cross-sectional study, consisting of 44 adult patients of both sexes which presented myocardial infarction with ST-segment elevation (STEMI) referred to the Hemodynamic Service from Iquique Clinic, Chile, for coronary operation. All 44 patients had previous ECG and they were conducted a CCG. Results established a strong correlation between ECG and CCG diagnosis from the total of Clogged Arteries (according to Pearson correlation test = 0.80; p < 0.001). The correlation demonstrated in both exams was 92.3 % (p = 0.001) for blockage in the right coronary artery (RCA) with electrocardiographic finding corresponding to inferior wall infarction. 100 % relationship for the obstruction of the circumflex branch of the left coronary artery (LCA) (p = 0.036) and 100 % for the obstruction of RCA anterior interventricular branch or anterior descending coronary artery (p = 0.001) corresponding to a lateral wall infarction. It is concluded that there is a significant relationship between anterior wall infarction according to electrocardiographic findings and RCA obstruction and LCA circumflex branch according to CCG. In addition, there is a significant relationship between lateral wall infarction and interior walls by ECG findings and the obstruction of the anterior interventricular branch of the left coronary artery diagnosed by CCG. The correct interpretation of ECG is essential to improve the care of acute myocardial infarction.

Epidemiología de las lesiones de punta de dedo / Fingertip injuries epidemiology

Introducción: las lesiones de punta de dedo se relacionan comúnmente con actividades laborales y son una causa frecuente de consulta a los servicios de urgencias. Por lo tanto, el conocimiento de su epidemiología y pronóstico es fundamental en el planeamiento de políticas de salud pública. Materiales y métodos: se realizó un estudio descriptivo, retrospectivo, tipo serie de casos entre enero de 2005 y junio de 2009, en el servicio de cirugía de mano y miembro superior de la Clínica CES, de la ciudad de Medellín. Se revisaron 86 historias clínicas en igual número de pacientes con diagnóstico de lesión de punta de dedo. Se evaluó edad, sexo, tipo de lesión, intervención realizada y complicaciones asociadas. Resultados: las complicaciones encontradas fueron necrosis, infección y dolor residual en 9 pacientes (10,5 %). El 98 % de los pacientes presentaron recuperación completa de los arcos de movimiento; el tiempo promedio antes del retorno laboral fue de 30,2 días. Discusión: los resultados obtenidos demuestran que las lesiones de punta de dedo son frecuentes en los servicios de urgencias y que se requiere un manejo especializado para obtener recuperaciones funcionales, rápidas y completas.