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J. Health Biol. Sci. (Online) ; 10(1): 1-4, 01/jan./2022.
Artículo en Inglés | LILACS | ID: biblio-1369163


Introduction: One of the challenges of maxillofacial surgery is the rehabilitation of patients with severe bone loss, using implant-supported prostheses. This challenge is based on the small remaining bone structure, and on the need to reconstruct the structure for the rehabilitation with autogenous or exogenous grafts. Case report: We report the case of a patient with severe maxillary atrophy, where a skullcap graft was performed associated with implant placement and prosthetic completion 14 months after the start of treatment. Final considerations: We demonstrate clinical safety for the use of extraoral grafts without complications, representing a good alternative treatment for this group of patients.

Introdução: um dos desafios da cirurgia bucomaxilofacial é a reabilitação de pacientes com perda óssea severa, utilizando próteses implantossuportadas. Este desafio baseia-se na pequena estrutura óssea remanescente e na necessidade de reconstrução da estrutura para a reabilitação com enxertos autógenos ou exógenos. Relato de caso: Relatamos o caso de um paciente com atrofia maxilar grave, onde foi realizado enxerto de calota craniana associado à instalação de implante, com finalização protética 14 meses após o início do tratamento. Consideracoes finais: Demonstramos segurança clínica para o uso de enxertos extrabucais sem complicações, representando uma boa alternativa de tratamento para este grupo de pacientes.

Mandíbula , Pacientes , Prótesis e Implantes , Atrofia , Cráneo , Cirugía Bucal , Arcada Edéntula
J. Health Biol. Sci. (Online) ; 10(1): 1-4, 01/jan./2022.
Artículo en Inglés | LILACS | ID: biblio-1369172


Introduction: It is reported a case of a 57-year-old woman with multiple psychiatric hospitalizations, during which different diagnostic hypotheses and therapeutic procedures were proposed. Case report: After analyzing the patient's clinical records, the medical team proposed a diagnosis of Schizoaffective Disorder. This disorder presents a high risk of recurrent hospitalizations and high costs associated with therapeutic and follow-up withdrawal, yet there is limited data to assess the post-discharge critical periods. Final considerations: Further research in this area is required to adopt effective therapeutic strategies, reduce the probability of hospital admissions, improve prognosis, and lessen associated financial costs.

Introdução: é relatado o caso de uma mulher de 57 anos com múltiplas hospitalizações psiquiátricas, durante as quais diferentes hipóteses diagnósticas e terapêuticas associadas foram propostas. Relato do caso: Após análise dos registos clínicos, a equipa médica propôs o diagnóstico de Perturbação Esquizoafetiva. Esta Perturbação apresenta um elevado risco de re-internamento, para além do custo associado ao abandono do seguimento clínico e terapêutico. Porém, não existem dados suficientes que avaliem os períodos pós-alta. Consideracoes finais: Portanto, tornam-se necessárias pesquisas mais amplas na área para adotar estratégias terapêuticas eficazes, reduzir a probabilidade de re-internamento, melhorar o prognóstico e minimizar os custos financeiros associados.

Trastornos Psicóticos , Pacientes , Pronóstico , Terapéutica , Mujeres
J. Health Biol. Sci. (Online) ; 10(1): 1-4, 01/jan./2022. ilus
Artículo en Portugués | LILACS | ID: biblio-1368288


Introdução: Osteogênese Imperfeita (OI) é uma doença genética rara com fragilidade óssea. A classificação inclui muitos tipos. Além do risco de recorrência, o manejo pode variar com o tipo de OI. Relato do caso: Apresentamos um paciente do sexo masculino nascido com 39 semanas, de pais não consanguíneos e saudáveis. A hidrocefalia foi diagnosticada no pré-natal. Com 50 dias de vida, detectamos muitas fraturas e calos ósseos. O teste molecular identificou uma deleção em homozigose do éxon 4 do gene WNT1. Considerações finais: Concluímos que o caso apresentado tinha características clínicas de OI XV, e o teste molecular foi fundamental para o diagnóstico preciso e aconselhamento genético.

Introduction: Osteogenesis Imperfecta (OI) is a rare genetic disease with bone fragility. The classification includes many types. In addition, the risk of a recurrence, the management can vary with the kind of OI. Case report: We report a male patient born at 39 weeks from non-consanguineous healthy parents. The patient was diagnosed with Hydrocephalus at prenatal. At 50 days of life, we detected many fractures and bone calluses. The molecular test identified a homozygous deletion of exon 4 of the WNT1 gene. Final considerations: We conclude this case had clinical features of OI XV, and the molecular test was fundamental for the precise diagnosis and the genetic counseling.

Osteogénesis Imperfecta , Osteogénesis , Pacientes , Atención Prenatal , Sexo , Recien Nacido Prematuro , Fracturas Óseas , Asesoramiento Genético , Genética , Enfermedades Genéticas Congénitas , Hidrocefalia , Hombres
Clin. transl. oncol. (Print) ; 24(10): 1903–1913, octubre 2022. ilus
Artículo en Inglés | IBECS | ID: ibc-207946


Introduction: Immunotherapy is an effective treatment method for cancer cells with humoral and cellular immune mechanisms of action but triggers an inflammatory response and disrupts standard protective immune tolerance. Early detection of immune-related adverse events (irAEs) on PET/CT is crucial for patient management and subsequent therapy decisions. In this study, we aimed to evaluate the impact of 18F-FDG PET/CT on detecting of irAEs in patients receiving immunotherapy.Patients and methodsForty-six patients with advanced RCC (n: 32), malign melanoma (n: 9), lung cancer (n: 4), and laryngeal carcinoma (n: 1), who underwent 18F-FDG PET/CT imaging for response assessment after immunotherapy, were enrolled in the study. Newly detected findings associated with irAEs on posttreatment PET/CT images were compared with the pretreatment PET/CT, both qualitatively and semi-quantitatively.ResultsTwenty-eight (61%) patients developed irAEs as observed on PET/CT. Enteritis/colitis was the most frequent irAE visualized on PET/CT with 13 patients (28.2%), followed by gastritis (17.3%), thyroiditis (13%), and myositis/arthritis (13%). Hepatitis (6.5%), pneumonitis (6.5%), sarcoid-like reaction (4.3%), and hypophysitis (4.3%) were observed to a lesser extent. The median time between the appearance of irAEs on PET/CT and the initiation of immunotherapy was 4.3 months. There were no significant differences in age, sex, and treatment response status of patients with and without irAEs.Conclusion18F-FDG PET/CT plays a fundamental role in cancer immunotherapy with the potential to show significant irAEs both in the diagnosis and in follow-up of irAEs. IrAEs were present on PET/CT images of more than half of the patients who received immunotherapy in our study. (AU)

Humanos , Fluorodesoxiglucosa F18 , Inmunoterapia , Melanoma , Tomografía de Emisión de Positrones , Pacientes , Estudios Retrospectivos
Clin. transl. oncol. (Print) ; 24(10): 2029–2038, octubre 2022. ilus
Artículo en Inglés | IBECS | ID: ibc-207958


Purpose: OX40 signaling pathway occupies a vital place in anti-tumor immunity; however, the role of tumor-infiltrating OX40+ lymphocytes in pancreatic ductal adenocarcinoma (PDAC) remains to be identified.MethodsA total of 325 sequential PDAC patients who received curative tumor resection between January 2014 and December 2016 were enrolled. Tissues of these patients were immunohistochemically assessed for tumor infiltration of CD4+ T cells, CD8+ cytotoxic T cells (CTLs), and OX40+ lymphocytes. The frequency of OX40+ tumor-infiltrating lymphocytes (TILs) was then analyzed to various clinicopathological features, densities of tumor infiltration of CD4+ T cells and CTLs, and survival analysis was conducted using Kaplan–Meier (KM) curves. The risk scores of associated markers were calculated by the Cox proportional-hazards model.ResultsOur results showed that higher OX40+ lymphocytes infiltration was significantly correlated with superior median overall survival (OS) (25.8 vs 13.4 months, P < 0.001). Additionally, using univariate and multivariate Cox proportional hazards analyses, this study revealed that together with tumor differentiation, tumor size, serum CA199 levels, serum CA125 levels, and the infiltration of intratumoral CD8+ T cells. The abundance of OX40+ lymphocytes within the tumor was continued to be an independent predictor for OS (P = 0.023, HR = 0.713, 95% CI: 0.532–0.954).ConclusionsThis study demonstrated that intratumoral infiltration by a high number of OX40+ lymphocytes is a novel biomarker for favorable prognosis in resected PDAC patients, which implies that OX40-agonist-based immunotherapy might be a potential target in PDAC patients. (AU)

Humanos , Linfocitos T CD8-positivos , Carcinoma Ductal Pancreático , Neoplasias Pancreáticas , Pronóstico , Pacientes
PLoS One ; 17(9): e0273894, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36048853


BACKGROUND: There is increasing evidence of the need to consider advance care planning (ACP) for older adults who have been recently admitted to hospital as an emergency. However, there is a gap in knowledge regarding how to facilitate ACP following acute illness in later life. AIM/OBJECTIVES: To explore the perceived impact of ACP on the lives of older persons aged 70+ who have been acutely admitted to hospital. METHOD: Semi-structured qualitative interviews were conducted with older adults aged 70+ who were admitted to hospital as an emergency. Thematic analysis was enhanced by dual coding and exploration of divergent views within an interdisciplinary team. RESULTS: Twenty participants were interviewed. Thematic analysis generated the following themes: (1) Bespoke planning to holistically support a sense of self, (2) ACP as a socio-cultural phenomenon advocating for older persons rights, (3) The role of personal relationships, (4) Navigating unfamiliar territory and (5) Harnessing resources. CONCLUSION: These findings indicate that maintaining a sense of personal identity and protecting individuals' wishes and rights during ACP is important to older adults who have been acutely unwell. Following emergency hospitalization, older persons believe that ACP must be supported by a network of relationships and resources, improving the likelihood of adequate preparation to navigate the uncertainties of future care in later life. Therefore, emergency hospitalization in later life, and the uncertainty that may follow, may provide a catalyst for patients, carers and healthcare professionals to leverage existing or create new relationships and target resources to enable ACP, in order to uphold older persons' identity, rights and wishes following acute illness.

Planificación Anticipada de Atención , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Hospitalización , Humanos , Pacientes , Investigación Cualitativa
J Am Assoc Nurse Pract ; 34(9): 1098-1102, 2022 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-36083321


ABSTRACT: Hyperthyroidism in the elderly population is often associated with atypical, blunted, or nonspecific signs and symptoms, also known as apathetic hyperthyroidism (AH). The absence of the classical hyperkinetic clinical presentation can be confused with the normal aging process, or other diseases, and often leads to misdiagnosis, delayed treatment, and negative outcomes for elderly patients. We provide a case study of an elderly patient to illustrate the atypical presentation of AH. The vignette also highlights a diagnostic and treatment approach based on geriatric medicine fundamentals and evidence-based research. We then review the multiple factors and pathogenetic mechanisms contributing to endocrine disruptors and the paucity of hyperadrenergic signs and symptoms in the elderly with hyperthyroidism. Additionally, the article contrasts the symptomatology and diagnostic profile between primary hyperthyroidism and AH. Finally, we provide an evidence-based, patient-centered approach to manage AH in the elderly population. We recommend that nurse practitioners cultivate illness script inclusive of atypical presentations to guide their clinical decision making. Psychomotor retardation with or without cardiovascular symptoms warrant a high degree of suspicion and the initiation of laboratory studies, including thyroid functions to confirm or rule out hyperthyroidism.

Cardiopatías , Hipertiroidismo , Anciano , Cognición , Humanos , Hipertiroidismo/complicaciones , Hipertiroidismo/diagnóstico , Hipertiroidismo/tratamiento farmacológico , Pacientes
Acta otorrinolaringol. esp ; 73(5): 271-278, septiembre 2022. tab
Artículo en Español | IBECS | ID: ibc-JHG-269


Antecedentes y objetivo: Las alteraciones vestibulares se encuentran ligadas a un grupo de patologías que pueden afectar estructuras vestibulares, auditivas, o ambas partes del oído interno del ser humano. El problema abordado en este estudio responde a una escasez de información sobre el perfil audiológico de las personas que cursan con alteraciones vestibulares en Costa Rica. Existen investigaciones internacionales que abordan este tema, pero no hay registros de estudios realizados en la población costarricense. Es por este motivo que surge el interés de desarrollar esta investigación, cuyo objetivo es caracterizar el perfil audiológico y los grados de discapacidad en las personas con alteraciones vestibulares pertenecientes a la consulta del Centro Equilibra, durante los meses de septiembre a noviembre de 2019.Pacientes y métodosSe realizó un estudio descriptivo, transversal, cuantitativo y observacional-analítico con pacientes mayores de 18años que acudieron al Centro Equilibra. Las principales variables analizadas fueron el sexo, la edad, los antecedentes patológicos personales, el diagnóstico médico, los síntomas vestibulares primarios, las manifestaciones auditivas y los grados de discapacidad.ResultadosSe obtuvieron datos de 177 personas, donde las alteraciones vestibulares se presentaron más en el sexo femenino (razón 2,6:1). La media de edad fue de 56años. El 53,7% presentó pérdida auditiva, de tipo neurosensorial, ligera, gradualmente descendente. El 33,9% de la población presentó acúfeno, en su mayoría en frecuencias agudas. En la población adulta el 52% presentó algún grado de percepción de discapacidad auditiva; contrariamente, en los adultos mayores la mayoría (77%) no presentó ningún grado de discapacidad. El 87% de las personas percibieron discapacidad vestibular debido a su alteración vestibular. (AU)

Background and objective: Vestibular disorders are linked to a group of pathologies that can affect the vestibular part, the auditory part, or both parts of the inner ear. The problem in this study is the little information that exists about the audiological profile of people suffering from vestibular disorders in Costa Rica. There are international research studies on this topic, but there are no records of studies conducted in the Costa Rican population. This is why there is interest in developing this research which aims to characterize the audiological profile and the levels of handicap in people with vestibular disorders under Centro Equilibra, Vertigo and Equilibrio consultation during the months of September to November 2019.Patients and methodsA descriptive, cross-sectional, quantitative, and observational analytical study with patients over 18years old who attended Centro Equilibra. The main variables analysed were sex, age, personal pathological history, medical diagnosis, main vestibular symptoms, auditory manifestations, and levels of handicap.ResultsThe data was obtained from 177 people; vestibular disorders occurred more in the female sex (ratio 2.6:1). The mean age was 56years. Fifty-three point seven percent presented slight sensorineural hearing loss, gradually decreasing. Of the population, 33.9% presented tinnitus, mostly at high frequencies. In the adult population, 52% presented some level of hearing handicap, unlike older adults, where the majority (77%) did not present any level of handicap. People with vestibular disorders perceive greater physical handicap (83%).ConclusionsHearing loss was the most common hearing manifestation and although statistical analysis shows that it is not directly related to vestibular disorders, it is related to concomitant metabolic diseases. For this reason, it is necessary to promote the prevention of metabolic diseases as one of the measures to improve hearing health, even from an early age. (AU)

Humanos , Pérdida Auditiva , Acúfeno , Enfermedades Metabólicas , Diagnóstico , Pacientes
Acta otorrinolaringol. esp ; 73(5): 292-298, septiembre 2022. graf, tab
Artículo en Español | IBECS | ID: ibc-JHG-272


Introduction: Paradoxical vocal fold movement (PVFM) is a respiratory disorder related to inadequate movement of vocal folds during inspiration or expiration. Its epidemiology and pathogenesis are unknown. The present study describes the standardization of the examination performed in our service and the main endoscopic changes found, evaluating the prevalence of PVFM in patients with suggestive symptoms and describing the association of PVFM with asthma and other diseases.Materials and methodsRetrospective observational study of a series of cases over a 13-year period – adult patients referred for outpatient bronchoscopy due to suspected PVFM.ResultsWe analyzed 1131 laryngoscopies performed on patients referred for suspicion of PVFM from May 2006 to June 2019. Of these, 368 cases were excluded from the study. A total of 255 patients (33%) had a confirmed diagnosis of PVFM, 224 women (88%). The most frequent comorbidities found were asthma (62%), rhinitis (45%), gastro-oesophageal reflux disease (45%), obesity (24%), and psychiatric disorders (19%). Among the endoscopic findings concomitant with the diagnosis of PVDM, we highlight posterior laryngitis (71%), diseases of the nasal septum (18%), nasal polyps (7%).DiscussionFemale sex is more affected. There are several associations with other diseases, the main one being asthma, followed by rhinitis and psychiatric disorders. Obesity appears as a comorbidity in 24% of patients, as does sleep apnoea in 13%. Posterior laryngitis was the most common endoscopic finding. PVFM is an underdiagnosed disease, little known as it is a rare entity that still needs prospective studies. Exam standardization is important. (AU)

Introducción: El movimiento paradójico de las cuerdas vocales (MPCV) es un trastorno respiratorio relacionado con el movimiento inadecuado de las cuerdas vocales durante la inspiración o la espiración. Se desconocen su epidemiología y su patogenia. El presente estudio describe la estandarización de la exploración realizada en nuestro departamento y los principales cambios endoscópicos encontrados al evaluar la prevalencia de MPCV en pacientes con síntomas indicativos, y describe la asociación entre MPCV y el asma y otras enfermedades.Materiales y métodosEstudio retrospectivo observacional de una serie de casos, a lo largo de un periodo de 13años, de pacientes adultos remitidos para broncoscopia ambulatoria debido a sospecha de MPCV.ResultadosAnalizamos 1.131 laringoscopias practicadas en pacientes por sospecha de MPCV desde mayo de 2006 a junio de 2019. De ellas se excluyeron 368 casos del estudio. En 255 pacientes (33%) se confirmó el diagnóstico de MPCV; de ellos, 224 eran mujeres (88%). Las comorbilidades más frecuentemente encontradas fueron: asma (62%), rinitis (45%), reflujo gastroesofágico (45%), obesidad (24%) y trastornos psiquiátricos (19%). Entre los hallazgos endoscópicos concomitantes al diagnóstico de MPCV destacamos laringitis posterior (71%), enfermedades relacionadas con la nariz (18%) y pólipos nasales (7%).DiscusiónEl sexo femenino es el más afectado. Existen diversas asociaciones con otras enfermedades, siendo el asma la más destacada, seguida de rinitis y trastornos psiquiátricos. La obesidad aparece como comorbilidad en el 24% de los pacientes, y la apnea del sueño, en el 13%. La laringitis posterior fue el hallazgo endoscópico más común. El MPCV es una enfermedad infradiagnosticada, poco conocida, y al ser una entidad rara sigue necesitando estudios prospectivos, siendo importante la estandarización de la exploración. (AU)

Humanos , Disfunción de los Pliegues Vocales , Asma , Rinitis , Reflujo Gastroesofágico , Pacientes
Acta otorrinolaringol. esp ; 73(5): 299-309, septiembre 2022. tab, graf
Artículo en Español | IBECS | ID: ibc-JHG-273


Antecedentes y objetivo: Una traqueostomía de larga duración puede tener efectos negativos significativos sobre la calidad de vida, ya que ocasiona cambios físicos, funcionales, sensoriales, psicológicos, sociales, económicos y laborales en la vida del individuo. El objetivo de este estudio fue validar al español un cuestionario de calidad de vida para estos pacientes.Materiales y métodosEstudio de validación psicométrica de un cuestionario en 45 pacientes mayores de 18 años, con permanencia de 6 meses de su traqueostomía, que entienden el español y comprenden bien las preguntas del cuestionario de salud SF-36 y de un cuestionario específico de calidad de vida del paciente con traqueostomía (TQOL-versión española). Este cuestionario es una modificación y adaptación cultural al español del instrumento original denominado Tracheostomy Specific Quality of Life Questionnaire (TQOL). Los 2 cuestionarios (TQOL-versión española) y SF-36 se cumplimentaron transcurridos los 6 meses desde la traqueostomía y entre 30 días y 50 días después de la primera administración. Se ha evaluado la fiabilidad y la repetitividad del TQOL-versión española. Se estudió la validez de constructo a través de la correlación entre los resultados del TQOL-versión española y las dimensiones del cuestionario SF-36.ResultadosLa fiabilidad del TQOL-versión española estimada mediante la prueba de alfa de Cronbach fue de 0,814, con variación entre ítems de 0,783 a 0,817 en la muestra a los 6 meses y de 0,794 en la muestra de validación, con variación entre ítems de 0,758 a 0,813. El coeficiente de correlación intraclase para la puntuación total de la escala mediante el análisis de concordancia de Bland-Altman y concordancia para las preguntas individuales con la prueba de simetría de McNemar fueron indicativos de buena estabilidad temporal. Se encontró una buena correlación entre las escalas del TQOL-versión española y las dimensiones del SF-36. (AU)

Background and objective: A long-term tracheostomy can have significant negative effects on quality of life because it causes physical, functional, sensory, psychological, social, economic, and work impairments to the life of the individual. The objective of this study was to validate in Spanish a quality-of-life questionnaire for these patients.Materials and methodsA psychometric validation study of a questionnaire in 45 patients over 18 years of age, with tracheostomy for six months, who understand Spanish and have a good understanding of the questions of the SF-36 questionnaire and a specific quality of life questionnaire for the patient with tracheostomy (TQOL-versión española). This questionnaire is a modification and cultural adaptation into Spanish of the original English instrument named Tracheostomy Specific Quality of Life Questionnaire (TQOL). The 2 questionnaires (TQOL-versión española) and the SF-36 were completed 6 months after the tracheostomy and between 30 and 50 days after the first administration. The reliability, repeatability, and construct validity of the TQOL-versión española were evaluated. The construct validity was assessed by the correlation between the results of the TQOL-versión española and the dimensions of the SF-36 questionnaire.ResultsThe reliability of the TQOL-versión española measured by Cronbach's alpha coefficient was .814, with variation between items from .783 to .817 in the sample at 6 months and from .794 in the validation sample, with variation between items from .758 to .813. There was intraclass correlation for the total score of the scale using the concordance analysis of Bland-Altman and agreement for the individual questions with the McNemar symmetry test. There was also a good correlation between the scales of the TQOL-versión española and the dimensions of the S-F36. (AU)

Humanos , Calidad de Vida , Traqueostomía , Pacientes , Encuestas y Cuestionarios
Acta otorrinolaringol. esp ; 73(5): 310-322, septiembre 2022. tab, ilus
Artículo en Inglés | IBECS | ID: ibc-JHG-274


Introduction: The gracilis muscle free flap has gained popularity in head and neck reconstruction due to minimal donor-site morbidity, reliable vascular pedicle, strong muscular component, and possibility to perform nerve coaptation. However, almost all the existing evidence in the literature is related to its use for facial palsy reanimation. The aim of this study was therefore to review and provide a comprehensive summary of all the possible indications and outcomes of this versatile free flap in head neck reconstructive surgery.Materials and methodsA systematic review of the literature was conducted including articles from 1970 to 2019. All articles were examined and described.ResultsTwenty-seven papers published between 1994 and 2019 were identified for analysis. The evidence highlights the use of the gracilis muscle free flap for parotid, forehead and midface defects, oral tongue, oral sphincter, lower and upper lip, cheek, and oral commissure defects, among others, as the most common defects reconstructed.ConclusionThis flap represents an easy to harvest and versatile free flap with low donor-site morbidity and multiple proven uses in head & neck reconstruction. We therefore encourage reconstructive surgeons to include this flap in their armoury, either as a first or as a second-line option. (AU)

Introducción: El colgajo libre de músculo gracilis ha ganado popularidad en la reconstrucción de cabeza y cuello debido a una mínima morbilidad en el sitio donante, un pedículo vascular confiable, un componente muscular fuerte y la posibilidad de realizar una coaptación nerviosa. Sin embargo, casi toda la evidencia existente en la literatura está relacionada con su uso para la reanimación de la parálisis facial. El objetivo de este estudio fue, por tanto, revisar y proporcionar un resumen completo de todas las posibles indicaciones y resultados de este versátil colgajo libre en cirugía reconstructiva de cabeza y cuello.Materiales y métodosSe realizó una revisión sistemática de la literatura incluyendo artículos de 1970 a 2019. Todos fueron examinados y descritos.ResultadosSe identificaron 27 artículos publicados entre 1994 y 2019 para su análisis. La evidencia destaca el uso del colgajo libre de músculo gracilis para defectos de parótida, frente y región medio facial, lengua oral, esfínter oral, labio inferior y superior, defectos de mejilla y comisura oral, como los defectos reconstruidos más comunes.ConclusiónEste colgajo representa un colgajo libre versátil y fácil de elevar con baja morbilidad a nivel del sitio donante y múltiples posibilidades en la reconstrucción de cabeza y cuello. Por lo tanto, representa una herramienta útil en el arsenal reconstructivo de cualquier cirujano, ya sea como una opción de primera o de segunda línea. (AU)

Humanos , Colgajos Tisulares Libres , Morbilidad , Pacientes
Med. clín (Ed. impr.) ; 159(5): 230-233, septiembre 2022. graf
Artículo en Inglés | IBECS | ID: ibc-JHG-300


Background: There are few data on the clinical characteristics of COVID-19 patients who require blood transfusion. We aimed to investigate the clinical characteristics and indication for transfusion in COVID-19 patients seen during the epidemic's first wave.Material and methodsCross-sectional study that included all consecutive COVID-19 patients admitted to the Hospital Clínic of Barcelona, Spain, from mid-March to mid-May 2020.ResultsA total of 80 patients received 354 RBC units, 116 plasma units, and 48 platelet units. Median age was 71 years (IQR: 62–76), and 59 (74%) were males. In total, 138 of the 261 transfusion episodes that involved RBCs (59%) were related to spontaneous (n=94) or procedure-related (n=44) bleeding. Spontaneous bleeding was more frequent in the retroperitoneal space and the gastrointestinal apparatus. Tracheostomy with endotracheal intubation, surgical interventions, and cannulation of femoral vessels were the main procedures behind non-spontaneous bleeding. Most patients (91%) were on anticoagulants, mostly intermediate- or full-dose heparin.ConclusionAnticoagulation-related bleeding was a leading cause of blood transfusion in COVID-19 patients during the epidemic's first-wave. (AU)

Introducción: Las características de los pacientes con COVID-19 transfundidos son poco conocidas. Nuestro objetivo fue investigar el perfil clínico y el motivo de la transfusión en los pacientes con COVID-19 vistos durante la primera ola de la epidemia.Material y métodosEstudio transversal que incluyó a todos los pacientes con COVID-19 transfundidos en el Hospital Clínic de Barcelona entre marzo y mayo de 2020.ResultadosOchenta pacientes recibieron 354 unidades de hematíes, 116 de plasma y 48 de plaquetas. La edad mediana fue de 71 años y 59 (74%) eran hombres. En total, 138 de los 261 episodios de transfusión de hematíes (59%) estaban relacionados con hemorragia espontánea (n=94: principalmente retroperitoneal y gastrointestinal) o con procedimientos invasivos (n=44: principalmente traqueostomía, cirugía, y canulación de vasos femorales). El 91% de los pacientes recibía tratamiento anticoagulante el día de la transfusión o los dos días previos, sobre todo heparina a dosis intermedia o completa.ConclusiónEl sangrado relacionado con la anticoagulación fue el motivo principal de transfusión en los pacientes con COVID-19. (AU)

Humanos , Transfusión de Sangre Autóloga , Hemorragia , Anticoagulantes , Virus del SRAS , Infecciones por Coronavirus , Pacientes
Med. clín (Ed. impr.) ; 159(5): 234-237, septiembre 2022. tab
Artículo en Inglés | IBECS | ID: ibc-JHG-301


Background: Covid-19 infection and cancer are associated with an increased risk of thrombotic events. The aim of our study is to analyze the cumulative incidence of thrombosis in oncological patients with Covid-19 and detect differences with the non-cancer Covid-19 population.MethodsWe retrospectively reviewed 1127 medical records of all admitted patients to ward of the Hospital Universitario Infanta Leonor (Madrid, Spain), including 86 patients with active cancer between March 5th, 2020 to May 3rd, 2020. We analyzed cumulative incidence of thrombosis and risk factors associated to the cancer patient's cohort.ResultsWe diagnosed 10 thrombotic events in 8 oncological patients with a cumulative incidence of 9.3%. A statistically significant association was found regarding thrombosis and history of obesity (p=0.009). No differences related to cumulative incidence of thrombosis between both groups were detected (9.8% vs 5.80%) in our hospital (p=0.25).ConclusionNo significant differences were observed in the cumulative incidence of thrombosis in the two study groups. The thrombotic effect of Covid-19 is not as evident in cancer patients and does not seem to be added to its prothrombotic activity. (AU)

Antecedentes: La infección por COVID-19 y el cáncer se asocian a mayor riesgo de eventos trombóticos. El objetivo de nuestro estudio es analizar la incidencia acumulada de trombosis en pacientes oncológicos con COVID-19 y detectar diferencias con la población sin cáncer y COVID-19.MétodosRevisamos retrospectivamente 1.127 historias clínicas de los pacientes ingresados en del Hospital Infanta Leonor (Madrid, España), incluyendo 86 pacientes con cáncer activo entre el 5 de marzo y el 3 de mayo de 2020. Se analizó la incidencia acumulada de trombosis y los factores de riesgo asociados a la cohorte de pacientes con cáncer.ResultadosDiagnosticamos 10 eventos trombóticos en 8 pacientes oncológicos, con una incidencia acumulada del 9,3%. Se encontró una asociación estadísticamente significativa entre trombosis y obesidad (p=0,009). No se detectaron diferencias relacionadas con la incidencia acumulada de trombosis entre ambos grupos (9,8%vs. 5,80%, p=0,25).ConclusiónNo se observaron diferencias significativas en la incidencia acumulada de trombosis en los 2 grupos de estudio. El efecto trombótico de la COVID-19 no es tan evidente en los pacientes con cáncer y no parece sumarse a su actividad protrombótica. (AU)

Humanos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Virus del SRAS , Neoplasias/complicaciones , Neoplasias/epidemiología , Trombosis/diagnóstico , Trombosis/epidemiología , Trombosis/etiología , Estudios Retrospectivos , Pacientes
Clin. transl. oncol. (Print) ; 24(9): 1744–1754, septiembre 2022.
Artículo en Inglés | IBECS | ID: ibc-206260


PurposeWe conducted a systematic review to analyse the performance of the sentinel lymph-node biopsy (SLNB) after the neoadjuvant chemotherapy, compared to axillary lymph-node dissection, in terms of false-negative rate (FNR) and sentinel lymph-node identification rate (SLNIR), sensitivity, negative predictive value (NPV), need for axillary lymph-node dissection (ALND), morbidity, preferences, and costs.MethodsMEDLINE, Embase, Scopus, and The Cochrane Library were searched. We assessed the quality of the included systematic reviews using AMSTAR2 tool, and estimated the degree of overlapping of the individual studies on the included reviews.ResultsSix systematic reviews with variable quality were selected. We observed a very high overlapping degree across the included reviews. The FNR and the SLNIR were quite consistent (FNR 13–14%; SLNIR ~ 90% or higher). In women with initially clinically node-negative breast cancer, the FNR was better (6%), with similar SLNIR (96%). The included reviews did not consider the other prespecified outcomes.ConclusionsIt would be reasonable to suggest performing an SLNB in patients treated with NACT, adjusting the procedure to the previous marking of the affected lymph node, using double tracer, and biopsy of at least three sentinel lymph nodes. More well-designed research is needed. (AU)

Humanos , Axila , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/cirugía , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Terapia Neoadyuvante/métodos , Estadificación de Neoplasias , Pacientes