INTRODUCTION: Metastatic urothelial carcinoma (mUC) is a lethal disease with limited treatment options. We aimed to compare the treatment patterns and outcomes of patients with mUC who were treated before and after the introduction of immune checkpoint inhibitors (ICIs) at a tertiary hospital in Barcelona. METHODS: Single-center retrospective study from 2004 to 2021. Access to ICIs began in December 2014. We analyzed differences in clinical characteristics and survival outcomes, such as overall survival (OS), progression-free survival (PFS), and restricted mean survival time (RMST). RESULTS: A total of 206 patients were included. The median follow-up was 48.6 months. Ninety and 116 patients were treated during the pre-ICIs and the post-ICIs eras, respectively. We found high treatment attrition rates, with no differences in the number of patients who received second-line (48%) and third-line (26%) therapies between the two eras. In the second-line, ICIs became the predominant therapy (58%), leading to a 30% reduction in the utilisation of platinum-based ChT and non-platinum ChT. Innovative approaches including ICIs in the first-line treatment (18%) and targeted therapies in the third-line setting (34%) were observed. We found no differences in the median OS, 2-year OS, or 24-month RMST between the two periods. CONCLUSION: ICIs have emerged as a transformative treatment option, reshaping the treatment landscape. Nevertheless, substantial attrition rates from first-line to subsequent lines of systemic therapies might impede the potential impact of ICIs on long-term survival outcomes across the entire population.
Immune Checkpoint Inhibitors , Humans , Retrospective Studies , Male , Female , Immune Checkpoint Inhibitors/therapeutic use , Aged , Middle Aged , Carcinoma, Transitional Cell/drug therapy , Carcinoma, Transitional Cell/mortality , Carcinoma, Transitional Cell/secondary , Urinary Bladder Neoplasms/drug therapy , Urinary Bladder Neoplasms/mortality , Urinary Bladder Neoplasms/pathology , Treatment Outcome , Aged, 80 and over , Urologic Neoplasms/drug therapy , Urologic Neoplasms/mortality , Urologic Neoplasms/pathology , Spain , Progression-Free Survival , Survival Rate , Follow-Up Studies
Introducción. La deuda económica durante la residencia en cirugía general puede afectar el desempeño profesional, las decisiones de vida y el bienestar psicológico. La información disponible en Colombia es limitada. El objetivo de este estudio fue cuantificar la deuda económica del residente de cirugía general, identificar los factores asociados y evaluar su efecto en el bienestar psicológico. Métodos. Estudio de corte transversal analítico. Se invitó a 380 residentes a diligenciar una encuesta sobre los aspectos relacionados con su deuda económica y se utilizó el WHO-index para evaluar su bienestar psicológico. Resultados. Un total de 259 residentes participaron en el estudio (67,6 %). El 56 % posee una deuda económica promedio de COP $88.000.000 ((US$21.826)). Un alto nivel de endeudamiento se relacionó con el año de residencia, el tipo de institución (privada) y la solicitud de préstamos. Se identificó algún trastorno mental en 14,7 % y un bajo nivel de bienestar psicológico en 56,4 % de los participantes. No se identificó ninguna asociación entre una elevada deuda económica y el bajo bienestar psicológico. Conclusiones. La deuda económica tiene un efecto sobre los residentes. El endeudamiento de los residentes de cirugía en Colombia es altamente prevalente, y no se correlaciona con un pobre bienestar psicológico. La autodeterminación favorece el bienestar psicológico en el posgrado en cirugía general. Existe la necesidad de educación financiera en los residentes. Se requieren nuevos estudios que evalúen las causas del pobre bienestar psicológico.
Introduction. Financial debt during surgery residency can affect professional performance, life decisions, and psychological well-being. The information available in Colombia is limited. The objective of this study is to quantify the financial debt of the general surgery resident, identify the associated factors and evaluate their effect on psychological well-being. Methods. A cross-sectional study was carried out. A total of 380 residents were invited to complete a survey on aspects related to their financial debt, and the WHO-index to evaluate their psychological well-being. Results. A total of 259 residents participated in the study (67.6%). 56% have an average economic debt of $88,000,000 COP (US$21,826). High debt was related to level of residence, type of institution (private), and loan application. Some mental disorder was identified in 14.7% and a low level of psychological well-being in 56.4% of the participants. No association was identified between high financial debt and low psychological well-being. Conclusions. Economic debt has an effect on residents. Financial debt among surgical residents in Colombia is highly prevalent; however, it does not correlate with poor psychological well-being. Self-determination favors psychological well-being in the postgraduate course in general surgery. Likewise, the need for financial education in residents is imminent. New studies are required that thoroughly evaluate the causes of poor well-being.
Humans , General Surgery , Economics , Psychological Well-Being , Training Support , Education, Medical, Graduate
PURPOSE: To evaluate the effect of different whole-corneal and whole-eye higher order aberrations (HOAs) on levels of axis discrepancy. METHODS: This was a retrospective study including healthy candidates for refractive surgery, with one eye being randomly selected. A total of 360 eyes were included. Whole-corneal and whole-eye HOAs were measured twice with a Pentacam AXL Wave (Oculus Optikgeräte GmbH), and subjective manifest refraction was obtained. Axis discrepancy was defined as the absolute difference between Total Corneal Refractive Power flat keratometry axis and manifest refractive axis. Two multiple linear regression models that sought to explore the effect of HOAs in predicting axis discrepancy while adjusting for corneal and refractive confounders were built. RESULTS: Mean age was 29.1 ± 5.8 years and 63.9% of the patients were women. Mean manifest sphere and cylinder were -3.09 ± 2.36 and -1.45 ± 1.37 diopters (D), respectively. Mean cylinder axis discrepancy was 14.4 ± 14.5°. On multiple linear regression, the only variables significantly associated with axis discrepancy were corneal cylinder and corneal lower order aberrations [F(5,339) = 29.746; P < .001; adjusted R2 = 0.295]. Lower levels of corneal cylinder are by far the main contributor to astigmatism axis mismatch (ß = -1.164). There was not a single HOA, either corneal or ocular, that significantly loaded into any models. CONCLUSIONS: Astigmatism axis mismatch decreases rapidly with increasing levels of corneal astigmatism. Corneal and whole-eye HOAs have no role in astigmatism axis mismatch in healthy candidates for refractive surgery. [J Refract Surg. 2024;40(2):e89-e97.].
Astigmatism , Corneal Diseases , Refractive Surgical Procedures , Humans , Female , Young Adult , Adult , Male , Astigmatism/diagnosis , Astigmatism/surgery , Retrospective Studies , Visual Acuity , Corneal Topography , Refraction, Ocular , Cornea/surgery , Corneal Diseases/surgery
Aim: Faces pain scales are widely used to measure pain. So far, no faces pain scale has ever been constructed by Rasch modeling. Hence the authors aimed to construct a new scale by this method. Methods: Rasch modeling was used to provide an initial calibration and development of the 'Balparda-Herrera Pain Scale' (BHPS) and this scale was compared with the existing Faces Pain Scale - Revised. The scale was later refined. Results: Both the existing scale and the initial version of the BHPS required category collapsing. Statistical tests demonstrated an excellent concordance between both scales. The final version of the BHPS was found to behave excellently and to be capable of adequately measuring pain. Conclusion: The BHPS provides an excellent instrument for measuring pain in the adult population.
Lay abstract Pain is an unpleasant experience for patients, and it is useful for physicians to try to measure how much pain the patient is experiencing. Some scales used by physicians include faces with different expressions to represent various amounts of pain. Rasch modeling is a mathematical approach to develop better scales. In this study, the researchers performed two surveys in order to develop and improve a new scale for measuring pain: the BalpardaHerrera Pain Scale. They used mathematical and statistical approaches to optimize the scale and to compare with another well-known scale. The authors found that the new scale is very useful for measuring pain.
Facial Pain , Adult , Humans , Pain Measurement , Psychometrics , Reproducibility of Results , Surveys and Questionnaires
Resumen Introducción: Staphylococcus aureus es uno de los agentes causales más comunes de la endocarditis infecciosa. Se reportan pocos estudios en Latinoamérica acerca de las diferencias entre los perfiles de resistencia a la meticilina. Objetivo: Describir las características y el curso clínico de los pacientes con S. aureus sensible a meticilina frente al resistente. Métodos: Estudio observacional retrospectivo, cohorte histórica de pacientes adultos con diagnóstico confirmado de endocarditis entre los años 2011 y 2015. Se seleccionaron pacientes positivos para S. aureus comparando las características y el curso clínico entre los casos S. aureus sensible a meticilina frente al resistente. Resultados: Se estudiaron 86 pacientes con endocarditis. 28 (33%) tenían infección por S. aureus. 21 (75%) tenían endocarditis por S. aureus sensible a meticilina y 7 (25%) por S. aureus resistente a meticilina. En el grupo S. aureus sensible a meticilina, 11 (52,3%) fueron infecciones asociadas a atención en salud. La mayoría de casos de S. aureus resistente a meticilina fueron (85,7%) adquiridos en comunidad. La mortalidad de endocarditis por S. aureus sensible a meticilina fue superior a la causada por el resistente (33,3% vs. 14%). Conclusiones: S. aureus sigue siendo el agente más frecuente en endocarditis, más comúnmente el sensible a la meticilina. Los eventos embólicos y la gravedad fueron mayores en S. aureus sensible a meticilina. La mayor proporción de endocarditis debido a S. aureus resistente a meticilina se adquirió en la comunidad, por lo que se sugiere iniciar cobertura empírica contra S. aureus resistente a meticilina en todo caso de endocarditis adquirida en la comunidad.
Abstract Introduction: Staphylococcus aureus is one of the most common sources of infectious endocarditis. There are few studies in Latin America that report on the differences between the methicillin resistance profiles. Objective: To describe the characteristics and clinical course of patients with methicillin-sensitive S. aureus (MSSA) compared to methicillin-resistance S. aureus (MRSA) Methods: An observational, retrospective study was conducted on a historical cohort of adult patients with a confirmed diagnosis of endocarditis between the years 2011 and 2015. Patients positive for S. aureus were selected and the characteristics and clinical course and the cases of MSSA were compared with those of MRSA. Results: A total of 86 patients with endocarditis were included, of whom 28 (33%) had an infection due to S. aureus, and 21 (75%) had endocarditis due to methicillin-sensitive S. aureus, and 7 (25%) due to MRSA. In the MSSA group, 11 (52.3%) were infections associated with health care. The majority (85.7%) of cases of MRSA were community acquired. The endocarditis mortality due to MSSA was higher than that caused by MRSA (33.3% vs. 14%). Conclusions: S. aureus continues to be the most common agent in endocarditis, with MSSA being more common. The embolic events and the severity were greater in MSSA. The majority of endocarditis due to MRSA is acquired in the community, and for this reason it is suggested starting empirical cover against MRSA in all cases of community acquired endocarditis.
Humans , Male , Middle Aged , Endocarditis , Mortality , Embolization, Therapeutic , Methicillin , Micrococcal Nuclease
BACKGROUND: Neuroendocrine tumors (NETs) are heterogeneous neoplasms that originate from cells with a secretory function. Small bowel NETs (SB-NETs) are related to serotonin hypersecretion which causes: flushing, diarrhea, abdominal pain, bronchoconstriction and heart involvement, also known as carcinoid syndrome (CS). CS can be confused with an allergic reaction and thus should be considered as a differential diagnosis in the allergy consult. We present the case of a pediatric patient initially referred under the suspicion of food allergies. CASE PRESENTATION: We present the case of a 17-year-old male with evanescent non-pruriginous erythematous lesions- flushing that appeared with food consumption, associated with conjunctival injection, warmth and diaphoresis after the lesions disappeared. He denied abdominal pain, diarrhea, cough or wheezing. The 24-h urinary 5-hydroxyindoleacetic acid (5-HIAA) excretion was elevated. The CT scan showed thickening of the distal ileum and multiple lesions on both hepatic lobules and the colonoscopy revealed a tumor in the ileocecal valve. Hepatic and intestinal biopsies reported a well-differentiated NET of the ileocecal valve with hepatic metastasis. He was started on octreotide and underwent a wide hepatectomy and right hemicolectomy with improvement of symptoms. CONCLUSIONS: NETs can present as carcinoid syndrome (flushing, diarrhea, abdominal pain, wheezing), which constitutes vague symptomatology and represents a challenging diagnosis for physicians. They can be confused with an allergic reaction and the allergist should consider it as a differential diagnosis. Accurate diagnostic tests will help to diagnose NETs earlier and potentially prevent carcinoid heart disease, bowel obstruction, and improve quality of life and mortality in these patients.
UNLABELLED: Congenital diaphragmatic hernia (CDH) is found frequently in from 0.17 to 0.57 among 1000 newborns and is associated with intrathoracic kidney (IK) in 0.25%. The objective of the present work was to describe both present pathologies in a newborn and to review the literature in this respect. CLINICAL CASE: male newborns, who presented tachypnea sudden and persistent for the first 24 h of life. For the that was physical exam, we included breathing difficult, (eight points of Silverman's) and cyanosis; initial arterial gases: hypoxemia and hypocapnia (acute respiratory failure type I); thorax X-ray; increase of bronchial plot and of parahiliary density; normal lungs, pleuro-peritoneal membrane and solid mass superimposed on heart silhouette were observed and confirmed by echocardiogram. Computed axial tomography (CAT) revealed left kidney and part of spleen inside thorax, beside inferior lobe of left lung. Immediately, the patient was mechanically ventilated and after 2 days, was operated surgically for correction of CDH and descent of left kidney. After surgical intervention, initial symtomatology disappeared and evolution was satisfactory. The present case illustrates how the kidney on occasion can emigrate due to congenital default to the thorax of the wall of the diaphragm and be a casual discovery at the moment of radiologic exploration.
Hernia, Diaphragmatic/complications , Hernias, Diaphragmatic, Congenital , Kidney/abnormalities , Respiratory Insufficiency/etiology , Humans , Infant, Newborn , Kidney/diagnostic imaging , Male , Radiography , Syndrome
La hernia diafragmática congénita (HDC) se presenta con frecuencia de 0.17 a 0.57 por 1000 recién nacidos vivos y se asocia con riñón intratorácico (RI) en 0.25%. El objetivo del presente trabajo es describir las dos patología presentes en un neonato y revisar la literatura al respecto. Caso clínico: recién nacido, masculino, quien a las cuatro horas de vida presentó taquipnea de aparición súbita y persistente. Al examen físico: dificultad respiratoria (Silverman de ocho puntos) y cianosis; gases arteriales a su ingreso: hipoxemia e hipocapnia (insuficiencia respiratoria tipo I). Radiografía de tórax: aumento discreto de la trama bronquial y de la densidad parahiliar; pulmones normales, evidencia de membrana pleuroperitoneal y masa sólida superpuesta sobre silueta cardiaca, confirmada por ecocardiograma. Tomografía axial computada (TAC): riñón izquierdo y parte de bazo dentro del tórax, al lado del lóbulo inferior del pulmón izquierdo. Inmediatamente se le instaló al paciente ventilación mecánica convencional y dos días después, se intervino quirúrgicamente para corrección de HDC y descenso de riñón izquierdo. Posterior al acto operatorio, desapareció la sintomatología inicial y su evolución posterior fue satisfactoria. El presente caso ilustra como el riñón en ocasiones puede emigrar al tórax por defecto congénito de la pared del diafragma y ser un hallazgo causal al momento de la exploración radiológica.
Congenital diaphragmatic hernia (CDH) is found frequently in from 0.17 to 0.57 among 1000 newborns and is associated with intrathoracic kidney (IK) in 0.25%. The objective of the present work was to describe both present pathologies in a newborn and to review the literature in this respect. Clinical case: male newborns, who presented tachypnea sudden and persistent for the first 24 h of life. For the that was physical exam, we included breathing difficulty (eight points of Silverman's) and cyanosis; initial arterial gases: hypoxemia and hypocapnia (acute respiratory failure type I); thorax X-ray; increase of bronchial plot and of parahiliary density; normal lungs, pleuroperitoneal membrane and solid mass superimposed on heart silhouette were observed and confirmed by echocardiogram. Computed axial tomography (CAT) revealed left kidney and part of spleen inside thorax, beside inferior lobe of left lung. Immediately, the patient was mechanically ventilated and after 2 days, was operated sourgically for correction of CDH and descent of left kidney. After surgical intervention, initial syntomatology disappeared and evolution was satisfactory. The present case illustrates how the kidney on occasion can emigrate due to congenital default to the thorax of the wall of the diaphragm and be a casual discovery at the moment of radiologic exploration.
Humans , Infant, Newborn , Male , Hernia, Diaphragmatic/complications , Hernia, Diaphragmatic/congenital , Kidney/abnormalities , Respiratory Insufficiency/etiology , Kidney , Syndrome
