Saving time in the radiotherapy procedures for COVID-19 pneumonia treatment. A single-institution experience.

BACKGROUND: The use of low dose radiotherapy (LD-RT) for the treatment of COVID-19 pneumonia is supported by biological rationale for its immunomodulatory effect. Some institutions have started to treat these patients showing encouraging results. To shorten procedure times is crucial for the comfort of symptomatic patients receiving respiratory support and to optimize institutional facilities. PATIENTS AND METHODS: At our institution, LD-RT is offered to hospitalized patients with COVID-19 pneumonia and signs of early cytokine-released syndrome on behalf of a multicenter study. We designed a coordinated process flow starting from the patient transfer to the simulation CT-scan (first-step), to the end of the LD-RT treatment (last step). The times spent on each step of the process flow were evaluated. RESULTS: Mean age of treated patients was 83 (72-91) years-old. The timing parameters of the first 10 consecutive patients were analyzed. Except for the first (dummy run), patients were managed from the first to the last step in a median of 38 min (25-58, SD 10.67). The most time-consuming sub-process was the contouring of the treatment volumes and dosimetry. CONCLUSIONS: LD-RT is not only an encouraging option for COVID-19 pneumonia patients, but a convenient and feasible procedure if performed in a coordinated way by reducing procedure times.

Adjuvant therapy for true ampullary cancer: a systematic review.

BACKGROUND: Given the lack of evidence on the best adjuvant approach, this review closely examines optimal adjuvant management for resected true ampullary cancer and its histological subtypes. MATERIALS AND METHODS: A comprehensive literature search of PubMed was performed to identify studies on resected true ampullary cancers, published between January 2010 and December 2018. Data including the use of radiation, chemotherapy or chemoradiation and the outcomes were extracted. RESULTS: A total of 116 records were identified, of which 65 screened were selected. Finally, nine studies were included. Only two of the studies reported separately the outcomes of pancreatobiliary and intestinal subtypes. Patients in the selected studies were treated with a pancreaticoduodenectomy with negative margins. Patients treated with adjuvant therapy were more likely to be pT3-4 and have positive nodes; median survival ranged from 30 to 47 months. A significant benefit for adjuvant treatment was observed in four of the studies, restricted to patients at stage IIB or higher. Likewise, patients with positive nodes may have a longer median survival with adjuvant chemoradiation compared to observation. CONCLUSIONS: The present review suggests a benefit for adjuvant treatment for patients with locally advanced tumors. Randomized trials are needed to ascertain the topic, as well as studies reporting toxicity and quality of life of resected true ampullary cancer patients.

Correction to: Curative radiation therapy for very elderly bladder cancer patients with localized disease.

In the original version of this article the figure captions of Figs. 1 and 2 were interchanged.

Curative radiation therapy for very elderly bladder cancer patients with localized disease.

PURPOSE: To report the outcomes of a cohort of very elderly muscle-invasive bladder cancer (MIBC) patients treated with contemporary 3D-conformal radiation therapy (3D-CRT) with or without concurrent chemotherapy, after transurethral resection of bladder tumor (TURBT). METHODS: From February 2010 to January 2014, a total of 41 patients older than 75 years, with T2-3 N0-1 high-grade MIBC, a Karnofsky index (KI) of at least 90% and/or a Barthel scale score of at least 95, were treated with TURBT followed by radiotherapy (RT) with or without chemotherapy, and were prospectively followed-up. RESULTS: The mean age of patients was 82 years (range 76-88). Median follow-up was 47 months for surviving patients. Mean Charlson Comorbidity Index (CCI) score was 5 points. 28 patients (68.29%) were T2N0. All received 3D-CRT to a mean dose of 60 Gy (range 48.6-66 Gy), and chemotherapy was delivered to 34 patients (83%). Cause-specific survival (CSS) was 86 and 78.8% at 1 and 5 years, respectively. Patients achieving a complete response lived longer (48 vs 14 m, p = 0.036) than those with a progressive disease, who were more likely to die from cancer than from other causes (HR 3.865, IC95% 1.562-9.562). Dead patients had a longest treatment time (mean 56.78 vs 48.91 days, p = 0.019) than survivors. CONCLUSION: RT with contemporary 3D-CRT techniques after TURBT for MIBC in elderly patients is feasible and well-tolerated. Achieving a maximal response and shortening the total radiation treatment time may improve outcomes and quality of life.

Assessment of acute bowel function after radiotherapy for prostate cancer: Is it accurate enough?

BACKGROUND AND PURPOSE: Pelvic radiotherapy for prostate cancer can be associated with bowel toxicity, which may have a significant impact on quality of life. Our aim was to assess the adequacy of the tools currently used to assess bowel symptoms after radiotherapy, including physician and patient reported outcomes. This sub-study on acute toxicity was part of a prospective trial assessing long-term bowel dysfunction. MATERIALS AND METHODS: Between February 2013 and July 2015, 75 patients with prostate cancer who received radiotherapy completed the LENT/SOMA and the EPIC questionnaires baseline and 2 weeks after the treatment. The Bristol stool scale and two additional questions on faecal urgency were added. Physicians assessed toxicity using Common Terminology Criteria for Adverse Events v.4.0. Agreement between patients and clinicians was assessed using the Cohen's κ coefficient. RESULTS: Acute toxicity during radiotherapy was very low. The pattern of overall bowel bother was similar before and after treatment. Faecal urgency significantly increased after radiotherapy compared to baseline but was only detected by the additional questions and not by the physicians or the patient-reported outcomes (PRO) questionnaires. Correlation between physician and PRO was poor for most symptoms. CONCLUSION: Bowel symptoms such as urgency may remain undetected by usual tools to assess toxicity after radiotherapy. Assessment of bowel toxicity should be reappraised in order to identify those patients who may have symptoms with an impact on their quality of life.

Púrpura de Schönlein-Henoch en un adulto asociada a losartán / Schönlein-Henoch purpura in an adult associated with losartan

La púrpura de Schönlein-Henoch, es una vasculitis sistémica de pequeños vasos, con depósitos de IgA en las paredes vasculares, que se caracteriza clínicamente por: púrpura palpable, artritis o artralgias, dolor abdominal y compromiso renal. Es más frecuente en niños pero puede presentarse en adultos. La etiología es desconocida, pero se la ha relacionado a infecciones vacunas, fármacos y en adultos a neoplasias. Presentamos el caso de una mujer de 74 años, que había comenzado a tomar losartán diez días previos al comienzo de los síntomas. Para normalización de la tensión arterial, se suspendió el losartán. Al reiniciar la droga, la paciente presentó nuevamente una púrpura palpable, en miembros inferiores.

Schönlein-Henoch purpura is a systemic vasculitis of small vessels with IgA deposits in vessel walls. It presents with palpable purpura, arthritis or arthralgia, abdominal pain and renal involvement. It is more common in children, but it can also be seen in adults. Although, the etiology is unknown, the illness has been associated with infections, vaccines, drugs and, in adults, with neoplasias, as well. A 74 year-old woman who had started taking losartan ten days before she started with the onset of symptoms are reported. Days after, the arterial tension normalized, so losartan was suspended. When the drug was reintroduced, the patient presented once again a palpable purpura on lower limbs.

Pilomatrixoma: una presentación clínica atípica / Pilomatrixoma: An atypical presentation

El pilomatrixoma es un tumor anexial benigno, que deriva de las células matriciales del folículo piloso. Tiene dos picos de incidencia: entre los 5 y los 15 años y entre los 50 y 65 años. Aproximadamente el 60-80% de los casos, se desarrolla en la primera década de la vida. En adultos, generalmente es sub-diagnosticado debido a su baja frecuencia. Presentamos el caso de un pilomatrixoma en edad adulta, de rápido crecimiento y realizamos una breve revisión sobre el tema.

Pilomatrixoma is a benign adnexal tumor derived from the matrix cells of the hair follicle. It has two peaks of incidence: between 5 and 15 years and between 50 and 65 years. Approximately 60-80% of cases develop in the first decade of life. In adults, it is generally under-diagnosed due to its low frequency. We report the case of a pilomatrixoma in adulthood of rapid growth and a brief review on the subject.

Xantogranuloma juvenil del adulto: Reporte de un caso clínico y revisión de la literatura / Juvenile xanthogranuloma in adult: A case report and review

El xantoganuloma juvenil es una enfermedad benigna, poco frecuente en el adulto, forma parte del grupo de las histiocitosis de células no Langerhans, representando el 90 % de las mismas y el 15 % de éstas, se presentan en el adulto. El compromiso de otros órganos es excepcional. La evolución suele ser benigna con autoresolución de las lesiones. Presentamos el caso de una paciente de sexo femenino de 27 años de edad, que presentaba lesiones papulares de 15 días de evolución, en zona periocular, asintomáticas, las que fueron biopsiadas con diagnóstico histopatológico de xantogranuloma juvenil.

Juvenile Xanthogranuloma (JX) is an uncommon benign disease in adults, is part of the group of non-Langerhans cells histiocytosis, representing 90 % of them and 15% of these occur in adults. The involvement of other organs is exceptional. The evolution is usually benign with resolution of disease. We present a case of a female patient of 27 years who had papules with 15 days of evolution, in periocular area, asymptomatic, which were biopsied with histopathologic diagnosis of juvenile xanthogranuloma.

Elastolisis de la dermis media: Comunicación de un caso clínico y revisión de la literatura / Mid dermal elastolysis: A case report and review

Describimos el cuadro clínico de un paciente, que presenta placas y pápulas con aspecto de piel arrugada en papel de cigarrillo, localizadas en abdomen. El estudio histopatológico muestra ausencia de fibras elásticas, en una banda que compromete la porción media de la dermis. La elastolisis de la dermis media es una afección infrecuente, adquirida, idiopática o secundaria a un proceso inflamatorio previo, caracterizada por la pérdida focal de tejido elástico en la dermis media y sin compromiso extra cutáneo.

We describe a patient presenting plaques and papules -like wrinkled cigarette paper-, located in abdomen. Histopathological study shows absence of elastic fibers in a band that compromised the middle portion of the dermis. Mid dermal elastolysis is a rare, acquired idiopathic condition characterized by focal loss of elastic tissue in the middle dermis without extra cutaneous involment.

Prediction of asthma by common risk factors: a follow-up study in Cuban schoolchildren.

OBJECTIVE: To determine which common risk factors, including environmental factors, are predictors for the development of asthma in Cuban schoolchildren. METHODS: A longitudinal study was conducted in 1042 schoolchildren without asthma at baseline in 2 Cuban municipalities. Asthma status in 2007, diagnosed using the International Study of Asthma and Allergies in Childhood questionnaire, was related to a set of common risk factors assessed in 2003/2004 in a multivariable logistic regression model. Multiple imputation was used for missing values. The final prediction model was obtained by backward selection (P<.15). The model's prognostic accuracy (R2) and discriminative ability (area under the receiver operating characteristic curve [AUC]) were assessed and internal validation by bootstrapping was performed. RESULTS: A family history of atopic diseases (odds ratio [OR], 2.19; 95% CI, 1.19-4.04), allergic sensitization (OR, 1.83; 95% CI, 0.94-3.55), municipality (OR, 0.34; 95% CI, 0.15-0.74), and use of antibiotics in the child's first year of life (OR, 1.66; 95% CI, 0.89-3.11) were predictors for asthma development. The model had an R2 of 8.0% and a moderate discriminative ability (AUC, 0.69; 95% CI, 0.60-0.78). Internal validation hardly influenced the model's performance. CONCLUSIONS: Antibiotics use, genetic predisposition, and allergic sensitization were predictors of asthma in Cuban schoolchildren. Although known as common risk factors they could only partly predict asthma development. Poverty-related factors, such as low income and education, and parasitic infections, did not have an effect. Other or additional environmental predictors need to be identified, as these are potential targets for prevention and control of childhood asthma in affluent as well as nonaffluent countries.

Frequency of antibodies to Toxocara in Cuban schoolchildren.

OBJECTIVE: The aim of the study was to determine the frequency of antibodies to Toxocara in Cuban schoolchildren. METHODS: The frequency of antibodies to Toxocara canis was assessed with a commercial enzyme-linked immunosorbent assays kit in school-aged children from two municipalities of Cuba. Univariate analysis and a multivariable logistic regression analysis adjusted for age, sex, municipality and co-infection with helminth and/or protozoa were conducted. RESULTS: The percentage of children with antibodies to Toxocara was 38.8% (392/1011; 95% CI = 36.8-42.8). Antibody positivity was significantly associated with gender and co-infections with intestinal parasites, but not with age or municipality. CONCLUSION: Cuban children are highly exposed to the Toxocara parasite, corresponding well with reported environmental contamination with Toxocara parasite eggs and T. canis prevalences in dogs in Cuba. Relevant policy makers and the Cuban population need to be better informed about this preventable infection.

Characteristics and outcome of prostate cancer with PSA <4 ng/ml at diagnosis: a population-based study.

This population-based study aims to assess prognosis of prostate cancer diagnosed with prostate-specific antigen (PSA) levels <4 ng/ml in routine care. Materials and methods We compared prostate cancer patients with low PSA values (n=59) with other prostate cancer patients (n=1330) by logistic regression and the Cox model using data from the Geneva Cancer Registry. Results Patients with low PSA values more frequently had early-stage and well differentiated tumours. Nevertheless, 35% presented with aggressive tumour characteristics or metastases. After adjustment for other prognostic factors, prostate cancer-specific mortality was similar for both groups (hazard ratio: 1.1; 95%CI: 0.6-2.2). Conclusion We conclude that cancer with low PSA values at diagnosis is not indolent.

Health-risk perception in the inner city community of Centro Habana, Cuba.

Perceptions of health risks were surveyed in the inner city of Centro Habana, Cuba. A questionnaire developed by community leaders and experts was administered to 348 residents to determine the level of perceived risk for each of 41 risk items. Ecologic-level data on morbidity, mortality, and environmental indicators were also gathered. Using factor analysis to reduce the dimensionality of the data, five factor groupings accounted for 60% of the variance, as follows: social environment (40.8%); infectious agents and other health-risk factors of immediate concern (6.1%); lifestyle risks (4. 9%); environmental sanitation (4.1%); and living conditions (3.3%). A relationship between the perception of risk and the ecologic data was found, with inconsistencies largely attributable to factors known to influence risk perception. The greatest concern identified throughout the municipality was housing conditions, highest in the neighborhood that had already begun to address this problem. The analysis was useful in planning targeted health promotion campaigns and prioritizing further interventions. Repeat evaluation of risk perception will be conducted following the completion of interventions.

[Semantic scales for noise evaluation. Third stage: subjective characterization of sound stimuli]. / Escalas semánticas para la evaluación del ruido. Tercera etapa: caracterización subjectiva de estímulos sonoros.

This is the third step of a research for which Osgood's Differential Semantic Technique was resorted to in order to get suitable scales on a subjective evaluation of sound stimuli. Thus, a three-stage work was fulfilled. The first one dealt with the construction of seven-point bipolar scales starting from experimentally selected adjectives. The second one succeeded in finding the subjacent dimensions of the said scales by means of Factorial Analysis Method. The present stage aims at characterizing 40 sound stimuli through the discovered dimensions most representative scales. A special Semantic Differential Program was used to getting the following Index: Scalar Scores, Polarity, Familiarity and Interconcept Distances. The interpretation of the Index showed the best characterized stimuli altogether with their affective meanings and their similarities and differences as well.

Escalas semánticas para la evaluación del ruido. Tercera etapa: caracterización subjectiva de estímulos sonoros. / [Semantic scales for noise evaluation. Third stage: subjective characterization of sound stimuli]

This is the third step of a research for which Osgoods Differential Semantic Technique was resorted to in order to get suitable scales on a subjective evaluation of sound stimuli. Thus, a three-stage work was fulfilled. The first one dealt with the construction of seven-point bipolar scales starting from experimentally selected adjectives. The second one succeeded in finding the subjacent dimensions of the said scales by means of Factorial Analysis Method. The present stage aims at characterizing 40 sound stimuli through the discovered dimensions most representative scales. A special Semantic Differential Program was used to getting the following Index: Scalar Scores, Polarity, Familiarity and Interconcept Distances. The interpretation of the Index showed the best characterized stimuli altogether with their affective meanings and their similarities and differences as well.

[Semantic scales for the evaluation of noise (II). Subjacent dimensions in subjective judgments of sound stimuli]. / Escalas semánticas para la evaluación del ruido (II). Dimensiones subyacentes en los juicios subjetivos de estímulos sonoros.

Second stage of a research in which Osgood's Diferential Semantic Technique was used in two experiments with the following aims: a) to find out the subyacent dimensions of subjective evaluation of sound stimuli; b) to know if Osgood's Evaluation, Potency and Activity dimensions appear when sound stimuli are judged; c) to obtain a group of semantic scales that represent the found dimensions, which can be used in other researches in the same field. In the first experiment 37 scales were used by 98 Ss for judging 10 sound stimuli. In the second, 120 Ss performed the same task through 46 scales and 40 sound stimuli. Data of both experiments were processed by factor analysis method and a Varimax rotation was done. Having obtained 12 similar factors in both experiments the results were analized in a comparative way. Eight dimensions that explain the subject-sound stimuli relation were found. The other dimensions deal with the stimulis control, cognitive experience and structural caracteristics of sound stimuli, being the affective component also present in some of their scales. In the third stage the sound stimuli used will be analized through the found dimensions.

Escalas semanticas para la evaluacion del ruido (II). Dimensiones subyacentes en los juicios subjetivos de estimulos sonoros. / Semantic scales for the noise (II). Subjacent dimensions in subjective judgement of sound stimuli

Segunda etapa de una investigacion en la cual utilizando la tecnica del diferencial semantico de Osgood se realizaron dos experiencias con el objeto de investigar: a) las dimensiones que subyacen en la evaluacion de estimulos sonoros; b) si las dimensiones EPA del mismo autor aparecen en el dominio estudiado; c) si existe un grupo de escalas semanticas representativas de las dimensiones encontradas. Dos muestras de sujetos juzgaron diferentes grupos de estimulos sonoros mediante escalas de adjetivos bipolares.Los datos obtenidos en cada experiencia fueron procesados por el metodo de analisis factorial, interpretandose los resultados en forma comparativa.Obtuvieron 8 dimensiones que explican la relacion sujeto-juicio-estimulo sonoro, comprobandose la importancia de las dimensiones afectivas en esta relacion

Escalas semanticas para la evaluacion del ruido (II). Dimensiones subyacentes en los juicios subjetivos de estimulos sonoros. / Semantic scales for the noise (II). Subjacent dimensions in subjective judgement of sound stimuli

Segunda etapa de una investigacion en la cual utilizando la tecnica del diferencial semantico de Osgood se realizaron dos experiencias con el objeto de investigar: a) las dimensiones que subyacen en la evaluacion de estimulos sonoros; b) si las dimensiones EPA del mismo autor aparecen en el dominio estudiado; c) si existe un grupo de escalas semanticas representativas de las dimensiones encontradas. Dos muestras de sujetos juzgaron diferentes grupos de estimulos sonoros mediante escalas de adjetivos bipolares.Los datos obtenidos en cada experiencia fueron procesados por el metodo de analisis factorial, interpretandose los resultados en forma comparativa.Obtuvieron 8 dimensiones que explican la relacion sujeto-juicio-estimulo sonoro, comprobandose la importancia de las dimensiones afectivas en esta relacion

Escalas semánticas para la evaluación del ruido (II). Dimensiones subyacentes en los juicios subjetivos de estímulos sonoros. / [Semantic scales for the evaluation of noise (II). Subjacent dimensions in subjective judgments of sound stimuli]

Second stage of a research in which Osgoods Diferential Semantic Technique was used in two experiments with the following aims: a) to find out the subyacent dimensions of subjective evaluation of sound stimuli; b) to know if Osgoods Evaluation, Potency and Activity dimensions appear when sound stimuli are judged; c) to obtain a group of semantic scales that represent the found dimensions, which can be used in other researches in the same field. In the first experiment 37 scales were used by 98 Ss for judging 10 sound stimuli. In the second, 120 Ss performed the same task through 46 scales and 40 sound stimuli. Data of both experiments were processed by factor analysis method and a Varimax rotation was done. Having obtained 12 similar factors in both experiments the results were analized in a comparative way. Eight dimensions that explain the subject-sound stimuli relation were found. The other dimensions deal with the stimulis control, cognitive experience and structural caracteristics of sound stimuli, being the affective component also present in some of their scales. In the third stage the sound stimuli used will be analized through the found dimensions.