[Risk factors at admission associated with intubation in patients with COVID-19]. / Factores de riesgo al ingreso asociados a intubación en pacientes con COVID-19.

Background: Intubation rates up to 33% have been found in patients diagnosed with COVID-19. Some cohorts have reported the presence of dyspnea in 84.1% of intubated patients, being this the only symptom associated with intubation. Oxygen saturation < 90% and increased respiratory rate have also been described as predictors of intubation. Objective: To analyze the risk factors associated with intubation in patients hospitalized for COVID-19 at their admission. Material and methods: An observational, retrospective, analytical, cross-sectional study was carried out. The universe of study consisted of patients over 18 years of age hospitalized due to a diagnosis of SARS-CoV-2 virus infection from April 1, 2020 to April 31, 2021 in the Hospital de Especialidades (Specialties Hospital) "Dr. Bernardo Sepúlveda Gutiérrez" at the National Medical Center. Results: The mean age of intubated patients was 59.17 years (95% confidence interval [95% CI] -9.994 to -3.299, p < 0.001). Overall, 76.7% (230) of patients had a history of one or more preexisting comorbidities, including hypertension in 42.3% (127), obesity in 36.7% (110), and diabetes mellitus in 34.3% (103). Conclusions: The main clinical characteristics of patients hospitalized for COVID-19 in our center who required intubation are very similar to those observed in different centers, including male sex, age over 50 years and obesity, which were the most common.

Introducción: se han encontrado tasas de intubación de hasta 33% en pacientes con diagnóstico de COVID-19. Algunas cohortes han informado la presencia de disnea en el 84.1% de los pacientes intubados y este ha sido el único síntoma asociado con la intubación. La saturación de oxígeno < 90% y el aumento de la frecuencia respiratoria también han sido descritos como predictores de intubación. Objetivo: analizar los factores de riesgo asociados a intubación en pacientes con COVID-19 al momento de su admisión hospitalaria. Material y métodos: se realizó un estudio observacional, transversal, analítico y retrospectivo. El universo de estudio consistió en pacientes mayores de 18 años, hospitalizados por diagnóstico de infección por virus SARS-CoV-2 del 1 abril de 2020 al 31 abril de 2021 en el Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez" del Centro Médico Nacional. Resultados: se analizaron un total de 300 pacientes. La media de edad de los pacientes intubados fue de 59.17 años (p < 0.001, intervalo de confianza del 95% [IC 95%] −9.994 a −3.299). En general, el 76.7% (230) de los pacientes tenía antecedentes de una o más comorbilidades preexistentes, incluida la hipertensión en 42.3% (127), la obesidad en 36.7% (110) y la diabetes mellitus en 34.3% (103). Conclusiones: las principales características clínicas de los pacientes hospitalizados por COVID-19 en nuestro centro que requirieron de intubación son muy similares a las observadas en distintos centros, entre ellas el sexo masculino, la edad mayor de 50 años y la obesidad, que fueron las más prevalentes.

Importancia del uso adecuado del equipo de protección individual y la implementación de protocolos de seguridad perioperatorios durante la pandemia de COVID-19 / Importance of the Proper use of Personal Protective Equipment and the Implementation of Perioperative Safety Protocols During the COVID-19 Pandemic

RESUMEN El panorama que se presenta en la actualidad es un reto sin precedentes para el manejo de los pacientes quirúrgicos, la toma de decisiones y el empleo de recursos en cuanto a material y equipos de protección en el contexto de la pandemia por COVID-19. Por lo que el presente artículo pretende dar a conocer los lineamientos para el correcto actuar en el quirófano, el uso del equipo de protección individual, las indicaciones de cirugía y el mejor abordaje en el marco de esta situación. El principal objetivo de seguir estas recomendaciones es mitigar el riesgo de contagio y educar al personal de salud médico-quirúrgico para que esté preparado para hacer frente a esta pandemia.

ABSTRACT The current landscape represents an unprecedented challenge in managing surgical patients, decision-making and the use of resources such as protective equipment in the context of the COVID-19 pandemic. Therefore, the objective of this article is to provide guidelines for good conduct in the operating room, the use of personal protective equipment, suggestions for surgeries and the best approach in the context of this situation. The main objective of these recommendations is to mitigate the risk of contagion and to educate medical-surgical health personnel in how to deal with this pandemic.

Exploring the association between diabetes and breast cancer morbidity: considerations for quality care improvements among Latinas.

OBJECTIVE: Cancer and diabetes are two severe chronic illnesses that often co-occur. In cancer patients, diabetes increases the risk for treatment complexities and mortality. Yet patient-reported outcomes with co-occurring chronic illness are understudied. DESIGN: This preliminary study investigated the association of diabetes with breast cancer-related morbidity among underserved Latina breast cancer survivors (BCS). PARTICIPANTS: 137 Latina BCS were recruited from the California Cancer Registry and hospitals.Setting and Main Outcome Measure(s): BCS completed a self-administered mailed questionnaire assessing demographic and medical characteristics e.g. Type2 diabetes mellitus (T2DM). RESULTS: 28% Latina BCS reported co-occurring T2DM at twice the general population rate. Diabetes was most prevalent among Latina BCS > 65 years (43%). Latina BCS with diabetes were more likely to report advanced cancer staging at diagnosis (P = 0.036) and more lymphedema symptoms (P = 0.036). Results suggest non-significant but lower general health and greater physical functioning limitations among BCS with T2DM. CONCLUSIONS: This study has relevance for precision population medicine by (i) consideration of routine diabetes screening in Latina BCS, (ii) underscoring attention to disease co-occurrence in treatment planning and care delivery and (iii) informing follow-up care and survivorship care planning e.g. patient self-management, oncology and primarily care surveillance and specialty care. Our findings can inform providers, survivors and caregivers about the impact of disease co-occurrence that influence clinically and patient responsive care for both initial treatment and long-term follow-up care to address disparities.

Environmental Exposures during Puberty: Window of Breast Cancer Risk and Epigenetic Damage.

During puberty, a woman's breasts are vulnerable to environmental damage ("window of vulnerability"). Early exposure to environmental carcinogens, endocrine disruptors, and unhealthy foods (refined sugar, processed fats, food additives) are hypothesized to promote molecular damage that increases breast cancer risk. However, prospective human studies are difficult to perform and effective interventions to prevent these early exposures are lacking. It is difficult to prevent environmental exposures during puberty. Specifically, young women are repeatedly exposed to media messaging that promotes unhealthy foods. Young women living in disadvantaged neighborhoods experience additional challenges including a lack of access to healthy food and exposure to contaminated air, water, and soil. The purpose of this review is to gather information on potential exposures during puberty. In future directions, this information will be used to help elementary/middle-school girls to identify and quantitate environmental exposures and develop cost-effective strategies to reduce exposures.

Assessment of general bullying and bullying due to appearance of teeth in a sample of 11-16 year-old Peruvian schoolchildren

OBJECTIVE: to assess the incidence of general bullying and bullying due to the appearance of teeth in a sample of 11-16 year-old peruvian schoolchildren. MATERIALS AND METHODS: cross-sectional study with a sample of 218 students aged 11 to 16 years old (13.41±1.44), 109 males, and 153 from a public school. a survey on general bullying and the appearance of teeth was applied using a validated questionnaire. RESULTS: the frequency of general bullying was 32.57 precent, and bullying due to dental appearance was 18.81 percent. general bullying (p=0.005) and dental appearance (p=0.024) were more frequent in the public school, but there were no statistically significant differences according to sex. the highest frequency of general bullying was related to name-calling, which accounted for 47.71 percent. victimization by appearance of teeth in one or two occasions in the last two months accounted for 12.39 percent, according to participating subjects. CONCLUSION: general and tooth-related bullying was more frequent among students in public schools, with no significant differences according to sex.

HPV Vaccine-Related Knowledge, Beliefs, Acceptability, and Uptake Among Latinas Who Prefer English and Those Who Prefer Spanish.

Latinas compose almost 10% of the U.S. population and suffer the highest incidence of and one of the highest mortality rates from cervical cancer. Human papillomavirus (HPV) vaccination can prevent most HPV infections that cause more than 90% of cervical cancer. Unfortunately, limited knowledge and low rates of HPV vaccination persist among Latinas. The current study compared awareness, knowledge, beliefs, acceptability, uptake, and 3-dose series completion of HPV vaccination between Latinas who prefer English (EPL) and those who prefer Spanish (SPL), ages 18-62, living in Southern California. (The 3-dose series completion was based on HPV vaccine completion guidelines at the time of the study. HPV vaccination guidelines do change over time to improve coverage.) More EPL (n = 57) than SPL (n = 150) reported significantly (a) more HPV vaccine awareness and more knowledge of where to access the vaccine and additional vaccine information and (b) greater endorsement of vaccine effectiveness and safety (p < .05). Regardless of language preference, Latinas reporting knowledge of where to access the vaccine and additional information endorsed greater acceptability of the vaccine and more favorable beliefs regarding vaccine safety and effectiveness (p < .05). In multivariate analyses, language and income predicted the outcomes of knowledge regarding accessing the vaccine and additional information. Only 15.6% of all eligible Latinas (n = 45) initiated the HPV vaccine, with 8.9% completion. Interventions seeking to improve HPV vaccination should address linguistic and socioecological differences within Latinas to enhance effectiveness.

Towards developing a bilingual treatment summary and survivorship care plan responsive to Spanish language preferred breast cancer survivors.

BACKGROUND: Treatment summary and survivorship care plan studies are at the forefront of research priorities with precedence for ethnic minority inclusion. This preliminary study joined the advocacy, scientific, and medical communities to inform the development and evaluation of the Treatment Summary and Survivorship Care Plan (TSSCP-S) template targeted for Latino breast cancer patients (LCA). METHODS: The development of the TSSCP-S began as modifications to the American Society of Cancer Oncology (ASCO) (TSSCP-ASCO) template via a transcreation process informed by 12 LCA survivors/advocates, and evaluated by 10 survivor/advocates and health professionals. The TSSCP-S template development was guided by the Shared Care, Psychooncology Models, and Contextual Model of Health Related Quality of Life. RESULTS: The bilingual TSSCP-S was independently evaluated by bilingual, survivor/advocates, and health professionals (n = 10). Preliminary analyses indicate that the TSSCP-S template was rated more favorably than the TSSCP-ASCO on the following domains: content (p = 0.02), clarity (p = 0.02), utility (p = 0.04), cultural and linguistic responsiveness (p = 0.03), and socioecological responsiveness (p = 0.01). Evaluators noted that the TSSCP-S template was more patient-centered, and endorsed the acceptability as well as the potential utility and applicability of the bilingual TSSCP-S template to appropriately guide surveillance and follow-up care. CONCLUSIONS: Our findings indicate that the TSSCP-S achieved clinical, cultural, and linguistic responsiveness relevant to Latinos. Patient-centered TSSCP that are presented in a bilingual format are necessary to achieve the intended goals of TSSCP including appropriate patient information, education, and resources pertaining to their treatment, potential side effects, and recommended surveillance and follow-up care for English language limited patients. Additionally, our culturally responsive TSSCP-S development framework offers a model for TSSCP template development for targeted and underserved populations, including ethnic and linguistic minority cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: These data support the development and evaluation of a TSSCP targeted to an underserved, high-risk population, LCAs. Identifying methods to improve surveillance and follow-up guideline adherence may lead to improved clinical cancer outcomes and quality of life.

Obstrucción intestinal por tumor neuroendocrino. Reporte de un caso / Neuroendocrine tumor intestinal obstruction. A case report

Los tumores neuroendocrinos bien diferenciados anteriormente denominado "tumores carcinoides" son tumores relativamente raros procedentes del sistema difuso neuroendocrino, se encuentran con mayor frecuencia en los sistemas bronquial y gastrointestinal y su presencia puede ser imperceptible por años, sin signos obvios o síntomas. Se presenta el caso de un paciente de 61 años sin comorbilidades, quien consulta en varias ocasiones a una IPS (Institución Prestadora de Salud) de la ciudad de Bucaramanga por sintomatología compatible con obstrucción intestinal a quien se le da manejo con medicamentos, teniendo poca mejoría. El paciente llega a nuestra IPS por cuadro de dolor abdominal tipo cólico, náuseas, distensión abdominal y sin deposiciones de dos días de evolución. Al examen físico se encuentra rubicundez en la cara. La laparotomía exploratoria muestra obstrucción intestinal y la investigación histopatológica de las biopsias revela un tumor carcinoide mixto. En el postoperatorio el estado de salud empeora. La obstrucción intestinal por este tipo de tumor, es de difícil diagnóstico y manejo, por lo cual se requiere de personal muy bien entrenado, así como de alta sospecha clínica para hacer un diagnóstico oportuno. [Ramírez S, Prada M. Obstrucción intestinal por tumor endocrino. Reporte de un caso. MedUNAB 2013; 15:175-179].

Well-differentiated neuroendocrine tumors (previously called "carcinoid tumours") are relatively rare tumors originating from the diffuse neuroendocrine system. They are found most often in the bronchial or gastrointestinal systems, their presence may be undetectable for years without obvious signs or symptoms. The following is a case of a 61 years old patient, with no comorbidities, who consulted several times a medical institution in the city of Bucaramanga for symptoms consistent with bowel obstruction. During this time, the patient was managed medically, showing little improvement. Eventually, the patient consulted with our institution showing signs of cramping, abdominal pain, nauseas, abdominal distension, and no discharge for two days. During physical examination flushing on face is found. Exploratory laparotomy revealed intestinal obstruction secondary to distal ileum tumor, and histopathological investigation of biopsies revealed a well-differentiated carcinoid mixed tumor. During post-operatory care his health situation deteriorated. Intestinal obstruction by this type of tumor is difficult to diagnose and therefore management requires a well trained staff and high clinical suspicion for timely diagnosis .[Ramírez S, Prada M. Neuroendocrine tumor intestinal obstruction. Acase report. MedUNAB 2013; 15:175-179].