Intervention for Alleviating Clinical Inertia in the Management of Urinary Incontinence.

PURPOSE: The purpose of this study was to determine whether clinical inertia exists in the care of patients with urinary incontinence and to test the effects of an educational intervention designed to alleviate inertia related to care of urinary incontinence. DESIGN: Single-group, pretest/posttest design. SUBJECTS AND SETTING: The sample comprised 132 participants practicing in 6 medical-surgical inpatient care units at an urban hospital in Almería, Spain; 66 (50%) were RNs, and all other participants were unlicensed assistive personnel. Most participants (87.9%) were female; their average age was 43.99 years (SD = 7.85 years). METHODS: An educational intervention (online course) was provided. The main objective of the course was application of evidence-based knowledge for prevention and management of urinary incontinence in hospitalized patients. The course program comprised 3 didactic units: (1) introduction and evaluation of the patient with urinary incontinence, (2) care plans, and (3) instructions and rational use of absorbent products. Data collection included demographic and professional characteristics of respondents, desired results when caring for patients with incontinence, a medical record checklist, an occupational environment and satisfaction scale, and an assessment record of knowledge/skills and training activity satisfaction. RESULTS: After comparing the pre- and posttest scores of knowledge on urinary incontinence, significant differences were found before and after the intervention (z = -14.113, P = .000). Specifically, analysis revealed differences in caring actions related to urinary incontinence (z = -14.248, P = .000) and differences in direct observation of urinary incontinence practice following the intervention (z = -14.326, P = .000). CONCLUSIONS: Our findings indicate existence of inertia in nursing care for hospitalized patients with urinary incontinence. The educational intervention improved knowledge, observable nursing care activities related to incontinence management, and improved documentation of care.

Inertia in nursing care of hospitalised patients with urinary incontinence.

AIMS AND OBJECTIVES: To assess the existence of therapeutic inertia in the nursing care of patients with urinary incontinence during the patient's time in hospital, together with the sociodemographic and professional variables involved. BACKGROUND: Inertia in care is a problem which appears in the nursing care process. Actions related to inertia can be attributed to not adhering to protocols, clinical guidelines and the lack of prevention measures which have undesirable effects on the efficiency of care. DESIGN: This was a prospective observational study. METHODS: A total of 132 nursing professionals participated over two consecutive months. Data were collected randomly through the method of systematic, nonparticipative observation of medical practice units and patients' medical records. RESULTS: The results showed a pattern of severely compromised action in the assessment of the pattern of urinary elimination, in actions related to urinary continence, in therapeutic behaviour and in patient satisfaction and were found to be consistent with professional experience (p < .05). In the 600 records analysed, no statistically significant differences were found between gender and the use of records. In 50% (n = 301), the use of a rating scale was not reflected. In over 90% (n = 560) of cases, the type of incontinence was not recorded. In no continuity of care report were recommendations regarding incontinence included, nor was the type of continence products recommended indicated. CONCLUSION: It is clear that inertia exists in nursing care in the hospital environment while the patient is hospitalised, in prevention care, in the treatment of urinary incontinence and in the management of records. RELEVANCE TO CLINICAL PRACTICE: Contributing to the understanding of the existence of inertia in nursing care raises questions regarding its causes and interventions to predict or monitor it.

Incomplete type of intestinal metaplasia has the highest risk to progress to gastric cancer: results of the Spanish follow-up multicenter study.

BACKGROUND AND AIM: In high or moderate risk populations, periodic surveillance of patients at risk of progression from gastric precursor lesions (PL) to gastric cancer (GC) is the most effective strategy for reducing the burden of GC. Incomplete type of intestinal metaplasia (IIM) may be considered as the best candidate, but it is still controversial and more research is needed. To further assess the progression of subtypes of IM as predictors of GC occurrence. METHODS: A follow-up study was carried-out including 649 patients, diagnosed with PL between 1995-2004 in 9 participating hospitals from Spain, and who repeated the biopsy during 2011-2013. Medical information and habits were collected through a questionnaire. Based on morphology, IM was sub-classified as complete (small intestinal type, CIM) and incomplete (colonic type, IIM). Analyses were done using Cox (HR) models. RESULTS: At baseline, 24% of patients had atrophic gastritis, 38% CIM, 34% IIM, and 4% dysplasia. Mean follow-up was 12 years. 24 patients (3.7%) developed a gastric adenocarcinoma during follow-up. The incidence rate of GC was 2.76 and 5.76 per 1,000 person-years for those with CIM and IIM, respectively. The HR of progression to CG was 2.75 (95% CI 1.06-6.26) for those with IIM compared with those with CIM at baseline, after adjusting for sex, age, smoking, family history of GC and use of NSAIDs. CONCLUSIONS: IIM is the PL with highest risk to progress to GC. Sub-typing of IM is a valid procedure for the identification of high risk patients that require more intensive surveillance.

Therapeutic Relational Communication and Resilience among Nursing Professionals in a Pandemic Situation.

Therapeutic relational communication has become a fundamental human resource in the nursing profession. The positive relationship between nurse-patient communication and resilience has been shown in several studies. However, these aspects can be affected in adverse circumstances. The purpose of this study was to identify the relationship between nurse-patient therapeutic relational communication and the resilience of nursing professionals in adverse circumstances. A cross-sectional study with a sample of 201 nursing professionals was conducted. This study found high levels of both therapeutic relational communication between nurses and patients as well as resilience among nurses. The sociodemographic variables of age and years of experience in the profession positively correlated with the data obtained through the measurement instruments. The co-relational analysis revealed a positive correlation between nurse-patient therapeutic relational communication and nurse resilience, and the regression analysis showed that levels of successful therapeutic communication skills were minimally explained by resilience. Nursing professionals who participated in this study demonstrated adequate levels of therapeutic relational communication with their patients as well as adequate levels of resilience required to cope with the challenges of the COVID-19 pandemic in their daily nursing practice. This study was not registered.

Follow-Up Study Confirms the Presence of Gastric Cancer DNA Methylation Hallmarks in High-Risk Precursor Lesions.

To adopt prevention strategies in gastric cancer, it is imperative to develop robust biomarkers with acceptable costs and feasibility in clinical practice to stratified populations according to risk scores. With this aim, we applied an unbiased genome-wide CpG methylation approach to a discovery cohort composed of gastric cancer (n = 24), and non-malignant precursor lesions (n = 64). Then, candidate-methylation approaches were performed in a validation cohort of precursor lesions obtained from an observational longitudinal study (n = 264), with a 12-year follow-up to identify repression or progression cases. H. pylori stratification and histology were considered to determine their influence on the methylation dynamics. As a result, we ascertained that intestinal metaplasia partially recapitulates patterns of aberrant methylation of intestinal type of gastric cancer, independently of the H. pylori status. Two epigenetically regulated genes in cancer, RPRM and ZNF793, consistently showed increased methylation in intestinal metaplasia with respect to earlier precursor lesions. In summary, our result supports the need to investigate the practical utilities of the quantification of DNA methylation in candidate genes as a marker for disease progression. In addition, the H. pylori-dependent methylation in intestinal metaplasia suggests that pharmacological treatments aimed at H. pylori eradication in the late stages of precursor lesions do not prevent epigenome reprogramming toward a cancer signature.

Living with chronic obstructive pulmonary disease: A story conditioned by the symptoms. / Vivir con una enfermedad pulmonar obstructiva crónica: una historia condicionada por los síntomas.

OBJECTIVE: To determine the meaning of the experience of people with chronic obstructive pulmonary disease. METHOD: A qualitative approach study rooted in hermeneutic phenomenology. In-depth interviews were conducted with 10 people with critical and severe chronic obstructive pulmonary disease. RESULTS: The findings obtained are described in three emerging topics and their consequent subtopics, which describe the process of the disease focusing on five subtopics related to awareness of the disease, the choking characteristic of the disease and tiredness as daily unpleasant symptoms, as well as choking as a death threat, rejection of oxygen dependency and coping systems to control the disease. In the second topic, family support with two subtopics are described: the loss of the patient's role, the burden of care; and the third topic concerns the support of health system on two subtopics: medical care and nursing care. CONCLUSION: The symptoms and functional changes in general, denote a different meaning not only in everyday life, but also in times of exacerbation of the condition. Likewise, changes in lifestyle due to the loss of roles and health care processes are revealed, as experiences that do not allow effective coping and adaptation.

Angioimmunoblastic T-cell lymphoma after acute myeloid leukemia: Alleged common pathogenesis. A case report and literature review.

The genomic landscape of AITL is characterized by mutation of epigenetic modifiers. This gene expression pattern resembles myeloid diseases and shows a potential role for hypomethylating agents as possible therapy for AITL.

Human epidermal growth factor receptor 2 fluorescence in situ hybridization and P57KIP2 immunohistochemistry using tissue microarray: Improving histopathological subtyping of hydatidiform mole.

INTRODUCTION: Trophoblastic neoplasia is detected in approximately 25% of complete hydatidiform moles (CMs) and 0.5% of partial hydatidiform moles (PMs). Hydatidiform mole (HM) subtyping is important to properly monitor and predict patient outcomes. Ploidy studies generally involve diploid CMs and triploid PMs. P57KIP2, expressed in the maternal genome, is usually not detected in CM. We determined whether HER2 FISH and p57 immunostaining contributed to the histopathological classification of HMs. METHODS: This retrospective cohort study focused on patients diagnosed with HM by histopathological examination who were followed up at a trophoblastic disease center from 2002 to 2017. Pathological samples of 108 products of conception were reviewed and reclassified according to detailed criteria. Tissue microarray technology (TMA) was used for p57 KIP2 immunostaining and HER2 FISH analysis. RESULTS: Histopathological review showed 57 (53%) CMs, 47 (43%) PMs and 4 (4%) inconclusive cases. P57 immunostaining revealed 59 (55%) negative and 22 (20%) positive specimens, and 27 (25%) were inadequate for analysis. FISH HER2 detected 68 (63%) diploid and 33 (30%) triploid cases; two (2%) had oncogene amplification. The three strategies led to a diagnostic change in 28 samples (26%). The final diagnosis was CM in 75 cases (70%) and PM in 30 (28%); three cases remained inconclusive. DISCUSSION: TMA is a cost-saving method that allows the simultaneous study of large case series. The combination of histopathology, HER2 FISH and p57 tests can be useful for accurately differentiating CM and PM, thus providing additional information on disease prognosis.

[Quality of healthcare directed to people with spinal cord injury according to Colombian regulations]. / Calidad de la atención en salud de las personas con trauma raquimedular según criterios normativos de Colombia.

OBJECTIVE: To determine how heath regulations affect the comprehensive rehabilitation of people with spinal cord injury in two health institutions of the city of Cali- Colombia. MATERIALS AND METHODS: Cross-sectional descriptive study with 53 people. The independent variable was health regulations and the dependent variable was comprehensive rehabilitation. A univariate analysis was applied. RESULTS: Claiming fundamental health rights before a court is a mechanism that allows people with spinal injury to access health services for comprehensive rehabilitation, of which 81% claim pain treatment, 62% spasticity, 95% neurogenic bladder care, and 93% orthotic devices or wheel chairs. CONCLUSIONS: Current health regulations in Colombia do not include timely mechanisms for people with spinal cord injury to have access to specific health services for comprehensive rehabilitation. It is important for interdisciplinary health teams to become familiar with regulations and provide early guidance to people with this type of injury, so that they can access the necessary healthcare services and prevent further complications such as depression or death from sepsis derived from urinary tract infections or pressure ulcers.

OBJETIVO: Determinar cómo influye la normatividad de salud en la rehabilitación integral de la persona con Trauma Raquimedular en dos instituciones de salud de la ciudad de Cali, Colombia. MÉTODOS: Este estudio descriptivo trasversal se realizó con 53 personas. Las variable independiente fue la normatividad en salud y la dependiente la rehabilitación integral. Se aplicó análisis univariado. RESULTADOS: El reclamo de los derechos fundamentales en salud ante un tribunal, es un mecanismo que permite a las personas con trauma raquimedular acceder a los servicios de salud para la rehabilitación integral, especialmente al 81% para el tratamiento del dolor, 62% para espasticidad, 95% para el cuidado de vejiga neurogénica, y al 93% para el acceso a equipos de órtesis o sillas de ruedas. CONCLUSIONES: La normatividad actual en salud de Colombia no permite mecanismos oportunos para que la persona con trauma raquimedular pueda acceder a los servicios de salud específicos para la rehabilitación integral. Es importante que los equipos interdisciplinarios en salud, conozcan la norma, oriente de manera temprana a las personas con este tipo de lesión para acceder a los servicios de salud requeridos, lo que permitirá la prevención de complicaciones como la depresión o la muerte por sepsis derivada de la infección urinaria o las úlceras por presión.

Gestational Trophoblastic Neoplasia after Ectopic Molar Pregnancy: Clinical, Diagnostic, and Therapeutic Aspects.

This report presents the case of a patient with gestational trophoblastic neoplasia after a partial hydatidiform mole formed in the Fallopian tube. Ectopic molar pregnancy is a rare condition, with an estimated incidence of 1 in every 20,000 to 100,000 pregnancies; less than 300 cases of it have been reported in the Western literature. The present report is important because it presents current diagnostic criteria for this rare condition, which has been incorrectly diagnosed in the past, not only morphologically but also immunohistochemically. It also draws the attention of obstetricians to the occurrence of ectopic molar pregnancy, which tends to progress to Fallopian tube rupture more often than in cases of ectopic non-molar pregnancy. Progression to gestational trophoblastic neoplasia ensures that patients with ectopic molar pregnancy must undergo postmolar monitoring, which must be just as thorough as that of patients with intrauterine hydatidiform moles, even if chemotherapy results in high cure rates.

Esse relato apresenta um caso de neoplasia trofoblástica gestacional após mola hidatiforme parcial ocorrida na tuba uterina. Trata-se de uma associação rara, cuja incidência estima-se de 1 em cada 20.000 a 100.000 gestações, havendo menos de 300 casos apresentados na literatura ocidental. O tema é importante porque apresenta critérios diagnósticos atuais para essa ocorrência incomum, que vinha sendo diagnosticada equivocadamente, não apenas sob o ponto de vista morfológico, como também imunohistoquímico. Da mesma forma, alerta o obstetra para a ocorrência da gravidez molar ectópica, que tende a evoluir com rotura tubária mais frequentemente do que os casos de gravidez ectópica não molar. Por fim, a evolução do caso para neoplasia trofoblástica gestacional impõe às pacientes com gravidez ectópica molar a necessidade de seguimento pós-molar tão rigoroso quanto nos casos de mola hidatiforme intrauterina, ainda que o tratamento quimioterápico determine elevadas taxas de cura.

Mecanismos de Acción de la Microbiota Oral en el Desarrollo del Cáncer. Revisión Sistemática Exploratoria

En esta revisión sistemática exploratoria, presentamos la evidencia registrada en la literatura, de que la microbiota oral puede generar una acción carcinogénica, actuando a través de tres mecanismos principales: sobre el medio extracelular, activando vías de señalización intracelular y/o generando acción directa sobre el DNA, y que las principales bacterias estudiadas corresponden a Fusobacterium nucleatum y Porphyromona gingivalis. En la actualidad hay evidencia suficiente acerca de la asociación entre microbiota oral y distintos tipos de cáncer, sin embargo, no hay gran conocimiento de los mecanismos por los cuales esta microbiota participa en su desarrollo. Presentamos una recopilación de los diversos mecanismos de acción que utilizan las bacterias de la cavidad oral en el proceso de carcinogénesis en cuatro tipos diferentes de cáncer. Es de gran importancia aumentar el conocimiento acerca del rol etiológico de la microbiota oral en el desarrollo de la enfermedad de cáncer debido a que se establecería como un nuevo agente carcinogénico y su conocimiento podría ser utilizado como una herramienta valiosa en la detección y tratamiento de esta enfermedad.

In this Scoping Review, we present the evidence recorded in the literature about that oral microbiota can generate a carcinogenic action, acting through three main mechanisms: on the extracellular space, activating intracellular signaling pathways and/or generating direct action on DNA, and that the principal pathogens studied are Fusobacterium nucleatum and Porphyromona gingivalis. Nowadays, there is sufficient evidence about the association between oral microbiota and several types of cancer, however, there is not much knowledge about the mechanisms by which this microbiota participates in its development. We present a compilation of different mechanisms of action used by oral cavity bacteria in the process of carcinogenesis in four different types of cancer. It is of great importance to increase the knowledge about the etiological role of the oral microbiota in the development of cancer disease because it would be established as a new carcinogenic agent and its knowledge could be used as a valuable tool in the detection and treatment of this disease.

Gene expression study and pathway analysis of histological subtypes of intestinal metaplasia that progress to gastric cancer.

BACKGROUND: Intestinal metaplasia (IM) is a precursor lesion that precedes gastric cancer (GC). There are two IM histological subtypes, complete (CIM) and incomplete (IIM), the latter having higher progression rates to GC. This study was aimed at analysing gene expression and molecular processes involved in the progression from normal mucosa to IM, and also from IM subtypes to GC. METHODOLOGY: We used expression data to compare the transcriptome of healthy gastric mucosa to that of IM not progressing to GC, and the transcriptome of IM subtypes that had progressed to GC to those that did not progress. Some deregulated genes were validated and pathway analyses were performed. RESULTS: Comparison of IM subtypes that had progressed to GC with those that did not progress showed smaller differences in the expression profiles than the comparison of IM that did not progress with healthy mucosa. New transcripts identified in IM not progressing to GC included TRIM, TMEM, homeobox and transporter genes and SNORD116. Comparison to normal mucosa identified non tumoral Warburg effect and melatonin degradation as previously unreported processes involved in IM. Overexpressed antigen processing is common to both IM-subtypes progressing to GC, but IIM showed more over-expressed oncogenic genes and molecular processes than CIM. CONCLUSIONS: There are greater differences in gene expression and molecular processes involved in the progression from normal healthy mucosa to IM than from IM to gastric cancer. While antigen processing is common in both IM-subtypes progressing to GC, more oncogenic processes are observed in the progression of IIM.

HIF1A expression in localized prostate cancer treated with dose escalation radiation therapy.

PURPOSE: To analyze the expression of hypoxia inducible factor 1 alpha (HIF1A) and its correlation with clinical outcome in men with localized prostate cancer (PC) treated with dose escalation radiotherapy (RT) and androgen deprivation (AD). METHODS: Between 1996 and 2004, 129 PC patients who had diagnostic biopsies pre-treatment and 24-36 months following RT were enrolled in this study. Median follow-up was 129 months. Suitable archival diagnostic tissue was obtained from 86 patients. Correlation analysis was done to assess association between HIF1A expression and clinical outcome. RESULTS: HIF1A expression was observed in 25/86 (29%) of diagnostic biopsies, and in 5/14 (36%) of post-RT biopsies. No significant association was noted between HIF1A expression and clinical and treatment parameters. We also failed to show a significant correlation between HIF1A overexpression and outcome. A borderline significant relationship was observed between expression of HIF1A and overall survival (OS) (HR 0.03, p=0.08). CONCLUSION: To our knowledge this is the first study assessing the pattern of change of HIF1A staining in biopsies of patients prior and following treatment. While we did not find significant variations in the expression of HIF1A following radio-hormone therapy, a high HIF1A expression was unexpectedly associated with a borderline improved OS.

Incidence of human papillomavirus-related oropharyngeal cancer and outcomes after chemoradiation in a population of heavy smokers.

BACKGROUND: Incidence of human papillomavirus (HPV)-related oropharyngeal carcinomas is increasing worldwide. The purpose of this study was to report the incidence in our region, and to determine the influence of HPV status on survival among a heavy smoking population. METHODS: p16 expression was analyzed in 102 patients with stage II to IV treated with chemoradiation. Overall survival (OS), locoregional control, and disease-free survival (DFS) were compared for HPV+ and HPV- status. RESULTS: The majority of patients were smokers (86%). p16 positivity was found in 26.7%. Patients who were HPV+ were younger (56 vs 59 years old; p = .052). No differences were observed regarding tumor stage, sex, or smoking between HPV+ and HPV-. Three-year OS was 67.4% for patients who were HPV+ versus 49.7% for HPV- (hazard ratio [HR], 0.55; p = .095). CONCLUSION: Incidence of HPV-related oropharyngeal carcinoma in Spain is similar to that reported in other European countries. In this sample of heavy smokers, we observed a nonsignificant trend for better outcomes in patients who were HPV+.

Predictive value of PAK6 and PSMB4 expression in patients with localized prostate cancer treated with dose-escalation radiation therapy and androgen deprivation therapy.

PURPOSE: The present study analyzed the expression by immunochemistry of the novel markers P21-activated protein kinase 6 (PAK6) and proteasome beta-4 subunit (PSMB4) in men with localized prostate cancer (PC) who were treated with dose-escalation radiotherapy (RT) and androgen deprivation therapy. MATERIALS AND METHODS: Between 1996 and 2004, a cohort of 129 patients with PC who underwent diagnostic biopsies pretreatment and 24 to 36 months following RT were enrolled in this study. Suitable archival diagnostic tissue was obtained from 89 patients. Median follow-up was 129 months (48-198). Correlation analysis was done to assess association between PAK6 and PSMB4 expression and clinical outcome. RESULTS: PAK6 and PSMB4 were expressed in the cytoplasm in 62% and 96.7% of diagnostic biopsies, respectively. Increased staining for PAK6 was significantly (P = 0.04) correlated with higher Gleason scores. In the multivariate analysis, the intensity of PSMB4 staining was an independent predictor of local relapse (hazard ratio = 8.6, P = 0.04). CONCLUSIONS: To our knowledge, this is the first description of PAK6 and PSMB4 expression in the diagnostic specimens of men with PC who were treated with RT. If confirmed by further studies, increased expression of these genes could be used to identify patients at a high risk of developing local failure following high-dose RT, thus better tailoring treatments for the individual patient.

Dysplasia and colorectal cancer in a patient with ulcerative colitis and primary sclerosing cholangitis: a case report and a short review of the literature.

Primary sclerosing cholangitis is a chronic progressive disorder which involves the medium size and large ducts in the intrahepatic and extrahepatic biliary tree. The great majority of cases have underlying inflammatory bowel disease, mainly ulcerative colitis. A higher risk of colorectal cancer has been described among ulcerative colitis patients with primary sclerosing cholangitis. Here we report a case of a primary sclerosing cholangitis in a young male with a newly diagnosed ulcerative colitis presenting with colonic dysplasia. Surveillance for colorectal cancer should be strongly recommended in this group of patients.

Calidad de la atención en salud de las personas con trauma raquimedular según criterios normativos de Colombia / Quality of healthcare directed to people with spinal cord injury according to Colombian regulations

RESUMEN Objetivo Determinar cómo influye la normatividad de salud en la rehabilitación integral de la persona con Trauma Raquimedular en dos instituciones de salud de la ciudad de Cali, Colombia. Métodos Este estudio descriptivo trasversal se realizó con 53 personas. Las variable independiente fue la normatividad en salud y la dependiente la rehabilitación integral. Se aplicó análisis univariado. Resultados El reclamo de los derechos fundamentales en salud ante un tribunal, es un mecanismo que permite a las personas con trauma raquimedular acceder a los servicios de salud para la rehabilitación integral, especialmente al 81% para el tratamiento del dolor, 62% para espasticidad, 95% para el cuidado de vejiga neurogénica, y al 93% para el acceso a equipos de órtesis o sillas de ruedas. Conclusiones La normatividad actual en salud de Colombia no permite mecanismos oportunos para que la persona con trauma raquimedular pueda acceder a los servicios de salud específicos para la rehabilitación integral. Es importante que los equipos interdisciplinarios en salud, conozcan la norma, oriente de manera temprana a las personas con este tipo de lesión para acceder a los servicios de salud requeridos, lo que permitirá la prevención de complicaciones como la depresión o la muerte por sepsis derivada de la infección urinaria o las úlceras por presión.(AU)

ABSTRACT Objective To determine how heath regulations affect the comprehensive rehabilitation of people with spinal cord injury in two health institutions of the city of Cali- Colombia. Materials and Methods Cross-sectional descriptive study with 53 people. The independent variable was health regulations and the dependent variable was comprehensive rehabilitation. A univariate analysis was applied. Results Claiming fundamental health rights before a court is a mechanism that allows people with spinal injury to access health services for comprehensive rehabilitation, of which 81% claim pain treatment, 62% spasticity, 95% neurogenic bladder care, and 93% orthotic devices or wheel chairs. Conclusions Current health regulations in Colombia do not include timely mechanisms for people with spinal cord injury to have access to specific health services for comprehensive rehabilitation. It is important for interdisciplinary health teams to become familiar with regulations and provide early guidance to people with this type of injury, so that they can access the necessary healthcare services and prevent further complications such as depression or death from sepsis derived from urinary tract infections or pressure ulcers.(AU)

Gestational trophoblastic neoplasia after ectopic molar pregnancy: clinical, diagnostic, and therapeutic aspects / Neoplasia trofoblástica gestacional após gestaçãomolar ectópica: aspectos clínicos, diagnósticos e terapêuticos

Abstract This report presents the case of a patient with gestational trophoblastic neoplasia after a partial hydatidiform mole formed in the Fallopian tube. Ectopic molar pregnancy is a rare condition, with an estimated incidence of 1 in every 20,000 to 100,000 pregnancies; less than 300 cases of it have been reported in the Western literature. The present report is important because it presents current diagnostic criteria for this rare condition, which has been incorrectly diagnosed in the past, not only morphologically but also immunohistochemically. It also draws the attention of obstetricians to the occurrence of ectopic molar pregnancy, which tends to progress to Fallopian tube rupture more often than in cases of ectopic non-molar pregnancy. Progression to gestational trophoblastic neoplasia ensures that patients with ectopic molar pregnancy must undergo postmolar monitoring, which must be just as thorough as that of patients with intrauterine hydatidiform moles, even if chemotherapy results in high cure rates.

Resumo Esse relato apresenta um caso de neoplasia trofoblástica gestacional após mola hidatiforme parcial ocorrida na tuba uterina. Trata-se de uma associação rara, cuja incidência estima-se de 1 em cada 20.000 a 100.000 gestações, havendomenos de 300 casos apresentados na literatura ocidental. O tema é importante porque apresenta critérios diagnósticos atuais para essa ocorrência incomum, que vinha sendo diagnosticada equivocadamente, não apenas sob o ponto de vista morfológico, como também imunohistoquímico. Da mesma forma, alerta o obstetra para a ocorrência da gravidez molar ectópica, que tende a evoluir com rotura tubária mais frequentemente do que os casos de gravidez ectópica não molar. Por fim, a evolução do caso para neoplasia trofoblástica gestacional impõe às pacientes com gravidez ectópica molar a necessidade de seguimento pós-molar tão rigoroso quanto nos casos de mola hidatiforme intrauterina, ainda que o tratamento quimioterápico determine elevadas taxas de cura.

[Review of mortality from hypertensive disease and diabetes mellitus after the error because of new death certificate: region of Murcia, Spain, 2009]. / Revisión de la mortalidad por diabetes mellitus y enfermedad hipertensiva tras el error detectado en el nuevo certificado de defunción: Región de Murcia en 2009.

BACKGROUND: The Medical Death Certificate and the Death Statistics Bulletin were unified and implemented in the year 2009 in Spain. National statistics detected an unusual increase for diabetes mellitus (DM) and hypertensive disease (HT) deaths in 2009, in relation to previous years trend.The objective is to study the documental causes of the increase, and describe the procedures and consequences in rates, after the revision and recodification of DM and HT. METHODS: All death certificates in 2009 for diabetes and hypertension in the Region of Murcia (cases=670) were revised, according to previous guidelines for direct recoding after consultation to the certifying physician. A telephone survey to certifying physician was designed to determine the accuracy of the pattern of recoding. Kappa index and 95% confidence intervals (95%CI) were performed between initial and recoded causes. Confirmation rate and 95%CI was estimated after phone inquiry to the certifying physician, and the annual age-adjusted and age-specific rates from 1999 to 2009 (uncorrected and corrected) for DM and HT were calculated. RESULTS: Simple agreement was 37% for DM and 30% for HT. The Kappa index between the initial and final causes was 49% (95%CI, 45 to 54%). Confirmation rates were 47% (95%CI, 43 to 52%) for DM and 38% (95%CI, 34 to 43%) for HT. The initial annual rates of 2009 for DM were corrected from 21.4 per 100,000 inhabitants to 17.1, and from 19.0 to 14.0 for hypertension. The respective specific age rates of 70 to 84 and older experienced similar reductions. CONCLUSIONS: The revision restored temporal trends in mortality of DM and HT in 2009, and identified no variations from previous years. It was detected that the erroneous fulfillment of DM AND HT came from the new death certificate.

Factores fisiológicos y psicológicos que influyen en la rehabilitación de las personas con trauma raquimedular / Physiological and psychological factors in rehabilitation of persons with traumatic of spinal cord

Resumen La rehabilitación integral de las personas con trauma raquimedular requiere integrar lo físico, emocional y social, es necesario indagar como estos factores se interrelacionan y afectan su calidad de vida. El objetivo fue determinar la interrelación de los factores fisiológicos y psicológicos en la rehabilitación integral de las personas con trauma raquimedular a partir de la Teoría de los Síntomas Desagradables de Elizabeth Lenz. Estudio descriptivo transversal, con 51 personas. Las variables independientes fueron clasificación ASIA, nivel de la lesión y sexo; las variables dependientes los factores fisiológicos y psicológicos. Se aplico análisis univariado y la prueba t para identificar las diferencias estadísticamente significativas. La disrreflexia autonómica, las disfunciones vesicales e intestinales generan estados de depresión y expresión de ira especialmente en los hombres, es muy importante brindar soporte para el cuidado de estos factores durante la rehabilitación integral.

Abstract The comprehensive rehabilitation of people with spinal cord trauma takes into account the person as a whole being in the physical, emotional and social sense; therefore, it is necessary to investigate how these factors interact and affect their quality of life. The objective was determining the interrelation between the physiological and psychological factors on rehabilitation of people with spinal cord trauma from the theory of unpleasant symptoms Elizabeth Lenz. A transversal descriptive study, with 51 people. The independent variables were ASIA classification, the level of injury, and gender; the dependent variables were the physiological and psychological factors. A univariate analysis, the t- test was applied to identify statistically significant differences. The autonomic dysreflexia and both bladder as well as bowel dysfunction, are symptoms that generate states of depression and expression of anger, and are more evident in men. The support is required in the care of these factors during la integral rehabilitation.