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The TERT (Telomerase Reverse Transcriptase) gene promoter mutation is one of the most prevalent mutations in urothelial bladder tumors and this mutation is related to bladder tumor progression. Our purpose was to evaluate the presence of this mutation in a population of patients who were first diagnosed at age ≤ 40 years and to examine its relationship with tumor characteristics and progression. A molecular study was performed to detect the two most prevalent mutations in the TERT promoter (C228T and C250T). The study included 29 patients, with a mean follow-up of 152 months. There were no statistically significant differences in the clinical or tumor characteristics according to the presence or absence of the mutation. Although the mutation group showed poorer recurrence-free survival (RFS), there was no statistically significant difference and there was no difference in progression-free survival by group (p > 0.05). The pTERT mutations in bladder tumor cells occurred less frequently in younger patients than in older patients, a finding that could indicate different mechanisms of carcinogenesis. The trend towards lower RFS in patients with mutated pTERT needs to be confirmed by further studies, given the small number of patients included in these studies due to the low incidence of bladder tumors in this age group.
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Our aim was to analyze trends in fracture rates in SpA patients over an extended time period. Only an increase of axial fractures, more specifically vertebral fractures, is observed in SpA. PURPOSE: To analyze fracture incidence and trend in patients with spondyloarthritis (SpA) over an extended time period. METHODS: Retrospective observational population-based study with matched cohorts. Data from the Minimum Basic Data Set (MBDS) of Spain were reviewed. All SpA patient hospitalizations reported from 1999 to 2015 (SpA cohort) were analyzed. A control cohort (non-SpA cohort) matched by age, sex, region, and year of hospitalization was recruited. The age and sex-adjusted crude incidence rate was calculated for any fractures (axial and peripheral). Generalized linear models (GLM) were used for trend analysis. Association between fracture type and SpA (and its subtypes) was assessed using unconditional logistic regression models. RESULTS: In the SpA cohort, the age and sex-adjusted rates per 100,000 inhabitants/year of total fracture and different types of fracture were 45.72 any fractures, 17.64 axial, and 28.02 peripheral; 29.42 osteoporotic (12.67 vertebra, 12.29 hip, 1.50 pelvis, 1.82 humerus and 2.09 radius). In the non-SpA cohort, they were 65.79 any, 12.08 axial, 51.52 peripheral; 31.17 osteoporotic (4.94 vertebra, 16.15 hip, 2.29 pelvis, 3.64 humerus, 5.38 radius). Between 1999 and 2015, the trend in incidence rate for total fracture and different types of fracture increased similarly for both cohorts. In the SpA cohort, an increase of axial fractures was found (AOR 1.444; 95%CI 1.297-1.609), and specifically of vertebral fractures (AOR 2.440; 95%CI 2.097-2.839). Other types of fractures did not increase. CONCLUSIONS: Only an increase of axial fractures, more specifically vertebral fractures, is observed in SpA. Trend in incidence is similar in both cohorts.
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Fraturas do Quadril , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Espondilartrite , Humanos , Incidência , Fraturas por Osteoporose/epidemiologia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Espondilartrite/epidemiologiaRESUMO
INTRODUCTION: There is no consensus on the management of the coronavirus disease (COVID-19) in patients with secondary immunosuppression due to either an underlying hematological disease or to the effects of immunochemotherapy (ICT). Some of them may present persistent infection with multiple relapses of COVID-19, requiring several admissions. This study evaluated the clinical characteristics and outcomes after treatment of 5 patients with follicular lymphoma (FL), previously treated with ICT, who developed several episodes of COVID-19. METHODS: We analyzed the clinical evolution and response to treatment with antiviral agent, steroids, and convalescent plasma in 5 patients with FL and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) persistent infection. Reverse transcriptase polymerase chain reaction tests and peripheral blood immunophenotype were performed for all patients. RESULTS: All patients required hospitalization due to pneumonia with severity criteria and were re-admitted after a median of 22 days (13-42) from the previous discharge. They all showed B-cell depletion by immunophenotyping, and no traces of immunoglobulin antibodies against SARS-CoV-2 were detected in any of the cases. The survival rate was 80%. CONCLUSION: The combination therapy evidenced clinical benefits, demonstrating its capacity to control infection in immunosuppressed FL patients treated with ICT.
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COVID-19 , Linfoma Folicular , COVID-19/complicações , COVID-19/terapia , Humanos , Imunização Passiva , Hospedeiro Imunocomprometido , Linfoma Folicular/complicações , Linfoma Folicular/tratamento farmacológico , Recidiva , SARS-CoV-2 , Soroterapia para COVID-19RESUMO
BACKGROUND: The TMPRSS2 protein has been involved in severe acute respiratory syndrome caused by coronavirus 2 (SARS-CoV-2). The production is regulated by the androgen receptor (AR). It is speculated that androgen deprivation therapy (ADT) may protect patients affected by prostate cancer (PC) from SARS-CoV-2 infection. METHODS: This is a retrospective study of patients treated for COVID-19 in our institution who had a previous diagnosis of PC. We analyzed the influence of exposure of ADT on the presence of severe course of COVID-19. RESULTS: A total of 2280 patients were treated in our center for COVID-19 with a worse course of disease in males (higher rates of hospitalization, intense care unit [ICU] admission, and death). Out of 1349 subjects registered in our PC database, 156 were on ADT and 1193 were not. Out of those, 61 (4.52%) PC patients suffered from COVID-19, 11 (18.0%) belonged to the ADT group, and 50 (82.0%) to the non-ADT group. Regarding the influence of ADT on the course of the disease, statistically significant differences were found neither in the death rate (27.3% vs. 34%; p = 0.481), nor in the presence of severe COVID-19: need for intubation or ICU admission (0% vs. 6.3%; p = 0.561) and need for corticoid treatment, interferon beta, or tocilizumab (60% vs. 34.7%; p = 0.128). Multivariate analysis adjusted for clinically relevant comorbidities did not find that ADT was a protective factor for worse clinical evolution (risk ratio [RR] 1.08; 95% confidence interval [CI], 0.64-1.83; p = 0.77) or death (RR, 0.67; 95% CI, 0.26-1.74; p = 0.41). CONCLUSIONS: Our study confirms that COVID-19 is more severe in men. However, the use of ADT in patients with PC was not shown to prevent the risk of severe COVID-19.
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Antagonistas de Androgênios/uso terapêutico , COVID-19/epidemiologia , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/epidemiologia , SARS-CoV-2 , Índice de Gravidade de Doença , Idoso , Idoso de 80 Anos ou mais , COVID-19/mortalidade , COVID-19/terapia , Comorbidade , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
PURPOSE: To evaluate the utility of choroidal thickness (CT) measurement by enhanced depth imaging optical coherence tomography (EDI-OCT) for central serous chorioretinopathy (CSC) diagnosis. METHODS: Cross-sectional comparative study of 62 consecutive patients: 38 with acute CSC and 24 with macular subretinal fluid from differential diagnoses (DD). Subfoveolar choroidal thickness was measured using EDI 9-mm horizontal protocol. We evaluated sensitivity, specificity and intraclass correlation coefficient. RESULTS: Mean subfoveolar CT was greater in CSC group than in DD group (465.45 ± 115.42 µm vs. 347.54 ± 111.27 µm, p < 0.001). The best threshold measure was 390 µm in patients younger than 50 years giving a sensitivity of 89.7% (CI 95%: 73.6-100%) and a specificity of 75% (CI 95%: 40.9-87.3%). For patients older than 50 years best threshold measure was found at 400 µm giving a sensitivity of 45.5% (CI 95%: 21.3-72%) and a specificity of 80% (CI 95%: 58.4-91.9%). Intraclass correlation coefficient for CT measurement was 0.87 (CI 95%: 0.74-0.93). CONCLUSION: CT measurement with EDI-OCT helps to differentiate CSC from other causes of macular subretinal fluid in patients younger than 50 years.
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Coriorretinopatia Serosa Central , Tomografia de Coerência Óptica , Coriorretinopatia Serosa Central/diagnóstico , Corioide , Estudos Transversais , Angiofluoresceinografia , Humanos , Estudos RetrospectivosRESUMO
BACKGROUND: Active surveillance (AS) has become a valid option for patients with a very low risk of prostate cancer (PC) with a widespread application. There are still a few series, with a medium follow-up longer than 5 years, reporting data on pathological upgrading. The objective is to evaluate the changes in surveillance biopsies of patients with low-risk PC in a long-term follow-up and determine if a longer stay in AS could involve worse pathological findings. MATERIALS AND METHODS: A retrospective analysis of our institutional database of patients with PC undergoing AS during 2004 to 2018 was performed. The inclusion criteria were prostate-specific antigen (PSA) ≤ 10 ng/mL, Gleason grade 1 and T1c/T2a. Patients were assessed by serum PSA level and digital rectal examination at 6-month intervals. Transrectal ultrasound-guided prostate biopsies were performed during the first year of follow-up, and every 2 or 3 years thereafter. The pathology details of biopsies were analyzed and compared with the current series on AS. RESULTS: Three-hundred nineteen patients undergoing AS were evaluated with a median follow-up of 5.3 years and a mean age of 67.4 years. Sixty-three patients did not meet all the criteria to be considered low-risk PC but were included in the analysis. Overall, 128 patients (40.1%) underwent active treatment (84.7% of them due to pathological progression in surveillance biopsies). The proportion of patients with a reported upgrading ranged between 19.4% and 35.3%, although only the fourth biopsy showed an upgrading proportion of over 30%. Limitations include the retrospective design of the study and the existence of different protocols between other cohorts that make it difficult to compare their results. CONCLUSIONS: For patients who remained in surveillance the percentage of upgrading increased slightly with the time, being more frequent after the third-surveillance biopsy. These findings support the importance of extending surveillance biopsies for patients who remain candidates for curative treatment.
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Neoplasias da Próstata/classificação , Idoso , Estudos de Coortes , Bases de Dados Factuais , Seguimentos , Humanos , Calicreínas/sangue , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Estudos RetrospectivosRESUMO
OBJECTIVE: To investigate 90-day mortality rate of RC for bladder cancer in a nationwide population-based study. DESIGN, SETTING, AND PARTICIPANTS: We used mandatory hospital discharge forms of all patients submitted to RC due to bladder cancer in Spain during 2011-2015 (n = 12,154 in 196 hospitals). At present, a centralization policy for RC has not been issued by the health authorities. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We calculated in-hospital, 30-, 60- and 90-day mortality. Average annual RC volume was used as a continuous variable (log-transformed) and also grouped into deciles to identify any potential non-linear relationships. Logistic regression model with mixed effect was performed adjusting for year of surgery, comorbidity, surgical approach, type of admission, age, sex, and hospital size. RESULTS AND LIMITATION: Overall 90-day mortality rate was 6.5%. Lowest mortality rates (3.3% at 90 days) are achieved in hospitals doing more than 38 cases per year. The 90-day adjusted mortality rate is associated with annual average RC volume with a 20.6% decrease per 10 extra RCs/year (95% CI 12.3-28.1% p < 0.001). High Charlson comorbidity index, advanced age, and open surgical approach were the clinical variables associated with higher mortality. CONCLUSIONS: Our study identifies an inverse association between 90-day mortality and hospital volume. High-volume hospitals achieve lower mortality rate within 90 days.
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Cistectomia , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistectomia/métodos , Cistectomia/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Hospitais com Alto Volume de Atendimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologia , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: The frequency of nevus-associated melanoma (NAM) has been estimated to be 29% of diagnosed melanomas. MATERIALS AND METHODS: This is an observational retrospective study of 22 cases of NAM diagnosed in the Universitary Hospital Alcorcón between September 2011 and 2018. The main objective was to analyze dermoscopic and RCM features of NAM. We also studied if there was an association between any dermoscopic or RCM parameter and Breslow depth. RESULTS: The most frequent dermoscopic characteristics were multicomponent pattern (50%), multifocal pigmentation (45.5%), atypical network (59.1%), and blue-gray regression structures (77.3%). RCM evidenced pagetoid cells in 95.5% melanomas (abundant in 59.1%), non-edged dermal papillae in 86.4%, atypical cells at the dermal-epidermal junction in 90.9%, and atypical junctional nesting in 81.8%. Deeper Breslow index was associated with red color (mean Breslow 0.65 vs 0.37 in melanomas without red, P = 0.035), shiny white streaks (0.85 vs 0.38, P = 0.041), abundant pagetoid cells (0.68 vs 0.26, P = 0.017), and non-edged papillae (0.59 vs 0.00, P = 0.014). CONCLUSION: RCM is a valuable tool for diagnosing NAM. Even it is very difficult to differentiate NAM from DNM both with dermoscopy and RCM, RCM can help us to detect remnants of a preexisting nevus and estimate Breslow depth.
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Melanoma , Nevo , Adulto , Idoso , Dermoscopia , Feminino , Humanos , Masculino , Melanoma/diagnóstico por imagem , Melanoma/epidemiologia , Melanoma/patologia , Microscopia Confocal , Pessoa de Meia-Idade , Nevo/diagnóstico por imagem , Nevo/epidemiologia , Nevo/patologia , Estudos Retrospectivos , Pele/diagnóstico por imagem , Pele/patologiaRESUMO
IMPORTANCE: To evaluate peripapillary vascular flow using optical coherence tomography angiography (angio-OCT) in patients with optic nerve head drusen (ONHD). BACKGROUND: Angio-OCT allows non-invasive visualization and quantification peripapillary vascular flow. DESIGN: Cross-sectional study. PARTICIPANTS: Seventy-six eyes of 40 patients. METHODS: Between January 2018 and May 2019, consecutive patients with ONHD and healthy controls underwent a complete ocular assessment, including visual acuity testing, biomicroscopy, tonometry, funduscopy, automated perimetry, retinography and autofluorescence, spectral-domain OCT and peripapillary angio-OCT. MAIN OUTCOMES MEASURES: Peripapillary vascular flow, vascular density, retinal nerve fibre layer (RNFL) and ganglion cell layer (GCL) thicknesses. RESULTS: We included 23 patients with ONHD (42 eyes, 32 with visible drusen; mean age 50.96 years, 12 men) and 17 control patients (34 eyes; mean age 47.12 years, 7 men), without significant differences in age or sex. Vascular flow and density were significantly lower in patients with ONHD (0.409% and 40.18%, respectively) than in normal eyes (0.438% and 43.30%, respectively) (P = .006 and P < .001). RNFL and GCL thicknesses were significantly lower in patients with ONHD (81.81 and 77.43 µm, respectively) than in controls (91.38 and 81.97 µm, respectively) (P = .001 and P = .032). We obtained high correlation indexes between RNFL and GCL and vascular flow and density (RNFL = 0.702 and 0.744, respectively, and GCL = 0.808 and 0.857, respectively). CONCLUSIONS AND RELEVANCE: Angio-OCT demonstrated significant reductions in peripapillary vascular flow and vascular density in patients with ONHD, with strong correlations with RNFL and GCL thicknesses.
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Disco Óptico , Tomografia de Coerência Óptica , Angiografia , Estudos Transversais , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas , Células Ganglionares da Retina , Acuidade VisualRESUMO
INTRODUCTION: Active surveillance (AS) seems to be a cost-effective strategy. However, most publications are based on simulation models of theoretical cohorts, and long-term implications are not usually considered. OBJECTIVE: To assess the real cost differences of two cohorts of men with low-risk prostate cancer (PCa) treated with AS or laparoscopic radical prostatectomy (LRP) in a public health system. MATERIALS AND METHODS: Patients diagnosed from 2005 to 2009 were included in an AS program (Group 1) or treated with LRP at diagnosis (Group 2), with a minimum follow-up of 5 years. Actual costs for each patient were calculated on an individual basis: Group 1: semiannual PSA measurements and repeat biopsies are scheduled every 1-3 years. Costs of outpatient clinic visits were calculated, as well as all tests required for monitoring or active treatment. Group 2: costs of the procedure, emergency visits, re-admissions and outpatient clinic visits were calculated, as well as costs of oncological salvage therapies or functional surgical procedures. RESULTS: Out of 151 men diagnosed with low-risk PC, 54 (35.8%) were included in an AS (Group 1) and 97 (64.2%) were submitted to LRP (Group 2). Mean follow-up for both groups was 6.5 years (SD 1.8) and 6.7 years (SD 1.4), respectively, p = 0.49. Group 1 had a total cost per patient of 2970.47. Group 2 had a total cost per patient of 5694.06. CONCLUSIONS: AS was associated with cost-saving over LRP. This cost reduction of AS in the management of low-risk PCa is based on the accounting of real costs of individual patients and confirms previously published estimation-based reports.
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Custos de Cuidados de Saúde , Prostatectomia/economia , Neoplasias da Próstata/terapia , Conduta Expectante/economia , Idoso , Assistência Ambulatorial/economia , Biópsia/economia , Custos e Análise de Custo , Serviço Hospitalar de Emergência/economia , Hospitalização/economia , Humanos , Laparoscopia/economia , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/economia , Terapia de Salvação/economia , EspanhaRESUMO
Older persons who have suffered a hip fracture (HFx) are at increased risk of subsequent hip fractures. The cumulative incidence of a second hip fracture (SHFx) has been estimated in 8.4%; however, no studies have been carried out in our country, and the information on risk markers of SHFx is limited. The aim of this study was to estimate the incidence, explore trends, and examine predictors of SHFx in a suburban population of Spain. An observational longitudinal retrospective study was performed in a universal health coverage setting (Alcorcón, 1999-2011). Data were obtained from the area hospital discharge database. Annual incidence of HFx was estimated over 100,000 population (general and persons with HFx), and median time to SHFx by Kaplan-Meier tables. Cox regression was used for the analysis of association between SHFx and baseline predictors, measured by hazard ratio (HR). Among the 3430 patients who suffered a first HFx in the study period, 255 (7.4%) experienced a SHFx (4.5% of men and 8.5% of women). Median time between the first and second HFx was 3.7 years (SD 3.2). Annual incidence of HFx in population over 45 was 290.5 per 100,000 inhabitants (131.03 in men and 433.11 in women). Annual incidence of SHFx among persons with a HFx was 956.7 per 100,000 (1052.1 in women and 595.5 in men). There was a decline trend along the study period with an annual reduction of 10.4% (95% CI 7.7-13.0%; p < 0.001) in both sexes. The following associations were found: female sex (HR 1.41, 95% CI 0.97-2.02), age (HR 1.03, 95% CI 1.01-1.04), living in a nursing house (HR 1.46, 95% CI 1.10-1.94), and moderate to severe liver disease (HR 4.96, 95% CI 1.23-20.06). In our environment the occurrence of a SHFx is 7.4%, three-fold risk compared to no previous HFx. Being woman, elderly, living in a nursing home, and having severe to moderate liver disease may be important predictors of a SHFx. There seems to be adequate time between the first and the SHFx for interventions that may reduce the risk.
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Fatores Etários , Fraturas do Quadril/epidemiologia , Incidência , Ossos Pélvicos/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Quadril/diagnóstico , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de RiscoRESUMO
Plasma levels of endocannabinoids (eCBs) are very dynamic and variable in different circumstances and pathologies. The aim of the study was to determine the levels of the main eCBs and N-acylethanolamines (NAEs) in COVID-19 patients during the acute and post-acute phase of SARS-CoV-2 infection. Samples collected before December 31, 2020 were used for the determination of circulating eCB levels by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The association between plasma eCB measurements and biochemical and hematological parameters, as well as serum IL-6 levels, was evaluated. Samples of 64 individuals were analysed, n = 18 healthy donors, n = 30 acute, and n = 16 post-acute patients. Plasma levels of 2-arachidonoylglycerol (2-AG), were significantly elevated in COVID-19 patients when compared to healthy individuals. Plasma N-palmitoylethanolamide (PEA) and N-arachidonoylethanolamide (AEA) levels were found to be decreased in post-acute patient samples. These results suggest that 2-AG plays an important role in the inflammatory cascade in COVID-19 disease; in addition, eCBs might be involved in the post-acute pathogenesis of COVID-19. This study provides evidence of altered levels of circulating eCBs as a consequence of SARS-CoV-2 infection.
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Ácidos Araquidônicos , COVID-19 , Endocanabinoides , Glicerídeos , Inflamação , SARS-CoV-2 , Humanos , Endocanabinoides/sangue , COVID-19/sangue , COVID-19/virologia , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Ácidos Araquidônicos/sangue , Inflamação/sangue , Glicerídeos/sangue , Alcamidas Poli-Insaturadas/sangue , Etanolaminas/sangue , Idoso , Interleucina-6/sangue , Ácidos Palmíticos/sangue , Espectrometria de Massas em Tandem , Amidas , Cromatografia LíquidaRESUMO
Background: Single anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) is a predominantly malabsorptive technique that has shown excellent results in morbid obese patients. The aim of this study is to establish a rodent model modifying the SADI-S technique by performing a proximal duodenojejunal anastomosis. This model can be useful for the study of glucose metabolism without malabsorption observed after the SADI-S technique. Methods: Goto-Kakizaki rats, a genetic model of non-obese and non-hypertensive type 2 diabetes mellitus, that develop hyperglycemia at an early age was used. Surgery consisted in a sleeve gastrectomy, duodenojejunal anastomosis and duodenal exclusion using three different techniques: duodenal transection (DT), duodenal ligation with hem-o-lock (DLH), and duodenal ligation with suture (DLS). Surgery time, weight loss, morbidity and mortality were recorded. Results: A total of 16 animals were subjected to surgical intervention and overall mortality was 25 %, with the DT group showing the highest mortality rate (42.9 %). No differences were observed among groups in terms of weight loss. Conclusion: The surgical technique described in this work is feasible and reproducible. Weight loss is comparable regardless of the technique used for duodenal exclusion.
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INTRODUCTION: Rotator cuff-related shoulder pain (RCRSP) is the most common cause of shoulder pain. Currently, exercise is proposed as the first-line treatment for patients suffering from RCRSP. However, adherence to therapeutic exercise programmes can be poor in the long term in a home setting. The aim of this study is to evaluate the effects of adding video animations to a traditional paper-based exercise programme. METHODS AND ANALYSIS: A single-centre, randomised, open-labelled clinical trial will be conducted in a hospital in Spain. Adults aged between 18 and 80 years diagnosed with RCRSP who meet the eligibility criteria will be included. Patients (n=132) will be randomised into two groups, with both receiving paper-based exercises, and the experimental group will also be provided with video animations. The participants will receive seven face-to-face physical therapy sessions and will be asked to perform the exercises at home for 6 months. The primary outcome measure will be the Shoulder Pain and Disability Index, measured at baseline, 3 weeks, 3 months (primary analysis) and 6 months. Secondary outcomes will be the patient's pain intensity during the last week (rest, during movement and at night); expectations of improvement; satisfaction with treatment; impression of improvement; perceived usability, usefulness and satisfaction of multimedia animations; and adherence to exercises. Generalised least squares regression models with an autoregressive-moving average lag one correlation structure will be implemented, with an intention-to-treat analysis. ETHICS AND DISSEMINATION: This study has been approved by the ethics committee of Hospital Universitario Fundación Alcorcón (Madrid, Spain), reference number CI18/16. All participants will sign an informed consent. The results will be published in a peer-reviewed scientific journal. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05770908.
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Terapia por Exercício , Multimídia , Dor de Ombro , Humanos , Dor de Ombro/terapia , Terapia por Exercício/métodos , Adulto , Pessoa de Meia-Idade , Idoso , Masculino , Feminino , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto Jovem , Medição da Dor , Espanha , Adolescente , Idoso de 80 Anos ou mais , Lesões do Manguito Rotador/terapia , Manguito Rotador/fisiopatologiaRESUMO
OBJECTIVE: The aim of the study was to develop and validate an algorithm based on procalcitonin (PCT) monitoring to predict the prognosis of patients with sepsis. DESIGN: The design was a retrospective and observational prospective study. SETTING: The study was set in intensive care units (ICUs) in 2 different hospitals in Spain. PATIENTS: Patients in the study included 101 patients with sepsis aged ≥18 years. INTERVENTIONS: In the retrospective study, PCT results from patients admitted to the ICU in 2011-2012 were collected. In the prospective study, PCT was determined at specific time points as indicated by the algorithm from March 2018 to April 2019. The primary outcome measure, 28-day mortality, was the main variable of interest. RESULTS: The study developed an algorithm based on early PCT monitoring for predicting the prognosis of patients with sepsis. The algorithm was initially developed retrospectively in 1 cohort and subsequently validated prospectively in another cohort. CONCLUSIONS: The developed algorithm provides information on the prognosis of patients with sepsis, distinguishing between those with a good prognosis and those with a poor prognosis (defined as mortality).
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INTRODUCTION: Studies focused on dermoscopic aspects of pigmented Bowen disease (pBD) in Latin American population are scarce and limited to only case reports or small series. OBJECTIVES: To report dermoscopic findings in a large series of 147 pBD diagnosed in Ibero-Latin American population. METHODS: We conducted a multicentric, retrospective study on 147 histologically proven pBD under the auspices of the Dermoscopy Chapter of the Ibero-Latin American College of Dermatology. RESULTS: The study population consisted of 77 females (52%) and 70 males (48%) with a mean age of 68.6 years. 70.1% of patients had skin phototype 3, 15.6% to skin phototype 2, and 14.3% to skin phototype 4. On clinical examination, near 60% of pBD were flat, 70% presented with scales, and 90% were asymmetric. Under dermoscopy, structureless hypopigmented areas, dots brown and pink color were the most frequently observed. Regarding specific dermoscopic clues to pBD, the most prevalent were structureless hypopigmented areas, vessels arranged in linear fashion at the periphery, and pigmented lines or pigmented dots distributed in a linear fashion. Clustered, coiled, and dotted vessels were observed in 55.8%, 45.6%, and 45.6% of the cases, respectively. CONCLUSIONS: We report a large series of cases of pBD in Latin American patients, with most patients being skin phototype 3 and 4. Distinctively in our study, the pigmented structures and the clues derived from the presence of melanin were much more frequent than in previous reports in fair skin.
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BACKGROUND: Bladder cancer is highly prevalent even though its incidence is considerably lower in patients younger than 40 years, thus raising the issue of the influence of age at diagnosis on the natural history of this disease. This study aimed to evaluate the characteristics and progression of young patients with urothelial bladder carcinoma with at least 10 years of follow-up and to compare the results with those of previously reported studies. MATERIAL AND METHODS: A retrospective study between 1990 and 2007 was conducted. The medical records and tissue samples of patients with urothelial bladder tumours were reviewed, and patients with a first diagnosis of urothelial carcinoma of the bladder at age 40 years or younger were selected. Their clinical and pathological data and disease-free survival were analysed. RESULTS: This study included 43 patients, with a median follow-up of 152 months (interquartile range (IQR): 96-222) and a mean age at diagnosis of 34 years (SD: 4.6). Thirty-five patients (81.4%) had non-muscle invasive tumours at diagnosis, and 53.5%, 27.9% and 18.6% had tumour grades of G1, G2 and G3, respectively. Fifteen patients (34.9%) experienced recurrence, and eight (18.6%) progressed. At 24 and 60 months, the recurrence-free survival rates were 84.8% (95% confidence interval (CI): 69.2%-92.9%) and 68.9% (95% CI: 51.7%-81%), respectively, and the progression-free survival rates were 94.9% (95% CI: 81%-98.7%) and 92.2% (95% CI: 77.8%-97.4%), respectively. CONCLUSIONS: Bladder cancer is an uncommon disease in young patients. In most cases, it consists of non-muscle-invasive tumours, with a low rate of recurrence and progression. The prognosis is based on the tumour's characteristics and not on the patient's age.
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Carcinoma de Células de Transição , Progressão da Doença , Neoplasias da Bexiga Urinária , Humanos , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/mortalidade , Estudos Retrospectivos , Adulto , Masculino , Feminino , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/mortalidadeRESUMO
BACKGROUND: One of the main drawbacks of tunneled central venous catheters (CVCs) is catheter-related bloodstream infections (CRBSIs). Antibiotic lock therapy (ALT) can be combined with systemic antibiotics to achieve catheter salvage. Our objectives are to describe cases of CRBSI and our experience with ALT in a pediatric oncology-hematology ward. METHODS: a retrospective descriptive study of pediatric CRBSI cases in a Spanish oncology-hematology unit from 2007 to 2017 was conducted. We collected demographic, clinical, and microbiological data from all patients. RESULTS: fifty-eight CRBSIs were diagnosed in thirty-nine patients; 72.9% of these patients were male, with a median age of 42.1 months. The main underlying diseases were leukemia/lymphoma (51.7%) and solid tumors (32.7%). Thirty-five (60.3%) CRBSIs were caused by Gram-positive cocci, of which 70.6% were coagulase-negative Staphylococci, and sixteen (27.6%) were caused by Gram-negative bacilli. We treated 41/58 (71%) cases with ALT. A total of 12/17 (71%) CVCs that were not treated with adjunctive ALT were removed, compared with 13/41 (32%) that were treated with ALT (relative risk (RR), 0.449; confidence interval (CI), 95%: 0.259-0.778, p = 0.004). Major reasons to remove the CVC in the CRBSI-ALT group were local insertion/pocket site infection (23%), persistent symptoms (23%), and infectious' relapses (15%). CONCLUSIONS: ALT was shown to be an effective approach to keeping the CVC in place, with no added adverse effects.
RESUMO
CLINICAL RELEVANCE: Choroidal and macular thickness assessments are essential to understand the evolution of central serous chorioretinopathy and could help in identifying patients more prone to recurrence. BACKGROUND: The aim of this work was to evaluate changes in the choroidal thickness and macular thickness in acute non-treated central serous chorioretinopathy during a one-year follow-up. METHODS: A prospective longitudinal study of 38 patients with central serous chorioretinopathy and 35 healthy controls at a tertiary care facility (Fundación Alcorcón University Hospital) was conducted. Choroidal and macular thicknesses were measured using enhanced-depth-imaging optical coherence tomography and subretinal fluid resolution and best-corrected visual acuity were evaluated, at baseline and 1, 3, 6 and 12 months. Prognostic factors determining the need for treatment were evaluated. RESULTS: Choroidal thickness decreased in eyes with central serous chorioretinopathy (p < 0.001) but not in fellow eyes (p = 0.24) during one-year follow-up since the acute episode. The estimated mean choroidal thickness in symptomatic eyes was 465 µm (SE: 17.18) at baseline and decreased 58.1 µm (CI 95%: 30.1-85.9) at 12 months (p < 0.001). Best-corrected visual acuity improved over time (p = 0.037), with a decrease of logMAR 0.086 (CI95%: 0-0.172).The macular thickness changed over time (p < 0.001), with a decrease from baseline of 124.6 µm (CI95%: 61.4-187.9). Subretinal fluid resolved in 67% (CI 95%: 51-82) of patients at 6 months. There was no significant association between baseline choroidal thickness, macular thickness, best-corrected visual acuity, age or sex and the need for treatment. CONCLUSIONS: The choroidal thickness decreased in acute central serous chorioretinopathy episodes during a one-year follow-up. Subretinal fluid persisted in less than 20% of patients at the end of the one-year follow-up. No prognostic factors determining the need for treatment were found.